<1. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27418553 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Vozoris NT AU - Wang X AU - Fischer HD AU - Bell CM AU - O'Donnell DE AU - Austin PC AU - Stephenson AL AU - Gill SS AU - Rochon PA FA - Vozoris, Nicholas T FA - Wang, Xuesong FA - Fischer, Hadas D FA - Bell, Chaim M FA - O'Donnell, Denis E FA - Austin, Peter C FA - Stephenson, Anne L FA - Gill, Sudeep S FA - Rochon, Paula A IN - Vozoris, Nicholas T. Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada Dept of Medicine, University of Toronto, Toronto, ON, Canada nick.vozoris@utoronto.ca. IN - Wang, Xuesong. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. IN - Fischer, Hadas D. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. IN - Bell, Chaim M. Dept of Medicine, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada Division of General Internal Medicine, Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada. IN - O'Donnell, Denis E. Dept of Medicine, Queen's University, Kingston, ON, Canada. IN - Austin, Peter C. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. IN - Stephenson, Anne L. Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada Dept of Medicine, University of Toronto, Toronto, ON, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. IN - Gill, Sudeep S. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Dept of Medicine, Queen's University, Kingston, ON, Canada. IN - Rochon, Paula A. Dept of Medicine, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. TI - Incident opioid drug use and adverse respiratory outcomes among older adults with COPD. CM - Comment in: Ann Intern Med. 2017 Jan 17;166(2):JC11; PMID: 28114467 SO - European Respiratory Journal. 48(3):683-93, 2016 Sep AS - Eur Respir J. 48(3):683-93, 2016 Sep NJ - The European respiratory journal VO - 48 IP - 3 PG - 683-93 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8803460, ery IO - Eur. Respir. J. SB - Index Medicus CP - England MH - Aged MH - Aged, 80 and over MH - Algorithms MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Bronchodilator Agents/tu [Therapeutic Use] MH - Databases, Factual MH - Emergency Service, Hospital/ut [Utilization] MH - Female MH - Hospitalization MH - Humans MH - Male MH - Middle Aged MH - Ontario MH - *Opioid-Related Disorders/co [Complications] MH - Pneumonia/co [Complications] MH - Pneumonia/mo [Mortality] MH - Probability MH - Propensity Score MH - Proportional Hazards Models MH - *Pulmonary Disease, Chronic Obstructive/co [Complications] MH - *Pulmonary Disease, Chronic Obstructive/dt [Drug Therapy] MH - Pulmonary Medicine MH - Retrospective Studies MH - Sensitivity and Specificity MH - Treatment Outcome AB - We evaluated risk of adverse respiratory outcomes associated with incident opioid use among older adults with chronic obstructive pulmonary diseases (COPD).This was a retrospective population-based cohort study using a validated algorithm applied to health administrative data to identify adults aged 66 years and older with COPD. Inverse probability of treatment weighting using the propensity score was used to estimate hazard ratios comparing adverse respiratory outcomes within 30 days of incident opioid use compared to controls.Incident opioid use was associated with significantly increased emergency room visits for COPD or pneumonia (HR 1.14, 95% CI 1.00-1.29; p=0.04), COPD or pneumonia-related mortality (HR 2.16, 95% CI 1.61-2.88; p<0.0001) and all-cause mortality (HR 1.76, 95% CI 1.57-1.98; p<0.0001), but significantly decreased outpatient exacerbations (HR 0.88, 95% CI 0.83-0.94; p=0.0002). Use of more potent opioid-only agents was associated with significantly increased outpatient exacerbations, emergency room visits and hospitalisations for COPD or pneumonia, and COPD or pneumonia-related and all-cause mortality.Incident opioid use, and in particular use of the generally more potent opioid-only agents, was associated with increased risk for adverse respiratory outcomes, including respiratory-related mortality, among older adults with COPD. Potential adverse respiratory outcomes should be considered when prescribing new opioids in this population. Copyright ©ERS 2016. RN - 0 (Analgesics, Opioid) RN - 0 (Bronchodilator Agents) ES - 1399-3003 IL - 0903-1936 DO - https://dx.doi.org/10.1183/13993003.01967-2015 PT - Journal Article ID - 13993003.01967-2015 [pii] ID - 10.1183/13993003.01967-2015 [doi] PP - ppublish PH - 2015/11/24 [received] PH - 2016/05/16 [accepted] LG - English EP - 20160713 DP - 2016 Sep EZ - 2016/07/16 06:00 DA - 2018/04/06 06:00 DT - 2016/07/16 06:00 YR - 2016 ED - 20180405 RD - 20180405 UP - 20180406 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27418553 <2. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28472543 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Manhapra A AU - Petrakis I AU - Rosenheck R AI - Manhapra, Ajay; ORCID: http://orcid.org/0000-0001-9208-1490 FA - Manhapra, Ajay FA - Petrakis, Ismene FA - Rosenheck, Robert IN - Manhapra, Ajay. VA New England Mental Illness Research and Education Center, West Haven, Connecticut. IN - Manhapra, Ajay. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut. IN - Manhapra, Ajay. Department of Internal Medicine, Yale Medical School, New Haven, Connecticut. IN - Manhapra, Ajay. VA Hampton Medical Center, Hampton, Virginia. IN - Petrakis, Ismene. VA New England Mental Illness Research and Education Center, West Haven, Connecticut. IN - Petrakis, Ismene. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut. IN - Rosenheck, Robert. VA New England Mental Illness Research and Education Center, West Haven, Connecticut. IN - Rosenheck, Robert. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut. TI - Three-year retention in buprenorphine treatment for opioid use disorder nationally in the Veterans Health Administration. SO - American Journal on Addictions. 26(6):572-580, 2017 Sep AS - Am J Addict. 26(6):572-580, 2017 Sep NJ - The American journal on addictions VO - 26 IP - 6 PG - 572-580 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9208821 IO - Am J Addict SB - Index Medicus CP - England MH - Adult MH - *Buprenorphine/ad [Administration & Dosage] MH - Buprenorphine/tu [Therapeutic Use] MH - Demography MH - Female MH - Humans MH - Long-Term Care/px [Psychology] MH - Long-Term Care/sn [Statistics & Numerical Data] MH - Male MH - Medication Adherence/px [Psychology] MH - Medication Adherence/sn [Statistics & Numerical Data] MH - *Medication Adherence MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Opiate Substitution Treatment/mt [Methods] MH - Opiate Substitution Treatment/px [Psychology] MH - Opiate Substitution Treatment/sn [Statistics & Numerical Data] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/px [Psychology] MH - Proportional Hazards Models MH - Socioeconomic Factors MH - United States/ep [Epidemiology] MH - United States Department of Veterans Affairs/sn [Statistics & Numerical Data] MH - *Veterans/px [Psychology] MH - Veterans Health/sn [Statistics & Numerical Data] AB - BACKGROUND: Buprenorphine has become the major treatment for opioid use disorder (OUD) but data on long treatment term retention and its correlates are sparse. AB - METHODS: All veterans with OUD treated in Veterans Health Administration (VHA) facilities nationally in fiscal year (FY) 2012, and who began treatment with buprenorphine as indicated by a first prescription after the first 60 days of the year were identified with the date of and their last prescription from FY 2012-2015. Veterans were classified into four groups based on time from first to last prescription: (0-30 days, 31-365 days; 1-3 years; and more than 3 years). These groups were compared on socio-demographic, diagnoses and service, and psychotropic drug use. Kaplan-Meier curves and Cox proportional hazards models were used to identify variables independently associated with retention in buprenorphine treatment. AB - RESULTS: Veterans newly started on buprenorphine (n=3,151) were retained in treatment for a mean duration of 1.68 years (standard deviation [SD] 1.23), with 61.60% (n=1,941) retained for more than a year and 31.83% (n=1,003) for more than 3 years. Cox proportion hazards model showed that only black race (Hazards ratio [HR] 1.26; standard error [SE] .06; p.0003), the Charlson index (HR 1.03; SE .01; p.0132) and emergency room visits during FY 2012 (HR 1.03; SE .01; p<.0001) were the only available variables independently associated higher odds of buprenorphine discontinuation. AB - CONCLUSIONS: Buprenorphine retention was substantial among veterans treated in VHA, but few individual characteristics correlated with retention. AB - SCIENTIFIC SIGNIFICANCE: Future research focused on identifying further correlates of treatment retention is required to help devise interventions to improve treatment continuation. (Am J Addict 2017;26:572-580). Copyright Published 2017. This article is a U.S. Government work and is in the public domain in the USA. RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) ES - 1521-0391 IL - 1055-0496 DO - https://dx.doi.org/10.1111/ajad.12553 PT - Journal Article ID - 10.1111/ajad.12553 [doi] PP - ppublish PH - 2016/10/06 [received] PH - 2017/02/07 [revised] PH - 2017/03/27 [accepted] LG - English EP - 20170504 DP - 2017 Sep EZ - 2017/05/05 06:00 DA - 2018/04/03 06:00 DT - 2017/05/05 06:00 YR - 2017 ED - 20180402 RD - 20180402 UP - 20180403 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28472543 <3. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28623805 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Banta-Green CJ AU - Coffin PO AU - Schoeppe JA AU - Merrill JO AU - Whiteside LK AU - Ebersol AK FA - Banta-Green, Caleb J FA - Coffin, Phillip O FA - Schoeppe, Jennie A FA - Merrill, Joseph O FA - Whiteside, Lauren K FA - Ebersol, Abigail K IN - Banta-Green, Caleb J. Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle WA, USA. Electronic address: calebbg@uw.edu. IN - Coffin, Phillip O. San Francisco Department of Public Health, San Francisco, CA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: pcoffin@gmail.com. IN - Schoeppe, Jennie A. Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA; Group Health Research Institute, Seattle, WA, USA. Electronic address: jennie.schoeppe@gmail.com. IN - Merrill, Joseph O. Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: joem@uw.edu. IN - Whiteside, Lauren K. Division of Emergency Medicine, University of Washington Seattle WA, USA; Harborview Injury Prevention and Research Center, Seattle WA, USA. Electronic address: laurenkw@uw.edu. IN - Ebersol, Abigail K. Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: aebersol@uw.edu. TI - Heroin and pharmaceutical opioid overdose events: Emergency medical response characteristics. SO - Drug & Alcohol Dependence. 178:1-6, 2017 Sep 01 AS - Drug Alcohol Depend. 178:1-6, 2017 Sep 01 NJ - Drug and alcohol dependence VO - 178 PG - 1-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Adult MH - Age Factors MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - *Heroin/po [Poisoning] MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Sex Factors MH - Washington/ep [Epidemiology] MH - Young Adult KW - Emergency medical services; Heroin; Naloxone; Overdose; Pharmaceutical opioid AB - BACKGROUND: Emergency Medical Services (EMS) data may provide insight into opioid overdose incidence, clinical characteristics, and medical response. This analysis describes patient characteristics, clinical features, and EMS response to opioid overdoses, comparing heroin and pharmaceutical opioid (PO) overdoses, using a structured opioid overdose case criteria definition. AB - METHODS: A case series study was conducted. EMS medical staff screened cases for possible overdoses and study staff categorized the likelihood of opioid overdose. Medical form data were abstracted. Patient characteristics, clinical presentation, and medical response to heroin and PO-involved overdoses were compared with bi-variate test statistics. AB - RESULTS: We identified 229 definite or probable opioid overdose cases over six months: heroin in 98 (43%) cases (10 also involved PO), PO without heroin in 85 (37%) cases, and 46 (20%) that could not be categorized and were excluded from analyses. Heroin overdose patients were younger than PO (median age 33 v 41 (p<0.05)), more often male (80% v 61% (p=<0.01)), intubated less (8% v 22%, p<0.01) and more likely to be administered naloxone (72% v 51%, p<0.01). No significant differences were found between heroin and PO overdoses for initial respiratory rate, Glasgow Coma Scale score, or co-ingestants, but heroin users were more likely to have miotic pupils (p<0.01). AB - CONCLUSIONS: While heroin and PO events presented similarly, heroin-involved cases were more likely to receive naloxone and less likely to be intubated. Standardized case definitions and data documentation could aid opioid overdose surveillance as well as provide data for measuring the impact of professional and lay interventions. Copyright © 2017 Elsevier B.V. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(17)30263-6 DO - https://dx.doi.org/10.1016/j.drugalcdep.2017.04.021 PT - Journal Article ID - S0376-8716(17)30263-6 [pii] ID - 10.1016/j.drugalcdep.2017.04.021 [doi] PP - ppublish PH - 2016/12/19 [received] PH - 2017/03/24 [revised] PH - 2017/04/19 [accepted] LG - English EP - 20170610 DP - 2017 Sep 01 EZ - 2017/06/18 06:00 DA - 2018/03/27 06:00 DT - 2017/06/18 06:00 YR - 2017 ED - 20180326 RD - 20180326 UP - 20180327 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28623805 <4. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27875053 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Donaldson M AU - Goodchild JH FA - Donaldson, Mark FA - Goodchild, Jason H IN - Donaldson, Mark. Director of Clinical Pharmacy, Vizient Advisory Services, Whitefish, Montana; Clinical Professor, School of Pharmacy, University of Montana, Missoula, Montana; Clinical Assistant Professor, School of Dentistry, Oregon Health and Sciences University, Portland, Oregon. IN - Goodchild, Jason H. Clinical Associate Professor, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania; Associate Professor and Chairman, Department of Diagnostic Sciences, Creighton University School of Dentistry, Omaha, Nebraska; Private Practice, Havertown, Pennsylvania. TI - Pharmacological Reversal Agents in Dental Practice: Keys to Patient Safety. [Review] SO - Compendium of Continuing Education in Dentistry. 37(10):681-687; quiz 688, 2016 Nov/Dec AS - Compend Contin Educ Dent. 37(10):681-687; quiz 688, 2016 Nov/Dec NJ - Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) VO - 37 IP - 10 PG - 681-687; quiz 688 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9600713 IO - Compend Contin Educ Dent SB - Dental Journals CP - United States MH - Atropine/tu [Therapeutic Use] MH - Diphenhydramine/tu [Therapeutic Use] MH - *Drug-Related Side Effects and Adverse Reactions/dt [Drug Therapy] MH - Emergency Medical Services/mt [Methods] MH - Epinephrine/tu [Therapeutic Use] MH - Flumazenil/tu [Therapeutic Use] MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - Patient Safety MH - Phentolamine/tu [Therapeutic Use] AB - Though uncommon, medical emergencies in the dental office are harrowing occurrences that can be the result of adverse drug reactions. Pharmacological antagonists have been developed for administration as reversal agents in emergency situations in which patients may have an untoward effect, typically caused by too much medication. Dental practitioners should be familiar with these agents to keep patients safe and help mitigate drug-induced medical emergencies. This article reviews the pharmacokinetic and pharmacodynamic principles of pharmacological antagonists; it emphasizes six specific reversal agents as they relate to the clinical practice of dentistry: naloxone, flumazenil, epinephrine, diphenhydramine, phentolamine, and atropine. Outside of emergency situations, the pharmacological antagonist phentolamine has been developed to reverse the effects of the vasoconstrictor in dental local anesthesia preparations when the effects of the agonist medication are no longer required. Such newer reversal agents are being considered for more routine use once the dental procedure is complete. This article is intended to assist dental practitioners who are familiar with pharmacological antagonists to be better able to help mitigate drug-induced medical emergencies should they occur. RN - 36B82AMQ7N (Naloxone) RN - 40P7XK9392 (Flumazenil) RN - 7C0697DR9I (Atropine) RN - 8GTS82S83M (Diphenhydramine) RN - YKH834O4BH (Epinephrine) RN - Z468598HBV (Phentolamine) ES - 2158-1797 IL - 1548-8578 PT - Journal Article PT - Review PP - ppublish LG - English DP - 2016 Nov/Dec EZ - 2016/11/23 06:00 DA - 2018/03/24 06:00 DT - 2016/11/23 06:00 YR - 2016 ED - 20180323 RD - 20180323 UP - 20180326 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27875053 <5. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29085548 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hoppe JA AU - McStay C AU - Sun BC AU - Capp R FA - Hoppe, Jason A FA - McStay, Christopher FA - Sun, Benjamin C FA - Capp, Roberta IN - Hoppe, Jason A. University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado. IN - McStay, Christopher. University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado. IN - Sun, Benjamin C. Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon. IN - Capp, Roberta. University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado. TI - Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain. SO - The Western Journal of Emergency Medicine. 18(6):1135-1142, 2017 Oct AS - West J Emerg Med. 18(6):1135-1142, 2017 Oct NJ - The western journal of emergency medicine VO - 18 IP - 6 PG - 1135-1142 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med SB - Index Medicus CP - United States MH - Academic Medical Centers MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Back Pain/dt [Drug Therapy] MH - Drug Prescriptions MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Medical Staff, Hospital MH - Middle Aged MH - *Practice Patterns, Physicians' MH - Retrospective Studies MH - Urban Population MH - Young Adult AB - INTRODUCTION: Despite treatment guidelines suggesting alternatives, as well as evidence of a lack of benefit and evidence of poor long-term outcomes, opioid analgesics are commonly prescribed for back pain from the emergency department (ED). Variability in opioid prescribing suggests a lack of consensus and an opportunity to standardize and improve care. We evaluated the variation in attending emergency physician (EP) opioid prescribing for patients with uncomplicated, low acuity back pain (LABP). AB - METHODS: This retrospective study evaluated the provider-specific proportion of LABP patients discharged from an urban academic ED over a seven-month period with a prescription for opioids. LABP was strictly defined as (1) back pain chief complaint, (2) discharged from ED with no interventions, and (3) predefined discharge diagnosis of back pain. We excluded providers if they had less than 25 LABP patients in the study period. The primary outcome was the physician-specific proportion of LABP patients discharged with an opioid analgesic prescription. We performed a descriptive analysis and then risk standardized prescribing proportion by adjusting for patient and clinical characteristics using hierarchical logistic regression. AB - RESULTS: During the seven-month study period, 23 EPs treated and discharged at least 25 LABP patients and were included. Eight (34.8%) were female, and six (26.1%) were junior attendings (<= 5 years after residency graduation). There were 943 LABP patients included in the analysis. Provider-specific proportions ranged from 3.7% to 88.1% (mean 58.4% [SD +/- 22.2]), and we found a 22-fold variation in prescribing proportions. There was a six-fold variation in the adjusted, risk-standardized prescribing proportion with a range from 12.0% to 78.2% [mean 50.4% (SD +/-16.4)]. AB - CONCLUSION: We found large variability in opioid prescribing practices for LABP that persisted after adjustment for patient and clinical characteristics. Our findings support the need to further standardize and improve adherence to treatment guidelines and evidence suggesting alternatives to opioids. CI - Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare. RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2017.7.33306 PT - Journal Article ID - 10.5811/westjem.2017.7.33306 [doi] ID - wjem-18-1135 [pii] ID - PMC5654885 [pmc] PP - ppublish PH - 2016/12/09 [received] PH - 2017/06/30 [revised] PH - 2017/07/06 [accepted] LG - English EP - 20170918 DP - 2017 Oct EZ - 2017/11/01 06:00 DA - 2018/03/23 06:00 DT - 2017/11/01 06:00 YR - 2017 ED - 20180322 RD - 20180322 UP - 20180323 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29085548 <6. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28368908 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pauly NJ AU - Michailidis L AU - Kindred MG AU - Flomenhoft D AU - Lofwall MR AU - Walsh SL AU - Talbert JC AU - Barrett TA FA - Pauly, Nathan J FA - Michailidis, Lamprinos FA - Kindred, Michael G FA - Flomenhoft, Deborah FA - Lofwall, Michelle R FA - Walsh, Sharon L FA - Talbert, Jeffery C FA - Barrett, Terrence A IN - Pauly, Nathan J. *University of Kentucky College of Pharmacy, Institute for Pharmaceutical Outcomes and Policy, Lexington, Kentucky; +University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, Kentucky; ++University of Kentucky College of Medicine, Department of Psychiatry, Lexington, Kentucky; University of Kentucky College of Medicine, Department of Digestive Diseases and Nutrition, Lexington, Kentucky; and ||University of Kentucky, Center on Drugs and Alcohol Research, Lexington, Kentucky. TI - Predictors of Chronic Opioid Use in Newly Diagnosed Crohn's Disease. SO - Inflammatory Bowel Diseases. 23(6):1004-1010, 2017 Jun AS - Inflamm Bowel Dis. 23(6):1004-1010, 2017 Jun NJ - Inflammatory bowel diseases VO - 23 IP - 6 PG - 1004-1010 PI - Journal available in: Print PI - Citation processed from: Internet JC - c2i, 9508162 IO - Inflamm. Bowel Dis. SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Chronic Pain/dt [Drug Therapy] MH - *Crohn Disease/co [Complications] MH - *Crohn Disease/pp [Physiopathology] MH - Databases, Factual MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Kentucky/ep [Epidemiology] MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/et [Etiology] MH - Prognosis MH - Retrospective Studies AB - BACKGROUND AND AIMS: Patients with Crohn's disease (CD) are often prescribed opioids chronically to manage pain associated with their disease. However, little evidence exists to support this practice. Here, we examine newly diagnosed patients with CD with and without chronic opioid use (COU) and sought to identify predictors and consequences of COU. AB - METHODS: A nationally representative administrative health care claims that data set identified newly diagnosed patients with CD. Their data were examined during the periods 6 months before and 2 years after diagnosis. Multivariable logistic regression was used to assess predictors of COU at diagnosis. AB - RESULTS: The final study cohort consisted of 47,164 patients with CD. Of them, 3.8% were identified with new COU. Chronic opioid users were more likely women, older, and likely who had more surgeries, endoscopies, admissions, and medication usage compared with other patients. Features detected before CD diagnosis that correlated with COU after diagnosis included previous opioid use (odds ratio [OR] = 6.6), chronic pain (OR = 1.36), arthritis (OR = 1.95), and mental disorders (OR = 1.58). Interestingly, emergency department visits before CD Dx increased the risk of COU (OR = 1.11), whereas endoscopy reduced COU risk (OR = 0.88). AB - CONCLUSIONS: This study presents a nationally representative assessment of COU in newly diagnosed patients with CD. The results may be used to determine the impact of COU in this population and to alert clinicians to those patients with CD at high risk of COU. Chronic opioids are consistently associated with indicators of more severe disease; however, additional research is needed to determine whether COU drives disease severity or vice versa. RN - 0 (Analgesics, Opioid) ES - 1536-4844 IL - 1078-0998 DO - https://dx.doi.org/10.1097/MIB.0000000000001087 PT - Journal Article ID - 10.1097/MIB.0000000000001087 [doi] ID - PMC5706777 [pmc] ID - NIHMS922709 [mid] PP - ppublish GI - No: UL1 TR001998 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English DP - 2017 Jun EZ - 2017/04/04 06:00 DA - 2018/03/23 06:00 DT - 2017/04/04 06:00 YR - 2017 ED - 20180322 RD - 20180322 UP - 20180323 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28368908 <7. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28874942 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kahler ZP AU - Musey PI AU - Schaffer JT AU - Johnson AN AU - Strachan CC AU - Shufflebarger CM FA - Kahler, Zachary P FA - Musey, Paul I FA - Schaffer, Jason T FA - Johnson, Annelyssa N FA - Strachan, Christian C FA - Shufflebarger, Charles M IN - Kahler, Zachary P. Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana. IN - Kahler, Zachary P. University of South Carolina, Greenville School of Medicine, Department of Emergency Medicine, Greenville, South Carolina. IN - Musey, Paul I. Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana. IN - Musey, Paul I. Indiana University Health Methodist Hospital, Indianapolis, Indiana. IN - Schaffer, Jason T. Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana. IN - Schaffer, Jason T. Indiana University Health Methodist Hospital, Indianapolis, Indiana. IN - Johnson, Annelyssa N. Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana. IN - Johnson, Annelyssa N. Indiana University Health Methodist Hospital, Indianapolis, Indiana. IN - Strachan, Christian C. Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana. IN - Strachan, Christian C. Indiana University Health Methodist Hospital, Indianapolis, Indiana. IN - Shufflebarger, Charles M. Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana. IN - Shufflebarger, Charles M. Indiana University Health Methodist Hospital, Indianapolis, Indiana. TI - Effect Of A "No Superuser Opioid Prescription" Policy On ED Visits And Statewide Opioid Prescription. SO - The Western Journal of Emergency Medicine. 18(5):894-902, 2017 Aug AS - West J Emerg Med. 18(5):894-902, 2017 Aug NJ - The western journal of emergency medicine VO - 18 IP - 5 PG - 894-902 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Chronic Pain MH - Clinical Protocols MH - *Drug Overdose/pc [Prevention & Control] MH - *Emergency Service, Hospital/st [Standards] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - *Inappropriate Prescribing/pc [Prevention & Control] MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Pain Management MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Prescription Drug Misuse/pc [Prevention & Control] MH - Referral and Consultation MH - Retrospective Studies MH - Young Adult AB - INTRODUCTION: The U.S. opioid epidemic has highlighted the need to identify patients at risk of opioid abuse and overdose. We initiated a novel emergency department- (ED) based interventional protocol to transition our superuser patients from the ED to an outpatient chronic pain program. The objective was to evaluate the protocol's effect on superusers' annual ED visits. Secondary outcomes included a quantitative evaluation of statewide opioid prescriptions for these patients, unique prescribers of controlled substances, and ancillary testing. AB - METHODS: Patients were referred to the program with the following inclusion criteria: >= 6 visits per year to the ED; at least one visit identified by the attending physician as primarily driven by opioid-seeking behavior; and a review by a committee comprising ED administration and case management. Patients were referred to a pain management clinic and informed that they would no longer receive opioid prescriptions from visits to the ED for chronic pain complaints. Electronic medical record (EMR) alerts notified ED providers of the patient's referral at subsequent visits. We analyzed one year of data pre- and post-referral. AB - RESULTS: A total of 243 patients had one year of data post-referral for analysis. Median annual ED visits decreased from 14 to 4 (58% decrease, 95% CI [50 to 66]). We also found statistically significant decreases for these patients' state prescription drug monitoring program (PDMP) opioid prescriptions (21 to 13), total unique controlled-substance prescribers (11 to 7), computed tomography imaging (2 to 0), radiographs (5 to 1), electrocardiograms (12 to 4), and labs run (47 to 13). AB - CONCLUSION: This program and the EMR-based alerts were successful at decreasing local ED visits, annual opioid prescriptions, and hospital resource allocation for this population of patients. There is no evidence that these patients diverted their visits to neighboring EDs after being informed that they would not receive opioids at this hospital, as opioid prescriptions obtained by these patients decreased on a statewide level. This implies that individual ED protocols can have significant impact on the behavior of patients. CI - Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. COI summary: Paul Musey is a consultant to and has received research funding from Trevena, Inc. ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2017.6.33414 PT - Journal Article ID - 10.5811/westjem.2017.6.33414 [doi] ID - wjem-18-894 [pii] ID - PMC5576626 [pmc] PP - ppublish PH - 2016/12/21 [received] PH - 2017/06/19 [revised] PH - 2017/06/26 [accepted] LG - English EP - 20170725 DP - 2017 Aug EZ - 2017/09/07 06:00 DA - 2018/03/21 06:00 DT - 2017/09/07 06:00 YR - 2017 ED - 20180320 RD - 20180320 UP - 20180321 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28874942 <8. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28647680 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Baird J AU - Faul M AU - Green TC AU - Howland J AU - Adams CA AU - George A AU - Mello MJ FA - Baird, Jannette FA - Faul, Mark FA - Green, Traci C FA - Howland, Jonathan FA - Adams, Charles A FA - George, Ann FA - Mello, Michael J IN - Baird, Jannette. Warren Alpert School of Medicine at Brown University, United States. Electronic address: jbaird@lifespan.org. IN - Faul, Mark. Centers for Disease Control and Prevention, United States. IN - Green, Traci C. Warren Alpert School of Medicine at Brown University, United States; Boston University School of Medicine, United States. IN - Howland, Jonathan. Warren Alpert School of Medicine at Brown University, United States; Boston University School of Medicine, United States. IN - Adams, Charles A. Rhode Island Hospital, Division of Trauma and Surgical Critical Care, United States. IN - George, Ann. University Surgical Associates, United States. IN - Mello, Michael J. Warren Alpert School of Medicine at Brown University, United States; Brown University School of Public Health, United States. TI - A retrospective review of unintentional opioid overdose risk and mitigating factors among acutely injured trauma patients. SO - Drug & Alcohol Dependence. 178:130-135, 2017 Sep 01 AS - Drug Alcohol Depend. 178:130-135, 2017 Sep 01 NJ - Drug and alcohol dependence VO - 178 PG - 130-135 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/ep [Epidemiology] MH - *Drug Prescriptions MH - Electronic Health Records/td [Trends] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Patient Discharge/td [Trends] MH - Retrospective Studies MH - Risk Factors MH - Substance-Related Disorders/di [Diagnosis] MH - Substance-Related Disorders/dt [Drug Therapy] MH - Substance-Related Disorders/ep [Epidemiology] MH - *Trauma Centers/td [Trends] MH - Young Adult KW - Alcohol and other substance use; Opioid medication; Risk factors; Traumatic injury AB - BACKGROUND: Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher prevalence of alcohol and other substance misuse in this population compared to the general population increases the vulnerability of such patients to both misuse of their prescribed opioids, and also unintentional opioid overdose. The primary purpose of this study was to assess the prevalence of substance use and unintentional opioid overdose risk among acutely injured trauma patients, and to examine the frequency and predictors of high opioid dose at discharge. AB - METHODS: A retrospective electronic medical record (EMR) review of three-months of data from two Level 1 trauma centers. We assessed the prevalence of substance misuse, unintentional opioid overdose risk, and presence of documentation of clinical strategies to mitigate these risks, such as co-prescription of the opioid agonist naloxone. AB - RESULTS: In total, 352 patient EMRs were examined. Over 40% of the patients reviewed had at least one indication of substance misuse (42.5% [95%CI: 37.3, 47.7]); at least 1 unintentional opioid overdose risk factor was identified in 240 EMR reviewed (68.2% [95%CI: 63.3, 73.1]). Dose of opioid medication was not significantly different for patients with substance misuse versus those without. There was no co-prescription of naloxone for any of the discharged patients. AB - CONCLUSIONS: Our results indicate that despite the high rates of substance misuse, the potential for misuse, dependence and unintentional overdose risk from prescribed opioid medications are prevalent among acutely injured trauma patients. Prescribing after acute trauma care should address these risk factors. Copyright © 2017 Elsevier B.V. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 36B82AMQ7N (Naloxone) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(17)30272-7 DO - https://dx.doi.org/10.1016/j.drugalcdep.2017.04.030 PT - Journal Article PT - Multicenter Study PT - Observational Study ID - S0376-8716(17)30272-7 [pii] ID - 10.1016/j.drugalcdep.2017.04.030 [doi] PP - ppublish PH - 2016/11/04 [received] PH - 2017/04/25 [revised] PH - 2017/04/29 [accepted] LG - English EP - 20170613 DP - 2017 Sep 01 EZ - 2017/06/26 06:00 DA - 2018/03/20 06:00 DT - 2017/06/26 06:00 YR - 2017 ED - 20180319 RD - 20180319 UP - 20180320 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28647680 <9. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28194688 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - D'Onofrio G AU - Chawarski MC AU - O'Connor PG AU - Pantalon MV AU - Busch SH AU - Owens PH AU - Hawk K AU - Bernstein SL AU - Fiellin DA FA - D'Onofrio, Gail FA - Chawarski, Marek C FA - O'Connor, Patrick G FA - Pantalon, Michael V FA - Busch, Susan H FA - Owens, Patricia H FA - Hawk, Kathryn FA - Bernstein, Steven L FA - Fiellin, David A IN - D'Onofrio, Gail. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA. gail.donofrio@yale.edu. IN - Chawarski, Marek C. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA. IN - Chawarski, Marek C. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. IN - O'Connor, Patrick G. Department of General Medicine, Yale School of Medicine, New Haven, CT, USA. IN - Pantalon, Michael V. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA. IN - Busch, Susan H. Yale School of Public Health, New Haven, CT, USA. IN - Owens, Patricia H. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA. IN - Hawk, Kathryn. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA. IN - Bernstein, Steven L. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA. IN - Fiellin, David A. Department of General Medicine, Yale School of Medicine, New Haven, CT, USA. IN - Fiellin, David A. Yale School of Public Health, New Haven, CT, USA. TI - Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention. SO - Journal of General Internal Medicine. 32(6):660-666, 2017 Jun AS - J Gen Intern Med. 32(6):660-666, 2017 Jun NJ - Journal of general internal medicine VO - 32 IP - 6 PG - 660-666 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8605834 IO - J Gen Intern Med SB - Index Medicus CP - United States MH - Adult MH - *Buprenorphine/tu [Therapeutic Use] MH - Emergency Service, Hospital MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Opiate Substitution Treatment/mt [Methods] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/ur [Urine] MH - Outcome Assessment (Health Care) MH - *Primary Health Care/mt [Methods] MH - Referral and Consultation MH - Self Report MH - Young Adult KW - emergency medicine; opioid use disorder; primary care; substance use disorder AB - BACKGROUND: Emergency department (ED)-initiated buprenorphine/naloxone with continuation in primary care was found to increase engagement in addiction treatment and reduce illicit opioid use at 30 days compared to referral only or a brief intervention with referral. AB - OBJECTIVE: To evaluate the long-term outcomes at 2, 6 and 12 months following ED interventions. AB - DESIGN: Evaluation of treatment engagement, drug use, and HIV risk among a cohort of patients from a randomized trial who completed at least one long-term follow-up assessment. AB - PARTICIPANTS: A total of 290/329 patients (88% of the randomized sample) were included. The followed cohort did not differ significantly from the randomized sample. AB - INTERVENTIONS: ED-initiated buprenorphine with 10-week continuation in primary care, referral, or brief intervention were provided in the ED at study entry. AB - MAIN MEASURES: Self-reported engagement in formal addiction treatment, days of illicit opioid use, and HIV risk (2, 6, 12 months); urine toxicology (2, 6 months). AB - KEY RESULTS: A greater number of patients in the buprenorphine group were engaged in addiction treatment at 2 months [68/92 (74%), 95% CI 65-83] compared with referral [42/79 (53%), 95% CI 42-64] and brief intervention [39/83 (47%), 95% CI 37-58; p<0.001]. The differences were not significant at 6 months [51/92 (55%), 95% CI 45-65; 46/70 (66%) 95% CI 54-76; 43/76 (57%) 95% CI 45-67; p=0.37] or 12 months [42/86 (49%) 95% CI 39-59; 37/73 (51%) 95% CI 39-62; 49/78 (63%) 95% CI 52-73; p=0.16]. At 2 months, the buprenorphine group reported fewer days of illicit opioid use [1.1 (95% CI 0.6-1.6)] versus referral [1.8 (95% CI 1.2-2.3)] and brief intervention [2.0 (95% CI 1.5-2.6), p=0.04]. No significant differences in illicit opioid use were observed at 6 or 12 months. There were no significant differences in HIV risk or rates of opioid-negative urine results at any time. AB - CONCLUSIONS: ED-initiated buprenorphine was associated with increased engagement in addiction treatment and reduced illicit opioid use during the 2-month interval when buprenorphine was continued in primary care. Outcomes at 6 and 12 months were comparable across all groups. RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) ES - 1525-1497 IL - 0884-8734 DO - https://dx.doi.org/10.1007/s11606-017-3993-2 PT - Journal Article PT - Randomized Controlled Trial ID - 10.1007/s11606-017-3993-2 [doi] ID - 10.1007/s11606-017-3993-2 [pii] ID - PMC5442013 [pmc] PP - ppublish PH - 2016/07/29 [received] PH - 2017/01/11 [accepted] PH - 2016/11/30 [revised] LG - English EP - 20170213 DP - 2017 Jun PQ - 2018/06/01 EZ - 2017/02/15 06:00 DA - 2018/03/14 06:00 DT - 2017/02/15 06:00 YR - 2017 ED - 20180313 RD - 20180313 UP - 20180314 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28194688 <10. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29518069 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Vivolo-Kantor AM AU - Seth P AU - Gladden RM AU - Mattson CL AU - Baldwin GT AU - Kite-Powell A AU - Coletta MA FA - Vivolo-Kantor, Alana M FA - Seth, Puja FA - Gladden, R Matthew FA - Mattson, Christine L FA - Baldwin, Grant T FA - Kite-Powell, Aaron FA - Coletta, Michael A TI - Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses - United States, July 2016-September 2017. SO - MMWR - Morbidity & Mortality Weekly Report. 67(9):279-285, 2018 Mar 09 AS - MMWR Morb Mortal Wkly Rep. 67(9):279-285, 2018 Mar 09 NJ - MMWR. Morbidity and mortality weekly report VO - 67 IP - 9 PG - 279-285 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - ne8, 7802429 IO - MMWR Morb. Mortal. Wkly. Rep. SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/ep [Epidemiology] MH - Emergency Service, Hospital/td [Trends] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Male MH - Middle Aged MH - United States/ep [Epidemiology] MH - Young Adult AB - INTRODUCTION: From 2015 to 2016, opioid overdose deaths increased 27.7%, indicating a worsening of the opioid overdose epidemic and highlighting the importance of rapid data collection, analysis, and dissemination. AB - METHODS: Emergency department (ED) syndromic and hospital billing data on opioid-involved overdoses during July 2016-September 2017 were examined. Temporal trends in opioid overdoses from 52 jurisdictions in 45 states were analyzed at the regional level and by demographic characteristics. To assess trends based on urban development, data from 16 states were analyzed by state and urbanization level. AB - RESULTS: From July 2016 through September 2017, a total of 142,557 ED visits (15.7 per 10,000 visits) from 52 jurisdictions in 45 states were suspected opioid-involved overdoses. This rate increased on average by 5.6% per quarter. Rates increased across demographic groups and all five U.S. regions, with largest increases in the Southwest, Midwest, and West (approximately 7%-11% per quarter). In 16 states, 119,198 ED visits (26.7 per 10,000 visits) were suspected opioid-involved overdoses. Ten states (Delaware, Illinois, Indiana, Maine, Missouri, Nevada, North Carolina, Ohio, Pennsylvania, and Wisconsin) experienced significant quarterly rate increases from third quarter 2016 to third quarter 2017, and in one state (Kentucky), rates decreased significantly. The highest rate increases occurred in large central metropolitan areas. AB - CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: With continued increases in opioid overdoses, availability of timely data are important to inform actions taken by EDs and public health practitioners. Increases in opioid overdoses varied by region and urbanization level, indicating a need for localized responses. Educating ED physicians and staff members about appropriate services for immediate care and treatment and implementing a post-overdose protocol that includes naloxone provision and linking persons into treatment could assist EDs with preventing overdose. CI - No conflicts of interest were reported. RN - 0 (Analgesics, Opioid) ES - 1545-861X IL - 0149-2195 DO - https://dx.doi.org/10.15585/mmwr.mm6709e1 PT - Journal Article ID - 10.15585/mmwr.mm6709e1 [doi] PP - epublish LG - English EP - 20180309 DP - 2018 Mar 09 EZ - 2018/03/09 06:00 DA - 2018/03/13 06:00 DT - 2018/03/09 06:00 YR - 2018 ED - 20180312 RD - 20180312 UP - 20180313 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29518069 <11. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28035699 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Heppell SPE AU - Isbister GK AI - Isbister, Geoffrey K; ORCID: http://orcid.org/0000-0003-1519-7419 FA - Heppell, Simon P E FA - Isbister, Geoffrey K IN - Heppell, Simon P E. Department of Clinical Toxicology, Calvary Mater Newcastle, New South Wales, Australia. IN - Isbister, Geoffrey K. Department of Clinical Toxicology, Calvary Mater Newcastle, New South Wales, Australia. IN - Isbister, Geoffrey K. Clinical Toxicology Research Group, University of Newcastle, New South Wales, Australia. TI - Lack of respiratory depression in paracetamol-codeine combination overdoses. SO - British Journal of Clinical Pharmacology. 83(6):1273-1278, 2017 Jun AS - Br J Clin Pharmacol. 83(6):1273-1278, 2017 Jun NJ - British journal of clinical pharmacology VO - 83 IP - 6 PG - 1273-1278 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - au9, 7503323 IO - Br J Clin Pharmacol SB - Index Medicus CP - England MH - *Acetaminophen/po [Poisoning] MH - Acetylcysteine/tu [Therapeutic Use] MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Antidotes/tu [Therapeutic Use] MH - Child MH - *Codeine/po [Poisoning] MH - Critical Care/sn [Statistics & Numerical Data] MH - Drug Combinations MH - *Drug Overdose/pp [Physiopathology] MH - Female MH - Glasgow Coma Scale MH - Humans MH - Length of Stay MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Respiration, Artificial MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Retrospective Studies MH - Suicide, Attempted MH - Treatment Outcome MH - Young Adult KW - codeine; naloxone; overdose; paracetamol; poisoning; respiratory depression AB - AIMS: Codeine containing analgesics are commonly taken in overdose, but the frequency of respiratory depression is unknown. We investigated whether paracetamol-codeine combination overdoses caused respiratory depression more than paracetamol alone. AB - METHODS: We reviewed deliberate self-poisoning admissions with paracetamol (>2 g) and paracetamol-codeine combinations presenting to a tertiary toxicology unit (1987-2013). Demographic information, clinical effects, treatment (naloxone, length of stay [LOS], mechanical ventilation) were extracted from a prospective database. Primary outcome was naloxone requirement or ventilation for respiratory depression. AB - RESULTS: From 4488 presentations, 1376 admissions were included with paracetamol alone (929), paracetamol-codeine combinations (346) or paracetamol-codeine-doxylamine combinations (101) without co-ingestants. Median age was 23 years (12-89 years); 1002 (73%) were female. Median dose was 12 g (interquartile range [IQR]: 7.5-20 g). Median LOS was 16 h (IQR: 6.5-27 h) and 564 (41%) were given acetylcysteine. Significantly larger paracetamol doses were ingested and more acetylcysteine given in paracetamol alone versus paracetamol combination overdoses. Seven out of 1376 patients were intubated or received naloxone (0.5%; 95% CI: 0.2-1.1%), three intubated, three given naloxone and one both. Three out of 929 patients ingesting paracetamol alone (0.3%; 95% CI: 0.1-1%) required intubation or naloxone, compared to two out of 346 ingesting paracetamol-codeine combinations (0.6%; 95% CI: 0.1-2.3%; absolute difference, 0.26%; 95% CI: -0.7-1.2%; P = 0.62). Two out of 101 patients ingesting paracetamol-codeine-doxylamine combinations (2%; 95% CI: 0.3-8%) required intubation or naloxone. Four patients were intubated for reasons other than respiratory depression: hepatotoxicity (2), retrieval (1), no data (1). Two out of 929 (0.2%) paracetamol alone overdoses had a Glasgow coma score < 9 compared to three out of 346 (0.9%) in the paracetamol-codeine group. AB - CONCLUSIONS: Paracetamol-codeine combination overdoses are rarely associated with severe respiratory depression, with only two given naloxone and none intubated for respiratory depression. Copyright © 2016 The British Pharmacological Society. RN - 0 (Antidotes) RN - 0 (Drug Combinations) RN - 0 (Narcotic Antagonists) RN - 0 (acetaminophen, codeine drug combination) RN - 362O9ITL9D (Acetaminophen) RN - 36B82AMQ7N (Naloxone) RN - Q830PW7520 (Codeine) RN - WYQ7N0BPYC (Acetylcysteine) ES - 1365-2125 IL - 0306-5251 DO - https://dx.doi.org/10.1111/bcp.13224 PT - Journal Article PT - Observational Study ID - 10.1111/bcp.13224 [doi] ID - PMC5427223 [pmc] PP - ppublish PH - 2016/10/10 [received] PH - 2016/12/12 [revised] PH - 2016/12/22 [accepted] LG - English EP - 20170201 DP - 2017 Jun PQ - 2018/06/01 EZ - 2016/12/31 06:00 DA - 2018/03/13 06:00 DT - 2016/12/31 06:00 YR - 2017 ED - 20180312 RD - 20180312 UP - 20180313 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28035699 <12. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29518069 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Vivolo-Kantor AM AU - Seth P AU - Gladden RM AU - Mattson CL AU - Baldwin GT AU - Kite-Powell A AU - Coletta MA FA - Vivolo-Kantor, Alana M FA - Seth, Puja FA - Gladden, R Matthew FA - Mattson, Christine L FA - Baldwin, Grant T FA - Kite-Powell, Aaron FA - Coletta, Michael A TI - Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses - United States, July 2016-September 2017. SO - MMWR - Morbidity & Mortality Weekly Report. 67(9):279-285, 2018 Mar 09 AS - MMWR Morb Mortal Wkly Rep. 67(9):279-285, 2018 Mar 09 NJ - MMWR. Morbidity and mortality weekly report VO - 67 IP - 9 PG - 279-285 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - ne8, 7802429 IO - MMWR Morb. Mortal. Wkly. Rep. SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/ep [Epidemiology] MH - Emergency Service, Hospital/td [Trends] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Male MH - Middle Aged MH - United States/ep [Epidemiology] MH - Young Adult AB - INTRODUCTION: From 2015 to 2016, opioid overdose deaths increased 27.7%, indicating a worsening of the opioid overdose epidemic and highlighting the importance of rapid data collection, analysis, and dissemination. AB - METHODS: Emergency department (ED) syndromic and hospital billing data on opioid-involved overdoses during July 2016-September 2017 were examined. Temporal trends in opioid overdoses from 52 jurisdictions in 45 states were analyzed at the regional level and by demographic characteristics. To assess trends based on urban development, data from 16 states were analyzed by state and urbanization level. AB - RESULTS: From July 2016 through September 2017, a total of 142,557 ED visits (15.7 per 10,000 visits) from 52 jurisdictions in 45 states were suspected opioid-involved overdoses. This rate increased on average by 5.6% per quarter. Rates increased across demographic groups and all five U.S. regions, with largest increases in the Southwest, Midwest, and West (approximately 7%-11% per quarter). In 16 states, 119,198 ED visits (26.7 per 10,000 visits) were suspected opioid-involved overdoses. Ten states (Delaware, Illinois, Indiana, Maine, Missouri, Nevada, North Carolina, Ohio, Pennsylvania, and Wisconsin) experienced significant quarterly rate increases from third quarter 2016 to third quarter 2017, and in one state (Kentucky), rates decreased significantly. The highest rate increases occurred in large central metropolitan areas. AB - CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: With continued increases in opioid overdoses, availability of timely data are important to inform actions taken by EDs and public health practitioners. Increases in opioid overdoses varied by region and urbanization level, indicating a need for localized responses. Educating ED physicians and staff members about appropriate services for immediate care and treatment and implementing a post-overdose protocol that includes naloxone provision and linking persons into treatment could assist EDs with preventing overdose. CI - No conflicts of interest were reported. RN - 0 (Analgesics, Opioid) ES - 1545-861X IL - 0149-2195 DO - https://dx.doi.org/10.15585/mmwr.mm6709e1 PT - Journal Article ID - 10.15585/mmwr.mm6709e1 [doi] ID - PMC5844282 [pmc] PP - epublish LG - English EP - 20180309 DP - 2018 Mar 09 EZ - 2018/03/09 06:00 DA - 2018/03/13 06:00 DT - 2018/03/09 06:00 YR - 2018 ED - 20180312 RD - 20180316 UP - 20180316 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=29518069 <13. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28398192 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pantalon MV AU - Dziura J AU - Li FY AU - Owens PH AU - O'Connor PG AU - D'Onofrio G FA - Pantalon, Michael V FA - Dziura, James FA - Li, Fang-Yong FA - Owens, Patricia H FA - O'Connor, Patrick G FA - D'Onofrio, Gail IN - Pantalon, Michael V. a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA. IN - Dziura, James. a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA. IN - Li, Fang-Yong. b Yale University School of Public Health , New Haven , Connecticut , USA. IN - Owens, Patricia H. a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA. IN - O'Connor, Patrick G. c Department of Internal Medicine , Yale University School of Medicine , New Haven , Connecticut , USA. IN - D'Onofrio, Gail. a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA. TI - An interventionist adherence scale for a specialized brief negotiation interview focused on treatment engagement for opioid use disorders. SO - Substance Abuse. 38(2):191-199, 2017 Apr-Jun AS - Subst Abus. 38(2):191-199, 2017 Apr-Jun NJ - Substance abuse VO - 38 IP - 2 PG - 191-199 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8808537, 101514834 IO - Subst Abus SB - Index Medicus CP - United States MH - Emergency Service, Hospital MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Interview, Psychological MH - *Opioid-Related Disorders/px [Psychology] MH - *Patient Acceptance of Health Care/px [Psychology] MH - Psychometrics MH - Surveys and Questionnaires KW - Brief intervention; buprenorphine; emergency department; interventionist adherence; opioid use disorders, primary care, psychometrics; scale construction and validation; treatment engagement AB - BACKGROUND: No psychometrically validated instrument for evaluating the extent to which interventionists correctly implement brief interventions designed to motivate treatment engagement for opioid use disorders has been reported in the literature. The objective of this study was to develop and examine the psychometric properties of the Brief Negotiation Interview (BNI) Adherence Scale for Opioid Use Disorders (BAS-O). AB - METHODS: In the context of a randomized controlled trial evaluating the efficacy of 3 models of emergency department care for opioid use disorders, the authors developed and subsequently examined the psychometric properties of the BAS-O, a 38-item scale that required raters to answer whether or not ("Yes" or "No") each of the critical actions of the BNI was correctly implemented by the research interventionist. BAS-O items pertained to the BNI's 4 steps: (1) Raise the Subject, (2) Provide Feedback, (3) Enhance Motivation, and (4) Negotiate and Advise. A total of 215 audio-recorded BNI and 88 control encounters were rated by 3 trained raters who were independent of the study team and blind to study hypotheses, treatment, and assignment. AB - RESULTS: The results indicated the BAS-O has fair to excellent psychometric properties, in terms of good internal consistency, excellent interrater reliability, discriminant validity, and construct validity, and fair predictive validity. A 13-item, 2-factor solution accounted for nearly 80% of the variance, where factor 1 addressed "Autonomy and Planning" (7 items) and factor 2 addressed "Motivation and Problems" (6 items). However, predictive validity was found for only one of the BAS-O factor items (i.e., Telling patients that treatment will address a range of issues related to their opioid use disorder). AB - CONCLUSIONS: This study suggests that the BAS-O is a psychometrically valid measure of adherence to the specialized BNI for motivating treatment engagement in patients with opioid use disorders, thus providing a brief (13-item), objective method of evaluating BNI skill performance. ES - 1547-0164 IL - 0889-7077 DO - https://dx.doi.org/10.1080/08897077.2017.1294548 PT - Journal Article ID - 10.1080/08897077.2017.1294548 [doi] PP - ppublish LG - English EP - 20170223 DP - 2017 Apr-Jun EZ - 2017/04/12 06:00 DA - 2018/03/10 06:00 DT - 2017/04/12 06:00 YR - 2017 ED - 20180309 RD - 20180309 UP - 20180312 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28398192 <14. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28166464 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pardo D AU - Miller L AU - Chiulli D FA - Pardo, Deborah FA - Miller, Lacey FA - Chiulli, Dana IN - Pardo, Deborah. a Veterans Affairs Palo Alto Health Care System (VAPAHCS) , Palo Alto , California , USA. IN - Miller, Lacey. a Veterans Affairs Palo Alto Health Care System (VAPAHCS) , Palo Alto , California , USA. IN - Chiulli, Dana. a Veterans Affairs Palo Alto Health Care System (VAPAHCS) , Palo Alto , California , USA. TI - Implementation of a pharmacy consult to reduce co-prescribing of opioids and benzodiazepines in a Veteran population. SO - Substance Abuse. 38(2):157-160, 2017 Apr-Jun AS - Subst Abus. 38(2):157-160, 2017 Apr-Jun NJ - Substance abuse VO - 38 IP - 2 PG - 157-160 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8808537, 101514834 IO - Subst Abus SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Benzodiazepines/ae [Adverse Effects] MH - Databases, Factual MH - *Drug Overdose/pc [Prevention & Control] MH - Drug Therapy, Combination/ae [Adverse Effects] MH - *Drug Therapy, Combination/td [Trends] MH - Drug Therapy, Combination/ut [Utilization] MH - Female MH - Hospitalization/td [Trends] MH - Humans MH - Male MH - Middle Aged MH - *Pharmacy Service, Hospital MH - *Referral and Consultation/td [Trends] MH - Retrospective Studies MH - Veterans/sn [Statistics & Numerical Data] MH - Young Adult KW - Benzodiazepine; Veteran; opioid; pharmacy AB - BACKGROUND: The dangers of co-administration of opioid pain relievers (OPRs) and benzodiazepines (BZDs) are well documented. The combination of OPRs and BZDs make up the majority of medications involved in prescription drug-related overdose and are often used concomitantly. This pattern is consistent among the veteran population where mental health illness and substance abuse are prominent. The Veterans Health Administration implemented the Opioid Safety Initiative (OSI) aimed at improving patient safety surrounding OPRs. In alignment with OSI, the study facility implemented a prior authorization pharmacy consult in an effort to reduce OPR and BZD co-prescribing and optimize patient safety. The purpose of this article is to report the frequency of co-prescribing before and after implementation of the consult. Secondary aims include reporting the emergency room visits and hospitalizations, prescribers' actions in the setting of disapproved consults, patient characteristics associated with co-prescribing, and frequency of co-prescribing without a consult. AB - METHODS: This was a single-center, retrospective chart review study. Microsoft Structured Query Language server database and Veterans Health Information Systems and Technology Architecture were used to extract data and identify study patients. The Computerized Patient Record System was used to collect patient data. Microsoft Access and Excel were utilized to organize, query, and analyze the extracted data. AB - RESULTS: There was a 34.6% reduction in patients on chronic OPR therapy co-prescribed a BZD, and the total number of overdose-related events decreased after implementation of the consult. In the event of disapproved consults, pharmacists' evidence-based recommendations were implemented 63% of the time. Patients for whom co-prescribing consults were placed were more likely to have mental health diagnoses. AB - CONCLUSIONS: Following implementation of a pharmacy consult, there was a reduction in co-prescribing and overdose-related events at the study facility. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) ES - 1547-0164 IL - 0889-7077 DO - https://dx.doi.org/10.1080/08897077.2017.1290011 PT - Journal Article ID - 10.1080/08897077.2017.1290011 [doi] PP - ppublish LG - English EP - 20170206 DP - 2017 Apr-Jun EZ - 2017/02/07 06:00 DA - 2018/03/10 06:00 DT - 2017/02/07 06:00 YR - 2017 ED - 20180309 RD - 20180309 UP - 20180312 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28166464 <15. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26995800 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pomerleau AC AU - Nelson LS AU - Hoppe JA AU - Salzman M AU - Weiss PS AU - Perrone J FA - Pomerleau, Adam C FA - Nelson, Lewis S FA - Hoppe, Jason A FA - Salzman, Matthew FA - Weiss, Paul S FA - Perrone, Jeanmarie IN - Pomerleau, Adam C. Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. IN - Nelson, Lewis S. Department of Emergency Medicine, New York University School of Medicine, New York, USA. IN - Hoppe, Jason A. Department of Emergency Medicine, University of Colorado, Aurora, Colorado; Rocky Mountain Poison and Drug Center, Denver, Colorado, USA. IN - Salzman, Matthew. Department of Emergency Medicine, Cooper Medical School at Rowan University, Camden, New Jersey, USA. IN - Weiss, Paul S. Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. IN - Perrone, Jeanmarie. Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA. TI - The Impact of Prescription Drug Monitoring Programs and Prescribing Guidelines on Emergency Department Opioid Prescribing: A Multi-Center Survey. SO - Pain Medicine. 18(5):889-897, 2017 05 01 AS - PAIN MED. 18(5):889-897, 2017 05 01 NJ - Pain medicine (Malden, Mass.) VO - 18 IP - 5 PG - 889-897 PI - Journal available in: Print PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Monitoring/st [Standards] MH - Drug Monitoring/sn [Statistics & Numerical Data] MH - Drug Prescriptions/st [Standards] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital/st [Standards] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Guideline Adherence/st [Standards] MH - Guideline Adherence/ut [Utilization] MH - Humans MH - Male MH - Middle Aged MH - *Pain Management/st [Standards] MH - Pain Management/sn [Statistics & Numerical Data] MH - *Practice Guidelines as Topic MH - Practice Patterns, Physicians'/st [Standards] MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Prescription Drug Monitoring Programs/st [Standards] MH - Prescription Drug Monitoring Programs/sn [Statistics & Numerical Data] MH - Prescription Drug Overuse/pc [Prevention & Control] MH - Prescription Drug Overuse/sn [Statistics & Numerical Data] MH - United States/ep [Epidemiology] KW - *Opioids; *Pain Management; *Prescription Drug Abuse; *Prescription Drug Monitoring Program AB - Objective: Emergency department (ED) providers are high volume but low quantity prescribers of opioid analgesics (OA). Few studies have examined differences in opioid prescribing decisions specifically among ED providers. The aim of this study was to describe OA prescribing decisions of ED providers at geographically diverse centers, including utilization of prescribing guidelines and prescription drug monitoring programs (PDMP). AB - Methods: This was a multi-center cross-sectional Web-based survey of ED providers who prescribe OA. Respondents were asked about their OA prescribing decisions, their use of PDMPs, and their use of prescribing guidelines. Data was analyzed using descriptive statistics and chi-square tests of association were used to assess the relationship between providers' opioid prescribing decisions and independent covariates. AB - Results: The total survey population was 957 individuals and 515 responded to the survey for an overall response rate of 54%. The frequency respondents prescribed different types of pain medication was variable between centers. of respondents were registered to access a PDMP, and were not aware whether their state had a PDMP. Forty percent (172/426) of respondents used OA prescribing guidelines, while 24% (103/426) did not, and 35% (151/426) were unaware of prescribing guidelines. No significant differences in OA prescribing decisions were found between groups either by use of PDMP or by guideline adherence. AB - Conclusions: In this multi-center survey study of ED clinicians, OA prescribing varied between centers The utilization of prescribing guidelines and PDMPs was not associated with differences in OA prescribing decisions. Copyright © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com RN - 0 (Analgesics, Opioid) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1093/pm/pnw032 PT - Journal Article PT - Multicenter Study ID - pnw032 [pii] ID - 10.1093/pm/pnw032 [doi] PP - ppublish LG - English DP - 2017 05 01 EZ - 2016/03/21 06:00 DA - 2018/03/09 06:00 DT - 2016/03/21 06:00 YR - 2017 ED - 20180308 RD - 20180308 UP - 20180309 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=26995800 <16. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28036135 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Madah-Amiri D AU - Clausen T AU - Myrmel L AU - Brattebo G AU - Lobmaier P FA - Madah-Amiri, Desiree FA - Clausen, Thomas FA - Myrmel, Lars FA - Brattebo, Guttorm FA - Lobmaier, Philipp IN - Madah-Amiri, Desiree. The Norwegian Centre for Addiction Research, The University of Oslo, Oslo, Norway. IN - Clausen, Thomas. The Norwegian Centre for Addiction Research, The University of Oslo, Oslo, Norway. IN - Myrmel, Lars. Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. IN - Brattebo, Guttorm. Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. IN - Brattebo, Guttorm. Department of Clinical Medicine, University of Bergen, Bergen, Norway. IN - Lobmaier, Philipp. The Norwegian Centre for Addiction Research, The University of Oslo, Oslo, Norway. IN - Lobmaier, Philipp. Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. TI - Circumstances surrounding non-fatal opioid overdoses attended by ambulance services. SO - Drug & Alcohol Review. 36(3):288-294, 2017 May AS - Drug Alcohol Rev. 36(3):288-294, 2017 May NJ - Drug and alcohol review VO - 36 IP - 3 PG - 288-294 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9015440 IO - Drug Alcohol Rev SB - Index Medicus CP - Australia MH - Adolescent MH - Adult MH - *Ambulances MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services/td [Trends] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Norway/ep [Epidemiology] MH - Retrospective Studies MH - Young Adult KW - EMS; ambulance; non-fatal overdose; opioid; pre-hospital AB - INTRODUCTION AND AIMS: Opioid overdose fatalities are a significant concern globally. Non-fatal overdoses have been described as a strong predictor for future overdoses, and are often attended by the ambulance services. This paper explores characteristics associated with non-fatal overdoses and aims to identify possible trends among these events in an urban area in Norway. AB - DESIGN AND METHODS: This is a retrospective analysis of non-fatal overdoses from Bergen ambulance services from 2012 to 2013. Demographic, temporal and geographic data were explored. AB - RESULTS: During the two years, 463 non-fatal opioid overdoses were attended by ambulance services. Ambulance call-outs occurred primarily during the late afternoon and evening hours of weekdays. Summer months had more overdoses than other seasons, with a peak in August. Overdoses were nearly twice as likely to occur in a public location in August (risk ratio 1.92, P=0.042). Ambulance response times were more likely to be longer to private locations, and these victims were more likely to be treated and left at the scene. There was no difference in arrival time for drug-related and non-drug related dispatch. AB - DISCUSSION AND CONCLUSIONS: The temporal patterns suggest that non-fatal overdoses occur during non-recreational time periods. The longer ambulance response time and disposition for private addresses indicate potential opportunities for peer interventions. Our analysis describes circumstances surrounding non-fatal overdoses and can be useful in guiding relevant, targeted prevention interventions. [Madah-Amiri D, Clausen T, Myrmel L, Brattebo G, Lobmaier P. Circumstances surrounding non-fatal opioid overdoses attended by ambulance services. Drug Alcohol Rev 2017;36:288-294]. Copyright © 2016 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1465-3362 IL - 0959-5236 DO - https://dx.doi.org/10.1111/dar.12451 PT - Journal Article ID - 10.1111/dar.12451 [doi] ID - PMC5434850 [pmc] PP - ppublish PH - 2016/01/22 [received] PH - 2016/05/18 [revised] PH - 2016/05/31 [accepted] LG - English EP - 20161230 DP - 2017 May EZ - 2016/12/31 06:00 DA - 2018/03/03 06:00 DT - 2016/12/31 06:00 YR - 2017 ED - 20180302 RD - 20180302 UP - 20180305 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28036135 <17. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27614084 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McAuley A AU - Bouttell J AU - Barnsdale L AU - Mackay D AU - Lewsey J AU - Hunter C AU - Robinson M FA - McAuley, Andrew FA - Bouttell, Janet FA - Barnsdale, Lee FA - Mackay, Daniel FA - Lewsey, Jim FA - Hunter, Carole FA - Robinson, Mark IN - McAuley, Andrew. Health Protection Scotland, Meridian Court, Glasgow, UK. IN - McAuley, Andrew. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK. IN - Bouttell, Janet. Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. IN - Barnsdale, Lee. NHS National Services Scotland, Information Services Division, Gyle Square, Edinburgh, UK. IN - Mackay, Daniel. Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. IN - Lewsey, Jim. Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. IN - Hunter, Carole. NHS Greater Glasgow and Clyde, Possilpark Health and Care Centre, Glasgow, UK. IN - Robinson, Mark. Public Health Science Directorate, NHS Health Scotland, Meridian Court, Glasgow, UK. TI - Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time-series analysis. SO - Addiction. 112(2):301-308, 2017 Feb AS - Addiction. 112(2):301-308, 2017 Feb NJ - Addiction (Abingdon, England) VO - 112 IP - 2 PG - 301-308 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - *Ambulances/sn [Statistics & Numerical Data] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Scotland/ep [Epidemiology] MH - *Substance Abuse, Intravenous/ep [Epidemiology] KW - Ambulance; controlled time-series; evaluation; naloxone; opioid; overdose AB - BACKGROUND AND AIMS: It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid-related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid-related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call-outs to opioid-related overdose incidents and the cumulative number of 'take-home naloxone' (THN) kits in issue; and is there evidence of an association between ambulance call-outs to opioid-related overdose incidents in early adopter (pilot) or later adopting (non-pilot) regions and the cumulative number of THN kits issued in those areas? AB - DESIGN: Controlled time-series analysis. AB - SETTING: Scotland, UK, 2008-15. AB - PARTICIPANTS: Pre-NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post-implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid-related overdose were recorded for the pre-NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post-implementation period (mean 24.8 attendances per week). AB - INTERVENTION: Scotland's NNP; formally implemented on 1 April 2011. AB - MEASUREMENTS: Primary outcome measure was weekly incidence (counts) of call-outs to opioid-related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further for a control group: weekly incidence (counts) of call-outs to heroin-related overdose in the London Borough area acquired from the London Ambulance Service. AB - FINDINGS: There was no significant association between SAS call-outs to opioid-related overdose incidents and THN kits in issue for Scotland as a whole (coefficient 0.009, 95% confidence intervals = -0.01, 0.03, P = 0.39). In addition, the magnitude of association between THN kits and SAS call-outs did not differ significantly between pilot and non-pilot regions (interaction test, P = 0.62). AB - CONCLUSIONS: The supply of take-home naloxone kits through a National Naloxone Programme in Scotland was not associated clearly with a decrease in ambulance attendance at opioid-related overdose incidents in the 4-year period after it was implemented in April 2011. Copyright © 2016 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1360-0443 IL - 0965-2140 DO - https://dx.doi.org/10.1111/add.13602 PT - Journal Article ID - 10.1111/add.13602 [doi] ID - PMC5248605 [pmc] PP - ppublish PH - 2016/03/15 [received] PH - 2016/06/06 [revised] PH - 2016/09/08 [accepted] LG - English EP - 20161106 DP - 2017 Feb EZ - 2016/09/11 06:00 DA - 2018/02/23 06:00 DT - 2016/09/11 06:00 YR - 2017 ED - 20180222 RD - 20180222 UP - 20180223 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27614084 <18. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27411064 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Browne LR AU - Shah MI AU - Studnek JR AU - Ostermayer DG AU - Reynolds S AU - Guse CE AU - Brousseau DC AU - Lerner EB FA - Browne, Lorin R FA - Shah, Manish I FA - Studnek, Jonathan R FA - Ostermayer, Daniel G FA - Reynolds, Stacy FA - Guse, Clare E FA - Brousseau, David C FA - Lerner, E Brooke TI - Multicenter Evaluation of Prehospital Opioid Pain Management in Injured Children. SO - Prehospital Emergency Care. 20(6):759-767, 2016 Nov-Dec AS - Prehosp Emerg Care. 20(6):759-767, 2016 Nov-Dec NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 20 IP - 6 PG - 759-767 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adolescent MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - Documentation/sn [Statistics & Numerical Data] MH - *Emergency Medical Services/mt [Methods] MH - Female MH - Humans MH - Male MH - *Pain/dt [Drug Therapy] MH - *Pain Management/mt [Methods] MH - Pain Measurement MH - Retrospective Studies KW - Key words: ; anaglesia; pain; pediatrics; prehospital AB - BACKGROUND: The National Association of Emergency Medical Services Physicians' (NAEMSP) Position Statement on Prehospital Pain Management and the joint National Highway Traffic Safety Administration (NHTSA) and Emergency Medical Services for Children (EMSC) Evidence-based Guideline for Prehospital Analgesia in Trauma aim to improve the recognition, assessment, and treatment of prehospital pain. The impact of implementation of these guidelines on pain management in children by emergency medical services (EMS) agencies has not been assessed. AB - OBJECTIVE: Determine the change in frequency of documented pain severity assessment and opiate administration among injured pediatric patients in three EMS agencies after adoption of best practice recommendations. AB - METHODS: This is a retrospective study of children <18 years of age with a prehospital injury-related primary impression from three EMS agencies. Each agency independently implemented pain protocol changes which included adding the use of age-appropriate pain scales, decreasing the minimum age for opiate administration, and updating fentanyl dosing. We abstracted data from prehospital electronic patient records before and after changes to the pain management protocols. The primary outcomes were the frequency of administration of opioid analgesia and documentation of pain severity assessment as recorded in the prehospital patient care record. AB - RESULTS: A total of 3,597 injured children were transported prior to pain protocol changes and 3,743 children after changes. Opiate administration to eligible patients across study sites regardless of documentation of pain severity was 156/3,089 (5%) before protocol changes and 175/3,509 (5%) after (p = 0.97). Prior to protocol changes, 580 (18%) children had documented pain assessments and 430 (74%) had moderate-to-severe pain. After protocol changes, 644 (18%) patients had pain severity documented with 464 (72%) in moderate-to-severe pain. For all study agencies, pain severity was documented in 13%, 19%, and 22% of patient records both before and after protocol changes. There was a difference in intranasal fentanyl administration rates before (27%) and after (17%) protocol changes (p = 0.02). AB - CONCLUSION: The proportion of injured children who receive prehospital opioid analgesia remains suboptimal despite implementation of best practice recommendations. Frequency of pain severity assessment of injured children is low. Intranasal fentanyl administration may be an underutilized modality of prehospital opiate administration. RN - 0 (Analgesics, Opioid) ES - 1545-0066 IL - 1090-3127 PT - Journal Article PT - Multicenter Study ID - 10.1080/10903127.2016.1194931 [doi] PP - ppublish LG - English EP - 20160713 DP - 2016 Nov-Dec EZ - 2016/11/01 06:00 DA - 2016/11/01 06:00 DT - 2016/07/14 06:00 YR - 2016 ED - 20180221 RD - 20180221 UP - 20180222 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27411064 <19. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27218446 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fisher R AU - O'Donnell D AU - Ray B AU - Rusyniak D FA - Fisher, Rian FA - O'Donnell, Daniel FA - Ray, Bradley FA - Rusyniak, Daniel TI - Police Officers Can Safely and Effectively Administer Intranasal Naloxone. SO - Prehospital Emergency Care. 20(6):675-680, 2016 Nov-Dec AS - Prehosp Emerg Care. 20(6):675-680, 2016 Nov-Dec NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 20 IP - 6 PG - 675-680 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Administration, Intranasal MH - Adult MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - Emergency Medical Services MH - Female MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Police/sn [Statistics & Numerical Data] MH - Young Adult KW - naloxone; overdose; police AB - INTRODUCTION: Opioid overdose rates continue to rise at an alarming rate. One method used to combat this epidemic is the administration of naloxone by law enforcement. Many cities have implemented police naloxone administration programs, but there is a minimal amount of research examining this policy. The following study examines data over 18 months, after implementation of a police naloxone program in an urban setting. We describe the most common indications and outcomes of naloxone administration as well as examine the incidence of arrest, immediate detention, or voluntary transport to the hospital. In doing so, this study seeks to describe the clinical factors surrounding police use of naloxone, and the effects of police administration. AB - METHODS: All police officer administrations were queried from April 2014 through September 2015 (n = 126). For each incident we collected the indication, response, and disposition of the patient that was recorded on a "sick-injured civilian" report that officers were required to complete after administration of naloxone. All of the relevant information was abstracted from this report into an electronic data collection form that was then input into SPSS for analysis. AB - RESULTS: The most common indication for administration was unconscious/unresponsive (n = 117; 92.9%) followed by slowed breathing (n = 72; 57.1%), appeared blue (n = 63; 50.0%) and not breathing (n = 41; 32.5%). After administration of naloxone the majority of patients regained consciousness (n = 82; 65.1%) followed by began to breath (n = 71; 56.3%). However, in 17.5% (n = 22) of the cases "Nothing" happened when naloxone was administered. The majority of patients were transported voluntarily to the hospital (n = 122; 96.8%). Lastly, there was only one report where the patient became combative. AB - CONCLUSION: Our study shows that police officers trained in naloxone administration can correctly recognize symptoms of opioid overdose, and can appropriately administer naloxone without significant adverse effects or outcomes. Furthermore, the administration of police naloxone does not result in a significant incidence of combativeness or need for scene escalations such as immediate detention. Further research is needed to investigate the impact of police naloxone; specifically, comparing outcomes of police delivery to EMS alone, as well as the impact on rural opioid overdoses. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1545-0066 IL - 1090-3127 PT - Journal Article ID - 10.1080/10903127.2016.1182605 [doi] PP - ppublish LG - English EP - 20160524 DP - 2016 Nov-Dec EZ - 2016/11/01 06:00 DA - 2016/11/01 06:00 DT - 2016/05/25 06:00 YR - 2016 ED - 20180221 RD - 20180221 UP - 20180222 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27218446 <20. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27606669 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Elzey MJ AU - Fudin J AU - Edwards ES FA - Elzey, Mark J FA - Fudin, Jeffrey FA - Edwards, Eric S IN - Elzey, Mark J. a Medical Affairs , kaleo, Inc ., Richmond , VA , USA. IN - Fudin, Jeffrey. b Scientific and Clinical Affairs at Remitigate, LLC , Delmar , NY , USA. IN - Fudin, Jeffrey. c PGY2 Pharmacy Pain Management, Stratton VA Medical Center , Albany , NY , USA. IN - Fudin, Jeffrey. d Albany College of Pharmacy & Health Sciences , Albany , NY , USA. IN - Fudin, Jeffrey. e Western New England University College of Pharmacy , Springfield , MA , USA. IN - Edwards, Eric S. a Medical Affairs , kaleo, Inc ., Richmond , VA , USA. TI - Take-home naloxone treatment for opioid emergencies: a comparison of routes of administration and associated delivery systems. [Review] SO - Expert Opinion on Drug Delivery. 14(9):1045-1058, 2017 Sep AS - Expert Opin Drug Deliv. 14(9):1045-1058, 2017 Sep NJ - Expert opinion on drug delivery VO - 14 IP - 9 PG - 1045-1058 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101228421 IO - Expert Opin Drug Deliv SB - Index Medicus CP - England MH - *Analgesics, Opioid/po [Poisoning] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Administration Routes MH - Drug Approval MH - Drug Delivery Systems MH - *Drug Overdose/dt [Drug Therapy] MH - Emergencies MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/pk [Pharmacokinetics] MH - Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/pk [Pharmacokinetics] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Respiratory Insufficiency/ci [Chemically Induced] MH - United States MH - United States Food and Drug Administration KW - Auto-injector; intranasal kit; naloxone; nasal spray; opioid emergency; opioid overdose; opioid-induced respiratory depression AB - INTRODUCTION: Naloxone reversal of opioid-induced respiratory depression outside of medical facilities has become more prevalent because of the escalating opioid epidemic in the USA. Take-home naloxone for treatment of opioid emergencies is now being recommended by numerous federal, state, and professional organizations. Areas covered: The scope of the opioid overdose epidemic is reviewed along with practical, clinical, regulatory, and usability considerations for take-home naloxone routes of administration currently available and associated delivery systems. Specific opioid-related factors are discussed in detail with emphasis placed on life-threatening respiratory depression and naloxone antagonism. A clinical overview, including pharmacokinetic and FDA approval information for each take-home naloxone product is discussed in detail as well as the impact of take-home naloxone in the community. Finally, given these products are to be used in a panic-stricken, life-threatening opioid emergency, an analysis of available usability data is provided with proposed directions for further study. Expert opinion: Based on the available clinical evidence, auto-injectable naloxone should be the preferred administration route for take-home naloxone treatment until additional safety, efficacy, and comparative outcomes data are available for unconventional routes of administration that unequivocally provide equal or superior results. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1744-7593 IL - 1742-5247 DO - https://dx.doi.org/10.1080/17425247.2017.1230097 PT - Journal Article PT - Review ID - 10.1080/17425247.2017.1230097 [doi] PP - ppublish LG - English EP - 20160916 DP - 2017 Sep EZ - 2016/09/09 06:00 DA - 2018/02/16 06:00 DT - 2016/09/09 06:00 YR - 2017 ED - 20180215 RD - 20180215 UP - 20180216 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27606669 <21. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27018626 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Levine M AU - Sanko S AU - Eckstein M FA - Levine, Michael FA - Sanko, Stephen FA - Eckstein, Marc TI - Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care. SO - Prehospital Emergency Care. 20(5):566-9, 2016 Sep-Oct AS - Prehosp Emerg Care. 20(5):566-9, 2016 Sep-Oct NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 20 IP - 5 PG - 566-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adult MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cause of Death MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services/mt [Methods] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Los Angeles MH - Male MH - Middle Aged MH - Naloxone/ae [Adverse Effects] MH - *Naloxone/tu [Therapeutic Use] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Opioid-Related Disorders/mo [Mortality] MH - Retrospective Studies MH - Risk Assessment MH - *Treatment Refusal/sn [Statistics & Numerical Data] KW - AMA; EMS; against medical advice; death; naloxone; opiate AB - BACKGROUND: EMS providers frequently encounter opioid-toxic patients who receive naloxone and then refuse further medical care. Older studies revealed this practice to be safe. In light of the evolving patterns of opioid abuse, this study attempted to determine the safety of this practice. AB - METHODS: This is a retrospective review of all patient encounters by the Los Angeles Fire Department (LAFD) between July 1, 2011-December 31, 2013. All LAFD patient encounters are stored electronically. These electronic records were reviewed for subjects who received naloxone had a documented respiratory rate (RR) less than 12, and subsequently refused transport. Data abstracted included name, social security number (SSN), date of birth (DOB), date of EMS encounter, age, and treatment rendered. The names, SSN, and DOB, as available, were supplied to the coroner's office. The Coroner's records were reviewed to determine if a patient with the same or similar name (e.g., Jon vs. Jonathan) had died within 24 hours, 30 days, or 6 months of the initial EMS encounter. The abstractor was blinded to the study hypothesis. AB - RESULTS: 205 subjects were identified; the median (IQR) age was 41 (29-53) years. 27 (13%) were female. One subject (0.49%) died within 24 hours of the initial EMS encounter. The cause of death (COD) was coronary artery disease and heroin use. Two additional subjects (1. %) died within 30 days. One of these subjects died 6 days later; the COD is unknown. The other subject died 20 days after the EMS encounter; the COD was cardiovascular disease and liver cirrhosis. No additional subjects were identified at the 6 month follow up. A third subject died of a heroin overdose 16 months after the initial EMS encounter, but was beyond the pre-defined follow up period. AB - CONCLUSIONS: The practice of receiving pre-hospital naloxone by paramedics and subsequently refusing care is associated with an extremely low short- and intermediate-term mortality. Despite an evolving pattern of opioid abuse, the results of this study are consistent with previously reported studies. RN - 0 (Analgesics, Opioid) RN - 36B82AMQ7N (Naloxone) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2016.1142626 PT - Journal Article ID - 10.3109/10903127.2016.1142626 [doi] PP - ppublish LG - English EP - 20160328 DP - 2016 Sep-Oct EZ - 2016/03/29 06:00 DA - 2018/02/16 06:00 DT - 2016/03/29 06:00 YR - 2016 ED - 20180215 RD - 20180215 UP - 20180216 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27018626 <22. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28435482 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Broida RI AU - Gronowski T AU - Kalnow AF AU - Little AG AU - Lloyd CM FA - Broida, Robert I FA - Gronowski, Tanner FA - Kalnow, Andrew F FA - Little, Andrew G FA - Lloyd, Christopher M IN - Broida, Robert I. US Acute Care Solutions, Risk Management Department, Canton, Ohio. IN - Gronowski, Tanner. Doctors Hospital, Department of Emergency Medicine, Columbus, Ohio. IN - Kalnow, Andrew F. Doctors Hospital, Department of Emergency Medicine, Columbus, Ohio. IN - Little, Andrew G. Doctors Hospital, Department of Emergency Medicine, Columbus, Ohio. IN - Lloyd, Christopher M. Doctors Hospital, Department of Emergency Medicine, Columbus, Ohio. TI - State Emergency Department Opioid Guidelines: Current Status. SO - The Western Journal of Emergency Medicine. 18(3):340-344, 2017 Apr AS - West J Emerg Med. 18(3):340-344, 2017 Apr NJ - The western journal of emergency medicine VO - 18 IP - 3 PG - 340-344 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med SB - Index Medicus CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Analgesics, Opioid MH - Clinical Protocols MH - Drug Prescriptions/sn [Statistics & Numerical Data] MH - *Drug Prescriptions MH - *Emergency Service, Hospital MH - *Guideline Adherence MH - Humans MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Outcome Assessment (Health Care) MH - *Pain/dt [Drug Therapy] MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Prescription Drug Misuse/pc [Prevention & Control] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - United States AB - INTRODUCTION: The purpose of this study was to evaluate and categorize current state-sponsored opioid guidelines for the practice of emergency medicine (EM). AB - METHODS: We conducted a comprehensive search of EM-specific opioid prescribing guidelines and/or policies in each state to determine current state involvement in EM opioid prescribing, as well as to evaluate some of the specifics of each guideline or policy. The search was conducted using an online query and a follow-up email request to each state chapter of ACEP. AB - RESULTS: We found that 17 states had emergency department-specific guidelines. We further organized the guidelines into four categories: limiting prescriptions for opioids with 67 total recommendations; preventing/diverting abuse with 56 total recommendations; addiction-related guidelines with 29 total recommendations; and a community resources section with 24 total recommendations. Our results showed that current state guidelines focus on providers limiting opioid pain prescriptions and vetting patients for possible abuse/diversion. AB - CONCLUSION: This study highlights the 17 states that have addressed opioid prescribing guidelines and categorizes their efforts to date. It is hoped that this study will provide the basis for similar efforts in other states. CI - Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none. RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2016.12.30854 PT - Journal Article ID - 10.5811/westjem.2016.12.30854 [doi] ID - wjem-18-340 [pii] ID - PMC5391881 [pmc] PP - ppublish PH - 2016/05/10 [received] PH - 2016/12/12 [revised] PH - 2016/12/22 [accepted] LG - English EP - 20170307 DP - 2017 Apr EZ - 2017/04/25 06:00 DA - 2018/02/14 06:00 DT - 2017/04/25 06:00 YR - 2017 ED - 20180213 RD - 20180213 UP - 20180214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28435482 <23. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27597400 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Alghnam S AU - Castillo R FA - Alghnam, Suliman FA - Castillo, Renan IN - Alghnam, Suliman. King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, KAIMRC, KSAU-HS, Riyadh, Saudi Arabia. IN - Castillo, Renan. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. TI - Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey. SO - Injury Prevention. 23(2):87-92, 2017 Apr AS - Inj Prev. 23(2):87-92, 2017 Apr NJ - Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention VO - 23 IP - 2 PG - 87-92 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - crz, 9510056 IO - Inj. Prev. SB - Index Medicus CP - England MH - Adult MH - Ambulatory Care MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Emergency Medical Services MH - Female MH - Health Expenditures MH - Health Surveys MH - Hospitalization MH - Humans MH - Incidence MH - Logistic Models MH - Male MH - Meta-Analysis as Topic MH - Middle Aged MH - Opioid-Related Disorders/co [Complications] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Practice Patterns, Physicians' MH - Risk Factors MH - United States/ep [Epidemiology] MH - Wounds and Injuries/ci [Chemically Induced] MH - *Wounds and Injuries/ep [Epidemiology] MH - Wounds and Injuries/pc [Prevention & Control] MH - Young Adult AB - BACKGROUND: Although opioid abuse is a rising epidemic in the USA, there are no studies to date on the incidence of persistent opioid use following injuries. Therefore, the aims of this study are: (1) to examine the incidence of persistent opioid use among a nationally representative sample of injured and non-injured populations; (2) to evaluate whether an injury is an independent predictor of persistent opioid use. AB - METHOD: Data from the Medical Expenditure Panel Survey were pooled (years 2009-2012). Adults were followed for about 2 years, during which they were surveyed about injury status and opioid use every 4-5 months. To determine whether injuries are associated with persistent opioid use, weighted multiple logistic regressions were constructed. AB - RESULTS: While 2.3 million injured individuals received any opioid during the follow-up, 371 170 (15.6%) individuals became persistent opioid users (defined as opioid use across multiple time points). In a multiple logistic regression analysis adjusting for sociodemographic characteristics and self-reported health, those who sustained injuries were 1.4 times (95% CI 1.1 to 1.9) more likely to report persistent opioid use than those without injuries. AB - CONCLUSIONS: We found injuries to be significantly associated with persistent opioid use in a nationally representative sample. Further investment in injury prevention may facilitate reduction of persistent opioid use and, thus, improve population health and reduce health expenditures. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. RN - 0 (Analgesics, Opioid) ES - 1475-5785 IL - 1353-8047 DO - https://dx.doi.org/10.1136/injuryprev-2016-042059 PT - Journal Article PT - Observational Study ID - injuryprev-2016-042059 [pii] ID - 10.1136/injuryprev-2016-042059 [doi] PP - ppublish PH - 2016/04/06 [received] PH - 2016/08/04 [revised] PH - 2016/08/10 [accepted] LG - English EP - 20160905 DP - 2017 Apr EZ - 2016/09/07 06:00 DA - 2018/02/14 06:00 DT - 2016/09/07 06:00 YR - 2017 ED - 20180213 RD - 20180213 UP - 20180214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27597400 <24. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27597400 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Alghnam S AU - Castillo R FA - Alghnam, Suliman FA - Castillo, Renan IN - Alghnam, Suliman. King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, KAIMRC, KSAU-HS, Riyadh, Saudi Arabia. IN - Castillo, Renan. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. TI - Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey. SO - Injury Prevention. 23(2):87-92, 2017 04 AS - Inj Prev. 23(2):87-92, 2017 04 NJ - Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention VO - 23 IP - 2 PG - 87-92 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - crz, 9510056 IO - Inj. Prev. SB - Index Medicus CP - England MH - Adult MH - Ambulatory Care MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Emergency Medical Services MH - Female MH - Health Expenditures MH - Health Surveys MH - Hospitalization MH - Humans MH - Incidence MH - Logistic Models MH - Male MH - Meta-Analysis as Topic MH - Middle Aged MH - Opioid-Related Disorders/co [Complications] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Practice Patterns, Physicians' MH - Risk Factors MH - United States/ep [Epidemiology] MH - Wounds and Injuries/ci [Chemically Induced] MH - *Wounds and Injuries/ep [Epidemiology] MH - Wounds and Injuries/pc [Prevention & Control] MH - Young Adult AB - BACKGROUND: Although opioid abuse is a rising epidemic in the USA, there are no studies to date on the incidence of persistent opioid use following injuries. Therefore, the aims of this study are: (1) to examine the incidence of persistent opioid use among a nationally representative sample of injured and non-injured populations; (2) to evaluate whether an injury is an independent predictor of persistent opioid use. AB - METHOD: Data from the Medical Expenditure Panel Survey were pooled (years 2009-2012). Adults were followed for about 2 years, during which they were surveyed about injury status and opioid use every 4-5 months. To determine whether injuries are associated with persistent opioid use, weighted multiple logistic regressions were constructed. AB - RESULTS: While 2.3 million injured individuals received any opioid during the follow-up, 371 170 (15.6%) individuals became persistent opioid users (defined as opioid use across multiple time points). In a multiple logistic regression analysis adjusting for sociodemographic characteristics and self-reported health, those who sustained injuries were 1.4 times (95% CI 1.1 to 1.9) more likely to report persistent opioid use than those without injuries. AB - CONCLUSIONS: We found injuries to be significantly associated with persistent opioid use in a nationally representative sample. Further investment in injury prevention may facilitate reduction of persistent opioid use and, thus, improve population health and reduce health expenditures. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. RN - 0 (Analgesics, Opioid) ES - 1475-5785 IL - 1353-8047 DO - https://dx.doi.org/10.1136/injuryprev-2016-042059 PT - Journal Article PT - Observational Study ID - injuryprev-2016-042059 [pii] ID - 10.1136/injuryprev-2016-042059 [doi] PP - ppublish PH - 2016/04/06 [received] PH - 2016/08/04 [revised] PH - 2016/08/10 [accepted] LG - English EP - 20160905 DP - 2017 04 EZ - 2016/09/07 06:00 DA - 2018/02/14 06:00 DT - 2016/09/07 06:00 YR - 2017 ED - 20180213 RD - 20180306 UP - 20180307 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27597400 <25. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27426210 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Beaudoin FL AU - Merchant RC AU - Clark MA FA - Beaudoin, Francesca L FA - Merchant, Roland C FA - Clark, Melissa A IN - Beaudoin, Francesca L. Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA. Electronic address: francesca_beaudoin@brown.edu. IN - Merchant, Roland C. Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA. IN - Clark, Melissa A. Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA. TI - Prevalence and Detection of Prescription Opioid Misuse and Prescription Opioid Use Disorder Among Emergency Department Patients 50 Years of Age and Older: Performance of the Prescription Drug Use Questionnaire, Patient Version. SO - American Journal of Geriatric Psychiatry. 24(8):627-636, 2016 Aug AS - Am J Geriatr Psychiatry. 24(8):627-636, 2016 Aug NJ - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry VO - 24 IP - 8 PG - 627-636 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - cm3, 9309609 IO - Am J Geriatr Psychiatry SB - Index Medicus CP - England MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Chronic Pain/dt [Drug Therapy] MH - Cross-Sectional Studies MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - ROC Curve MH - Rhode Island MH - Sensitivity and Specificity MH - *Surveys and Questionnaires KW - Drug use disorder; Emergency department; Older adults; Prescription opioid misuse; Prescription opioid use disorder; Prescription opioids; Screening; Substance abuse AB - BACKGROUND: Despite increased concern about prescription opioid misuse among older adults, there is limited work examining the best means to identify misuse by older adults. The goal of this investigation was to examine the performance the Prescription Drug Use Questionnaire Patient Version (PDUQp), in detecting prescription opioid misuse and prescription opioid use disorders among adult emergency department (ED) patients aged 50 years and older. AB - METHODS: This was a cross-sectional study of a random sample of adult ED patients, aged 50 years and older. All participants were without cognitive impairment and reported prescription opioid use within the past 30 days. We evaluated the sensitivity, specificity, predictive values, and receiver operating characteristics of the PDUQp against a standard definition of opioid misuse and DSM-5 criteria for prescription opioid use disorder. AB - RESULTS: Overall, 112 participants completed the study; 74 were aged 50-64 years and 38 were aged 65 years and older. Over half of the participants satisfied DSM-5 criteria for prescription opioid use disorder, with slightly less participants reporting misuse. Overall, the respective sensitivity and specificity of the PDUQp was: 44% and 79% (Receiver Operating Characteristic [ROC] area under the curve: 0.61) for prescription opioid misuse, 38% and 81% (ROC area under the curve: 0.64) for the presence of any prescription opioid use disorder, and 56% and 75% (ROC area under the curve: 0.71) for moderate to severe prescription opioid use disorder. AB - CONCLUSIONS: Based on this preliminary work, the PDUQp may be a viable instrument to screen for prescription opioid misuse and prescription opioid use disorder, but it likely requires modifications to optimize its predictive ability in adults over age 50 years. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1545-7214 IL - 1064-7481 DI - S1064-7481(16)30073-2 DO - https://dx.doi.org/10.1016/j.jagp.2016.03.010 PT - Journal Article PT - Multicenter Study ID - S1064-7481(16)30073-2 [pii] ID - 10.1016/j.jagp.2016.03.010 [doi] PP - ppublish PH - 2015/09/15 [received] PH - 2016/03/08 [revised] PH - 2016/03/23 [accepted] LG - English EP - 20160401 DP - 2016 Aug EZ - 2016/07/19 06:00 DA - 2018/02/09 06:00 DT - 2016/07/19 06:00 YR - 2016 ED - 20180208 RD - 20180208 UP - 20180209 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27426210 <26. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28059635 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Jeffery RM AU - Dickinson L AU - Ng ND AU - DeGeorge LM AU - Nable JV FA - Jeffery, Ryan M FA - Dickinson, Laura FA - Ng, Nicholas D FA - DeGeorge, Lindsey M FA - Nable, Jose V IN - Jeffery, Ryan M. a Georgetown Emergency Response Medical Service , Georgetown University , Washington , District of Columbia , USA. IN - Dickinson, Laura. a Georgetown Emergency Response Medical Service , Georgetown University , Washington , District of Columbia , USA. IN - Ng, Nicholas D. a Georgetown Emergency Response Medical Service , Georgetown University , Washington , District of Columbia , USA. IN - DeGeorge, Lindsey M. b MedStar Washington Hospital Center/Georgetown University Hospital , Washington , District of Columbia , USA. IN - Nable, Jose V. a Georgetown Emergency Response Medical Service , Georgetown University , Washington , District of Columbia , USA. IN - Nable, Jose V. c Department of Emergency Medicine , MedStar Georgetown University Hospital, Georgetown University School of Medicine , Washington , District of Columbia , USA. TI - Naloxone administration for suspected opioid overdose: An expanded scope of practice by a basic life support collegiate-based emergency medical services agency. SO - Journal of American College Health. 65(3):212-216, 2017 Apr AS - J Am Coll Health. 65(3):212-216, 2017 Apr NJ - Journal of American college health : J of ACH VO - 65 IP - 3 PG - 212-216 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - h5e, 8214119, 7503059 IO - J Am Coll Health SB - Index Medicus CP - United States MH - Administration, Intranasal/mt [Methods] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/mt [Methods] MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Students/sn [Statistics & Numerical Data] MH - Universities/og [Organization & Administration] MH - Universities/td [Trends] KW - Collegiate-based emergency medical services; intranasal; naloxone; opioid overdose AB - Opioid abuse is a growing and significant public health concern in the United States. Naloxone is an opioid antagonist that can rapidly reverse the respiratory depression associated with opioid toxicity. Georgetown University's collegiate-based emergency medical services (EMS) agency recently adopted a protocol, allowing providers to administer intranasal naloxone for patients with suspected opioid overdose. While normally not within the scope of practice of basic life support prehospital agencies, the recognition of an increasing epidemic of opioid abuse has led many states, including the District of Columbia, to expand access to naloxone for prehospital providers of all levels of training. In particular, intranasal naloxone is a method of administering this medication that potentially avoids needlestick injuries among EMS providers. Universities with collegiate-based EMS agencies are well positioned to provide life-saving treatments for patients acutely ill from opioid overdose. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1940-3208 IL - 0744-8481 DO - https://dx.doi.org/10.1080/07448481.2016.1277730 PT - Journal Article ID - 10.1080/07448481.2016.1277730 [doi] PP - ppublish LG - English EP - 20170106 DP - 2017 Apr EZ - 2017/01/07 06:00 DA - 2018/02/07 06:00 DT - 2017/01/07 06:00 YR - 2017 ED - 20180206 RD - 20180206 UP - 20180207 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28059635 <27. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29121712 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Babak K AU - Mohammad A AU - Mazaher G AU - Samaneh A AU - Fatemeh T AI - Samaneh, Akbarpour; ORCID: https://orcid.org/0000-0003-1459-5757 FA - Babak, Khoshideh FA - Mohammad, Arefi FA - Mazaher, Ghorbani FA - Samaneh, Akbarpour FA - Fatemeh, Taghizadeh IN - Babak, Khoshideh. Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran. IN - Mohammad, Arefi. Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran. IN - Mazaher, Ghorbani. Department of Forensic Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. IN - Samaneh, Akbarpour. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. IN - Fatemeh, Taghizadeh. Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran. TI - Clinical and laboratory findings of rhabdomyolysis in opioid overdose patients in the intensive care unit of a poisoning center in 2014 in Iran. SO - Epidemiology and health. 39:e2017050, 2017 AS - Epidemiol Health. 39:e2017050, 2017 NJ - Epidemiology and health VO - 39 PG - e2017050 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Internet JC - 101519472 IO - Epidemiol Health SB - Index Medicus CP - Korea (South) MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/to [Toxicity] MH - Clinical Laboratory Techniques MH - Cross-Sectional Studies MH - *Drug Overdose MH - Female MH - Hospitalization MH - Humans MH - Intensive Care Units MH - Iran MH - Male MH - Middle Aged MH - Poison Control Centers MH - *Rhabdomyolysis/di [Diagnosis] MH - Rhabdomyolysis/th [Therapy] MH - Young Adult KW - Laboratory findings; Opioid; Rhabdomyolysis; Toxicity AB - OBJECTIVES: The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis. AB - METHODS: This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test. AB - RESULTS: A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20-29 and 30-39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8+/-1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8+/-0.3 mg/dL and 140.4+/-4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%). AB - CONCLUSIONS: Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment. RN - 0 (Analgesics, Opioid) ES - 2092-7193 IL - 2092-7193 DO - https://dx.doi.org/10.4178/epih.e2017050 PT - Journal Article ID - epih.e2017050 [pii] ID - 10.4178/epih.e2017050 [doi] ID - PMC5790980 [pmc] PP - epublish PH - 2017/09/07 [received] PH - 2017/11/08 [accepted] LG - English EP - 20171108 DP - 2017 EZ - 2017/11/11 06:00 DA - 2018/02/02 06:00 DT - 2017/11/10 06:00 YR - 2017 ED - 20180201 RD - 20180213 UP - 20180213 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=29121712 <28. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27079639 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hwang CS AU - Kang EM AU - Kornegay CJ AU - Staffa JA AU - Jones CM AU - McAninch JK FA - Hwang, Catherine S FA - Kang, Elizabeth M FA - Kornegay, Cynthia J FA - Staffa, Judy A FA - Jones, Christopher M FA - McAninch, Jana K IN - Hwang, Catherine S. Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland. IN - Kang, Elizabeth M. Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland. IN - Kornegay, Cynthia J. Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland. IN - Staffa, Judy A. Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland. IN - Jones, Christopher M. Division of Science Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. IN - McAninch, Jana K. Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland. Electronic address: jana.mcaninch@fda.hhs.gov. TI - Trends in the Concomitant Prescribing of Opioids and Benzodiazepines, 2002-2014. SO - American Journal of Preventive Medicine. 51(2):151-160, 2016 Aug AS - Am J Prev Med. 51(2):151-160, 2016 Aug NJ - American journal of preventive medicine VO - 51 IP - 2 PG - 151-160 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8704773, apl IO - Am J Prev Med SB - Index Medicus CP - Netherlands MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Benzodiazepines/tu [Therapeutic Use] MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - *Drug-Related Side Effects and Adverse Reactions MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Practice Patterns, Physicians'/td [Trends] AB - INTRODUCTION: Although many clinical guidelines caution against the combined use of opioids and benzodiazepines, overdose deaths and emergency department visits involving the co-ingestion of these drugs are increasing. AB - METHODS: In this ecologic time series study, the IMS Health Total Patient Tracker was used to describe nationally projected trends of patients receiving opioids and benzodiazepines in the U.S. outpatient retail setting between January 2002 and December 2014. The IMS Health Data Extract Tool was used to examine trends in the concomitant prescribing of these two medication classes among 177 million individuals receiving opioids during this period. The annual proportion of opioid recipients who were prescribed benzodiazepines concomitantly was calculated and stratified by gender, age, duration of opioid use, immediate-release versus extended-release/long-acting opioids, and benzodiazepine molecule. The proportion of patients with concomitancy receiving opioids and benzodiazepines from the same prescriber was also analyzed. Analyses were conducted from April to June 2015. AB - RESULTS: The nationally projected number of patients receiving opioids and benzodiazepines increased by 8% and 31%, respectively, from 2002 to 2014. During this period, the annual proportion of opioid recipients dispensed a benzodiazepine concomitantly increased from 6.8% to 9.6%, which corresponded to a relative increase of 41%. Approximately half of these patients received both prescriptions from the same prescriber on the same day. Concomitancy was more common in patients receiving opioids for >=90 days, women, and the elderly. AB - CONCLUSIONS: Concomitant prescribing of opioids and benzodiazepines is increasing and may play a growing role in adverse patient outcomes related to these medications. Copyright Published by Elsevier Inc. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) ES - 1873-2607 IL - 0749-3797 DI - S0749-3797(16)00094-5 DO - https://dx.doi.org/10.1016/j.amepre.2016.02.014 PT - Journal Article ID - S0749-3797(16)00094-5 [pii] ID - 10.1016/j.amepre.2016.02.014 [doi] PP - ppublish PH - 2015/11/12 [received] PH - 2016/01/25 [revised] PH - 2016/02/08 [accepted] LG - English EP - 20160411 DP - 2016 Aug EZ - 2016/04/16 06:00 DA - 2018/01/24 06:00 DT - 2016/04/16 06:00 YR - 2016 ED - 20180123 RD - 20180123 UP - 20180124 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27079639 <29. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27541623 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Goett R AU - Todd KH AU - Nelson LS FA - Goett, Rebecca FA - Todd, Knox H FA - Nelson, Lewis S TI - Addressing the Challenge of Emergency Department Analgesia: Innovation in the Use of Opioid Alternatives. SO - Journal of Pain & Palliative Care Pharmacotherapy. 30(3):225-7, 2016 Sep AS - J Pain Pall Care Pharmacother. 30(3):225-7, 2016 Sep NJ - Journal of pain & palliative care pharmacotherapy VO - 30 IP - 3 PG - 225-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101125608 IO - J Pain Palliat Care Pharmacother SB - Index Medicus CP - England MH - Analgesics, Non-Narcotic/ae [Adverse Effects] MH - *Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital MH - Humans MH - *Pain/dt [Drug Therapy] MH - Practice Patterns, Physicians'/st [Standards] KW - alternatives; emergency; harm; medicine; nonopioid; opioid; overdose AB - The current epidemic of opioid toxicity and deaths has led clinicians and policy-makers to explore alternatives to opioids for management of moderate to severe pain. One environment in which opioid use has been questioned is the emergency department (ED). This commentary addresses the proposal for "opioid-free EDs" and discusses the risk-to-benefit ratios of opioid and alternative pharmacotherapy for acutely injured patients requiring analgesia. The authors recognize that a truly opioid-free ED is not practical and that alternative analgesic approaches also carry risks. Innovations in managing pain in the ED are needed. But excessive restriction on opioid pharmacotherapy in emergency medicine carries the risk of replacing overprescribing with underprescribing of opioids. The commentary supports the need to establish a core of evidence to support efforts to increase the use of nonopioid and nonpharmacologic modalities for those suffering from pain. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) ES - 1536-0539 IL - 1536-0288 DO - https://dx.doi.org/10.1080/15360288.2016.1209612 PT - Journal Article ID - 10.1080/15360288.2016.1209612 [doi] PP - ppublish LG - English EP - 20160819 DP - 2016 Sep EZ - 2016/08/20 06:00 DA - 2018/01/20 06:00 DT - 2016/08/20 06:00 YR - 2016 ED - 20180119 RD - 20180119 UP - 20180122 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27541623 <30. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29140760 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rutkow L AU - Vernick JS FA - Rutkow, Lainie FA - Vernick, Jon S IN - Rutkow, Lainie. From the Department of Health Policy and Management and the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore. IN - Vernick, Jon S. From the Department of Health Policy and Management and the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore. TI - Emergency Legal Authority and the Opioid Crisis. SO - New England Journal of Medicine. 377(26):2512-2514, 2017 Dec 28 AS - N Engl J Med. 377(26):2512-2514, 2017 Dec 28 NJ - The New England journal of medicine VO - 377 IP - 26 PG - 2512-2514 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 0255562, now IO - N. Engl. J. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/ep [Epidemiology] MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/pc [Prevention & Control] MH - *Drug and Narcotic Control/lj [Legislation & Jurisprudence] MH - Epidemics MH - Federal Government MH - *Health Policy/lj [Legislation & Jurisprudence] MH - Humans MH - *State Government MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1533-4406 IL - 0028-4793 DO - https://dx.doi.org/10.1056/NEJMp1710862 PT - Journal Article ID - 10.1056/NEJMp1710862 [pii] ID - 10.1056/NEJMp1710862 [doi] PP - ppublish LG - English EP - 20171115 DP - 2017 Dec 28 EZ - 2017/11/16 06:00 DA - 2018/01/16 06:00 DT - 2017/11/16 06:00 YR - 2017 ED - 20180115 RD - 20180115 UP - 20180116 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29140760 <31. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27376233 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Butt MU AU - Nadir R FA - Butt, Mujeeb-Ur-Rehman Abid FA - Nadir, Reeja IN - Butt, Mujeeb-Ur-Rehman Abid. Department of Medicine, Shalamar Medical and Dental College, Shalamar Hospital, Lahore, Pakistan. IN - Nadir, Reeja. Department of Clinical Dietition, Shalamar Medical and Dental College, Shalamar Hospital, Lahore, Pakistan. TI - An Unusual Presentation of Opioid Induced Cerebral Infarction. SO - Jcpsp, Journal of the College of Physicians & Surgeons - Pakistan. 26(6 Suppl):S76-8, 2016 06 AS - J Coll Physicians Surg Pak. 26(6 Suppl):S76-8, 2016 06 NJ - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP VO - 26 IP - 6 Suppl PG - S76-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9606447 IO - J Coll Physicians Surg Pak SB - Index Medicus CP - Pakistan MH - Adult MH - *Analgesics, Opioid/to [Toxicity] MH - Brain/bs [Blood Supply] MH - *Cerebral Infarction/ci [Chemically Induced] MH - *Cerebral Infarction/dg [Diagnostic Imaging] MH - Consciousness Disorders/di [Diagnosis] MH - *Consciousness Disorders/et [Etiology] MH - Drug Overdose/dg [Diagnostic Imaging] MH - Humans MH - Hypertension MH - Male MH - Opioid-Related Disorders MH - Tomography, X-Ray Computed/mt [Methods] AB - Opioid induced cerebral infarction is one of the most dreadful complications encountered in clinical practice. A30-year known hypertensive male presented to the emergency department of Shalamar Hospital, Lahore, Pakistan, with altered state of consciousness. He had been in his usual state of health a day before the presentation. On examination he was afebrile, his GCS was 3/15 having pinpoint pupils with absent doll's eye movements. His blood pressure was 90/60 mmHg, pulse rate was 62/minute, and respiratory rate was 10/minute. His right plantar was upgoing. He was resuscitated in emergency and was placed on ventilator due to hypoxemia. Computed tomography (CT) of brain revealed bilateral internal capsule hypolucencies and bilateral frontal lobe infarction. His urinary toxicological screening revealed extremely high concentrations of opioids and benzodiazepine. Patient made an uneventful recovery with antidote and supportive care. RN - 0 (Analgesics, Opioid) ES - 1681-7168 IL - 1022-386X PT - Case Reports PT - Journal Article ID - 040579197 [pii] PP - ppublish PH - 2015/07/29 [received] PH - 2015/12/30 [accepted] LG - English DP - 2016 06 EZ - 2016/07/05 06:00 DA - 2016/07/05 06:00 DT - 2016/07/05 06:00 YR - 2016 ED - 20180111 RD - 20180111 UP - 20180112 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27376233 <32. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29215840 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Richmond NJ FA - Richmond, Neal J TI - Rethinking Naloxone: Overdose drug is only one part of the cycle of narcotic abuse. SO - Journal of Emergency Medical Services. 42(2):63, 2017 02 AS - J Emerg Med Serv JEMS. 42(2):63, 2017 02 NJ - JEMS : a journal of emergency medical services VO - 42 IP - 2 PG - 63 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - United States RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 PT - Journal Article PP - ppublish LG - English DP - 2017 02 EZ - 2017/12/08 06:00 DA - 2018/01/09 06:00 DT - 2017/12/08 06:00 YR - 2017 ED - 20180108 RD - 20180108 UP - 20180109 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29215840 <33. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29214309 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Abbasi J FA - Abbasi, Jennifer TI - Emergency Department Opioid Misuse Diagnoses Increasing in Adolescents and Young Adults. SO - JAMA. 318(24):2416-2417, 2017 Dec 26 AS - JAMA. 318(24):2416-2417, 2017 Dec 26 NJ - JAMA VO - 318 IP - 24 PG - 2416-2417 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - *Analgesics, Opioid MH - Emergency Service, Hospital MH - Humans MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Prescription Drug Misuse/td [Trends] MH - United States/ep [Epidemiology] MH - Young Adult RN - 0 (Analgesics, Opioid) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2017.16586 PT - Journal Article ID - 2665901 [pii] ID - 10.1001/jama.2017.16586 [doi] PP - ppublish LG - English DP - 2017 Dec 26 EZ - 2017/12/08 06:00 DA - 2018/01/09 06:00 DT - 2017/12/08 06:00 YR - 2017 ED - 20180108 RD - 20180108 UP - 20180109 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29214309 <34. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29188965 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Linder SH AU - Huang LC AU - Hodge K FA - Linder, Steven H FA - Huang, Lisa C FA - Hodge, Kathryn TI - Fentanyl Rising: EMS strategies for combatting the increasing use and abuse of highly potent opioids. SO - Journal of Emergency Medical Services. 41(11):49-51, 2016 11 AS - J Emerg Med Serv JEMS. 41(11):49-51, 2016 11 NJ - JEMS : a journal of emergency medical services VO - 41 IP - 11 PG - 49-51 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/th [Therapy] MH - *Emergency Medical Services/og [Organization & Administration] MH - *Emergency Treatment MH - *Fentanyl/po [Poisoning] MH - Humans MH - *Narcotic Antagonists/tu [Therapeutic Use] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - UF599785JZ (Fentanyl) IS - 0197-2510 IL - 0197-2510 PT - Journal Article PP - ppublish LG - English DP - 2016 11 EZ - 2017/12/01 06:00 DA - 2018/01/09 06:00 DT - 2017/12/01 06:00 YR - 2016 ED - 20180108 RD - 20180108 UP - 20180109 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29188965 <35. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29188963 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hamel MG FA - Hamel, Michael G TI - Revisiting Naloxone: A different take on overdose guidelines from Lee County, Fla. SO - Journal of Emergency Medical Services. 41(11):46-8, 2016 11 AS - J Emerg Med Serv JEMS. 41(11):46-8, 2016 11 NJ - JEMS : a journal of emergency medical services VO - 41 IP - 11 PG - 46-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/og [Organization & Administration] MH - *Emergency Treatment MH - Florida MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Practice Guidelines as Topic RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 PT - Journal Article PP - ppublish LG - English DP - 2016 11 EZ - 2017/12/01 06:00 DA - 2018/01/09 06:00 DT - 2017/12/01 06:00 YR - 2016 ED - 20180108 RD - 20180108 UP - 20180109 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29188963 <36. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29188960 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Garza A AU - Dyer S FA - Garza, Alex FA - Dyer, Sophia TI - Overdose Nation: A look at EMS' role in the U.S. opioid epidemic. SO - Journal of Emergency Medical Services. 41(11):41-5, 2016 11 AS - J Emerg Med Serv JEMS. 41(11):41-5, 2016 11 NJ - JEMS : a journal of emergency medical services VO - 41 IP - 11 PG - 41-5 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services/mt [Methods] MH - *Emergency Treatment MH - Humans MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) IS - 0197-2510 IL - 0197-2510 PT - Journal Article PP - ppublish LG - English DP - 2016 11 EZ - 2017/12/01 06:00 DA - 2018/01/09 06:00 DT - 2017/12/01 06:00 YR - 2016 ED - 20180108 RD - 20180108 UP - 20180109 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29188960 <37. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29188938 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wirth SR FA - Wirth, Stephen R TI - Naloxone Conundrum: Reduce risk in managing the opioid overdose patient. SO - Journal of Emergency Medical Services. 41(11):14-5, 2016 11 AS - J Emerg Med Serv JEMS. 41(11):14-5, 2016 11 NJ - JEMS : a journal of emergency medical services VO - 41 IP - 11 PG - 14-5 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/mt [Methods] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 PT - Journal Article PP - ppublish LG - English DP - 2016 11 EZ - 2017/12/01 06:00 DA - 2018/01/09 06:00 DT - 2017/12/01 06:00 YR - 2016 ED - 20180108 RD - 20180108 UP - 20180109 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29188938 <38. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29181532 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chou R AU - Korthuis PT AU - McCarty D AU - Coffin PO AU - Griffin JC AU - Davis-O'Reilly C AU - Grusing S AU - Daya M FA - Chou, Roger FA - Korthuis, P Todd FA - McCarty, Dennis FA - Coffin, Phillip O FA - Griffin, Jessica C FA - Davis-O'Reilly, Cynthia FA - Grusing, Sara FA - Daya, Mohamud IN - Chou, Roger. From Oregon Health & Science University, Portland, Oregon, and San Francisco Department of Public Health, San Francisco, California. IN - Korthuis, P Todd. From Oregon Health & Science University, Portland, Oregon, and San Francisco Department of Public Health, San Francisco, California. IN - McCarty, Dennis. From Oregon Health & Science University, Portland, Oregon, and San Francisco Department of Public Health, San Francisco, California. IN - Coffin, Phillip O. From Oregon Health & Science University, Portland, Oregon, and San Francisco Department of Public Health, San Francisco, California. IN - Griffin, Jessica C. From Oregon Health & Science University, Portland, Oregon, and San Francisco Department of Public Health, San Francisco, California. IN - Davis-O'Reilly, Cynthia. From Oregon Health & Science University, Portland, Oregon, and San Francisco Department of Public Health, San Francisco, California. IN - Grusing, Sara. From Oregon Health & Science University, Portland, Oregon, and San Francisco Department of Public Health, San Francisco, California. IN - Daya, Mohamud. From Oregon Health & Science University, Portland, Oregon, and San Francisco Department of Public Health, San Francisco, California. TI - Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review. [Review] SO - Annals of Internal Medicine. 167(12):867-875, 2017 Dec 19 AS - Ann Intern Med. 167(12):867-875, 2017 Dec 19 NJ - Annals of internal medicine VO - 167 IP - 12 PG - 867-875 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 0372351 IO - Ann. Intern. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Administration, Intranasal MH - Analgesics, Opioid/ai [Antagonists & Inhibitors] MH - *Analgesics, Opioid/to [Toxicity] MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/mt [Methods] MH - Humans MH - Injections, Intramuscular MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] AB - Background: Naloxone is effective for reversing opioid overdose, but optimal strategies for out-of-hospital use are uncertain. AB - Purpose: To synthesize evidence on 1) the effects of naloxone route of administration and dosing for suspected opioid overdose in out-of-hospital settings on mortality, reversal of overdose, and harms, and 2) the need for transport to a health care facility after reversal of overdose with naloxone. AB - Data Sources: Ovid MEDLINE (1946 through September 2017), PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, U.S. Food and Drug Administration (FDA) materials, and reference lists. AB - Study Selection: English-language cohort studies and randomized trials that compared different doses of naloxone, administration routes, or transport versus nontransport after reversal of overdose with naloxone. Main outcomes were mortality, reversal of overdose, recurrence of overdose, and harms. AB - Data Extraction: Dual extraction and quality assessment of individual studies; consensus assessment of overall strength of evidence (SOE). AB - Data Synthesis: Of 13 eligible studies, 3 randomized controlled trials and 4 cohort studies compared different administration routes. At the same dose (2 mg), 1 trial found similar efficacy between higher-concentration intranasal naloxone (2 mg/mL) and intramuscular naloxone, and 1 trial found that lower-concentration intranasal naloxone (2 mg/5 mL) was less effective than intramuscular naloxone but was associated with decreased risk for agitation (low SOE). Evidence was insufficient to evaluate other comparisons of route of administration. Six uncontrolled studies reported low rates of death and serious adverse events (0% to 1.25%) in nontransported patients after successful naloxone treatment. AB - Limitation: There were few studies, all had methodological limitations, and none evaluated FDA-approved autoinjectors or highly concentrated intranasal formulations. AB - Conclusion: Higher-concentration intranasal naloxone (2 mg/mL) seems to have efficacy similar to that of intramuscular naloxone for reversal of opioid overdose, with no difference in adverse events. Nontransport after reversal of overdose with naloxone seems to be associated with a low rate of serious harms, but no study evaluated risks of transport versus nontransport. AB - Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42016053891). RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1539-3704 IL - 0003-4819 DO - https://dx.doi.org/10.7326/M17-2224 PT - Journal Article PT - Review ID - 2664376 [pii] ID - 10.7326/M17-2224 [doi] PP - ppublish LG - English EP - 20171128 DP - 2017 Dec 19 EZ - 2017/11/29 06:00 DA - 2018/01/09 06:00 DT - 2017/11/29 06:00 YR - 2017 ED - 20180108 RD - 20180108 UP - 20180109 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29181532 <39. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28681615 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Griswold MK AU - Chai PR AU - Krotulski AJ AU - Friscia M AU - Chapman B AU - Boyer EW AU - Logan BK AU - Babu KM AI - Babu, Kavita M; ORCID: http://orcid.org/0000-0002-2908-0468 FA - Griswold, Matthew K FA - Chai, Peter R FA - Krotulski, Alex J FA - Friscia, Melissa FA - Chapman, Brittany FA - Boyer, Edward W FA - Logan, Barry K FA - Babu, Kavita M IN - Griswold, Matthew K. a Division of Medical Toxicology, Department of Emergency Medicine , University of Massachusetts Medical School , Worcester , MA , USA. IN - Chai, Peter R. b Division of Medical Toxicology, Department of Emergency Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA. IN - Krotulski, Alex J. c The Center for Forensic Science Research and Education (CFSRE) , Willow Grove , PA , USA. IN - Friscia, Melissa. c The Center for Forensic Science Research and Education (CFSRE) , Willow Grove , PA , USA. IN - Chapman, Brittany. a Division of Medical Toxicology, Department of Emergency Medicine , University of Massachusetts Medical School , Worcester , MA , USA. IN - Boyer, Edward W. b Division of Medical Toxicology, Department of Emergency Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA. IN - Logan, Barry K. c The Center for Forensic Science Research and Education (CFSRE) , Willow Grove , PA , USA. IN - Logan, Barry K. d NMS Labs , Willow Grove , PA , USA. IN - Babu, Kavita M. a Division of Medical Toxicology, Department of Emergency Medicine , University of Massachusetts Medical School , Worcester , MA , USA. TI - Self-identification of nonpharmaceutical fentanyl exposure following heroin overdose. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 56(1):37-42, 2018 Jan AS - Clin Toxicol (Phila). 56(1):37-42, 2018 Jan NJ - Clinical toxicology (Philadelphia, Pa.) VO - 56 IP - 1 PG - 37-42 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Cross-Sectional Studies MH - Drug Overdose/ur [Urine] MH - Emergency Service, Hospital MH - *Fentanyl/ur [Urine] MH - *Heroin/po [Poisoning] MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - Naloxone/ur [Urine] MH - *Self Report MH - Young Adult KW - Heroin; U-47700; acetylfentanyl; drug testing; fentanyl; opioid epidemic; overdose; time-of-flight AB - OBJECTIVE: To compare user self-identification of nonpharmaceutical fentanyl exposure with confirmatory urine drug testing in emergency department (ED) patients presenting after heroin overdose. AB - METHODS: This was a cross-sectional study of adult ED patients who presented after a heroin overdose requiring naloxone administration. Participants provided verbal consent after which they were asked a series of questions regarding their knowledge, attitudes and beliefs toward heroin and nonpharmaceutical fentanyl. Participants also provided urine samples, which were analyzed using liquid chromatography coupled to quadrupole time-of-flight mass spectrometry to identify the presence of fentanyl, heroin metabolites, other clandestine opioids, common pharmaceuticals and drugs of abuse. AB - RESULTS: Thirty participants were enrolled in the study period. Ten participants (33%) had never required naloxone for an overdose in the past, 20 participants (67%) reported recent abstinence, and 12 participants (40%) reported concomitant cocaine use. Naloxone was detected in all urine drug screens. Heroin or its metabolites were detected in almost all samples (93.3%), as were fentanyl (96.7%) and its metabolite, norfentanyl (93.3%). Acetylfentanyl was identified in nine samples (30%) while U-47700 was present in two samples (6.7%). Sixteen participants self-identified fentanyl in their heroin (sensitivity 55%); participants were inconsistent in their qualitative ability to identify fentanyl in heroin. AB - CONCLUSIONS: Heroin users presenting to the ED after heroin overdose requiring naloxone are unable to accurately identify the presence of nonpharmaceutical fentanyl in heroin. Additionally, cutting edge drug testing methodologies identified fentanyl exposures in 96.7% of our patients, as well as unexpected clandestine opioids (like acetylfentanyl and U-47700). RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) RN - UF599785JZ (Fentanyl) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.1080/15563650.2017.1339889 PT - Journal Article ID - 10.1080/15563650.2017.1339889 [doi] PP - ppublish LG - English EP - 20170706 DP - 2018 Jan EZ - 2017/07/07 06:00 DA - 2018/01/05 06:00 DT - 2017/07/07 06:00 YR - 2018 ED - 20180104 RD - 20180104 UP - 20180105 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28681615 <40. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28645559 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Young N AU - Silverman D AU - Bradford H AU - Finkelstein J FA - Young, Neil FA - Silverman, Daniel FA - Bradford, Heather FA - Finkelstein, Jeffrey IN - Young, Neil. UCONN Integrated Residency in Emergency Medicine, Hartford, CT, United States. Electronic address: Neil.Young@stfranciscare.org. IN - Silverman, Daniel. UCONN Integrated Residency in Emergency Medicine, Hartford, CT, United States. IN - Bradford, Heather. UCONN Integrated Residency in Emergency Medicine, Hartford, CT, United States. IN - Finkelstein, Jeffrey. Hartford HealthCare, Hartford, CT, United States. TI - Multicenter prevalence of opioid medication use as abortive therapy in the ED treatment of migraine headaches. SO - American Journal of Emergency Medicine. 35(12):1845-1849, 2017 Dec AS - Am J Emerg Med. 35(12):1845-1849, 2017 Dec NJ - The American journal of emergency medicine VO - 35 IP - 12 PG - 1845-1849 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use] MH - Clinical Protocols MH - Cross-Sectional Studies MH - *Dopamine Antagonists/tu [Therapeutic Use] MH - *Emergency Medical Services MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Migraine Disorders/dt [Drug Therapy] MH - Migraine Disorders/ep [Epidemiology] MH - Patient Discharge MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Prevalence MH - United States/ep [Epidemiology] AB - Despite a range of therapeutic options for treating acute migraine headaches, the use of opioids is still reported to be common practice. This study describes treatment practices in regards to migraines in the ED. It characterizes the prevalence of opioid orders during visits in three different settings, an academic medical center, a non-academic urban ED, and a community ED. Fourteen months of consecutive migraine visits were identified. All medications ordered were separated into first-line and rescue medications. Number of visits, length of stay, door to provider time, and total provider time were compared. A total of 1222 visits were identified. Opioids were ordered in 35.8% of these visits. By facility, opioids were ordered in 12.3% of academic medical center visits, 40.9% of urban ED visits, and 68.6% of community ED visits. This ranged from 6.9% of first-line therapies in the academic center to 69.9% of rescue therapies in the community ED. Of those who received opioids, 36.0% versus 25.1% required rescue medications. Patients who received opioids had more repeat visits, 1.79 versus 1.30. The academic center and urban ED both found greater than 30% decrease in length of stay in visits where opioids were not given. In the face of evidence against opioids for migraines, over one third of patients received them. There was a higher prevalence in the community setting. There were no significant benefits in overall throughput time, however, opioid visits required more rescue medications, increased length of stay, and resulted in more repeat visits. Copyright © 2017 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 0 (Dopamine Antagonists) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(17)30454-0 DO - https://dx.doi.org/10.1016/j.ajem.2017.06.015 PT - Journal Article PT - Multicenter Study PT - Observational Study ID - S0735-6757(17)30454-0 [pii] ID - 10.1016/j.ajem.2017.06.015 [doi] PP - ppublish PH - 2017/01/11 [received] PH - 2017/06/07 [revised] PH - 2017/06/08 [accepted] LG - English EP - 20170616 DP - 2017 Dec EZ - 2017/06/25 06:00 DA - 2018/01/04 06:00 DT - 2017/06/25 06:00 YR - 2017 ED - 20180103 RD - 20180103 UP - 20180104 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28645559 <41. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27329442 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ambrose G AU - Amlani A AU - Buxton JA FA - Ambrose, Graham FA - Amlani, Ashraf FA - Buxton, Jane A IN - Ambrose, Graham. Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada. IN - Amlani, Ashraf. Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada. IN - Buxton, Jane A. Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. TI - Predictors of seeking emergency medical help during overdose events in a provincial naloxone distribution programme: a retrospective analysis. SO - BMJ Open. 6(6):e011224, 2016 Jun 21 AS - BMJ Open. 6(6):e011224, 2016 Jun 21 NJ - BMJ open VO - 6 IP - 6 PG - e011224 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101552874 IO - BMJ Open PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916577 SB - Index Medicus CP - England MH - Adult MH - British Columbia MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services MH - Female MH - Health Care Surveys MH - *Heroin Dependence/co [Complications] MH - Heroin Dependence/dt [Drug Therapy] MH - Heroin Dependence/ep [Epidemiology] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Patient Acceptance of Health Care/sn [Statistics & Numerical Data] MH - Program Evaluation MH - Retrospective Studies MH - Substance Abuse, Intravenous KW - ACCIDENT & EMERGENCY MEDICINE; PUBLIC HEALTH AB - OBJECTIVES: This study sought to identify factors that may be associated with help-seeking by witnesses during overdoses where naloxone is administered. AB - SETTING: Overdose events occurred in and were reported from the five regional health authorities across British Columbia, Canada. Naloxone administration forms completed following overdose events were submitted to the British Columbia Take Home Naloxone programme. AB - PARTICIPANTS: All 182 reported naloxone administration events, reported by adult men and women and occurring between 31 August 2012 and 31 March 2015, were considered for inclusion in the analysis. Of these, 18 were excluded: 10 events which were reported by the person who overdosed, and 8 events for which completed forms did not indicate whether or not emergency medical help was sought. AB - PRIMARY AND SECONDARY OUTCOME MEASURES: Seeking emergency medical help (calling 911), as reported by participants, was the sole outcome measure of this analysis. AB - RESULTS: Medical help was sought (emergency services-911 called) in 89 (54.3%) of 164 overdoses where naloxone was administered. The majority of administration events occurred in private residences (50.6%) and on the street (23.4%), where reported rates of calling 911 were 27.5% and 81.1%, respectively. Overdoses occurring on the street (compared to private residence) were significantly associated with higher odds of calling 911 in multivariate analysis (OR=10.68; 95% CI 2.83 to 51.87; p<0.01), after adjusting for other variables. AB - CONCLUSIONS: Overdoses occurring on the street were associated with higher odds of seeking emergency medical help by responders. Further research is needed to determine if sex and stimulant use by the person who overdosed are associated with seeking emergency medical help. The results of this study will inform interventions within the British Columbia Take Home Naloxone programme and other jurisdictions to encourage seeking emergency medical help. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 2044-6055 IL - 2044-6055 DO - https://dx.doi.org/10.1136/bmjopen-2016-011224 PT - Journal Article ID - bmjopen-2016-011224 [pii] ID - 10.1136/bmjopen-2016-011224 [doi] ID - PMC4916577 [pmc] PP - epublish LG - English EP - 20160621 DP - 2016 Jun 21 EZ - 2016/06/23 06:00 DA - 2018/01/02 06:00 DT - 2016/06/23 06:00 YR - 2016 ED - 20180101 RD - 20180101 UP - 20180102 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27329442 <42. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28802541 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Molokie RE AU - Montminy C AU - Dionisio C AU - Farooqui MA AU - Gowhari M AU - Yao Y AU - Suarez ML AU - Ezenwa MO AU - Schlaeger JM AU - Wang ZJ AU - Wilkie DJ FA - Molokie, Robert E FA - Montminy, Chariz FA - Dionisio, Corissa FA - Farooqui, Muhammad Ahmen FA - Gowhari, Michel FA - Yao, Yingwei FA - Suarez, Marie L FA - Ezenwa, Miriam O FA - Schlaeger, Judith M FA - Wang, Zaijie J FA - Wilkie, Diana J IN - Molokie, Robert E. University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States; Jesse Brown Veterans Administration Medical Center, 820 S. Damen Avenue, MP 111, Chicago, IL 60612, United States; University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States. Electronic address: remolokie@uic.edu. IN - Montminy, Chariz. University of Illinois Hospital and Health Sciences System, Department of Nursing, 1740 W. Taylor, Chicago, IL 60614, United States. Electronic address: ccalip2@uic.edu. IN - Dionisio, Corissa. Riley Hospital for Children at Indiana University Health Department of Psychiatry, 705 Riley Hospital Drive, Indianapolis, IN 46202, United States. Electronic address: coridion@iu.edu. IN - Farooqui, Muhammad Ahmen. Saint George's University, University Centre, Grenada. IN - Gowhari, Michel. University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States. Electronic address: mgowhal@uic.edu. IN - Yao, Yingwei. University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States. Electronic address: yyao@uic.edu. IN - Suarez, Marie L. University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States. Electronic address: mlsuarez@uic.edu. IN - Ezenwa, Miriam O. University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States. Electronic address: moezenwa@uic.edu. IN - Schlaeger, Judith M. University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States. Electronic address: jschlaeg@uic.edu. IN - Wang, Zaijie J. University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States. Electronic address: zjwang@uic.edu. IN - Wilkie, Diana J. University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States. Electronic address: diwilkie@uic.edu. TI - Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit. SO - American Journal of Emergency Medicine. 36(1):88-92, 2018 Jan AS - Am J Emerg Med. 36(1):88-92, 2018 Jan NJ - The American journal of emergency medicine VO - 36 IP - 1 PG - 88-92 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Anemia, Sickle Cell/co [Complications] MH - *Critical Care/og [Organization & Administration] MH - Dose-Response Relationship, Drug MH - *Emergency Service, Hospital/og [Organization & Administration] MH - Female MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Middle Aged MH - Pain Measurement MH - Regression Analysis MH - Retrospective Studies MH - Tertiary Care Centers MH - United States MH - Young Adult KW - Acute care unit; Emergency department; Hospital admission; Opioid; Pain; Sickle cell disease AB - BACKGROUND: Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay. AB - METHODS: In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay. AB - FINDINGS: Pain on admission to the ED averaged 8.7+/-1.5 and to the ACU averaged 8.0+/-1.6. The average pain on discharge from the ED was 6.4+/-3.0 and for the ACU was 4.5+/-2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted. AB - CONCLUSIONS: Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions. Copyright Published by Elsevier Inc. RN - 0 (Analgesics, Opioid) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(17)30566-1 DO - https://dx.doi.org/10.1016/j.ajem.2017.07.037 PT - Comparative Study PT - Journal Article ID - S0735-6757(17)30566-1 [pii] ID - 10.1016/j.ajem.2017.07.037 [doi] PP - ppublish PH - 2017/04/20 [received] PH - 2017/07/11 [revised] PH - 2017/07/12 [accepted] LG - English EP - 20170713 DP - 2018 Jan EZ - 2017/08/15 06:00 DA - 2017/12/27 06:00 DT - 2017/08/14 06:00 YR - 2018 ED - 20171226 RD - 20171226 UP - 20171227 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28802541 <43. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28830119 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Seither J AU - Reidy L FA - Seither, Joshua FA - Reidy, Lisa IN - Seither, Joshua. Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Rosenstiel Medical Science Building (RMSB), 1600 NW 10th Avenue, 7th Floor Suite 7020 (R-5), Miami, FL 33136, USA. IN - Reidy, Lisa. Email: lreidy@med.miami.edu TI - Confirmation of Carfentanil, U-47700 and Other Synthetic Opioids in a Human Performance Case by LC-MS-MS. SO - Journal of Analytical Toxicology. 41(6):493-497, 2017 07 01 AS - J Anal Toxicol. 41(6):493-497, 2017 07 01 NJ - Journal of analytical toxicology VO - 41 IP - 6 PG - 493-497 PI - Journal available in: Print PI - Citation processed from: Internet JC - k4r, 7705085 IO - J Anal Toxicol SB - Index Medicus CP - England MH - Analgesics, Opioid/an [Analysis] MH - *Analgesics, Opioid/me [Metabolism] MH - Benzamides/an [Analysis] MH - *Benzamides/me [Metabolism] MH - Chromatography, Liquid MH - *Fentanyl/aa [Analogs & Derivatives] MH - Fentanyl/an [Analysis] MH - Fentanyl/me [Metabolism] MH - Humans MH - Opioid-Related Disorders/di [Diagnosis] MH - *Substance Abuse Detection/mt [Methods] MH - Tandem Mass Spectrometry AB - Recently, it has been documented that there has been a rise in synthetic opioid abuse. Synthetic opioids are compounds that were created to act as agonists for the opioid receptors. Like synthetic cannabinoids, most of these compounds were created by research groups or pharmaceutical companies in an attempt to find compounds that have medicinal use. Synthetic opioids have severe health implications when abused that can include hospitalization and death. Due to the high potency and the low dose required to produce the desired effects for these compounds, it was hypothesized that they may not be detectable in human performance case samples. However, this report documents a male driver who was involved in a single-vehicle incident. First responders treated the subject with naloxone as opioid drug impairment was suspected and he was transported to the local emergency room. The subject consented to a blood draw for a driving under the influence (DUI) investigation. Initial routine testing identified alprazolam at 55 ng/mL and fentanyl at less than 0.5 ng/mL. Further testing using a validated liquid chromatography-tandem mass spectrometry (LC-MS-MS) assay, confirmed the presence of carfentanil, furanyl fentanyl, para-fluoroisobutyryl fentanyl, U-47700 and its metabolite. To the author's knowledge, this is the first report of a DUI cases where carfentanil, U-47700 and other synthetic opioids were confirmed and described in a human performance blood sample. This case demonstrates the need to supplement routine toxicological analyses with a sensitive methodology that can detect synthetic opioids in human performance cases where opioid use may be implicated. Copyright © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com. RN - 0 (Analgesics, Opioid) RN - 0 (Benzamides) RN - 0 (U-47700) RN - LA9DTA2L8F (carfentanil) RN - UF599785JZ (Fentanyl) ES - 1945-2403 IL - 0146-4760 DO - https://dx.doi.org/10.1093/jat/bkx049 PT - Case Reports PT - Journal Article ID - 3926148 [pii] ID - 10.1093/jat/bkx049 [doi] PP - ppublish PH - 2017/01/27 [received] PH - 2017/06/21 [accepted] LG - English DP - 2017 07 01 EZ - 2017/08/24 06:00 DA - 2017/12/21 06:00 DT - 2017/08/24 06:00 YR - 2017 ED - 20171220 RD - 20171220 UP - 20171221 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28830119 <44. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28541419 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dempsey SK AU - Poklis JL AU - Sweat K AU - Cumpston K AU - Wolf CE FA - Dempsey, Sara K FA - Poklis, Justin L FA - Sweat, Kacie FA - Cumpston, Kirk FA - Wolf, Carl E IN - Dempsey, Sara K. Department of Pharmacology and Toxicology, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298-0613, USA. IN - Poklis, Justin L. Department of Pharmacology and Toxicology, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298-0613, USA. IN - Sweat, Kacie. Department of Emergency Medicine, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298-0613, USA. IN - Cumpston, Kirk. Department of Emergency Medicine, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298-0613, USA. IN - Wolf, Carl E. Department of Pathology, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298-0613, USA. TI - Acute Toxicity From Intravenous Use of the Tricyclic Antidepressant Tianeptine. SO - Journal of Analytical Toxicology. 41(6):547-550, 2017 Jul 01 AS - J Anal Toxicol. 41(6):547-550, 2017 Jul 01 NJ - Journal of analytical toxicology VO - 41 IP - 6 PG - 547-550 PI - Journal available in: Print PI - Citation processed from: Internet JC - k4r, 7705085 IO - J Anal Toxicol SB - Index Medicus CP - England MH - Adult MH - *Antidepressive Agents, Tricyclic/po [Poisoning] MH - Antidepressive Agents, Tricyclic/ur [Urine] MH - *Drug Overdose/di [Diagnosis] MH - Humans MH - Male MH - *Thiazepines/po [Poisoning] MH - Thiazepines/ur [Urine] AB - Tianeptine (7-[([3-chloro-6,11]-dihydro-6-methyldibenzo[c,f][1,2]thiazepin-11-yl) amino] heptanoic acid S, S dioxide) is a tricyclic compound prescribed as an antidepressant in European countries, but is not currently approved for use in the United States. There are few published case reports of tianeptine intoxication. Presented is the first case of acute toxicity associated with the intravenous use of tianeptine. A 36-year-old male intentionally injected tianeptine powder intravenously to "help him see into the future". He became unresponsive and a bystander called emergency medical services. Upon arrival to the Emergency Department, excessive constriction of the pupils, sedation, and a respiratory rate of 6 respirations per minute (rpm) were noted. Blood and urine were collected ~2 h post admission. The patient's serum ethanol concentration was 133 mg/dL. His toxicity was successfully reversed with two doses of naloxone 0.4 mg IV. He was started on a naloxone infusion at 0.2 mg/h and discharged 13 h after admittance awake, alert and oriented. The patient's urine sample screened negative for common drugs of abuse and total tricyclic antidepressants. A high performance liquid chromatography tandem mass spectrometry method was developed and validated to quantify tianeptine in urine. The calibration range was 1-100 ng/mL with linear regression correlation (r2) of 0.9996 or greater. The limit of quantitation was administratively set at 1 ng/mL. The bias of the assay was determined to be within +/-20% of the target value for each quality control specimen. The intra-day and inter-day precision did not exceed 15% coefficient of variation for each quality control specimen. Matrix effects, absolute recovery, carryover and specificity were also evaluated. The patient's tianeptine urine concentration was determined to be 2 ng/mL. Copyright © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com. RN - 0 (Antidepressive Agents, Tricyclic) RN - 0 (Thiazepines) RN - 0T493YFU8O (tianeptine) ES - 1945-2403 IL - 0146-4760 DO - https://dx.doi.org/10.1093/jat/bkx034 PT - Case Reports PT - Journal Article ID - 3852120 [pii] ID - 10.1093/jat/bkx034 [doi] PP - ppublish PH - 2017/02/08 [received] PH - 2017/05/11 [accepted] GI - No: P30 DA033934 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2017 Jul 01 EZ - 2017/05/26 06:00 DA - 2017/12/21 06:00 DT - 2017/05/26 06:00 YR - 2017 ED - 20171220 RD - 20171220 UP - 20171221 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28541419 <45. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28544288 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sun BC AU - Lupulescu-Mann N AU - Charlesworth CJ AU - Kim H AU - Hartung DM AU - Deyo RA AU - John McConnell K FA - Sun, Benjamin C FA - Lupulescu-Mann, Nicoleta FA - Charlesworth, Christina J FA - Kim, Hyunjee FA - Hartung, Daniel M FA - Deyo, Richard A FA - John McConnell, K IN - Sun, Benjamin C. Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR. IN - Lupulescu-Mann, Nicoleta. Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR. IN - Charlesworth, Christina J. Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR. IN - Kim, Hyunjee. Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR. IN - Hartung, Daniel M. College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR. IN - Deyo, Richard A. Department of Family Medicine, Department of Medicine, Department of Public Health and Preventive Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR. IN - John McConnell, K. Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR. IN - John McConnell, K. Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR. TI - Impact of Hospital "Best Practice" Mandates on Prescription Opioid Dispensing After an Emergency Department Visit. SO - Academic Emergency Medicine. 24(8):905-913, 2017 Aug AS - Acad Emerg Med. 24(8):905-913, 2017 Aug NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 24 IP - 8 PG - 905-913 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - *Hospitals/st [Standards] MH - Humans MH - Interrupted Time Series Analysis MH - Male MH - Medicaid MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Practice Patterns, Physicians'/st [Standards] MH - Retrospective Studies MH - United States MH - Washington/ep [Epidemiology] MH - Young Adult AB - OBJECTIVE: Washington State mandated seven hospital "best practices" in July 2012, several of which may affect emergency department (ED) opioid prescribing and provide a policy template for addressing the opioid prescription epidemic. We tested the hypothesis that the mandates would reduce opioid dispensing after an ED visit. We further assessed for a selective effect in patients with prior risky or chronic opioid use. AB - METHODS: We performed a retrospective, observational analysis of ED visits by Medicaid fee-for-service beneficiaries in Washington State, between July 1, 2011, and June 30, 2013. We used an interrupted time-series design to control for temporal trends and patient characteristics. The primary outcome was any opioid dispensing within 3 days after an ED visit. The secondary outcome was total morphine milligram equivalents (MMEs) dispensed within 3 days. AB - RESULTS: We analyzed 266,614 ED visits. Mandates were associated with a small reduction in opioid dispensing after an ED visit (-1.5%, 95% confidence interval [CI] = -2.8% to -0.15%). The mandates were associated with decreased opioid dispensing in 42,496 ED visits by patients with prior risky opioid use behavior (-4.7%, 95% CI = -7.1% to -2.3%) and in 20,238 visits by patients with chronic opioid use (-3.6%, 95% CI = -5.6% to -1.7%). Mandates were not associated with reductions in MMEs per dispense in the overall cohort or in either subgroup. AB - CONCLUSIONS: Washington State best practice mandates were associated with small but nonselective reductions in opioid prescribing rates. States should focus on alternative policies to further reduce opioid dispensing in subgroups of high-risk and chronic users. Copyright © 2017 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.13230 PT - Journal Article PT - Observational Study ID - 10.1111/acem.13230 [doi] ID - PMC5552416 [pmc] ID - NIHMS878455 [mid] PP - ppublish PH - 2017/03/13 [received] PH - 2017/05/06 [revised] PH - 2017/05/15 [accepted] GI - No: R01 DA036522 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20170726 DP - 2017 Aug PQ - 2018/08/01 EZ - 2017/05/26 06:00 DA - 2017/12/13 06:00 DT - 2017/05/26 06:00 YR - 2017 ED - 20171212 RD - 20171212 UP - 20171213 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28544288 <46. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28946984 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mackle T AU - Rhine D FA - Mackle, Trisha FA - Rhine, David IN - Mackle, Trisha. Department of Emergency Medicine, Kelowna General Hospital, University of British Columbia, Kelowna, British Columbia, Canada. IN - Rhine, David. Department of Emergency Medicine, Kelowna General Hospital, University of British Columbia, Kelowna, British Columbia, Canada. TI - Elderly Man in Respiratory Arrest. SO - Annals of Emergency Medicine. 70(4):599-604, 2017 Oct AS - Ann Emerg Med. 70(4):599-604, 2017 Oct NJ - Annals of emergency medicine VO - 70 IP - 4 PG - 599-604 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Aged MH - *Cardiopulmonary Resuscitation/ae [Adverse Effects] MH - Drug Overdose/co [Complications] MH - *Drug Overdose/th [Therapy] MH - *Heroin/po [Poisoning] MH - Heroin Dependence MH - Humans MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - *Pneumoperitoneum/dg [Diagnostic Imaging] MH - Pneumoperitoneum/et [Etiology] MH - Radiography, Thoracic MH - Respiratory Insufficiency/et [Etiology] MH - *Respiratory Insufficiency/th [Therapy] MH - *Stomach/in [Injuries] MH - Tomography, X-Ray Computed RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(17)30511-5 DO - https://dx.doi.org/10.1016/j.annemergmed.2017.04.035 PT - Case Reports PT - Journal Article ID - S0196-0644(17)30511-5 [pii] ID - 10.1016/j.annemergmed.2017.04.035 [doi] PP - ppublish PH - 2017/04/11 [received] LG - English DP - 2017 Oct EZ - 2017/09/28 06:00 DA - 2017/12/12 06:00 DT - 2017/09/27 06:00 YR - 2017 ED - 20171211 RD - 20171211 UP - 20171212 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28946984 <47. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28644688 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Elliott A AU - Dube PA AU - Cossette-Cote A AU - Patakfalvi L AU - Villeneuve E AU - Morris M AU - Gosselin S AI - Dube, Pierre-Andre; ORCID: http://orcid.org/0000-0003-0114-7648 AI - Villeneuve, Eric; ORCID: http://orcid.org/0000-0003-0510-8144 AI - Morris, Martin; ORCID: http://orcid.org/0000-0002-5659-2995 AI - Gosselin, Sophie; ORCID: http://orcid.org/0000-0002-0694-5588 FA - Elliott, Audree FA - Dube, Pierre-Andre FA - Cossette-Cote, Amelie FA - Patakfalvi, Laura FA - Villeneuve, Eric FA - Morris, Martin FA - Gosselin, Sophie IN - Elliott, Audree. a Department of Environmental Health and Toxicology , Institut National de Sante Publique du Quebec , Quebec , QC , Canada. IN - Dube, Pierre-Andre. a Department of Environmental Health and Toxicology , Institut National de Sante Publique du Quebec , Quebec , QC , Canada. IN - Dube, Pierre-Andre. b Faculty of Pharmacy , Universite Laval , QC , Canada. IN - Cossette-Cote, Amelie. c Department of Pharmacy, Centre Integre de Sante et de Services Sociaux du Bas-Saint-Laurent , Hopital de Rimouski , Rimouski , QC , Canada. IN - Patakfalvi, Laura. d Department of Family Medicine & Hospital Medicine , McGill University , Montreal , Canada. IN - Villeneuve, Eric. e Department of Pharmacy , McGill University Health Centre , Montreal , Quebec , Canada. IN - Morris, Martin. f Schulich Library of Physical Sciences, Life Sciences and Engineering , McGill University , Montreal , Canada. IN - Gosselin, Sophie. g Department of Medicine and Emergency Medicine , McGill University Health Centre , Montreal , Quebec , Canada. IN - Gosselin, Sophie. h Centre antipoison du Quebec, Province of Alberta Drug Information Service , Quebec , Canada. TI - Intraosseous administration of antidotes - a systematic review. [Review] SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 55(10):1025-1054, 2017 Dec AS - Clin Toxicol (Phila). 55(10):1025-1054, 2017 Dec NJ - Clinical toxicology (Philadelphia, Pa.) VO - 55 IP - 10 PG - 1025-1054 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Animals MH - *Antidotes/ad [Administration & Dosage] MH - Humans MH - Infusions, Intraosseous/ae [Adverse Effects] MH - *Infusions, Intraosseous MH - *Poisoning/dt [Drug Therapy] MH - Poisoning/mo [Mortality] MH - Resuscitation/mt [Methods] KW - Intoxication; administration route; poisoning; shock; treatment AB - CONTEXT: Intraosseous (IO) access is an established route of administration in resuscitation situations. Patients with serious poisoning presenting to the emergency department may require urgent antidote therapy. However, intravenous (IV) access is not always readily available. AB - OBJECTIVE: This study reviews the current evidence for IO administration of antidotes that could be used in poisoning. The primary outcome was mortality as a surrogate of efficacy. Secondary outcomes included hemodynamic variables, electrocardiographic variables, neurological status, pharmacokinetics outcomes, and adverse effects as defined by each article. AB - METHODS: A medical librarian created a systematic search strategy for Medline, subsequently translated to Embase, BIOSIS, PubMed, Web of Science, Cochrane, Database of Abstracts of Reviews of Effects (DARE), and the CENTRAL clinical trial register, all of which we searched from inception to 30 June 2016. Interventions included IO administration of selected antidotes. Articles included volunteer studies, poisoning, or other resuscitation contexts such as cardiac arrest, burns, dehydration, seizure, hemorrhagic shock, or undifferentiated shock. We considered all human studies and animal experiments to the exception of in vitro studies. Two reviewers independently selected studies, and a third adjudicated in case of disagreement. Three reviewers extracted all relevant data. Three reviewers evaluated the risk of bias and quality of the articles using specific scales according to each type of study design. AB - RESULTS: A total of 47 publications (46 articles and one abstract) met our inclusion criteria and described IO administration of 13 different antidotes. These included one case series and 21 case reports describing 26 patients, and 25 animal experiments. Of those, seven human case reports and four animal experiments specifically reported the use of antidotes in poisoning. Human case reports suggested favorable outcomes with IO use of atropine, diazepam, hydroxocobalamin, insulin, lipid emulsion, methylene blue, phentolamine, prothrombin complex concentrate, and sodium bicarbonate. Clinical outcomes varied according to the antidote used. The only reported adverse event was ventricular tachycardia following IO naloxone. Regarding the animal experiments, IO administration of lipid emulsion and of hydroxocobalamin showed improved survival in bupivacaine-poisoned rats and in cyanide-intoxicated swine, respectively. Animal data also suggested an equivalent bio-availability between IO and IV administration for atropine, calcium chloride, dextrose 50%, diazepam, methylene blue, pralidoxime, and sodium bicarbonate. Adverse effect reporting of fat emboli after IO administration of sodium bicarbonate, for example, was conflicting due to the significant heterogeneity in the timing of lung examination across studies. AB - CONCLUSION: The evidence supporting the use of IO route for the administration of antidotes in a context of poisoning is scarce. The majority of the evidence consists of case reports and animal experiments. Common antidotes such as acetylcysteine, fomepizole, and digoxin-specific antibody fragments have not been studied or reported with the use of the IO route. Despite the low-quality evidence available, IO access is a potential option for antidotal treatments in toxicological resuscitation when IV access is unavailable. RN - 0 (Antidotes) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.1080/15563650.2017.1337122 PT - Journal Article PT - Review ID - 10.1080/15563650.2017.1337122 [doi] PP - ppublish LG - English EP - 20170623 DP - 2017 Dec EZ - 2017/06/24 06:00 DA - 2017/12/12 06:00 DT - 2017/06/24 06:00 YR - 2017 ED - 20171211 RD - 20171211 UP - 20171212 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28644688 <48. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26626298 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gold LS AU - Strassels SA AU - Hansen RN FA - Gold, Laura S FA - Strassels, Scott A FA - Hansen, Ryan N IN - Gold, Laura S. Departments of *Radiology +Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA ++Health Economics and Outcomes Research, Mallinckrodt Pharmaceuticals, Hazelwood, MO. TI - Health Care Costs and Utilization in Patients Receiving Prescriptions for Long-acting Opioids for Acute Postsurgical Pain. SO - Clinical Journal of Pain. 32(9):747-54, 2016 09 AS - Clin J Pain. 32(9):747-54, 2016 09 NJ - The Clinical journal of pain VO - 32 IP - 9 PG - 747-54 PI - Journal available in: Print PI - Citation processed from: Internet JC - beg, 8507389 IO - Clin J Pain SB - Index Medicus CP - United States MH - Age Factors MH - *Analgesics, Opioid/ec [Economics] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Arthroplasty, Replacement, Hip MH - Arthroplasty, Replacement, Knee MH - Arthroplasty, Replacement, Shoulder MH - Female MH - *Health Care Costs MH - Humans MH - Male MH - Middle Aged MH - Pain Management/ec [Economics] MH - Pain Management/ut [Utilization] MH - *Pain, Postoperative/dt [Drug Therapy] MH - *Pain, Postoperative/ec [Economics] MH - Pain, Postoperative/ep [Epidemiology] MH - *Patient Acceptance of Health Care AB - OBJECTIVES: Severe pain after joint replacement surgeries is common and is usually managed by opioid analgesics. We described joint replacement surgery patients who received prescriptions for long-acting opioids (LAOs) and compared their health care utilization and costs with postsurgical patients who did not receive LAO prescriptions. AB - MATERIALS AND METHODS: Patients undergoing hip, knee, or shoulder replacement surgery between January 1, 2008 and December 31, 2011were included in the study and were classified by their exposure to LAOs. We estimated multivariate models to compare the groups' health care utilization and costs in the first 7 days and in the 1, 3, 6, and 12 months after surgery. AB - RESULTS: Of 118,816 patients who met our inclusion criteria, 15,094 (13%) received LAO prescriptions in 30 days following surgery. LAO recipients were slightly younger and more likely than nonrecipients to have taken antibiotics, antidepressants, benzodiazepines, antihypertensives, sedatives, muscle relaxants, and short-acting opioids in the 60 days before surgery. LAO recipients were more likely to have had a hospitalization and an emergency department visit in the subsequent 1 week and in the next 1, 3, 6, and 12 months. Patients receiving LAO prescriptions incurred greater costs in the 1 week and in the 1, 3, 6, and 12 months following their surgeries compared with patients who did not receive LAO prescriptions. AB - DISCUSSION: We found associations between patients who received prescriptions for LAOs and increased costs and utilization. Future studies should elucidate causal relationships between LAOs and increased resource use. Providers should consider alternative pain management strategies. RN - 0 (Analgesics, Opioid) ES - 1536-5409 IL - 0749-8047 DO - https://dx.doi.org/10.1097/AJP.0000000000000322 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1097/AJP.0000000000000322 [doi] PP - ppublish LG - English DP - 2016 09 EZ - 2015/12/03 06:00 DA - 2017/12/12 06:00 DT - 2015/12/03 06:00 YR - 2016 ED - 20171211 RD - 20180206 UP - 20180206 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=26626298 <49. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27296656 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mohlman MK AU - Tanzman B AU - Finison K AU - Pinette M AU - Jones C FA - Mohlman, Mary Kate FA - Tanzman, Beth FA - Finison, Karl FA - Pinette, Melanie FA - Jones, Craig IN - Mohlman, Mary Kate. Vermont Blueprint for Health, NOB 1 South, 280 State Drive, Waterbury, VT 05671, USA. Electronic address: marykate.mohlman@vermont.gov. IN - Tanzman, Beth. Vermont Blueprint for Health, NOB 1 South, 280 State Drive, Waterbury, VT 05671, USA. IN - Finison, Karl. Onpoint Health Data, 254 Commercial Street, Suite 257, Portland, ME 04101, USA. IN - Pinette, Melanie. Onpoint Health Data, 254 Commercial Street, Suite 257, Portland, ME 04101, USA. IN - Jones, Craig. Vermont Blueprint for Health, NOB 1 South, 280 State Drive, Waterbury, VT 05671, USA. TI - Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid Expenditures and Health Services Utilization Rates in Vermont. SO - Journal of Substance Abuse Treatment. 67:9-14, 2016 08 AS - J Subst Abuse Treat. 67:9-14, 2016 08 NJ - Journal of substance abuse treatment VO - 67 PG - 9-14 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - kai, 8500909 IO - J Subst Abuse Treat SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Cross-Sectional Studies MH - Emergency Service, Hospital/ec [Economics] MH - Emergency Service, Hospital/st [Standards] MH - Female MH - *Health Care Costs/sn [Statistics & Numerical Data] MH - *Health Expenditures/sn [Statistics & Numerical Data] MH - Health Services/ut [Utilization] MH - Hospitalization/ec [Economics] MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - *Medicaid/ec [Economics] MH - Middle Aged MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/ec [Economics] MH - Opioid-Related Disorders/rh [Rehabilitation] MH - United States MH - Vermont MH - Young Adult KW - *Addiction; *MAT; *Medicaid; *Medication-assisted treatment; *Opioid AB - In the face of increasing rates of overdose deaths, escalating health care costs, and the tremendous social costs of opioid addiction, policy makers are asked to address the questions of whether and how to expand access to treatment services. In response to an upward trend in opioid abuse and adverse outcomes, Vermont is investing in statewide expansion of a medication-assisted therapy program delivered in a network of community practices and specialized treatment centers (Hub & Spoke Program). This study was conducted to test the rationale for these investments and to establish a pre-Hub & Spoke baseline for evaluating the additive impact of the program. Using a serial cross-sectional design from 2008 to 2013 to evaluate medical claims for Vermont Medicaid beneficiaries with opioid dependence or addiction (6158 in the intervention group, 2494 in the control group), this study assesses the treatment and medical service expenditures for those receiving medication-assisted treatment compared to those receiving substance abuse treatment without medication. Results suggest that medication-assisted therapy is associated with reduced general health care expenditures and utilization, such as inpatient hospital admissions and outpatient emergency department visits, for Medicaid beneficiaries with opioid addiction. For state Medicaid leaders facing similar decisions on approaches to opioid addiction, these results provide early support for expanding medication-assisted treatment services rather than relying only on psychosocial, abstinence, or detoxification interventions. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved. ES - 1873-6483 IL - 0740-5472 DI - S0740-5472(15)30065-9 DO - https://dx.doi.org/10.1016/j.jsat.2016.05.002 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0740-5472(15)30065-9 [pii] ID - 10.1016/j.jsat.2016.05.002 [doi] PP - ppublish PH - 2015/11/20 [received] PH - 2016/05/01 [revised] PH - 2016/05/04 [accepted] LG - English EP - 20160509 DP - 2016 08 EZ - 2016/06/15 06:00 DA - 2017/12/08 06:00 DT - 2016/06/15 06:00 YR - 2016 ED - 20171207 RD - 20180215 UP - 20180215 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27296656 <50. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27717562 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Brindley PG AU - Douma MJ FA - Brindley, Peter G FA - Douma, Matthew J IN - Brindley, Peter G. Critical Care Medicine, Medical Ethics, Anesthesiology, University of Alberta Hospital, Edmonton, Alberta, Canada, T6G2B7; Intensive Care Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada, T6G2B7. Electronic address: brindley@ualberta.ca. IN - Douma, Matthew J. Royal Alexandra Hospital Emergency Department, Edmonton, Alberta. Electronic address: matthew.douma@AHS.ca. TI - Opioids and overdoses: Time to get serious; time to get sensible. CM - Comment on: J Crit Care. 2017 Feb;37:252-253; PMID: 27665365 SO - Journal of Critical Care. 37:254, 2017 02 AS - J Crit Care. 37:254, 2017 02 NJ - Journal of critical care VO - 37 PG - 254 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - buy, 8610642 IO - J Crit Care SB - Index Medicus CP - United States MH - *Analgesics, Opioid MH - *Drug Overdose MH - Emergency Service, Hospital MH - Humans RN - 0 (Analgesics, Opioid) ES - 1557-8615 IL - 0883-9441 DI - S0883-9441(16)30529-9 DO - https://dx.doi.org/10.1016/j.jcrc.2016.09.015 PT - Letter PT - Comment ID - S0883-9441(16)30529-9 [pii] ID - 10.1016/j.jcrc.2016.09.015 [doi] PP - ppublish PH - 2016/09/16 [received] PH - 2016/09/16 [accepted] LG - English EP - 20160927 DP - 2017 02 EZ - 2016/10/09 06:00 DA - 2017/12/06 06:00 DT - 2016/10/09 06:00 YR - 2017 ED - 20171205 RD - 20171208 UP - 20171208 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27717562 <51. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27540098 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - John A AU - Okolie C AU - Porter A AU - Moore C AU - Thomas G AU - Whitfield R AU - Oretti R AU - Snooks H AI - Okolie, Chukwudi; ORCID: https://orcid.org/0000-0003-1423-9306 AI - Snooks, Helen; ORCID: https://orcid.org/0000-0003-0173-8843 FA - John, Ann FA - Okolie, Chukwudi FA - Porter, Alison FA - Moore, Chris FA - Thomas, Gareth FA - Whitfield, Richard FA - Oretti, Rossana FA - Snooks, Helen IN - John, Ann. Swansea University Medical School, Swansea, UK. IN - Okolie, Chukwudi. Swansea University Medical School, Swansea, UK. IN - Porter, Alison. Swansea University Medical School, Swansea, UK. IN - Moore, Chris. Welsh Ambulance Services NHS Trust, H.M.Stanley Hospital, St Asaph, Denbighshire, UK. IN - Thomas, Gareth. Swansea University Medical School, Swansea, UK. IN - Whitfield, Richard. Welsh Ambulance Services NHS Trust, H.M.Stanley Hospital, St Asaph, Denbighshire, UK. IN - Oretti, Rossana. Community Addiction Unit, Cardiff and Vale University Health Board, Cardiff, UK. IN - Snooks, Helen. Swansea University Medical School, Swansea, UK. TI - Non-accidental non-fatal poisonings attended by emergency ambulance crews: an observational study of data sources and epidemiology. SO - BMJ Open. 6(8):e011049, 2016 08 18 AS - BMJ Open. 6(8):e011049, 2016 08 18 NJ - BMJ open VO - 6 IP - 8 PG - e011049 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101552874 IO - BMJ Open PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013357 SB - Index Medicus CP - England MH - Acetaminophen/po [Poisoning] MH - Adolescent MH - Adult MH - Analgesics, Non-Narcotic/po [Poisoning] MH - Cross-Sectional Studies MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Service Communication Systems/sn [Statistics & Numerical Data] MH - Emergency Medical Services/mt [Methods] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Psychotropic Drugs/po [Poisoning] MH - Wales/ep [Epidemiology] MH - Young Adult KW - *Drug abuse; *EPIDEMIOLOGY; *Emergency ambulance systems AB - BACKGROUND: Non-accidental non-fatal poisoning (NANFP) is associated with high risk of repeat episodes and fatality. This cross-sectional study aims to describe the data sources and epidemiology of non-fatal poisonings (NFPs) presenting to the emergency ambulance service. AB - METHODS: We assessed incidents of NFP across Wales from electronic ambulance call centre records and paper records completed by attending ambulance crews, December 2007 to February 2008. We descriptively analysed data completed by attending crews. AB - RESULTS: 92 331 calls were made to the ambulance call centre, of which 3923 (4.2%) were coded as 'overdose' or 'poisoning'. During the same period, ambulance crews recorded 1827 attended NANFP incidents in those categories, of which 1287 (70.4%) had been identified in the call centre. 76.1% (1356/1782) were aged 15-44 years and 54.2% (991/1827) were female. 75.0% (1302/1753) of incidents occurred in areas from the lower 2 quintiles of deprivation in Wales. Substance taken was reported in 90% of cases (n=1639). Multiple ingestion was common (n=886, 54.1%). Psychotropic was the most frequently taken group of substances (n=585, 32.0%) and paracetamol (n=484, 26.5%) was the most frequently taken substance prehospital. Almost half of patients had taken alcohol alongside other substances (n=844, 46.2%). Naloxone was the most frequently administered treatment (n=137, 7.5%). Only 142/1827 (7.8%) patients were not transported to hospital, of whom 4 were recorded to have been given naloxone. AB - CONCLUSIONS: We report new data on the epidemiology of NFP across substance types at national level, highlighting deficiencies in information systems and high levels of multiple ingestion. In order to develop policy and practice for this patient group prehospital and further along the care pathway, information systems need to be developed to allow accurate routine monitoring of volume, presentation and outcomes. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Narcotic Antagonists) RN - 0 (Psychotropic Drugs) RN - 362O9ITL9D (Acetaminophen) RN - 36B82AMQ7N (Naloxone) ES - 2044-6055 IL - 2044-6055 DO - https://dx.doi.org/10.1136/bmjopen-2016-011049 PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't ID - bmjopen-2016-011049 [pii] ID - 10.1136/bmjopen-2016-011049 [doi] ID - PMC5013357 [pmc] PP - epublish LG - English EP - 20160818 DP - 2016 08 18 EZ - 2016/08/20 06:00 DA - 2017/12/02 06:00 DT - 2016/08/20 06:00 YR - 2016 ED - 20171201 RD - 20171201 UP - 20171204 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27540098 <52. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26973177 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Yealy DM AU - Green SM FA - Yealy, Donald M FA - Green, Steven M IN - Yealy, Donald M. Department of Emergency Medicine, University of Pittsburgh/UPMC. Electronic address: yealydm@upmc.edu. IN - Green, Steven M. Department of Emergency Medicine, Loma Linda University. TI - Opioids and the Emergency Physician: Ducking Between Pendulum Swings. CM - Comment on: Ann Emerg Med. 2016 Aug;68(2):202-8; PMID: 26875061 SO - Annals of Emergency Medicine. 68(2):209-12, 2016 08 AS - Ann Emerg Med. 68(2):209-12, 2016 08 NJ - Annals of emergency medicine VO - 68 IP - 2 PG - 209-12 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid MH - Humans MH - *Physicians RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(16)00036-6 DO - https://dx.doi.org/10.1016/j.annemergmed.2016.01.026 PT - Editorial PT - Comment ID - S0196-0644(16)00036-6 [pii] ID - 10.1016/j.annemergmed.2016.01.026 [doi] PP - ppublish PH - 2016/01/18 [received] LG - English EP - 20160310 DP - 2016 08 EZ - 2016/03/15 06:00 DA - 2017/12/02 06:00 DT - 2016/03/15 06:00 YR - 2016 ED - 20171201 RD - 20171201 UP - 20171204 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=26973177 <53. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29079683 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Roehr B FA - Roehr, Bob IN - Roehr, Bob. Washington, DC. TI - Trump declares opioid public health emergency but no extra money. SO - BMJ. 359:j4998, 2017 10 27 AS - BMJ. 359:j4998, 2017 10 27 NJ - BMJ (Clinical research ed.) VO - 359 PG - j4998 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 8900488, bmj, 101090866 IO - BMJ SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Emergencies/ec [Economics] MH - *Financing, Government MH - Humans MH - *Opioid-Related Disorders/th [Therapy] MH - *Public Health/ec [Economics] MH - United States ES - 1756-1833 IL - 0959-535X DO - https://dx.doi.org/10.1136/bmj.j4998 PT - News PP - epublish LG - English EP - 20171027 DP - 2017 10 27 EZ - 2017/10/29 06:00 DA - 2017/11/29 06:00 DT - 2017/10/29 06:00 YR - 2017 ED - 20171128 RD - 20171128 UP - 20171129 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=29079683 <54. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28061909 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kerensky T AU - Walley AY FA - Kerensky, Todd FA - Walley, Alexander Y IN - Kerensky, Todd. Instructor of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, Floor 2, Boston, MA, 02118, USA. Todd.Kerensky@bmc.org. IN - Walley, Alexander Y. Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, Floor 2, Boston, MA, 02118, USA. TI - Opioid overdose prevention and naloxone rescue kits: what we know and what we don't know. [Review] SO - Addiction Science & Clinical Practice. 12(1):4, 2017 01 07 AS - Addict Sci Clin Pract. 12(1):4, 2017 01 07 NJ - Addiction science & clinical practice VO - 12 IP - 1 PG - 4 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101316917 IO - Addict Sci Clin Pract SB - Index Medicus CP - England MH - *Drug Overdose/pc [Prevention & Control] MH - Drug Users MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - United States KW - *Naloxone rescue kits; *Opioid overdose education; *Overdose prevention AB - The opioid use and overdose crisis is persistent and dynamic. Opioid overdoses were initially driven in the 1990s and 2000s by the increasing availability and misuse of prescription opioids. More recently, opioid overdoses are increasing at alarming rates due to wider use of heroin, which in some places is mixed with fentanyl or fentanyl derivatives. Naloxone access for opioid overdose rescue is one of the US Department of Health and Human Services' three priority areas for responding to the opioid crisis. This article summarizes the known benefits of naloxone access and details unanswered questions about overdose education and naloxone rescue kits. Hopefully future research will address these knowledge gaps, improve the effectiveness of opioid overdose education and naloxone distribution programs, and unlock the full promise of naloxone rescue kits. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1940-0640 IL - 1940-0632 DO - https://dx.doi.org/10.1186/s13722-016-0068-3 PT - Journal Article PT - Review ID - 10.1186/s13722-016-0068-3 [doi] ID - 10.1186/s13722-016-0068-3 [pii] ID - PMC5219773 [pmc] PP - epublish PH - 2016/07/12 [received] PH - 2016/12/22 [accepted] LG - English EP - 20170107 DP - 2017 01 07 EZ - 2017/01/08 06:00 DA - 2017/11/29 06:00 DT - 2017/01/08 06:00 YR - 2017 ED - 20171128 RD - 20171128 UP - 20171129 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28061909 <55. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28549620 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weiner SG AU - Baker O AU - Poon SJ AU - Rodgers AF AU - Garner C AU - Nelson LS AU - Schuur JD FA - Weiner, Scott G FA - Baker, Olesya FA - Poon, Sabrina J FA - Rodgers, Ann F FA - Garner, Chad FA - Nelson, Lewis S FA - Schuur, Jeremiah D IN - Weiner, Scott G. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: sweiner@bwh.harvard.edu. IN - Baker, Olesya. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA. IN - Poon, Sabrina J. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. IN - Rodgers, Ann F. Department of Emergency Medicine, Swedish Medical Center, Seattle, WA. IN - Garner, Chad. State of Ohio Board of Pharmacy, Columbus, OH. IN - Nelson, Lewis S. Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ. IN - Schuur, Jeremiah D. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. TI - The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio. SO - Annals of Emergency Medicine. 70(6):799-808.e1, 2017 Dec AS - Ann Emerg Med. 70(6):799-808.e1, 2017 Dec NJ - Annals of emergency medicine VO - 70 IP - 6 PG - 799-808.e1 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Codeine/tu [Therapeutic Use] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Guideline Adherence/sn [Statistics & Numerical Data] MH - Humans MH - Hydrocodone/tu [Therapeutic Use] MH - Hydromorphone/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - Ohio MH - Oxycodone/tu [Therapeutic Use] MH - *Practice Guidelines as Topic MH - Practice Patterns, Physicians'/st [Standards] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Tramadol/tu [Therapeutic Use] AB - STUDY OBJECTIVE: The objective of our study is to evaluate the association between Ohio's April 2012 emergency physician guidelines aimed at reducing inappropriate opioid prescribing and the number and type of opioid prescriptions dispensed by emergency physicians. AB - METHODS: We used Ohio's prescription drug monitoring program data from January 1, 2010, to December 31, 2014, and included the 5 most commonly prescribed opioids (hydrocodone, oxycodone, tramadol, codeine, and hydromorphone). The primary outcome was the monthly statewide prescription total of opioids written by emergency physicians in Ohio. We used an interrupted time series analysis to compare pre- and postguideline level and trend in number of opioid prescriptions dispensed by emergency physicians per month, number of prescriptions stratified by 5 commonly prescribed opioids, and number of prescriptions for greater than 3 days' supply of opioids. AB - RESULTS: Beginning in January 2010, the number of prescriptions dispensed by all emergency physicians in Ohio decreased by 0.3% per month (95% confidence interval [CI] -0.49% to -0.15%). The implementation of the guidelines in April 2012 was associated with a 12% reduction (95% CI -17.7% to -6.3%) in the level of statewide total prescriptions per month and an additional decline of 0.9% (95% CI -1.1% to -0.7%) in trend relative to the preguideline trend. The estimated effect of the guidelines on total monthly prescriptions greater than a 3-day supply was an 11.2% reduction in level (95% CI -18.8% to -3.6%) and an additional 0.9% (95% CI -1.3% to -0.5%) decline in trend per month after the guidelines. Guidelines were also associated with a reduction in prescribing for each of the 5 individual opioids, with various effect. AB - CONCLUSION: In Ohio, emergency physician opioid prescribing guidelines were associated with a decrease in the quantity of opioid prescriptions written by emergency physicians. Although introduction of the guidelines occurred in parallel with other opioid-related interventions, our findings suggest an additional effect of the guidelines on prescribing behavior. Similar guidelines may have the potential to reduce opioid prescribing in other geographic areas and for other specialties as well. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 39J1LGJ30J (Tramadol) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - CD35PMG570 (Oxycodone) RN - Q812464R06 (Hydromorphone) RN - Q830PW7520 (Codeine) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(17)30353-0 DO - https://dx.doi.org/10.1016/j.annemergmed.2017.03.057 PT - Journal Article ID - S0196-0644(17)30353-0 [pii] ID - 10.1016/j.annemergmed.2017.03.057 [doi] PP - ppublish PH - 2016/12/01 [received] PH - 2017/03/17 [revised] PH - 2017/03/22 [accepted] LG - English EP - 20170523 DP - 2017 Dec EZ - 2017/05/28 06:00 DA - 2017/11/29 06:00 DT - 2017/05/28 06:00 YR - 2017 ED - 20171127 RD - 20171128 UP - 20171129 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28549620 <56. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27334894 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Carreiro S AU - Wittbold K AU - Indic P AU - Fang H AU - Zhang J AU - Boyer EW FA - Carreiro, Stephanie FA - Wittbold, Kelley FA - Indic, Premananda FA - Fang, Hua FA - Zhang, Jianying FA - Boyer, Edward W IN - Carreiro, Stephanie. Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA. stephanie.carreiro@umassmemorial.org. IN - Wittbold, Kelley. Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA. IN - Indic, Premananda. Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA. IN - Fang, Hua. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. IN - Zhang, Jianying. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. IN - Boyer, Edward W. Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA. TI - Wearable Biosensors to Detect Physiologic Change During Opioid Use. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 12(3):255-62, 2016 09 AS - J Med Toxicol. 12(3):255-62, 2016 09 NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 12 IP - 3 PG - 255-62 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996791 SB - Index Medicus CP - United States MH - Administration, Intravenous MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/po [Poisoning] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Biosensing Techniques/is [Instrumentation] MH - Combined Modality Therapy MH - Dose-Response Relationship, Drug MH - Drug Overdose/et [Etiology] MH - *Drug Overdose/pc [Prevention & Control] MH - Emergency Service, Hospital MH - Female MH - Galvanic Skin Response/de [Drug Effects] MH - Humans MH - Locomotion/de [Drug Effects] MH - Male MH - Monitoring, Ambulatory/is [Instrumentation] MH - Opioid-Related Disorders/pp [Physiopathology] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Opioid-Related Disorders/th [Therapy] MH - Pilot Projects MH - *Secondary Prevention/is [Instrumentation] MH - Skin Temperature/de [Drug Effects] MH - *Substance Abuse Detection/is [Instrumentation] MH - Substance Abuse, Intravenous/pp [Physiopathology] MH - Substance Abuse, Intravenous/pc [Prevention & Control] MH - Substance Abuse, Intravenous/th [Therapy] MH - *Wearable Electronic Devices MH - Wrist KW - *Biometrics; *Biosensors; *Opioids; *Signal Processing; *Wearables AB - INTRODUCTION: Opioid analgesic use is a major cause of morbidity and mortality in the US, yet effective treatment programs have a limited ability to detect relapse. The utility of current drug detection methods is often restricted due to their retrospective and subjective nature. Wearable biosensors have the potential to improve detection of relapse by providing objective, real time physiologic data on opioid use that can be used by treating clinicians to augment behavioral interventions. AB - METHODS: Thirty emergency department (ED) patients who were prescribed intravenous opioid medication for acute pain were recruited to wear a wristband biosensor. The biosensor measured electrodermal activity, skin temperature and locomotion data, which was recorded before and after intravenous opioid administration. Hilbert transform analyses combined with paired t-tests were used to compare the biosensor data A) within subjects, before and after administration of opioids; B) between subjects, based on hand dominance, gender, and opioid use history. AB - RESULTS: Within subjects, a significant decrease in locomotion and increase in skin temperature were consistently detected by the biosensors after opioid administration. A significant change in electrodermal activity was not consistently detected. Between subjects, biometric changes varied with level of opioid use history (heavy vs. nonheavy users), but did not vary with gender or type of opioid. Specifically, heavy users demonstrated a greater decrease in short amplitude movements (i.e. fidgeting movements) compared to non-heavy users. AB - CONCLUSION: A wearable biosensor showed a consistent physiologic pattern after ED opioid administration and differences between patterns of heavy and non-heavy opioid users were noted. Potential applications of biosensors to drug addiction treatment and pain management should be studied further. CI - Compliance with Ethical Standards Funding NIH NIDA R01DA033769-01, L30 DA038357, NIH NIDA 1R01DA033323-01, and NIH NCATS 5UL1TR000161-04. Conflicts of Interest The authors have no conflicts to disclose. RN - 0 (Analgesics, Opioid) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-016-0557-5 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1007/s13181-016-0557-5 [doi] ID - 10.1007/s13181-016-0557-5 [pii] ID - PMC4996791 [pmc] PP - ppublish PH - 2016/01/20 [received] PH - 2016/05/14 [accepted] PH - 2016/05/10 [revised] GI - No: R01 DA033323 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: UL1 TR000161 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: UL1 TR001453 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: R01 DA033769 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: L30 DA038357 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20160622 DP - 2016 09 EZ - 2016/06/24 06:00 DA - 2017/11/29 06:00 DT - 2016/06/24 06:00 YR - 2016 ED - 20171122 RD - 20171206 UP - 20171206 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27334894 <57. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27150104 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pomerleau AC AU - Schrager JD AU - Morgan BW FA - Pomerleau, Adam C FA - Schrager, Justin D FA - Morgan, Brent W IN - Pomerleau, Adam C. Department of Emergency Medicine, Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA. adam.pomerleau@emory.edu. IN - Schrager, Justin D. Department of Emergency Medicine, Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA. IN - Morgan, Brent W. Department of Emergency Medicine, Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA. TI - Pilot Study of the Importance of Factors Affecting Emergency Department Opioid Analgesic Prescribing Decisions. CM - Comment in: J Med Toxicol. 2016 Sep;12 (3):221-3; PMID: 27492362 SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 12(3):282-8, 2016 09 AS - J Med Toxicol. 12(3):282-8, 2016 09 NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 12 IP - 3 PG - 282-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996790 SB - Index Medicus CP - United States MH - Academic Medical Centers MH - Adult MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Clinical Decision-Making MH - Cross-Sectional Studies MH - Drug Prescriptions MH - Emergency Medicine/ed [Education] MH - Emergency Medicine/ma [Manpower] MH - *Emergency Medicine/mt [Methods] MH - *Emergency Service, Hospital/ma [Manpower] MH - Georgia MH - Gestalt Theory MH - Health Care Surveys MH - Humans MH - Internet MH - Internship and Residency/ma [Manpower] MH - Medical Staff, Hospital MH - Nurse Practitioners MH - *Pain Management/mt [Methods] MH - Physician Assistants MH - Pilot Projects MH - *Practice Patterns, Physicians' MH - Secondary Prevention MH - Self Report MH - Substance-Related Disorders/pc [Prevention & Control] KW - *Opioid prescribing; *Pain management; *Prescription drug abuse AB - INTRODUCTION: Little is known about the factors driving decision-making among emergency department (ED) providers when prescribing opioid analgesics (OA). The aim of this pilot study was to identify the importance of factors influencing OA-prescribing decisions and to determine how this varied among different types of providers. AB - METHODS: This was an observational cross-sectional survey study of 203 ED providers. The importance of decisional factors was rated on a 5-point Likert scale. Differences between provider groups were tested using Chi-squared or ANOVA tests where applicable. AB - RESULTS: Overall, 142/203 (69.9 %) potential respondents participated in the study. The five highest-rated factors were (mean +/- SD) patient's opioid prescription history (4.4+/-0.8), patient's history of substance abuse or dependence (4.4+/-0.7), diagnosis thought to be the cause of patient's pain (4.2+/-0.8), clinical gestalt (4.2+/-0.7), and provider's concern about unsafe use of the medication (4.0+/-0.9). The importance of 6 of 21 decisional factors varied significantly between different groups of providers. AB - CONCLUSION: In this pilot study of ED providers, the self-reported importance of several factors influencing OA-prescribing decisions were significantly different among attending physicians, resident physicians, and advanced practice providers. Further investigation into how ED providers make OA-prescribing decisions is needed to help guide interventions aimed at improving appropriate pain management. CI - The authors have no conflicts of interest to report. Funding Sources This study is supported in part by the ECIC Faculty Pilot Grant Program from the Emory Center for Injury Control, Emory University; CDC Grant #5R49CE001494 RN - 0 (Analgesics, Opioid) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-016-0553-9 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - 10.1007/s13181-016-0553-9 [doi] ID - 10.1007/s13181-016-0553-9 [pii] ID - PMC4996790 [pmc] PP - ppublish PH - 2016/02/01 [received] PH - 2016/04/26 [accepted] GI - No: R49 CE001494 Organization: (CE) *NCIPC CDC HHS* Country: United States LG - English EP - 20160505 DP - 2016 09 EZ - 2016/05/07 06:00 DA - 2017/11/29 06:00 DT - 2016/05/07 06:00 YR - 2016 ED - 20171122 RD - 20171206 UP - 20171206 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27150104 <58. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27083903 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Friedman MS AU - Manini AF FA - Friedman, Matt S FA - Manini, Alex F IN - Friedman, Matt S. Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA. IN - Manini, Alex F. Division of Medical Toxicology, the Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, One Gustave Levy Place, Box 1620, New York, NY, 10029, USA. alex.manini@mssm.edu. TI - Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 12(3):270-5, 2016 09 AS - J Med Toxicol. 12(3):270-5, 2016 09 NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 12 IP - 3 PG - 270-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996789 SB - Index Medicus CP - United States MH - Adult MH - Cohort Studies MH - Delivery of Health Care MH - Drug Overdose/di [Diagnosis] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/pp [Physiopathology] MH - Drug Overdose/px [Psychology] MH - Emergency Medical Services/ma [Manpower] MH - *Emergency Medical Services/mt [Methods] MH - Female MH - Glasgow Coma Scale MH - Humans MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Neurotoxicity Syndromes/et [Etiology] MH - Neurotoxicity Syndromes/pc [Prevention & Control] MH - New York City MH - Poison Control Centers MH - *Practice Guidelines as Topic MH - Prospective Studies MH - Reflex, Pupillary/de [Drug Effects] MH - Respiratory Rate/de [Drug Effects] MH - Sensitivity and Specificity MH - Substance Abuse Detection MH - Substance-Related Disorders/di [Diagnosis] MH - *Substance-Related Disorders/dt [Drug Therapy] MH - Substance-Related Disorders/pp [Physiopathology] MH - Substance-Related Disorders/px [Psychology] MH - Tertiary Care Centers KW - *Naloxone; *Overdose; *Prehospital AB - INTRODUCTION: We aimed to validate previously derived clinical criteria to predict successful prehospital response to naloxone in patients with altered mental status treated by EMS. We hypothesized that prehospital naloxone criteria would have high sensitivity for effective antidote response, but would be underutilized, in patients with drug-related altered mental status (DRAMS). AB - METHODS: This study was a secondary data analysis of a prospective cohort of acute DRAMS at an urban ED. Naloxone criteria (respiratory rate (RR) <12, miotic pupils, or drug paraphernalia) and mental status, graded by either AVPU (Alert, Verbal, Painful, Unresponsive) or Glasgow Coma Scales, were abstracted from prehospital care reports. Interventions were compared for effective antidote response (EAR), defined as immediate improvement in RR, AVPU, or GCS. AB - RESULTS: EMS transported 249 DRAMS over 17 months (48 % males, mean age 41.5, ALS 33.7 %). Forty-three (17 %) patients met naloxone criteria, of whom 44.2 % received the antidote. Naloxone criteria significantly predicted EAR (OR 7.0, p<0.05) with 83 % sensitivity (95 % CI, 55-95 %). Miotic pupils (OR 20.0, p<0.01) outperformed RR (OR 2.3, p=NS) as the best single criterion with 91 % sensitivity (95 % CI, 62-98 %). AB - CONCLUSIONS: This study validates prehospital criteria to guide naloxone administration. In addition, prehospital naloxone was underutilized for DRAMS. Further studies should address potential barriers to prehospital naloxone administration. CI - Compliance with Ethical Standard Conflicts of Interest The authors report no commercial conflicts of interest. Sources of Funding This study was funded, in part, by the National Institutes of Health (DA026476, PI: Manini). This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-016-0549-5 PT - Comparative Study PT - Journal Article PT - Validation Studies PT - Research Support, N.I.H., Extramural ID - 10.1007/s13181-016-0549-5 [doi] ID - 10.1007/s13181-016-0549-5 [pii] ID - PMC4996789 [pmc] PP - ppublish PH - 2015/12/18 [received] PH - 2016/04/01 [accepted] PH - 2016/03/29 [revised] GI - No: K23 DA026476 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA037317 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20160415 DP - 2016 09 EZ - 2016/04/17 06:00 DA - 2017/11/29 06:00 DT - 2016/04/17 06:00 YR - 2016 ED - 20171122 RD - 20171206 UP - 20171206 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27083903 <59. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26621354 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Frank JW AU - Levy C AU - Calcaterra SL AU - Hoppe JA AU - Binswanger IA FA - Frank, Joseph W FA - Levy, Cari FA - Calcaterra, Susan L FA - Hoppe, Jason A FA - Binswanger, Ingrid A IN - Frank, Joseph W. Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA. joseph.frank@ucdenver.edu. IN - Frank, Joseph W. VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO, 80207, USA. joseph.frank@ucdenver.edu. IN - Levy, Cari. VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO, 80207, USA. IN - Levy, Cari. Division of Health Care Policy and Research, University of Colorado, Mailstop F-480, 13199 E. Montview Blvd., Suite 400, Aurora, CO, 80045, USA. IN - Calcaterra, Susan L. Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA. IN - Calcaterra, Susan L. Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA. IN - Hoppe, Jason A. Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA. IN - Hoppe, Jason A. Rocky Mountain Poison and Drug Center, 777 Bannock Street, Denver, CO, 80204, USA. IN - Binswanger, Ingrid A. Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA. IN - Binswanger, Ingrid A. Institute for Health Research, Kaiser Permanente Colorado, 10065 East Harvard Avenue, Suite 300, Denver, CO, 80231, USA. TI - Naloxone Administration in US Emergency Departments, 2000-2011. CM - Comment in: J Med Toxicol. 2016 Jun;12 (2):145-7; PMID: 27083902 SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 12(2):148-56, 2016 06 AS - J Med Toxicol. 12(2):148-56, 2016 06 NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 12 IP - 2 PG - 148-56 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880605 SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Cross-Sectional Studies MH - Drug Overdose/di [Diagnosis] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/pp [Physiopathology] MH - Emergency Service, Hospital/ma [Manpower] MH - Female MH - Health Care Surveys MH - Health Transition MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/pp [Physiopathology] MH - Practice Patterns, Physicians'/td [Trends] MH - *Practice Patterns, Physicians' MH - Prescription Drug Overuse/ae [Adverse Effects] MH - Prescription Drug Overuse/td [Trends] MH - Respiratory Insufficiency/et [Etiology] MH - *Respiratory Insufficiency/pc [Prevention & Control] MH - United States MH - Young Adult KW - *Drug overdose; *Emergency department; *Naloxone; *Opioid analgesics AB - Rates of opioid overdose and opioid-related emergency department (ED) visits have increased dramatically. Naloxone is an effective antidote to potentially fatal opioid overdose, but little is known about naloxone administration in ED settings. We examined trends and correlates of naloxone administration in ED visits nationally from 2000 to 2011. Using data from the National Hospital Ambulatory Medical Care Survey, we examined ED visits involving (1) the administration of naloxone or (2) a diagnosis of opioid overdose, abuse, or dependence. We assessed patient characteristics in these visits, including concomitant administration of prescription opioid medications. We used logistic regression to identify correlates of naloxone administration. From 2000 to 2011, naloxone was administered in an estimated 1.7 million adult ED visits nationally; 19 % of these visits recorded a diagnosis of opioid overdose, abuse, or dependence. An estimated 2.9 million adult ED visits were related to opioid overdose, abuse, or dependence; 11 % of these visits involved naloxone administration. In multivariable logistic regression models, patient age, race, and insurance and non-rural facility location were independently associated with naloxone administration. An opioid medication was provided in 14 % of visits involving naloxone administration. Naloxone was administered in a minority of ED visits related to opioid overdose, abuse, or dependence. Among all ED visits involving naloxone administration, prescription opioids were also provided in one in seven visits. Further work should explore the provider decision-making in the management of opioid overdose in ED settings and examine patient outcomes following these visits. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-015-0525-5 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - 10.1007/s13181-015-0525-5 [doi] ID - 10.1007/s13181-015-0525-5 [pii] ID - PMC4880605 [pmc] PP - ppublish GI - No: R34 DA035952 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2016 06 EZ - 2015/12/02 06:00 DA - 2017/11/29 06:00 DT - 2015/12/02 06:00 YR - 2016 ED - 20171122 RD - 20171205 UP - 20171206 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=26621354 <60. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28832871 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gostin LO AU - Hodge JG Jr AU - Noe SA FA - Gostin, Lawrence O FA - Hodge, James G Jr FA - Noe, Sarah A IN - Gostin, Lawrence O. O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. IN - Hodge, James G Jr. Center for Public Health Law and Policy, Sandra Day O'Connor College of Law, Arizona State University, Phoenix. IN - Noe, Sarah A. University of Pennsylvania Law School, Philadelphia. TI - Reframing the Opioid Epidemic as a National Emergency. SO - JAMA. 318(16):1539-1540, 2017 Oct 24 AS - JAMA. 318(16):1539-1540, 2017 Oct 24 NJ - JAMA VO - 318 IP - 16 PG - 1539-1540 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid MH - Emergencies MH - *Epidemics MH - Humans MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Public Health MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2017.13358 PT - Journal Article ID - 2652445 [pii] ID - 10.1001/jama.2017.13358 [doi] PP - ppublish LG - English DP - 2017 Oct 24 EZ - 2017/08/24 06:00 DA - 2017/11/29 06:00 DT - 2017/08/24 06:00 YR - 2017 ED - 20171120 RD - 20171128 UP - 20171129 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28832871 <61. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28168588 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lorenzati B AU - Allione A AU - Pizzolato E AU - Dutto L AU - Lauria G FA - Lorenzati, Bartolomeo FA - Allione, Attilio FA - Pizzolato, Elisa FA - Dutto, Luca FA - Lauria, Giuseppe IN - Lorenzati, Bartolomeo. Emergency Medicine, Emergency Department, A.O.S. Croce e Carle, Via Coppino 26, 12100, Cuneo, Italy. lorebato@gmail.com. IN - Allione, Attilio. Emergency Medicine, Emergency Department, A.O.S. Croce e Carle, Via Coppino 26, 12100, Cuneo, Italy. IN - Pizzolato, Elisa. Emergency Medicine, Emergency Department, A.O.S. Croce e Carle, Via Coppino 26, 12100, Cuneo, Italy. IN - Dutto, Luca. Emergency Medicine, Emergency Department, A.O.S. Croce e Carle, Via Coppino 26, 12100, Cuneo, Italy. IN - Lauria, Giuseppe. Emergency Medicine, Emergency Department, A.O.S. Croce e Carle, Via Coppino 26, 12100, Cuneo, Italy. TI - We have to "think" before prescribing an opioid in Italian Emergency Department?. CM - Comment on: Intern Emerg Med. 2016 Dec;11(8):1121-1124; PMID: 27424280 SO - Internal & Emergency Medicine. 12(3):415-416, 2017 04 AS - Intern. emerg. medicine. 12(3):415-416, 2017 04 NJ - Internal and emergency medicine VO - 12 IP - 3 PG - 415-416 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101263418 IO - Intern Emerg Med SB - Index Medicus CP - Italy MH - *Analgesics, Opioid MH - *Emergency Service, Hospital MH - Humans MH - Practice Patterns, Physicians' RN - 0 (Analgesics, Opioid) ES - 1970-9366 IL - 1828-0447 DO - https://dx.doi.org/10.1007/s11739-017-1621-0 PT - Letter PT - Comment ID - 10.1007/s11739-017-1621-0 [doi] ID - 10.1007/s11739-017-1621-0 [pii] PP - ppublish PH - 2016/12/05 [received] PH - 2017/01/25 [accepted] LG - English EP - 20170206 DP - 2017 04 EZ - 2017/02/09 06:00 DA - 2017/11/29 06:00 DT - 2017/02/08 06:00 YR - 2017 ED - 20171120 RD - 20171128 UP - 20171129 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28168588 <62. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28807927 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McCarthy M FA - McCarthy, Michael IN - McCarthy, Michael. Seattle. TI - US declares opioid epidemic a "national emergency". SO - BMJ. 358:j3881, 2017 08 14 AS - BMJ. 358:j3881, 2017 08 14 NJ - BMJ (Clinical research ed.) VO - 358 PG - j3881 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 8900488, bmj, 101090866 IO - BMJ SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Drug Overdose/mo [Mortality] MH - Emergencies/ep [Epidemiology] MH - *Emergencies MH - Humans MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/mo [Mortality] MH - United States/ep [Epidemiology] ES - 1756-1833 IL - 0959-535X DO - https://dx.doi.org/10.1136/bmj.j3881 PT - News PP - epublish LG - English EP - 20170814 DP - 2017 08 14 EZ - 2017/08/16 06:00 DA - 2017/11/29 06:00 DT - 2017/08/16 06:00 YR - 2017 ED - 20171117 RD - 20171128 UP - 20171129 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28807927 <63. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28111065 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Osborn SR AU - Yu J AU - Williams B AU - Vasilyadis M AU - Blackmore CC FA - Osborn, Scott R FA - Yu, Julianna FA - Williams, Barbara FA - Vasilyadis, Maria FA - Blackmore, C Craig IN - Osborn, Scott R. Virginia Mason Medical Center, Seattle, Washington. IN - Yu, Julianna. Virginia Mason Medical Center, Seattle, Washington. IN - Williams, Barbara. Virginia Mason Medical Center, Seattle, Washington. IN - Vasilyadis, Maria. Virginia Mason Medical Center, Seattle, Washington. IN - Blackmore, C Craig. Virginia Mason Medical Center, Seattle, Washington. TI - Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy. SO - Journal of Emergency Medicine. 52(4):538-546, 2017 Apr AS - J Emerg Med. 52(4):538-546, 2017 Apr NJ - The Journal of emergency medicine VO - 52 IP - 4 PG - 538-546 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Codeine/tu [Therapeutic Use] MH - Drug Prescriptions/st [Standards] MH - Drug Prescriptions/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital/og [Organization & Administration] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Hydrocodone/tu [Therapeutic Use] MH - Hydromorphone/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - *Organizational Policy MH - Practice Patterns, Physicians'/st [Standards] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Quality Improvement MH - United States KW - chronic pain; narcotic; opioid; overdose; prescription policy AB - BACKGROUND: Prescription opioid-associated abuse and overdose is a significant cause of morbidity and mortality in the United States. Opioid prescriptions generated from emergency departments (EDs) nationwide have increased dramatically over the past 20 years, and opioid-related overdose deaths have become an epidemic, according to the Centers for Disease Control and Prevention. AB - OBJECTIVE: Our aim was to determine the effectiveness of implementing a prescription policy for opioids on overall opioid prescribing patterns in a hospital ED. AB - METHODS: The ED provider group of an academic, non-university-affiliated urban hospital with 23,000 annual patient visits agreed to opioid prescribing guidelines for chronic pain with the goal of limiting prescriptions that may be used for abuse or diversion. These guidelines were instituted in the ED through collaborative staff meetings and educational and training sessions. We used the electronic medical record to analyze the number and type of opioid discharge prescriptions during the study period from 2006-2014, before and after the prescribing guidelines were instituted in the ED. AB - RESULTS: The number of patients discharged with a prescription for opioids decreased 39.6% (25.7% to 15.6%; absolute decrease 10.2%; 95% confidence interval [CI] 9.6-10.7; p < 0.001) after the intervention. The improvements were sustained 2.5 years after the intervention. Decreases were seen in all major opioids (hydrocodone, oxycodone, hydromorphone, and codeine). The number of pills per prescription also decreased 14.8%, from 19.5% to 16.6% (absolute decrease 2.9; 95% CI 2.6-3.1; p < 0.001). AB - CONCLUSIONS: Implementation of an ED prescription opioid policy was associated with a significant reduction in total opioid prescriptions and in the number of pills per prescription. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - Q812464R06 (Hydromorphone) RN - Q830PW7520 (Codeine) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(16)30988-X DO - https://dx.doi.org/10.1016/j.jemermed.2016.07.120 PT - Journal Article ID - S0736-4679(16)30988-X [pii] ID - 10.1016/j.jemermed.2016.07.120 [doi] PP - ppublish PH - 2015/06/12 [received] PH - 2016/01/15 [revised] PH - 2016/07/19 [accepted] LG - English EP - 20170119 DP - 2017 Apr EZ - 2017/01/24 06:00 DA - 2017/11/29 06:00 DT - 2017/01/24 06:00 YR - 2017 ED - 20171116 RD - 20171128 UP - 20171129 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=28111065 <64. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27727038 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chumpitazi CE AU - Rees CA AU - Camp EA AU - Bernhardt MB FA - Chumpitazi, Corrie E FA - Rees, Chris A FA - Camp, Elizabeth A FA - Bernhardt, M Brooke IN - Chumpitazi, Corrie E. Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas. IN - Rees, Chris A. Department of Pediatrics, Baylor College of Medicine, Houston, Texas. IN - Camp, Elizabeth A. Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas. IN - Bernhardt, M Brooke. Department of Pharmacy, Texas Children's Hospital, Houston, Texas. TI - Decreased Opioid Prescribing in a Pediatric Emergency Department After the Rescheduling of Hydrocodone. SO - Journal of Emergency Medicine. 52(4):547-553, 2017 Apr AS - J Emerg Med. 52(4):547-553, 2017 Apr NJ - The Journal of emergency medicine VO - 52 IP - 4 PG - 547-553 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Analgesics, Opioid/pd [Pharmacology] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Cross-Sectional Studies MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital/og [Organization & Administration] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - *Hydrocodone/tu [Therapeutic Use] MH - Male MH - Pain/dt [Drug Therapy] MH - Pediatrics/ma [Manpower] MH - Pediatrics/mt [Methods] MH - Practice Patterns, Physicians'/st [Standards] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] KW - DEA rescheduling; codeine; emergency department; hydrocodone; pediatric AB - BACKGROUND: The Drug Enforcement Administration (DEA) changed hydrocodone-containing products (HCPs) from Schedule III to II status on October 6, 2014, making codeine-containing products (CCPs) the only non-Schedule II oral opioid agents. AB - OBJECTIVES: We sought to describe prescribing patterns of oral opioid agents in the pediatric emergency department before and after the 2014 DEA rescheduling of HCPs. AB - METHODS: We performed a cross-sectional study evaluating prescribing patterns in the pediatric emergency department at an urban, academic, quaternary care children's hospital system for 6 months before and 6 months after the DEA rescheduling of HCPs. Differences in patient demographics, provider type, and diagnoses were assessed during the two time periods using Pearson's chi-squared test. The Breslow-Day statistic was used to assess differences in prescribing patterns by provider type. AB - RESULTS: There were 1256 prescriptions for HCPs and CCPs in our pediatric emergency department during the study period, and only 36 prescriptions for alternate oral opioid medications. Prescriptions of all opioid pain medications decreased by 55% after rescheduling. The odds of prescribing HCPs were reduced by 60% after the DEA rescheduling (odds ratio 0.40 [95% confidence interval {CI} 0.30-0.54]; p < 0.001). There was no difference between monthly ordering frequencies for CCPs before or after the DEA rescheduling (p = 0.75). AB - CONCLUSIONS: The period after rescheduling of HCPs was associated with a lower odds of HCP prescriptions in our emergency department without an increase in the prescription of CCPs. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 6YKS4Y3WQ7 (Hydrocodone) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(16)30685-0 DO - https://dx.doi.org/10.1016/j.jemermed.2016.08.026 PT - Journal Article ID - S0736-4679(16)30685-0 [pii] ID - 10.1016/j.jemermed.2016.08.026 [doi] PP - ppublish PH - 2016/06/20 [received] PH - 2016/08/14 [revised] PH - 2016/08/22 [accepted] LG - English EP - 20161007 DP - 2017 Apr EZ - 2016/10/12 06:00 DA - 2017/11/29 06:00 DT - 2016/10/12 06:00 YR - 2017 ED - 20171116 RD - 20171128 UP - 20171129 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=27727038 <65. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29114833 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chang AK AU - Bijur PE AU - Esses D AU - Barnaby DP AU - Baer J FA - Chang, Andrew K FA - Bijur, Polly E FA - Esses, David FA - Barnaby, Douglas P FA - Baer, Jesse IN - Chang, Andrew K. Department of Emergency Medicine, Albany Medical College, Albany, New York. IN - Bijur, Polly E. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. IN - Esses, David. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. IN - Barnaby, Douglas P. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. IN - Baer, Jesse. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. TI - Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial. CM - Comment in: JAMA. 2017 Nov 7;318(17 ):1655-1656; PMID: 29114813 CM - Comment in: Am J Nurs. 2018 Feb;118(2):69-70; PMID: 29369883 SO - JAMA. 318(17):1661-1667, 2017 11 07 AS - JAMA. 318(17):1661-1667, 2017 11 07 NJ - JAMA VO - 318 IP - 17 PG - 1661-1667 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Acetaminophen/ad [Administration & Dosage] MH - *Acute Pain/dt [Drug Therapy] MH - Administration, Oral MH - Adult MH - *Analgesics, Non-Narcotic/ad [Administration & Dosage] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Codeine/ad [Administration & Dosage] MH - Double-Blind Method MH - Drug Combinations MH - *Emergency Service, Hospital MH - Extremities MH - Female MH - Humans MH - Hydrocodone/ad [Administration & Dosage] MH - Ibuprofen/ad [Administration & Dosage] MH - Male MH - Middle Aged MH - Oxycodone/ad [Administration & Dosage] MH - Pain Measurement MH - Young Adult AB - Importance: The choice of analgesic to treat acute pain in the emergency department (ED) lacks a clear evidence base. The combination of ibuprofen and acetaminophen (paracetamol) may represent a viable nonopioid alternative. AB - Objectives: To compare the efficacy of 4 oral analgesics. AB - Design, Settings, and Participants: Randomized clinical trial conducted at 2 urban EDs in the Bronx, New York, that included 416 patients aged 21 to 64 years with moderate to severe acute extremity pain enrolled from July 2015 to August 2016. AB - Interventions: Participants (104 per each combination analgesic group) received 400 mg of ibuprofen and 1000 mg of acetaminophen; 5 mg of oxycodone and 325 mg of acetaminophen; 5 mg of hydrocodone and 300 mg of acetaminophen; or 30 mg of codeine and 300 mg of acetaminophen. AB - Main Outcomes and Measures: The primary outcome was the between-group difference in decline in pain 2 hours after ingestion. Pain intensity was assessed using an 11-point numerical rating scale (NRS), in which 0 indicates no pain and 10 indicates the worst possible pain. The predefined minimum clinically important difference was 1.3 on the NRS. Analysis of variance was used to test the overall between-group difference at P=.05 and 99.2% CIs adjusted for multiple pairwise comparisons. AB - Results: Of 416 patients randomized, 411 were analyzed (mean [SD] age, 37 [12] years; 199 [48%] women; 247 [60%] Latino). The baseline mean NRS pain score was 8.7 (SD, 1.3). At 2 hours, the mean NRS pain score decreased by 4.3 (95% CI, 3.6 to 4.9) in the ibuprofen and acetaminophen group; by 4.4 (95% CI, 3.7 to 5.0) in the oxycodone and acetaminophen group; by 3.5 (95% CI, 2.9 to 4.2) in the hydrocodone and acetaminophen group; and by 3.9 (95% CI, 3.2 to 4.5) in the codeine and acetaminophen group (P=.053). The largest difference in decline in the NRS pain score from baseline to 2 hours was between the oxycodone and acetaminophen group and the hydrocodone and acetaminophen group (0.9; 99.2% CI, -0.1 to 1.8), which was less than the minimum clinically important difference in NRS pain score of 1.3. Adverse events were not assessed. AB - Conclusions and Relevance: For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics. Further research to assess adverse events and other dosing may be warranted. AB - Trial Registration: clinicaltrials.gov Identifier: NCT02455518. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 362O9ITL9D (Acetaminophen) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - CD35PMG570 (Oxycodone) RN - Q830PW7520 (Codeine) RN - WK2XYI10QM (Ibuprofen) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2017.16190 PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial ID - 2661581 [pii] ID - 10.1001/jama.2017.16190 [doi] ID - PMC5818795 [pmc] PP - ppublish SI - ClinicalTrials.gov SA - ClinicalTrials.gov/NCT02455518 SA - ClinicalTrials.gov/NCT02455518 SL - https://clinicaltrials.gov/search/term=NCT02455518 SL - https://clinicaltrials.gov/search/term=NCT02455518 GI - No: K23 AG033100 Organization: (AG) *NIA NIH HHS* Country: United States LG - English DP - 2017 11 07 PQ - 2018/05/07 EZ - 2017/11/09 06:00 DA - 2017/11/29 06:00 DT - 2017/11/09 06:00 YR - 2017 ED - 20171116 RD - 20180228 UP - 20180228 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=29114833 <66. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27206486 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Deonarine A AU - Amlani A AU - Ambrose G AU - Buxton JA FA - Deonarine, Andrew FA - Amlani, Ashraf FA - Ambrose, Graham FA - Buxton, Jane A IN - Deonarine, Andrew. School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. IN - Amlani, Ashraf. School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. IN - Ambrose, Graham. School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. IN - Ambrose, Graham. BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. IN - Buxton, Jane A. School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. jane.buxton@bccdc.ca. IN - Buxton, Jane A. BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. jane.buxton@bccdc.ca. TI - Qualitative assessment of take-home naloxone program participant and law enforcement interactions in British Columbia. SO - Harm Reduction Journal. 13(1):17, 2016 05 21 AS - Harm Reduct J. 13(1):17, 2016 05 21 NJ - Harm reduction journal VO - 13 IP - 1 PG - 17 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101153624 IO - Harm Reduct J SB - Index Medicus CP - England MH - Attitude to Health MH - British Columbia MH - Crime/sn [Statistics & Numerical Data] MH - Female MH - Home Care Services/lj [Legislation & Jurisprudence] MH - Home Care Services/sn [Statistics & Numerical Data] MH - Humans MH - *Law Enforcement MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Opiate Substitution Treatment/sn [Statistics & Numerical Data] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Police KW - *British Columbia; *Canada; *Law enforcement; *Naloxone; *Take-home naloxone AB - BACKGROUND: The British Columbia take-home naloxone (BCTHN) program has been in operation since 2012 and has resulted in the successful reversal of over 581 opioid overdoses. The study aims to explore BCTHN program participant perspectives about the program, barriers to participants contacting emergency services (calling "911") during an overdose, and perspectives of law enforcement officials on naloxone administration by police officers. AB - METHODS: Two focus groups and four individual interviews were conducted with BCTHN program participants; interviews with two law enforcement officials were also conducted. Qualitative analysis of all transcripts was performed. AB - RESULTS: Positive themes about the BCTHN program from participants included easy to understand training, correcting misperceptions in the community, and positive interactions with emergency services. Potential barriers to contacting emergency services during an overdose include concerns about being arrested for outstanding warrants or for other illegal activities (such as drug possession) and confiscation of kits. Law enforcement officials noted that warrants were complex situational issues, kits would normally not be confiscated, and admitted arrests for drug possession or other activities may not serve the public good in an overdose situation. Law enforcement officials were concerned about legal liability and jurisdictional/authorization issues if naloxone administration privileges were expanded to police. AB - CONCLUSIONS: Program participants and law enforcement officials expressed differing perspectives about warrants, kit confiscation, and arrests. Facilitating communication between BCTHN program participants and other stakeholders may address some of the confusion and remove potential barriers to further improving program outcomes. Naloxone administration by law enforcement would require policies to address jurisdiction/authorization and liability issues. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1477-7517 IL - 1477-7517 DO - https://dx.doi.org/10.1186/s12954-016-0106-1 PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't ID - 10.1186/s12954-016-0106-1 [doi] ID - 10.1186/s12954-016-0106-1 [pii] ID - PMC4875634 [pmc] PP - epublish PH - 2016/02/24 [received] PH - 2016/05/06 [accepted] LG - English EP - 20160521 DP - 2016 05 21 EZ - 2016/05/22 06:00 DA - 2017/11/14 06:00 DT - 2016/05/22 06:00 YR - 2016 ED - 20171113 RD - 20180303 UP - 20180305 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27206486 <67. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 29114813 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kyriacou DN FA - Kyriacou, Demetrios N IN - Kyriacou, Demetrios N. Senior Editor, , Chicago, Illinois. IN - Kyriacou, Demetrios N. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. TI - Opioid vs Nonopioid Acute Pain Management in the Emergency Department. CM - Comment on: JAMA. 2017 Nov 7;318(17 ):1661-1667; PMID: 29114833 SO - JAMA. 318(17):1655-1656, 2017 11 07 AS - JAMA. 318(17):1655-1656, 2017 11 07 NJ - JAMA VO - 318 IP - 17 PG - 1655-1656 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Non-Narcotic MH - *Analgesics, Opioid MH - Emergency Service, Hospital MH - Humans RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2017.16725 PT - Editorial PT - Comment ID - 2661559 [pii] ID - 10.1001/jama.2017.16725 [doi] PP - ppublish LG - English DP - 2017 11 07 EZ - 2017/11/09 06:00 DA - 2017/11/14 06:00 DT - 2017/11/09 06:00 YR - 2017 ED - 20171113 RD - 20171113 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=29114813 <68. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28092325 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Beaudoin FL AU - Gutman R AU - Merchant RC AU - Clark MA AU - Swor RA AU - Jones JS AU - Lee DC AU - Peak DA AU - Domeier RM AU - Rathlev NK AU - McLean SA FA - Beaudoin, Francesca L FA - Gutman, Roee FA - Merchant, Roland C FA - Clark, Melissa A FA - Swor, Robert A FA - Jones, Jeffrey S FA - Lee, David C FA - Peak, David A FA - Domeier, Robert M FA - Rathlev, Niels K FA - McLean, Samuel A IN - Beaudoin, Francesca L. aDepartment of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA Departments of bEpidemiology and cBiostatistics, Brown University, Providence, RI, USA dDepartment of Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, USA eDepartment of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA fDepartment of Emergency Medicine, Spectrum Health Butterworth Campus, Grand Rapids, MI, USA gDepartment of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA hDepartment of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA iDepartment of Emergency Medicine, St Joseph Mercy Hospital, Yipsilanti, MI, USA jDepartment of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA Departments of k Emergency Medicine and l Anesthesiology, University of North Carolina, Chapel Hill, NC, USA mTRYUMPH Research Program, University Of North Carolina, Chapel Hill, NC, USA. TI - Persistent pain after motor vehicle collision: comparative effectiveness of opioids vs nonsteroidal antiinflammatory drugs prescribed from the emergency department-a propensity matched analysis. SO - Pain. 158(2):289-295, 2017 Feb AS - Pain. 158(2):289-295, 2017 Feb NJ - Pain VO - 158 IP - 2 PG - 289-295 PI - Journal available in: Print PI - Citation processed from: Internet JC - opf, 7508686 IO - Pain SB - Index Medicus CP - United States MH - *Accidents, Traffic/sn [Statistics & Numerical Data] MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use] MH - Cohort Studies MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Outcome Assessment (Health Care) MH - *Pain/dt [Drug Therapy] MH - *Pain/ep [Epidemiology] MH - Pain Measurement MH - Self Report MH - Young Adult AB - Each year millions of Americans present to the emergency department (ED) for care after a motor vehicle collision (MVC); the majority (>90%) are discharged to home after evaluation. Acute musculoskeletal pain is the norm in this population, and such patients are typically discharged to home with prescriptions for oral opioid analgesics or nonsteroidal antiinflammatory drugs (NSAIDs). The influence of acute pain management on subsequent pain outcomes in this common ED population is unknown. We evaluated the effect of opioid analgesics vs NSAIDs initiated from the ED on the presence of moderate to severe musculoskeletal pain and ongoing opioid use at 6 weeks in a large cohort of adult ED patients presenting to the ED after MVC (n = 948). The effect of opioids vs NSAIDs was evaluated using an innovative quasi-experimental design method using propensity scores to account for covariate imbalances between the 2 treatment groups. No difference in risk for moderate to severe musculoskeletal pain at 6 weeks was observed between those discharged with opioid analgesics vs NSAIDs (risk difference = 7.2% [95% confidence interval: -5.2% to 19.5%]). However, at follow-up participants prescribed opioids were more likely than those prescribed NSAIDs to report use of prescription opioids medications at week 6 (risk difference = 17.5% [95% confidence interval: 5.8%-29.3%]). These results suggest that analgesic choice at ED discharge does not influence the development of persistent moderate to severe musculoskeletal pain 6 weeks after an MVC, but may result in continued use of prescription opioids. Supported by NIAMS R01AR056328 and AHRQ 5K12HS022998. CI - The authors have no conflicts of interest to report. RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) ES - 1872-6623 IL - 0304-3959 DO - https://dx.doi.org/10.1097/j.pain.0000000000000756 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial ID - 10.1097/j.pain.0000000000000756 [doi] ID - 00006396-201702000-00013 [pii] ID - PMC5242416 [pmc] ID - NIHMS827247 [mid] PP - ppublish GI - No: K12 HS022998 Organization: (HS) *AHRQ HHS* Country: United States GI - No: R01 AR056328 Organization: (AR) *NIAMS NIH HHS* Country: United States GI - No: R01 AR060852 Organization: (AR) *NIAMS NIH HHS* Country: United States GI - No: UL1 TR001111 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English DP - 2017 Feb EZ - 2017/01/17 06:00 DA - 2017/11/09 06:00 DT - 2017/01/17 06:00 YR - 2017 ED - 20171108 RD - 20180201 UP - 20180201 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=28092325 <69. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27398815 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tadros A AU - Layman SM AU - Davis SM AU - Bozeman R AU - Davidov DM FA - Tadros, Allison FA - Layman, Shelley M FA - Davis, Stephen M FA - Bozeman, Rachel FA - Davidov, Danielle M IN - Tadros, Allison. a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA. IN - Layman, Shelley M. a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA. IN - Davis, Stephen M. a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA. IN - Bozeman, Rachel. a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA. IN - Davidov, Danielle M. a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA. TI - Emergency department visits by pediatric patients for poisoning by prescription opioids. SO - American Journal of Drug & Alcohol Abuse. 42(5):550-555, 2016 09 AS - Am J Drug Alcohol Abuse. 42(5):550-555, 2016 09 NJ - The American journal of drug and alcohol abuse VO - 42 IP - 5 PG - 550-555 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 3gw, 7502510 IO - Am J Drug Alcohol Abuse SB - Index Medicus CP - England MH - Adolescent MH - Analgesics, Opioid/ec [Economics] MH - *Analgesics, Opioid/po [Poisoning] MH - Child MH - Child, Preschool MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Health Care Costs/sn [Statistics & Numerical Data] MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Prescription Drugs/ec [Economics] MH - *Prescription Drugs/po [Poisoning] MH - Retrospective Studies MH - United States KW - *Emergency visits; *adolescent prescription opioids; *pediatrics; *poisonings AB - BACKGROUND: Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied. AB - OBJECTIVES: We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients. AB - METHODS: This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012. AB - RESULTS: There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0-5 years) were unintentional, while the majority of visits in the adolescent age group (15-17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges. AB - CONCLUSION: Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts. CI - of Interest: The authors are not aware of any personal or financial conflicts of interest that are associated with this study. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1097-9891 IL - 0095-2990 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - PMC5055434 [pmc] ID - 10.1080/00952990.2016.1194851 [doi] ID - NIHMS804447 [mid] PP - ppublish GI - No: U54 GM104942 Organization: (GM) *NIGMS NIH HHS* Country: United States LG - English EP - 20160711 DP - 2016 09 EZ - 2016/07/12 06:00 DA - 2017/11/07 06:00 DT - 2016/07/12 06:00 YR - 2016 ED - 20171106 RD - 20180327 UP - 20180328 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27398815 <70. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28506507 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Moore PQ AU - Weber J AU - Cina S AU - Aks S FA - Moore, P Quincy FA - Weber, Joseph FA - Cina, Steven FA - Aks, Steven IN - Moore, P Quincy. 1900 W Polk St., 10th Floor, Administration Building, Chicago, IL 60612, USA. Electronic address: moore.quincy@gmail.com. IN - Weber, Joseph. Chicago West EMS System, 1900 W Polk St., 10th Floor, Administration Building, Chicago, IL 60612, USA. Electronic address: jweber@cookcountyhhs.org. IN - Cina, Steven. Cook County Medical Examiner's Office, Chicago, IL, USA. Electronic address: sjcina@gmail.com. IN - Aks, Steven. Toxikon Consortium, 1900 W Polk St., 10th Floor, Administration Building, Chicago, IL 60612, USA. Electronic address: saks@cookcountyhhs.org. TI - Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases. SO - American Journal of Emergency Medicine. 35(11):1706-1708, 2017 Nov AS - Am J Emerg Med. 35(11):1706-1708, 2017 Nov NJ - The American journal of emergency medicine VO - 35 IP - 11 PG - 1706-1708 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Chicago/ep [Epidemiology] MH - Coroners and Medical Examiners MH - Cross-Sectional Studies MH - Databases, Factual MH - *Disease Outbreaks MH - Drug Contamination MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/ep [Epidemiology] MH - Drug Overdose/et [Etiology] MH - Drug Overdose/mo [Mortality] MH - Emergency Medical Services MH - *Fentanyl/po [Poisoning] MH - *Heroin/po [Poisoning] MH - Humans MH - Illinois/ep [Epidemiology] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Poison Control Centers MH - Retrospective Studies KW - EMS; Fentanyl; Heroin; Opioid; Outbreak; Surveillance AB - OBJECTIVE: Describe surveillance data from three existing surveillance systems during an unexpected fentanyl outbreak in a large metropolitan area. AB - METHODS: We performed a retrospective analysis of three data sets: Chicago Fire Department EMS, Cook County Medical Examiner, and Illinois Poison Center. Each included data from January 1, 2015 through December 31, 2015. EMS data included all EMS responses in Chicago, Illinois, for suspected opioid overdose in which naloxone was administered and EMS personnel documented other criteria indicative of opioid overdose. Medical Examiner data included all deaths in Cook County, Illinois, related to heroin, fentanyl or both. Illinois Poison Center data included all calls in Chicago, Illinois, related to fentanyl, heroin, and other prescription opioids. Descriptive statistics using Microsoft Excel were used to analyze the data and create figures. AB - RESULTS: We identified a spike in opioid-related EMS responses during an 11-day period from September 30-October 10, 2015. Medical Examiner data showed an increase in both fentanyl and mixed fentanyl/heroin related deaths during the months of September and October, 2015 (375% and 550% above the median, respectively.) Illinois Poison Center data showed no significant increase in heroin, fentanyl, or other opioid-related calls during September and October 2015. AB - CONCLUSION: Our data suggests that EMS data is an effective real-time surveillance mechanism for changes in the rate of opioid overdoses. Medical Examiner's data was found to be valuable for confirmation of EMS surveillance data and identification of specific intoxicants. Poison Center data did not correlate with EMS or Medical Examiner data. Copyright © 2017 Elsevier Inc. All rights reserved. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) RN - UF599785JZ (Fentanyl) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(17)30367-4 DO - https://dx.doi.org/10.1016/j.ajem.2017.05.003 PT - Journal Article ID - S0735-6757(17)30367-4 [pii] ID - 10.1016/j.ajem.2017.05.003 [doi] PP - ppublish PH - 2017/03/31 [received] PH - 2017/05/08 [accepted] LG - English EP - 20170508 DP - 2017 Nov EZ - 2017/05/17 06:00 DA - 2017/11/07 06:00 DT - 2017/05/17 06:00 YR - 2017 ED - 20171106 RD - 20171106 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28506507 <71. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27727036 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sammon M AU - Dawood A AU - Beaudoin S AU - Harrigan RA FA - Sammon, Maura FA - Dawood, Alveena FA - Beaudoin, Scott FA - Harrigan, Richard A IN - Sammon, Maura. Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania. IN - Dawood, Alveena. Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania. IN - Beaudoin, Scott. Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania. IN - Harrigan, Richard A. Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania. TI - An Unusual Case of Alternating Ventricular Morphology on the 12-Lead Electrocardiogram. SO - Journal of Emergency Medicine. 52(3):348-353, 2017 Mar AS - J Emerg Med. 52(3):348-353, 2017 Mar NJ - The Journal of emergency medicine VO - 52 IP - 3 PG - 348-353 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Electrocardiography/cl [Classification] MH - Emergency Service, Hospital/og [Organization & Administration] MH - *Heart Conduction System/ab [Abnormalities] MH - Heart Conduction System/pp [Physiopathology] MH - Heroin Dependence/co [Complications] MH - Humans MH - Male MH - Naloxone/pd [Pharmacology] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/pd [Pharmacology] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Wolff-Parkinson-White Syndrome/di [Diagnosis] MH - Wolff-Parkinson-White Syndrome/pp [Physiopathology] KW - ECG; Wolff-Parkinson-White; dysrhythmia AB - BACKGROUND: One of the principal tasks of an emergency physician is identifying potentially life-threatening conditions in the undifferentiated patient; cardiac dysrhythmia is an example of such a condition. A systematic approach to a patient with atypical dysrhythmia enables proper identification of such-life threatening conditions. AB - CASE REPORT: We describe a 31-year-old man presenting to the emergency department with an undifferentiated dysrhythmia after naloxone reversal of an opiate overdose. A systematic approach to the electrocardiogram led to the rare diagnosis of Wolff-Parkinson-White (WPW) alternans. We review the differential diagnosis of this dysrhythmia and the initial evaluation of a patient with the WPW pattern present on their electrocardiogram. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be prepared to use a systematic approach to an undifferentiated dysrhythmia to identify potentially life-threatening conditions. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(16)30686-2 DO - https://dx.doi.org/10.1016/j.jemermed.2016.08.027 PT - Case Reports PT - Journal Article ID - S0736-4679(16)30686-2 [pii] ID - 10.1016/j.jemermed.2016.08.027 [doi] PP - ppublish PH - 2016/08/18 [received] PH - 2016/08/22 [accepted] LG - English EP - 20161007 DP - 2017 Mar EZ - 2016/10/12 06:00 DA - 2017/11/03 06:00 DT - 2016/10/12 06:00 YR - 2017 ED - 20171102 RD - 20171102 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27727036 <72. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27219823 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Doyon S AU - Benton C AU - Anderson BA AU - Baier M AU - Haas E AU - Hadley L AU - Maehr J AU - Rebbert-Franklin K AU - Olsen Y AU - Welsh C FA - Doyon, Suzanne FA - Benton, Carleigh FA - Anderson, Bruce A FA - Baier, Michael FA - Haas, Erin FA - Hadley, Lisa FA - Maehr, Jennifer FA - Rebbert-Franklin, Kathleen FA - Olsen, Yngvild FA - Welsh, Christopher IN - Doyon, Suzanne. Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. IN - Benton, Carleigh. University of Maryland School of Medicine, Baltimore, Maryland. IN - Anderson, Bruce A. University of Maryland School of Pharmacy, Baltimore, Maryland. IN - Baier, Michael. Department of Health and Mental Hygiene, Behavioral Health Administration, Baltimore, Maryland. IN - Haas, Erin. Department of Health and Mental Hygiene, Behavioral Health Administration, Baltimore, Maryland. IN - Hadley, Lisa. Department of Health and Mental Hygiene, Behavioral Health Administration, Baltimore, Maryland. IN - Maehr, Jennifer. Maryland Department of Juvenile Services, Baltimore, Maryland. IN - Rebbert-Franklin, Kathleen. Department of Health and Mental Hygiene, Behavioral Health Administration, Baltimore, Maryland. IN - Olsen, Yngvild. Institutes for Behavioral Resources, Baltimore, Maryland. IN - Welsh, Christopher. Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland. TI - Incorporation of poison center services in a state-wide overdose education and naloxone distribution program. SO - American Journal on Addictions. 25(4):301-6, 2016 Jun AS - Am J Addict. 25(4):301-6, 2016 Jun NJ - The American journal on addictions VO - 25 IP - 4 PG - 301-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9208821 IO - Am J Addict SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/po [Poisoning] MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/pc [Prevention & Control] MH - Female MH - Humans MH - Male MH - Maryland MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Poison Control Centers/og [Organization & Administration] MH - Preventive Health Services/mt [Methods] MH - *Preventive Health Services/og [Organization & Administration] MH - Program Evaluation MH - Retrospective Studies MH - Substance Abuse Treatment Centers/mt [Methods] MH - *Substance Abuse Treatment Centers/og [Organization & Administration] MH - Treatment Outcome MH - Young Adult AB - BACKGROUND: To help curb the opioid overdose epidemic, many states are implementing overdose education and naloxone distribution (OEND) programs. Few evaluations of these programs exist. Maryland's OEND program incorporated the services of the poison center. It asked bystanders to call the poison center within 2 hours of administration of naloxone. Bystanders included law enforcement (LE). AB - OBJECTIVE: Description of the initial experience with this unique OEND program component. AB - METHODS: Retrospective case series of all cases of bystander-administered naloxone reported to the Maryland Poison Center over 16 months. Cases were followed to final outcome, for example, hospital discharge or death. Indications for naloxone included suspected opioid exposure and unresponsiveness, respiratory depression, or cyanosis. Naloxone response was defined as person's ability to breathe, talk, or walk within minutes of administration. AB - RESULTS: Seventy-eight cases of bystander-administered naloxone were reported. Positive response to naloxone was observed in 75.6% of overall cases. Response rates were 86.1% and 70.9% for suspected exposures to heroin and prescription opioids, respectively. Two individuals failed to respond to naloxone and died. AB - DISCUSSION: Naloxone response rates were higher and admission to the intensive care unit rates were lower in heroin overdoses than prescription opioid overdoses. AB - CONCLUSIONS: This retrospective case series of 78 cases of bystander-administered naloxone reports a 75.6% overall rate of reversal. AB - SCIENTIFIC SIGNIFICANCE: The findings of this study may be more generalizable. Incorporation of poison center services facilitated the capture of more timely data not usually available to OEND programs. (Am J Addict 2016;25:301-306). Copyright © 2016 American Academy of Addiction Psychiatry. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1521-0391 IL - 1055-0496 DO - https://dx.doi.org/10.1111/ajad.12384 PT - Evaluation Studies PT - Journal Article ID - 10.1111/ajad.12384 [doi] PP - ppublish PH - 2016/01/21 [received] PH - 2016/05/07 [revised] PH - 2016/05/07 [accepted] LG - English EP - 20160524 DP - 2016 Jun EZ - 2016/05/25 06:00 DA - 2017/11/03 06:00 DT - 2016/05/25 06:00 YR - 2016 ED - 20171102 RD - 20171102 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27219823 <73. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27769615 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kolinsky D AU - Keim SM AU - Cohn BG AU - Schwarz ES AU - Yealy DM FA - Kolinsky, Daniel FA - Keim, Samuel M FA - Cohn, Brian G FA - Schwarz, Evan S FA - Yealy, Donald M IN - Kolinsky, Daniel. Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri. IN - Keim, Samuel M. Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona. IN - Cohn, Brian G. Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri. IN - Schwarz, Evan S. Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri. IN - Yealy, Donald M. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. TI - Is a Prehospital Treat and Release Protocol for Opioid Overdose Safe?. [Review] SO - Journal of Emergency Medicine. 52(1):52-58, 2017 Jan AS - J Emerg Med. 52(1):52-58, 2017 Jan NJ - The Journal of emergency medicine VO - 52 IP - 1 PG - 52-58 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Analgesics/ae [Adverse Effects] MH - Analgesics/tu [Therapeutic Use] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Analgesics, Opioid/to [Toxicity] MH - *Drug Overdose/th [Therapy] MH - Emergency Service, Hospital/og [Organization & Administration] MH - *Guidelines as Topic/st [Standards] MH - Heroin/ae [Adverse Effects] MH - Heroin/tu [Therapeutic Use] MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - *Patient Safety/st [Standards] KW - emergency medical services; naloxone; opioid overdose; prehospital AB - BACKGROUND: The current standards for domestic emergency medical services suggest that all patients suspected of opioid overdose be transported to the emergency department for evaluation and treatment. This includes patients who improve after naloxone administration in the field because of concerns for rebound toxicity. However, various emergency medical services systems release such patients at the scene after a 15- to 20-min observation period as long as they return to their baseline. AB - OBJECTIVES: We sought to determine if a "treat and release" clinical pathway is safe in prehospital patients with suspected opioid overdose. AB - RESULTS: Five studies were identified and critically appraised. From a pooled total of 3875 patients who refused transport to the emergency department after an opioid overdose, three patient deaths were attributed to rebound toxicity. These results imply that a "treat and release" policy might be safe with rare complications. A close review of these studies reveals several confounding factors that make extrapolation to our population limited. AB - CONCLUSION: The existing literature suggests a "treat and release" policy for suspected prehospital opioid overdose might be safe, but additional research should be conducted in a prospective design. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(16)30777-6 DO - https://dx.doi.org/10.1016/j.jemermed.2016.09.015 PT - Journal Article PT - Review ID - S0736-4679(16)30777-6 [pii] ID - 10.1016/j.jemermed.2016.09.015 [doi] PP - ppublish PH - 2016/09/02 [received] PH - 2016/09/07 [accepted] LG - English EP - 20161018 DP - 2017 Jan EZ - 2016/10/23 06:00 DA - 2017/11/01 06:00 DT - 2016/10/23 06:00 YR - 2017 ED - 20171031 RD - 20171031 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27769615 <74. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27646288 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tao W AU - Zhou W AU - Wang Y AU - Sun T AU - Wang H AU - Zhang Z AU - Jin Y FA - Tao, Wenjuan FA - Zhou, Wenjie FA - Wang, Yuping FA - Sun, Tingting FA - Wang, Haitao FA - Zhang, Zhi FA - Jin, Yan IN - Tao, Wenjuan. Key Laboratory of Brain Function and Disease of Chinese Academy of Science and Collaborative Innovation Center of Chemistry for Life Sciences, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, Anhui 230027, China. IN - Zhou, Wenjie. Key Laboratory of Brain Function and Disease of Chinese Academy of Science and Collaborative Innovation Center of Chemistry for Life Sciences, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, Anhui 230027, China. IN - Wang, Yuping. Key Laboratory of Brain Function and Disease of Chinese Academy of Science and Collaborative Innovation Center of Chemistry for Life Sciences, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, Anhui 230027, China. IN - Sun, Tingting. Key Laboratory of Brain Function and Disease of Chinese Academy of Science and Collaborative Innovation Center of Chemistry for Life Sciences, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, Anhui 230027, China. IN - Wang, Haitao. Key Laboratory of Brain Function and Disease of Chinese Academy of Science and Collaborative Innovation Center of Chemistry for Life Sciences, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, Anhui 230027, China. IN - Zhang, Zhi. Key Laboratory of Brain Function and Disease of Chinese Academy of Science and Collaborative Innovation Center of Chemistry for Life Sciences, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, Anhui 230027, China. Electronic address: zhizhang@ustc.edu.cn. IN - Jin, Yan. Key Laboratory of Brain Function and Disease of Chinese Academy of Science and Collaborative Innovation Center of Chemistry for Life Sciences, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, Anhui 230027, China. Electronic address: jinyan@ustc.edu.cn. TI - Histone deacetylase inhibitor-induced emergence of synaptic delta-opioid receptors and behavioral antinociception in persistent neuropathic pain. SO - Neuroscience. 339:54-63, 2016 Dec 17 AS - Neuroscience. 339:54-63, 2016 Dec 17 NJ - Neuroscience VO - 339 PG - 54-63 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - nzr, 7605074 IO - Neuroscience SB - Index Medicus CP - United States MH - *Analgesics/pd [Pharmacology] MH - Animals MH - Cell Membrane/de [Drug Effects] MH - Cell Membrane/me [Metabolism] MH - *Chronic Pain/dt [Drug Therapy] MH - Chronic Pain/me [Metabolism] MH - Disease Models, Animal MH - Epigenesis, Genetic MH - *Histone Deacetylase Inhibitors/pd [Pharmacology] MH - Histones/me [Metabolism] MH - Hydroxamic Acids/me [Metabolism] MH - Male MH - *Neuralgia/dt [Drug Therapy] MH - Neuralgia/me [Metabolism] MH - Nucleus Raphe Magnus/de [Drug Effects] MH - Nucleus Raphe Magnus/me [Metabolism] MH - Rats, Wistar MH - Receptors, Opioid, delta/ag [Agonists] MH - *Receptors, Opioid, delta/me [Metabolism] MH - Sciatic Nerve/pp [Physiopathology] MH - Synapses/de [Drug Effects] MH - *Synapses/me [Metabolism] MH - Time Factors MH - Tissue Culture Techniques KW - antinociception; histone deacetylase; neuropathic pain; delta-opioid receptors AB - The efficacy of opioids in patients with chronic neuropathic pain remains controversial. Although activation of delta-opioid receptors (DORs) in the brainstem reduces inflammation-induced persistent hyperalgesia, it is not effective under persistent neuropathic pain conditions and these clinical problems remain largely unknown. In this study, by using a chronic constriction injury (CCI) of the sciatic nerve in rats, we found that in the brainstem nucleus raphe magnus (NRM), DORs emerged on the surface membrane of central synaptic terminals on day 3 after CCI surgery and disappeared on day 14. Histone deacetylase (HDAC) inhibitors microinjected into the NRM in vivo increased the level of synaptosomal DOR protein and NRM infusion of DOR agonists producing an antinociceptive effect in a nerve growth factor (NGF) signaling-dependent manner. In vitro, in CCI rat slices incubated with HDAC inhibitors, DOR agonists significantly inhibited EPSCs. This effect was blocked by tyrosine receptor kinase A antagonists. Chromatin immunoprecipitation analysis revealed that NRM infusion of HDAC inhibitors in CCI rats increased the level of histone H4 acetylation at Ngf gene promoter regions. NGF was infused into the NRM or incubated CCI rat slices drove DORs to the surface membrane of synaptic terminals. Taken together, epigenetic upregulation of NGF activity by HDAC inhibitors in the NRM promotes the trafficking of DORs to pain-modulating neuronal synapses under neuropathic pain conditions, leading to delta-opioid analgesia. These findings indicate that therapeutic use of DOR agonists combined with HDAC inhibitors might be effective in chronic neuropathic pain managements. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved. RN - 0 (Analgesics) RN - 0 (Histone Deacetylase Inhibitors) RN - 0 (Histones) RN - 0 (Hydroxamic Acids) RN - 0 (Receptors, Opioid, delta) RN - 3X2S926L3Z (trichostatin A) ES - 1873-7544 IL - 0306-4522 DI - S0306-4522(16)30453-5 DO - https://dx.doi.org/10.1016/j.neuroscience.2016.09.015 PT - Journal Article ID - S0306-4522(16)30453-5 [pii] ID - 10.1016/j.neuroscience.2016.09.015 [doi] PP - ppublish PH - 2016/05/02 [received] PH - 2016/07/31 [revised] PH - 2016/09/09 [accepted] LG - English EP - 20160917 DP - 2016 Dec 17 EZ - 2016/11/05 06:00 DA - 2017/10/31 06:00 DT - 2016/11/05 06:00 YR - 2016 ED - 20171030 RD - 20171030 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27646288 <75. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27562292 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Raffa RB AU - Taylor R Jr AU - Pergolizzi JV Jr AU - Nalamachu S AU - Edwards ES AU - Edwards ET AI - Taylor, Robert Jr; ORCID: https://orcid.org/0000-0001-5971-361X FA - Raffa, Robert B FA - Taylor, Robert Jr FA - Pergolizzi, Joseph V Jr FA - Nalamachu, Srinivas FA - Edwards, Eric S FA - Edwards, Evan T IN - Raffa, Robert B. Temple University School of Pharmacy, Philadelphia, PA, USA. IN - Taylor, Robert Jr. NEMA Research, Bonita Springs, FL, USA. IN - Pergolizzi, Joseph V Jr. NEMA Research, Bonita Springs, FL, USA. IN - Pergolizzi, Joseph V Jr. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. IN - Nalamachu, Srinivas. International Clinical Research Institute, Overland Park, KS, USA. IN - Edwards, Eric S. Kaleo, Inc., Richmond, VA, USA. IN - Edwards, Evan T. Kaleo, Inc., Richmond, VA, USA. Evan.Edwards@kaleopharma.com. TI - Application of human factors engineering (HFE) to the design of a naloxone auto-injector for the treatment of opioid emergencies. SO - Drug Delivery & Translational Research. 7(1):1-10, 2017 02 AS - Drug deliv. transl. res.. 7(1):1-10, 2017 02 NJ - Drug delivery and translational research VO - 7 IP - 1 PG - 1-10 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101540061 IO - Drug Deliv Transl Res SB - Index Medicus CP - United States MH - Analgesics, Opioid/to [Toxicity] MH - *Drug Delivery Systems MH - *Drug Overdose/dt [Drug Therapy] MH - Equipment Design MH - *Ergonomics MH - Humans MH - Injections MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] KW - *Auto-injector; *Human factors engineering; *Naloxone; *Opioid overdose; *Opioid-induced respiratory depression AB - The increased use of opioids for chronic treatment of pain and the resulting epidemic of opioid overdoses have created a major public health challenge. Parenteral naloxone has been used since the 1970's to treat opioid overdose. Recently, a novel naloxone auto-injector device (EVZIO, kaleo, Inc., Richmond, VA) was approved by the Food and Drug Administration. In this article, we review the Human Factors Engineering (HFE) process used in the development and testing of this novel naloxone auto-injector currently used in nonmedical settings for the emergency treatment of known or suspected opioid overdose. HFE methods were employed throughout the product development process for the naloxone auto-injector including formative and summative studies in order to optimize the auto-injector's user interface, mitigate use-related hazards and increase reliability during an opioid emergency use scenario. HFE was also used to optimize the product's design and user interface in order to reduce or prevent user confusion and misuse. The naloxone auto-injector went through a rigorous HFE process that included perceptual, cognitive, and physical action analysis; formative usability evaluations; use error analysis and summative design validation studies. Applying HFE resulted in the development of a product that is safe, fast, easy and predictably reliable to deliver a potentially life-saving dose of naloxone during an opioid overdose emergency. The naloxone auto-injector may be considered as a universal precaution option for at-risk patients prescribed opioids or those who are at increased risk for an opioid overdose emergency. CI - disclosure This paper was prepared by NEMA Research Inc. medical writing staff. NEMA Research Inc. received funding from kaleo, Inc. for the preparation of this manuscript. Dr. Nalamachu and Dr. Pergolizzi are consultants for kaleo Inc. Dr. Raffa is a consultant for NEMA Research. Dr. Taylor is an employee of NEMA Research. Dr. Elzey and Dr. Edwards are employees of kaleo Inc. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 2190-3948 IL - 2190-393X DO - https://dx.doi.org/10.1007/s13346-016-0323-x PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1007/s13346-016-0323-x [doi] ID - 10.1007/s13346-016-0323-x [pii] ID - PMC5222905 [pmc] PP - ppublish LG - English DP - 2017 02 EZ - 2016/08/27 06:00 DA - 2017/10/27 06:00 DT - 2016/08/27 06:00 YR - 2017 ED - 20171026 RD - 20180215 UP - 20180215 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27562292 <76. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26977787 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Alqurshi A AU - Kumar Z AU - McDonald R AU - Strang J AU - Buanz A AU - Ahmed S AU - Allen E AU - Cameron P AU - Rickard JA AU - Sandhu V AU - Holt C AU - Stansfield R AU - Taylor D AU - Forbes B AU - Royall PG FA - Alqurshi, Abdulmalik FA - Kumar, Zahrae FA - McDonald, Rebecca FA - Strang, John FA - Buanz, Asma FA - Ahmed, Shagufta FA - Allen, Elizabeth FA - Cameron, Peter FA - Rickard, James A FA - Sandhu, Verity FA - Holt, Chris FA - Stansfield, Rebecca FA - Taylor, David FA - Forbes, Ben FA - Royall, Paul G IN - Alqurshi, Abdulmalik. Institute of Pharmaceutical Science, King's College London , Franklin-Wilkins Building, 150 Stamford Street, London, U.K. , SE1 9NH. IN - Kumar, Zahrae. Institute of Pharmaceutical Science, King's College London , Franklin-Wilkins Building, 150 Stamford Street, London, U.K. , SE1 9NH. IN - McDonald, Rebecca. Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London (National Addiction Centre) , Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, U.K. , SE5 8BB. IN - Strang, John. Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London (National Addiction Centre) , Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, U.K. , SE5 8BB. IN - Buanz, Asma. UCL School of Pharmacy, University College London , 29-39 Brunswick Square, London, U.K. , WC1N 1AX. IN - Ahmed, Shagufta. Quintiles Ltd, Quintiles Drug Research Unit at Guy's Hospital , 6 Newcomen Street London, U.K. , SE1 1YR. IN - Allen, Elizabeth. Quintiles Ltd, Quintiles Drug Research Unit at Guy's Hospital , 6 Newcomen Street London, U.K. , SE1 1YR. IN - Cameron, Peter. Guy's and St Thomas' NHS Foundation Trust Pharmacy Manufacturing Unit, Guy's Hospital , Great Maze Pond, London, U.K. , SE1 9RT. IN - Rickard, James A. Guy's and St Thomas' NHS Foundation Trust Pharmacy Manufacturing Unit, Guy's Hospital , Great Maze Pond, London, U.K. , SE1 9RT. IN - Sandhu, Verity. Guy's and St Thomas' NHS Foundation Trust Pharmacy Manufacturing Unit, Guy's Hospital , Great Maze Pond, London, U.K. , SE1 9RT. IN - Holt, Chris. Guy's and St Thomas' NHS Foundation Trust Pharmacy Manufacturing Unit, Guy's Hospital , Great Maze Pond, London, U.K. , SE1 9RT. IN - Stansfield, Rebecca. Guy's and St Thomas' NHS Foundation Trust Pharmacy Manufacturing Unit, Guy's Hospital , Great Maze Pond, London, U.K. , SE1 9RT. IN - Taylor, David. Institute of Pharmaceutical Science, King's College London , Franklin-Wilkins Building, 150 Stamford Street, London, U.K. , SE1 9NH. IN - Forbes, Ben. Institute of Pharmaceutical Science, King's College London , Franklin-Wilkins Building, 150 Stamford Street, London, U.K. , SE1 9NH. IN - Royall, Paul G. Institute of Pharmaceutical Science, King's College London , Franklin-Wilkins Building, 150 Stamford Street, London, U.K. , SE1 9NH. TI - Amorphous Formulation and in Vitro Performance Testing of Instantly Disintegrating Buccal Tablets for the Emergency Delivery of Naloxone. SO - Molecular Pharmaceutics. 13(5):1688-98, 2016 05 02 AS - Mol Pharm. 13(5):1688-98, 2016 05 02 NJ - Molecular pharmaceutics VO - 13 IP - 5 PG - 1688-98 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101197791 IO - Mol. Pharm. SB - Index Medicus CP - United States MH - Administration, Oral MH - Calorimetry, Differential Scanning/mt [Methods] MH - Chemistry, Pharmaceutical/mt [Methods] MH - Crystallization/mt [Methods] MH - Excipients/ch [Chemistry] MH - Freeze Drying/mt [Methods] MH - Mannitol/ad [Administration & Dosage] MH - Mannitol/ch [Chemistry] MH - Mouth/me [Metabolism] MH - *Mouth Mucosa/me [Metabolism] MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/ch [Chemistry] MH - Porosity MH - Powders/ad [Administration & Dosage] MH - Powders/ch [Chemistry] MH - Solubility MH - Tablets/ad [Administration & Dosage] MH - *Tablets/ch [Chemistry] MH - Temperature MH - X-Ray Diffraction/mt [Methods] KW - *amorphous; *buccal delivery; *buccal disintegration assay; *freeze-dried; *heroin; *inhibition of crystallization; *instant disintegrating tablets; *naloxone; *opioid overdose AB - The aim of this study was to develop a freeze-dried buccal tablet for the rapid delivery of naloxone in opioid overdose. The tablet composition was optimized to produce an amorphous matrix, which was confirmed by the absence of peaks associated with crystallinity observed by differential scanning calorimetry and powder X-ray diffraction. Tablets with high gelatin content lacked adequate porosity. Mannitol was added to the formulation to bridge and intercalate gelatin's tight polymer aggregates, however sodium bicarbonate was also required to prevent crystallization within the tablets. A linear reduction in mannitol's recrystallization enthalpy was observed with increasing sodium bicarbonate concentration (DELTArecryH = -20.3[NaHCO3] + 220.9; r(2) = 0.9, n = 18). The minimum sodium bicarbonate concentration for full inhibition of mannitol crystallization was 10.9% w/w. Freeze-dried tablets with lower amounts of sodium bicarbonate possessed a crystalline fraction that PXRD identified as mannitol hemihydrate from the unique peak at 9.7degree 2theta. Mannitol's greater affinity for both ions and residual water rather than its affinity for self-association was the mechanism for the inhibition of crystallization observed here. The optimized tablet (composition mannitol 24% w/w (4.26 mg), gelatin 65% w/w (11.7 mg), sodium bicarbonate 11% w/w (1.98 mg), and naloxone 800 mug) formed predominantly amorphous tablets that disintegrated in less than 10 s. Optimized tablets were chemically and physically stable over 9 months storage at 25 degreeC. As speed of drug liberation is the critical performance attribute for a solid dosage form designed to deliver drug in an emergency, a novel imaging based in vitro disintegration assay for buccal tablets was developed. The assay was optimized with regard to conditions in the buccal cavity: i.e., temperature 33-37 degreeC, volume of medium (0.1-0.7 mL), and use of mucin-containing biorelevant medium. The disintegration assay was sensitive to temperature, medium volume, and medium composition; naloxone tablet disintegration was extremely rapid, with full disintegration ranging from 5 to 20 s. In conclusion, rapidly disintegrating tablets have been developed which are suitable for proof-of-concept clinical trial in humans to determine the pharmacokinetics of naloxone delivered via the buccal route. RN - 0 (Excipients) RN - 0 (Powders) RN - 0 (Tablets) RN - 36B82AMQ7N (Naloxone) RN - 3OWL53L36A (Mannitol) ES - 1543-8392 IL - 1543-8384 DO - https://dx.doi.org/10.1021/acs.molpharmaceut.6b00096 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1021/acs.molpharmaceut.6b00096 [doi] PP - ppublish LG - English EP - 20160328 DP - 2016 05 02 EZ - 2016/03/16 06:00 DA - 2017/10/20 06:00 DT - 2016/03/16 06:00 YR - 2016 ED - 20171019 RD - 20171220 UP - 20171220 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=26977787 <77. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27507658 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Levy B AU - Spelke B AU - Paulozzi LJ AU - Bell JM AU - Nolte KB AU - Lathrop S AU - Sugerman DE AU - Landen M FA - Levy, Benjamin FA - Spelke, Bridget FA - Paulozzi, Leonard J FA - Bell, Jeneita M FA - Nolte, Kurt B FA - Lathrop, Sarah FA - Sugerman, David E FA - Landen, Michael IN - Levy, Benjamin. Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway MS-F62, Chamblee, GA 30341, United States. Electronic address: benalevy@hotmail.com. IN - Spelke, Bridget. Women and Infants' Hospital of Rhode Island, Warrren Alpert Medical School at Brown University, United States. Electronic address: mspelke@wihri.org. IN - Paulozzi, Leonard J. Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, 601 Sunland Park Dr. Suite 200, El Paso, TX 79912, United States. Electronic address: lbp4@cdc.gov. IN - Bell, Jeneita M. Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway MS-F62, Chamblee, GA 30341, United States. Electronic address: hqp8@cdc.gov. IN - Nolte, Kurt B. The University of New Mexico, 1101 Camino de Salud NE, Albuquerque, NM 87102, United States. Electronic address: knolte@salud.unm.edu. IN - Lathrop, Sarah. The University of New Mexico, Albuquerque, NM 87131, United States. Electronic address: slathrop@salud.unm.edu. IN - Sugerman, David E. Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30329-4018, United States. Electronic address: ggi4@cdc.gov. IN - Landen, Michael. New Mexico Department of Health, 1190 S. St. Francis Drive, Santa Fe, NM 87505, United States. Electronic address: Michael.Landen@state.nm.us. TI - Recognition and response to opioid overdose deaths-New Mexico, 2012. SO - Drug & Alcohol Dependence. 167:29-35, 2016 10 01 AS - Drug Alcohol Depend. 167:29-35, 2016 10 01 NJ - Drug and alcohol dependence VO - 167 PG - 29-35 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Adult MH - Age Factors MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/ep [Epidemiology] MH - Drug Overdose/et [Etiology] MH - Drug Overdose/pc [Prevention & Control] MH - Emergency Medical Services/mt [Methods] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Health Status MH - *Heroin/po [Poisoning] MH - Humans MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - New Mexico/ep [Epidemiology] KW - *Drug abuse; *Heroin; *Naloxone; *Opioid pain relievers; *Overdose deaths; *Respiratory depression AB - PURPOSE: Drug overdose deaths are epidemic in the U.S. Prescription opioid pain relievers (OPR) and heroin account for the majority of drug overdoses. Preventing death after an opioid overdose by naloxone administration requires the rapid identification of the overdose by witnesses. This study used a state medical examiner database to characterize fatal overdoses, evaluate witness-reported signs of overdose, and identify opportunities for intervention. AB - METHODS: We reviewed all unintentional drug overdose deaths that occurred in New Mexico during 2012. Data were abstracted from medical examiner records at the New Mexico Office of the Medical Investigator. We compared mutually exclusive groups of OPR and heroin-related deaths. AB - RESULTS: Of the 489 overdose deaths reviewed, 49.3% involved OPR, 21.7% involved heroin, 4.7% involved a mixture of OPR and heroin, and 24.3% involved only non-opioid substances. The majority of OPR-related deaths occurred in non-Hispanic whites (57.3%), men (58.5%), persons aged 40-59 years (55.2%), and those with chronic medical conditions (89.2%). Most overdose deaths occurred in the home (68.7%) and in the presence of bystanders (67.7%). OPR and heroin deaths did not differ with respect to paramedic dispatch and CPR delivery, however, heroin overdoses received naloxone twice as often (20.8% heroin vs. 10.0% OPR; p<0.01). AB - CONCLUSION: OPR overdose deaths differed by age, health status, and the presence of bystanders, yet received naloxone less often when compared to heroin overdose deaths. These findings suggest that naloxone education and distribution should be targeted in future prevention efforts. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(16)30208-3 DO - https://dx.doi.org/10.1016/j.drugalcdep.2016.07.011 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. ID - S0376-8716(16)30208-3 [pii] ID - 10.1016/j.drugalcdep.2016.07.011 [doi] PP - ppublish PH - 2016/03/13 [received] PH - 2016/07/13 [revised] PH - 2016/07/14 [accepted] LG - English EP - 20160803 DP - 2016 10 01 EZ - 2016/08/11 06:00 DA - 2017/10/19 06:00 DT - 2016/08/11 06:00 YR - 2016 ED - 20171018 RD - 20180122 UP - 20180122 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27507658 <78. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28366351 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rech MA AU - Barbas B AU - Chaney W AU - Greenhalgh E AU - Turck C FA - Rech, Megan A FA - Barbas, Brian FA - Chaney, Whitney FA - Greenhalgh, Elizabeth FA - Turck, Charles IN - Rech, Megan A. Department of Pharmacy, Loyola University Medical Center, Maywood, IL; Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL. Electronic address: mrech@lumc.edu. IN - Barbas, Brian. Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL. IN - Chaney, Whitney. Department of Pharmacy, Loyola University Medical Center, Maywood, IL. IN - Greenhalgh, Elizabeth. Department of Pharmacy, Loyola University Medical Center, Maywood, IL. IN - Turck, Charles. ScientiaCME, LLC, Highland Park, IL. TI - When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications. [Review] CM - Comment in: Ann Emerg Med. 2017 Aug;70(2):212-214; PMID: 28734466 SO - Annals of Emergency Medicine. 70(2):203-211, 2017 Aug AS - Ann Emerg Med. 70(2):203-211, 2017 Aug NJ - Annals of emergency medicine VO - 70 IP - 2 PG - 203-211 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Administration, Intranasal MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Conscious Sedation/mt [Methods] MH - Dexmedetomidine/ad [Administration & Dosage] MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Service, Hospital MH - Fentanyl/ad [Administration & Dosage] MH - Humans MH - *Hypnotics and Sedatives/ad [Administration & Dosage] MH - Ketamine/ad [Administration & Dosage] MH - Midazolam/ad [Administration & Dosage] MH - Naloxone/ad [Administration & Dosage] MH - Patient Safety MH - Practice Guidelines as Topic MH - Randomized Controlled Trials as Topic MH - Treatment Outcome MH - *Wounds and Injuries/th [Therapy] AB - The intranasal route for medication administration is increasingly popular in the emergency department and out-of-hospital setting because such administration is simple and fast, and can be used for patients without intravenous access and in situations in which obtaining an intravenous line is difficult or time intensive (eg, for patients who are seizing or combative). Several small studies (mostly pediatric) have shown midazolam to be effective for procedural sedation, anxiolysis, and seizures. Intranasal fentanyl demonstrates both safety and efficacy for the management of acute pain. The intranasal route appears to be an effective alternative for naloxone in opioid overdose. The literature is less clear on roles for intranasal ketamine and dexmedetomidine. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 36B82AMQ7N (Naloxone) RN - 67VB76HONO (Dexmedetomidine) RN - 690G0D6V8H (Ketamine) RN - R60L0SM5BC (Midazolam) RN - UF599785JZ (Fentanyl) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(17)30194-4 DO - https://dx.doi.org/10.1016/j.annemergmed.2017.02.015 PT - Journal Article PT - Review ID - S0196-0644(17)30194-4 [pii] ID - 10.1016/j.annemergmed.2017.02.015 [doi] PP - ppublish PH - 2016/12/04 [received] PH - 2017/02/10 [revised] PH - 2017/02/15 [accepted] LG - English EP - 20170330 DP - 2017 Aug EZ - 2017/04/04 06:00 DA - 2017/10/19 06:00 DT - 2017/04/04 06:00 YR - 2017 ED - 20171018 RD - 20171201 UP - 20171201 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=28366351 <79. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28177167 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bowers KJ AU - McAllister KB AU - Ray M AU - Heitz C FA - Bowers, Karen J FA - McAllister, Kelly B FA - Ray, Meredith FA - Heitz, Corey IN - Bowers, Karen J. Virginia Tech Carilion School of Medicine, Roanoke, VA. IN - Bowers, Karen J. Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA. IN - McAllister, Kelly B. Department of Pharmacy, Carilion Clinic, Roanoke, VA. IN - Ray, Meredith. Department of Epidemiology, Biostatistics and Environmental Health, University of Memphis, Memphis, TN. IN - Heitz, Corey. Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA. IN - Heitz, Corey. Department of Emergency Medicine, Carilion Clinic, Roanoke, VA. TI - Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency Department: A Randomized Controlled Trial. SO - Academic Emergency Medicine. 24(6):676-685, 2017 Jun AS - Acad Emerg Med. 24(6):676-685, 2017 Jun NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 24 IP - 6 PG - 676-685 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Dose-Response Relationship, Drug MH - Double-Blind Method MH - Drug Therapy, Combination MH - Emergency Service, Hospital MH - Female MH - Humans MH - *Ketamine/ad [Administration & Dosage] MH - Ketamine/ae [Adverse Effects] MH - Male MH - Middle Aged MH - *Pain Management/mt [Methods] MH - Pain Measurement MH - Patient Satisfaction MH - Time Factors AB - OBJECTIVES: This study had five objectives: 1) to measure and compare total opioid use and number of opioid doses in patients treated with opioids versus ketamine in conjunction with opioids; 2) to measure pain scores up to 2 hours after presentation in the ED patient with pain, comparing standard opioid pain control to ketamine in conjunction with opioids; 3) to compare patient satisfaction with pain control using opioids alone versus ketamine in conjunction with opioids; 4) to monitor and compare side effects in patients treated with opioids versus ketamine in conjunction with opioids; and 5) to identify effect variation between different subgroups of patients, with the purpose of focusing future research. We hypothesized that low-dose ketamine, compared to placebo, as an adjunctive treatment to opioids would result in better pain control over 2 hours and greater patient satisfaction with pain control; further, this protocol will result in a lower opioid dosage over 2 hours. AB - METHODS: This was a randomized, double-blinded, placebo-controlled trial at a single academic emergency department evaluating the use of ketamine versus placebo in conjunction with opioids for moderate to severe pain. Subjects with a continued high level of pain after an initial dose of opioid analgesia were randomized to receive either 0.1 mg/kg ketamine or placebo prior to protocol-based dosing of additional opioid analgesia, if required. Over 120 minutes, subjects were assessed for pain level (0-10), satisfaction with pain control (0-4), side effects, sedation level, and need for additional pain medication. Total opioid dose, including the initial dose, was compared between groups. AB - RESULTS: Sixty-three subjects were randomized to the placebo group and 53 to the ketamine group. No significant differences were found in demographics between the groups. Patients receiving ketamine reported lower pain scores over 120 minutes than patients receiving placebo (p = 0.015). Total opioid dose was lower in the ketamine group (mean +/- SD = 9.95 +/- 4.83 mg) compared to placebo (mean +/- SD = 12.81 +/- 6.81 mg; p = 0.02). Satisfaction did not differ between groups. Fewer patients in the ketamine group required additional opioid doses. More patients reported light-headedness and dizziness in the ketamine group. AB - CONCLUSIONS: Ketamine, as an adjunct to opioid therapy, was more effective at reducing pain over 120 minutes and resulted in a lower total opioid dose as well as fewer repeat doses of analgesia. More side effects were reported in the ketamine group (51% vs. 19%), but the side effect profile appears tolerable. Copyright © 2017 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 690G0D6V8H (Ketamine) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.13172 PT - Journal Article PT - Randomized Controlled Trial ID - 10.1111/acem.13172 [doi] PP - ppublish PH - 2016/10/22 [received] PH - 2016/12/29 [revised] PH - 2017/01/14 [accepted] LG - English EP - 20170322 DP - 2017 Jun EZ - 2017/02/09 06:00 DA - 2017/10/19 06:00 DT - 2017/02/09 06:00 YR - 2017 ED - 20171017 RD - 20171017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28177167 <80. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27624507 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Neven D AU - Paulozzi L AU - Howell D AU - McPherson S AU - Murphy SM AU - Grohs B AU - Marsh L AU - Lederhos C AU - Roll J FA - Neven, Darin FA - Paulozzi, Leonard FA - Howell, Donelle FA - McPherson, Sterling FA - Murphy, Sean M FA - Grohs, Becky FA - Marsh, Linda FA - Lederhos, Crystal FA - Roll, John IN - Neven, Darin. Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington. IN - Paulozzi, Leonard. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia. IN - Howell, Donelle. Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington. IN - McPherson, Sterling. Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington. IN - Murphy, Sean M. Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington; Department of Health Policy and Administration, Washington State University College of Nursing, Spokane, Washington. IN - Grohs, Becky. Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington. IN - Marsh, Linda. Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington. IN - Lederhos, Crystal. Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington. IN - Roll, John. Program of Excellence in Addictions Research, Washington State University College of Nursing, Spokane, Washington. TI - A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits. SO - Journal of Emergency Medicine. 51(5):498-507, 2016 Nov AS - J Emerg Med. 51(5):498-507, 2016 Nov NJ - The Journal of emergency medicine VO - 51 IP - 5 PG - 498-507 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Chi-Square Distribution MH - Continuity of Patient Care/sn [Statistics & Numerical Data] MH - Continuity of Patient Care/td [Trends] MH - *Cooperative Behavior MH - *Drug Overdose/pc [Prevention & Control] MH - Emergency Service, Hospital/og [Organization & Administration] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Male MH - Pain/dt [Drug Therapy] MH - Prescription Drug Misuse/ae [Adverse Effects] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Washington KW - ED care coordination; frequent ED users; opioid prescribing; prescription drug monitoring program; prescription opioid abuse AB - BACKGROUND: Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users. AB - OBJECTIVES: We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients. AB - METHODS: We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual. AB - RESULTS: The intervention arm experienced a 34% decrease (incident rate ratios = 0.66, p < 0.001; 95% confidence interval 0.57-0.78) in ED visits and an 80% decrease (odds ratio = 0.21, p = 0.001) in the odds of receiving an opioid prescription from the ED relative to the control group. Declines of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for morphine milligram equivalents, controlled substance pills, prescriptions, and prescribers, respectively. AB - CONCLUSION: This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(16)30385-7 DO - https://dx.doi.org/10.1016/j.jemermed.2016.06.057 PT - Journal Article PT - Randomized Controlled Trial ID - S0736-4679(16)30385-7 [pii] ID - 10.1016/j.jemermed.2016.06.057 [doi] ID - PMC5568539 [pmc] ID - NIHMS893641 [mid] PP - ppublish PH - 2016/02/11 [received] PH - 2016/06/06 [revised] PH - 2016/06/29 [accepted] GI - No: P30 DA040500 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20160910 DP - 2016 Nov EZ - 2016/10/30 06:00 DA - 2017/10/17 06:00 DT - 2016/09/15 06:00 YR - 2016 ED - 20171016 RD - 20171101 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27624507 <81. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27596964 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sheridan DC AU - Laurie A AU - Hendrickson RG AU - Fu R AU - Kea B AU - Horowitz BZ FA - Sheridan, David C FA - Laurie, Amber FA - Hendrickson, Robert G FA - Fu, Rongwei FA - Kea, Bory FA - Horowitz, B Zane IN - Sheridan, David C. Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon. IN - Laurie, Amber. Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon; School of Public Health, Oregon Health and Science University, Portland, Oregon. IN - Hendrickson, Robert G. Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Oregon Poison Center, Oregon Health and Science University, Portland, Oregon. IN - Fu, Rongwei. Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon; School of Public Health, Oregon Health and Science University, Portland, Oregon. IN - Kea, Bory. Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon. IN - Horowitz, B Zane. Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Oregon Poison Center, Oregon Health and Science University, Portland, Oregon. TI - Association of Overall Opioid Prescriptions on Adolescent Opioid Abuse. SO - Journal of Emergency Medicine. 51(5):485-490, 2016 Nov AS - J Emerg Med. 51(5):485-490, 2016 Nov NJ - The Journal of emergency medicine VO - 51 IP - 5 PG - 485-490 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Analgesics/pd [Pharmacology] MH - Analgesics/tu [Therapeutic Use] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Female MH - Humans MH - Male MH - *Poison Control Centers/sn [Statistics & Numerical Data] MH - Poisson Distribution MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - United States MH - Young Adult KW - adolescent; child; ingestion; medicine; opioid pain AB - BACKGROUND: Opioid abuse is a public health epidemic in the United States. Much literature has focused on the prescribing practices of physicians and opioid misuse by adults. However, there are limited data on the effect of opioid prescriptions on adolescent recreational ingestion of these medications. AB - OBJECTIVES: The objective of this study was to assess for a relationship between opioid prescribing practices across the United States and adolescent opioid ingestion calls to poison centers. AB - METHODS: This was an observational study using the National Poison Data System. The study population consisted of poison center calls regarding adolescents between 2005 and 2010 in the database with a coding of "intentional abuse" and an opioid ingestion. National opioid prescription estimates were generated using nationally representative outpatient and inpatient databases. AB - RESULTS: There were 4186 adolescent opioid ingestion calls during the study period. There was a general increase between 2005 and 2010 in both teen opioid abuse calls (617 in 2005 to 782 in 2010) and national opioid prescriptions (approximately 78 million in 2005 to 108 million in 2010). For each opioid prescription increase per 100 persons per year, the annual teen opioid abuse calls increased by 1.8% (95% confidence interval 0.9-2.8%), equivalent to an absolute increase of about 0.04 to 0.05 calls per 100,000 teens annually. AB - CONCLUSIONS: There appears to be an association between opioid prescriptions nationally and poison center calls for adolescent opioid ingestions. This is particularly important in this patient population because of impulsivity and early exposure to substance abuse. Providers should be aware of the nonmedical use of opioids by adolescents and educate patients accordingly. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(16)30377-8 DO - https://dx.doi.org/10.1016/j.jemermed.2016.06.049 PT - Journal Article PT - Observational Study ID - S0736-4679(16)30377-8 [pii] ID - 10.1016/j.jemermed.2016.06.049 [doi] PP - ppublish PH - 2016/04/28 [received] PH - 2016/06/07 [revised] PH - 2016/06/29 [accepted] LG - English EP - 20160903 DP - 2016 Nov EZ - 2016/10/30 06:00 DA - 2017/10/17 06:00 DT - 2016/09/07 06:00 YR - 2016 ED - 20171016 RD - 20171016 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27596964 <82. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27557947 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Feng J AU - Iser JP AU - Yang W FA - Feng, Jing FA - Iser, Joseph P FA - Yang, Wei IN - Feng, Jing. Southern Nevada Health District, PO Box 3902, Las Vegas, NV, 89032, USA. IN - Iser, Joseph P. Southern Nevada Health District, PO Box 3902, Las Vegas, NV, 89032, USA. IN - Yang, Wei. School of Community Health Sciences/MS274, University of Nevada, Reno, Reno, NV, 89557, USA. weiyang@unr.edu. TI - Medical encounters for opioid-related intoxications in Southern Nevada: sociodemographic and clinical correlates. SO - BMC Health Services Research. 16:438, 2016 Aug 24 AS - BMC Health Serv Res. 16:438, 2016 Aug 24 NJ - BMC health services research VO - 16 PG - 438 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101088677 IO - BMC Health Serv Res PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997771 SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - African Americans/eh [Ethnology] MH - Analgesics, Opioid/po [Poisoning] MH - Benzodiazepines/ae [Adverse Effects] MH - Chronic Disease MH - Comorbidity MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/rh [Rehabilitation] MH - *Emergency Service, Hospital/ut [Utilization] MH - European Continental Ancestry Group/eh [Ethnology] MH - Female MH - Hispanic Americans/sn [Statistics & Numerical Data] MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Nevada/ep [Epidemiology] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Poverty MH - Prevalence MH - Suicide, Attempted/sn [Statistics & Numerical Data] MH - Urban Health MH - Young Adult KW - Comorbidity; Intoxication; Medical encounter; Opioid AB - BACKGROUND: Despite today's heightened concern over opioid overdose, the lack of population-based data examining clinical and contextual factors associated with opioid use represents a knowledge gap with relevance to prevention and treatment interventions. We sought to quantify rates of emergency department (ED) visits and inpatient hospitalizations for harmful opioid effects and their sociodemographic differentials as well as clinical correlates in Southern Nevada, using ED visit and hospital inpatient discharge records from 2011 to 2013. AB - METHODS: Cases were identified by ICD-9-CM diagnosis codes for opioid poisoning and opioid-type drug dependence and abuse as well as poisoning and adverse effect E-codes. Comorbid conditions, including pain-related diagnoses, major chronic diseases, affective disorders, sleep disorders, sexually transmitted infections and viral hepatitis were assessed from all available diagnosis fields. Counts by age-race per zip code were modeled by negative binomial regression. Opioid injuries were further examined as a function both of neighborhood income and individual characteristics, with mixed-effects logistic regression to estimate the likelihood for an adverse outcome. AB - RESULTS: Opioid intoxications and comorbidities were more common in low-income communities. The multivariable-adjusted rate for opioid-related healthcare utilization was 42 % higher in the poorest vs. richest quartile during the study period. The inter-quartile (quartile 1 vs. 4) rate increases for chronic bodily pains (44 %), hypertension (89 %), renal failure/diabetes (2.6 times), chronic lower respiratory disease (2.2 times), and affective disorders (57 %) were statistically significant. Chronic disease comorbidity was greater among non-Hispanic blacks, whereas abuse/dependence related disorders, alcohol or benzodiazepine co-use, chronic bodily pains, and affective disorders were more prevalent among non-Hispanic whites than nonwhites. AB - CONCLUSIONS: There were consistent patterns of disparities in healthcare utilization across sociodemographic groups for opioid-associated disorders. Further initiatives to evaluate the determinants of overdose and abuse and to implement targeted response efforts are needed. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) ES - 1472-6963 IL - 1472-6963 DO - https://dx.doi.org/10.1186/s12913-016-1692-z PT - Journal Article ID - 10.1186/s12913-016-1692-z [doi] ID - 10.1186/s12913-016-1692-z [pii] ID - PMC4997771 [pmc] PP - epublish PH - 2016/03/10 [received] PH - 2016/08/18 [accepted] LG - English EP - 20160824 DP - 2016 Aug 24 EZ - 2016/08/26 06:00 DA - 2017/10/17 06:00 DT - 2016/08/26 06:00 YR - 2016 ED - 20171016 RD - 20171016 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27557947 <83. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27062245 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bohnert AS AU - Bonar EE AU - Cunningham R AU - Greenwald MK AU - Thomas L AU - Chermack S AU - Blow FC AU - Walton M FA - Bohnert, Amy S B FA - Bonar, Erin E FA - Cunningham, Rebecca FA - Greenwald, Mark K FA - Thomas, Laura FA - Chermack, Stephen FA - Blow, Frederic C FA - Walton, Maureen IN - Bohnert, Amy S B. Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA; University of Michigan Injury Center, University of Michigan Medical School, 2800 Plymouth Rd., Bldg. 10, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA. Electronic address: amybohne@med.umich.edu. IN - Bonar, Erin E. Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA. IN - Cunningham, Rebecca. University of Michigan Injury Center, University of Michigan Medical School, 2800 Plymouth Rd., Bldg. 10, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA. IN - Greenwald, Mark K. Department of Psychiatry and Behavioral Neurosciences, and Department of Pharmacy Practice, 3901Chrysler Service Drive, Suite 2A, Wayne State University, Detroit, MI 48201, USA. IN - Thomas, Laura. Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA. IN - Chermack, Stephen. Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA. IN - Blow, Frederic C. Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Bldg. 16, Ann Arbor, MI 48109, USA. IN - Walton, Maureen. Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA; University of Michigan Injury Center, University of Michigan Medical School, 2800 Plymouth Rd., Bldg. 10, Ann Arbor, MI 48109, USA. TI - A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose. SO - Drug & Alcohol Dependence. 163:40-7, 2016 06 01 AS - Drug Alcohol Depend. 163:40-7, 2016 06 01 NJ - Drug and alcohol dependence VO - 163 PG - 40-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Adult MH - Analgesics, Opioid/ae [Adverse Effects] MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/px [Psychology] MH - *Drug Overdose/th [Therapy] MH - *Early Medical Intervention/mt [Methods] MH - *Emergency Service, Hospital MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - *Motivational Interviewing/mt [Methods] MH - Opioid-Related Disorders/di [Diagnosis] MH - Opioid-Related Disorders/px [Psychology] MH - *Opioid-Related Disorders/th [Therapy] MH - Pilot Projects MH - *Prescription Drug Misuse/pc [Prevention & Control] MH - Prescription Drug Misuse/px [Psychology] MH - Risk Factors MH - Risk-Taking MH - Self Report KW - *Behavioral intervention; *Overdose; *Pain; *Prescription opioids AB - BACKGROUND AND AIMS: Prescription opioid overdose is a significant public health problem. Interventions to prevent overdose risk behaviors among high-risk patients are lacking. This study examined the impact of a motivational intervention to reduce opioid misuse and overdose risk behaviors. AB - METHODS: This study was a pilot randomized controlled trial set in a single emergency department (ED) in which, 204 adult, English-speaking patients seeking care who reported prescription opioid misuse during the prior 3 months were recruited. Patients were randomized to either the intervention, a 30-minute motivational interviewing-based session delivered by a therapist plus educational enhanced usual care (EUC), or EUC alone. Participants completed self-reported surveys at baseline and 6 months post-baseline (87% retention rate) to measure the primary outcomes of overdose risk behaviors and the secondary outcome of non-medical opioid use. AB - FINDINGS: Participants in the intervention condition reported significantly lower levels of overdose risk behaviors (incidence rate ratio [IRR]=0.72, 95% CI: 0.59-0.87; 40.5% reduction in mean vs. 14.7%) and lower levels of non-medical opioid use (IRR=0.81, 95% CI: 0.70-0.92; 50.0% reduction in mean vs. 39.5%) at follow-up compared to the EUC condition. AB - CONCLUSIONS: This study represents the first clinical trial of a behavioral intervention to reduce overdose risk. Results indicate that this single motivational enhancement session reduced prescription opioid overdose risk behaviors, including opioid misuse, among adult patients in the ED. Copyright Published by Elsevier Ireland Ltd. RN - 0 (Analgesics, Opioid) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(16)30005-9 DO - https://dx.doi.org/10.1016/j.drugalcdep.2016.03.018 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, P.H.S. ID - S0376-8716(16)30005-9 [pii] ID - 10.1016/j.drugalcdep.2016.03.018 [doi] PP - ppublish PH - 2015/12/17 [received] PH - 2016/03/14 [revised] PH - 2016/03/17 [accepted] SI - ClinicalTrials.gov SA - ClinicalTrials.gov/NCT01894087 SL - https://clinicaltrials.gov/search/term=NCT01894087 LG - English EP - 20160326 DP - 2016 06 01 EZ - 2016/04/12 06:00 DA - 2017/10/12 06:00 DT - 2016/04/11 06:00 YR - 2016 ED - 20171011 RD - 20180122 UP - 20180122 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27062245 <84. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27693070 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Motov S AU - Rosenbaum S AU - Vilke GM AU - Nakajima Y FA - Motov, Sergey FA - Rosenbaum, Steven FA - Vilke, Gary M FA - Nakajima, Yuko IN - Motov, Sergey. Maimonides Medical Center, Brooklyn, New York. IN - Rosenbaum, Steven. American Academy of Emergency Medicine, Milwaukee, Wisconsin. IN - Vilke, Gary M. University of California at San Diego Medical Center, San Diego, California. IN - Nakajima, Yuko. University of California at San Diego Medical Center, San Diego, California. TI - Is There a Role for Intravenous Subdissociative-Dose Ketamine Administered as an Adjunct to Opioids or as a Single Agent for Acute Pain Management in the Emergency Department?. [Review] SO - Journal of Emergency Medicine. 51(6):752-757, 2016 Dec AS - J Emerg Med. 51(6):752-757, 2016 Dec NJ - The Journal of emergency medicine VO - 51 IP - 6 PG - 752-757 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - Administration, Intravenous MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Anesthetics, Dissociative/ad [Administration & Dosage] MH - Anesthetics, Dissociative/tu [Therapeutic Use] MH - Drug Therapy, Combination MH - Emergency Service, Hospital MH - Humans MH - *Ketamine/ad [Administration & Dosage] MH - Ketamine/tu [Therapeutic Use] MH - Pain Management/mt [Methods] MH - Randomized Controlled Trials as Topic KW - analgesia; low-dose ketamine; subdissociative-dose ketamine AB - BACKGROUND: Whether acute or chronic, emergency physicians frequently encounter patients reporting pain. It is the responsibility of the emergency physician to assess and evaluate, and if appropriate, safely and effectively reduce pain. Recently, analgesics other than opioids are being considered in an effort to provide safe alternatives for pain management in the emergency department (ED). Opioids have significant adverse effects such as respiratory depression, hypotension, and sedation, to say nothing of their potential for abuse. Although ketamine has long been used in the ED for procedural sedation and rapid sequence intubation, it is used infrequently for analgesia. Recent evidence suggests that ketamine use in subdissociative doses proves to be effective for pain control and serves as a feasible alternative to traditional opioids. This paper evaluates ketamine's analgesic effectiveness and safety in the ED. AB - METHODS: This is a literature review of randomized controlled trials, systematic reviews, meta-analyses, and observational studies evaluating ketamine for pain control in the ED setting. Based on these search parameters, eight studies were included in the final analysis and graded based on the American Academy of Emergency Medicine Clinical Practice Committee manuscript review process. AB - RESULTS: A total of eight papers were reviewed in detail and graded. Recommendations were given based upon this review process. AB - CONCLUSIONS: Subdissociative-dose ketamine (low-dose ketamine) is effective and safe to use alone or in combination with opioid analgesics for the treatment of acute pain in the ED. Its use is associated with higher rates of minor, but well-tolerated adverse side effects. Copyright A© 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Dissociative) RN - 690G0D6V8H (Ketamine) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(16)30538-8 DO - https://dx.doi.org/10.1016/j.jemermed.2016.07.087 PT - Journal Article PT - Review ID - S0736-4679(16)30538-8 [pii] ID - 10.1016/j.jemermed.2016.07.087 [doi] PP - ppublish PH - 2016/05/20 [received] PH - 2016/07/19 [accepted] LG - English EP - 20160929 DP - 2016 Dec EZ - 2016/10/04 06:00 DA - 2017/10/11 06:00 DT - 2016/10/04 06:00 YR - 2016 ED - 20171010 RD - 20171010 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27693070 <85. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28000295 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Secora A AU - Trinidad JP AU - Zhang R AU - Gill R AU - Dal Pan G FA - Secora, Alex FA - Trinidad, James Phillip FA - Zhang, Rongmei FA - Gill, Rajdeep FA - Dal Pan, Gerald IN - Secora, Alex. Office of Surveillance and Epidemiology, Division of Epidemiology, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), USA. IN - Trinidad, James Phillip. Office of Surveillance and Epidemiology, Division of Epidemiology, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), USA. IN - Zhang, Rongmei. Office of Biostatistics, Division of Biometrics VII, CDER, FDA, USA. IN - Gill, Rajdeep. Office of Surveillance and Epidemiology, Division of Epidemiology, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), USA. IN - Dal Pan, Gerald. Office of Surveillance and Epidemiology, Division of Epidemiology, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), USA. TI - Drug availability adjustments in population-based studies of prescription opioid abuse. SO - Pharmacoepidemiology & Drug Safety. 26(2):180-191, 2017 Feb AS - Pharmacoepidemiol Drug Saf. 26(2):180-191, 2017 Feb NJ - Pharmacoepidemiology and drug safety VO - 26 IP - 2 PG - 180-191 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - d0r, 9208369 IO - Pharmacoepidemiol Drug Saf SB - Index Medicus CP - England MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Drug Utilization/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Humans MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Population Surveillance MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Regression Analysis KW - denominators; drug abuse; drug utilization; epidemiologic study; opioid; pharmacoepidemiology AB - PURPOSE: Population-based prescription opioid abuse studies in which one drug is compared to another, or drugs are compared across time, often account for the availability of those drugs in the community. The objective of this investigation is to assess consistency in the relative abuse ratios (RARs) across different approaches for adjusting for drug availability. AB - METHODS: For the years 2004 through 2010, RARs for each of four prescription opioids (hydrocodone, oxycodone, hydromorphone, and morphine) were calculated using negative binomial regression. Measures of abuse (outcome) were misuse/abuse-related emergency department visits obtained from the Drug Abuse Warning Network. Measures of drug availability (offsets) were drug utilization estimates obtained from IMS Health. Separate regression models were run using each of five measures of drug utilization: unique patients (URDD), prescriptions dispensed (RX), tablets dispensed (TD), kilograms (KGs) sold, and morphine-equivalents (MEs) of kilograms sold. These results were compared for consistency. AB - RESULTS: Aside from oxycodone-combination products, across molecules, RARs adjusted by RXs, TDs, and URDDs were generally similar to each other while RARs adjusted by KGs and MEs were different. For example, compared to hydrocodone, oxycodone had statistically significantly increased RARs of 3.6 (95%CI: 2.0-6.5), 3.5 (95%CI: 1.9-6.4), and 2.7 (95%CI: 1.5-5.0) when adjusted by URDDs, RXs, and TDs, respectively, but not when adjusted by KGs or MEs. AB - CONCLUSIONS: Different drug utilization adjustment approaches may yield inconsistent RAR estimates in population-based prescription opioid abuse analyses. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. Copyright Published 2016. This article is a U.S. Government work and is in the public domain in the USA. RN - 0 (Analgesics, Opioid) ES - 1099-1557 IL - 1053-8569 DO - https://dx.doi.org/10.1002/pds.4139 PT - Comparative Study PT - Journal Article ID - 10.1002/pds.4139 [doi] PP - ppublish PH - 2015/06/16 [received] PH - 2016/10/26 [revised] PH - 2016/10/31 [accepted] LG - English EP - 20161221 DP - 2017 Feb EZ - 2016/12/22 06:00 DA - 2017/10/05 06:00 DT - 2016/12/22 06:00 YR - 2017 ED - 20171004 RD - 20171004 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28000295 <86. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28025373 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mazer-Amirshahi M AU - Mullins PM AU - Sun C AU - Pines JM AU - Nelson LS AU - Perrone J FA - Mazer-Amirshahi, Maryann FA - Mullins, Peter M FA - Sun, Christie FA - Pines, Jesse M FA - Nelson, Lewis S FA - Perrone, Jeanmarie IN - Mazer-Amirshahi, Maryann. *Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC. IN - Mazer-Amirshahi, Maryann. Georgetown University School of Medicine, Washington, DC. IN - Mullins, Peter M. Center for Clinical Practice Innovation, The George Washington University, Washington, DC. IN - Sun, Christie. *Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC. IN - Sun, Christie. Georgetown University School of Medicine, Washington, DC. IN - Pines, Jesse M. Center for Clinical Practice Innovation, The George Washington University, Washington, DC. IN - Pines, Jesse M. Department of Emergency Medicine, The George Washington University, Washington, DC. IN - Nelson, Lewis S. Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York. IN - Nelson, Lewis S. *Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC. IN - Perrone, Jeanmarie. Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. TI - Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in U.S. Emergency Departments. SO - Pain Medicine. 17(12):2389-2396, 2016 Dec AS - PAIN MED. 17(12):2389-2396, 2016 Dec NJ - Pain medicine (Malden, Mass.) VO - 17 IP - 12 PG - 2389-2396 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Health Care Surveys MH - Humans MH - Internship and Residency MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - United States KW - Emergency Department; Opioids; Trainee AB - BACKGROUND: Opioid analgesic use has increased dramatically in emergency departments (EDs), but the relative contribution of physician trainees has not been explored. We assessed trends in opioid utilization focusing on ED encounters where a physician trainee was involved. AB - METHODS: We studied ED visits from the National Hospital Ambulatory Medical Care Survey, 2001-2011. Adult ED visits in which an opioid was administered in the ED or prescribed at discharge were stratified by whether or not there was trainee involvement. Trends in use over time for five common opioids (codeine, hydrocodone, hydromorphone, morphine, oxycodone) were tested using survey-weighted logistic regression. AB - RESULTS: From 2001-02 to 2009-11, the proportion of ED visits where an opioid analgesic was used increased 31.5% from 21.9% (95% CI: 20.3-23.6) of visits to 28.8% (95% CI: 27.5-30.1). Trainee involvement in ED visits was stable, with 9.3% (95% CI: 7.7-11.3) seen by a trainee in 2001-02 vs. 10.2% (95% CI: 8.1-12.7) in 2010-11. Opioid use in visits with trainee involvement did not change significantly over time relative to visits without a trainee (increase of 36.8% compared to 31.2% without trainees, P=0.652). Trends in opioid utilization for trainee visits paralleled non-trainee visits. Hydromorphone had the greatest relative increase in use for all providers. Adjusted for patient- and hospital-level factors, the probability of receiving opioids when a trainee was involved increased to a greater extent than among non-trainee visits (30.9% vs. 24.0%). AB - CONCLUSION: Opioid utilization patterns for visits involving trainees reflect similar trends in attending practice, and highlights the more liberal opioid prescribing climate over time. Copyright © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. RN - 0 (Analgesics, Opioid) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1093/pm/pnw048 PT - Journal Article ID - pnw048 [pii] ID - 10.1093/pm/pnw048 [doi] PP - ppublish LG - English EP - 20160414 DP - 2016 Dec EZ - 2016/12/28 06:00 DA - 2017/10/04 06:00 DT - 2016/12/28 06:00 YR - 2016 ED - 20171003 RD - 20171003 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28025373 <87. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28934186 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Massey J AU - Kilkenny M AU - Batdorf S AU - Sanders SK AU - Ellison D AU - Halpin J AU - Gladden RM AU - Bixler D AU - Haddy L AU - Gupta R FA - Massey, Joel FA - Kilkenny, Michael FA - Batdorf, Samantha FA - Sanders, Sarah K FA - Ellison, Debra FA - Halpin, John FA - Gladden, R Matthew FA - Bixler, Danae FA - Haddy, Loretta FA - Gupta, Rahul TI - Opioid Overdose Outbreak - West Virginia, August 2016. SO - MMWR - Morbidity & Mortality Weekly Report. 66(37):975-980, 2017 Sep 22 AS - MMWR Morb Mortal Wkly Rep. 66(37):975-980, 2017 Sep 22 NJ - MMWR. Morbidity and mortality weekly report VO - 66 IP - 37 PG - 975-980 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - ne8, 7802429 IO - MMWR Morb. Mortal. Wkly. Rep. SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesics, Opioid/to [Toxicity] MH - Designer Drugs/to [Toxicity] MH - *Disease Outbreaks MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/ep [Epidemiology] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Fentanyl/aa [Analogs & Derivatives] MH - Fentanyl/to [Toxicity] MH - Humans MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - West Virginia/ep [Epidemiology] MH - Young Adult AB - On August 15, 2016, the Mayor's Office of Drug Control Policy in Huntington, West Virginia, notified the Cabell-Huntington Health Department (CHHD) of multiple calls regarding opioid overdose received by the emergency medical system (EMS) during 3 p.m.-8 p.m. that day. A public health investigation and response conducted by the West Virginia Bureau for Public Health (BPH) and CHHD identified 20 opioid overdose cases within a 53-hour period in Cabell County; all cases included emergency department (ED) encounters. EMS personnel, other first responders, and ED providers administered the opioid antidote naloxone to 16 (80%) patients, six of whom were administered multiple doses, suggesting exposure to a highly potent opioid. No patients received referral for recovery support services. In addition to the public health investigation, a public safety investigation was conducted; comprehensive opioid toxicology testing of clinical specimens identified the synthetic opioid fentanyl* and novel fentanyl analogs, including carfentanil,⁺ which had been used by patients who overdosed in Huntington. Results of these two investigations highlight the importance of collaboration between public health and public safety agencies to provide in-depth surveillance data from opioid overdose outbreaks that involve high-potency fentanyl analogs. These data facilitated a public health response through increased awareness of powerful opioid substances requiring multiple naloxone doses for reversal, and improved patient linkage to recovery support services and a harm reduction program from the ED after opioid overdose. RN - 0 (Analgesics, Opioid) RN - 0 (Designer Drugs) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - LA9DTA2L8F (carfentanil) RN - UF599785JZ (Fentanyl) ES - 1545-861X IL - 0149-2195 DO - https://dx.doi.org/10.15585/mmwr.mm6637a3 PT - Journal Article ID - 10.15585/mmwr.mm6637a3 [doi] PP - epublish LG - English EP - 20170922 DP - 2017 Sep 22 EZ - 2017/09/22 06:00 DA - 2017/09/28 06:00 DT - 2017/09/22 06:00 YR - 2017 ED - 20170926 RD - 20170926 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28934186 <88. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28122657 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Maragh-Bass AC AU - Fields JC AU - McWilliams J AU - Knowlton AR FA - Maragh-Bass, Allysha C FA - Fields, Julie C FA - McWilliams, Junette FA - Knowlton, Amy R IN - Maragh-Bass, Allysha C. 1Center for Surgery and Public Health,Brigham and Women's Hospital,Harvard Schools of Medicine and Public Health,Boston,MassachusettsUSA. IN - Fields, Julie C. 2Johns Hopkins Bloomberg School of Public Health,Department of Health,Behavior and Society,Baltimore,MarylandUSA. IN - McWilliams, Junette. 2Johns Hopkins Bloomberg School of Public Health,Department of Health,Behavior and Society,Baltimore,MarylandUSA. IN - Knowlton, Amy R. 2Johns Hopkins Bloomberg School of Public Health,Department of Health,Behavior and Society,Baltimore,MarylandUSA. TI - Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study. SO - Prehospital & Disaster Medicine. 32(2):148-155, 2017 Apr AS - Prehospital Disaster Med. 32(2):148-155, 2017 Apr NJ - Prehospital and disaster medicine VO - 32 IP - 2 PG - 148-155 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bdf, 8918173 IO - Prehosp Disaster Med SB - Health Technology Assessment Journals CP - United States MH - Adult MH - *Drug Overdose/pc [Prevention & Control] MH - *Emergency Medical Technicians MH - Female MH - Humans MH - Interviews as Topic MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Pilot Projects MH - Research Design MH - *Substance Abuse, Intravenous/pc [Prevention & Control] KW - ALS Advanced Life Support; BCFD Baltimore City Fire Department; BLS Basic Life Support; ED emergency department; EMS Emergency Medical Services; JHSPH Johns Hopkins Bloomberg School of Public Health; NAM National Academy of Medicine; Emergency Medical Services; health care utilization; minority health; socio-economic status; substance use; urban health AB - Introduction Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers. Problem Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment. AB - METHODS: Qualitative interviews were conducted with Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers (N=22). Topics included EMS misuse, work demands, and views on participating in the pilot program. Interviews were transcribed and analyzed using grounded theory and constant-comparison. AB - RESULTS: Participants were mostly white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%). Mean age was 37.5 years. Providers described the "frequent flyer problem" (eg, EMS over-use by a few repeat non-emergent cases). Providers expressed disappointment with local health delivery due to resource limitations and being excluded from decision making within their administration, leading to reduced team morale and burnout. Nonetheless, providers acknowledged they are well-positioned to intervene with substance-using patients because they are in direct contact and have built rapport with them. They noted patients might be most receptive to motivational messages immediately after overdose revival, which several called "hitting their bottom." Several stated that involvement with the proposed study would be facilitated by direct incorporation into EMS providers' current workflow. Many recommended that research team members accompany EMS providers while on-call to observe their day-to-day work. Barriers identified by the providers included time constraints to intervene, limited knowledge of substance abuse treatment modalities, and fearing negative repercussions from supervisors and/or patients. Despite reservations, several EMS providers expressed inclination to deliver brief motivational messages to encourage substance-using patients to consider treatment, given adequate training and skill-building. AB - CONCLUSIONS: Emergency Medical Service providers may have many demands, including difficult case time/resource limitations. Even so, participants recognized their unique position as first responders to deliver motivational, harm-reduction messages to substance-using patients during transport. With incentivized training, implementing this program could be life- and cost-saving, improving emergency and behavioral health services. Findings will inform future efforts to connect substance users with drug treatment, potentially reducing EMS over-use in Baltimore. Maragh-Bass AC , Fields JC , McWilliams J , Knowlton AR . Challenges and opportunities to engaging Emergency Medical Service providers in substance use research: a qualitative study. Prehosp Disaster Med. 2017;32(2):148-155. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1945-1938 IL - 1049-023X DO - https://dx.doi.org/10.1017/S1049023X16001424 PT - Journal Article ID - S1049023X16001424 [pii] ID - 10.1017/S1049023X16001424 [doi] PP - ppublish LG - English EP - 20170126 DP - 2017 Apr EZ - 2017/01/27 06:00 DA - 2017/09/26 06:00 DT - 2017/01/27 06:00 YR - 2017 ED - 20170925 RD - 20170925 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28122657 <89. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28268113 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bode AD AU - Singh M AU - Andrews J AU - Kapur GB AU - Baez AA FA - Bode, Alexander Diaz FA - Singh, Mallika FA - Andrews, James FA - Kapur, Girish B FA - Baez, Amado Alejandro IN - Bode, Alexander Diaz. University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, United States. Electronic address: adb127@med.miami.edu. IN - Singh, Mallika. University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, United States. Electronic address: mallika.singh@med.miami.edu. IN - Andrews, James. University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, United States. Electronic address: james.andrews@med.miami.edu. IN - Kapur, Girish B. Jackson Memorial Hospital Department of Emergency Medicine, 1611 NW 12th Ave, Miami, FL 33136, United States. Electronic address: girish.kapur@jhsmiami.org. IN - Baez, Amado Alejandro. Jackson Memorial Hospital Department of Emergency Medicine, 1611 NW 12th Ave, Miami, FL 33136, United States. Electronic address: amado.baez@jhsmiami.org. TI - Fentanyl laced heroin and its contribution to a spike in heroin overdose in Miami-Dade County. SO - American Journal of Emergency Medicine. 35(9):1364-1365, 2017 09 AS - Am J Emerg Med. 35(9):1364-1365, 2017 09 NJ - The American journal of emergency medicine VO - 35 IP - 9 PG - 1364-1365 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Cross-Sectional Studies MH - *Drug Overdose/ep [Epidemiology] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Fentanyl/po [Poisoning] MH - Florida MH - *Heroin/po [Poisoning] MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Retrospective Studies KW - *Fentanyl; *Fentanyl laced heroin; *Heroin overdose; *Opiate use RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) RN - UF599785JZ (Fentanyl) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(17)30158-4 DO - https://dx.doi.org/10.1016/j.ajem.2017.02.043 PT - Letter ID - S0735-6757(17)30158-4 [pii] ID - 10.1016/j.ajem.2017.02.043 [doi] PP - ppublish PH - 2017/02/15 [received] PH - 2017/02/23 [revised] PH - 2017/02/25 [accepted] LG - English EP - 20170228 DP - 2017 09 EZ - 2017/03/08 06:00 DA - 2017/09/21 06:00 DT - 2017/03/08 06:00 YR - 2017 ED - 20170920 RD - 20170920 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28268113 <90. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27424280 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Smulowitz PB AU - Cary C AU - Boyle KL AU - Novack V AU - Jagminas L AI - Smulowitz, Peter B; ORCID: http://orcid.org/0000-0002-4155-6844 FA - Smulowitz, Peter B FA - Cary, Chris FA - Boyle, Katherine L FA - Novack, Victor FA - Jagminas, Liudvikas IN - Smulowitz, Peter B. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. psmulowi@bidmc.harvard.edu. IN - Cary, Chris. Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, MA, USA. IN - Boyle, Katherine L. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. IN - Novack, Victor. Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel. IN - Jagminas, Liudvikas. Department of Emergency Medicine, Beth Israel Deaconess Hospital-Plymouth, Plymouth, MA, USA. TI - Variation in opioid prescribing patterns between ED providers. CM - Comment in: Intern Emerg Med. 2017 Apr;12 (3):415-416; PMID: 28168588 SO - Internal & Emergency Medicine. 11(8):1121-1124, 2016 Dec AS - Intern. emerg. medicine. 11(8):1121-1124, 2016 Dec NJ - Internal and emergency medicine VO - 11 IP - 8 PG - 1121-1124 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101263418 IO - Intern Emerg Med SB - Index Medicus CP - Italy MH - Analgesics/ae [Adverse Effects] MH - Analgesics/tu [Therapeutic Use] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Medicine/ma [Manpower] MH - *Emergency Medicine/mt [Methods] MH - Emergency Service, Hospital/og [Organization & Administration] MH - Humans MH - Pain Management/mt [Methods] MH - Pain Management/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Prescription Drug Misuse/ae [Adverse Effects] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Retrospective Studies KW - Emergency department; Opioids; Variation AB - Abuse of opioid prescription drugs has become an epidemic across the developed world. Despite the fact that emergency physicians overall account for a small proportion of total opioids prescribed, the number of prescriptions has risen dramatically in the past decade and, to some degree, contributes to the available supply of opioids in the community, some of which are diverted for non-medical use. Since successfully reducing opioid prescribing on the individual level first requires knowledge of current prescribing patterns, we sought to determine to what extent variation exists in opioid prescribing patterns at our institution. This was a single-institution observational study at a community hospital with an annual ED volume of 47,000 visits. We determined the number of prescriptions written by each provider, both total number and accounting for the number of patients seen. Our primary outcome measure was the level of variation at the physician level for number of prescriptions written per patient. We also identified the mean number of pills written per prescription. We analyzed data from November 13, 2014 through July 31, 2015 for 21 full-time providers. There were a total of 2211 prescriptions for opioids written over this time period for a total of 17,382 patients seen. On a per-patient basis, the rate of opioid prescriptions written per patient during this period was 127 per 1000 visits (95 % CI 122-132). There was a variation on the individual provider level, with rates ranging from 33 per to 332 per 1000 visits. There was also substantial variation by provider in the number of pills written per prescription with coefficient of variation (standard deviation divided by mean) averaged over different opioids ranging from 16 to 40 %. There was significant variation in opioid prescribing patterns at the individual physician level, even when accounting for the number of patients seen. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) ES - 1970-9366 IL - 1828-0447 PT - Journal Article PT - Observational Study ID - 10.1007/s11739-016-1505-8 [doi] ID - 10.1007/s11739-016-1505-8 [pii] PP - ppublish PH - 2016/04/01 [received] PH - 2016/07/08 [accepted] LG - English EP - 20160716 DP - 2016 Dec EZ - 2016/07/18 06:00 DA - 2017/09/19 06:00 DT - 2016/07/18 06:00 YR - 2016 ED - 20170918 RD - 20171116 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27424280 <91. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27828892 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sullivan D AU - Lyons M AU - Montgomery R AU - Quinlan-Colwell A FA - Sullivan, Denise FA - Lyons, Mary FA - Montgomery, Robert FA - Quinlan-Colwell, Ann IN - Sullivan, Denise. Anesthesiology/Pain Management Service, Jacobi Medical Center, Bronx, New York (Ms Sullivan); Inpatient Pain Management, Northwestern Medicine-Central DuPage Hospital, Winfield, Illinois (Ms Lyons); Anesthesiology, University of Colorado Hospital, Aurora, Colorado (Dr Montgomery); and Clinical Outcomes, New Hanover Regional Medical Center, Wilmington, North Carolina (Dr Quinlan-Colwell). TI - Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective. [Review] SO - Journal of Trauma Nursing. 23(6):361-375, 2016 Nov/Dec AS - J Trauma Nurs. 23(6):361-375, 2016 Nov/Dec NJ - Journal of trauma nursing : the official journal of the Society of Trauma Nurses VO - 23 IP - 6 PG - 361-375 PI - Journal available in: Print PI - Citation processed from: Internet JC - cfl, 9512997 IO - J Trauma Nurs SB - Nursing Journal CP - United States MH - Administration, Oral MH - Analgesia/mt [Methods] MH - *Analgesics/ad [Administration & Dosage] MH - Analgesics/pd [Pharmacology] MH - Anti-Inflammatory Agents, Non-Steroidal/ad [Administration & Dosage] MH - Female MH - Humans MH - Injections, Intravenous MH - Male MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - Pain/pp [Physiopathology] MH - *Pain Management/mt [Methods] MH - Pain Measurement MH - *Trauma Centers/og [Organization & Administration] MH - Treatment Outcome MH - Wounds and Injuries/co [Complications] MH - *Wounds and Injuries/di [Diagnosis] AB - Challenges with opioids (e.g., adverse events, misuse and abuse with long-term administration) have led to a renewed emphasis on opioid-sparing multimodal management of trauma pain. To assess the extent to which currently available evidence supports the efficacy and safety of various nonopioid analgesics and techniques to manage trauma pain, a literature search of recently published references was performed. Additional citations were included on the basis of authors' knowledge of the literature. Effective options for opioid-sparing analgesics include oral and intravenous (IV) acetaminophen; nonsteroidal anti-inflammatory drugs available via multiple routes; and anticonvulsants, which are especially effective for neuropathic pain associated with trauma. Intravenous routes (e.g., IV acetaminophen, IV ketorolac) may be associated with a faster onset of action than oral routes. Additional adjuvants for the treatment of trauma pain are muscle relaxants and alpha-2 adrenergic agonists. Ketamine and regional techniques play an important role in multimodal therapy but require medical and nursing support. Nonpharmacologic treatments (e.g., cryotherapy, distraction techniques, breathing and relaxation, acupuncture) supplement pharmacologic analgesics and can be safe and easy to implement. In conclusion, opioid-sparing multimodal analgesia addresses concerns associated with high doses of opioids, and many pharmacologic and nonpharmacologic options are available to implement this strategy. Nurses play key roles in comprehensive patient assessment; administration of patient-focused, opioid-sparing, multimodal analgesia in trauma; and monitoring for safety concerns. RN - 0 (Analgesics) RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) IS - 1078-7496 IL - 1078-7496 PT - Journal Article PT - Meta-Analysis PT - Review ID - 10.1097/JTN.0000000000000250 [doi] ID - 00043860-201611000-00013 [pii] ID - PMC5123624 [pmc] PP - ppublish LG - English DP - 2016 Nov/Dec EZ - 2016/11/10 06:00 DA - 2017/09/14 06:00 DT - 2016/11/10 06:00 YR - 2016 ED - 20170913 RD - 20170913 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27828892 <92. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28663006 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chacko J AU - Greenstein J AU - Ardolic B AU - Berwald N FA - Chacko, Jerel FA - Greenstein, Josh FA - Ardolic, Brahim FA - Berwald, Nicole IN - Chacko, Jerel. Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States. Electronic address: jchacko3@northwell.edu. IN - Greenstein, Josh. Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States. IN - Ardolic, Brahim. Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States. IN - Berwald, Nicole. Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States. TI - Effect of an emergency department opioid prescription policy on prescribing patterns. SO - American Journal of Emergency Medicine. 35(9):1327-1329, 2017 Sep AS - Am J Emerg Med. 35(9):1327-1329, 2017 Sep NJ - The American journal of emergency medicine VO - 35 IP - 9 PG - 1327-1329 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Controlled Substances MH - *Drug Overdose/ep [Epidemiology] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Drug and Narcotic Control MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - New York MH - Organizational Policy MH - *Practice Patterns, Physicians'/st [Standards] MH - Retrospective Studies AB - BACKGROUND: Staten Island University Hospital is located in NYC, where the opioid epidemic has resulted in significant mortalities from unintentional overdoses. In 2013 as a response to the rising threat to our community, our Emergency Department (ED) administration adopted a clinical practice policy focused on decreasing the prescription of controlled substances. The effects of this policy on our provider prescription patterns are presented here. AB - METHODS: A retrospective chart review of patients prescribed opioids from the ED before and after policy implementation was performed. Dates chosen for analysis was November 1, 2012 through January 31, 2013 and November 1, 2013 through January 31, 2014; these time periods were used to serve as a seasonally comparative group pre and post clinical practice policy implementation. Opioids written for the treatment of cough, and for children under eighteen were excluded from analysis. Patient age, sex, diagnoses, and prescription formulation, strength, and pill number was recorded for each patient receiving an opioid prescription. AB - RESULTS: There was a drop in the total prescriptions from 1756 to 1128 without a change in the average number of pills (12.78 vs 12.44) or average total dose prescribed (69.39 vs 68.98) mg of morphine equivalent per prescription. Additionally, there were sizable reductions in opioid prescriptions written for arthralgias/myalgias, dental pain, soft tissue injuries, and headaches. AB - CONCLUSION: The opioid clinical policy had a clear effect in decreasing the number of patients prescribed opioids. Such policies may be the key to reducing the epidemic and saving lives from unintentional opioid overdoses. Copyright © 2017 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Controlled Substances) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(17)30468-0 DO - https://dx.doi.org/10.1016/j.ajem.2017.06.024 PT - Comparative Study PT - Journal Article ID - S0735-6757(17)30468-0 [pii] ID - 10.1016/j.ajem.2017.06.024 [doi] PP - ppublish PH - 2017/03/05 [received] PH - 2017/06/09 [revised] PH - 2017/06/10 [accepted] LG - English EP - 20170615 DP - 2017 Sep EZ - 2017/07/01 06:00 DA - 2017/09/08 06:00 DT - 2017/07/01 06:00 YR - 2017 ED - 20170907 RD - 20170907 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28663006 <93. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28820565 VI - 1 RO - HSR ST - MEDLINE AU - Anonymous TI - Are Opioid Deaths Affected by Macroeconomic Conditions?. SO - National Bureau of Economic Research Bulletin on Aging & Health. (3):1-2, 2017 AS - Natl Bur Econ Res Bull Aging Health. (3):1-2, 2017 NJ - National Bureau of Economic Research bulletin on aging and health IP - 3 PG - 1-2 PI - Journal available in: Print PI - Citation processed from: Print JC - 101215702 IO - Natl Bur Econ Res Bull Aging Health SB - Health Technology Assessment Journals CP - United States MH - *Drug Overdose/ec [Economics] MH - *Drug Overdose/ep [Epidemiology] MH - *Drug Overdose/mo [Mortality] MH - Economic Recession MH - Emergency Medical Services/ec [Economics] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Emergency Medical Services/ut [Utilization] MH - Humans MH - *Opioid-Related Disorders/ec [Economics] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/mo [Mortality] MH - Socioeconomic Factors MH - *Unemployment/sn [Statistics & Numerical Data] MH - United States PT - Journal Article PP - ppublish LG - English DP - 2017 EZ - 2017/08/19 06:00 DA - 2017/09/07 06:00 DT - 2017/08/19 06:00 YR - 2017 ED - 20170905 RD - 20170906 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28820565 <94. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28141758 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gillon J AU - Muller LS FA - Gillon, Jennifer FA - Muller, Lynn S IN - Gillon, Jennifer. Jennifer Gillon, BSN, RN, has been an emergency department nurse for more than 20 years at Englewood Hospital and Medical Center in Englewood, NJ, where she is a three-time recipient of the Lifesaving Award. Jen who received her nursing education and her bachelor of science and nursing degree from William Paterson University is currently a master's degree candidate in the adult nurse practitioner program at Saint Peters University of Englewood Cliffs, NJ. When Jen is not in the clinical setting, you will find her teaching several indoor cycling classes throughout the week. Jen resides in Northern New Jersey and is the proud mother of two sons. Lynn S. Muller, JD, BA-HCM, RN, CCM, is a nurse attorney, independent case manager, and managing partner of Muller & Muller. She is an adjunct professor in the MSN and DNP programs at Saint Peter's University of New Jersey. Lynn is a registered nurse and certified case manager with extensive nursing and case management experience. Her law practice includes defense of health care professionals before the state licensing boards, consultant on such issues as regulatory compliance and accreditation, civil litigation, Wills, Trusts and Estates, and Family law. Lynn is the author of numerous articles and the legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and the second edition of the CMSA Core Curriculum for Case Management (as well as the third edition, expected to be released in 2016). Lynn is a contributor to the CMSA Career & Knowledge Pathways Project and Standards of Practice. She is as a former commissioner for CCMC, a past president of the NJ Chapter of CMSA. TI - Eradicating the Overuse of Opioids on the Front Line. SO - Professional Case Management. 22(2):81-85, 2017 Mar/Apr AS - Prof Case Manag. 22(2):81-85, 2017 Mar/Apr NJ - Professional case management VO - 22 IP - 2 PG - 81-85 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101291585 IO - Prof Case Manag SB - Nursing Journal CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Case Management MH - *Chronic Pain/dt [Drug Therapy] MH - *Emergency Medical Services/st [Standards] MH - Humans MH - *Opioid-Related Disorders/di [Diagnosis] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/et [Etiology] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - *Practice Guidelines as Topic MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1932-8095 IL - 1932-8087 DO - https://dx.doi.org/10.1097/NCM.0000000000000212 PT - Journal Article ID - 10.1097/NCM.0000000000000212 [doi] ID - 01269241-201703000-00006 [pii] PP - ppublish LG - English DP - 2017 Mar/Apr EZ - 2017/02/01 06:00 DA - 2017/09/07 06:00 DT - 2017/02/01 06:00 YR - 2017 ED - 20170905 RD - 20170906 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28141758 <95. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28292506 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Winstanley EL AU - Mashni R AU - Schnee S AU - Miller N AU - Mashni SM FA - Winstanley, Erin L FA - Mashni, Rebecca FA - Schnee, Sydney FA - Miller, Nate FA - Mashni, Susan M TI - The development and feasibility of a pharmacy-delivered opioid intervention in the emergency department. SO - Journal of the American Pharmacists Association: JAPhA. 57(2S):S87-S91, 2017 Mar - Apr AS - J Am Pharm Assoc (2003). 57(2S):S87-S91, 2017 Mar - Apr NJ - Journal of the American Pharmacists Association : JAPhA VO - 57 IP - 2S PG - S87-S91 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101176252 IO - J Am Pharm Assoc (2003) SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Counseling/mt [Methods] MH - *Drug Overdose/pc [Prevention & Control] MH - Emergency Service, Hospital MH - Feasibility Studies MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Patient Education as Topic/mt [Methods] MH - *Pharmacists/og [Organization & Administration] MH - *Pharmacy Service, Hospital/og [Organization & Administration] MH - Pilot Projects MH - Students, Pharmacy AB - OBJECTIVES: To develop a brief intervention and to assess the feasibility of pharmacy-delivered education on opioid safety and overdose prevention in the emergency department. AB - METHODS: A convenience sample of patients (n = 102) approached between May and June 2016 at a single community-based suburban emergency department located in the Midwest. AB - RESULTS: The intervention included scripted counseling to be delivered in person and 2 educational brochures. The counseling took approximately 5 minutes, and only 2 patients refused the counseling. All the patients were satisfied with the intervention, and 97.4% of them reported that the counseling improved their knowledge of opioid side effects. The majority of patients thought that their own risk of addiction was significantly less than the general public's risk of addiction when taking opioids. AB - CONCLUSION: This study provides preliminary evidence that student pharmacists or pharmacists are able to deliver opioid safety and overdose education in the emergency department. Copyright © 2017. Published by Elsevier Inc. RN - 0 (Analgesics, Opioid) ES - 1544-3450 IL - 1086-5802 DI - S1544-3191(17)30023-7 DO - https://dx.doi.org/10.1016/j.japh.2017.01.021 PT - Journal Article ID - S1544-3191(17)30023-7 [pii] ID - 10.1016/j.japh.2017.01.021 [doi] ID - PMC5527332 [pmc] ID - NIHMS871255 [mid] PP - ppublish PH - 2016/09/01 [received] PH - 2017/01/24 [revised] PH - 2017/01/24 [accepted] GI - No: U54 GM104942 Organization: (GM) *NIGMS NIH HHS* Country: United States LG - English DP - 2017 Mar - Apr EZ - 2017/03/16 06:00 DA - 2017/09/05 06:00 DT - 2017/03/16 06:00 YR - 2017 ED - 20170904 RD - 20180301 UP - 20180301 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=28292506 <96. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28189539 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Penm J AU - MacKinnon NJ AU - Boone JM AU - Ciaccia A AU - McNamee C AU - Winstanley EL FA - Penm, Jonathan FA - MacKinnon, Neil J FA - Boone, Jill M FA - Ciaccia, Antonio FA - McNamee, Cameron FA - Winstanley, Erin L TI - Strategies and policies to address the opioid epidemic: A case study of Ohio. SO - Journal of the American Pharmacists Association: JAPhA. 57(2S):S148-S153, 2017 Mar - Apr AS - J Am Pharm Assoc (2003). 57(2S):S148-S153, 2017 Mar - Apr NJ - Journal of the American Pharmacists Association : JAPhA VO - 57 IP - 2S PG - S148-S153 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101176252 IO - J Am Pharm Assoc (2003) SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - Health Policy MH - Health Services Accessibility MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/sd [Supply & Distribution] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/sd [Supply & Distribution] MH - Ohio/ep [Epidemiology] MH - *Opioid-Related Disorders/co [Complications] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Pharmaceutical Services/og [Organization & Administration] MH - *Pharmacists/og [Organization & Administration] MH - Professional Role MH - Public Health AB - OBJECTIVE: To describe the strategies and policies implemented in Ohio to improve opioid safety and to discuss the role that pharmacists can play in implementing, promoting, and enhancing the effectiveness of these policies. AB - SETTING: Ohio has the fifth highest rate of drug overdose deaths (24.6 deaths per 100,000) in the United States. Unintentional drug overdose has become the leading cause of injury-related death in Ohio. In 2015, there were 3050 overdose deaths in Ohio, and in 2014 there were an estimated 12,847 overdose events reversed by emergency medical services with naloxone. AB - PRACTICE DESCRIPTION: Not applicable. AB - PRACTICE POLICY INNOVATION: In 2011, the Governor's Cabinet Opiate Action Team was created to implement a multifaceted strategy, in part (1) to promote the responsible use of opioids, (2) to reduce the supply of opioids, and (3) to support overdose prevention and expand access to naloxone. Innovations to assist these goals include the development of Ohio guidelines on the responsible use of opioids, mandatory use of Ohio's prescription drug monitoring program, closing pill mills, promotion of drug take-back programs and increased access to naloxone and public health campaigns. AB - EVALUATION: Not applicable. AB - RESULTS: Since the development of the Governor's Cabinet Opiate Action Team, there were 81 million fewer doses of opioids dispensed to Ohio patients in 2015 compared with 782 million doses dispensed in 2011. As such, the proportion of unintentional drug overdose deaths involving prescription opioids has reduced from 45% in 2011 to 22% in 2015. AB - CONCLUSION: Strong political support was crucial in Ohio to facilitate the rapid implementation opioid overdose prevention programs and the promotion of public awareness campaigns. However, the misuse and abuse of prescription opioids are complex problems requiring a comprehensive and multifaceted approach. Pharmacists are identified as a crucial component of the state strategy to addressing opioid abuse by promoting responsible prescribing and adopting prevention practices. Copyright © 2017 American Pharmacists Association. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1544-3450 IL - 1086-5802 DI - S1544-3191(17)30001-8 DO - https://dx.doi.org/10.1016/j.japh.2017.01.001 PT - Journal Article ID - S1544-3191(17)30001-8 [pii] ID - 10.1016/j.japh.2017.01.001 [doi] ID - PMC5497298 [pmc] ID - NIHMS871254 [mid] PP - ppublish PH - 2016/08/21 [received] PH - 2017/01/03 [revised] PH - 2017/01/04 [accepted] GI - No: U54 GM104942 Organization: (GM) *NIGMS NIH HHS* Country: United States LG - English EP - 20170208 DP - 2017 Mar - Apr EZ - 2017/02/13 06:00 DA - 2017/09/05 06:00 DT - 2017/02/13 06:00 YR - 2017 ED - 20170904 RD - 20180301 UP - 20180301 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=28189539 <97. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28292505 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schwartz L AU - Mercurio-Zappala M AU - Howland MA AU - Hoffman RS AU - Su MK FA - Schwartz, Lauren FA - Mercurio-Zappala, Maria FA - Howland, Mary Ann FA - Hoffman, Robert S FA - Su, Mark K TI - Unintentional methadone and buprenorphine exposures in children: Developing prevention messages. SO - Journal of the American Pharmacists Association: JAPhA. 57(2S):S83-S86, 2017 Mar - Apr AS - J Am Pharm Assoc (2003). 57(2S):S83-S86, 2017 Mar - Apr NJ - Journal of the American Pharmacists Association : JAPhA VO - 57 IP - 2S PG - S83-S86 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101176252 IO - J Am Pharm Assoc (2003) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Buprenorphine/po [Poisoning] MH - Child, Preschool MH - Female MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - *Methadone/po [Poisoning] MH - *Naloxone/ad [Administration & Dosage] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Poison Control Centers MH - Retrospective Studies AB - OBJECTIVES: To develop key messages for methadone and buprenorphine safety education material based on an analysis of calls to the NYC Poison Control Center (NYC PCC) and designed for distribution to caregivers of young children. AB - METHODS: Retrospective review of all calls for children 5 years of age and younger involving methadone or buprenorphine from January 1, 2000, to June 15, 2014. A data abstraction form was completed for each case to capture patient demographics, exposure and caller sites, caller relation to patient, qualitative information regarding the exposure scenario, the product information, if naloxone was given, and the medical outcome of the case. AB - RESULTS: A total of 123 cases were identified. The ages of the children ranged from 4 days to 5 years; 55% were boys. All exposures occurred in a home environment. The majority of the calls were made to the NYC PCC by the doctor (74%) or nurse (2%) at a health care facility. Approximately one-fourth of the calls came from the home and were made by the parent (22%) or grandparent (2%). More than one-half of the exposures involved methadone (64%). Naloxone was administered in 28% of cases. Approximately one-fourth of the children did not experience any effect after the reported exposure, one-half (51%) experienced some effect (minor, moderate, or major), and there was 1 death (1%). More than one-half of the children were admitted to the hospital, with 40% admitted to critical care and 13% to noncritical care. Approximately 23% were treated and released from the hospital, and 20% were lost to follow-up or never arrived to the hospital. The remaining 4% were managed on site without a visit to the hospital. AB - CONCLUSION: Exposures to methadone and buprenorphine are dangerous with some leading to serious health effects. Safe storage and disposal instructions are needed for homes where children may be present. Copyright Published by Elsevier Inc. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) RN - UC6VBE7V1Z (Methadone) ES - 1544-3450 IL - 1086-5802 DI - S1544-3191(17)30015-8 DO - https://dx.doi.org/10.1016/j.japh.2017.01.015 PT - Journal Article ID - S1544-3191(17)30015-8 [pii] ID - 10.1016/j.japh.2017.01.015 [doi] PP - ppublish PH - 2016/08/16 [received] PH - 2017/01/18 [revised] PH - 2017/01/19 [accepted] LG - English DP - 2017 Mar - Apr EZ - 2017/03/16 06:00 DA - 2017/09/05 06:00 DT - 2017/03/16 06:00 YR - 2017 ED - 20170904 RD - 20170904 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28292505 <98. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27521969 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Jelacic S AU - Bollag L AU - Bowdle A AU - Rivat C AU - Cain KC AU - Richebe P FA - Jelacic, Srdjan FA - Bollag, Laurent FA - Bowdle, Andrew FA - Rivat, Cyril FA - Cain, Kevin C FA - Richebe, Philippe IN - Jelacic, Srdjan. Department of Anesthesiology and Pain Medicine. Electronic address: sjelacic@uw.edu. IN - Bollag, Laurent. Department of Anesthesiology and Pain Medicine. IN - Bowdle, Andrew. Department of Anesthesiology and Pain Medicine. IN - Rivat, Cyril. Department of Anesthesiology and Pain Medicine. IN - Cain, Kevin C. Biostatistics, University of Washington School of Public Health, Seattle, WA. IN - Richebe, Philippe. Department of Anesthesiology and Pain Medicine. TI - Intravenous Acetaminophen as an Adjunct Analgesic in Cardiac Surgery Reduces Opioid Consumption But Not Opioid-Related Adverse Effects: A Randomized Controlled Trial. SO - Journal of Cardiothoracic & Vascular Anesthesia. 30(4):997-1004, 2016 Aug AS - J Cardiothorac Vasc Anesth. 30(4):997-1004, 2016 Aug NJ - Journal of cardiothoracic and vascular anesthesia VO - 30 IP - 4 PG - 997-1004 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - a6i, 9110208 IO - J. Cardiothorac. Vasc. Anesth. SB - Index Medicus CP - United States MH - Acetaminophen/ad [Administration & Dosage] MH - *Acetaminophen/pd [Pharmacology] MH - Administration, Intravenous MH - Adolescent MH - Adult MH - Aged MH - Analgesia/mt [Methods] MH - Analgesics, Non-Narcotic/ad [Administration & Dosage] MH - *Analgesics, Non-Narcotic/pd [Pharmacology] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Cardiac Surgical Procedures MH - Double-Blind Method MH - Drug Therapy, Combination MH - Female MH - Humans MH - Hyperalgesia MH - Length of Stay/sn [Statistics & Numerical Data] MH - Male MH - Middle Aged MH - *Pain, Postoperative/dt [Drug Therapy] MH - Prospective Studies MH - Respiration, Artificial/sn [Statistics & Numerical Data] MH - Young Adult KW - analgesia; cardiac surgery; intravenous acetaminophen AB - OBJECTIVES: The authors hypothesized that intravenous acetaminophen as an adjunct analgesic would significantly decrease 24-hour postoperative opioid consumption. AB - DESIGN: Double-blind, randomized, placebo-controlled trial. AB - SETTING: A single academic medical center. AB - PARTICIPANTS: The study was comprised of 68 adult patients undergoing cardiac surgery. AB - INTERVENTIONS: Patients were assigned randomly to receive either 1,000 mg of intravenous acetaminophen or placebo immediately after anesthesia induction, at the end of surgery, and then every 6 hours for the first 24 hours in the intensive care unit, for a total of 6-1,000 mg doses. AB - MEASUREMENTS AND MAIN RESULTS: The primary outcome was 24-hour postoperative opioid consumption. The secondary outcomes included 48-hour postoperative opioid consumption, incisional pain scores, opioid-related adverse effects, length of mechanical ventilation, length of intensive care unit stay, and the extent of wound hyperalgesia assessed at 24 and 48 hours postoperatively. The mean+/-standard deviation postoperative 24-hour opioid consumption expressed in morphine equivalents was significantly less in the acetaminophen group (45.6+/-29.5 mg) than in the placebo group (62.3+/-29.5 mg), representing a 27% reduction in opioid consumption (95% CI, 2.3-31.1 mg; p = 0.024). There were no differences in pain scores and opioid-related adverse effects between the 2 groups. A significantly greater number of patients in the acetaminophen group responded "very much" and "extremely well" when asked how their overall pain experience met their expectation (p = 0.038). AB - CONCLUSIONS: The administration of intravenous acetaminophen during cardiac surgery and for the first 24 hours postoperatively reduced opioid consumption and improved patient satisfaction with their overall pain experience but did not reduce opioid side effects. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 362O9ITL9D (Acetaminophen) ES - 1532-8422 IL - 1053-0770 DI - S1053-0770(16)00073-2 DO - https://dx.doi.org/10.1053/j.jvca.2016.02.010 PT - Journal Article PT - Randomized Controlled Trial ID - S1053-0770(16)00073-2 [pii] ID - 10.1053/j.jvca.2016.02.010 [doi] PP - ppublish PH - 2015/12/16 [received] LG - English EP - 20160212 DP - 2016 Aug EZ - 2016/08/16 06:00 DA - 2017/09/02 06:00 DT - 2016/08/14 06:00 YR - 2016 ED - 20170901 RD - 20170901 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27521969 <99. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27439227 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - ED-based Counseling Sessions Reduce Risky Opioid Use Among Certain Patients. SO - ED Management. 28(7):81-3, 2016 Jul AS - ED Manag. 28(7):81-3, 2016 Jul NJ - ED management : the monthly update on emergency department management VO - 28 IP - 7 PG - 81-3 PI - Journal available in: Print PI - Citation processed from: Print JC - chx, 9425690 IO - ED Manag SB - Health Administration Journals CP - United States MH - Counseling MH - Drug Overdose MH - *Emergency Service, Hospital MH - Humans MH - Motivation MH - Opioid-Related Disorders AB - Investigators at the University of Michigan have shown promising results from an ED-based intervention designed to curb risky opioid use among patients who have reported opioid misuse within the previous three months. The intervention includes a 30-minute counseling session with a therapist who utilizes motivational interviewing techniques to strengthen their desire to move away from opioid use behaviors. The randomized clinical trial included 204 emergency patients, divided between patients receiving printed educational materials and patients receiving printed materials as well as counseling sessions. Researchers followed up with all patients after six months, finding that those who received the counseling intervention demonstrated a substantially higher reduction in behaviors that heighten the risk of an overdose than patients who received only printed materials. Investigators are working now to adapt the counseling intervention so that it can be delivered by more cost-efficient,means, such as via interactive voice response messages or computer. IS - 1044-9167 IL - 1044-9167 PT - Journal Article PT - Randomized Controlled Trial PP - ppublish LG - English DP - 2016 Jul EZ - 2016/07/22 06:00 DA - 2017/08/30 06:00 DT - 2016/07/22 06:00 YR - 2016 ED - 20170829 RD - 20170829 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27439227 <100. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28362828 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dworkis DA AU - Taylor LA AU - Peak DA AU - Bearnot B AI - Dworkis, Daniel A; ORCID: http://orcid.org/0000-0003-0706-5117 FA - Dworkis, Daniel A FA - Taylor, Lauren A FA - Peak, David A FA - Bearnot, Benjamin IN - Dworkis, Daniel A. Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts, United States of America. IN - Dworkis, Daniel A. Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts, United States of America. IN - Taylor, Lauren A. Harvard Management Business School, Boston, Massachusetts, United States of America. IN - Peak, David A. Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts, United States of America. IN - Peak, David A. Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts, United States of America. IN - Bearnot, Benjamin. Harvard Medical School, Department of Medicine, Boston, Massachusetts, United States of America. IN - Bearnot, Benjamin. Massachusetts General Hospital, Division of General Internal Medicine, Department of Medicine, Boston, Massachusetts, United States of America. TI - Geospatial analysis of emergency department visits for targeting community-based responses to the opioid epidemic. SO - PLoS ONE [Electronic Resource]. 12(3):e0175115, 2017 AS - PLoS ONE. 12(3):e0175115, 2017 NJ - PloS one VO - 12 IP - 3 PG - e0175115 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Internet JC - 101285081 IO - PLoS ONE SB - Index Medicus CP - United States MH - Age Distribution MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Epidemics/sn [Statistics & Numerical Data] MH - Female MH - Hospitals, General/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Sex Distribution AB - The opioid epidemic in the United States carries significant morbidity and mortality and requires a coordinated response among emergency providers, outpatient providers, public health departments, and communities. Anecdotally, providers across the spectrum of care at Massachusetts General Hospital (MGH) in Boston, MA have noticed that Charlestown, a community in northeast Boston, has been particularly impacted by the opioid epidemic and needs both emergency and longer-term resources. We hypothesized that geospatial analysis of the home addresses of patients presenting to the MGH emergency department (ED) with opioid-related emergencies might identify "hot spots" of opioid-related healthcare needs within Charlestown that could then be targeted for further investigation and resource deployment. Here, we present a geospatial analysis at the United States census tract level of the home addresses of all patients who presented to the MGH ED for opioid-related emergency visits between 7/1/2012 and 6/30/2015, including 191 visits from 100 addresses in Charlestown, MA. Among the six census tracts that comprise Charlestown, we find a 9.5-fold difference in opioid-related ED visits, with 45% of all opioid-related visits from Charlestown originating in tract 040401. The signal from this census tract remains strong after adjusting for population differences between census tracts, and while this tract is one of the higher utilizing census tracts in Charlestown of the MGH ED for all cause visits, it also has a 2.9-fold higher rate of opioid-related visits than the remainder of Charlestown. Identifying this hot spot of opioid-related emergency needs within Charlestown may help re-distribute existing resources efficiently, empower community and ED-based physicians to advocate for their patients, and serve as a catalyst for partnerships between MGH and local community groups. More broadly, this analysis demonstrates that EDs can use geospatial analysis to address the emergency and longer-term health needs of the communities they are designed to serve. ES - 1932-6203 IL - 1932-6203 DO - https://dx.doi.org/10.1371/journal.pone.0175115 PT - Journal Article ID - 10.1371/journal.pone.0175115 [doi] ID - PONE-D-16-44323 [pii] ID - PMC5376332 [pmc] PP - epublish PH - 2016/11/07 [received] PH - 2017/03/21 [accepted] LG - English EP - 20170331 DP - 2017 EZ - 2017/04/01 06:00 DA - 2017/08/29 06:00 DT - 2017/04/01 06:00 YR - 2017 ED - 20170828 RD - 20170828 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28362828 <101. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27322591 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sutter ME AU - Gerona RR AU - Davis MT AU - Roche BM AU - Colby DK AU - Chenoweth JA AU - Adams AJ AU - Owen KP AU - Ford JB AU - Black HB AU - Albertson TE FA - Sutter, Mark E FA - Gerona, Roy R FA - Davis, M Thais FA - Roche, Bailey M FA - Colby, Daniel K FA - Chenoweth, James A FA - Adams, Axel J FA - Owen, Kelly P FA - Ford, Jonathan B FA - Black, Hugh B FA - Albertson, Timothy E IN - Sutter, Mark E. Division of Medical Toxicology, Department of Emergency Medicine, University of California, Davis, Sacramento, CA. IN - Sutter, Mark E. Veterans Affairs Northern California, Mather, CA. IN - Gerona, Roy R. Division of Laboratory Medicine, University of California, San Francisco, San Francisco, CA. IN - Davis, M Thais. Division of Medical Toxicology, Department of Emergency Medicine, University of California, Davis, Sacramento, CA. IN - Davis, M Thais. Veterans Affairs Northern California, Mather, CA. IN - Roche, Bailey M. Division of Medical Toxicology, Department of Emergency Medicine, University of California, Davis, Sacramento, CA. IN - Roche, Bailey M. Veterans Affairs Northern California, Mather, CA. IN - Colby, Daniel K. Division of Medical Toxicology, Department of Emergency Medicine, University of California, Davis, Sacramento, CA. IN - Colby, Daniel K. Veterans Affairs Northern California, Mather, CA. IN - Chenoweth, James A. Division of Medical Toxicology, Department of Emergency Medicine, University of California, Davis, Sacramento, CA. IN - Chenoweth, James A. Veterans Affairs Northern California, Mather, CA. IN - Adams, Axel J. University of California San Francisco School of Medicine, San Francisco, CA. IN - Owen, Kelly P. Division of Medical Toxicology, Department of Emergency Medicine, University of California, Davis, Sacramento, CA. IN - Owen, Kelly P. Veterans Affairs Northern California, Mather, CA. IN - Ford, Jonathan B. Division of Medical Toxicology, Department of Emergency Medicine, University of California, Davis, Sacramento, CA. IN - Ford, Jonathan B. Veterans Affairs Northern California, Mather, CA. IN - Black, Hugh B. Veterans Affairs Northern California, Mather, CA. IN - Black, Hugh B. Division of Pulmonary and Critical Care, University of California, Davis, Patient Services Support Building, Sacramento, CA. IN - Albertson, Timothy E. Veterans Affairs Northern California, Mather, CA. IN - Albertson, Timothy E. Division of Pulmonary and Critical Care, University of California, Davis, Patient Services Support Building, Sacramento, CA. TI - Fatal Fentanyl: One Pill Can Kill. SO - Academic Emergency Medicine. 24(1):106-113, 2017 Jan AS - Acad Emerg Med. 24(1):106-113, 2017 Jan NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 24 IP - 1 PG - 106-113 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - *Acetaminophen/po [Poisoning] MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - California MH - Drug Combinations MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - *Fentanyl/po [Poisoning] MH - Humans MH - *Hydrocodone/po [Poisoning] MH - Male MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - *Street Drugs/po [Poisoning] AB - OBJECTIVE: The current national opioid epidemic is a public health emergency. We have identified an outbreak of exaggerated opioid toxicity caused by fentanyl adulterated tablets purchased on the street as hydrocodone/acetaminophen. AB - METHODS: Over an 8-day period in late March 2016, a total of 18 patients presented to our institution with exaggerated opioid toxicity. The patients provided a similar history: ingesting their "normal dose" of hydrocodone/acetaminophen tablets but with more pronounced symptoms. Toxicology testing and analysis was performed on serum, urine, and surrendered pills. AB - RESULTS: One of the 18 patients died in hospital. Five patients underwent cardiopulmonary resuscitation, one required extracorporeal life support, three required intubation, and two received bag-valve-mask ventilation. One patient had recurrence of toxicity after 8 hours after naloxone discontinuation. Seventeen of 18 patients required boluses of naloxone, and four required prolonged naloxone infusions (26-39 hours). All 18 patients tested positive for fentanyl in the serum. Quantitative assays conducted in 13 of the sera revealed fentanyl concentrations of 7.9 to 162 ng/mL (mean = 52.9 ng/mL). Pill analysis revealed fentanyl amounts of 600-6,900 mug/pill. The pills are virtually indistinguishable from authentic hydrocodone/acetaminophen tablets and are similar in weight. To date, our county has reported 56 cases of fentanyl opioid toxicity, with 15 fatalities. In our institution, the outbreak has stressed the capabilities and resources of the emergency department and intensive care units. AB - CONCLUSIONS: A serious outbreak of exaggerated opioid toxicity caused by fentanyl-adulterated tablets purchased on the street as hydrocodone/acetaminophen is under way in California. These patients required higher dosing and prolonged infusions of naloxone. Additionally, observation periods off naloxone were extended due to delayed, recurrent toxicity. The outbreak has serious ramifications for public health and safety, law enforcement, and healthcare facilities and resources. Copyright © 2016 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 0 (Street Drugs) RN - 0 (acetaminophen, hydrocodone drug combination) RN - 362O9ITL9D (Acetaminophen) RN - 36B82AMQ7N (Naloxone) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - UF599785JZ (Fentanyl) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.13034 PT - Case Reports PT - Journal Article ID - 10.1111/acem.13034 [doi] PP - ppublish PH - 2016/05/04 [received] PH - 2016/06/07 [revised] PH - 2016/06/16 [accepted] LG - English EP - 20161031 DP - 2017 Jan EZ - 2016/11/01 06:00 DA - 2017/08/23 06:00 DT - 2016/06/21 06:00 YR - 2017 ED - 20170822 RD - 20170822 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27322591 <102. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27834915 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Blake D AU - Lyons A FA - Blake, Denise FA - Lyons, Antonia IN - Blake, Denise. Joint Centre for Disaster Research, School of Psychology, Massey University, Wellington 6140, New Zealand. d.blake@massey.ac.nz. IN - Lyons, Antonia. School of Psychology, Massey University, Wellington 6140, New Zealand. A.Lyons@massey.ac.nz. TI - Opioid Substitution Treatment Planning in a Disaster Context: Perspectives from Emergency Management and Health Professionals in Aotearoa/New Zealand. SO - International Journal of Environmental Research & Public Health [Electronic Resource]. 13(11), 2016 11 10 AS - Int J Environ Res Public Health. 13(11), 2016 11 10 NJ - International journal of environmental research and public health VO - 13 IP - 11 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101238455 IO - Int J Environ Res Public Health SB - Index Medicus CP - Switzerland MH - *Attitude of Health Personnel MH - *Disaster Planning MH - *Emergency Responders/px [Psychology] MH - *Health Personnel/px [Psychology] MH - Humans MH - New Zealand MH - *Opiate Substitution Treatment/ut [Utilization] KW - *OST; *disaster; *opioid substitution treatment; *planning; *preparedness; *vulnerability AB - Opioid Substitution Treatment (OST) is a harm reduction strategy enabling opiate consumers to avoid withdrawal symptoms and maintain health and wellbeing. Some research shows that within a disaster context service disruptions and infrastructure damage affect OST services, including problems with accessibility, dosing, and scripts. Currently little is known about planning for OST in the reduction and response phases of a disaster. This study aimed to identify the views of three professional groups working in Aotearoa/New Zealand about OST provision following a disaster. In-depth, semi-structured interviews were conducted with 17 service workers, health professionals, and emergency managers in OST and disaster planning fields. Thematic analysis of transcripts identified three key themes, namely "health and wellbeing", "developing an emergency management plan", and "stock, dose verification, and scripts" which led to an overarching concept of "service continuity in OST preparedness planning". Participants viewed service continuity as essential for reducing physical and psychological distress for OST clients, their families, and wider communities. Alcohol and drug and OST health professionals understood the specific needs of clients, while emergency managers discussed the need for sufficient preparedness planning to minimise harm. It is concluded that OST preparedness planning must be multidisciplinary, flexible, and inclusive. CI - The authors declare no conflict of interest. ES - 1660-4601 IL - 1660-4601 DI - E1122 PT - Journal Article ID - ijerph13111122 [pii] ID - 10.3390/ijerph13111122 [doi] ID - PMC5129332 [pmc] PP - epublish PH - 2016/09/18 [received] PH - 2016/10/28 [revised] PH - 2016/11/05 [accepted] LG - English EP - 20161110 DP - 2016 11 10 EZ - 2016/11/12 06:00 DA - 2017/08/18 06:00 DT - 2016/11/12 06:00 YR - 2016 ED - 20170817 RD - 20171222 UP - 20171222 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27834915 <103. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27098615 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weiner SG AU - Raja AS AU - Bittner JC AU - Curtis KM AU - Weimersheimer P AU - Hasegawa K AU - Espinola JA AU - Camargo CA Jr FA - Weiner, Scott G FA - Raja, Ali S FA - Bittner, Jane C FA - Curtis, Kevin M FA - Weimersheimer, Peter FA - Hasegawa, Kohei FA - Espinola, Janice A FA - Camargo, Carlos A Jr IN - Weiner, Scott G. Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. sweiner@massmed.org. IN - Raja, Ali S. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. IN - Bittner, Jane C. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. IN - Curtis, Kevin M. Section of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH. IN - Weimersheimer, Peter. Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, University of Vermont College of Medicine, Burlington, VT. IN - Hasegawa, Kohei. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. IN - Espinola, Janice A. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. IN - Camargo, Carlos A Jr. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. TI - Opioid-related Policies in New England Emergency Departments. CM - Comment in: Acad Emerg Med. 2016 Nov;23 (11):1290-1292; PMID: 27343859 SO - Academic Emergency Medicine. 23(9):1086-90, 2016 Sep AS - Acad Emerg Med. 23(9):1086-90, 2016 Sep NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 23 IP - 9 PG - 1086-90 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Service, Hospital/og [Organization & Administration] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - New England MH - Referral and Consultation MH - Surveys and Questionnaires AB - OBJECTIVES: The opioid abuse and overdose epidemic in the United States has led to the need for new practice policies to guide clinicians. We describe implementation of opioid-related policies in emergency departments (EDs) in New England to gauge progress and determine where further work is needed. AB - METHODS: This study analyzed data from the 2015 National Emergency Department Inventory-New England survey. The survey queried directors of every ED (n = 195) in the six New England states to determine the implementation of five specific policies related to opioid management. ED characteristics (e.g., annual visits, location, and admission rates) were also obtained and a multivariable analysis was conducted to identify ED characteristics independently associated with the number of opioid-related policies implemented. AB - RESULTS: Overall, 169 EDs (87%) responded, with a >80% response rate in each state. Implementation of opioid-related policies varied as follows: 1) use of a screening tool for patients with suspected prescription opioid abuse potential (n = 30, 18%), 2) access state prescription drug monitoring program (PDMP) before prescribing opioids (n = 132, 78%), 3) notify the primary opioid prescriber when prescribing opioids for ED patients with chronic pain (n = 69, 41%), 4) refer patients with opioid abuse to recovery resources (n = 117, 70%), and 5) prescribe naloxone to patients at risk of opioid overdose after ED discharge (n = 19, 12%). EDs located in metropolitan areas and with at least one attending physician on duty 24/7 were less likely to implement opioid policies (incident rate ratio [IRR] = 0.65, 95% confidence interval [CI] = 0.48-0.89; and IRR = 0.78, 95% CI = 0.6-1.0, respectively) while EDs with >=15% hospitalization rate that used electronic computerized medication ordering and those in Rhode Island were more likely to implement opioid policies (IRR = 1.23, 95% CI = 1.03-1.48; IRR = 1.95, 95% CI = 1.19-3.22; and IRR = 1.30, 95% CI = 1.08-1.56, respectively). AB - CONCLUSIONS: The implementation of opioid-related policies varies among New England EDs. The presence of policies recommending use of screening tools and prescribing naloxone for at-risk patients was low, whereas those regarding utilization of the PDMP and referral of patients with opioid abuse to recovery resources were more common. These data provide important benchmarks for future evaluations and recommendations. Copyright © 2016 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12992 PT - Journal Article ID - 10.1111/acem.12992 [doi] PP - ppublish PH - 2016/02/11 [received] PH - 2016/03/30 [revised] PH - 2016/04/17 [accepted] LG - English EP - 20160906 DP - 2016 Sep EZ - 2016/04/22 06:00 DA - 2017/08/17 06:00 DT - 2016/04/22 06:00 YR - 2016 ED - 20170816 RD - 20171016 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27098615 <104. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28087496 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chai PR AU - Carreiro S AU - Innes BJ AU - Rosen RK AU - O'Cleirigh C AU - Mayer KH AU - Boyer EW AI - Chai, Peter R; ORCID: http://orcid.org/0000-0003-0955-4117 AI - Carreiro, Stephanie; ORCID: http://orcid.org/0000-0003-1798-9006 AI - Innes, Brendan J; ORCID: http://orcid.org/0000-0003-2107-1767 AI - Rosen, Rochelle K; ORCID: http://orcid.org/0000-0003-1598-667X AI - O'Cleirigh, Conall; ORCID: http://orcid.org/0000-0002-5639-5043 AI - Mayer, Kenneth H; ORCID: http://orcid.org/0000-0001-7460-733X AI - Boyer, Edward W; ORCID: http://orcid.org/0000-0002-3454-1310 FA - Chai, Peter R FA - Carreiro, Stephanie FA - Innes, Brendan J FA - Rosen, Rochelle K FA - O'Cleirigh, Conall FA - Mayer, Kenneth H FA - Boyer, Edward W IN - Chai, Peter R. Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States. IN - Carreiro, Stephanie. Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States. IN - Innes, Brendan J. University of Massachusetts Medical School, Worcester, MA, United States. IN - Rosen, Rochelle K. Behavioral and Preventative Medicine, The Miriam Hospital, Brown School of Public Health, Providence, RI, United States. IN - O'Cleirigh, Conall. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States. IN - Mayer, Kenneth H. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. IN - Boyer, Edward W. Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States. TI - Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study. SO - Journal of Medical Internet Research. 19(1):e19, 2017 Jan 13 AS - J Med Internet Res. 19(1):e19, 2017 Jan 13 NJ - Journal of medical Internet research VO - 19 IP - 1 PG - e19 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100959882 IO - J. Med. Internet Res. SB - Index Medicus CP - Canada MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Biosensing Techniques MH - Emergency Service, Hospital MH - Female MH - *Fractures, Bone/dt [Drug Therapy] MH - *Fractures, Bone/pp [Physiopathology] MH - Humans MH - Male MH - Medication Adherence MH - Middle Aged MH - *Oxycodone/ad [Administration & Dosage] MH - *Pain/dt [Drug Therapy] MH - *Pain/et [Etiology] MH - Pilot Projects MH - Practice Patterns, Physicians' MH - Radio Waves KW - digital health; digital pills; emergency medicine; medication adherence; opioid; pain management AB - BACKGROUND: Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy. AB - OBJECTIVE: The purpose of this study was to determine the feasibility of a novel digital pill system to measure as-needed opioid ingestion patterns in patients discharged from the emergency department (ED) after an acute bony fracture. AB - METHODS: We used a digital pill with individuals who presented to a teaching hospital ED with an acute extremity fracture. The digital pill consisted of a digital radiofrequency emitter within a standard gelatin capsule that encapsulated an oxycodone tablet. When ingested, the gastric chloride ion gradient activated the digital pill, transmitting a radiofrequency signal that was received by a hip-worn receiver, which then transmitted the ingestion data to a cloud-based server. After a brief, hands-on training session in the ED, study participants were discharged home and used the digital pill system to ingest oxycodone prescribed as needed for pain for one week. We conducted pill counts to verify digital pill data and open-ended interviews with participants at their follow-up appointment with orthopedics or at one week after enrollment in the study to determine the knowledge, attitudes, beliefs, and practices regarding digital pills. We analyzed open-ended interviews using applied thematic analysis. AB - RESULTS: We recruited 10 study participants and recorded 96 ingestion events (87.3%, 96/110 accuracy). Study participants reported being able to operate all aspects of the digital pill system after their training. Two participants stopped using the digital pill, reporting they were in too much pain to focus on the novel technology. The digital pill system detected multiple simultaneous ingestion events by the digital pill system. Participants ingested a mean 8 (SD 5) digital pills during the study period and four participants continued on opioids at the end of the study period. After interacting with the digital pill system in the real world, participants found the system highly acceptable (80%, 8/10) and reported a willingness to continue to use a digital pill to improve medication adherence monitoring (90%, 9/10). AB - CONCLUSIONS: The digital pill is a feasible method to measure real-time opioid ingestion patterns in individuals with acute pain and to develop real-time interventions if opioid abuse is detected. Deploying digital pills is possible through the ED with a short instructional course. Patients who used the digital pill accepted the technology. Copyright ©Peter R Chai, Stephanie Carreiro, Brendan J Innes, Rochelle K Rosen, Conall O'Cleirigh, Kenneth H Mayer, Edward W Boyer. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.01.2017. CI - Conflicts of Interest: None declared. RN - 0 (Analgesics, Opioid) RN - CD35PMG570 (Oxycodone) ES - 1438-8871 IL - 1438-8871 DO - https://dx.doi.org/10.2196/jmir.7050 PT - Clinical Trial PT - Journal Article ID - v19i1e19 [pii] ID - 10.2196/jmir.7050 [doi] ID - PMC5273398 [pmc] PP - epublish PH - 2016/11/25 [received] PH - 2016/12/22 [accepted] PH - 2016/12/21 [revised] GI - No: UL1 TR001453 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: KL2 TR001455 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: U01 HD068040 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: R01 MH095624 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: K24 DA037109 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20170113 DP - 2017 Jan 13 EZ - 2017/01/15 06:00 DA - 2017/08/12 06:00 DT - 2017/01/15 06:00 YR - 2017 ED - 20170811 RD - 20180308 UP - 20180308 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=28087496 <105. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27501459 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Singhal A AU - Tien YY AU - Hsia RY AI - Singhal, Astha; ORCID: http://orcid.org/0000-0001-9191-6978 FA - Singhal, Astha FA - Tien, Yu-Yu FA - Hsia, Renee Y IN - Singhal, Astha. Health Policy and Health Services Research, Boston University School of Dental Medicine, Boston, Massachusetts, United States of America. IN - Tien, Yu-Yu. University of Iowa College of Pharmacy, Iowa City, Iowa, United States of America. IN - Hsia, Renee Y. Department of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California, United States of America. TI - Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse. SO - PLoS ONE [Electronic Resource]. 11(8):e0159224, 2016 AS - PLoS ONE. 11(8):e0159224, 2016 NJ - PloS one VO - 11 IP - 8 PG - e0159224 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Internet JC - 101285081 IO - PLoS ONE PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976905 SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Continental Population Groups MH - Drug Utilization/sn [Statistics & Numerical Data] MH - *Drug Utilization/td [Trends] MH - Drug-Seeking Behavior MH - Emergency Service, Hospital/td [Trends] MH - *Emergency Service, Hospital/ut [Utilization] MH - Ethnic Groups/cl [Classification] MH - Ethnic Groups/sn [Statistics & Numerical Data] MH - Female MH - Health Care Surveys MH - Healthcare Disparities/sn [Statistics & Numerical Data] MH - *Healthcare Disparities/td [Trends] MH - Humans MH - Male MH - Middle Aged MH - *Pain/dt [Drug Therapy] MH - *Pain/eh [Ethnology] MH - Pain/et [Etiology] MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians'/td [Trends] MH - *Prescription Drug Misuse/td [Trends] MH - Quality Indicators, Health Care MH - Young Adult AB - Prescription drug abuse is a growing problem nationally. In an effort to curb this problem, emergency physicians might rely on subjective cues such as race-ethnicity, often unknowingly, when prescribing opioids for pain-related complaints, especially for conditions that are often associated with drug-seeking behavior. Previous studies that examined racial-ethnic disparities in opioid dispensing at emergency departments (EDs) did not differentiate between prescriptions at discharge and drug administration in the ED. We examined racial-ethnic disparities in opioid prescription at ED visits for pain-related complaints often associated with drug-seeking behavior and contrasted them with conditions objectively associated with pain. We hypothesized a priori that racial-ethnic disparities will be present among opioid prescriptions for conditions associated with non-medical use, but not for objective pain-related conditions. Using data from the National Hospital Ambulatory Medical Care Survey for 5 years (2007-2011), the odds of opioid prescription during ED visits made by non-elderly adults aged 18-65 for 'non-definitive' conditions (toothache, back pain and abdominal pain) or 'definitive' conditions (long-bone fracture and kidney stones) were modeled. Opioid prescription at discharge and opioid administration at the ED were the primary outcomes. We found significant racial-ethnic disparities, with non-Hispanic Blacks being less likely (adjusted odds ratio ranging from 0.56-0.67, p-value < 0.05) to receive opioid prescription at discharge during ED visits for back pain and abdominal pain, but not for toothache, fractures and kidney stones, compared to non-Hispanic whites after adjusting for other covariates. Differential prescription of opioids by race-ethnicity could lead to widening of existing disparities in health, and may have implications for disproportionate burden of opioid abuse among whites. The findings have important implications for medical provider education to include sensitization exercises towards their inherent biases, to enable them to consciously avoid these biases from defining their practice behavior. RN - 0 (Analgesics, Opioid) ES - 1932-6203 IL - 1932-6203 DO - https://dx.doi.org/10.1371/journal.pone.0159224 PT - Journal Article ID - 10.1371/journal.pone.0159224 [doi] ID - PONE-D-16-13262 [pii] ID - PMC4976905 [pmc] PP - epublish PH - 2016/04/04 [received] PH - 2016/06/29 [accepted] LG - English EP - 20160808 DP - 2016 EZ - 2016/08/09 06:00 DA - 2017/08/09 06:00 DT - 2016/08/09 06:00 YR - 2016 ED - 20170808 RD - 20170808 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27501459 <106. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28301629 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rodrigues Fernandes LC AU - Galvao TF AU - Toledo Ricardi AS AU - De Capitani EM AU - Hyslop S AU - Bucaretchi F FA - Rodrigues Fernandes, Luciane Cristina FA - Galvao, Tais Freire FA - Toledo Ricardi, Adriana Safioti FA - De Capitani, Eduardo Mello FA - Hyslop, Stephen FA - Bucaretchi, Fabio IN - Rodrigues Fernandes, Luciane Cristina. RN, MSc. Nurse, Campinas Poison Control Center, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil. IN - Galvao, Tais Freire. BPharm, MSc, PhD. Professor, School of Pharmaceutical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil. IN - Galvao, Tais Freire. Professor, Postgraduate Pharmaceutical Sciences Program, Universidade Federal do Amazonas (UFAM), Manaus (AM), Brazil. IN - Toledo Ricardi, Adriana Safioti. RN, MSc. Nurse, Campinas Poison Control Center, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil. IN - De Capitani, Eduardo Mello. MD, MSc, PhD. Professor, Campinas Poison Control Center, and Professor, Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil. IN - De Capitani, Eduardo Mello. Professor, Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil. IN - Hyslop, Stephen. BSc, PhD. Professor, Campinas Poison Control Center, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil. IN - Hyslop, Stephen. Professor, Department of Pharmacology, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil. IN - Bucaretchi, Fabio. MD, MSc, PhD. Professor, Campinas Poison Control Center, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil. IN - Bucaretchi, Fabio. Professor, Department of Pediatrics, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil. TI - Antidote availability in the municipality of Campinas, Sao Paulo, Brazil. SO - Sao Paulo Medical Journal = Revista Paulista de Medicina. 135(1):15-22, 2017 Jan-Feb AS - Sao Paulo Med J. 135(1):15-22, 2017 Jan-Feb NJ - Sao Paulo medical journal = Revista paulista de medicina VO - 135 IP - 1 PG - 15-22 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100897261, dio IO - Sao Paulo Med J SB - Index Medicus CP - Brazil MH - Antidotes/cl [Classification] MH - Antidotes/st [Standards] MH - *Antidotes/sd [Supply & Distribution] MH - Brazil MH - Cross-Sectional Studies MH - Emergency Service, Hospital/st [Standards] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Health Care Surveys MH - Humans MH - *Poisoning AB - CONTEXT AND OBJECTIVE:: The lack of availability of antidotes in emergency services is a worldwide concern. The aim of the present study was to evaluate the availability of antidotes used for treating poisoning in Campinas (SP). AB - DESIGN AND SETTING:: This was a cross-sectional study of emergency services in Campinas, conducted in 2010-2012. AB - METHODS:: The availability, amount in stock, place of storage and access time for 26 antidotal treatments was investigated. In the hospitals, the availability of at least one complete treatment for a 70 kg adult over the first 24 hours of admission was evaluated based on stock and access recommendations contained in two international guidelines. AB - RESULTS:: 14 out of 17 functioning emergency services participated in the study, comprising pre-hospital services such as the public emergency ambulance service (SAMU; n = 1) and public emergency rooms for admissions lasting <= 24 hours (UPAs; n = 3), and 10 hospitals with emergency services. Six antidotes (atropine, sodium bicarbonate, diazepam, Phytomenadione, flumazenil and calcium gluconate) were stocked in all the services, followed by 13 units that also stocked activated charcoal, naloxone and diphenhydramine or biperiden. No service stocked all of the recommended antidotes; only the regional Poison Control Center had stocks close to recommended (22/26 antidotal treatments). The 10 hospitals had almost half of the antidotes for starting treatments, but only one quarter of the antidotes was present with stocks sufficient for providing treatment for 24 hours. AB - CONCLUSION:: The stock of antidotes for attending poisoning emergencies in the municipality of Campinas is incomplete and needs to be improved. RN - 0 (Antidotes) ES - 1806-9460 IL - 1516-3180 DI - S1516-31802017000100015 DO - https://dx.doi.org/10.1590/1516-3180.2016.00171120816 PT - Journal Article ID - S1516-31802017005003101 [pii] ID - 10.1590/1516-3180.2016.00171120816 [doi] PP - ppublish PH - 2016/08/08 [received] PH - 2016/08/12 [accepted] LG - English EP - 20170313 DP - 2017 Jan-Feb EZ - 2017/03/17 06:00 DA - 2017/08/08 06:00 DT - 2017/03/17 06:00 YR - 2017 ED - 20170807 RD - 20170807 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28301629 <107. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28320869 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Allen JD AU - Casavant MJ AU - Spiller HA AU - Chounthirath T AU - Hodges NL AU - Smith GA FA - Allen, Jakob D FA - Casavant, Marcel J FA - Spiller, Henry A FA - Chounthirath, Thiphalak FA - Hodges, Nichole L FA - Smith, Gary A IN - Allen, Jakob D. Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital, Columbus, Ohio. IN - Casavant, Marcel J. Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital, Columbus, Ohio. IN - Casavant, Marcel J. Central Ohio Poison Center, Columbus, Ohio; and. IN - Casavant, Marcel J. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio. IN - Spiller, Henry A. Central Ohio Poison Center, Columbus, Ohio; and. IN - Spiller, Henry A. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio. IN - Chounthirath, Thiphalak. Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital, Columbus, Ohio. IN - Hodges, Nichole L. Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital, Columbus, Ohio. IN - Smith, Gary A. Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital, Columbus, Ohio; gary.smith@nationwidechildrens.org. IN - Smith, Gary A. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio. TI - Prescription Opioid Exposures Among Children and Adolescents in the United States: 2000-2015. SO - Pediatrics. 139(4), 2017 Apr AS - Pediatrics. 139(4), 2017 Apr NJ - Pediatrics VO - 139 IP - 4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Child MH - Child, Preschool MH - Databases, Factual MH - Female MH - Humans MH - Infant MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/th [Therapy] MH - *Poison Control Centers/sn [Statistics & Numerical Data] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - *Prescriptions/sn [Statistics & Numerical Data] MH - United States MH - Young Adult AB - OBJECTIVES: This study analyzes and compares exposures to prescription opioids among children and adolescents younger than 20 years old in the United States. AB - METHODS: Data from the National Poison Data System for 2000 through 2015 were analyzed. AB - RESULTS: Poison control centers received reports of 188468 prescription opioid exposures among children aged <20 years old from 2000 through 2015. The annual number and rate of exposures increased early in the study period, but declined after 2009, except for buprenorphine exposures, which increased during the last 3 study years. Hydrocodone accounted for the largest proportion of exposures (28.7%), and 47.1% of children exposed to buprenorphine were admitted to a health care facility (HCF). The odds of being admitted to an HCF were higher for teenagers than for children aged 0 to 5 years (odds ratio [OR]: 2.86; 95% confidence interval [CI]: 2.78-2.94) or children aged 6 to 12 years (OR: 6.62; 95% CI: 6.06-7.02). Teenagers also had greater odds of serious medical outcomes than did children aged 0 to 5 years (OR: 3.03; 95% CI: 2.92-3.15) or children aged 6 to 12 years (OR: 4.59; 95% CI: 4.21-5.00). The rate of prescription opioid-related suspected suicides among teenagers increased by 52.7% during the study period. AB - CONCLUSIONS: Prescription opioid-related HCF admissions and serious medical outcomes were higher among teenagers. Contrary to trends for other prescription opioids, exposures to buprenorphine have increased in recent years; children aged 0 to 5 years accounted for almost 90% of buprenorphine exposures. These findings indicate that additional prevention efforts are needed. Copyright © 2017 by the American Academy of Pediatrics. CI - POTENTIAL CONFLICT OF INTEREST: Dr Casavant has been retained to review and comment on a legal case involving buprenorphine; the other authors have indicated they have no potential conflicts of interest to disclose. RN - 0 (Analgesics, Opioid) ES - 1098-4275 IL - 0031-4005 DI - e20163382 DO - https://dx.doi.org/10.1542/peds.2016-3382 PT - Journal Article ID - peds.2016-3382 [pii] ID - 10.1542/peds.2016-3382 [doi] PP - ppublish PH - 2017/01/10 [accepted] LG - English EP - 20170320 DP - 2017 Apr EZ - 2017/03/23 06:00 DA - 2017/08/05 06:00 DT - 2017/03/22 06:00 YR - 2017 ED - 20170803 RD - 20170803 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28320869 <108. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26660909 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - West NA AU - Dart RC FA - West, Nancy A FA - Dart, Richard C IN - West, Nancy A. Research Department, Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA. IN - Dart, Richard C. Research Department, Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA. IN - Dart, Richard C. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. TI - Prescription opioid exposures and adverse outcomes among older adults. SO - Pharmacoepidemiology & Drug Safety. 25(5):539-44, 2016 May AS - Pharmacoepidemiol Drug Saf. 25(5):539-44, 2016 May NJ - Pharmacoepidemiology and drug safety VO - 25 IP - 5 PG - 539-44 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - d0r, 9208369 IO - Pharmacoepidemiol Drug Saf SB - Index Medicus CP - England MH - Adult MH - Age Factors MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/po [Poisoning] MH - Chronic Pain/dt [Drug Therapy] MH - Female MH - Humans MH - Linear Models MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Poison Control Centers MH - Polypharmacy MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Prevalence MH - Time Factors MH - United States/ep [Epidemiology] MH - Young Adult KW - United States; aging; epidemiology; opioids; pharmacoepidemiology AB - PURPOSE: A high prevalence of chronic pain and high rates of polypharmacy among older adults suggest that this age group may be particularly susceptible to unintentional misuse of prescription opioids. We examined recent trends in misuse of prescription opioids and associated medical outcomes among older-aged adults (60+ years) and compared the patterns with trends among younger-aged adults (20-59years). AB - METHODS: Linear regression trend analysis was used to analyze 57681 misuse cases reported to participating US poison centers during 2006-2014. AB - RESULTS: Population rates of misuse of prescription opioids were higher for older adults than for younger adults, and this disparity increased over time. Rates among the older ages increased each year, although the rate of increase slowed over time (p<0.0001 for negative quadratic trend). In contrast, among the younger adults, there was a significant negative quadratic trend in population rates (p<0.0001) with a rise in rates during 2006-2010 followed by a decline during 2011-2014. Rates of serious medical outcomes among the older ages followed an increasing linear trend (p<0.0001); in contrast, rates among younger adults rose and fell during the period, with recent rates trending downward (p<0.0001 for quadratic trend). AB - CONCLUSIONS: Recent increases in rates of misuse of prescription opioids and associated unfavorable medical outcomes among older adults have important implications as the USA undergoes a rapid expansion of its elderly population. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd. RN - 0 (Analgesics, Opioid) ES - 1099-1557 IL - 1053-8569 DO - https://dx.doi.org/10.1002/pds.3934 PT - Journal Article ID - 10.1002/pds.3934 [doi] PP - ppublish PH - 2015/05/01 [received] PH - 2015/10/29 [revised] PH - 2015/11/16 [accepted] LG - English EP - 20151213 DP - 2016 May EZ - 2015/12/15 06:00 DA - 2017/08/02 06:00 DT - 2015/12/15 06:00 YR - 2016 ED - 20170731 RD - 20170731 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26660909 <109. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28536980 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kelty E AU - Hulse G AI - Kelty, Erin; ORCID: http://orcid.org/0000-0002-0841-2216 FA - Kelty, Erin FA - Hulse, Gary IN - Kelty, Erin. School of Psychiatry and Clinical Neuroscience, University of Western Australia, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia. erin.kelty@uwa.edu.au. IN - Kelty, Erin. School of Population and Global Health, University of Western Australia, Crawley, WA, 6009, Australia. erin.kelty@uwa.edu.au. IN - Hulse, Gary. School of Psychiatry and Clinical Neuroscience, University of Western Australia, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia. TI - A Retrospective Cohort Study of Obstetric Outcomes in Opioid-Dependent Women Treated with Implant Naltrexone, Oral Methadone or Sublingual Buprenorphine, and Non-Dependent Controls. SO - Drugs. 77(11):1199-1210, 2017 Jul AS - Drugs. 77(11):1199-1210, 2017 Jul NJ - Drugs VO - 77 IP - 11 PG - 1199-1210 PI - Journal available in: Print PI - Citation processed from: Internet JC - ec2, 7600076 IO - Drugs SB - Index Medicus CP - New Zealand MH - Administration, Oral MH - Administration, Sublingual MH - *Buprenorphine/ad [Administration & Dosage] MH - Buprenorphine/tu [Therapeutic Use] MH - Drug Implants MH - Female MH - Humans MH - *Methadone/ad [Administration & Dosage] MH - Methadone/tu [Therapeutic Use] MH - *Naltrexone/ad [Administration & Dosage] MH - Naltrexone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Opiate Substitution Treatment MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/me [Metabolism] MH - Pregnancy MH - *Pregnancy Complications/dt [Drug Therapy] MH - *Pregnancy Outcome MH - Retrospective Studies AB - BACKGROUND: Opioid pharmacotherapies play an important role in the treatment of opioid-dependent women; however, very little is known about the safety of naltrexone in pregnant patients. AB - OBJECTIVE: This study examined the obstetric health of opioid-dependent women who were treated with implant naltrexone during pregnancy, and compared them with women treated with methadone and/or buprenorphine and a cohort of non-opioid-dependent controls. AB - METHODS: Women treated with implant naltrexone, oral methadone or sublingual buprenorphine between 2001 and 2010, along with a cohort of age-matched controls, were linked with records from midwives, hospital and emergency departments (EDs) and the death registry to identify pregnancy and health events that occurred during pregnancy and in the post-partum period. AB - RESULTS: Overall rates of pregnancy loss (requiring hospital or ED attendance) were significantly elevated in naltrexone-treated women compared with buprenorphine-treated women (p = 0.018) and controls (p < 0.001); however, they were not statistically different to methadone-treated women (p = 0.210). Birth rates in women on naltrexone implant treatment were significantly higher than in all three comparison groups (p < 0.001). Rates of hospital and ED attendance during pregnancy in the naltrexone-treated women were not statistically different to those of either the methadone or buprenorphine groups, and neither were overall complications during pregnancy and labour. Overall rates of complications during pregnancy were significantly higher in the naltrexone-treated women than in the controls. AB - CONCLUSION: Opioid-dependent women treated with naltrexone implant had higher rates of birth than the other three groups (methadone- or buprenorphine-treated women, or age-matched controls). Overall rates of complications during pregnancy were elevated in naltrexone-treated women when compared with the control group, but were generally not significantly different to rates in methadone- or buprenorphine-treated women. RN - 0 (Drug Implants) RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) RN - 5S6W795CQM (Naltrexone) RN - UC6VBE7V1Z (Methadone) ES - 1179-1950 IL - 0012-6667 DO - https://dx.doi.org/10.1007/s40265-017-0762-9 PT - Journal Article PT - Meta-Analysis ID - 10.1007/s40265-017-0762-9 [doi] ID - 10.1007/s40265-017-0762-9 [pii] PP - ppublish LG - English DP - 2017 Jul EZ - 2017/05/26 06:00 DA - 2017/07/27 06:00 DT - 2017/05/25 06:00 YR - 2017 ED - 20170726 RD - 20170726 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28536980 <110. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27936038 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Iwanicki JL AU - Severtson SG AU - McDaniel H AU - Rosenblum A AU - Fong C AU - Cicero TJ AU - Ellis MS AU - Kurtz SP AU - Buttram ME AU - Dart RC FA - Iwanicki, Janetta L FA - Severtson, S Geoff FA - McDaniel, Heather FA - Rosenblum, Andrew FA - Fong, Chunki FA - Cicero, Theodore J FA - Ellis, Matthew S FA - Kurtz, Steven P FA - Buttram, Mance E FA - Dart, Richard C IN - Iwanicki, Janetta L. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, United States of America. IN - Severtson, S Geoff. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, United States of America. IN - McDaniel, Heather. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, United States of America. IN - Rosenblum, Andrew. National Development and Research Institutes, Incorporated, New York, New York, United States of America. IN - Fong, Chunki. National Development and Research Institutes, Incorporated, New York, New York, United States of America. IN - Cicero, Theodore J. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America. IN - Ellis, Matthew S. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America. IN - Kurtz, Steven P. Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, Florida, United States of America. IN - Buttram, Mance E. Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, Florida, United States of America. IN - Dart, Richard C. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, United States of America. TI - Abuse and Diversion of Immediate Release Opioid Analgesics as Compared to Extended Release Formulations in the United States. SO - PLoS ONE [Electronic Resource]. 11(12):e0167499, 2016 AS - PLoS ONE. 11(12):e0167499, 2016 NJ - PloS one VO - 11 IP - 12 PG - e0167499 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Internet JC - 101285081 IO - PLoS ONE SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Delayed-Action Preparations/ae [Adverse Effects] MH - Drug Prescriptions/sn [Statistics & Numerical Data] MH - Humans MH - Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/et [Etiology] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Poison Control Centers/sn [Statistics & Numerical Data] MH - Prevalence MH - Regression Analysis MH - Risk Assessment/sn [Statistics & Numerical Data] MH - Risk Factors MH - *Substance Abuse Treatment Centers/sn [Statistics & Numerical Data] MH - United States/ep [Epidemiology] AB - BACKGROUND: Therapeutic use and abuse of prescription opioids in the United States increased substantially between 1990 and 2010. The Centers for Disease Control estimated deaths related to pharmaceutical opioids reached nearly 19,000 in 2014. Of prescription opioids sold, 10% are extended release (ER) and 90% immediate release (IR). However, most regulations and interventions have focused on decreasing ER abuse. Our objective was to compare rates of abuse and diversion of ER and IR opioid analgesics over time using multiple surveillance programs. AB - METHODS: Rates of abuse and diversion of ER and IR opioid formulations were compared using data from four surveillance programs in the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS) System. Data were evaluated from 2009 through 2015, and Poisson regression used to compare IR and ER opioid cases over time. AB - RESULTS: From 2009 to 2015, IR opioids were prescribed at a rate 12 to 16 times higher than ER. In the Poison Center Program, population-adjusted rates of Intentional Abuse for IR were 4.6 fold higher than ER opioids (p<0.001). In the Drug Diversion Program, population-adjusted rates of diversion were 6.1 fold higher for IR than ER opioids (p<0.001). In the Opioid Treatment Program, population-adjusted rates of endorsements for abuse were 1.6 fold higher for IR opioids than ER (p = 0.002). In the Survey of Key Informants' Patients Program, population-adjusted rates of endorsements for abuse were 1.5 fold higher for IR opioids than ER (p<0.001). AB - CONCLUSIONS: Between 2009 and 2015, IR opioids were prescribed at a much higher rate than ER opioids. Results from four surveillance programs show population-adjusted rates of prescription opioid abuse were markedly higher for IR than ER medications. For the greatest public health benefit, future interventions to decrease prescription opioid abuse should focus on both IR and ER formulations. CI - The authors have declared that no additional competing interests exist. RN - 0 (Analgesics, Opioid) RN - 0 (Delayed-Action Preparations) ES - 1932-6203 IL - 1932-6203 DO - https://dx.doi.org/10.1371/journal.pone.0167499 PT - Comparative Study PT - Journal Article ID - 10.1371/journal.pone.0167499 [doi] ID - PONE-D-16-16811 [pii] ID - PMC5147916 [pmc] PP - epublish PH - 2016/05/07 [received] PH - 2016/11/15 [accepted] LG - English EP - 20161209 DP - 2016 EZ - 2016/12/10 06:00 DA - 2017/07/27 06:00 DT - 2016/12/10 06:00 YR - 2016 ED - 20170726 RD - 20170726 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27936038 <111. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28692390 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Daly ER AU - Dufault K AU - Swenson DJ AU - Lakevicius P AU - Metcalf E AU - Chan BP FA - Daly, Elizabeth R FA - Dufault, Kenneth FA - Swenson, David J FA - Lakevicius, Paul FA - Metcalf, Erin FA - Chan, Benjamin P IN - Daly, Elizabeth R. 1 New Hampshire Department of Health and Human Services, Concord, NH, USA. IN - Dufault, Kenneth. 1 New Hampshire Department of Health and Human Services, Concord, NH, USA. IN - Swenson, David J. 1 New Hampshire Department of Health and Human Services, Concord, NH, USA. IN - Lakevicius, Paul. 1 New Hampshire Department of Health and Human Services, Concord, NH, USA. IN - Metcalf, Erin. 1 New Hampshire Department of Health and Human Services, Concord, NH, USA. IN - Chan, Benjamin P. 1 New Hampshire Department of Health and Human Services, Concord, NH, USA. TI - Use of Emergency Department Data to Monitor and Respond to an Increase in Opioid Overdoses in New Hampshire, 2011-2015. SO - Public Health Reports. 132(1_suppl):73S-79S, 2017 Jul/Aug AS - Public Health Rep. 132(1_suppl):73S-79S, 2017 Jul/Aug NJ - Public health reports (Washington, D.C. : 1974) VO - 132 IP - 1_suppl PG - 73S-79S PI - Journal available in: Print PI - Citation processed from: Internet JC - 9716844, qja IO - Public Health Rep SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/po [Poisoning] MH - Child MH - Drug Overdose/di [Diagnosis] MH - *Drug Overdose/ep [Epidemiology] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital/td [Trends] MH - Female MH - Humans MH - International Classification of Diseases/cl [Classification] MH - International Classification of Diseases/sn [Statistics & Numerical Data] MH - Male MH - Middle Aged MH - New Hampshire/ep [Epidemiology] KW - emergency department data; heroin; opioid; syndromic surveillance AB - OBJECTIVES: Opioid-related overdoses and deaths in New Hampshire have increased substantially in recent years, similar to increases observed across the United States. We queried emergency department (ED) data in New Hampshire to monitor opioid-related ED encounters as part of the public health response to this health problem. AB - METHODS: We obtained data on opioid-related ED encounters for the period January 1, 2011, through December 31, 2015, from New Hampshire's syndromic surveillance ED data system by querying for (1) chief complaint text related to the words "fentanyl," "heroin," "opiate," and "opioid" and (2) opioid-related International Classification of Diseases ( ICD) codes. We then analyzed the data to calculate frequencies of opioid-related ED encounters by age, sex, residence, chief complaint text values, and ICD codes. AB - RESULTS: Opioid-related ED encounters increased by 70% during the study period, from 3300 in 2011 to 5603 in 2015; the largest increases occurred in adults aged 18-29 and in males. Of 20994 total opioid-related ED visits, we identified 18554 (88%) using ICD code alone, 690 (3%) using chief complaint text alone, and 1750 (8%) using both chief complaint text and ICD code. For those encounters identified by ICD code only, the corresponding chief complaint text included varied and nonspecific words, with the most common being "pain" (n = 3335, 18%), "overdose" (n = 1555, 8%), "suicidal" (n = 816, 4%), "drug" (n = 803, 4%), and "detox" (n = 750, 4%). Heroin-specific encounters increased by 827%, from 4% of opioid-related encounters in 2011 to 24% of encounters in 2015. AB - CONCLUSIONS: Opioid-related ED encounters in New Hampshire increased substantially from 2011 to 2015. Data from New Hampshire's ED syndromic surveillance system provided timely situational awareness to public health partners to support the overall response to the opioid epidemic. RN - 0 (Analgesics, Opioid) ES - 1468-2877 IL - 0033-3549 DO - https://dx.doi.org/10.1177/0033354917707934 PT - Journal Article ID - 10.1177/0033354917707934 [doi] ID - PMC5676510 [pmc] PP - ppublish GI - No: U50 OE000065 Organization: (OE) *OSELS CDC HHS* Country: United States GI - No: U90 TP000535 Organization: (TP) *OPHPR CDC HHS* Country: United States LG - English DP - 2017 Jul/Aug PQ - 2018/07/01 EZ - 2017/07/12 06:00 DA - 2017/07/25 06:00 DT - 2017/07/11 06:00 YR - 2017 ED - 20170724 RD - 20171123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28692390 <112. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27973601 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fernandes K AU - Martins D AU - Juurlink D AU - Mamdani M AU - Paterson JM AU - Spooner L AU - Singh S AU - Gomes T FA - Fernandes, Kimberly FA - Martins, Diana FA - Juurlink, David FA - Mamdani, Muhammad FA - Paterson, J Michael FA - Spooner, Luke FA - Singh, Samantha FA - Gomes, Tara IN - Fernandes, Kimberly. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. IN - Martins, Diana. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. IN - Juurlink, David. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. IN - Juurlink, David. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. IN - Mamdani, Muhammad. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. IN - Mamdani, Muhammad. Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. IN - Mamdani, Muhammad. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. IN - Mamdani, Muhammad. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. IN - Mamdani, Muhammad. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. IN - Paterson, J Michael. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. IN - Paterson, J Michael. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. IN - Paterson, J Michael. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. IN - Spooner, Luke. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada. IN - Singh, Samantha. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. IN - Gomes, Tara. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. IN - Gomes, Tara. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. IN - Gomes, Tara. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. IN - Gomes, Tara. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. TI - High-Dose Opioid Prescribing and Opioid-Related Hospitalization: A Population-Based Study.[Erratum appears in PLoS One. 2017 Jan 20;12 (1):e0170834; PMID: 28107478] SO - PLoS ONE [Electronic Resource]. 11(12):e0167479, 2016 AS - PLoS ONE. 11(12):e0167479, 2016 NJ - PloS one VO - 11 IP - 12 PG - e0167479 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Internet JC - 101285081 IO - PLoS ONE SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Canada MH - Drug Administration Schedule MH - Female MH - Fentanyl/ad [Administration & Dosage] MH - Fentanyl/ae [Adverse Effects] MH - Fentanyl/tu [Therapeutic Use] MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - Morphine/ae [Adverse Effects] MH - Morphine/tu [Therapeutic Use] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Oxycodone/ad [Administration & Dosage] MH - Oxycodone/ae [Adverse Effects] MH - Oxycodone/tu [Therapeutic Use] MH - Young Adult AB - AIMS: To examine the impact of national clinical practice guidelines and provincial drug policy interventions on prevalence of high-dose opioid prescribing and rates of hospitalization for opioid toxicity. AB - DESIGN: Interventional time-series analysis. AB - SETTING: Ontario, Canada, from 2003 to 2014. AB - PARTICIPANTS: Ontario Drug Benefit (ODB) beneficiaries aged 15 to 64 years from 2003 to 2014. AB - INTERVENTIONS: Publication of Canadian clinical practice guidelines for use of opioids in chronic non-cancer pain (May 2010) and implementation of Ontario's Narcotics Safety and Awareness Act (NSAA; November 2011). AB - MEASUREMENTS: Three outcomes were explored: the rate of opioid use among ODB beneficiaries, the prevalence of opioid prescriptions exceeding 200 mg and 400 mg morphine equivalents per day, and rates of opioid-related emergency department visits and hospital admissions. AB - FINDINGS: Over the 12 year study period, the rate of opioid use declined 15.2%, from 2764 to 2342 users per 10,000 ODB eligible persons. The rate of opioid use was significantly impacted by the Canadian clinical practice guidelines (p-value = .03) which led to a decline in use, but no impact was observed by the enactment of the NSAA (p-value = .43). Among opioid users, the prevalence of high-dose prescribing doubled (from 4.2% to 8.7%) over the study period. By 2014, 40.9% of recipients of long-acting opioids exceeded daily doses of 200 mg morphine or equivalent, including 55.8% of long-acting oxycodone users and 76.3% of transdermal fentanyl users. Moreover, in the last period, 18.7% of long-acting opioid users exceeded daily doses of 400 mg morphine or equivalent. Rates of opioid-related emergency department visits and hospital admissions increased 55.0% over the study period from 9.0 to 14.0 per 10,000 ODB beneficiaries from 2003 to 2013. This rate was not significantly impacted by the Canadian clinical practice guidelines (p-value = .68) or enactment of the NSAA (p-value = .59). AB - CONCLUSIONS: Although the Canadian clinical practice guidelines for use of opioids in chronic non-cancer pain led to a decline in opioid prescribing rates among ODB beneficiaries these guidelines and subsequent Ontario legislation did not result in a significant change in rates of opioid-related hospitalizations. Given the prevalence of high dose opioid prescribing in this population, this suggests that improved strategies and programs for the safe prescribing of long-acting opioids are needed. CI - of the authors include: MM has served on advisory boards and/or received honorariums for unrelated work from Astra Zeneca, Bristol-Myers Squibb, Eli Lilly and Company, GlaxoSmithKline, Hoffman La Roche, Novartis, Novo Nordisk, and Pfizer; KF is currently employed at Hoffman La Roche, however during the conduct of the project KF had no involvement with Hoffman La Roche and no competing interests as this employment initiated after the completion of data analysis and interpretation. MP and TG report grants from the Ontario Ministry of Health and Long-Term Care during the conduct of the study; no other relationships or activities that could appear to have influenced the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) RN - CD35PMG570 (Oxycodone) RN - UF599785JZ (Fentanyl) ES - 1932-6203 IL - 1932-6203 DO - https://dx.doi.org/10.1371/journal.pone.0167479 PT - Journal Article ID - 10.1371/journal.pone.0167479 [doi] ID - PONE-D-16-13644 [pii] ID - PMC5156349 [pmc] PP - epublish PH - 2016/04/04 [received] PH - 2016/11/15 [accepted] LG - English EP - 20161214 DP - 2016 EZ - 2016/12/16 06:00 DA - 2017/07/06 06:00 DT - 2016/12/16 06:00 YR - 2016 ED - 20170705 RD - 20170705 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27973601 <113. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27389132 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bugaev N AU - Breeze JL AU - Alhazmi M AU - Anbari HS AU - Arabian SS AU - Holewinski S AU - Rabinovici R FA - Bugaev, Nikolay FA - Breeze, Janis L FA - Alhazmi, Majid FA - Anbari, Hassan S FA - Arabian, Sandra S FA - Holewinski, Sharon FA - Rabinovici, Reuven IN - Bugaev, Nikolay. From the Division of Trauma and Acute Care Surgery (N.B., M.A., H.S.A., S.S.A., S.H., R.R.), Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; and Tufts Clinical and Translational Science Institute (J.L.B.), Tufts University; and Institute for Clinical Research and Health Policy Studies (J.L.B.), Tufts Medical Center, Boston, Massachusetts. TI - Magnitude of rib fracture displacement predicts opioid requirements. SO - The Journal of Trauma and Acute Care Surgery. 81(4):699-704, 2016 10 AS - J Trauma Acute Care Surg. 81(4):699-704, 2016 10 NJ - The journal of trauma and acute care surgery VO - 81 IP - 4 PG - 699-704 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101570622 IO - J Trauma Acute Care Surg SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Analgesia, Patient-Controlled MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Boston MH - Female MH - Humans MH - Injury Severity Score MH - Male MH - Middle Aged MH - *Pain Management/mt [Methods] MH - Retrospective Studies MH - Rib Fractures/dg [Diagnostic Imaging] MH - *Rib Fractures/pa [Pathology] MH - Tomography, X-Ray Computed MH - Trauma Centers MH - Wounds, Nonpenetrating/dg [Diagnostic Imaging] MH - *Wounds, Nonpenetrating/pa [Pathology] AB - INTRODUCTION: It is unknown whether the magnitude of rib fracture (RF) displacement predicts pain medication requirements in blunt chest trauma patients. AB - METHODS: Adult blunt RF patients undergoing computed tomography (CT) of the chest admitted to an urban Level 1 trauma center (2007-2012) were retrospectively reviewed. Pain management in those with displaced RF (DRF), nondisplaced RF (NDRF), or combined DRF and NDRF (CRF) was compared by univariate analysis. Linear regression models were developed to determine whether total opioid requirements [expressed as log morphine equianalgesic dose (MED)] could be predicted by the magnitude of RF displacement (expressed as the sum of the Euclidean distance of all displaced RF) or number of RF, after adjusting for patient and injury characteristics. AB - RESULTS: There were 245 patients, of whom 39 (16%) had DRF only, 77 (31%) had NDRF only, and 129 (53%) had CRF. Opioids were given to 224 patients (91%). Compared to DRF (mean, 1.7 RF per patient) and NDRF patients (2.4 RF per patient), those with CRF (6.8 RF per patient) were older and had more RF per patient and a higher Injury Severity Score (ISS) and MED (251 vs 53 and 105 mg, respectively, p < 0.0001 and p = 0.0045). They also more frequently received patient-controlled analgesia. Patients with displaced RF had a lower mean ISS and MED and received more epidural analgesia compared with patients with NDRF. Total MED was associated with both the magnitude of RF displacement (p < 0.0001) and the number of RF (p < 0.0001). Every 5-mm increase in total displacement predicted a 6.3% increase in mean MED (p = 0.0035), while every additional RF predicted an 11.2% increase in MED (p = 0.0001). These associations included adjustment for age, ISS, and presence of chest tubes. AB - CONCLUSION: The magnitude of RF displacement and the number of RF predicted opioid requirements. This information may assist in anticipating patients with blunt RF who might have higher analgesic requirements. AB - LEVEL OF EVIDENCE: Therapeutic study, level IV. CI - There are no conflicts of interest to declare RN - 0 (Analgesics, Opioid) ES - 2163-0763 IL - 2163-0755 DO - https://dx.doi.org/10.1097/TA.0000000000001169 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1097/TA.0000000000001169 [doi] ID - PMC5028263 [pmc] ID - NIHMS798722 [mid] PP - ppublish GI - No: UL1 TR001064 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English DP - 2016 10 EZ - 2016/07/09 06:00 DA - 2017/07/01 06:00 DT - 2016/07/09 06:00 YR - 2016 ED - 20170629 RD - 20180124 UP - 20180124 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27389132 <114. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28166446 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weiner SG AU - Mitchell PM AU - Temin ES AU - Langlois BK AU - Dyer KS FA - Weiner, Scott G FA - Mitchell, Patricia M FA - Temin, Elizabeth S FA - Langlois, Breanne K FA - Dyer, K Sophia TI - Use of Intranasal Naloxone by Basic Life Support Providers. SO - Prehospital Emergency Care. 21(3):322-326, 2017 May-Jun AS - Prehosp Emerg Care. 21(3):322-326, 2017 May-Jun NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 21 IP - 3 PG - 322-326 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Administration, Intranasal MH - Adult MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/mt [Methods] MH - Female MH - Humans MH - Life Support Care/mt [Methods] MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Resuscitation/mt [Methods] MH - Retrospective Studies KW - basic life support; naloxone; opioid overdose AB - STUDY OBJECTIVES: Intranasal delivery of naloxone to reverse the effects of opioid overdose by Advanced Life Support (ALS) providers has been studied in several prehospital settings. In 2006, in response to the increase in opioid-related overdoses, a special waiver from the state allowed administration of intranasal naloxone by Basic Life Support (BLS) providers in our city. This study aimed to determine: 1) if patients who received a 2-mg dose of nasal naloxone administered by BLS required repeat dosing while in the emergency department (ED), and 2) the disposition of these patients. AB - METHODS: This was a retrospective review of patients transported by an inner-city municipal ambulance service to one of three academic medical centers. We included patients aged 18 and older that were transported by ambulance between 1/1/2006 and 12/12/2012 and who received intranasal naloxone by BLS providers as per a state approved protocol. Site investigators matched EMS run data to patients from each hospital's EMR and performed a chart review to confirm that the patient was correctly identified and to record the outcomes of interest. Descriptive statistics were then generated. AB - RESULTS: A total of 793 patients received nasal naloxone by BLS and were transported to three hospitals. ALS intervened and transported 116 (14.6%) patients, and 11 (1.4%) were intubated in the field. There were 724 (91.3%) patients successfully matched to an ED chart. Hospital A received 336 (46.4%) patients, Hospital B received 210 (29.0%) patients, and Hospital C received 178 (24.6%) patients. Mean age was 36.2 (SD 10.5) years and 522 (72.1%) were male; 702 (97.1%) were reported to have abused heroin while 21 (2.9%) used other opioids. Nasal naloxone had an effect per the prehospital record in 689 (95.2%) patients. An additional naloxone dose was given in the ED to 64 (8.8%) patients. ED dispositions were: 507 (70.0%) discharged, 105 (14.5%) admitted, and 112 (15.5%) other (e.g., left against medical advice, left without being seen, or transferred). AB - CONCLUSIONS: Only a small percentage of patients receiving prehospital administration of nasal naloxone by BLS providers required additional doses of naloxone in the ED and the majority of patients were discharged. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.1080/10903127.2017.1282562 PT - Journal Article ID - 10.1080/10903127.2017.1282562 [doi] PP - ppublish LG - English EP - 20170206 DP - 2017 May-Jun EZ - 2017/02/07 06:00 DA - 2017/06/29 06:00 DT - 2017/02/07 06:00 YR - 2017 ED - 20170628 RD - 20170628 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28166446 <115. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28059581 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Armenian P AU - Campagne D AU - Stroh G AU - Ives Tallman C AU - Zeng WZD AU - Lin T AU - Gerona RR FA - Armenian, Patil FA - Campagne, Danielle FA - Stroh, Geoff FA - Ives Tallman, Crystal FA - Zeng, William Z D FA - Lin, Thomas FA - Gerona, Roy R TI - Hot and Cold Drugs: National Park Service Medication Stability at the Extremes of Temperature. SO - Prehospital Emergency Care. 21(3):378-385, 2017 May-Jun AS - Prehosp Emerg Care. 21(3):378-385, 2017 May-Jun NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 21 IP - 3 PG - 378-385 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Cold Temperature MH - *Drug Stability MH - *Emergency Medical Services/st [Standards] MH - Hot Temperature MH - *Parks, Recreational KW - National Park Service; Parkmedic; medication stability; pharmacology AB - STUDY OBJECTIVE: National Park Service (NPS) Parkmedics provide medical care in austere environments. The objective of this study was to evaluate the stability of specific medications used by Parkmedics at extremes of temperatures likely to be faced in the field. AB - METHODS: This is a bench research study conducted in the laboratory setting over a 4-week period. Parenteral medications were separated into 4 temperature exposure groups: A) 45degreeC (hot); B) -20degreeC (cold); C) hot then cold temperatures alternating weekly; and D) cold then hot temperatures alternating weekly. At study start and the end of each week, three aliquots from each group were sampled to determine the remaining drug concentration through liquid chromatography-quadrupole time-of-flight mass spectrometry (Agilent LC 1260- QTOF/MS 6550). Quantitative analysis was done using Agilent MassHunter Quantitative Analysis software. The mean drug concentration from triplicate aliquots was expressed as percentage of its baseline concentration to monitor the drug's stability during storage. AB - RESULTS: Eight medications were analyzed (atropine, diphenhydramine, fentanyl, hydromorphone, midazolam, morphine, naloxone, ondansetron). Hydromorphone, morphine, and ondansetron showed the greatest stability, at above 90% of original concentration in all study arms. Diphenhydramine, fentanyl and midazolam showed heat independent degradation, degrading the same way regardless of heat exposure. By the end of the study period, 51-56% midazolam remained in all groups. Atropine and naloxone showed heat dependent degradation, degrading more when exposed to heat. Atropine had the most degradation, being undetectable after 4 weeks of heat exposure. AB - CONCLUSIONS: We recommend that EMS providers replace atropine, naloxone, diphenhydramine, fentanyl, and midazolam frequently if they are practicing in low call volume or high-temperature environments. Further studies will be needed to determine if re-dosing midazolam, naloxone, and atropine is the appropriate clinical strategy in this setting if adequate clinical effect is not reached with a single dose. ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.1080/10903127.2016.1258098 PT - Journal Article ID - 10.1080/10903127.2016.1258098 [doi] PP - ppublish LG - English EP - 20170106 DP - 2017 May-Jun EZ - 2017/01/07 06:00 DA - 2017/06/29 06:00 DT - 2017/01/07 06:00 YR - 2017 ED - 20170628 RD - 20170628 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28059581 <116. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27473610 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Armenian P AU - Olson A AU - Anaya A AU - Kurtz A AU - Ruegner R AU - Gerona RR FA - Armenian, Patil FA - Olson, Alexander FA - Anaya, Andres FA - Kurtz, Alicia FA - Ruegner, Rawnica FA - Gerona, Roy R IN - Armenian, Patil. Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, CA. Electronic address: parmenian@fresno.ucsf.edu. IN - Olson, Alexander. Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA. IN - Anaya, Andres. Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, CA. IN - Kurtz, Alicia. Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, CA. IN - Ruegner, Rawnica. Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, CA. IN - Gerona, Roy R. Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA. TI - Fentanyl and a Novel Synthetic Opioid U-47700 Masquerading as Street "Norco" in Central California: A Case Report. CM - Comment in: Ann Emerg Med. 2017 Jan;69(1):91-93; PMID: 27745765 SO - Annals of Emergency Medicine. 69(1):87-90, 2017 Jan AS - Ann Emerg Med. 69(1):87-90, 2017 Jan NJ - Annals of emergency medicine VO - 69 IP - 1 PG - 87-90 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Benzamides/to [Toxicity] MH - California MH - *Designer Drugs/to [Toxicity] MH - Drug Interactions MH - Emergency Service, Hospital MH - Female MH - *Fentanyl/to [Toxicity] MH - Humans MH - *Narcotics/to [Toxicity] MH - Opioid-Related Disorders/co [Complications] MH - Opioid-Related Disorders/di [Diagnosis] AB - In 2013 and 2014, more than 700 deaths were attributed to fentanyl and fentanyl analogues in the United States. Of recent concern is the cluster of unintentional fentanyl overdoses because of tablets thought to be "Norco" purchased on the street in Northern California. U-47700 (trans-3,4-dichloro-N-[2-(dimethyl-amino)cyclohexyl]-N-methylbenz-amide) is a nonfentanyl-based synthetic opioid with 7.5 times the binding affinity of morphine to mu-opioid. We report a case of fentanyl and U-47700 intoxication from what was thought to be illicitly purchased Norco. A 41-year-old woman presented to the emergency department (ED) for altered mental status shortly after ingesting 3 beige Norco pills bearing a Watson imprint. She had pinpoint pupils and respiratory depression, which reversed after 0.4 mg naloxone administration intravenously. She had complete recovery and was discharged from the ED after a 4-hour observation period. Serum testing with liquid chromatography-quadrupole time-of-flight mass spectrometry (LC 1260 QTOF/MS 6550; Agilent, Santa Clara, CA) confirmed the presence of the medications the patient reported receiving, and additionally fentanyl (15.2 ng/mL) and U-47700 (7.6 ng/mL). In this case report, street Norco purchased in Central California resulted in altered mental status requiring naloxone reversal because of fentanyl and the novel synthetic opioid U-47700. Because these compounds are not detected by routine urine drug testing and physical examination findings are similar to those of a traditional opioid toxidrome, emergency providers should use the patient's history and other circumstantial details to aid in diagnosis. In cases with suspicion of opioid or opioid analogue cause, we recommend that emergency providers contact their local poison control center, medical toxicologist, or public health department to aid in the investigation. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Benzamides) RN - 0 (Designer Drugs) RN - 0 (Narcotics) RN - 0 (U-47700) RN - UF599785JZ (Fentanyl) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(16)30292-X DO - https://dx.doi.org/10.1016/j.annemergmed.2016.06.014 PT - Case Reports PT - Journal Article ID - S0196-0644(16)30292-X [pii] ID - 10.1016/j.annemergmed.2016.06.014 [doi] PP - ppublish PH - 2016/04/27 [received] LG - English EP - 20160726 DP - 2017 Jan EZ - 2016/07/31 06:00 DA - 2017/06/28 06:00 DT - 2016/07/31 06:00 YR - 2017 ED - 20170627 RD - 20171130 UP - 20171130 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27473610 <117. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27861834 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ahmed ZA AU - Nacopoulos DA AU - John S AU - Papesh N AU - Levine D AU - Bamford CC FA - Ahmed, Zubair A FA - Nacopoulos, Dimitrios A FA - John, Seby FA - Papesh, Nancy FA - Levine, David FA - Bamford, Cynthia C IN - Ahmed, Zubair A. Division of Headache, Department of Neurology, University of Utah, Salt Lake City, UT, USA. IN - Nacopoulos, Dimitrios A. Department of Adult Neurology, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA. IN - John, Seby. Department of Adult Neurology, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA. IN - Papesh, Nancy. Department of Adult Neurology, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA. IN - Levine, David. Department of Emergency Medicine, Lakewood Hospital, Lakewood, OH, USA. IN - Bamford, Cynthia C. Center for Neuro-Restoration, Center for Headache and Pain, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA. TI - An Algorithm for Opioid and Barbiturate Reduction in the Acute Management of Headache in the Emergency Department. SO - Headache. 57(1):71-79, 2017 Jan AS - Headache. 57(1):71-79, 2017 Jan NJ - Headache VO - 57 IP - 1 PG - 71-79 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 2985091r, g1n IO - Headache SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Algorithms MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Barbiturates/tu [Therapeutic Use] MH - *Central Nervous System Agents/tu [Therapeutic Use] MH - Clinical Protocols MH - Disease Management MH - *Emergency Medical Services/mt [Methods] MH - Emergency Service, Hospital MH - Female MH - *Headache/dt [Drug Therapy] MH - Humans MH - Male MH - Middle Aged MH - Pilot Projects MH - Quality Improvement MH - Retrospective Studies MH - Young Adult KW - headache; migraine; opioid; quality improvement AB - OBJECTIVE: To develop and implement an algorithm for the management of headaches presenting to the emergency department (ED) in order to decrease the frequency of opioid and barbiturate treatment both acutely as well as on discharge. AB - BACKGROUND: Headache is the fifth leading cause of ED visits in the United States. In the case of primary headache, particularly migraine, treatment in the ED can be highly variable. Patients with migraine continue to be treated with opioids more commonly than nonopioid, migraine specific medications. In addition, discharge plans seldom include measures to prevent recurrence or instructions to re-treat if pain persists. At this time, there is no standardized management protocol directed at acute headaches presenting to the ED. AB - METHODS: An ED headache treatment algorithm with step-wise instructions for diagnosis, treatment, and discharge planning was piloted at Lakewood Hospital, a regional Cleveland Clinic affiliated hospital. This non-randomized interventional study compared outcomes after implementation of the algorithm to historical controls. Patient demographic data including age, gender, and payer mix was collected. Outcomes measured included the frequency of treatment with opioids or barbiturates, imaging, neurology consults, admissions, and a patient reported pain score. Data relevant to patient disposition and follow-up, including prescriptions for opioids or barbiturates given at discharge, and ensuring PCP or neurology follow-up appointments at discharge was also reviewed. AB - RESULTS: Demographic data did not differ significantly between the pre- and post-algorithm groups. There was a significant decline in the number of patients treated with opioids and barbiturates from 66.0% pre-algorithm to 6.8% immediately after algorithm implementation (P <. 001), and to 28% (P<.001) one year after algorithm implementation, indicating both an immediate effect of the algorithm and a sustained effect. Similarly, pre-algorithm implementation, 37% of patients were discharged with a prescription for opioids or barbiturates as compared to 12% and 6% in the early post-algorithm cohort and at 1 year, respectively. There was also an increase in scheduled follow-up appointments after discharge from the ED from 59% to 98% immediately post algorithm (P<.001). Other measures including the frequency of imaging, and patient reported pain did not significantly change. There was a significant increase in neurology consults and admissions a year after the algorithm was implemented. AB - CONCLUSIONS: A quality improvement pilot study aimed at treating headache in an Emergency Department setting was successfully implemented in a regional Cleveland Clinic Hospital. Our results demonstrated significant decrease in acute treatment with opioids or barbiturates and a decrease in prescriptions written for opioids or barbiturates on discharge. This study is limited by small sample size. More data are needed to determine the reason for 1) increased consultation and subsequent admission after algorithm implementation and 2) decreased scheduled follow-up appointments at one-year post algorithm. Copyright © 2016 American Headache Society. RN - 0 (Analgesics, Opioid) RN - 0 (Barbiturates) RN - 0 (Central Nervous System Agents) ES - 1526-4610 IL - 0017-8748 DO - https://dx.doi.org/10.1111/head.12961 PT - Clinical Study PT - Journal Article ID - 10.1111/head.12961 [doi] PP - ppublish PH - 2016/05/16 [received] PH - 2016/08/15 [revised] PH - 2016/08/16 [accepted] LG - English EP - 20161110 DP - 2017 Jan EZ - 2016/11/20 06:00 DA - 2017/06/27 06:00 DT - 2016/11/19 06:00 YR - 2017 ED - 20170626 RD - 20170817 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27861834 <118. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27800652 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Okorji LM AU - Muntz DS AU - Liem RI FA - Okorji, Leslie M FA - Muntz, Devin S FA - Liem, Robert I IN - Okorji, Leslie M. Division of Hematology, Oncology & Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. IN - Okorji, Leslie M. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. IN - Muntz, Devin S. Division of Hematology, Oncology & Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. IN - Muntz, Devin S. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. IN - Liem, Robert I. Division of Hematology, Oncology & Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. IN - Liem, Robert I. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. TI - Opioid prescription practices at discharge and 30-day returns in children with sickle cell disease and pain. SO - Pediatric Blood & Cancer. 64(5), 2017 May AS - Pediatr Blood Cancer. 64(5), 2017 May NJ - Pediatric blood & cancer VO - 64 IP - 5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101186624 IO - Pediatr Blood Cancer SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - Adolescent MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Anemia, Sickle Cell/pa [Pathology] MH - *Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use] MH - Child MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Humans MH - Pain Measurement MH - Patient Discharge MH - Patient Readmission/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians' MH - Retrospective Studies MH - Young Adult KW - opioids; pain crises; readmission; sickle cell disease AB - BACKGROUND: Acute pain episodes in children with sickle cell disease (SCD) represent a leading cause of readmissions. We examined prescription practices at the time of discharge in children with SCD presenting with acute pain to determine their impact on 30-day emergency department (ED) revisits and readmissions. AB - METHODS: In this single-institution, 5-year retrospective study, we reviewed 290 encounters of patients with SCD aged 7-21 years hospitalized or discharged from the ED with acute pain. We reviewed demographic, treatment and discharge data, and 30-day returns, defined as ED revisits and readmissions within 30 days of discharge. Bivariate and multivariable analyses were performed to evaluate the association between discharge prescription practices and 30-day returns. AB - RESULTS: Compared to hospitalizations, treat-and-release ED visits for acute pain were associated with a higher incidence of 30-day returns (OR = 2.7 [95% CI: 1.5-4.8], P < 0.01). We found no association between prescribed opioid frequency (scheduled vs. as-needed) and 30-day returns (OR = 1.12 [95% CI: 0.62-2.02], P = 0.70). By multivariable logistic regression, the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) only, without opioids, after treat-and-release ED visits was independently associated with a higher frequency of 30-day ED revisits (OR = 6.9 [95% CI: 1.3-37.3], P = 0.03) but not readmissions. AB - CONCLUSION: Variability exists in opioid prescription practices after discharge in children with SCD and pain episodes. Prescription of NSAIDs only, without opioids, was an independent predictor of higher 30-day ED revisits. Formalized studies to better understand factors that influence returns, including outpatient opioid management, are warranted in this population. Copyright © 2016 Wiley Periodicals, Inc. RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) ES - 1545-5017 IL - 1545-5009 DO - https://dx.doi.org/10.1002/pbc.26319 PT - Journal Article ID - 10.1002/pbc.26319 [doi] PP - ppublish PH - 2016/05/05 [received] PH - 2016/09/26 [accepted] LG - English EP - 20161101 DP - 2017 May EZ - 2016/11/02 06:00 DA - 2017/06/27 06:00 DT - 2016/11/02 06:00 YR - 2017 ED - 20170626 RD - 20170626 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27800652 <119. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27330662 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ryoo HJ AU - Choo EK FA - Ryoo, Hyeon-Ju FA - Choo, Esther K IN - Ryoo, Hyeon-Ju. The Warren Alpert Medical School of Brown University, Providence, Rhode Island. IN - Choo, Esther K. The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island. TI - Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids. SO - The Western Journal of Emergency Medicine. 17(3):295-301, 2016 May AS - West J Emerg Med. 17(3):295-301, 2016 May NJ - The western journal of emergency medicine VO - 17 IP - 3 PG - 295-301 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899061 SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Cross-Sectional Studies MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Inactivation, Metabolic MH - Logistic Models MH - Male MH - Middle Aged MH - *Opiate Substitution Treatment/sn [Statistics & Numerical Data] MH - Prevalence MH - *Referral and Consultation/sn [Statistics & Numerical Data] MH - Referral and Consultation/td [Trends] MH - Sex Distribution MH - *Street Drugs MH - *Substance-Related Disorders/ep [Epidemiology] MH - United States/ep [Epidemiology] MH - Young Adult AB - INTRODUCTION: Visits to the emergency department (ED) for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide. AB - METHODS: We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN). All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient "seeking detox," or patient explicitly requesting for detox referral. AB - RESULTS: Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]). Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02-1.22]), for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15-1.40]), and for prescription opioids (OR 1.30, 95% CI [1.17-1.43]). This significant association prevailed after controlling for "seeking detox." AB - CONCLUSION: Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are "seeking detox." Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes. RN - 0 (Street Drugs) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2016.2.29425 PT - Journal Article ID - 10.5811/westjem.2016.2.29425 [doi] ID - wjem-17-295 [pii] ID - PMC4899061 [pmc] PP - ppublish PH - 2015/12/03 [received] PH - 2016/01/27 [revised] PH - 2016/02/06 [accepted] LG - English EP - 20160428 DP - 2016 May EZ - 2016/06/23 06:00 DA - 2017/06/24 06:00 DT - 2016/06/23 06:00 YR - 2016 ED - 20170622 RD - 20170622 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27330662 <120. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27330656 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Burton JH AU - Hoppe JA AU - Echternach JM AU - Rodgers JM AU - Donato M FA - Burton, John H FA - Hoppe, Jason A FA - Echternach, Jeff M FA - Rodgers, Justin M FA - Donato, Michael IN - Burton, John H. Carilion Clinic, Department of Emergency Medicine, Roanoke, Virginia. IN - Hoppe, Jason A. University of Colorado Denver School of Medicine, Department of Emergency Medicine, Aurora, Colorado; Rocky Mountain Poison and Drug Center, Denver, Colorado. IN - Echternach, Jeff M. Carilion Clinic, Department of Emergency Medicine, Roanoke, Virginia. IN - Rodgers, Justin M. Carilion Clinic, Department of Emergency Medicine, Roanoke, Virginia. IN - Donato, Michael. Carilion Clinic, Department of Emergency Medicine, Roanoke, Virginia. TI - Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing. SO - The Western Journal of Emergency Medicine. 17(3):258-63, 2016 May AS - West J Emerg Med. 17(3):258-63, 2016 May NJ - The western journal of emergency medicine VO - 17 IP - 3 PG - 258-63 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899055 SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Analysis of Variance MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Guideline Adherence MH - Guidelines as Topic MH - Humans MH - *Inappropriate Prescribing/sn [Statistics & Numerical Data] MH - *Pain/dt [Drug Therapy] MH - Pain/ep [Epidemiology] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Program Evaluation MH - Quality Improvement MH - Retrospective Studies MH - United States/ep [Epidemiology] AB - INTRODUCTION: Addressing pain is a crucial aspect of emergency medicine. Prescription opioids are commonly prescribed for moderate to severe pain in the emergency department (ED); unfortunately, prescribing practices are variable. High variability of opioid prescribing decisions suggests a lack of consensus and an opportunity to improve care. This quality improvement (QI) initiative aimed to reduce variability in ED opioid analgesic prescribing. AB - METHODS: We evaluated the impact of a three-part QI initiative on ED opioid prescribing by physicians at seven sites. Stage 1: Retrospective baseline period (nine months). Stage 2: Physicians were informed that opioid prescribing information would be prospectively collected and feedback on their prescribing and that of the group would be shared at the end of the stage (three months). Stage 3: After physicians received their individual opioid prescribing data with blinded comparison to the group means (from Stage 2) they were informed that individual prescribing data would be unblinded and shared with the group after three months. The primary outcome was variability of the standard error of the mean and standard deviation of the opioid prescribing rate (defined as number of patients discharged with an opioid divided by total number of discharges for each provider). Secondary observations included mean quantity of pills per opioid prescription, and overall frequency of opioid prescribing. AB - RESULTS: The study group included 47 physicians with 149,884 ED patient encounters. The variability in prescribing decreased through each stage of the initiative as represented by the distributions for the opioid prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction, p<0.01), and Stage 3 mean 8% (60% reduction, p<0.01). The mean quantity of pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage 2 (18% reduction, p<0.01), and 13 pills in Stage 3 (18% reduction, p<0.01). The group mean prescribing rate also decreased through each stage: 20% in Stage 1, 13% in Stage 2 (46% reduction, p<0.01), and 8% in Stage 3 (60% reduction, p<0.01). AB - CONCLUSION: ED physician opioid prescribing variability can be decreased through the systematic application of sharing of peer prescribing rates and prescriber specific normative feedback. RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2016.3.29692 PT - Journal Article ID - 10.5811/westjem.2016.3.29692 [doi] ID - wjem-17-258 [pii] ID - PMC4899055 [pmc] PP - ppublish PH - 2016/01/04 [received] PH - 2016/03/02 [revised] PH - 2016/03/08 [accepted] LG - English EP - 20160502 DP - 2016 May EZ - 2016/06/23 06:00 DA - 2017/06/24 06:00 DT - 2016/06/23 06:00 YR - 2016 ED - 20170622 RD - 20170622 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27330656 <121. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28349714 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Helander A AU - Backberg M AU - Signell P AU - Beck O FA - Helander, Anders FA - Backberg, Matilda FA - Signell, Patrick FA - Beck, Olof IN - Helander, Anders. a Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden. IN - Helander, Anders. b Clinical Pharmacology, Karolinska University Laboratory , Stockholm , Sweden. IN - Backberg, Matilda. c Swedish Poisons Information Centre , Stockholm , Sweden. IN - Signell, Patrick. b Clinical Pharmacology, Karolinska University Laboratory , Stockholm , Sweden. IN - Beck, Olof. a Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden. IN - Beck, Olof. b Clinical Pharmacology, Karolinska University Laboratory , Stockholm , Sweden. TI - Intoxications involving acrylfentanyl and other novel designer fentanyls - results from the Swedish STRIDA project. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 55(6):589-599, 2017 Jul AS - Clin Toxicol (Phila). 55(6):589-599, 2017 Jul NJ - Clinical toxicology (Philadelphia, Pa.) VO - 55 IP - 6 PG - 589-599 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adult MH - Analgesics, Opioid/ch [Chemistry] MH - *Analgesics, Opioid/po [Poisoning] MH - Antidotes/ad [Administration & Dosage] MH - Chromatography, Liquid/mt [Methods] MH - Designer Drugs/ch [Chemistry] MH - *Designer Drugs/po [Poisoning] MH - Emergency Service, Hospital MH - Female MH - Fentanyl/aa [Analogs & Derivatives] MH - Fentanyl/ch [Chemistry] MH - *Fentanyl/po [Poisoning] MH - Humans MH - Intensive Care Units MH - Internet MH - Male MH - Mass Spectrometry/mt [Methods] MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - Poison Control Centers MH - Street Drugs/ch [Chemistry] MH - *Street Drugs/po [Poisoning] MH - Substance Abuse Detection/mt [Methods] MH - Sweden/ep [Epidemiology] MH - Young Adult KW - 4-chloroisobutyrfentanyl; 4-fluoroisobutyrfentanyl; Acrylfentanyl; NPS; cyclopentylfentanyl; fentanyl; furanylfentanyl; internet drug; mass spectrometry method; new psychoactive substance; opioid analgesic drug; tetrahydrofuranfentanyl AB - BACKGROUND: The number of new psychoactive substances (NPS) introduced through the online recreational drugs market increases continuously. This report from the Swedish STRIDA project describes analytically confirmed intoxications involving the novel fentanyl analogs acrylfentanyl, 4-chloroisobutyrfentanyl (4Cl-iBF), 4-fluoroisobutyrfentanyl (4F-iBF), and tetrahydrofuranfentanyl (THF-F), and cyclopentylfentanyl in a drug product. AB - METHODS: Patients with suspected NPS exposure presenting in emergency departments (ED) or intensive care units (ICU) in Sweden and requiring hospital care are invited to the STRIDA project. NPS analysis of serum and urine samples was performed by multi-component liquid chromatography-mass spectrometry. Data on clinical features were retrieved from telephone consultations with the Swedish Poisons Information Centre and from medical records. AB - RESULTS: Between April and October 2016, eleven intoxications involving acrylfentanyl (8 cases), acrylfentanyl together with 4Cl-iBF (1), 4F-iBF (1), and THF-F (1) were analytically confirmed. Patients were aged 19-51 (median 28) years and 91% were men. Six (55%) were monitored at the ED, and five admitted to the ICU. Typical clinical features were decreased consciousness, respiratory depression, and miosis. In 8 cases, the antidote naloxone was administered to counter the opioid effects. The 4F-iBF positive patient eventually died of brain edema. The serum acrylfentanyl concentration (n=8) ranged 0.5-2.1 (median 0.9) ng/mL, and in urine (n=9) 0.2-10.5 (mean 4.6, median 5.2) mug/mmol creatinine. For 4Cl-iBF, 4F-iBF, and THF-F (n=1 each), higher serum (5-45ng/mL) and urine (11-136mug/mmol creatinine) concentrations were found. Other NPS (e.g., flunitrazolam) and/or classical drugs were detected in five cases. In early 2016, nasal sprays with a claimed content of acrylfentanyl brought to hospital by patients or obtained by test purchase were demonstrated to instead contain fentanyl. AB - CONCLUSIONS: Potentially life-threatening opioid toxicity was seen in 11 acute intoxications involving the fentanyl analogs acrylfentanyl, 4Cl-iBF, 4F-iBF, and THF-F, which are available through open Internet trading. All patients were supported with acute and intensive hospital care, and naloxone was effective to reverse the opioid symptoms. One patient died of brain edema. RN - 0 (Analgesics, Opioid) RN - 0 (Antidotes) RN - 0 (Designer Drugs) RN - 0 (Street Drugs) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.1080/15563650.2017.1303141 PT - Journal Article ID - 10.1080/15563650.2017.1303141 [doi] PP - ppublish LG - English EP - 20170328 DP - 2017 Jul EZ - 2017/03/30 06:00 DA - 2017/06/21 06:00 DT - 2017/03/29 06:00 YR - 2017 ED - 20170620 RD - 20170620 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28349714 <122. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27745764 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kestler A AU - Buxton J AU - Meckling G AU - Giesler A AU - Lee M AU - Fuller K AU - Quian H AU - Marks D AU - Scheuermeyer F FA - Kestler, Andrew FA - Buxton, Jane FA - Meckling, Gray FA - Giesler, Amanda FA - Lee, Michelle FA - Fuller, Kirsten FA - Quian, Hong FA - Marks, Dalya FA - Scheuermeyer, Frank IN - Kestler, Andrew. Department of Emergency Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: andrew.kestler@ubc.ca. IN - Buxton, Jane. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada. IN - Meckling, Gray. Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada. IN - Giesler, Amanda. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. IN - Lee, Michelle. School of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. IN - Fuller, Kirsten. Department of Emergency Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada. IN - Quian, Hong. Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada. IN - Marks, Dalya. London School of Tropical Medicine & Hygiene. IN - Scheuermeyer, Frank. Department of Emergency Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada. TI - Factors Associated With Participation in an Emergency Department-Based Take-Home Naloxone Program for At-Risk Opioid Users. SO - Annals of Emergency Medicine. 69(3):340-346, 2017 Mar AS - Ann Emerg Med. 69(3):340-346, 2017 Mar NJ - Annals of emergency medicine VO - 69 IP - 3 PG - 340-346 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Patient Acceptance of Health Care/px [Psychology] MH - Patient Acceptance of Health Care/sn [Statistics & Numerical Data] MH - *Patient Acceptance of Health Care MH - Patient Education as Topic MH - Self Care/mt [Methods] AB - STUDY OBJECTIVE: Although the World Health Organization recommends take-home naloxone to address the increasing global burden of opioid-related deaths, few emergency departments (EDs) offer a take-home naloxone program. We seek to determine the take-home naloxone acceptance rate among ED patients at high risk of opioid overdose and to examine factors associated with acceptance. AB - METHODS: At a single urban ED, consecutive eligible patients at risk of opioid overdose were invited to complete a survey about opioid use, overdose experience, and take-home naloxone awareness, and then offered take-home naloxone. The primary outcome was acceptance of take-home naloxone, including the kit and standardized patient training. Univariate and multivariable logistic analyses were used to evaluate factors associated with acceptance. AB - RESULTS: Of 241 eligible patients approached, 201 (83.4%) completed the questionnaire. Three-quarters of respondents used injection drugs, 37% were women, and 26% identified as "Indigenous." Of 201 respondents, 137 (68.2%; 95% confidence interval [CI] 61.7% to 74.7%) accepted take-home naloxone. Multivariable analysis revealed that factors associated with take-home naloxone acceptance included witnessing overdose in others (odds ratio [OR] 4.77; 95% CI 2.25 to 10.09), concern about own overdose death (OR 3.71; 95% CI 1.34 to 10.23), female sex (OR 2.50; 95% CI 1.21 to 5.17), and injection drug use (OR 2.22; 95% CI 1.06 to 4.67). AB - CONCLUSION: A two-thirds ED take-home naloxone acceptance rate in patients using opioids should encourage all EDs to dispense take-home naloxone. ED-based take-home naloxone programs have the potential to improve access to take-home naloxone and awareness in individuals most vulnerable to overdoses. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(16)30407-3 DO - https://dx.doi.org/10.1016/j.annemergmed.2016.07.027 PT - Journal Article ID - S0196-0644(16)30407-3 [pii] ID - 10.1016/j.annemergmed.2016.07.027 [doi] PP - ppublish PH - 2016/04/12 [received] PH - 2016/07/07 [revised] PH - 2016/07/15 [accepted] LG - English EP - 20161010 DP - 2017 Mar EZ - 2016/10/18 06:00 DA - 2017/06/21 06:00 DT - 2016/10/18 06:00 YR - 2017 ED - 20170620 RD - 20170728 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27745764 <123. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28489008 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Thorsdottir G AU - Benedikz E AU - Thorgeirsdottir SA AU - Johannsson M FA - Thorsdottir, Gudlaug FA - Benedikz, Elisabet FA - Thorgeirsdottir, Sigridur A FA - Johannsson, Magnus TI - [Do opioids, sedatives and proton-pump inhibitors increase the risk of fractures?]. [Icelandic] SO - Laeknabladid. 103(5):231-235, 2017 Mai AS - Laeknabladid. 103(5):231-235, 2017 Mai NJ - Laeknabladid VO - 103 IP - 5 PG - 231-235 PI - Journal available in: Print PI - Citation processed from: Print JC - 7901326 IO - Laeknabladid SB - Index Medicus CP - Iceland MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Databases, Factual MH - Emergency Medical Services MH - Female MH - *Fractures, Bone/ci [Chemically Induced] MH - Fractures, Bone/dg [Diagnostic Imaging] MH - Fractures, Bone/ep [Epidemiology] MH - Hospitals, University MH - Humans MH - *Hypnotics and Sedatives/ae [Adverse Effects] MH - Iceland/ep [Epidemiology] MH - Incidence MH - Male MH - Odds Ratio MH - *Proton Pump Inhibitors/ae [Adverse Effects] MH - Risk Assessment MH - Risk Factors MH - Time Factors AB - INTRODUCTION: A pharmacoepidemiological study was conducted to analyse the relationship between bone fracture and the use of certain drugs. AB - MATERIAL/METHODS: The study includes patients 40 years and older, diagnosed with bone fractures in the Emergency Department of Landspitali University Hospital in Reykjavik, Iceland, during a 10-year period (2002-2011). Also were included those who picked up from a pharmacy 90 DDD or more per year of the drugs included in the study in the capital region of Iceland during same period. Opiates, benzodiazepines/hypnotics (sedatives) were compared with HMG-CoA reductase inhibitors (statins), non-steroid anti-inflammatory drugs (NSAID) and beta blockers. Proton-pump inhibitors (PPI) and histamine H2-antagonists were also examined. To examine the association between above drugs and fractures the data from electronic hospital database were matched to the prescription database run by the Directorate of Health. AB - RESULTS: A total of 29,056 fractures in 22,891 individuals were identified. The females with fractures were significantly older and twice as many, compared to males. The odds ratio (OR) for fractures was not significantly different between the NSAID, statins and beta blockers. OR for opiates showed almost double increased risk of fractures, 40% increased risk for sedatives and 30% increased risk for PPIs compared to beta blockers. No increased fracture-risk was noted in patients taking H2 antagonists. AB - CONCLUSION: This study shows a relationship between the use of opiates, sedatives and bone fractures. The incidence of fractures was also increased in patients taking PPIs which is interesting in the light of the wide-spread use of PPIs in the community. Key words: Opiates, sedatives, proton- pump inhibitors, fractures. Correspondence: Magnus Johannsson, magjoh@hi.is. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 0 (Proton Pump Inhibitors) IS - 0023-7213 IL - 0023-7213 DO - https://dx.doi.org/10.17992/lbl.2017.05.136 PT - Journal Article PP - ppublish LG - Icelandic DP - 2017 Mai EZ - 2017/05/11 06:00 DA - 2017/06/20 06:00 DT - 2017/05/11 06:00 YR - 2017 ED - 20170619 RD - 20170619 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28489008 <124. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26875061 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Butler MM AU - Ancona RM AU - Beauchamp GA AU - Yamin CK AU - Winstanley EL AU - Hart KW AU - Ruffner AH AU - Ryan SW AU - Ryan RJ AU - Lindsell CJ AU - Lyons MS FA - Butler, Megan M FA - Ancona, Rachel M FA - Beauchamp, Gillian A FA - Yamin, Cyrus K FA - Winstanley, Erin L FA - Hart, Kimberly W FA - Ruffner, Andrew H FA - Ryan, Shawn W FA - Ryan, Richard J FA - Lindsell, Christopher J FA - Lyons, Michael S IN - Butler, Megan M. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. IN - Ancona, Rachel M. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. IN - Beauchamp, Gillian A. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. IN - Yamin, Cyrus K. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. IN - Winstanley, Erin L. James L. Winkle College of Pharmacy and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH. IN - Hart, Kimberly W. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. IN - Ruffner, Andrew H. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. IN - Ryan, Shawn W. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. IN - Ryan, Richard J. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. IN - Lindsell, Christopher J. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. IN - Lyons, Michael S. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. Electronic address: lyonsme@ucmail.uc.edu. TI - Emergency Department Prescription Opioids as an Initial Exposure Preceding Addiction. CM - Comment in: Ann Emerg Med. 2016 Aug;68(2):209-12; PMID: 26973177 SO - Annals of Emergency Medicine. 68(2):202-8, 2016 Aug AS - Ann Emerg Med. 68(2):202-8, 2016 Aug NJ - Annals of emergency medicine VO - 68 IP - 2 PG - 202-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958587 OI - Source: NLM. NIHMS759463 [Available on 08/01/17] SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cross-Sectional Studies MH - *Emergency Service, Hospital MH - Female MH - Hospitals, Teaching MH - Hospitals, Urban MH - Humans MH - Iatrogenic Disease MH - Male MH - *Opioid-Related Disorders/et [Etiology] MH - Practice Patterns, Physicians' MH - Prescription Drug Misuse AB - STUDY OBJECTIVE: Opioid abuse and overdose constitute an ongoing health emergency. Many presume opioids have little potential for iatrogenic addiction when used as directed, particularly in short courses, as is typical of the emergency department (ED) setting. We preliminarily explore the possibility that initial exposure to opioids by EDs could be related to subsequent opioid misuse. AB - METHODS: This cross-sectional study surveyed a convenience sample of patients reporting heroin or nonmedical opioid use at an urban, academic ED. We estimated the proportion whose initial exposure to opioids was a legitimate medical prescription and the proportion of those prescriptions that came from an ED. Secondary measurements included the proportion of patients receiving nonopioid substances before initial opioid exposure, the source of opioids between initial exposure and onset of regular nonmedical use, and time from initial prescription to opioid use disorder. AB - RESULTS: Of 59 subjects, 35 (59%; 95% confidence interval [CI] 47% to 71%) reported they were first exposed to opioids by a legitimate medical prescription, and for 10 of 35 (29%; 95% CI 16% to 45%), the prescription came from an ED. Most medically exposed subjects (28/35; 80%; 95% CI 65% to 91%) reported nonopioid substance use or treatment for nonopioid substance use disorders preceding the initial opioid exposure. Emergency providers were a source of opioids between exposure and onset of regular nonmedical use in 11 of 35 cases (31%; 95% CI 18% to 48%). Thirty-one of the 35 medically exposed subjects reported the time of onset of nonmedical use; median time from exposure to onset of nonmedical use was 6 months for use to get high (N=25; interquartile range [IQR] 2 to 36), 12 months for regular use to get high (N=24; IQR 2 to 36), 18 months for use to avoid withdrawal (N=26; IQR 2 to 38), and 24 months for regular use to avoid withdrawal (N=27; IQR 2 to 48). Eleven subjects (36%; 95% CI 21% to 53%) began nonmedical use within 2 months, and 9 of 11 (82%; 95% CI 53% to 96%) reported nonopioid substance use or treatment for alcohol abuse before initial opioid exposure. AB - CONCLUSION: Although short-term opioid administration by emergency providers is unlikely to cause addiction by itself, ED opioid prescriptions may contribute to the development of addiction in some patients. There is an urgent need for further research to estimate long-term risks of short-course opioid therapy so that the risk of iatrogenic addiction can be appropriately balanced with the benefit of analgesia. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(15)01567-X DO - https://dx.doi.org/10.1016/j.annemergmed.2015.11.033 PT - Journal Article ID - PMC4958587 [pmc] ID - NIHMS759463 [mid] ID - 10.1016/j.annemergmed.2015.11.033 [doi] ID - S0196-0644(15)01567-X [pii] PP - ppublish PH - 2015/09/22 [received] PH - 2015/11/19 [revised] PH - 2015/11/23 [accepted] GI - No: UL1 TR000077 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: UL1 TR001425 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English EP - 20160211 DP - 2016 Aug EZ - 2016/02/15 06:00 DA - 2017/06/14 06:00 DT - 2016/02/15 06:00 YR - 2016 ED - 20170613 RD - 20171130 UP - 20171130 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=26875061 <125. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28123207 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ellison J AU - Walley AY AU - Feldman JA AU - Bernstein E AU - Mitchell PM AU - Koppelman EA AU - Drainoni ML FA - Ellison, Jacqueline FA - Walley, Alexander Y FA - Feldman, James A FA - Bernstein, Edward FA - Mitchell, Patricia M FA - Koppelman, Elisa A FA - Drainoni, Mari-Lynn IN - Ellison, Jacqueline. Boston University School of Public Health, Boston, MA, USA. IN - Walley, Alexander Y. Boston University School of Medicine, Boston, MA, USA; Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MA, USA. IN - Feldman, James A. Boston University School of Medicine, Boston, MA, USA; Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA. IN - Bernstein, Edward. Boston University School of Public Health, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA. IN - Mitchell, Patricia M. Boston University School of Medicine, Boston, MA, USA; Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA. IN - Koppelman, Elisa A. Boston University School of Public Health, Boston, MA, USA. IN - Drainoni, Mari-Lynn. Boston University School of Public Health, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA. TI - Identifying Patients for Overdose Prevention With ICD-9 Classification in the Emergency Department, Massachusetts, 2013-2014. SO - Public Health Reports. 131(5):671-675, 2016 Sep AS - Public Health Rep. 131(5):671-675, 2016 Sep NJ - Public health reports (Washington, D.C. : 1974) VO - 131 IP - 5 PG - 671-675 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9716844, qja IO - Public Health Rep SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Drug Overdose/ep [Epidemiology] MH - *Drug Overdose/pc [Prevention & Control] MH - *Emergency Service, Hospital/og [Organization & Administration] MH - Female MH - Humans MH - International Classification of Diseases MH - Male MH - Massachusetts MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/sd [Supply & Distribution] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/sd [Supply & Distribution] MH - *Opioid-Related Disorders/di [Diagnosis] MH - Risk Assessment MH - Safety-net Providers/og [Organization & Administration] MH - Socioeconomic Factors MH - Young Adult KW - drug overdose; emergency medicine; intervention AB - The national rise in opioid overdose deaths signifies a need to integrate overdose prevention within healthcare delivery settings. The emergency department (ED) is an opportune location for such interventions. To effectively integrate prevention services, the target population must be clearly defined. We used ICD-9 discharge codes to establish and apply overdose risk categories to ED patients seen from January 1, 2013 to December 31, 2014 at an urban safety-net hospital in Massachusetts with the goal of informing ED-based naloxone rescue kit distribution programs. Of 96,419 patients, 4,468 (4.6%) were at increased risk of opioid overdose, defined by prior opioid overdose, misuse, or polysubstance misuse. A small proportion of those at risk were prescribed opioids on a separate occasion. Use of risk categories defined by ICD-9 codes identified a notable proportion of ED patients at risk for overdose, and provides a systematic means to prioritize and direct clinical overdose prevention efforts. CI - The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1468-2877 IL - 0033-3549 DO - https://dx.doi.org/10.1177/0033354916661981 PT - Journal Article ID - 10.1177/0033354916661981 [doi] ID - 10.1177_0033354916661981 [pii] ID - PMC5230809 [pmc] PP - ppublish LG - English EP - 20160822 DP - 2016 Sep EZ - 2017/01/27 06:00 DA - 2017/06/14 06:00 DT - 2017/01/27 06:00 YR - 2016 ED - 20170613 RD - 20170902 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28123207 <126. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27763703 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rowe C AU - Vittinghoff E AU - Santos GM AU - Behar E AU - Turner C AU - Coffin PO FA - Rowe, Christopher FA - Vittinghoff, Eric FA - Santos, Glenn-Milo FA - Behar, Emily FA - Turner, Caitlin FA - Coffin, Phillip O IN - Rowe, Christopher. Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA. IN - Vittinghoff, Eric. School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA. IN - Santos, Glenn-Milo. Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA. IN - Santos, Glenn-Milo. School of Nursing, Department of Community Health Systems, San Francisco, CA. IN - Behar, Emily. Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA. IN - Behar, Emily. Department of Global Health Sciences, San Francisco, CA. IN - Turner, Caitlin. Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA. IN - Coffin, Phillip O. Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA. IN - Coffin, Phillip O. School of Medicine, Division of HIV, ID, and Global Health, University of California San Francisco, San Francisco, CA. TI - Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department. SO - Academic Emergency Medicine. 24(4):475-483, 2017 Apr AS - Acad Emerg Med. 24(4):475-483, 2017 Apr NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 24 IP - 4 PG - 475-483 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - California MH - *Diagnostic Errors/pc [Prevention & Control] MH - *Drug Overdose/di [Diagnosis] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - *International Classification of Diseases/sn [Statistics & Numerical Data] MH - Logistic Models MH - Male MH - Medical Records MH - Middle Aged MH - Sensitivity and Specificity AB - OBJECTIVES: Opioid overdose mortality has tripled in the United States since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events. The present study aimed to validate the use of ICD, 9th revision, Clinical Modification (ICD-9-CM) codes in identifying opioid overdose events in the emergency department (ED) by examining multiple performance measures, including sensitivity and specificity. AB - METHODS: Data on ED visits from January 1, 2012, to December 31, 2014, including clinical determination of whether the visit constituted an opioid overdose event, were abstracted from electronic medical records for patients prescribed long-term opioids for pain from any of six safety net primary care clinics in San Francisco, California. Combinations of ICD-9-CM codes were validated in the detection of overdose events as determined by medical chart review. Both sensitivity and specificity of different combinations of ICD-9-CM codes were calculated. Unadjusted logistic regression models with robust standard errors and accounting for clustering by patient were used to explore whether overdose ED visits with certain characteristics were more or less likely to be assigned an opioid poisoning ICD-9-CM code by the documenting physician. AB - RESULTS: Forty-four (1.4%) of 3,203 ED visits among 804 patients were determined to be opioid overdose events. Opioid-poisoning ICD-9-CM codes (E850.2-E850.2, 965.00-965.09) identified overdose ED visits with a sensitivity of 25.0% (95% confidence interval [CI] = 13.6% to 37.8%) and specificity of 99.9% (95% CI = 99.8% to 100.0%). Expanding the ICD-9-CM codes to include both nonspecified and general (i.e., without a decimal modifier) drug poisoning and drug abuse codes identified overdose ED visits with a sensitivity of 56.8% (95% CI = 43.6%-72.7%) and specificity of 96.2% (95% CI = 94.8%-97.2%). Additional ICD-9-CM codes not explicitly relevant to opioid overdose were necessary to further enhance sensitivity. Among the 44 overdose ED visits, neither naloxone administration during the visit, whether the patient responded to the naloxone, nor the specific opioids involved were associated with the assignment of an opioid poisoning ICD-9-CM code (p >= 0.05). AB - CONCLUSIONS: Tracking opioid overdose ED visits by diagnostic coding is fairly specific but insensitive, and coding was not influenced by administration of naloxone or the specific opioids involved. The reason for the high rate of missed cases is uncertain, although these results suggest that a more clearly defined case definition for overdose may be necessary to ensure effective opioid overdose surveillance. Changes in coding practices under ICD-10 might help to address these deficiencies. Copyright © 2016 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.13121 PT - Journal Article PT - Validation Studies ID - 10.1111/acem.13121 [doi] PP - ppublish PH - 2016/05/24 [received] PH - 2016/10/12 [revised] PH - 2016/10/13 [accepted] GI - No: R21 DA036776 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20170317 DP - 2017 Apr EZ - 2016/10/21 06:00 DA - 2017/06/01 06:00 DT - 2016/10/21 06:00 YR - 2017 ED - 20170531 RD - 20171031 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27763703 <127. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28299720 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Neunhoeffer F AU - Hanser A AU - Esslinger M AU - Icheva V AU - Kumpf M AU - Gerbig I AU - Hofbeck M AU - Michel J FA - Neunhoeffer, Felix FA - Hanser, Anja FA - Esslinger, Martin FA - Icheva, Vanja FA - Kumpf, Matthias FA - Gerbig, Ines FA - Hofbeck, Michael FA - Michel, Jorg IN - Neunhoeffer, Felix. Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital Tubingen, Hoppe-Seyler Str. 1, 72076, Tubingen, Germany. felix.neunhoeffer@med.uni-tuebingen.de. IN - Hanser, Anja. Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital Tubingen, Hoppe-Seyler Str. 1, 72076, Tubingen, Germany. IN - Esslinger, Martin. Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital Tubingen, Hoppe-Seyler Str. 1, 72076, Tubingen, Germany. IN - Icheva, Vanja. Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital Tubingen, Hoppe-Seyler Str. 1, 72076, Tubingen, Germany. IN - Kumpf, Matthias. Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital Tubingen, Hoppe-Seyler Str. 1, 72076, Tubingen, Germany. IN - Gerbig, Ines. Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital Tubingen, Hoppe-Seyler Str. 1, 72076, Tubingen, Germany. IN - Hofbeck, Michael. Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital Tubingen, Hoppe-Seyler Str. 1, 72076, Tubingen, Germany. IN - Michel, Jorg. Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital Tubingen, Hoppe-Seyler Str. 1, 72076, Tubingen, Germany. TI - Ketamine Infusion as a Counter Measure for Opioid Tolerance in Mechanically Ventilated Children: A Pilot Study. SO - Paediatric Drugs. 19(3):259-265, 2017 Jun AS - Paediatr Drugs. 19(3):259-265, 2017 Jun NJ - Paediatric drugs VO - 19 IP - 3 PG - 259-265 PI - Journal available in: Print PI - Citation processed from: Internet JC - dse, 100883685 IO - Paediatr Drugs SB - Index Medicus CP - Switzerland MH - Adolescent MH - *Analgesics/tu [Therapeutic Use] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - Drug Substitution MH - Drug Tolerance MH - Feasibility Studies MH - Female MH - Fentanyl/tu [Therapeutic Use] MH - Humans MH - Infant MH - Infusions, Intravenous MH - Intensive Care Units, Pediatric MH - *Ketamine/tu [Therapeutic Use] MH - Male MH - Midazolam/tu [Therapeutic Use] MH - Pilot Projects MH - Respiration, Artificial MH - Retrospective Studies AB - BACKGROUND: Drug rotation to prevent opioid tolerance is well recognized in chronic pain management. However, ketamine infusion as a counter measure for opioid tolerance is rarely described in mechanically ventilated children developing tolerance from prolonged opioid infusion. AB - PATIENTS AND METHODS: We performed a retrospective study in a 14-bed medical-surgical-cardiac pediatric intensive care unit. Thirty-two mechanically ventilated children who had developed tolerance from prolonged intravenous infusion of opioids received a continuous intravenous infusion of ketamine as an opioid substitute for more than 2 days, scheduled in a drug rotation protocol. AB - RESULTS: Thirty-two children (median age 2.5 years, range 0.1-16.0; weight 11.2 kg [3.8-62.0]) were included. Patients had received continuous intravenous infusion of opioids and benzodiazepines for 16.0 days (4.0-34.0) when drug rotation was started. The median dose of continuous intravenous infusion of ketamine was 4.0 mg.kg^-1.h^-1 (1.8-6.0) and the median duration was 3.0 days (2.0-6.0). After having restarted opioids, fentanyl doses were significantly lower compared with the time before the drug rotation began (after, 2.9 micro g.kg^-1.h^-1 [0.8-4.9] vs before, 4.15 micro g.kg^-1.h^-1 [1.2-10.0]; p < 0.001). Continuous intravenous infusion of midazolam and clonidine were unchanged during drug rotation. COMFORT-B scoring was significantly lower after having started drug rotation (after, 14.5 [8-19] vs before, 16 [11-22]; p < 0.001). AB - CONCLUSION: Drug rotation with ketamine in mechanically ventilated children with opioid tolerance is feasible and seems to reduce the rate of fentanyl infusion. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) RN - 690G0D6V8H (Ketamine) RN - R60L0SM5BC (Midazolam) RN - UF599785JZ (Fentanyl) ES - 1179-2019 IL - 1174-5878 DO - https://dx.doi.org/10.1007/s40272-017-0218-4 PT - Journal Article ID - 10.1007/s40272-017-0218-4 [doi] ID - 10.1007/s40272-017-0218-4 [pii] PP - ppublish LG - English DP - 2017 Jun EZ - 2017/03/17 06:00 DA - 2017/05/23 06:00 DT - 2017/03/17 06:00 YR - 2017 ED - 20170522 RD - 20171114 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28299720 <128. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28492072 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Beaudoin FL AU - Rich JD FA - Beaudoin, Francesca L FA - Rich, Josiah D IN - Beaudoin, Francesca L. Warren Alpert Medical School of Brown University, Providence, RI IN - Beaudoin, Francesca L. francesca_beaudoin@brown.edu IN - Rich, Josiah D. Warren Alpert Medical School of Brown University, Providence, RI TI - Opioid Prescribing by Emergency Physicians and Risk of Long-Term Use. CM - Comment in: N Engl J Med. 2017 May 11;376(19):1896; PMID: 28489999 CM - Comment on: N Engl J Med. 2017 Feb 16;376(7):663-673; PMID: 28199807 SO - New England Journal of Medicine. 376(19):1895-6, 2017 05 11 AS - N Engl J Med. 376(19):1895-6, 2017 05 11 NJ - The New England journal of medicine VO - 376 IP - 19 PG - 1895-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0255562, now IO - N. Engl. J. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Prescriptions MH - Humans MH - Practice Patterns, Physicians' MH - Risk RN - 0 (Analgesics, Opioid) ES - 1533-4406 IL - 0028-4793 DO - https://dx.doi.org/10.1056/NEJMc1703338 PT - Letter PT - Comment ID - 10.1056/NEJMc1703338 [doi] ID - 10.1056/NEJMc1703338#SA2 [pii] PP - ppublish LG - English DP - 2017 05 11 EZ - 2017/05/12 06:00 DA - 2017/05/13 06:00 DT - 2017/05/12 06:00 YR - 2017 ED - 20170512 RD - 20170519 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28492072 <129. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28489999 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barnett ML AU - Olenksi AR AU - Jena AB FA - Barnett, Michael L FA - Olenksi, Andrew R FA - Jena, Anupam B IN - Barnett, Michael L. Harvard T.H. Chan School of Public Health, Boston, MA mbarnett@hsph.harvard.edu. IN - Olenksi, Andrew R. Harvard Medical School, Boston, MA. IN - Jena, Anupam B. Harvard Medical School, Boston, MA. TI - Opioid Prescribing by Emergency Physicians and Risk of Long-Term Use. CM - Comment on: N Engl J Med. 2017 May 11;376(19):1895; PMID: 28489998 CM - Comment on: N Engl J Med. ;376(19):1895-6; PMID: 28492072 SO - New England Journal of Medicine. 376(19):1896, 2017 05 11 AS - N Engl J Med. 376(19):1896, 2017 05 11 NJ - The New England journal of medicine VO - 376 IP - 19 PG - 1896 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0255562, now IO - N. Engl. J. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Prescriptions MH - Humans MH - Practice Patterns, Physicians' MH - Risk RN - 0 (Analgesics, Opioid) ES - 1533-4406 IL - 0028-4793 DO - https://dx.doi.org/10.1056/NEJMc1703338 PT - Letter PT - Comment ID - 10.1056/NEJMc1703338#SA3 [pii] ID - 10.1056/NEJMc1703338 [doi] PP - ppublish LG - English DP - 2017 05 11 EZ - 2017/05/11 06:00 DA - 2017/05/13 06:00 DT - 2017/05/11 06:00 YR - 2017 ED - 20170512 RD - 20170519 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28489999 <130. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28489998 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Menchine M AU - Kea B FA - Menchine, Michael FA - Kea, Bory IN - Menchine, Michael. Keck School of Medicine of the University of Southern California, Los Angeles, CA menchine@usc.edu IN - Kea, Bory. Oregon Health and Science University, Portland, OR TI - Opioid Prescribing by Emergency Physicians and Risk of Long-Term Use. CM - Comment in: N Engl J Med. 2017 May 11;376(19):1896; PMID: 28489999 CM - Comment on: N Engl J Med. 2017 Feb 16;376(7):663-673; PMID: 28199807 SO - New England Journal of Medicine. 376(19):1895, 2017 05 11 AS - N Engl J Med. 376(19):1895, 2017 05 11 NJ - The New England journal of medicine VO - 376 IP - 19 PG - 1895 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0255562, now IO - N. Engl. J. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Prescriptions MH - Humans MH - Practice Patterns, Physicians' MH - Risk RN - 0 (Analgesics, Opioid) ES - 1533-4406 IL - 0028-4793 DO - https://dx.doi.org/10.1056/NEJMc1703338 PT - Letter PT - Comment ID - 10.1056/NEJMc1703338 [doi] ID - 10.1056/NEJMc1703338#SA1 [pii] PP - ppublish LG - English DP - 2017 05 11 EZ - 2017/05/11 06:00 DA - 2017/05/13 06:00 DT - 2017/05/11 06:00 YR - 2017 ED - 20170512 RD - 20170519 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28489998 <131. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28019066 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Khemani D AU - Camilleri M AU - Roldan A AU - Nelson AD AU - Park SY AU - Acosta A AU - Zinsmeister AR FA - Khemani, D FA - Camilleri, M FA - Roldan, A FA - Nelson, A D FA - Park, S-Y FA - Acosta, A FA - Zinsmeister, A R IN - Khemani, D. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN, USA. IN - Camilleri, M. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN, USA. IN - Roldan, A. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN, USA. IN - Nelson, A D. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN, USA. IN - Park, S-Y. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN, USA. IN - Acosta, A. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN, USA. IN - Zinsmeister, A R. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. TI - Opioid analgesic use among patients presenting with acute abdominal pain and factors associated with surgical diagnoses. SO - Neurogastroenterology & Motility. 29(5), 2017 May AS - Neurogastroenterol Motil. 29(5), 2017 May NJ - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society VO - 29 IP - 5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce9, 9432572 IO - Neurogastroenterol. Motil. SB - Index Medicus CP - England MH - *Abdomen, Acute/di [Diagnosis] MH - Abdomen, Acute/dt [Drug Therapy] MH - *Abdomen, Acute/ep [Epidemiology] MH - *Abdomen, Acute/su [Surgery] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Constipation/ep [Epidemiology] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - ROC Curve MH - Retrospective Studies MH - Risk Factors KW - * CT; *abdominal pain; *constipation; *emergency; *opioids AB - BACKGROUND: The prevalence of chronic opioid use among non-cancer patients presenting with acute abdominal pain (AAP) is unknown. The aim was to characterize opioid use, constipation, diagnoses, and risk factors for surgical diagnoses among non-cancer patients presenting with AAP to an emergency department (ED). AB - METHODS: We performed a retrospective, observational cohort study of all (n=16,121) adult patients (88% from MN, IA and WI) presenting during 2014 with AAP. We used electronic medical records, and focused on 2352 adults with AAP who underwent abdominal CT scan within 24 hours of presentation. We determined odds ratios of association with constipation and features predicting conditions that may require surgery (surgical diagnosis). AB - KEY RESULTS: There were 2352 eligible patients; 18.8% were opioid users. Constipation was more frequent in opioid (35.1%) compared to non-opioid users [OR 2.88 (95% CI 2.28, 3.62)]. Prevalence of surgical diagnosis in the opioid and non-opioid users was 35.3% and 41.7% respectively (P=.019). By univariate analysis, age and neutrophil count independently predicted increased risk, and chronic opioid use decreased risk of surgical diagnosis. Internal validation of logistic models using a randomly selected validation subset (25% of entire cohort, 587/2352) showed receiver operating characteristic (ROC) curves for the validation and full cohorts were similar. AB - CONCLUSIONS AND INFERENCES: Approximately 19% of adults presenting with AAP were opioid users; constipation is almost three times as likely in opioid users compared to non-opioid users presenting with AAP. Factors significantly associated with altered risk of surgical diagnoses were age, opioid use, and neutrophil count. Copyright © 2016 John Wiley & Sons Ltd. RN - 0 (Analgesics, Opioid) ES - 1365-2982 IL - 1350-1925 DO - https://dx.doi.org/10.1111/nmo.13000 PT - Journal Article PT - Observational Study ID - 10.1111/nmo.13000 [doi] ID - PMC5393942 [pmc] ID - NIHMS827535 [mid] PP - ppublish PH - 2016/09/16 [received] PH - 2016/10/26 [accepted] GI - No: R01 DK092179 Organization: (DK) *NIDDK NIH HHS* Country: United States LG - English EP - 20161225 DP - 2017 May PQ - 2018/05/01 EZ - 2016/12/27 06:00 DA - 2017/05/10 06:00 DT - 2016/12/27 06:00 YR - 2017 ED - 20170509 RD - 20170509 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28019066 <132. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27923527 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kim HS AU - McCarthy DM AU - Mark Courtney D AU - Lank PM AU - Lambert BL FA - Kim, Howard S FA - McCarthy, Danielle M FA - Mark Courtney, D FA - Lank, Patrick M FA - Lambert, Bruce L IN - Kim, Howard S. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. Electronic address: howard.kim@northwestern.edu. IN - McCarthy, Danielle M. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. IN - Mark Courtney, D. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. IN - Lank, Patrick M. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. IN - Lambert, Bruce L. Department of Communication Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. TI - Benzodiazepine-opioid co-prescribing in a national probability sample of ED encounters. SO - American Journal of Emergency Medicine. 35(3):458-464, 2017 Mar AS - Am J Emerg Med. 35(3):458-464, 2017 Mar NJ - The American journal of emergency medicine VO - 35 IP - 3 PG - 458-464 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Benzodiazepines/ae [Adverse Effects] MH - Benzodiazepines/tu [Therapeutic Use] MH - *Drug Interactions MH - Drug Overdose/ep [Epidemiology] MH - *Drug Overdose/mo [Mortality] MH - Drug Therapy, Combination/ae [Adverse Effects] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Health Care Surveys MH - Humans MH - Male MH - Middle Aged MH - Odds Ratio MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Young Adult KW - Benzodiazepine; Opioid; Pain; Prescribing AB - BACKGROUND: Benzodiazepine-opioid combination therapy is potentially harmful due to the risk of synergistic respiratory depression, and the rate of death due to benzodiazepine-opioid overdose is increasing. Little is known about the prevalence and characteristics of benzodiazepine-opioid co-prescribing from the ED setting. AB - METHODS: Secondary analysis of data from the National Hospital Ambulatory Medical Care Survey, using sample weights to generate population estimates. The primary objective was to describe the annual prevalence of benzodiazepine-opioid co-prescribing from 2006 to 2012, using 95% confidence intervals (95% CI) to compare adjacent years. The secondary objective was to compare characteristics of ED encounters receiving a benzodiazepine-opioid co-prescription versus those receiving an opioid prescription alone, using a multivariable logistic regression. AB - RESULTS: The prevalence of benzodiazepine-opioid co-prescribing did not significantly change from 2006 to 2012. During this period, 2.7% (95% CI: 2.5-2.8%) of ED encounters prescribed an opioid were also prescribed a benzodiazepine. Relative to encounters receiving an opioid prescription alone, encounters receiving a co-prescription were more likely to represent a follow-up rather than initial visit (Odds Ratio [OR] 1.52), receive more medications (OR 1.41) and fewer procedures (OR 0.48) while in the ED, and more likely to have a diagnosis related to mental disorder (OR 20.60) or musculoskeletal problem (OR 3.71). AB - CONCLUSIONS: From 2006 to 2012, almost 3% of all ED encounters receiving an opioid prescription also received a benzodiazepine co-prescription. The odds of benzodiazepine-opioid co-prescribing were significantly higher in ED encounters representing a follow-up visit and in diagnoses relating to a mental disorder or musculoskeletal problem. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(16)30889-0 DO - https://dx.doi.org/10.1016/j.ajem.2016.11.054 PT - Journal Article ID - S0735-6757(16)30889-0 [pii] ID - 10.1016/j.ajem.2016.11.054 [doi] PP - ppublish PH - 2016/07/24 [received] PH - 2016/11/21 [revised] PH - 2016/11/28 [accepted] LG - English EP - 20161202 DP - 2017 Mar EZ - 2016/12/08 06:00 DA - 2017/05/04 06:00 DT - 2016/12/08 06:00 YR - 2017 ED - 20170503 RD - 20170503 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27923527 <133. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27366987 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Coffin PO AU - Behar E AU - Rowe C AU - Santos GM AU - Coffa D AU - Bald M AU - Vittinghoff E FA - Coffin, Phillip O FA - Behar, Emily FA - Rowe, Christopher FA - Santos, Glenn-Milo FA - Coffa, Diana FA - Bald, Matthew FA - Vittinghoff, Eric TI - Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain. CM - Comment in: Ann Intern Med. 2016 Aug 16;165(4):292-3; PMID: 27367047 SO - Annals of Internal Medicine. 165(4):245-52, 2016 Aug 16 AS - Ann Intern Med. 165(4):245-52, 2016 Aug 16 NJ - Annals of internal medicine VO - 165 IP - 4 PG - 245-52 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 0372351 IO - Ann. Intern. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Chronic Pain/dt [Drug Therapy] MH - Drug Overdose/et [Etiology] MH - *Drug Overdose/pc [Prevention & Control] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Primary Health Care MH - San Francisco AB - BACKGROUND: Unintentional overdose involving opioid analgesics is a leading cause of injury-related death in the United States. AB - OBJECTIVE: To evaluate the feasibility and effect of implementing naloxone prescription to patients prescribed opioids for chronic pain. AB - DESIGN: 2-year nonrandomized intervention study. AB - SETTING: 6 safety-net primary care clinics in San Francisco, California. AB - PARTICIPANTS: 1985 adults receiving long-term opioid therapy for pain. AB - INTERVENTION: Providers and clinic staff were trained and supported in naloxone prescribing. AB - MEASUREMENTS: Outcomes were proportion of patients prescribed naloxone, opioid-related emergency department (ED) visits, and prescribed opioid dose based on chart review. AB - RESULTS: 38.2% of 1985 patients receiving long-term opioids were prescribed naloxone. Patients prescribed higher doses of opioids and with an opioid-related ED visit in the past 12 months were independently more likely to be prescribed naloxone. Patients who received a naloxone prescription had 47% fewer opioid-related ED visits per month in the 6 months after receipt of the prescription (incidence rate ratio [IRR], 0.53 [95% CI, 0.34 to 0.83]; P = 0.005) and 63% fewer visits after 1 year (IRR, 0.37 [CI, 0.22 to 0.64]; P < 0.001) compared with patients who did not receive naloxone. There was no net change over time in opioid dose among those who received naloxone and those who did not (IRR, 1.03 [CI, 0.91 to 1.27]; P = 0.61). AB - LIMITATION: Results are observational and may not be generalizable beyond safety-net settings. AB - CONCLUSION: Naloxone can be coprescribed to primary care patients prescribed opioids for pain. When advised to offer naloxone to all patients receiving opioids, providers may prioritize those with established risk factors. Providing naloxone in primary care settings may have ancillary benefits, such as reducing opioid-related adverse events. AB - PRIMARY FUNDING SOURCE: National Institutes of Health. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1539-3704 IL - 0003-4819 DO - https://dx.doi.org/10.7326/M15-2771 PT - Clinical Study PT - Journal Article PT - Multicenter Study ID - 2531366 [pii] ID - 10.7326/M15-2771 [doi] ID - PMC5783639 [pmc] ID - NIHMS916740 [mid] PP - ppublish GI - No: R21 DA036776 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20160628 DP - 2016 Aug 16 EZ - 2016/07/02 06:00 DA - 2017/05/04 06:00 DT - 2016/07/02 06:00 YR - 2016 ED - 20170502 RD - 20180126 UP - 20180126 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27366987 <134. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25583043 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sencion Martinez GL AU - Samillan K AU - Espinosa JL AU - Rodriguez Puyol D AU - Martinez Miguel P AU - Villa P FA - Sencion Martinez, G L FA - Samillan, K FA - Espinosa, J L FA - Rodriguez Puyol, D FA - Martinez Miguel, P FA - Villa, P IN - Sencion Martinez, G L. Servicio de Nefrologia, Hospital Universitario Principe de Asturias, Madrid, Espana. Electronic address: lisette_glori@hotmail.com. IN - Samillan, K. Servicio de Nefrologia, Hospital Universitario Principe de Asturias, Madrid, Espana. IN - Espinosa, J L. Servicio de Nefrologia, Hospital Universitario Principe de Asturias, Madrid, Espana. IN - Rodriguez Puyol, D. Servicio de Nefrologia, Hospital Universitario Principe de Asturias, Madrid, Espana. IN - Martinez Miguel, P. Servicio de Nefrologia, Hospital Universitario Principe de Asturias, Madrid, Espana. IN - Villa, P. Unidad de Cuidados intensivos, Hospital Universitario Principe de Asturias, Madrid, Espana. TI - [Hemoperfusion with activated charcoal on valproic acid poisoning. A case report]. [Spanish] OT - Hemoperfusion con carbon activado en intoxicacion por acido valproico. A proposito de un caso. SO - Medicina Intensiva. 39(7):449-51, 2015 Oct AS - MED. INTENSIVA. 39(7):449-51, 2015 Oct NJ - Medicina intensiva VO - 39 IP - 7 PG - 449-51 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9207689 IO - Med Intensiva SB - Index Medicus CP - Spain MH - Benzodiazepines/po [Poisoning] MH - *Charcoal MH - Combined Modality Therapy MH - Depressive Disorder/dt [Drug Therapy] MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/th [Therapy] MH - Female MH - Flumazenil/tu [Therapeutic Use] MH - *Hemoperfusion/mt [Methods] MH - Humans MH - Hyperammonemia/ci [Chemically Induced] MH - Hyperammonemia/th [Therapy] MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Paranoid Disorders/dt [Drug Therapy] MH - Psychotropic Drugs/bl [Blood] MH - *Psychotropic Drugs/po [Poisoning] MH - Respiration, Artificial MH - Suicide, Attempted MH - Valproic Acid/bl [Blood] MH - *Valproic Acid/po [Poisoning] RN - 0 (Psychotropic Drugs) RN - 12794-10-4 (Benzodiazepines) RN - 16291-96-6 (Charcoal) RN - 36B82AMQ7N (Naloxone) RN - 40P7XK9392 (Flumazenil) RN - 614OI1Z5WI (Valproic Acid) RN - N7U69T4SZR (olanzapine) ES - 1578-6749 IL - 0210-5691 DI - S0210-5691(14)00260-5 DO - https://dx.doi.org/10.1016/j.medin.2014.11.006 PT - Case Reports PT - Letter ID - S0210-5691(14)00260-5 [pii] ID - 10.1016/j.medin.2014.11.006 [doi] PP - ppublish PH - 2014/10/07 [received] PH - 2014/11/20 [revised] PH - 2014/11/21 [accepted] LG - Spanish EP - 20150109 DP - 2015 Oct EZ - 2015/01/15 06:00 DA - 2017/05/02 06:00 DT - 2015/01/14 06:00 YR - 2015 ED - 20170501 RD - 20170501 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25583043 <135. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27698525 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - Letters. SO - Ulster Medical Journal. 85(3):203-210, 2016 Sep AS - Ulster Med J. 85(3):203-210, 2016 Sep NJ - The Ulster medical journal VO - 85 IP - 3 PG - 203-210 PI - Journal available in: Print PI - Citation processed from: Internet JC - wn2, 0417367 IO - Ulster Med J SB - Index Medicus CP - Northern Ireland MH - Administration, Inhalation MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Coma/ci [Chemically Induced] MH - Coma/dt [Drug Therapy] MH - Drug Packaging MH - Fentanyl/ad [Administration & Dosage] MH - *Fentanyl/ae [Adverse Effects] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Opioid-Related Disorders/et [Etiology] MH - *Pneumonia/ci [Chemically Induced] MH - Pneumonia/di [Diagnosis] MH - Pneumonia/dt [Drug Therapy] MH - Respiration, Artificial RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0041-6193 IL - 0041-6193 PT - Case Reports PT - Journal Article ID - PMC5031110 [pmc] PP - ppublish LG - English DP - 2016 Sep EZ - 2016/10/05 06:00 DA - 2017/04/26 06:00 DT - 2016/10/05 06:00 YR - 2016 ED - 20170425 RD - 20170425 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27698525 <136. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27802876 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Strayer RJ AU - Motov SM AU - Nelson LS FA - Strayer, Reuben J FA - Motov, Sergey M FA - Nelson, Lewis S IN - Strayer, Reuben J. 79-01 Broadway, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, NY 11373, United States. Electronic address: emupdates@gmail.com. IN - Motov, Sergey M. 4802 Tenth Ave, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY 11219, United States. IN - Nelson, Lewis S. 185 South Orange Avenue, Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, United States. TI - Something for pain: Responsible opioid use in emergency medicine. SO - American Journal of Emergency Medicine. 35(2):337-341, 2017 Feb AS - Am J Emerg Med. 35(2):337-341, 2017 Feb NJ - The American journal of emergency medicine VO - 35 IP - 2 PG - 337-341 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/st [Standards] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Chronic Pain/dt [Drug Therapy] MH - *Drug Tolerance/ph [Physiology] MH - Emergency Medicine/mt [Methods] MH - *Emergency Medicine/st [Standards] MH - Humans MH - Opioid-Related Disorders/et [Etiology] MH - Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Prescription Drug Misuse/td [Trends] MH - Risk Assessment MH - United States/ep [Epidemiology] AB - The United States is currently experiencing a public health crisis of opioid addiction, which has its genesis in an industry marketing effort that successfully encouraged clinicians to prescribe opioids liberally, and asserted the safety of prescribing opioids for chronic non-cancer pain, despite a preponderance of evidence demonstrating the risks of dependence and misuse. The resulting rise in opioid use has pushed drug overdose deaths in front of motor vehicle collisions to become the leading cause of accidental death in the country. Emergency providers frequently treat patients for complications of opioid abuse, and also manage patients with acute and chronic pain, for which opioids are routinely prescribed. Emergency providers are therefore well positioned to both prevent new cases of opioid misuse and initiate appropriate treatment of existing opioid addicts. In opioid-naive patients, this is accomplished by a careful consideration of the likelihood of benefit and harm of an opioid prescription for acute pain. If opioids are prescribed, the chance of harm is reduced by matching the number of pills prescribed to the expected duration of pain and selecting an opioid preparation with low abuse liability. Patients who present to acute care with exacerbations of chronic pain or painful conditions associated with opioid misuse are best managed by treating symptoms with opioid alternatives and encouraging treatment for opioid addiction. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(16)30739-2 DO - https://dx.doi.org/10.1016/j.ajem.2016.10.043 PT - Journal Article ID - S0735-6757(16)30739-2 [pii] ID - 10.1016/j.ajem.2016.10.043 [doi] PP - ppublish PH - 2016/09/16 [received] PH - 2016/10/18 [revised] PH - 2016/10/20 [accepted] LG - English EP - 20161024 DP - 2017 Feb EZ - 2016/11/03 06:00 DA - 2017/04/15 06:00 DT - 2016/11/03 06:00 YR - 2017 ED - 20170414 RD - 20170808 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27802876 <137. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27833690 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pomerleau AC AU - Perrone J AU - Hoppe JA AU - Salzman M AU - Weiss PS AU - Nelson LS FA - Pomerleau, Adam C FA - Perrone, Jeanmarie FA - Hoppe, Jason A FA - Salzman, Matthew FA - Weiss, Paul S FA - Nelson, Lewis S IN - Pomerleau, Adam C. Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia. IN - Perrone, Jeanmarie. University of Pennsylvania, Perelman School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania. IN - Hoppe, Jason A. University of Colorado, Department of Emergency Medicine, Aurora, Colorado; Rocky Mountain Poison and Drug Center, Denver, Colorado. IN - Salzman, Matthew. Rowman University, Cooper Medical School, Department of Emergency Medicine, Camden, New Jersey. IN - Weiss, Paul S. Emory University, Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, Georgia. IN - Nelson, Lewis S. New York University School of Medicine, Department of Emergency Medicine, New York, New York. TI - Impact of Prior Therapeutic Opioid Use by Emergency Department Providers on Opioid Prescribing Decisions. SO - The Western Journal of Emergency Medicine. 17(6):791-797, 2016 Nov AS - West J Emerg Med. 17(6):791-797, 2016 Nov NJ - The western journal of emergency medicine VO - 17 IP - 6 PG - 791-797 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Attitude of Health Personnel MH - *Chronic Pain/dt [Drug Therapy] MH - Cross-Sectional Studies MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Surveys and Questionnaires AB - INTRODUCTION: Our study sought to examine the opioid analgesic (OA) prescribing decisions of emergency department (ED) providers who have themselves used OA therapeutically and those who have not. A second objective was to determine if OA prescribing decisions would differ based on the patient's relationship to the provider. AB - METHODS: We distributed an electronic survey to a random sample of ED providers at participating centers in a nationwide research consortium. Question topics included provider attitudes about OA prescribing, prior personal therapeutic use of OAs (indications, dosing, and disposal of leftover medication), and hypothetical analgesic-prescribing decisions for their patients, family members, and themselves for different painful conditions. AB - RESULTS: The total survey population was 957 individuals; 515 responded to the survey, a 54% response rate. Prior personal therapeutic OA use was reported in 63% (95% CI = [58-68]). A majority of these providers (82%; 95% CI = [77-87]) took fewer than half the number of pills prescribed. Regarding provider attitudes towards OA prescribing, 66% (95% CI = [61-71]) agreed that OA could lead to addiction even with short-term use. When providers were asked if they would prescribe OA to a patient with 10/10 pain from an ankle sprain, 21% (95% CI = [17-25]) would for an adult patient, 13% (95% CI = [10-16]) would for an adult family member, and 6% (95% CI = [4-8]) indicated they themselves would take an opioid for the same pain. When the scenario involved an ankle fracture, 86% (95% CI = [83-89]) would prescribe OA for an adult patient, 75% (95% CI = [71-79]) for an adult family member, and 52% (95% CI = [47-57]) would themselves take OA. Providers who have personally used OA to treat their pain were found to make similar prescribing decisions compared to those who had not. AB - CONCLUSION: No consistent differences in prescribing decisions were found between ED providers based on their prior therapeutic use of OA. When making OA prescribing decisions, ED providers report that they are less likely to prescribe opioids to their family members, or themselves, than to an ED patient with the same painful condition. CI - By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X PT - Journal Article ID - 10.5811/westjem.2016.8.30965 [doi] ID - wjem-17-791 [pii] ID - PMC5102609 [pmc] PP - ppublish PH - 2016/05/19 [received] PH - 2016/07/19 [revised] PH - 2016/08/10 [accepted] GI - No: UL1 TR000454 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English EP - 20160929 DP - 2016 Nov EZ - 2016/11/12 06:00 DA - 2017/04/12 06:00 DT - 2016/11/12 06:00 YR - 2016 ED - 20170411 RD - 20180328 UP - 20180328 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27833690 <138. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27833691 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kesler KA AU - Langdorf MI AU - Burns MJ FA - Kesler, Kelly A FA - Langdorf, Mark I FA - Burns, Michael J IN - Kesler, Kelly A. University of California, Irvine, School of Medicine, Department of Emergency Medicine, Irvine, California. IN - Langdorf, Mark I. University of California, Irvine, School of Medicine, Department of Emergency Medicine, Irvine, California. IN - Burns, Michael J. University of California, Irvine, School of Medicine, Department of Emergency Medicine, Irvine, California. TI - Opioid Dependent Malingerer with Self-Induced Sepsis. SO - The Western Journal of Emergency Medicine. 17(6):798-800, 2016 Nov AS - West J Emerg Med. 17(6):798-800, 2016 Nov NJ - The western journal of emergency medicine VO - 17 IP - 6 PG - 798-800 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med SB - Index Medicus CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - Anti-Bacterial Agents/tu [Therapeutic Use] MH - Antifungal Agents/ad [Administration & Dosage] MH - Ciprofloxacin/tu [Therapeutic Use] MH - Echinocandins/ad [Administration & Dosage] MH - Emergency Service, Hospital MH - Female MH - Fluconazole/tu [Therapeutic Use] MH - Humans MH - Lipopeptides/ad [Administration & Dosage] MH - *Malingering/px [Psychology] MH - *Opioid-Related Disorders/px [Psychology] MH - *Sepsis/dt [Drug Therapy] MH - Sepsis/et [Etiology] MH - *Staphylococcal Infections/dt [Drug Therapy] MH - Young Adult AB - A 21-year-old woman was admitted to the emergency department (ED) with severe sepsis. Both the mechanism of infection and organisms discovered were unusual. CI - By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none. RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Bacterial Agents) RN - 0 (Antifungal Agents) RN - 0 (Echinocandins) RN - 0 (Lipopeptides) RN - 5E8K9I0O4U (Ciprofloxacin) RN - 8VZV102JFY (Fluconazole) RN - R10H71BSWG (micafungin) ES - 1936-9018 IL - 1936-900X PT - Case Reports PT - Journal Article ID - 10.5811/westjem.2016.9.31515 [doi] ID - wjem-17-798 [pii] ID - PMC5102610 [pmc] PP - ppublish PH - 2016/07/08 [received] PH - 2016/09/15 [revised] PH - 2016/09/21 [accepted] LG - English EP - 20161020 DP - 2016 Nov EZ - 2016/11/12 06:00 DA - 2017/04/12 06:00 DT - 2016/11/12 06:00 YR - 2016 ED - 20170411 RD - 20170411 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27833691 <139. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27833673 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Khidir H AU - Weiner SG FA - Khidir, Hazar FA - Weiner, Scott G IN - Khidir, Hazar. Harvard Medical School, Boston, Massachusetts. IN - Weiner, Scott G. Harvard Medical School, Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts. TI - A Call for Better Opioid Prescribing Training and Education. SO - The Western Journal of Emergency Medicine. 17(6):686-689, 2016 Nov AS - West J Emerg Med. 17(6):686-689, 2016 Nov NJ - The western journal of emergency medicine VO - 17 IP - 6 PG - 686-689 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Education, Medical/st [Standards] MH - Emergency Service, Hospital MH - Humans MH - Opioid-Related Disorders/pc [Prevention & Control] MH - *Pain/dt [Drug Therapy] MH - Pain Management MH - *Practice Patterns, Physicians' AB - Pain is the most common complaint in the emergency department (ED), and emergency physicians face unique challenges in making opioid-related treatment decisions. Medical students and residents experience significant variation in the quality of education they receive both about opioid prescribing as well as substance-use detection and intervention in the ED. To achieve a better standard of education, clinical educators will need to (a) develop a clearer understanding of the risk for aberrant opioid prescribing in the ED, (b) recognize prescribing bias and promote uptake of evidence-based opioid prescribing guidelines in their EDs, and Copyright (c) advocate for integrated opioid management and addiction medicine training formally into medical school curricula. CI - By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none. RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X PT - Journal Article ID - 10.5811/westjem.2016.8.31204 [doi] ID - wjem-17-686 [pii] ID - PMC5102592 [pmc] PP - ppublish PH - 2016/06/10 [received] PH - 2016/09/06 [revised] PH - 2016/08/29 [accepted] LG - English EP - 20161003 DP - 2016 Nov EZ - 2016/11/12 06:00 DA - 2017/04/12 06:00 DT - 2016/11/12 06:00 YR - 2016 ED - 20170411 RD - 20170411 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27833673 <140. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28292769 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sun EC AU - Dixit A AU - Humphreys K AU - Darnall BD AU - Baker LC AU - Mackey S FA - Sun, Eric C FA - Dixit, Anjali FA - Humphreys, Keith FA - Darnall, Beth D FA - Baker, Laurence C FA - Mackey, Sean IN - Sun, Eric C. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Dr, H3580, Stanford, CA 94305, USA. IN - Dixit, Anjali. Department of Anesthesiology and Perioperative Care, University of California, San Francisco, 521 Parnassus Ave, San Francisco, CA 94131, USA. IN - Humphreys, Keith. Center for Innovation to Implementation, VA Palo Alto Health Care System and Department of Psychiatry, Stanford University School of Medicine, Stanford University, 401 N Quarry Road, MC:5717, Stanford, CA 94305, USA. IN - Darnall, Beth D. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Dr, H3580, Stanford, CA 94305, USA. IN - Baker, Laurence C. Department of Health Research and Policy, Stanford University School of Medicine, Stanford University and National Bureau of Economic Research, 150 Governor's Lane, HRP Redwood Building, Stanford, CA 94305, USA. IN - Mackey, Sean. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Dr, H3580, Stanford, CA 94305, USA. TI - Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. CM - Comment in: BMJ. 2017 Mar 14;356:j1224; PMID: 28292825 SO - BMJ. 356:j760, 2017 Mar 14 AS - BMJ. 356:j760, 2017 Mar 14 NJ - BMJ (Clinical research ed.) VO - 356 PG - j760 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 8900488, bmj, 101090866 IO - BMJ SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Benzodiazepines/ae [Adverse Effects] MH - *Benzodiazepines/tu [Therapeutic Use] MH - *Drug Overdose/ep [Epidemiology] MH - Drug Overdose/th [Therapy] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - For-Profit Insurance Plans/sn [Statistics & Numerical Data] MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Polypharmacy MH - Prevalence MH - Retrospective Studies MH - Risk Factors MH - United States/ep [Epidemiology] MH - Young Adult AB - Objectives To identify trends in concurrent use of a benzodiazepine and an opioid and to identify the impact of these trends on admissions to hospital and emergency room visits for opioid overdose.Design Retrospective analysis of claims data, 2001-13.Setting Administrative health claims database.Participants 315428 privately insured people aged 18-64 who were continuously enrolled in a health plan with medical and pharmacy benefits during the study period and who also filled at least one prescription for an opioid.Interventions Concurrent benzodiazepine/opioid use, defined as an overlap of at least one day in the time periods covered by prescriptions for each drug. Main outcome measures Annual percentage of opioid users with concurrent benzodiazepine use; annual incidence of visits to emergency room and inpatient admissions for opioid overdose.Results 9% of opioid users also used a benzodiazepine in 2001, increasing to 17% in 2013 (80% relative increase). This increase was driven mainly by increases among intermittent, as opposed to chronic, opioid users. Compared with opioid users who did not use benzodiazepines, concurrent use of both drugs was associated with an increased risk of an emergency room visit or inpatient admission for opioid overdose (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24; P<0.001) among all opioid users. The adjusted odds ratio for an emergency room visit or inpatient admission for opioid overdose was 1.42 (1.33 to 1.51; P<0.001) for intermittent opioid users and 1.81 (1.67 to 1.96; P<0.001) chronic opioid users. If this association is causal, elimination of concurrent benzodiazepine/opioid use could reduce the risk of emergency room visits related to opioid use and inpatient admissions for opioid overdose by an estimated 15% (95% confidence interval 14 to 16).Conclusions From 2001 to 2013, concurrent benzodiazepine/opioid use sharply increased in a large sample of privately insured patients in the US and significantly contributed to the overall population risk of opioid overdose. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) ES - 1756-1833 IL - 0959-535X DO - https://dx.doi.org/10.1136/bmj.j760 PT - Journal Article ID - PMC5421443 [pmc] PP - epublish LG - English EP - 20170314 DP - 2017 Mar 14 EZ - 2017/03/16 06:00 DA - 2017/04/07 06:00 DT - 2017/03/16 06:00 YR - 2017 ED - 20170406 RD - 20171106 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28292769 <141. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27647616 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Donroe JH AU - Holt SR AU - Tetrault JM FA - Donroe, Joseph H FA - Holt, Stephen R FA - Tetrault, Jeanette M IN - Donroe, Joseph H. Department of General Internal Medicine, Yale University School of Medicine, New Haven, Conn. joseph.donroe@yale.edu. IN - Holt, Stephen R. Department of General Internal Medicine, Yale University School of Medicine, New Haven, Conn. IN - Tetrault, Jeanette M. Department of General Internal Medicine, Yale University School of Medicine, New Haven, Conn. TI - Caring for patients with opioid use disorder in the hospital. [Review] SO - CMAJ Canadian Medical Association Journal. 188(17-18):1232-1239, 2016 Dec 06 AS - CMAJ. 188(17-18):1232-1239, 2016 Dec 06 NJ - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne VO - 188 IP - 17-18 PG - 1232-1239 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9711805 IO - CMAJ SB - Core Clinical Journals (AIM) SB - Index Medicus CP - Canada MH - *Acute Pain/dt [Drug Therapy] MH - *Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/po [Poisoning] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Buprenorphine/tu [Therapeutic Use] MH - Buprenorphine, Naloxone Drug Combination/tu [Therapeutic Use] MH - Drug Overdose/th [Therapy] MH - *Hospitalization MH - Humans MH - Methadone/tu [Therapeutic Use] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Opiate Substitution Treatment/mt [Methods] MH - *Opioid-Related Disorders/th [Therapy] MH - Respiration, Artificial MH - Substance Withdrawal Syndrome/et [Etiology] MH - *Substance Withdrawal Syndrome/th [Therapy] RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) RN - UC6VBE7V1Z (Methadone) ES - 1488-2329 IL - 0820-3946 PT - Journal Article PT - Review ID - cmaj.160290 [pii] ID - 10.1503/cmaj.160290 [doi] ID - PMC5135493 [pmc] PP - ppublish LG - English EP - 20160919 DP - 2016 Dec 06 EZ - 2016/09/21 06:00 DA - 2017/04/04 06:00 DT - 2016/09/21 06:00 YR - 2016 ED - 20170403 RD - 20171206 UP - 20171207 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=27647616 <142. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26344571 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Monnat SM AU - Rigg KK FA - Monnat, Shannon M FA - Rigg, Khary K IN - Monnat, Shannon M. Department of Agricultural Economics, Sociology, and Education and The Population Research Institute, The Pennsylvania State University, University Park, Pennsylvania. IN - Rigg, Khary K. Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, Florida. TI - Examining Rural/Urban Differences in Prescription Opioid Misuse Among US Adolescents. SO - Journal of Rural Health. 32(2):204-18, 2016 AS - J Rural Health. 32(2):204-18, 2016 NJ - The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association VO - 32 IP - 2 PG - 204-18 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - jx4, 8508122 IO - J Rural Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779738 OI - Source: NLM. NIHMS713683 [Available on 03/01/17] SB - Index Medicus CP - England MH - Adolescent MH - Child MH - Female MH - Humans MH - Logistic Models MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/px [Psychology] MH - Parent-Child Relations MH - Peer Group MH - *Prescription Drugs MH - Religion MH - *Residence Characteristics/sn [Statistics & Numerical Data] MH - Risk Assessment MH - Risk Factors MH - *Rural Population/sn [Statistics & Numerical Data] MH - Socioeconomic Factors MH - Substance-Related Disorders/ep [Epidemiology] MH - Substance-Related Disorders/px [Psychology] MH - United States MH - *Urban Population/sn [Statistics & Numerical Data] KW - demography; drug abuse; epidemiology; geography; sociology AB - PURPOSE: This study examines differences in prescription opioid misuse (POM) among adolescents in rural, small urban, and large urban areas of the United States and identifies several individual, social, and community risk factors contributing to those differences. AB - METHODS: We used nationally representative data from the 2011 and 2012 National Survey on Drug Use and Health and estimated binary logistic regression and formal mediation models to assess past-year POM among 32,036 adolescents aged 12-17. AB - RESULTS: Among adolescents, 6.8% of rural, 6.0% of small urban, and 5.3% of large urban engaged in past-year POM. Net of multiple risk and protective factors, rural adolescents have 35% greater odds and small urban adolescents have 21% greater odds of past-year POM compared to large urban adolescents. The difference between rural and small urban adolescents was not significant. Criminal activity, lower perceived substance use risk, and greater use of emergency medical treatment partially contribute to higher odds among rural adolescents, but they are also partially buffered by less peer substance use, less illicit drug access, and stronger religious beliefs. AB - CONCLUSIONS: Researchers, policy makers, and treatment providers must consider the complex array of individual, social, and community risk and protective factors to understand rural/urban differences in adolescent POM. Potential points of intervention to prevent POM in general and reduce rural disparities include early education about addiction risks, use of family drug courts to link criminal offenders to treatment, and access to nonemergency medical services to reduce rural residents' reliance on emergency departments where opioid prescribing is more likely. Copyright © 2015 National Rural Health Association. RN - 0 (Prescription Drugs) ES - 1748-0361 IL - 0890-765X DO - https://dx.doi.org/10.1111/jrh.12141 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - 10.1111/jrh.12141 [doi] ID - PMC4779738 [pmc] ID - NIHMS713683 [mid] PP - ppublish PH - 2015/07/22 [accepted] GI - No: R24 HD041025 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: R24-HD041025 Organization: (HD) *NICHD NIH HHS* Country: United States LG - English EP - 20150906 DP - 2016 EZ - 2015/09/08 06:00 DA - 2017/03/16 06:00 DT - 2015/09/08 06:00 YR - 2016 ED - 20170315 RD - 20170403 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26344571 <143. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27654445 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bockhold CR AU - Hughes AK FA - Bockhold, Colleen R FA - Hughes, Ashley K IN - Bockhold, Colleen R. Colleen R. Bockhold works in quality management and Ashley Kate Hughes is a nurse practitioner in the Central Texas Veteran's Healthcare System in Temple, Tex. Yvonne D'Arcy, MS, RN, CRNP, CNS, FAANP is the coordinator of Controlling Pain and a Nursing2016 editorial board member. TI - The ethics of opioids for chronic noncancer pain. SO - Nursing. 46(10):63-7, 2016 Oct AS - Nursing. 46(10):63-7, 2016 Oct NJ - Nursing VO - 46 IP - 10 PG - 63-7 PI - Journal available in: Print PI - Citation processed from: Internet JC - oa3, 7600137 IO - Nursing SB - Nursing Journal CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Chronic Pain/dt [Drug Therapy] MH - Drug Administration Schedule MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/th [Therapy] MH - Emergency Medical Services MH - *Ethics, Nursing MH - Humans MH - Male MH - Middle Aged MH - Nurse-Patient Relations MH - *Pain Management/nu [Nursing] MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1538-8689 IL - 0360-4039 DO - https://dx.doi.org/10.1097/01.NURSE.0000484981.83948.9c PT - Journal Article ID - 10.1097/01.NURSE.0000484981.83948.9c [doi] ID - 00152193-201610000-00019 [pii] PP - ppublish LG - English DP - 2016 Oct EZ - 2016/09/23 06:00 DA - 2017/03/16 06:00 DT - 2016/09/23 06:00 YR - 2016 ED - 20170314 RD - 20170817 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27654445 <144. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27004905 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Winhusen T AU - Theobald J AU - Lewis D AU - Wilder CM AU - Lyons MS FA - Winhusen, T FA - Theobald, J FA - Lewis, D FA - Wilder, C M FA - Lyons, M S IN - Winhusen, T. Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA, winhusen@carc.uc.edu. IN - Theobald, J. Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA. IN - Lewis, D. Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA. IN - Wilder, C M. Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA, Cincinnati Veterans Affairs Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA and. IN - Lyons, M S. Department of Emergency Medicine, University of Cincinnati College of Medicine 231 Albert Sabin Way, Cincinnati, OH 45267, USA. TI - Development and initial testing of a tailored telephone intervention delivered by peers to prevent recurring opioid-overdoses (TTIP-PRO). SO - Health Education Research. 31(2):146-60, 2016 Apr AS - Health Educ Res. 31(2):146-60, 2016 Apr NJ - Health education research VO - 31 IP - 2 PG - 146-60 PI - Journal available in: Print PI - Citation processed from: Internet JC - bqp, 8608459 IO - Health Educ Res SB - Health Technology Assessment Journals CP - England MH - Adult MH - Comorbidity MH - *Drug Overdose/pc [Prevention & Control] MH - Female MH - Health Education/og [Organization & Administration] MH - Health Knowledge, Attitudes, Practice MH - Health Status MH - Humans MH - Male MH - *Opiate Substitution Treatment/mt [Methods] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - *Peer Group MH - Risk Factors MH - Secondary Prevention/og [Organization & Administration] MH - Substance-Related Disorders/dt [Drug Therapy] MH - *Telephone AB - Individuals with opioid use disorder experiencing a non-fatal opioid-overdose (OOD) are at heightened risk for future OODs; there are no interventions to facilitate treatment enrollment for these patients. Our goal was to develop and initially test the 'tailored telephone intervention delivered by peers to prevent recurring opioid-overdoses' (TTIP-PRO), a computer-facilitated, peer-delivered, individually tailored secondary prevention intervention designed to: (i) encourage patients to initiate medication-assisted treatment (MAT) and (ii) increase OOD knowledge. A pre-post-study assessed TTIP-PRO-content acceptability and software performance. Two Peer Interventionists, who were abstinent from illicit opioids, enrolled in MAT and had experience with OOD, were recruited from a MAT clinic. Recruitment letters were sent to patients treated for OOD in a hospital emergency department within the prior 8 months. Eight patients received TTIP-PRO and completed pre-/post-assessment. Peer Interventionists completed training within 4 h and reported high satisfaction with TTIP-PRO. There were no performance issues with the software. All participants rated TTIP-PRO as 'very helpful'. Participants' OOD knowledge increased significantly, with 69.9% correct responses pre-TTIP-PRO and 93.6% post-TTIP-PRO. Interest in receiving MAT, measured on a 10-point scale, increased from 8.1 to 9.5, but this change was not statistically significant. Further development and testing of TTIP-PRO appears warranted. Copyright © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com. ES - 1465-3648 IL - 0268-1153 DO - https://dx.doi.org/10.1093/her/cyw010 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - cyw010 [pii] ID - 10.1093/her/cyw010 [doi] PP - ppublish PH - 2015/09/08 [received] PH - 2016/02/03 [accepted] SI - ClinicalTrials.gov SA - ClinicalTrials.gov/NCT02282306 SL - https://clinicaltrials.gov/search/term=NCT02282306 LG - English DP - 2016 Apr EZ - 2016/03/24 06:00 DA - 2017/03/10 06:00 DT - 2016/03/24 06:00 YR - 2016 ED - 20170309 RD - 20170309 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27004905 <145. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27448790 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schneir A AU - Metushi IG AU - Sloane C AU - Benaron DJ AU - Fitzgerald RL FA - Schneir, Aaron FA - Metushi, Imir G FA - Sloane, Christian FA - Benaron, David J FA - Fitzgerald, Robert L IN - Schneir, Aaron. a Division of Medical Toxicology , University of California, San Diego Health System , San Diego , CA , USA. IN - Schneir, Aaron. b Department of Emergency Medicine , University of California, San Diego Health System , San Diego , CA , USA. IN - Metushi, Imir G. c Department of Pathology, Center for Advanced Laboratory Medicine , University of California, San Diego Health System , San Diego , CA , USA. IN - Sloane, Christian. b Department of Emergency Medicine , University of California, San Diego Health System , San Diego , CA , USA. IN - Benaron, David J. b Department of Emergency Medicine , University of California, San Diego Health System , San Diego , CA , USA. IN - Fitzgerald, Robert L. c Department of Pathology, Center for Advanced Laboratory Medicine , University of California, San Diego Health System , San Diego , CA , USA. TI - Near death from a novel synthetic opioid labeled U-47700: emergence of a new opioid class. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 55(1):51-54, 2017 Jan AS - Clin Toxicol (Phila). 55(1):51-54, 2017 Jan NJ - Clinical toxicology (Philadelphia, Pa.) VO - 55 IP - 1 PG - 51-54 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Analgesics, Opioid/po [Poisoning] MH - Analgesics, Opioid/ur [Urine] MH - *Benzamides/po [Poisoning] MH - Benzamides/ur [Urine] MH - *Designer Drugs/po [Poisoning] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Substance Abuse Detection/mt [Methods] MH - Young Adult KW - *U-47700; *novel opioid; *novel psychoactive substance; *opioid poisoning; *synthetic opioid AB - BACKGROUND: In the last decade there has been a worldwide surge in the recreational abuse of novel psychoactive substances, particularly amphetamine derivatives and synthetic cannabinoids. Synthetic opioids such as AH-7921, MT-45, and U-47700, with structures distinct from those ever used therapeutically or described recreationally, have also recently emerged. AB - CASE DETAILS: We report a patient who suffered respiratory failure and depressed level of consciousness after recreationally using a novel synthetic opioid labeled U-47700. A single dose of naloxone administered by paramedics completely reversed his opioid poisoning. Comprehensive laboratory analysis confirmed the presence of a novel synthetic opioid and excluded other drugs. The drug used appeared to have caused a false positive benzodiazepine result on the initial urine drugs of abuse panel. AB - CONCLUSION: The case we describe of toxicity from the synthetic opioid labeled U-47700 highlights the emerging trend of novel synthetic opioid abuse. RN - 0 (Analgesics, Opioid) RN - 0 (Benzamides) RN - 0 (Designer Drugs) RN - 0 (Narcotic Antagonists) RN - 0 (U-47700) RN - 36B82AMQ7N (Naloxone) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.1080/15563650.2016.1209764 PT - Case Reports PT - Journal Article ID - 10.1080/15563650.2016.1209764 [doi] PP - ppublish LG - English EP - 20160722 DP - 2017 Jan EZ - 2016/07/28 06:00 DA - 2017/03/07 06:00 DT - 2016/07/25 06:00 YR - 2017 ED - 20170306 RD - 20170817 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27448790 <146. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27849133 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Willman MW AU - Liss DB AU - Schwarz ES AU - Mullins ME FA - Willman, Michael W FA - Liss, David B FA - Schwarz, Evan S FA - Mullins, Michael E IN - Willman, Michael W. a Division of Emergency Medicine , Washington University , St. Louis , MO , USA. IN - Liss, David B. a Division of Emergency Medicine , Washington University , St. Louis , MO , USA. IN - Schwarz, Evan S. a Division of Emergency Medicine , Washington University , St. Louis , MO , USA. IN - Mullins, Michael E. a Division of Emergency Medicine , Washington University , St. Louis , MO , USA. TI - Do heroin overdose patients require observation after receiving naloxone?. [Review] CM - Comment in: Clin Toxicol (Phila). 2017 Apr;55(4):308; PMID: 28140683 SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 55(2):81-87, 2017 Feb AS - Clin Toxicol (Phila). 55(2):81-87, 2017 Feb NJ - Clinical toxicology (Philadelphia, Pa.) VO - 55 IP - 2 PG - 81-87 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Drug Overdose MH - Emergency Service, Hospital MH - Emergency Treatment/mt [Methods] MH - *Heroin/po [Poisoning] MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotics/po [Poisoning] MH - Time Factors MH - Transportation of Patients/mt [Methods] KW - *Heroin overdose; *antidote; *emergency medical services; *treat-and-release AB - CONTEXT: Heroin use in the US has exploded in recent years, and heroin overdoses requiring naloxone are very common. After awakening, some heroin users refuse further treatment or transport to the hospital. These patients may be at risk for recurrent respiratory depression or pulmonary edema. In those transported to the emergency department, the duration of the observation period is controversial. Additionally, non-medical first responders and lay bystanders can administer naloxone for heroin and opioid overdoses. There are concerns about the outcomes and safety of this practice as well. AB - OBJECTIVES: To search the medical literature related to the following questions: (1) What are the medical risks to a heroin user who refuses ambulance transport after naloxone? (2) If the heroin user is treated in the emergency department with naloxone, how long must they be observed prior to discharge? (3) How effective in heroin users is naloxone administered by first responders and bystanders? Are there risks associated with naloxone distribution programs? AB - METHODS: We searched PubMed and GoogleScholar with search terms related to each of the questions listed above. The search was limited to English language and excluded patents and citations. The search was last updated on September 31, 2016. The articles found were reviewed for relevance to our objective questions. Eight out of 1020 citations were relevant to the first 2 questions, 5 of 707 were relevant to the third question and 15 of 287 were relevant to the fourth question. In the prehospital environment, does a heroin user revived with naloxone always require ambulance transport and what are the medical risks if ambulance transport is refused after naloxone? The eight articles were all observational studies done either prospectively or retrospectively. Two studies focused on heroin overdoses and included 1069 patients not transported to the hospital. No deaths occurred in this group. In counting the patients from all eight studies, some of which included non-heroin opioid overdoses, there were 5443 patients treated without transport and four deaths from rebound opioid toxicity. The number needed to transport to save one life (NNT) is 1361. Adverse effects were mostly related to opioid withdrawal. If a heroin user is treated in the ED, how long must the patient stay under observation before being safe for discharge? Five articles addressing the duration of ED observation required for patients treated with naloxone for opioid overdoses. Although a wide range of observation durations were reported, one study supported observing patients for one hour. If after this period the patient mobilizes as usual, has normal vital signs, and a Glasgow Coma Scale of 15, they can be discharged safely. What are the likely risks in heroin users following naloxone use by lay bystanders or first responders? Of the 15 relevant papers, a systematic review reported a 100% survival rate in eleven studies and a range of 96-99% survival in the remaining four. Two other studies suffered from poor follow-up and had lower success rates of 83% and 89%. Few if any risks were associated with opioid overdose prevention programs in which lay people were trained to administer naloxone. AB - CONCLUSIONS: Patients revived with naloxone after heroin overdose may be safely released without transport to the hospital if they have normal mentation and vital signs. In the absence of co-intoxicants and further opioid use there is very low risk of death from rebound opioid toxicity. For those patients treated in the ED for opioid overdose, an observation period of one hour is sufficient if they ambulate as usual, have normal vital signs and a Glasgow Coma Scale of 15. Patients suffering opioid toxicity can be administered naloxone safely by first responders and trained lay people. Programs that train these individuals are likely safe and beneficial, however further research is necessary. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.1080/15563650.2016.1253846 PT - Journal Article PT - Review ID - 10.1080/15563650.2016.1253846 [doi] PP - ppublish LG - English EP - 20161116 DP - 2017 Feb EZ - 2016/11/17 06:00 DA - 2017/02/28 06:00 DT - 2016/11/17 06:00 YR - 2017 ED - 20170227 RD - 20170817 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27849133 <147. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26929211 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - King R FA - King, Rebecca IN - King, Rebecca. School Nurse/Clinical Nursing Instructor, St. George's Technical High School, New Castle County Vocational School District, Middletown, DE. TI - Science Over Stigma: Saving Lives--Implementation of Naloxone Use in the School Setting. SO - NASN school nurse. 31(2):96-101, 2016 Mar AS - NASN Sch Nurse. 31(2):96-101, 2016 Mar NJ - NASN school nurse (Print) VO - 31 IP - 2 PG - 96-101 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101528330 IO - NASN Sch Nurse SB - Nursing Journal CP - United States MH - Adolescent MH - Child MH - Delaware MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/st [Standards] MH - Female MH - Humans MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Practice Guidelines as Topic MH - *Prescription Drug Misuse/nu [Nursing] MH - *School Nursing/st [Standards] MH - Social Stigma KW - addiction; harm reduction; heroin; naloxone; prescription drugs; school nurses; stigma AB - Unintentional drug overdose is a leading cause of preventable death in the United States. Administration of naloxone hydrochloride ("naloxone") can reverse a potentially fatal opioid overdose and save lives. The school nurse is an essential part of the school team responsible for developing emergency response procedures and should facilitate access to naloxone for the management of opioid-related overdose in the school setting. Delaware has been leading efforts to provide education, increase awareness, and help erase the stigma of substance use disorder through school nurse collaboration with a grassroots organization and state stakeholders. This article discusses the successful implementation of naloxone use in the school setting in Delaware public high schools. Copyright © 2016 The Author(s). RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1942-6038 IL - 1942-602X DO - https://dx.doi.org/10.1177/1942602X16628890 PT - Journal Article ID - 31/2/96 [pii] ID - 10.1177/1942602X16628890 [doi] PP - ppublish LG - English DP - 2016 Mar EZ - 2016/03/02 06:00 DA - 2017/02/28 06:00 DT - 2016/03/02 06:00 YR - 2016 ED - 20170227 RD - 20170227 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26929211 <148. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28199807 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barnett ML AU - Olenski AR AU - Jena AB FA - Barnett, Michael L FA - Olenski, Andrew R FA - Jena, Anupam B IN - Barnett, Michael L. From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B.), the Department of Health Care Policy, Harvard Medical School (A.R.O., A.B.J.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), and the Department of Medicine, Massachusetts General Hospital (A.B.J.), Boston, and the National Bureau of Economic Research, Cambridge (A.B.J.) - all in Massachusetts. IN - Olenski, Andrew R. From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B.), the Department of Health Care Policy, Harvard Medical School (A.R.O., A.B.J.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), and the Department of Medicine, Massachusetts General Hospital (A.B.J.), Boston, and the National Bureau of Economic Research, Cambridge (A.B.J.) - all in Massachusetts. IN - Jena, Anupam B. From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B.), the Department of Health Care Policy, Harvard Medical School (A.R.O., A.B.J.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), and the Department of Medicine, Massachusetts General Hospital (A.B.J.), Boston, and the National Bureau of Economic Research, Cambridge (A.B.J.) - all in Massachusetts. TI - Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use. CM - Comment in: N Engl J Med. 2017 May 11;376(19):1895; PMID: 28489998 CM - Comment in: N Engl J Med. ;376(19):1895-6; PMID: 28492072 SO - New England Journal of Medicine. 376(7):663-673, 2017 02 16 AS - N Engl J Med. 376(7):663-673, 2017 02 16 NJ - The New England journal of medicine VO - 376 IP - 7 PG - 663-673 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0255562, now IO - N. Engl. J. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Chronic Disease MH - *Drug Utilization/sn [Statistics & Numerical Data] MH - *Emergency Medicine/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Inappropriate Prescribing/sn [Statistics & Numerical Data] MH - Male MH - Medicare Part D MH - Middle Aged MH - Odds Ratio MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - United States MH - Wounds and Injuries/dt [Drug Therapy] AB - BACKGROUND: Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown. AB - METHODS: We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit. After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high-intensity or low-intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital. We compared rates of long-term opioid use, defined as 6 months of days supplied, in the 12 months after a visit to the emergency department among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics. AB - RESULTS: Our sample consisted of 215,678 patients who received treatment from low-intensity prescribers and 161,951 patients who received treatment from high-intensity prescribers. Patient characteristics, including diagnoses in the emergency department, were similar in the two treatment groups. Within individual hospitals, rates of opioid prescribing varied widely between low-intensity and high-intensity prescribers (7.3% vs. 24.1%). Long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers (adjusted odds ratio, 1.30; 95% confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent across multiple sensitivity analyses. AB - CONCLUSIONS: Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers. (Funded by the National Institutes of Health.). RN - 0 (Analgesics, Opioid) ES - 1533-4406 IL - 0028-4793 DO - https://dx.doi.org/10.1056/NEJMsa1610524 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1056/NEJMsa1610524 [doi] ID - PMC5428548 [pmc] ID - NIHMS858308 [mid] PP - ppublish GI - No: DP5 OD017897 Organization: (OD) *NIH HHS* Country: United States LG - English DP - 2017 02 16 EZ - 2017/02/16 06:00 DA - 2017/02/24 06:00 DT - 2017/02/16 06:00 YR - 2017 ED - 20170223 RD - 20170816 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28199807 <149. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27471063 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kim HS AU - Lank PM AU - Pang PS AU - Courtney DM AU - Lambert BL AU - Gravenor SJ AU - McCarthy DM FA - Kim, Howard S FA - Lank, Patrick M FA - Pang, Peter S FA - Courtney, D Mark FA - Lambert, Bruce L FA - Gravenor, Stephanie J FA - McCarthy, Danielle M IN - Kim, Howard S. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: howard.kim@northwestern.edu. IN - Lank, Patrick M. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. IN - Pang, Peter S. Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN. IN - Courtney, D Mark. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. IN - Lambert, Bruce L. Department of Communication Studies, Northwestern University, Chicago, IL. IN - Gravenor, Stephanie J. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. IN - McCarthy, Danielle M. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. TI - ED opioid prescribing is not associated with higher patient satisfaction scores. SO - American Journal of Emergency Medicine. 34(10):2032-2034, 2016 Oct AS - Am J Emerg Med. 34(10):2032-2034, 2016 Oct NJ - The American journal of emergency medicine VO - 34 IP - 10 PG - 2032-2034 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Chicago MH - Drug Prescriptions/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital/st [Standards] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Patient Satisfaction/sn [Statistics & Numerical Data] MH - Retrospective Studies RN - 0 (Analgesics, Opioid) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(16)30428-4 DO - https://dx.doi.org/10.1016/j.ajem.2016.07.033 PT - Letter ID - S0735-6757(16)30428-4 [pii] ID - 10.1016/j.ajem.2016.07.033 [doi] PP - ppublish PH - 2016/05/19 [received] PH - 2016/07/07 [revised] PH - 2016/07/18 [accepted] LG - English EP - 20160721 DP - 2016 Oct EZ - 2016/07/30 06:00 DA - 2017/02/23 06:00 DT - 2016/07/30 06:00 YR - 2016 ED - 20170222 RD - 20170817 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27471063 <150. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27168876 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Siegler JE AU - Kable JW AU - Chatterjee A FA - Siegler, James E FA - Kable, Joseph W FA - Chatterjee, Anjan TI - Resident Decision Making: Opioids in the Outpatient Setting. SO - Journal of Graduate Medical Education. 8(2):138-41, 2016 May AS - J Grad Med Educ. 8(2):138-41, 2016 May NJ - Journal of graduate medical education VO - 8 IP - 2 PG - 138-41 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101521733 IO - J Grad Med Educ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857523 SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Attitude of Health Personnel MH - Chronic Pain/di [Diagnosis] MH - *Chronic Pain/dt [Drug Therapy] MH - *Decision Making MH - Emergency Service, Hospital MH - Humans MH - *Internship and Residency MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Opioid-Related Disorders/px [Psychology] MH - Outpatients RN - 0 (Analgesics, Opioid) ES - 1949-8357 IL - 1949-8357 DO - https://dx.doi.org/10.4300/JGME-D-15-00186.1 PT - Journal Article ID - 10.4300/JGME-D-15-00186.1 [doi] ID - Customer: JGME-D-15-00186.1 [pii] ID - PMC4857523 [pmc] PP - ppublish LG - English DP - 2016 May EZ - 2016/05/12 06:00 DA - 2017/05/02 06:00 DT - 2016/05/12 06:00 YR - 2016 ED - 20170220 RD - 20170501 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27168876 <151. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26369588 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Skaer TL AU - Nwude AC FA - Skaer, Tracy L FA - Nwude, Azuka C IN - Skaer, Tracy L. Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington, U.S.A. IN - Nwude, Azuka C. Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington, U.S.A. TI - Opioid Prescribing Laws and Emergency Department Guidelines for Chronic Non-Cancer Pain in Washington State. [Review] SO - Pain Practice. 16(5):642-7, 2016 06 AS - Pain pract.. 16(5):642-7, 2016 06 NJ - Pain practice : the official journal of World Institute of Pain VO - 16 IP - 5 PG - 642-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101130835 IO - Pain Pract SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Chronic Pain/dt [Drug Therapy] MH - *Drug Prescriptions MH - *Emergency Service, Hospital/lj [Legislation & Jurisprudence] MH - *Emergency Service, Hospital/st [Standards] MH - *Guidelines as Topic MH - Humans MH - *Legislation, Drug/td [Trends] MH - *Pain Management/td [Trends] MH - Practice Patterns, Physicians' MH - Washington KW - best practices; chronic pain; emergency department prescribing; medical legal; opioid agreement; opioid analgesics; pain contract; pain specialist; practice management AB - Rising mortality rates, increased opioid prescription abuse, and a perceived need to provide practitioners with structured guidance in opioid prescribing have prompted the Washington State Legislature to establish new legal standards of practice regarding chronic non-cancer pain management. Clinicians are required to conduct a detailed physical examination and health history prior to treatment. Risk assessments for abuse and detailed periodic reviews of treatment are required at least every 6 months. Those considered "high risk" or who have significant psychiatric comorbidities will be required to sign and follow a written agreement or pain contract, obtain their pain prescriptions from a single provider, and submit to biological drug screening. Unless an exemption exists, patients prescribed > 120 mg of morphine-equivalents daily, considered severe pain nonresponders, necessitating dosage escalation, diagnosed with multifaceted mental health-related comorbidities, demonstrating diagnostic ambiguity, and/or requiring significant treatment individualization are referred to a pain specialist. Episodic care settings should refrain from supplying opioids to chronic pain patients whenever possible. The ER is for Emergencies coalition instituted the Seven Best Practices program throughout the state to reduce unnecessary visits, coordinate prescribing practice, reduce Medicaid expenditures, and improve overall patient care. The state reported approximately $33.65 million in savings in 2013 through the use of these practices and converting Medicaid participants from fee-for-service to managed care plans. Similar legislation to complement clinical practice guidelines is expected to be enacted in other states. It is vital that practitioners comprehend the new guidelines and make appropriate adjustments in their opioid prescribing habits. Copyright © 2015 World Institute of Pain. RN - 0 (Analgesics, Opioid) ES - 1533-2500 IL - 1530-7085 DO - https://dx.doi.org/10.1111/papr.12359 PT - Journal Article PT - Review ID - 10.1111/papr.12359 [doi] PP - ppublish PH - 2015/05/19 [received] PH - 2015/07/20 [accepted] LG - English EP - 20150915 DP - 2016 06 EZ - 2015/09/16 06:00 DA - 2017/02/10 06:00 DT - 2015/09/16 06:00 YR - 2016 ED - 20170209 RD - 20170209 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26369588 <152. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27583928 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chen JH AU - Hom J AU - Richman I AU - Asch SM AU - Podchiyska T AU - Johansen NA FA - Chen, Jonathan H FA - Hom, Jason FA - Richman, Ilana FA - Asch, Steven M FA - Podchiyska, Tanya FA - Johansen, Nawal Atwan IN - Chen, Jonathan H. aDivision of General Medical Disciplines, Department of Medicine, Stanford University, Stanford bCenter for Innovation to Implementation (Ci2i), Veteran Affairs Palo Alto Health Care System, Palo Alto cCenter for Primary Care and Outcomes Research (PCOR) dDepartment of Health Research and Policy-Epidemiology, Stanford University, Stanford, CA. TI - Effect of opioid prescribing guidelines in primary care. SO - Medicine. 95(35):e4760, 2016 Aug AS - Medicine (Baltimore). 95(35):e4760, 2016 Aug NJ - Medicine VO - 95 IP - 35 PG - e4760 PI - Journal available in: Print PI - Citation processed from: Internet JC - mny, 2985248r IO - Medicine (Baltimore) PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008612 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Chronic Pain/dt [Drug Therapy] MH - *Drug Prescriptions/st [Standards] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Practice Patterns, Physicians' MH - *Primary Health Care/st [Standards] AB - Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education.We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed.After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed.An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical practice. CI - The authors have no conflicts of interest to disclose. RN - 0 (Analgesics, Opioid) ES - 1536-5964 IL - 0025-7974 DO - https://dx.doi.org/10.1097/MD.0000000000004760 PT - Journal Article PT - Practice Guideline ID - 10.1097/MD.0000000000004760 [doi] ID - 00005792-201608300-00088 [pii] ID - PMC5008612 [pmc] PP - ppublish GI - No: K01 ES026837 Organization: (ES) *NIEHS NIH HHS* Country: United States LG - English DP - 2016 Aug EZ - 2016/09/02 06:00 DA - 2017/02/09 06:00 DT - 2016/09/02 06:00 YR - 2016 ED - 20170207 RD - 20170606 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27583928 <153. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28151928 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tomassoni AJ AU - Hawk KF AU - Jubanyik K AU - Nogee DP AU - Durant T AU - Lynch KL AU - Patel R AU - Dinh D AU - Ulrich A AU - D'Onofrio G FA - Tomassoni, Anthony J FA - Hawk, Kathryn F FA - Jubanyik, Karen FA - Nogee, Daniel P FA - Durant, Thomas FA - Lynch, Kara L FA - Patel, Rushaben FA - Dinh, David FA - Ulrich, Andrew FA - D'Onofrio, Gail TI - Multiple Fentanyl Overdoses - New Haven, Connecticut, June 23, 2016. SO - MMWR - Morbidity & Mortality Weekly Report. 66(4):107-111, 2017 Feb 03 AS - MMWR Morb Mortal Wkly Rep. 66(4):107-111, 2017 Feb 03 NJ - MMWR. Morbidity and mortality weekly report VO - 66 IP - 4 PG - 107-111 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - ne8, 7802429 IO - MMWR Morb. Mortal. Wkly. Rep. SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Connecticut MH - *Drug Overdose/di [Diagnosis] MH - Drug Overdose/th [Therapy] MH - Emergency Service, Hospital MH - Fatal Outcome MH - Female MH - Fentanyl/bl [Blood] MH - *Fentanyl/po [Poisoning] MH - Fentanyl/ur [Urine] MH - Humans MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] AB - On the evening of June 23, 2016, a white powder advertised as cocaine was purchased off the streets from multiple sources and used by an unknown number of persons in New Haven, Connecticut. During a period of less than 8 hours, 12 patients were brought to the emergency department (ED) at Yale New Haven Hospital, experiencing signs and symptoms consistent with opioid overdose. The route of intoxication was not known, but presumed to be insufflation ("snorting") in most cases. Some patients required doses of the opioid antidote naloxone exceeding 4 mg (usual initial dose = 0.1-0.2 mg intravenously), and several patients who were alert after receiving naloxone subsequently developed respiratory failure. Nine patients were admitted to the hospital, including four to the intensive care unit (ICU); three required endotracheal intubation, and one required continuous naloxone infusion. Three patients died. The white powder was determined to be fentanyl, a drug 50 times more potent than heroin, and it included trace amounts of cocaine. The episode triggered rapid notification of public health and law enforcement agencies, interviews of patients and their family members to trace and limit further use or distribution of the fentanyl, immediate naloxone resupply and augmentation for emergency medical services (EMS) crews, public health alerts, and plans to accelerate naloxone distribution to opioid users and their friends and families. Effective communication and timely, coordinated, collaborative actions of community partners reduced the harm caused by this event and prevented potential subsequent episodes. RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) ES - 1545-861X IL - 0149-2195 DO - https://dx.doi.org/10.15585/mm6604a4 PT - Case Reports PT - Journal Article ID - 10.15585/mm6604a4 [doi] PP - epublish LG - English EP - 20170203 DP - 2017 Feb 03 EZ - 2017/02/06 06:00 DA - 2017/02/07 06:00 DT - 2017/02/03 06:00 YR - 2017 ED - 20170206 RD - 20170206 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28151928 <154. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27922764 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Coplan PM AU - Sessler NE AU - Harikrishnan V AU - Singh R AU - Perkel C FA - Coplan, Paul M FA - Sessler, Nelson E FA - Harikrishnan, Venkatesh FA - Singh, Richa FA - Perkel, Charles IN - Coplan, Paul M. a Purdue Pharma L.P ., Stamford , CT , USA. IN - Coplan, Paul M. b University of Pennsylvania , Philadelphia , PA , USA. IN - Sessler, Nelson E. a Purdue Pharma L.P ., Stamford , CT , USA. IN - Harikrishnan, Venkatesh. a Purdue Pharma L.P ., Stamford , CT , USA. IN - Singh, Richa. a Purdue Pharma L.P ., Stamford , CT , USA. IN - Perkel, Charles. c Mount Sinai Beth Israel, Bernstein Pavilion , New York , NY , USA. TI - Comparison of abuse, suspected suicidal intent, and fatalities related to the 7-day buprenorphine transdermal patch versus other opioid analgesics in the National Poison Data System. SO - Postgraduate Medicine. 129(1):55-61, 2017 Jan AS - Postgrad Med. 129(1):55-61, 2017 Jan NJ - Postgraduate medicine VO - 129 IP - 1 PG - 55-61 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 0401147, pfk IO - Postgrad Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adult MH - Aged MH - Aged, 80 and over MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Buprenorphine/ae [Adverse Effects] MH - *Buprenorphine/tu [Therapeutic Use] MH - *Cause of Death MH - *Chronic Pain/dt [Drug Therapy] MH - Cohort Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Poison Control Centers/sn [Statistics & Numerical Data] MH - *Prescription Drug Misuse/mo [Mortality] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Sex Factors MH - Suicide/sn [Statistics & Numerical Data] MH - Transdermal Patch MH - United States KW - Buprenorphine transdermal patch; National Poison Data System (NPDS); intentional abuse; suspected suicidal intent AB - OBJECTIVE: Prescription opioid related abuse, suicide and death are significant public health problems. This study compares rates of poison center calls categorized as intentional abuse, suspected suicidal intent or fatality for the 7-day buprenorphine transdermal system/patch (BTDS) with other extended-release and long-acting (ER/LA) opioids indicated for chronic pain. AB - METHODS: Retrospective 24-month cohort study using National Poison Data System data from July 2012 through June 2014. BTDS was introduced in the United States in January 2011. Numbers and rates of calls of intentional abuse, suspected suicidal intent and fatalities were evaluated for BTDS, ER morphine, ER oxycodone, fentanyl patch, ER oxymorphone and methadone tablets/capsules, using prescription adjustment to account for community availability. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. AB - RESULTS: Absolute numbers and prescription-adjusted rates of intentional abuse and suspected suicidal intent with BTDS were significantly lower (p < .0001) than for all other ER/LA opioid analgesics examined. No fatalities associated with BTDS exposure were reported. AB - CONCLUSION: This post-marketing evaluation of BTDS indicates infrequent poison center calls for intentional abuse and suspected suicidal intent events, suggesting lower rates of these risks with BTDS compared to other ER/LA opioids. RN - 0 (Analgesics, Opioid) RN - 40D3SCR4GZ (Buprenorphine) ES - 1941-9260 IL - 0032-5481 DO - https://dx.doi.org/10.1080/00325481.2017.1269596 PT - Comparative Study PT - Journal Article ID - 10.1080/00325481.2017.1269596 [doi] PP - ppublish LG - English EP - 20161221 DP - 2017 Jan EZ - 2016/12/07 06:00 DA - 2017/02/07 06:00 DT - 2016/12/07 06:00 YR - 2017 ED - 20170206 RD - 20170206 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27922764 <155. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 28005123 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kelly MA FA - Kelly, Michael A IN - Kelly, Michael A. Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, NJ; Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY. TI - Addressing the Opioid Epidemic With Multimodal Pain Management. SO - American Journal of Orthopedics (Chatham, Nj). 45(7):S6-S8, 2016 Nov/Dec AS - Am J Orthop. 45(7):S6-S8, 2016 Nov/Dec NJ - American journal of orthopedics (Belle Mead, N.J.) VO - 45 IP - 7 PG - S6-S8 PI - Journal available in: Print PI - Citation processed from: Internet JC - b41, 9502918 IO - Am J. Orthop. SB - Index Medicus CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Humans MH - *Opioid-Related Disorders/et [Etiology] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - *Pain Management/ae [Adverse Effects] AB - The opioid epidemic has become a national public health and safety problem affecting both adults and adolescents. There is little doubt that this epidemic is rooted in the need for pain control after surgery and that orthopedic surgeons have in part contributed to opioid overprescription. Indeed, opioid abuse, misuse, and diversion are associated with increased hospitalizations, emergency department visits, and associated health care costs. In addition, postoperative exposure to opioids correlates with long-term use and abuse.Moreover, opioid-related adverse effects are the leading cause of preventable harm in hospitals and can result in unexpected death. As such, there is an urgent need to address the opioid epidemic. Toward that end, several professional and governmental organizations have recommended opioid-sparing pain management approaches for surgeries-approaches that target different pain pathways to achieve adequate pain control. Such multimodal analgesia approaches are expected to reduce the writing of postoperative opioid prescriptions and their related adverse effects. RN - 0 (Analgesics, Opioid) ES - 1934-3418 IL - 1078-4519 PT - Journal Article PP - ppublish LG - English DP - 2016 Nov/Dec EZ - 2016/12/23 06:00 DA - 2017/02/07 06:00 DT - 2016/12/23 06:00 YR - 2016 ED - 20170206 RD - 20170206 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=28005123 <156. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27756427 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Drainoni ML AU - Koppelman EA AU - Feldman JA AU - Walley AY AU - Mitchell PM AU - Ellison J AU - Bernstein E FA - Drainoni, Mari-Lynn FA - Koppelman, Elisa A FA - Feldman, James A FA - Walley, Alexander Y FA - Mitchell, Patricia M FA - Ellison, Jacqueline FA - Bernstein, Edward IN - Drainoni, Mari-Lynn. Boston University School of Public Health, 715 Albany Street, T3 W, Boston, MA, 02118, USA. drainoni@bu.edu. IN - Drainoni, Mari-Lynn. Boston University School of Medicine, Boston, MA, USA. drainoni@bu.edu. IN - Drainoni, Mari-Lynn. Center for Healthcare Organization and Implementation Research, ENRM Veterans Administration Hospital, Bedford, MA, USA. drainoni@bu.edu. IN - Koppelman, Elisa A. Boston University School of Public Health, 715 Albany Street, T3 W, Boston, MA, 02118, USA. IN - Koppelman, Elisa A. Center for Healthcare Organization and Implementation Research, ENRM Veterans Administration Hospital, Bedford, MA, USA. IN - Feldman, James A. Boston University School of Medicine, Boston, MA, USA. IN - Feldman, James A. Boston Medical Center, Boston, MA, USA. IN - Walley, Alexander Y. Boston University School of Medicine, Boston, MA, USA. IN - Walley, Alexander Y. Boston Medical Center, Boston, MA, USA. IN - Mitchell, Patricia M. Boston University School of Medicine, Boston, MA, USA. IN - Mitchell, Patricia M. Boston Medical Center, Boston, MA, USA. IN - Ellison, Jacqueline. Boston University School of Public Health, 715 Albany Street, T3 W, Boston, MA, 02118, USA. IN - Bernstein, Edward. Boston University School of Public Health, 715 Albany Street, T3 W, Boston, MA, 02118, USA. IN - Bernstein, Edward. Boston University School of Medicine, Boston, MA, USA. IN - Bernstein, Edward. Boston Medical Center, Boston, MA, USA. TI - Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment. SO - BMC Research Notes. 9(1):465, 2016 Oct 18 AS - BMC Res Notes. 9(1):465, 2016 Oct 18 NJ - BMC research notes VO - 9 IP - 1 PG - 465 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101462768 IO - BMC Res Notes SB - Index Medicus CP - England MH - Administration, Intranasal MH - Adult MH - Aged MH - *Drug Overdose/pc [Prevention & Control] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/sd [Supply & Distribution] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/sd [Supply & Distribution] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Patient Acceptance of Health Care MH - *Personnel, Hospital/px [Psychology] KW - Emergency department; Opioid overdose; Overdose prevention; Policy implementation AB - BACKGROUND: The increase in opioid overdose deaths has become a national public health crisis. Naloxone is an important tool in opioid overdose prevention. Distribution of nasal naloxone has been found to be a feasible, and effective intervention in community settings and may have potential high applicability in the emergency department, which is often the initial point of care for persons at high risk of overdose. One safety net hospital introduced an innovative policy to offer take-home nasal naloxone via a standing order to ensure distribution to patients at risk for overdose. The aims of this study were to examine acceptance and uptake of the policy and assess facilitators and barriers to implementation. AB - METHODS: After obtaining pre-post data on naloxone distribution, we conducted a qualitative study. The PARiHS framework steered development of the qualitative guide. We used theoretical sampling in order to include the range of types of emergency department staff (50 total). The constant comparative method was initially used to code the transcripts and identify themes; the themes that emerged from the coding were then mapped back to the evidence, context and facilitation constructs of the PARiHS framework. AB - RESULTS: Acceptance of the policy was good but uptake was low. Primary themes related to facilitators included: real-world driven intervention with philosophical, clinician and leadership support; basic education and training efforts; availability of resources; and ability to leave the ED with the naloxone kit in hand. Barriers fell into five general categories: protocol and policy; workflow and logistical; patient-related; staff roles and responsibilities; and education and training. AB - CONCLUSIONS: The actual implementation of a new innovation in healthcare delivery is largely driven by factors beyond acceptance. Despite support and resources, implementation was challenging, with low uptake. While the potential of this innovation is unknown, understanding the experience is important to improve uptake in this setting and offer possible solutions for other facilities to address the opioid overdose crisis. Use of the PARiHS framework allowed us to recognize and understand key evidence, contextual and facilitation barriers to the successful implementation of the policy and to identify areas for improvement. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1756-0500 IL - 1756-0500 PT - Journal Article ID - 10.1186/s13104-016-2268-z [doi] ID - 10.1186/s13104-016-2268-z [pii] ID - PMC5070095 [pmc] PP - epublish PH - 2016/03/01 [received] PH - 2016/10/06 [accepted] LG - English EP - 20161018 DP - 2016 Oct 18 EZ - 2016/10/21 06:00 DA - 2017/01/31 06:00 DT - 2016/10/21 06:00 YR - 2016 ED - 20170130 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27756427 <157. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26860229 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Haug NA AU - Bielenberg J AU - Linder SH AU - Lembke A FA - Haug, Nancy A FA - Bielenberg, Jennifer FA - Linder, Steven H FA - Lembke, Anna IN - Haug, Nancy A. a PGSP-Stanford University PsyD Consortium , Palo Alto University , Palo Alto , California , USA. IN - Haug, Nancy A. b Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA. IN - Bielenberg, Jennifer. a PGSP-Stanford University PsyD Consortium , Palo Alto University , Palo Alto , California , USA. IN - Linder, Steven H. c VA Palo Alto Health Care System , Palo Alto , California , USA. IN - Lembke, Anna. b Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA. TI - Assessment of provider attitudes toward #naloxone on Twitter. SO - Substance Abuse. 37(1):35-41, 2016 AS - Subst Abus. 37(1):35-41, 2016 NJ - Substance abuse VO - 37 IP - 1 PG - 35-41 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8808537, 101514834 IO - Subst Abus SB - Index Medicus CP - United States MH - *Attitude of Health Personnel MH - Burnout, Professional MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Responders/px [Psychology] MH - Evaluation Studies as Topic MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Social Media MH - Social Stigma KW - Attitudes; Narcan; education; emergency personnel; naloxone; opioid; overdose; stigma; training AB - BACKGROUND: As opioid overdose rates continue to pose a major public health crisis, the need for naloxone treatment by emergency first responders is critical. Little is known about the views of those who administer naloxone. The current study examines attitudes of health professionals on the social media platform Twitter to better understand their perceptions of opioid users, the role of naloxone, and potential training needs. AB - METHODS: Public comments on Twitter regarding naloxone were collected for a period of 3 consecutive months. The occupations of individuals who posted tweets were identified through Twitter profiles or hashtags. Categories of emergency service first responders and medical personnel were created. Qualitative analysis using a grounded theory approach was used to produce thematic content. The relationships between occupation and each theme were analyzed using Pearson chi-square statistics and post hoc analyses. AB - RESULTS: A total of 368 individuals posted 467 naloxone-related tweets. Occupations consisted of professional first responders such as emergency medical technicians (EMTs), firefighters, and paramedics (n = 122); law enforcement officers (n = 70); nurses (n = 62); physicians (n = 48); other health professionals including pharmacists, pharmacy technicians, counselors, and social workers (n = 31); naloxone-trained individuals (n = 12); and students (n = 23). Primary themes included burnout, education and training, information seeking, news updates, optimism, policy and economics, stigma, and treatment. The highest levels of burnout, fatigue, and stigma regarding naloxone and opioid overdose were among nurses, EMTs, other health care providers, and physicians. In contrast, individuals who self-identified as "naloxone-trained" had the highest optimism and the lowest amount of burnout and stigma. AB - CONCLUSIONS: Provider training and refinement of naloxone administration procedures are needed to improve treatment outcomes and reduce provider stigma. Social networking sites such as Twitter may have potential for offering psychoeducation to health care providers. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1547-0164 IL - 0889-7077 DO - https://dx.doi.org/10.1080/08897077.2015.1129390 PT - Journal Article ID - 10.1080/08897077.2015.1129390 [doi] PP - ppublish LG - English DP - 2016 EZ - 2016/02/11 06:00 DA - 2017/01/27 06:00 DT - 2016/02/11 06:00 YR - 2016 ED - 20170126 RD - 20170126 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26860229 <158. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27261241 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kim HS AU - Heard KJ AU - Heard S AU - Hoppe JA FA - Kim, Howard S FA - Heard, Kennon J FA - Heard, Susan FA - Hoppe, Jason A IN - Kim, Howard S. Department of Emergency Medicine, Center for Education in Health Sciences, Northwestern University, Chicago, IL. howard.kim@northwestern.edu. IN - Heard, Kennon J. Section of Medical Pharmacology and Toxicology, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CORocky Mountain Poison and Drug Center, Denver, CO. IN - Heard, Susan. Rocky Mountain Poison and Drug Center, Denver, CO. IN - Hoppe, Jason A. Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CORocky Mountain Poison and Drug Center, Denver, CO. TI - Opioid prescription fill rates after emergency department discharge. SO - American Journal of Health-System Pharmacy. 73(12):902-7, 2016 Jun 15 AS - Am J Health-Syst Pharm. 73(12):902-7, 2016 Jun 15 NJ - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists VO - 73 IP - 12 PG - 902-7 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9503023, cbh IO - Am J Health Syst Pharm SB - Index Medicus CP - United States MH - Academic Medical Centers/td [Trends] MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cohort Studies MH - Drug Prescriptions MH - *Emergency Service, Hospital/td [Trends] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Pain/di [Diagnosis] MH - Pain/dt [Drug Therapy] MH - Pain/ep [Epidemiology] MH - *Patient Discharge/td [Trends] MH - *Prescription Drugs/tu [Therapeutic Use] AB - PURPOSE: Opioid prescription fill rates and the time to fill after emergency department (ED) discharge were studied. AB - METHODS: Data were evaluated for all patients discharged from the ED between September 1, 2011, who were February 1, 2012, who were diagnosed with one of the following: dental pain, jaw pain, flank pain, abdominal pain, pelvic pain, back pain, neck pain, knee pain, headache, fracture, or sprain. Clinical information was abstracted via computer algorithm, and prescription filling within 100 days of prescription writing was determined by cross-referencing patient demographics with the state prescription drug monitoring program. Logistic regression analysis and a Cox proportional hazards model were used to determine if any clinical and demographic characteristics were associated with fill rates or the time to fill, respectively. AB - RESULTS: Of the 2243 patients who received an opioid prescription at ED discharge, 1775 (79%) filled it, with a median time to fill of 0 days. On adjusted analysis, characteristics associated with filling the opioid prescriptions included Caucasian race, being insured by the federal government or through a state indigent assistance program, a chief complaint of back pain, and a history of filling an opioid prescription within the past year. No characteristics were predictive of a prolonged time to filling. AB - CONCLUSION: One in five patients who received an opioid prescription at discharge from an urban academic ED did not fill it. Several factors may be associated with a greater likelihood of filling, such as insurance status and history of filling an opioid prescription within the past year. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1535-2900 IL - 1079-2082 DO - https://dx.doi.org/10.2146/ajhp150528 PT - Journal Article ID - 73/12/902 [pii] ID - 10.2146/ajhp150528 [doi] PP - ppublish LG - English DP - 2016 Jun 15 EZ - 2016/06/05 06:00 DA - 2017/01/21 06:00 DT - 2016/06/05 06:00 YR - 2016 ED - 20170120 RD - 20170120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27261241 <159. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27208051 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Traynor K FA - Traynor, Kate TI - Small state takes big steps in opioid-overdose reversal. SO - American Journal of Health-System Pharmacy. 73(11):734-8, 2016 Jun 01 AS - Am J Health-Syst Pharm. 73(11):734-8, 2016 Jun 01 NJ - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists VO - 73 IP - 11 PG - 734-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9503023, cbh IO - Am J Health Syst Pharm SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - Emergency Medical Services/lj [Legislation & Jurisprudence] MH - Emergency Medical Services/mt [Methods] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *State Health Plans/lj [Legislation & Jurisprudence] MH - Vermont/ep [Epidemiology] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1535-2900 IL - 1079-2082 DO - https://dx.doi.org/10.2146/news160033 PT - News ID - 73/11/734 [pii] ID - 10.2146/news160033 [doi] PP - ppublish LG - English DP - 2016 Jun 01 EZ - 2016/05/22 06:00 DA - 2017/01/21 06:00 DT - 2016/05/22 06:00 YR - 2016 ED - 20170120 RD - 20170120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27208051 <160. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26383533 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sumner SA AU - Mercado-Crespo MC AU - Spelke MB AU - Paulozzi L AU - Sugerman DE AU - Hillis SD AU - Stanley C FA - Sumner, Steven Allan FA - Mercado-Crespo, Melissa C FA - Spelke, M Bridget FA - Paulozzi, Leonard FA - Sugerman, David E FA - Hillis, Susan D FA - Stanley, Christina TI - Use of Naloxone by Emergency Medical Services during Opioid Drug Overdose Resuscitation Efforts. SO - Prehospital Emergency Care. 20(2):220-5, 2016 AS - Prehosp Emerg Care. 20(2):220-5, 2016 NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 20 IP - 2 PG - 220-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4798917 OI - Source: NLM. HHSPA745395 [Available on 03/01/17] SB - Index Medicus CP - England MH - Adult MH - Cross-Sectional Studies MH - *Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Resuscitation KW - emergency medical services; heroin; naloxone; opioid; resuscitation AB - Naloxone administration is an important component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses. However, EMS providers must first recognize the possibility of opioid overdose in clinical encounters. As part of a public health response to an outbreak of opioid overdoses in Rhode Island, we examined missed opportunities for naloxone administration and factors potentially influencing EMS providers' decision to administer naloxone. We reviewed medical examiner files on all individuals who died of an opioid-related drug overdose in Rhode Island from January 1, 2012 through March 31, 2014, underwent attempted resuscitation by EMS providers, and had records available to assess for naloxone administration. We evaluated whether these individuals received naloxone as part of their resuscitation efforts and compared patient and scene characteristics of those who received naloxone to those who did not receive naloxone via chi-square, t-test, and logistic regression analyses. One hundred and twenty-four individuals who underwent attempted EMS resuscitation died due to opioid overdose. Naloxone was administered during EMS resuscitation attempts in 82 (66.1%) of cases. Females were nearly three-fold as likely not to receive naloxone as males (OR 2.9; 95% CI 1.2-7.0; p-value 0.02). Additionally, patients without signs of potential drug abuse also had a greater than three-fold odds of not receiving naloxone (OR 3.3; 95% CI 1.2-9.2; p-value 0.02). Older individuals, particularly those over age 50, were more likely not to receive naloxone than victims younger than age 30 (OR 4.8; 95% CI 1.3-17.4; p-value 0.02). Women, older individuals, and those patients without clear signs of illicit drug abuse, were less likely to receive naloxone in EMS resuscitation attempts. Heightened clinical suspicion for opioid overdose is important given the recent increase in overdoses among patients due to prescription opioids. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2015.1076096 PT - Journal Article ID - 10.3109/10903127.2015.1076096 [doi] ID - PMC4798917 [pmc] ID - NIHMS745395 [mid] PP - ppublish GI - No: CC999999 Organization: *Intramural CDC HHS* Country: United States LG - English EP - 20150918 DP - 2016 PQ - 2017/03/01 EZ - 2015/09/19 06:00 DA - 2017/01/20 06:00 DT - 2015/09/19 06:00 YR - 2016 ED - 20170119 RD - 20180123 UP - 20180124 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=26383533 <161. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27764078 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Budnitz DS AU - Lovegrove MC AU - Sapiano MR AU - Mathew J AU - Kegler SR AU - Geller AI AU - Hampp C FA - Budnitz, Daniel S FA - Lovegrove, Maribeth C FA - Sapiano, Mathew R P FA - Mathew, Justin FA - Kegler, Scott R FA - Geller, Andrew I FA - Hampp, Christian TI - Notes from the Field: Pediatric Emergency Department Visits for Buprenorphine/Naloxone Ingestion - United States, 2008-2015. SO - MMWR - Morbidity & Mortality Weekly Report. 65(41):1148-1149, 2016 Oct 21 AS - MMWR Morb Mortal Wkly Rep. 65(41):1148-1149, 2016 Oct 21 NJ - MMWR. Morbidity and mortality weekly report VO - 65 IP - 41 PG - 1148-1149 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - ne8, 7802429 IO - MMWR Morb. Mortal. Wkly. Rep. SB - Index Medicus CP - United States MH - *Buprenorphine/to [Toxicity] MH - Buprenorphine, Naloxone Drug Combination MH - Child, Preschool MH - Drug Packaging MH - Eating MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Infant MH - Male MH - *Naloxone/to [Toxicity] MH - *Pediatrics MH - United States AB - Expanding access to office-based medication-assisted treatment with buprenorphine/naloxone for opioid dependence is a key part of the national strategy to address the opioid abuse epidemic (1). However, as buprenorphine/naloxone prescribing increased, emergency department (ED) visits and hospitalizations for unsupervised ingestions by young children began to increase, with buprenorphine/naloxone ingestions becoming the most common cause of hospitalization for medication ingestions by young children during 2010-2011 (2). Buprenorphine ingestions might be asymptomatic or can cause drowsiness, vomiting, or respiratory depression, which if untreated can result in death (3). Buprenorphine/naloxone was available only as tablets in multidose child-resistant bottles (Suboxone) until late 2010, when film strips packaged in unit-dose, child-resistant pouches were introduced. In 2013, tablets became available in unit-dose packaging (Zubsolv). Because unit-dose, child-resistant packaging encloses each dose until opened, it might limit unintended ingestions by young children compared with traditional child-resistant bottles that must be resecured after every use (4). This study compared ED visits for pediatric buprenorphine/naloxone ingestions before and after these product packaging/formulation changes. RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) ES - 1545-861X IL - 0149-2195 DO - https://dx.doi.org/10.15585/mmwr.mm6541a5 PT - Journal Article ID - 10.15585/mmwr.mm6541a5 [doi] PP - epublish LG - English EP - 20161021 DP - 2016 Oct 21 EZ - 2016/10/21 06:00 DA - 2017/01/19 06:00 DT - 2016/10/21 06:00 YR - 2016 ED - 20170118 RD - 20170118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27764078 <162. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25525830 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hentschel H AU - Prasa D AU - Bergmann I AU - Enden G AU - Plenert B AU - Frimlova G AU - Just S AU - Liebetrau G AU - Sturzebecher A AU - Deters M FA - Hentschel, H FA - Prasa, D FA - Bergmann, I FA - Enden, G FA - Plenert, B FA - Frimlova, G FA - Just, S FA - Liebetrau, G FA - Sturzebecher, A FA - Deters, M IN - Hentschel, H. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. IN - Prasa, D. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. IN - Bergmann, I. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. IN - Enden, G. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. IN - Plenert, B. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. IN - Frimlova, G. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. IN - Just, S. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. IN - Liebetrau, G. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. IN - Sturzebecher, A. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. IN - Deters, M. Giftnotruf Erfurt, c/o HELIOS Klinikum Erfurt GmbH, Erfurt. TI - [Human Single Drug Exposures to Non-opioid Analgesics Reported to the Poisons Information Centre Erfurt from 2003 to 2012]. [German] OT - Humane nichtopioide Analgetika-Monoexpositionen im Einzugsbereich des Giftnotrufes Erfurt von 2003-2012. SO - Gesundheitswesen. 78(1):14-21, 2016 Jan AS - Gesundheitswesen. 78(1):14-21, 2016 Jan NJ - Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) VO - 78 IP - 1 PG - 14-21 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bfd, 9204210 IO - Gesundheitswesen SB - Index Medicus CP - Germany MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - Aged, 80 and over MH - Analgesics/cl [Classification] MH - *Analgesics/po [Poisoning] MH - Analgesics, Opioid/po [Poisoning] MH - Child MH - Child, Preschool MH - Female MH - Germany/ep [Epidemiology] MH - *Hotlines/ut [Utilization] MH - Humans MH - Incidence MH - Infant MH - Infant, Newborn MH - Male MH - Middle Aged MH - *Nonprescription Drugs/po [Poisoning] MH - *Poison Control Centers/ut [Utilization] MH - *Poisoning/mo [Mortality] MH - Risk Factors MH - Sex Distribution MH - *Suicide/sn [Statistics & Numerical Data] MH - Survival Rate MH - Young Adult AB - AIM OF THE STUDY: Because of their frequency, non-opioid analgesics (NOA) single drug exposures registered by Poisons Information Centre (PIC) Erfurt have been studied over a decade. AB - METHODS: A retrospective analysis of frequencies, circumstances of exposure, symptom severity, and age groups in NOA single drug exposures received by the PIC Erfurt from the beginning of 2003 to the end of 2012 was undertaken. AB - RESULTS: Of all 4749 NOA single drug exposures, the 10 most frequent were caused by paracetamol (n=1 686), ibuprofen (n=1 439), acetylsalicylic acid (n=456), dipyrone (n=274), diclofenac (n=267), flupirtine (n=138), naproxen (n=41), etoricoxib (n=36), indomethacin (n=24), and dexketoprofen (n=19). Paracetamol single drug exposures increased from 158 in 2003 to 216 in 2007 and fell afterwards to 133 in 2012. Ibuprofen single drug exposures continously rose from 57 in 2003 to 258 in 2012. Adults were more often involved in NOA (53.8%) and all single drug exposures (54.1%) than children (45.9% and 45.6%, respectively). Suicidal attempts were more frequent in NOA (43.1%) than in all single drug exposures (34.2%), whereas accidental exposures or exposures in abuse were less often (33.4 and 0.2%, 46.0 and 0.9% respectively). NOA single drug exposures resulted mostly in none to minor symptoms (77.0%) and rarely in moderate (2.1%) or severe symptoms (1.0%). One adult was found dead after probable ingestion of 32 g of acetylsalicylic acid in suicidal intention. AB - CONCLUSIONS: Because many NOA are over-the-counter drugs, it is difficult to obtain data on their use. PIC data could provide information on the NOA use in the population. Copyright © Georg Thieme Verlag KG Stuttgart . New York. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) RN - 0 (Nonprescription Drugs) ES - 1439-4421 IL - 0941-3790 DO - https://dx.doi.org/10.1055/s-0034-1389921 PT - Journal Article ID - 10.1055/s-0034-1389921 [doi] PP - ppublish LG - German EP - 20141219 DP - 2016 Jan EZ - 2014/12/20 06:00 DA - 2017/01/12 06:00 DT - 2014/12/20 06:00 YR - 2016 ED - 20170111 RD - 20170112 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25525830 <163. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26026843 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chang SC AU - Ma CC AU - Lee CT AU - Hsieh SW FA - Chang, Shu-Ching FA - Ma, Chen-Chung FA - Lee, Chun-Te FA - Hsieh, Shao-Wei IN - Chang, Shu-Ching. Division of Anesthesiology, E-DA Hospital, Kaohsiung, Taiwan. IN - Ma, Chen-Chung. Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan. IN - Lee, Chun-Te. Department of Leisure and Sports Management, Cheng-Shiu University, Kaohsiung, Taiwan. IN - Hsieh, Shao-Wei. Division of Anesthesiology, E-DA Hospital, Kaohsiung, Taiwan. Electronic address: felidhsieh@gmail.com. TI - Pharmacoepidemiology of chronic noncancer pain patients requiring chronic opioid therapy: A nationwide population-based study. SO - Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists. 53(3):89-94, 2015 Sep AS - Acta Anaesthesiol Taiwan. 53(3):89-94, 2015 Sep NJ - Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists VO - 53 IP - 3 PG - 89-94 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101214918 IO - Acta Anaesthesiol Taiwan SB - Index Medicus CP - China (Republic : 1949- ) MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Chronic Pain/dt [Drug Therapy] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - Pharmacoepidemiology/mt [Methods] KW - chronic noncancer pain; chronic opioid therapy; opioid therapeutic days AB - OBJECTIVE: This study was aimed to explore the pharmacoepidemiology of chronic noncancer pain (CNCP) patients who required chronic opioid therapy (COT) in the Taiwanese population. AB - METHODS: Using the Taiwan National Health Insurance Research Database during 2008-2009, COT-requiring CNCP patients were identified by the inclusion criteria of both chronic analgesic requirement for >3 months per year and long-term use of controlled opioids for >28 therapeutic days during any 3-month period in ambulatory visits with malignancy-related pain excluded. Their demographic data and pharmacoepidemiological characteristics of opioid consumption and opioid prescriptions issued in ambulatory visits were analyzed. AB - RESULTS: In total, 159 patients were enrolled as COT-requiring CNCP patients, and the prevalence was calculated at 0.016% in a 2-year period. Females were outnumbered by males (45.3% vs. 54.7%). Almost 60% of them were of working age and 93.7% belonged to low-income households, as in the health insurance claims, probably implying socioeconomic disadvantages associated with CNCP. The leading three diagnoses were unspecified myalgia and myositis, lumbago, and abdominal pain of unspecified site. The most common department from where these 159 CNCP patients obtained their opioid prescriptions was the emergency department (27.6%), ensued by a pain clinic (25.3%), but they could acquire only a few opioid therapeutic days through emergency department visits. Moreover, pain clinic satisfied the majority of opioid therapeutic days. Among all opioids, morphine was the most frequently prescribed in opioid-obtaining ambulatory visits, accounting for most of the opioid therapeutic days as well as opioid consumption. AB - CONCLUSION: COT-requiring CNCP patients were easily associated with adverse socioeconomic liabilities and often visited emergency department as well as pain clinics. Morphine was the main opioid used for their chronic pain. Transfer of COT-requiring CNCP patients to appropriate departments is strongly recommended for efficient long-term pharmacotherapy for their chronic pain. Copyright © 2015. Published by Elsevier B.V. RN - 0 (Analgesics, Opioid) ES - 1875-452X DI - S1875-4597(15)00044-2 DO - https://dx.doi.org/10.1016/j.aat.2015.04.002 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S1875-4597(15)00044-2 [pii] ID - 10.1016/j.aat.2015.04.002 [doi] PP - ppublish PH - 2014/03/17 [received] PH - 2015/03/30 [revised] PH - 2015/04/11 [accepted] LG - English EP - 20150527 DP - 2015 Sep EZ - 2015/06/01 06:00 DA - 2017/01/05 06:00 DT - 2015/06/01 06:00 YR - 2015 ED - 20170104 RD - 20170105 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26026843 <164. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26721613 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dilokthornsakul P AU - Moore G AU - Campbell JD AU - Lodge R AU - Traugott C AU - Zerzan J AU - Allen R AU - Page RL 2nd FA - Dilokthornsakul, Piyameth FA - Moore, Gina FA - Campbell, Jonathan D FA - Lodge, Robert FA - Traugott, Cathy FA - Zerzan, Judy FA - Allen, Richard FA - Page, Robert L 2nd IN - Dilokthornsakul, Piyameth. Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. Electronic address: piyamethd@gmail.com. IN - Moore, Gina. Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado. IN - Campbell, Jonathan D. Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado. IN - Lodge, Robert. Department of Health Care Policy and Financing, State of Colorado, Denver, Colorado. IN - Traugott, Cathy. Department of Health Care Policy and Financing, State of Colorado, Denver, Colorado. IN - Zerzan, Judy. Department of Health Care Policy and Financing, State of Colorado, Denver, Colorado. IN - Allen, Richard. Peak Statistical Services, Evergreen, Colorado. IN - Page, Robert L 2nd. Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado. TI - Risk Factors of Prescription Opioid Overdose Among Colorado Medicaid Beneficiaries. SO - Journal of Pain. 17(4):436-43, 2016 Apr AS - J PAIN. 17(4):436-43, 2016 Apr NJ - The journal of pain : official journal of the American Pain Society VO - 17 IP - 4 PG - 436-43 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100898657 IO - J Pain SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - Aged, 80 and over MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Case-Control Studies MH - Child MH - Chronic Pain/dt [Drug Therapy] MH - Chronic Pain/ep [Epidemiology] MH - Chronic Pain/et [Etiology] MH - Colorado/ep [Epidemiology] MH - Dose-Response Relationship, Drug MH - *Drug Overdose/ep [Epidemiology] MH - Female MH - Humans MH - Male MH - *Medicaid/sn [Statistics & Numerical Data] MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/et [Etiology] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Risk Factors MH - Sex Factors MH - United States/ep [Epidemiology] MH - Young Adult KW - Medicaid; Risk factor; chronic pain; opioid; opioid overdose AB - UNLABELLED: This study aims to determine risk factors of opioid overdose among the Colorado Medicaid population. A retrospective nested case-control study was undertaken. Medicaid beneficiaries who had >=1 medical claim for an emergency department visit or a hospitalization associated with an opioid overdose from July 2009 to June 2014 were defined as cases. Controls were selected using a nearest neighbor matching without replacement. The matched controls were selected on the basis of age, sex, and opioid prescription. One case was matched with three controls. Multivariate conditional logistic regression was used to compare risk factors. A total of 816 cases with 2,448 controls were included. Six factors were associated with opioid overdose: mean morphine dose equivalent (>50 mg/d; odds ratio [OR] = 1.986 [95% confidence interval [CI], 1.509-2.614]), methadone use (switching opioid to methadone vs. no methadone use; OR = 7.230 [95% CI, 2.346-22.286]), drug/alcohol abuse (OR = 3.104 [95% CI, 2.195-4.388]), other psychiatric illness (OR = 1.730 [95% CI, 1.307-2.291]), benzodiazepine use (OR = 2.005 [95% CI, 1.516-2.652]), and the number of pharmacies used by the beneficiary (>=4 pharmacies vs. 1 pharmacy; OR = 1.514 [95% CI, 1.003-2.286]). In conclusion, several factors are associated with opioid overdose. States and communities should ensure the availability of at-home intranasal naloxone for overdose rescue on the basis of the presence of risk factors. AB - PERSPECTIVE: This article presents the risk factors of opioid overdose among the Colorado Medicaid population. On the basis of study findings, Colorado Medicaid is currently working with physicians, hospitals, and other health system stakeholders to continue to develop policies to identify and assist this subset of our population. One such policy will be to provide at-home intranasal naloxone for overdose rescue. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1528-8447 IL - 1526-5900 DI - S1526-5900(15)00985-2 DO - https://dx.doi.org/10.1016/j.jpain.2015.12.006 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S1526-5900(15)00985-2 [pii] ID - 10.1016/j.jpain.2015.12.006 [doi] PP - ppublish PH - 2015/06/18 [received] PH - 2015/10/20 [revised] PH - 2015/12/16 [accepted] LG - English EP - 20151222 DP - 2016 Apr EZ - 2016/01/02 06:00 DA - 2016/12/28 06:00 DT - 2016/01/02 06:00 YR - 2016 ED - 20161227 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26721613 <165. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26289651 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kim HK AU - Nelson LS FA - Kim, Hong K FA - Nelson, Lewis S IN - Kim, Hong K. Department of Emergency Medicine, University of Maryland Emergency Medicine Network, University of Maryland School of Medicine, 110 South Paca Street 6th floor, Suite 200, Baltimore, MD, 21201, USA. hongkimmd@gmail.com. IN - Nelson, Lewis S. Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center, 462 First Ave. Room A345, New York, NY, 10016, USA. TI - Reversal of Opioid-Induced Ventilatory Depression Using Low-Dose Naloxone (0.04 mg): a Case Series. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 12(1):107-10, 2016 Mar AS - J Med Toxicol. 12(1):107-10, 2016 Mar NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 12 IP - 1 PG - 107-10 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781798 SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Antidotes/ad [Administration & Dosage] MH - Antidotes/ae [Adverse Effects] MH - Drug Overdose/di [Diagnosis] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/et [Etiology] MH - Drug Overdose/pp [Physiopathology] MH - Female MH - Humans MH - *Lung/de [Drug Effects] MH - Lung/pp [Physiopathology] MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/ae [Adverse Effects] MH - *Respiration/de [Drug Effects] MH - Respiratory Insufficiency/ci [Chemically Induced] MH - Respiratory Insufficiency/di [Diagnosis] MH - *Respiratory Insufficiency/dt [Drug Therapy] MH - Respiratory Insufficiency/pp [Physiopathology] MH - Retrospective Studies MH - Severity of Illness Index MH - Substance Withdrawal Syndrome/et [Etiology] MH - Treatment Outcome KW - Low-dose naloxone; Opioid intoxication reversal; Opioid toxicity AB - INTRODUCTION: Naloxone is commonly administered in emergency department (ED) to reverse opioid intoxication. Several naloxone dose recommendations exist for acute management of opioid intoxication based on limited published clinical data. A case series of ED patients with opioid-induced ventilatory depression that was reversed using a low-dose naloxone (0.04 mg with titration) is presented. AB - METHODS: ED patients with opioid-induced ventilatory depression requiring naloxone administration were identified through medical toxicology consultation. Retrospective review of medical records was performed. Collected data included history, and pre- and post-naloxone data, including respiratory rate (RR), pulse oximetry (pulse ox), end-tidal CO2 level (ET-CO2), and Richmond Agitation Sedation Scale (RASS). AB - RESULTS: Fifteen ED patients with moderate to severe opioid-induced ventilatory depression (median RR, 6 breaths/min) who were managed using low-dose naloxone strategy were identified. Twelve of 15 patients reported ingestion of methadone (range, 30 to 180 mg). The median naloxone dose of 0.08 mg (range, 0.04 to 0.12 mg) reversed opioid-induced ventilatory and CNS depression. Two patients experienced acute opioid withdrawal after receiving 0.08 mg. AB - CONCLUSION: ED patients with moderate to severe opioid-induced ventilatory depression can be reversed using 0.04 mg IV naloxone with appropriate dose titration. RN - 0 (Analgesics, Opioid) RN - 0 (Antidotes) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-015-0499-3 PT - Journal Article ID - 10.1007/s13181-015-0499-3 [doi] ID - 10.1007/s13181-015-0499-3 [pii] ID - PMC4781798 [pmc] PP - ppublish LG - English DP - 2016 Mar PQ - 2017/03/01 EZ - 2015/08/21 06:00 DA - 2016/12/22 06:00 DT - 2015/08/21 06:00 YR - 2016 ED - 20161221 RD - 20170301 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26289651 <166. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26332701 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Conrardy M AU - Lank P AU - Cameron KA AU - McConnell R AU - Chevrier A AU - Sears J AU - Ahlstrom E AU - Wolf MS AU - Courtney DM AU - McCarthy DM FA - Conrardy, Michael FA - Lank, Patrick FA - Cameron, Kenzie A FA - McConnell, Ryan FA - Chevrier, Alison FA - Sears, Jill FA - Ahlstrom, Eric FA - Wolf, Michael S FA - Courtney, D Mark FA - McCarthy, Danielle M TI - Emergency Department Patient Perspectives on the Risk of Addiction to Prescription Opioids. SO - Pain Medicine. 17(1):114-21, 2016 Jan AS - PAIN MED. 17(1):114-21, 2016 Jan NJ - Pain medicine (Malden, Mass.) VO - 17 IP - 1 PG - 114-21 PI - Journal available in: Print PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - *Acetaminophen/ae [Adverse Effects] MH - Acetaminophen/tu [Therapeutic Use] MH - *Acute Pain/dt [Drug Therapy] MH - Adult MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Back Pain/dt [Drug Therapy] MH - *Behavior, Addictive/px [Psychology] MH - Drug Combinations MH - *Emergency Service, Hospital MH - Female MH - Humans MH - *Hydrocodone/ae [Adverse Effects] MH - Hydrocodone/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - *Pain Measurement MH - Prescriptions MH - Risk AB - OBJECTIVE: To characterize emergency department (ED) patients' knowledge and beliefs about the addictive potential of opioids. AB - DESIGN: Mixed methods analysis of data from a randomized controlled trial. AB - SETTING: Urban academic ED (>88,000 visits). AB - SUBJECTS: One hundred and seventy four discharged ED patients prescribed hydrocodone-acetaminophen for acute pain. AB - METHODS: The study analyzed data collected from a randomized controlled trial investigating patients' knowledge of opioids. ED patients discharged with hydrocodone-acetaminophen completed an audio-recorded phone interview 4-7 days later. This analysis focuses on responses about addiction. Responses were categorized using content analysis; thematic analysis identified broad themes common across different categories. AB - RESULTS: Participants' mean age was 45.5 years (SD, 14.8), 58.6% female, 50.6% white, and the majority had an orthopedic diagnosis (24.1% back pain, 52.3% other injuries). Responses were categorized first based on whether the patient believed that opioids could be addictive (categorized as: yes, 58.7%; no, 19.5%; depends, 17.2%; or do not know, 4.6%), and second based on whether or not the patient discussed his/her own experience with the medication (categorized as: personalized, 35.6%; or not personalized, 64.4%). Cohen's Kappa was 0.84 for all categories. Three themes emerged in the thematic analysis: theme 1) patients expect to "feel" addicted if they are addicted, theme 2) patients fear addiction, and theme 3) side effects affected patient views of addiction. AB - CONCLUSION: In this sample, patients had misconceptions about opioid addiction. Some patients did not know opioids could be addictive, others underestimated their personal risk of addiction, and others overtly feared addiction and, therefore, risked inadequate pain management. Despite limited data, we recommend providers discuss opioid addiction with their patients. Copyright Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US. RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 0 (acetaminophen, hydrocodone drug combination) RN - 362O9ITL9D (Acetaminophen) RN - 6YKS4Y3WQ7 (Hydrocodone) ES - 1526-4637 IL - 1526-2375 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 10.1111/pme.12862 [doi] PP - ppublish PH - 2015/03/19 [received] PH - 2015/06/14 [revised] PH - 2015/06/20 [accepted] LG - English DP - 2016 Jan EZ - 2015/09/04 06:00 DA - 2016/12/21 06:00 DT - 2015/09/03 06:00 YR - 2016 ED - 20161220 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26332701 <167. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25611362 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gupta T AU - Mujib M AU - Agarwal P AU - Prakash P AU - Garg A AU - Sharma N AU - Aronow WS AU - Nabors C FA - Gupta, Tanush FA - Mujib, Marjan FA - Agarwal, Pallak FA - Prakash, Priya FA - Garg, Anjali FA - Sharma, Nisha FA - Aronow, Wilbert S FA - Nabors, Christopher IN - Gupta, Tanush. Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY. TI - Association Between Opioid Abuse/Dependence and Outcomes in Hospitalized Heart Failure Patients. SO - American Journal of Therapeutics. 23(2):e350-6, 2016 Mar-Apr AS - Am J Ther. 23(2):e350-6, 2016 Mar-Apr NJ - American journal of therapeutics VO - 23 IP - 2 PG - e350-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - db7, 9441347 IO - Am J Ther SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Aged, 80 and over MH - Female MH - Heart Failure/et [Etiology] MH - *Heart Failure/mo [Mortality] MH - Hospital Mortality MH - Hospitalization MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/co [Complications] AB - Opioid use is associated with unintentional and intentional overdose and is one of the leading causes of emergency room visits and accidental deaths. However, the association between opioid abuse/dependence and outcomes in hospitalized patients has not been well studied. Congestive heart failure (HF) is the fourth most common cause of hospitalization in the United States. The purpose of this study was to examine the effect of opioid abuse/dependence on outcomes in patients hospitalized with HF. We queried the 2002-2010 Nationwide Inpatient Sample databases to identify all patients aged 18 years and older admitted with the primary diagnosis of HF. Multivariate logistic regression analysis was used to compare the frequency of hospital-acquired conditions (HACs) and in-hospital mortality between patients with and without a history of opioid abuse/dependence. Of 9,993,240 patients with HF, 29,014 had a history of opioid abuse or dependence. Opioid abusers/dependents were likely to be younger men of poor socioeconomic background with self pay or Medicaid as their primary payer. They had a lower prevalence of dyslipidemia, diabetes mellitus, coronary artery disease, prior myocardial infarction, and peripheral vascular disease (P < 0.001 for all). They were more likely to be smokers and have chronic pulmonary disease, depression, liver disease, and obesity (P < 0.001 for all). Patients with a history of opioid abuse/dependence had lower incidence of HACs (14.8% vs. 16.5%, adjusted odds ratio: 0.71, P < 0.001) and lower in-hospital mortality (1.3% vs. 3.6%, adjusted odds ratio: 0.64, P < 0.001) as compared with patients without prior opioid abuse/dependence. In conclusion, among adult patients aged 18 years and older hospitalized with HF, opioid abuse/dependence was associated with lower frequency of HACs and lower in-hospital mortality. ES - 1536-3686 IL - 1075-2765 DO - https://dx.doi.org/10.1097/MJT.0000000000000190 PT - Journal Article ID - 10.1097/MJT.0000000000000190 [doi] PP - ppublish LG - English DP - 2016 Mar-Apr EZ - 2015/01/23 06:00 DA - 2016/12/21 06:00 DT - 2015/01/23 06:00 YR - 2016 ED - 20161220 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25611362 <168. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26589567 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rogers JS AU - Rehrer SJ AU - Hoot NR FA - Rogers, Jeremy S FA - Rehrer, Seth J FA - Hoot, Nathan R IN - Rogers, Jeremy S. Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas. IN - Rehrer, Seth J. Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas. IN - Hoot, Nathan R. Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas. TI - Acetylfentanyl: An Emerging Drug of Abuse. SO - Journal of Emergency Medicine. 50(3):433-6, 2016 Mar AS - J Emerg Med. 50(3):433-6, 2016 Mar NJ - The Journal of emergency medicine VO - 50 IP - 3 PG - 433-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Fentanyl/aa [Analogs & Derivatives] MH - Fentanyl/po [Poisoning] MH - Humans MH - Male MH - *Psychotropic Drugs/po [Poisoning] MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - *Substance-Related Disorders/et [Etiology] KW - drug overdose; naloxone; opioid analgesics; street drugs AB - BACKGROUND: Opioid analgesics are widely used in health care, yet have significant potential for abuse. High doses are associated with potentially fatal respiratory depression, which caused 21,314 deaths in the United States in 2011. Acetylfentanyl, a synthetic opioid agonist closely related to fentanyl, recently emerged as a drug of abuse linked to numerous deaths in North America. AB - CASE REPORT: A 36-year-old male developed the habit of using a propylene glycol electronic cigarette filled with acetylfentanyl to aid relaxation. He purchased the drug online in a manner that appeared legal to him, which compromised his insight about the danger of the substance. He had been using the e-cigarette with increasing frequency while on medical leave, and his wife reported finding him weakly responsive on more than one occasion. At approximately 3 am, the family activated 911 for altered mental status. His presentation included respiratory depression, pinpoint pupils, hypoxemia, and a Glasgow Coma Scale score of 6. He responded to serial doses of intravenous naloxone with improvement in his mental status and respiratory condition. Due to the need for repeated dosing, he was placed on a naloxone infusion and recovered uneventfully in intensive care. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Complications from emerging drugs of abuse, like acetylfentanyl, frequently present first to emergency departments. Prompt recognition and treatment can help avoid morbidity and mortality. Acetylfentanyl can be managed effectively with naloxone, although higher than conventional dosing may be required to achieve therapeutic effect. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Psychotropic Drugs) RN - 6DZ28538KS (N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide) RN - UF599785JZ (Fentanyl) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(15)01148-8 DO - https://dx.doi.org/10.1016/j.jemermed.2015.10.014 PT - Case Reports PT - Journal Article ID - S0736-4679(15)01148-8 [pii] ID - 10.1016/j.jemermed.2015.10.014 [doi] PP - ppublish PH - 2014/11/25 [received] PH - 2015/10/09 [revised] PH - 2015/10/13 [accepted] LG - English EP - 20151114 DP - 2016 Mar EZ - 2015/11/22 06:00 DA - 2016/12/17 06:00 DT - 2015/11/22 06:00 YR - 2016 ED - 20161216 RD - 20161217 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26589567 <169. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26803092 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Zeller B AU - Giebe J FA - Zeller, Brandy FA - Giebe, Jeanne TI - Opioid Analgesics for Sedation and Analgesia During Mechanical Ventilation. SO - Neonatal Network - Journal of Neonatal Nursing. 34(2):113-6, 2015 AS - Neonat Netw. 34(2):113-6, 2015 NJ - Neonatal network : NN VO - 34 IP - 2 PG - 113-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8503921 IO - Neonatal Netw SB - Nursing Journal CP - United States MH - Analgesics, Opioid/pd [Pharmacology] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Analgesics, Opioid MH - Conscious Sedation/mt [Methods] MH - Conscious Sedation/nu [Nursing] MH - Drug-Related Side Effects and Adverse Reactions/et [Etiology] MH - Drug-Related Side Effects and Adverse Reactions/nu [Nursing] MH - Drug-Related Side Effects and Adverse Reactions/pc [Prevention & Control] MH - *Drug-Related Side Effects and Adverse Reactions MH - Humans MH - Infant, Newborn MH - Long Term Adverse Effects/et [Etiology] MH - Long Term Adverse Effects/nu [Nursing] MH - Long Term Adverse Effects/pc [Prevention & Control] MH - *Long Term Adverse Effects MH - Neonatal Nursing/mt [Methods] MH - Pain/di [Diagnosis] MH - Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - *Pain MH - Pain Management/mt [Methods] MH - Pain Management/nu [Nursing] MH - Pain Measurement/mt [Methods] MH - Pain Measurement/nu [Nursing] MH - *Pain Measurement MH - Respiration, Artificial/ae [Adverse Effects] MH - Respiration, Artificial/mt [Methods] MH - *Respiration, Artificial AB - Neonates are exposed to repetitive pain and stress during their stay in a NICU, which can lead to chronic complications related to their neurodevelopment and neurobehavior. Approximately 20 percent of all neonates in a NICU are intubated, mechanically ventilated, and require suctioning, which can cause both acute and chronic pain. Pain management in the neonate can be challenging. Nurses and other caregivers need to be well trained to assess pain in the neonate to effectively identify and provide appropriate pain management strategies. There is a lack of evidence to support routine administration of opiates in the neonate. As with any medication, the possibility of short- and long-term adverse reactions must be considered. Nonpharmacologic therapy should be used as much as possible. RN - 0 (Analgesics, Opioid) ES - 1539-2880 IL - 0730-0832 DO - https://dx.doi.org/10.1891/0730-0832.34.2.113 PT - Journal Article ID - 10.1891/0730-0832.34.2.113 [doi] PP - ppublish LG - English DP - 2015 EZ - 2016/01/24 06:00 DA - 2016/12/15 06:00 DT - 2016/01/24 06:00 YR - 2015 ED - 20161214 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26803092 <170. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26754559 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lee SS AU - Choi Y AU - Pransky GS FA - Lee, Sharon S FA - Choi, YoonSun FA - Pransky, Glenn S IN - Lee, Sharon S. Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts. IN - Choi, YoonSun. Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts. IN - Pransky, Glenn S. Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts. TI - Extent and Impact of Opioid Prescribing for Acute Occupational Low Back Pain in the Emergency Department. SO - Journal of Emergency Medicine. 50(3):376-84.e1-2, 2016 Mar AS - J Emerg Med. 50(3):376-84.e1-2, 2016 Mar NJ - The Journal of emergency medicine VO - 50 IP - 3 PG - 376-84.e1-2 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Absenteeism MH - Adult MH - Analgesics, Opioid/ec [Economics] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Disability Evaluation MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Health Care Costs MH - Humans MH - *Low Back Pain/dt [Drug Therapy] MH - Low Back Pain/ec [Economics] MH - Male MH - Middle Aged MH - Multivariate Analysis MH - *Occupational Diseases/dt [Drug Therapy] MH - Occupational Diseases/ec [Economics] MH - Retrospective Studies MH - Workers' Compensation/sn [Statistics & Numerical Data] KW - emergency treatment; low back pain; opioid adverse effects AB - BACKGROUND: Initial management of acute occupational low back pain (AOLBP) commonly occurs in the emergency department (ED), where opioid prescribing can vary from the clinical guidelines that recommend limited use. AB - OBJECTIVE: The objective of this study was to explore how opioids are prescribed in the ED and the impact on work disability and other outcomes in AOLBP. AB - METHODS: A retrospective cohort study was conducted. All acute compensable lost-time LBP cases seen initially in the ED with a date of injury from January 1, 2009 to December 31, 2011 were identified within a nationally representative Workers' Compensation dataset. Multivariate models estimated the effect of early opioids (received within 2 days of ED visit) on disability duration, long-term opioid use, total medical costs, and subsequent surgeries. AB - RESULTS: Of the cohort (N = 2887), 12% received early opioids; controlling for severity, this was significantly associated with long-term opioid use (adjusted risk ratio = 1.29; 95% confidence interval 1.05-1.58) and increased total medical costs for those in the highest opioid dosage quartile, but not associated with disability duration or subsequent low back surgery. AB - CONCLUSIONS: Early opioid prescribing in the ED for uncomplicated AOLBP increased long-term opioid use and medical costs, and should be discouraged, as opioid use for low back pain has been associated with a variety of adverse outcomes. However, ED providers may be becoming more compliant with current LBP treatment guidelines. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(15)01150-6 DO - https://dx.doi.org/10.1016/j.jemermed.2015.10.015 PT - Journal Article ID - S0736-4679(15)01150-6 [pii] ID - 10.1016/j.jemermed.2015.10.015 [doi] PP - ppublish PH - 2015/06/01 [received] PH - 2015/10/09 [revised] PH - 2015/10/17 [accepted] LG - English EP - 20160102 DP - 2016 Mar EZ - 2016/01/13 06:00 DA - 2016/12/15 06:00 DT - 2016/01/13 06:00 YR - 2016 ED - 20161213 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26754559 <171. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26611212 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McLean MM AU - Adibi S AU - Ahmed A AU - Lathrop C AU - Kaster M AU - Tilney PV FA - McLean, Michelle M FA - Adibi, Sara FA - Ahmed, Ali FA - Lathrop, Charles FA - Kaster, Michael FA - Tilney, Peter V R TI - A 17-Year-Old Female With Respiratory Depression as a Result of Opioid Overdose. [Review] CM - Comment in: Air Med J. 2016 Mar-Apr;35(2):52; PMID: 27021664 SO - Air Medical Journal. 34(6):302-5, 2015 Nov-Dec AS - Air Med J. 34(6):302-5, 2015 Nov-Dec NJ - Air medical journal VO - 34 IP - 6 PG - 302-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - bs3, 9312325 IO - Air Med. J. SB - Health Administration Journals CP - United States MH - *Acetaminophen/po [Poisoning] MH - Adolescent MH - Air Ambulances MH - *Analgesics, Opioid/po [Poisoning] MH - Drug Combinations MH - *Drug Overdose/co [Complications] MH - Drug Overdose/et [Etiology] MH - Drug Overdose/th [Therapy] MH - Extracorporeal Membrane Oxygenation MH - Female MH - Humans MH - *Hydrocodone/po [Poisoning] MH - Patient Transfer MH - Respiration, Artificial MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Respiratory Insufficiency/th [Therapy] RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 0 (acetaminophen, hydrocodone drug combination) RN - 362O9ITL9D (Acetaminophen) RN - 6YKS4Y3WQ7 (Hydrocodone) ES - 1532-6497 IL - 1067-991X DI - S1067-991X(15)00272-2 DO - https://dx.doi.org/10.1016/j.amj.2015.08.003 PT - Case Reports PT - Journal Article PT - Review ID - S1067-991X(15)00272-2 [pii] ID - 10.1016/j.amj.2015.08.003 [doi] PP - ppublish PH - 2015/08/13 [received] PH - 2015/08/26 [accepted] LG - English DP - 2015 Nov-Dec EZ - 2015/11/28 06:00 DA - 2016/12/15 06:00 DT - 2015/11/28 06:00 YR - 2015 ED - 20161213 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26611212 <172. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26119038 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Neale J AU - Strang J FA - Neale, Joanne FA - Strang, John IN - Neale, Joanne. Reader in Qualitative and Mixed Methods Research, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. IN - Strang, John. Professor of the Addictions, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. TI - Naloxone--does over-antagonism matter? Evidence of iatrogenic harm after emergency treatment of heroin/opioid overdose. SO - Addiction. 110(10):1644-52, 2015 Oct AS - Addiction. 110(10):1644-52, 2015 Oct NJ - Addiction (Abingdon, England) VO - 110 IP - 10 PG - 1644-52 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/et [Etiology] MH - Emergency Service, Hospital MH - Emergency Treatment MH - Female MH - *Heroin/po [Poisoning] MH - Humans MH - Iatrogenic Disease MH - Male MH - Middle Aged MH - *Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - Patient Satisfaction MH - Qualitative Research MH - Scotland MH - *Substance Withdrawal Syndrome/et [Etiology] MH - Treatment Refusal MH - Young Adult KW - Contemporary legend; naloxone; opiates; overdose; qualitative study AB - AIM: To analyse drug users' views and experiences of naloxone during emergency resuscitation after illicit opiate overdose to identify (i) any evidence of harm caused by excessive naloxone dosing ('over-antagonism'); and (ii) implications for the medical administration of naloxone within contemporary emergency settings. AB - DESIGN: Re-analysis of a large qualitative data set comprising 70 face-to-face interviews conducted within a few hours of heroin/opioid overdose occurring, observations from hospital settings and a further 130 interviews with illicit opiate users. Data were generated between 1997 and 1999. AB - SETTING: Emergency departments, drug services and pharmacies in two Scottish cities. AB - PARTICIPANTS: Two hundred illicit opiate users: 131 males and 69 females. AB - FINDINGS: Participants had limited knowledge of naloxone and its pharmacology, yet described it routinely in negative terms and were critical of its medical administration. In particular, they complained that naloxone induced acute withdrawal symptoms, causing patients to refuse treatment, become aggressive, discharge themselves from hospital and take additional street drugs to counter the naloxone effects. Participants believed that hospital staff should administer naloxone selectively and cautiously, and prescribe counter-naloxone medication if dosing precipitated withdrawals. In contrast, observational data indicated that participants did not always know that they had received naloxone and hospital doctors did not necessarily administer it incautiously. AB - CONCLUSIONS: Opiate users in urban Scotland repeatedly report harm caused by naloxone over-antagonism, although this is not evident in observational data. The concept of contemporary legend (a form of folklore that can be based on fact and provides a means of communicating and negotiating anxiety) helps to explain why naloxone has such a feared reputation among opiate users. Copyright © 2015 Society for the Study of Addiction. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1360-0443 IL - 0965-2140 DO - https://dx.doi.org/10.1111/add.13027 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1111/add.13027 [doi] PP - ppublish PH - 2015/03/29 [received] PH - 2015/05/21 [revised] PH - 2015/06/22 [accepted] GI - Organization: *Chief Scientist Office* Country: United Kingdom LG - English EP - 20150730 DP - 2015 Oct EZ - 2015/06/30 06:00 DA - 2016/12/15 06:00 DT - 2015/06/30 06:00 YR - 2015 ED - 20161213 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26119038 <173. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26014310 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kern DM AU - Zhou S AU - Chavoshi S AU - Tunceli O AU - Sostek M AU - Singer J AU - LoCasale RJ FA - Kern, David M FA - Zhou, Siting FA - Chavoshi, Soheil FA - Tunceli, Ozgur FA - Sostek, Mark FA - Singer, Joseph FA - LoCasale, Robert J TI - Treatment patterns, healthcare utilization, and costs of chronic opioid treatment for non-cancer pain in the United States. SO - American Journal of Managed Care. 21(3):e222-34, 2015 Mar 01 AS - Am J Manag Care. 21(3):e222-34, 2015 Mar 01 NJ - The American journal of managed care VO - 21 IP - 3 PG - e222-34 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - cw0, 9613960 IO - Am J Manag Care SB - Health Administration Journals CP - United States MH - *Ambulatory Care/ut [Utilization] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cohort Studies MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - *Office Visits/ut [Utilization] MH - *Pain/dt [Drug Therapy] MH - Retrospective Studies MH - United States AB - OBJECTIVES: To evaluate treatment patterns, healthcare resource utilization, and costs among patients within a large managed care population chronically using opioids for non-cancer pain. AB - STUDY DESIGN: Retrospective cohort study. AB - METHODS: Patients aged >=18 years with >=1 prescription initiating opioids between January 1, 2007, and December 31, 2011, who also had 12 months of continuous pre-index health plan enrollment, were identified. Patients with pre-index opioid use or cancer diagnosis were excluded. Opioid exposure was stratified by treatment duration-short-term (30-182 days) versus chronic (>=183 days)-and by index opioid type (weak vs strong). AB - RESULTS: A total of 2.9 million patients initiating opioids were identified, of which 257,602 had at least 30 days of continuous use and were included in the study. The mean age was 51 years and 52% were female. Overall, 239,998 (93%) patients had short-term opioid use, and 17,604 (7%) had chronic use; 215,424 (84%) initiated treatment with a weak opioid, and 44,712 (17%) with a strong opioid. The specialty most associated with the use of less potent opioids was general/family practice (28%), and for more potent opioids it was surgery (22%). Large increases in health-care utilization were reported between the pre-index and first 6-month post initiation periods for chronic users. Utilization rates decreased after the first 6 months but never reverted to baseline levels. Costs mirrored utilization trends, more than doubling between baseline and the first 6 months of treatment for pharmacy ($2029 vs $4331) and all-cause medical ($11,430 vs $27,365). Costs declined after the first 6 months of opioid use but remained above pre-index levels. AB - CONCLUSIONS: These results demonstrated that healthcare resource utilization and costs increased during the first 6 months following clinical scenarios that necessitated opioid initiation and subsequently declined, suggesting the need to monitor patients beyond the acute care period. RN - 0 (Analgesics, Opioid) ES - 1936-2692 IL - 1088-0224 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 86041 [pii] PP - epublish LG - English EP - 20150301 DP - 2015 Mar 01 EZ - 2015/05/28 06:00 DA - 2016/12/15 06:00 DT - 2015/05/28 06:00 YR - 2015 ED - 20161213 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26014310 <174. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25851505 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Asche CV AU - Clay E AU - Kharitonova E AU - Zah V AU - Ruby J AU - Aballea S FA - Asche, Carl V FA - Clay, Emilie FA - Kharitonova, Elizaveta FA - Zah, Vladimir FA - Ruby, Jane FA - Aballea, Samuel IN - Asche, Carl V. a a University of Illinois College of Medicine at Peoria/University of Illinois at Chicago College of Pharmacy , Peoria , IL , USA. IN - Clay, Emilie. b b Creativ-Ceutical , Paris , France. IN - Kharitonova, Elizaveta. c c Creativ-Ceutical , Chicago , IL , USA. IN - Zah, Vladimir. d d ZRx Outcomes Research Inc. , Mississauga , ON , Canada. IN - Ruby, Jane. e e Reckitt Benckiser Pharmaceuticals Inc. , Richmond , VA , USA. IN - Aballea, Samuel. b b Creativ-Ceutical , Paris , France. TI - Budgetary impact of the utilization of buprenorphine/naloxone sublingual film and tablet for Medicaid in the United States. SO - Journal of Medical Economics. 18(8):600-11, 2015 AS - J Med Econ. 18(8):600-11, 2015 NJ - Journal of medical economics VO - 18 IP - 8 PG - 600-11 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9892255 IO - J Med Econ SB - Index Medicus CP - England MH - Administration, Sublingual MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ec [Economics] MH - Buprenorphine, Naloxone Drug Combination/ad [Administration & Dosage] MH - *Buprenorphine, Naloxone Drug Combination/ec [Economics] MH - Health Expenditures/sn [Statistics & Numerical Data] MH - Health Services/ec [Economics] MH - Health Services/ut [Utilization] MH - Humans MH - Markov Chains MH - *Medicaid/ec [Economics] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/ec [Economics] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Reproducibility of Results MH - Retrospective Studies MH - Tablets MH - Time Factors MH - United States KW - Budget impact model; Buprenorphine/naloxone; Healthcare expenditures; Medicaid AB - OBJECTIVES: The buprenorphine/naloxone combination for the treatment of opioid dependence is available in a film or tablet formulation. Recent retrospective studies demonstrated that treatment with the sublingual film formulation is associated with improved treatment retention and lower healthcare costs. In March 2013, generic buprenorphine/naloxone tablets were approved in the US. A budget impact model was built to compare healthcare expenditures for different market shares of sublingual film and tablet. AB - METHODS: A Markov model was developed to track a cohort of opioid dependent patients treated with sublingual film or tablet through the following treatment phases: initiation, maintenance, discontinuation, off-treatment and reinitiation. Transition probabilities and costs for each phase were estimated from the MarketScan Medicaid database for the period between 1 March 2010 and 30 June 2012. The total expenditure for the plan and expenditure per plan member per month were predicted over 5 years. Two market share scenarios were considered: 1) sublingual film is progressively replaced by generic tablet (current situation) and 2) the sublingual film holds a market share of 100%. AB - RESULTS: Predicted total costs over 5 years were $6400 million when the sublingual film holds a market share of 100% (as per Scenario 2) which is lower than when sublingual film is progressively replaced by generic tablet (current situation as per Scenario 1) by $64 million. These savings were mostly driven by inpatient care ($56 million saved over 5 years), followed by emergency room care ($27 million) and pharmaceutical costs ($24 million). Costs of outpatient care attenuated the difference as they were predicted to be higher by $44 million in Scenario 2. The reduction in total cost per member per month reached $0.027 in the fifth year. Results were most sensitive to price rebates and to the probability of non-psychiatric hospitalization. AB - CONCLUSIONS: While using the sublingual film formulation for more patients treated with buprenorphine/naloxone is predicted to increase outpatient care costs, it would generate savings in emergency care and hospitalizations. In the treatment of opioid dependence, total direct medical costs for Medicaid would be lower for sublingual film treated patients, at current drug prices. RN - 0 (Analgesics, Opioid) RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - 0 (Narcotic Antagonists) RN - 0 (Tablets) ES - 1941-837X IL - 1369-6998 DO - https://dx.doi.org/10.3111/13696998.2015.1036760 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.3111/13696998.2015.1036760 [doi] PP - ppublish LG - English EP - 20150520 DP - 2015 EZ - 2015/04/09 06:00 DA - 2016/12/15 06:00 DT - 2015/04/09 06:00 YR - 2015 ED - 20161213 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25851505 <175. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25846157 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Davis CS AU - Walley AY AU - Bridger CM FA - Davis, Corey S FA - Walley, Alexander Y FA - Bridger, Colleen M IN - Davis, Corey S. Deputy Director of the Southeastern Region of the Network for Public Health Law and a Staff Attorney for the National Health Law Program. TI - Lessons learned from the expansion of naloxone access in Massachusetts and North Carolina. SO - Journal of Law, Medicine & Ethics. 43 Suppl 1:19-22, 2015 AS - J Law Med Ethics. 43 Suppl 1:19-22, 2015 NJ - The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics VO - 43 Suppl 1 PG - 19-22 PI - Journal available in: Print PI - Citation processed from: Internet JC - bv9, 9315583 IO - J Law Med Ethics SB - Health Technology Assessment Journals CP - United States MH - *Drug Overdose/pc [Prevention & Control] MH - Drug Prescriptions MH - Emergency Medical Services/lj [Legislation & Jurisprudence] MH - *Health Policy/lj [Legislation & Jurisprudence] MH - *Health Services Accessibility/lj [Legislation & Jurisprudence] MH - Humans MH - Massachusetts MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - North Carolina MH - *Opioid-Related Disorders/dt [Drug Therapy] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1748-720X IL - 1073-1105 DO - https://dx.doi.org/10.1111/jlme.12208 PT - Journal Article ID - 10.1111/jlme.12208 [doi] PP - ppublish LG - English DP - 2015 EZ - 2015/04/08 06:00 DA - 2016/12/15 06:00 DT - 2015/04/08 06:00 YR - 2015 ED - 20161213 RD - 20170516 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25846157 <176. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25241635 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tanabe P AU - Martinovich Z AU - Buckley B AU - Schmelzer A AU - Paice JA FA - Tanabe, Paula FA - Martinovich, Zoran FA - Buckley, Barbara FA - Schmelzer, Annie FA - Paice, Judith A IN - Tanabe, Paula. Durham, NC; Chicago, IL. Electronic address: paula.tanabe@duke.edu. IN - Martinovich, Zoran. Durham, NC; Chicago, IL. IN - Buckley, Barbara. Durham, NC; Chicago, IL. IN - Schmelzer, Annie. Durham, NC; Chicago, IL. IN - Paice, Judith A. Durham, NC; Chicago, IL. TI - Safety of an ED High-Dose Opioid Protocol for Sickle Cell Disease Pain. SO - Journal of Emergency Nursing. 41(3):227-35, 2015 May AS - J Emerg Nurs. 41(3):227-35, 2015 May NJ - Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association VO - 41 IP - 3 PG - 227-35 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 7605913 IO - J Emerg Nurs SB - Nursing Journal CP - United States MH - Administration, Intravenous MH - Adolescent MH - Adult MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Anemia, Sickle Cell/co [Complications] MH - Emergency Nursing MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - *Morphine/tu [Therapeutic Use] MH - *Pain/dt [Drug Therapy] MH - *Pain/et [Etiology] MH - Retrospective Studies MH - Young Adult KW - Emergency department; Pain; Sickle cell AB - INTRODUCTION: A nurse-initiated high dose, opioid protocol for vaso-occlusive crisis (VOC) was implemented. Total intravenous morphine sulfate equivalents (IVMSE) in mgs] and safety was evaluated. AB - METHODS: A medical record review was conducted for all ED visits in adult patients with VOC post protocol implementation. Opioids doses and routes administered during the ED stay, and six hours into the hospital admission were abstracted and total IVMSE administered calculated. Oxygen saturation (SPO2), respiratory rate (RR), administration of naloxone or vasoactive medications, evidence of respiratory arrest, or any other types of resuscitation effort were abstracted. A RR of <10 or SPO2 <92% were coded as abnormal. Descriptive statistics report the total dose. Logistic regression was used to predict abnormal events. Predictors were age, gender, ED dose (10 mg increments) administered, and time from 1st dose to discharge from ED. AB - RESULTS: 72 patients, 603 visits, 276 admitted. The total (ED & hospital dose) mean (95% CI) mg IVMSE administered for all visits was 93 mg (CI 86, 100), ED visit 63 mg (CI 59, 67) and hospital 66 mg (CI 59, 72). The mean (SD) time from administration of 1st analgesic dose to discharge from the ED was 203 (143) minutes, (range = 30-1396 minutes). During two visits, patients experienced a RR <10; while 61 visits were associated with a SPO2 <92%. No medications were administered, or resuscitative measures required. Controlling for demographics and evaluated at the average total ED dose, the longer patients were in the ED, patients were 1.359 times more likely to experience an abnormal vital sign. Controlling for demographics and evaluated at the average total time in the ED, for every 10 mg increase in IVMSE, patients were 1.057 times more likely to experience an abnormal vital sign. The effect of ED dose on the odds of experiencing an abnormal vital sign decreased by a multiplicative factor of 0.0970 for every 1 hour increase in time until discharge. The larger the dose administered in less time, the more likely patients experienced an abnormal vital sign. AB - DISCUSSION: High opioid doses were safely administered to patients with sickle cell disease. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1527-2966 IL - 0099-1767 DI - S0099-1767(14)00325-0 DO - https://dx.doi.org/10.1016/j.jen.2014.07.014 PT - Journal Article ID - S0099-1767(14)00325-0 [pii] ID - 10.1016/j.jen.2014.07.014 [doi] PP - ppublish PH - 2014/05/06 [received] PH - 2014/07/29 [revised] PH - 2014/07/29 [accepted] LG - English EP - 20140918 DP - 2015 May EZ - 2014/09/23 06:00 DA - 2016/12/15 06:00 DT - 2014/09/23 06:00 YR - 2015 ED - 20161213 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25241635 <177. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26823927 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rathlev N AU - Almomen R AU - Deutsch A AU - Smithline H AU - Li H AU - Visintainer P FA - Rathlev, Niels FA - Almomen, Reda FA - Deutsch, Ashley FA - Smithline, Howard FA - Li, Haiping FA - Visintainer, Paul IN - Rathlev, Niels. Baystate Medical Center and Tufts University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts. IN - Almomen, Reda. ARAMCO, Department of Emergency Medicine, Dharan, Saudi Arabia. IN - Deutsch, Ashley. Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts. IN - Smithline, Howard. Baystate Medical Center and Tufts University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts. IN - Li, Haiping. Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts. IN - Visintainer, Paul. Baystate Medical Center, Department of Academic Affairs Administration, Springfield, Massachusetts. TI - Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder. SO - The Western Journal of Emergency Medicine. 17(1):28-34, 2016 Jan AS - West J Emerg Med. 17(1):28-34, 2016 Jan NJ - The western journal of emergency medicine VO - 17 IP - 1 PG - 28-34 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729415 SB - Index Medicus CP - United States MH - Analgesics, Opioid/ec [Economics] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Electronic Health Records MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Hospitalization MH - Humans MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Patient Discharge MH - Patient Selection MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Reminder Systems MH - United States/ep [Epidemiology] AB - INTRODUCTION: There is a paucity of literature supporting the use of electronic alerts for patients with high frequency emergency department (ED) use. We sought to measure changes in opioid prescribing and administration practices, total charges and other resource utilization using electronic alerts to notify providers of an opioid-use care plan for high frequency ED patients. AB - METHODS: This was a randomized, non-blinded, two-group parallel design study of patients who had 1) opioid use disorder and 2) high frequency ED use. Three affiliated hospitals with identical electronic health records participated. Patients were randomized into "Care Plan" versus "Usual Care groups". Between the years before and after randomization, we compared as primary outcomes the following: 1) opioids (morphine mg equivalents) prescribed to patients upon discharge and administered to ED and inpatients; 2) total medical charges, and the numbers of; 3) ED visits, 4) ED visits with advanced radiologic imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) studies, and 5) inpatient admissions. AB - RESULTS: A total of 40 patients were enrolled. For ED and inpatients in the "Usual Care" group, the proportion of morphine mg equivalents received in the post-period compared with the pre-period was 15.7%, while in the "Care Plan" group the proportion received in the post-period compared with the pre-period was 4.5% (ratio=0.29, 95% CI [0.07-1.12]; p=0.07). For discharged patients in the "Usual Care" group, the proportion of morphine mg equivalents prescribed in the post-period compared with the pre-period was 25.7% while in the "Care Plan" group, the proportion prescribed in the post-period compared to the pre-period was 2.9%. The "Care Plan" group showed an 89% greater proportional change over the periods compared with the "Usual Care" group (ratio=0.11, 95% CI [0.01-0.092]; p=0.04). Care plans did not change the total charges, or, the numbers of ED visits, ED visits with CT or MRI or inpatient admissions. AB - CONCLUSION: Electronic care plans were associated with an incremental decrease in opioids (in morphine mg equivalents) prescribed to patients with opioid use disorder and high frequency ED use. RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2015.11.28319 PT - Journal Article PT - Randomized Controlled Trial ID - 10.5811/westjem.2015.11.28319 [doi] ID - wjem-17-28 [pii] ID - PMC4729415 [pmc] PP - ppublish PH - 2015/07/31 [received] PH - 2015/10/28 [revised] PH - 2015/11/20 [accepted] LG - English EP - 20160112 DP - 2016 Jan EZ - 2016/01/30 06:00 DA - 2016/11/12 06:00 DT - 2016/01/30 06:00 YR - 2016 ED - 20161110 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26823927 <178. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26056833 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Henderson AW AU - Babu KM AU - Merchant RC AU - Beaudoin FL FA - Henderson, Adam W FA - Babu, Kavita M FA - Merchant, Roland C FA - Beaudoin, Francesca L IN - Henderson, Adam W. Medical Student, The Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI. IN - Babu, Kavita M. Assistant Professor of Emergency Medicine, The Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI. Current affiliation: The Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA. IN - Merchant, Roland C. Associate Professor of Emergency Medicine, The Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI. IN - Beaudoin, Francesca L. Assistant Professor of Emergency Medicine, The Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI. TI - Prescription Opioid Use and Misuse Among Older Adult Rhode Island Hospital Emergency Department Patients. SO - Rhode Island Medicine. 98(3):28-31, 2015 Mar 03 AS - R I Med. 98(3):28-31, 2015 Mar 03 NJ - Rhode Island medical journal (2013) VO - 98 IP - 3 PG - 28-31 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - bbe, 9203052, 101605827 IO - R I Med J (2013) SB - Index Medicus CP - United States MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Pilot Projects MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Rhode Island MH - Surveys and Questionnaires KW - emergency department; older adults; prescription drug misuse; prescription opioids; screening; substance abuse AB - Because of the multitude of financial, health, and social problems associated with prescription opioid misuse, effective methods of identifying older adults who are misusing these medications are needed. We conducted a pilot investigation to determine the prevalence of previous and current prescription opioid use among older adults visiting the Rhode Island Hospital Emergency Department and their need for opioid misuse interventions. Among 88 randomly selected older adults (>= 65 years of age) presenting to the ED with sub-critical illness or injury, 19% (95% CI: 11-27%) were current opioid users and 6% (95% CI: 4-8%) would require an intervention for prescription opioid misuse. We identified problems of improper acquisition, diversion, provider refusal to prescribe opioids, hoarding, and inappropriate use of opioids among this population. Emergency medicine clinicians should query their older adult patients about prescription opioid misuse and associated problematic behaviors. RN - 0 (Analgesics, Opioid) ES - 2327-2228 IL - 0363-7913 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - epublish LG - English EP - 20150303 DP - 2015 Mar 03 EZ - 2015/06/10 06:00 DA - 2016/11/10 06:00 DT - 2015/06/10 06:00 YR - 2015 ED - 20161109 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26056833 <179. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26179032 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gautam S AU - Franzini L AU - Mikhail OI AU - Chan W AU - Turner BJ FA - Gautam, Santosh FA - Franzini, Luisa FA - Mikhail, Osama I FA - Chan, Wenyaw FA - Turner, Barbara J IN - Gautam, Santosh. School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas. IN - Franzini, Luisa. School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas. IN - Mikhail, Osama I. School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas. IN - Chan, Wenyaw. School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas. IN - Turner, Barbara J. University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA. TI - Longitudinal Analysis of Opioid Analgesic Dose and Diabetes Quality of Care Measures. SO - Pain Medicine. 16(11):2134-41, 2015 Nov AS - PAIN MED. 16(11):2134-41, 2015 Nov NJ - Pain medicine (Malden, Mass.) VO - 16 IP - 11 PG - 2134-41 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Diabetes Mellitus/dt [Drug Therapy] MH - Dose-Response Relationship, Drug MH - Drug Overdose/pp [Physiopathology] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - *Morphine/ae [Adverse Effects] MH - Morphine/tu [Therapeutic Use] MH - *Pain/dt [Drug Therapy] MH - Risk Assessment MH - Young Adult KW - Chronic Pain; Diabetes; Opioid Analgesics; Quality of Care AB - OBJECTIVE: To examine associations of opioid analgesic dose with quality of care for diabetes mellitus. AB - DESIGN: Longitudinal statewide cohort. AB - SUBJECTS: Subjects with diabetes filled one or more prescriptions for Schedule II/III opioids for noncancer pain in Blue Cross Blue Shield of Texas from 2008 through 2012. AB - METHODS: Opioid dose and outcomes were assessed in 6-month intervals after first filled prescription. Two morphine equivalent dose measures were daily dose and quartiles of total dose from all filled prescriptions. In fixed effects models adjusted for clinical and treatment variables, associations of opioid measures were examined for five outcomes: hemoglobin A1c (HbA1c) test, low density lipoprotein cholesterol (LDL) test, any hospitalization, any diabetes-related preventable hospitalization, and any emergency department (ED) visit. AB - RESULTS: All daily and total opioid doses were associated (P<0.05) with poorer outcomes for all five measures. For HbA1c testing, adjusted odds ratios (AORs) were reduced by 19% for high daily dose (>=100 mg) and highest quartile total dose (>900 mg), respectively, vs no opioids but >900 mg total dose had the lowest AOR for LDL testing (0.74 [CI 0.68, 0.80]). The AORs of any hospitalization or diabetes-related hospitalization were, respectively, 8.19 (CI 7.21, 9.30) and 2.76 (CI 2.19, 3.48) for >900 mg total dose but only 6.22 (CI 4.94, 7.83) and 2.16 (CI 1.34, 3.48) for >100 mg daily dose. Both opioid measures had nonmonotonic associations with ED use. AB - CONCLUSIONS: Daily opioid dose but especially total dose of opioids was strongly associated with poorer diabetes quality of care in a statewide cohort. Copyright Wiley Periodicals, Inc. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/pme.12835 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1111/pme.12835 [doi] PP - ppublish LG - English EP - 20150714 DP - 2015 Nov EZ - 2015/07/17 06:00 DA - 2016/11/02 06:00 DT - 2015/07/17 06:00 YR - 2015 ED - 20161101 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26179032 <180. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26856978 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Reardon JM AU - Harmon KJ AU - Schult GC AU - Staton CA AU - Waller AE FA - Reardon, Joseph M FA - Harmon, Katherine J FA - Schult, Genevieve C FA - Staton, Catherine A FA - Waller, Anna E IN - Reardon, Joseph M. Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Box 3935, Durham, NC, 27710, USA. Joseph.Reardon@alumni.duke.edu. IN - Harmon, Katherine J. Carolina Center for Health Informatics and the Injury Prevention Research Center, University of North Carolina at Chapel Hill, 100 Market St, Chapel Hill, 27516, NC, USA. IN - Schult, Genevieve C. Department of Emergency Medicine, University of North Carolina at Chapel Hill, Box 7594, 170 Manning Dr, Chapel Hill, 27599, NC, USA. IN - Staton, Catherine A. Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Box 3935, Durham, NC, 27710, USA. IN - Staton, Catherine A. Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, 27710, NC, USA. IN - Waller, Anna E. Carolina Center for Health Informatics and the Injury Prevention Research Center, University of North Carolina at Chapel Hill, 100 Market St, Chapel Hill, 27516, NC, USA. IN - Waller, Anna E. Department of Emergency Medicine, University of North Carolina at Chapel Hill, Box 7594, 170 Manning Dr, Chapel Hill, 27599, NC, USA. TI - Use of diagnosis codes for detection of clinically significant opioid poisoning in the emergency department: A retrospective analysis of a surveillance case definition. SO - BMC Emergency Medicine. 16:11, 2016 Feb 08 AS - BMC emerg. med.. 16:11, 2016 Feb 08 NJ - BMC emergency medicine VO - 16 PG - 11 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100968543 IO - BMC Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746926 SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Clinical Coding MH - *Emergency Service, Hospital MH - Female MH - Humans MH - *International Classification of Diseases MH - Male MH - *Medical Overuse/td [Trends] MH - Middle Aged MH - Population Surveillance MH - Retrospective Studies MH - Triage MH - Young Adult AB - BACKGROUND: Although fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare. Public health authorities are in need of tools to track opioid poisonings in near real time. AB - METHODS: We determined the utility of ICD-9-CM diagnosis codes for identifying clinically significant opioid poisonings in a state-wide emergency department (ED) surveillance system. We sampled visits from four hospitals from July 2009 to June 2012 with diagnosis codes of 965.00, 965.01, 965.02 and 965.09 (poisoning by opiates and related narcotics) and/or an external cause of injury code of E850.0-E850.2 (accidental poisoning by opiates and related narcotics), and developed a novel case definition to determine in which cases opioid poisoning prompted the ED visit. We calculated the percentage of visits coded for opioid poisoning that were clinically significant and compared it to the percentage of visits coded for poisoning by non-opioid agents in which there was actually poisoning by an opioid agent. We created a multivariate regression model to determine if other collected triage data can improve the positive predictive value of diagnosis codes alone for detecting clinically significant opioid poisoning. AB - RESULTS: 70.1 % of visits (Standard Error 2.4 %) coded for opioid poisoning were primarily prompted by opioid poisoning. The remainder of visits represented opioid exposure in the setting of other primary diseases. Among non-opioid poisoning codes reviewed, up to 36 % were reclassified as an opioid poisoning. In multivariate analysis, only naloxone use improved the positive predictive value of ICD-9-CM codes for identifying clinically significant opioid poisoning, but was associated with a high false negative rate. AB - CONCLUSIONS: This surveillance mechanism identifies many clinically significant opioid overdoses with a high positive predictive value. With further validation, it may help target control measures such as prescriber education and pharmacy monitoring. RN - 0 (Analgesics, Opioid) ES - 1471-227X IL - 1471-227X DO - https://dx.doi.org/10.1186/s12873-016-0075-4 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1186/s12873-016-0075-4 [doi] ID - 10.1186/s12873-016-0075-4 [pii] ID - PMC4746926 [pmc] PP - epublish PH - 2015/03/13 [received] PH - 2016/02/01 [accepted] LG - English EP - 20160208 DP - 2016 Feb 08 EZ - 2016/02/10 06:00 DA - 2016/10/21 06:00 DT - 2016/02/10 06:00 YR - 2016 ED - 20161020 RD - 20170923 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26856978 <181. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26816030 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Samuels EA AU - Dwyer K AU - Mello MJ AU - Baird J AU - Kellogg AR AU - Bernstein E FA - Samuels, Elizabeth A FA - Dwyer, Kristin FA - Mello, Michael J FA - Baird, Janette FA - Kellogg, Adam R FA - Bernstein, Edward IN - Samuels, Elizabeth A. Department of Emergency Medicine, Brown University, Providence, RI. IN - Dwyer, Kristin. Department of Emergency Medicine, Boston Medical Center, Boston, MA. IN - Mello, Michael J. Department of Emergency Medicine, Brown University, Providence, RI. IN - Baird, Janette. Department of Emergency Medicine, Brown University, Providence, RI. IN - Kellogg, Adam R. Department of Emergency Medicine, Baystate Medical Center, Springfield, MA. IN - Bernstein, Edward. Department of Emergency Medicine, Boston Medical Center, Boston, MA. TI - Emergency Department-based Opioid Harm Reduction: Moving Physicians From Willing to Doing. SO - Academic Emergency Medicine. 23(4):455-65, 2016 Apr AS - Acad Emerg Med. 23(4):455-65, 2016 Apr NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 23 IP - 4 PG - 455-65 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid MH - *Attitude of Health Personnel MH - Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/pc [Prevention & Control] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Harm Reduction MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Male MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Patient Education as Topic MH - *Physicians/px [Psychology] MH - Referral and Consultation MH - Self Efficacy MH - Surveys and Questionnaires AB - OBJECTIVES: Develop and internally validate a survey tool to assess emergency department (ED) physician attitudes, clinical practice, and willingness to perform opiate harm reduction (OHR) interventions and to identify barriers and facilitators in translating willingness to action. AB - METHODS: This study was an anonymous, Web-based survey based on the Theory of Planned Behavior of ED physicians at three tertiary referral centers. Construction and internal validation of scaled questions was assessed through principal component and Cronbach's alpha analyses. Stepwise linear regression was conducted to measure impact of physician knowledge, attitudes, confidence, and self-efficacy on willingness to perform OHR interventions including opioid overdose education; naloxone prescribing; and referral to naloxone, methadone, and syringe access programs. AB - RESULTS: A total of 200 of 278 (71.9%) physicians completed the survey. Principal component analysis yielded five components: attitude, confidence, self-efficacy, professional impact factors, and personal impact factors. Overall, respondents were willing to perform OHR interventions, but few actually do. Willingness was correlated with attitude, confidence, and self-efficacy (R(2) = 0.50); however, overall physicians lacked confidence (mean = 3.06 of 5, 95% confidence interval [CI] = 2.94 to 3.18]). Knowledge, time, training, and institutional support were all prohibitive barriers. Physicians reported that research evidence, professional organization recommendations, and opinions of ED leaders would strongly influence a change in their clinical practice to incorporate OHR interventions (mean = 4.25 of 5, 95% CI = 4.18 to 4.32). AB - CONCLUSIONS: Compared to prior studies, emergency medicine physicians had increased willingness to perform OHR interventions, but there remains a disparity between willingness and clinical practice. Influential factors that may move physicians from "willing" to "doing" include dissemination of supportive research evidence; professional organization endorsement; ED leadership opinion; and addressing time, knowledge, and institutional barriers. Copyright © 2016 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12910 PT - Journal Article ID - 10.1111/acem.12910 [doi] PP - ppublish PH - 2015/08/07 [received] PH - 2015/10/19 [revised] PH - 2015/10/20 [accepted] LG - English EP - 20160322 DP - 2016 Apr EZ - 2016/01/28 06:00 DA - 2016/10/21 06:00 DT - 2016/01/28 06:00 YR - 2016 ED - 20161020 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26816030 <182. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26727339 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Browne LR AU - Studnek JR AU - Shah MI AU - Brousseau DC AU - Guse CE AU - Lerner EB FA - Browne, Lorin R FA - Studnek, Jonathan R FA - Shah, Manish I FA - Brousseau, David C FA - Guse, Clare E FA - Lerner, E Brooke TI - Prehospital Opioid Administration in the Emergency Care of Injured Children. SO - Prehospital Emergency Care. 20(1):59-65, 2016 AS - Prehosp Emerg Care. 20(1):59-65, 2016 NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 20 IP - 1 PG - 59-65 PI - Journal available in: Print PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adolescent MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - Cross-Sectional Studies MH - Documentation MH - *Emergency Medical Services/mt [Methods] MH - Female MH - Humans MH - Male MH - *Pain Management/mt [Methods] MH - Pain Measurement MH - Retrospective Studies MH - Wisconsin MH - *Wounds and Injuries/th [Therapy] KW - pain score; pediatric pain; prehospital opioid analgesia AB - OBJECTIVE: Prior studies have identified provider and system characteristics that impede pain management in children, but no studies have investigated the effect of changing these characteristics on prehospital opioid analgesia. Our objectives were to determine: 1) the frequency of opioid analgesia and pain score documentation among prehospital pediatric patients after system wide changes to improve pain treatment, and 2) if older age, longer transport times, the presence of vascular access and pain score documentation were associated with increased prehospital administration of opioid analgesia in children. AB - METHODS: This was a retrospective cross-sectional study of pediatric patients aged 3-18 years assessed by a single EMS system between October 1, 2011 and September 30, 2013. Prior to October 2011, the EMS system had implemented 3 changes to improve pain treatment: (1) training on age appropriate pain scales, (2) protocol changes to allow opioid analgesia without contacting medical control, and (3) the introduction of intranasal fentanyl. All patients with working assessments of blunt, penetrating, lacerating, and/or burn trauma were included. We used descriptive statistics to determine the frequency of pain score documentation and opioid analgesia administration and logistic regression to determine the association of age, transport time, and the presence of intravenous access with opioid analgesia administration. AB - RESULTS: Of the 1,368 eligible children, 336 (25%) had a documented pain score. Eleven percent (130/1204) of children without documented contraindications to opioid administration received opioids. Of the children with no documented pain score and no protocol exclusions, 9% (81/929) received opioid analgesia, whereas 18% (49/275) with a documented pain score >=4 and no protocol exclusions received opioids. Multivariate analysis revealed that vascular access (OR = 11.89; 95% CI: 7.33-19.29), longer patient transport time (OR = 1.07; 95% CI: 1.04-1.11), age (OR 0.93; 95% CI: 0.88-0.98) and pain score documentation (OR 2.23; 95% CI: 1.40-3.55) were associated with opioid analgesia. AB - CONCLUSIONS: Despite implementation of several best practice recommendations to improve prehospital pain treatment, few children have a documented pain score and even fewer receive opioid analgesia. Children with longer transport times, successful IV placement, and/or documentation of pain score(s) were more likely to receive prehospital analgesia. RN - 0 (Analgesics, Opioid) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2015.1056897 PT - Journal Article ID - 10.3109/10903127.2015.1056897 [doi] PP - ppublish LG - English DP - 2016 EZ - 2016/01/05 06:00 DA - 2016/10/19 06:00 DT - 2016/01/05 06:00 YR - 2016 ED - 20161017 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26727339 <183. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26782787 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pollack CV Jr AU - Diercks DB AU - Thomas SH AU - Shapiro NI AU - Fanikos J AU - Mace SE AU - Rafique Z AU - Todd KH FA - Pollack, Charles V Jr FA - Diercks, Deborah B FA - Thomas, Stephen H FA - Shapiro, Nathan I FA - Fanikos, John FA - Mace, Sharon E FA - Rafique, Zubaid FA - Todd, Knox H IN - Pollack, Charles V Jr. Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA. IN - Diercks, Deborah B. Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA. IN - Thomas, Stephen H. Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, OK. IN - Shapiro, Nathan I. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. IN - Fanikos, John. Department of Pharmacy, Brigham and Women's Hospital, Boston, MA. IN - Mace, Sharon E. Department of Emergency Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH. IN - Rafique, Zubaid. Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX. IN - Todd, Knox H. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. TI - Patient-reported Outcomes from A National, Prospective, Observational Study of Emergency Department Acute Pain Management With an Intranasal Nonsteroidal Anti-inflammatory Drug, Opioids, or Both. SO - Academic Emergency Medicine. 23(3):331-41, 2016 Mar AS - Acad Emerg Med. 23(3):331-41, 2016 Mar NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 23 IP - 3 PG - 331-41 PI - Journal available in: Print PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Administration, Intranasal MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Anti-Inflammatory Agents, Non-Steroidal/ad [Administration & Dosage] MH - Anti-Inflammatory Agents, Non-Steroidal/ae [Adverse Effects] MH - *Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use] MH - Drug Therapy, Combination MH - Drug Utilization MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Ketorolac Tromethamine MH - Male MH - Medication Adherence MH - Middle Aged MH - *Pain/dt [Drug Therapy] MH - Pain Management MH - Pain Measurement MH - Patient Outcome Assessment MH - *Patient Satisfaction MH - Prospective Studies AB - OBJECTIVES: Patient compliance and satisfaction with analgesics prescribed after emergency department (ED) care for acute pain are poorly understood, largely because of the lack of direct patient follow-up with the ED provider. Our objective was to compare patient satisfaction with three analgesia regimens prescribed for post-ED care-a nasally administered nonsteroidal anti-inflammatory drug (NSAID), an opioid, or combination therapy-by collecting granular follow-up on analgesic use, pain scores, side effects, work activity levels, and overall satisfaction directly from patients. AB - METHODS: We designed a prospective registry linking ED assessment and analgesic management for acute pain of specific musculoskeletal or visceral etiologies with self-reported automated telephonic follow-up daily for the 4 days post-ED discharge. Patients were prescribed a specific NSAID (SPRIX, ketorolac tromethamine for nasal instillation) only, an oral opioid only, or both with the opioid clearly defined as rescue therapy, at the ED provider's discretion. AB - RESULTS: There were 824 evaluable subjects. Maximum pain scores improved day to day more effectively with a ketorolac-based approach. Self-reported rates of return to work and work effectiveness were higher with SPRIX than with opioids or combination therapy. Adverse effects of nausea, constipation, drowsiness, and abdominal pain were higher each day among patients taking an opioid; nasal irritation was more common with SPRIX. Overall satisfaction at the end of the follow-up period was higher with SPRIX-based treatment than with opioid monotherapy. AB - CONCLUSIONS: Automated telephonic follow-up of ED patients prescribed short-term analgesia is feasible. Ketorolac-based analgesia after an ED visit for many acute pain syndromes was associated with favorable patient outcomes and higher satisfaction than opioid-based therapy. SPRIX, an NSAID that is not available over the counter and has a novel delivery approach, may be useful for short-term post-ED outpatient analgesia. Copyright © 2016 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 4EVE5946BQ (Ketorolac Tromethamine) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12902 PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't ID - 10.1111/acem.12902 [doi] PP - ppublish PH - 2015/08/25 [received] PH - 2015/10/07 [revised] PH - 2015/10/12 [accepted] LG - English DP - 2016 Mar EZ - 2016/01/20 06:00 DA - 2016/10/13 06:00 DT - 2016/01/20 06:00 YR - 2016 ED - 20161012 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26782787 <184. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26281819 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - del Portal DA AU - Healy ME AU - Satz WA AU - McNamara RM FA - del Portal, Daniel A FA - Healy, Megan E FA - Satz, Wayne A FA - McNamara, Robert M IN - del Portal, Daniel A. Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania. IN - Healy, Megan E. Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania. IN - Satz, Wayne A. Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania. IN - McNamara, Robert M. Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania. TI - Impact of an Opioid Prescribing Guideline in the Acute Care Setting. SO - Journal of Emergency Medicine. 50(1):21-7, 2016 Jan AS - J Emerg Med. 50(1):21-7, 2016 Jan NJ - The Journal of emergency medicine VO - 50 IP - 1 PG - 21-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital MH - Female MH - *Guideline Adherence MH - Humans MH - Male MH - Middle Aged MH - Pain/dt [Drug Therapy] MH - Philadelphia MH - *Practice Guidelines as Topic MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Young Adult KW - emergency department; narcotic; opioid abuse; overdose; prescribing guideline AB - BACKGROUND: Death from opioid abuse is a major public health issue. The death rate associated with opioid overdose nearly quadrupled from 1999 to 2008. Acute care settings are a major source of opioid prescriptions, often for minor conditions and chronic noncancer pain. AB - OBJECTIVE: Our aim was to determine whether a voluntary opioid prescribing guideline reduces the proportion of patients prescribed opioids for minor and chronic conditions. AB - METHODS: A retrospective chart review was performed on records of adult emergency department visits from January 2012 to July 2014 for dental, neck, back, or unspecified chronic pain, and the proportion of patients receiving opioid prescriptions at discharge was compared before and after the guideline. Attending emergency physicians were surveyed on their perceptions regarding the impact of the guideline on prescribing patterns, patient satisfaction, and physician-patient interactions. AB - RESULTS: In our sample of 13,187 patient visits, there was a significant (p < 0.001) and sustained decrease in rates of opioid prescriptions for dental, neck, back, or unspecified chronic pain. The rate of opioid prescribing decreased from 52.7% before the guideline to 29.8% immediately after its introduction, and to 33.8% at an interval of 12 to 18 months later. The decrease in opioid prescriptions was observed in all of these diagnosis groups and in all age groups. All 31 eligible prescribing physicians completed a survey. The opioid prescribing guideline was supported by 100% of survey respondents. AB - CONCLUSIONS: An opioid prescribing guideline significantly decreased the rates at which opioids were prescribed for minor and chronic complaints in an acute care setting. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(15)00621-6 DO - https://dx.doi.org/10.1016/j.jemermed.2015.06.014 PT - Journal Article PT - Observational Study ID - S0736-4679(15)00621-6 [pii] ID - 10.1016/j.jemermed.2015.06.014 [doi] PP - ppublish PH - 2015/05/21 [received] PH - 2015/06/02 [accepted] LG - English EP - 20150815 DP - 2016 Jan EZ - 2015/08/19 06:00 DA - 2016/10/13 06:00 DT - 2015/08/19 06:00 YR - 2016 ED - 20161012 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26281819 <185. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26759658 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sutter ME AU - Wintemute GJ AU - Clarke SO AU - Roche BM AU - Chenoweth JA AU - Gutierrez R AU - Albertson TE FA - Sutter, Mark E FA - Wintemute, Garen J FA - Clarke, Samuel O FA - Roche, Bailey M FA - Chenoweth, James A FA - Gutierrez, Rory FA - Albertson, Timothy E IN - Sutter, Mark E. University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California. IN - Wintemute, Garen J. University of California, Davis, Department of Emergency Medicine, Sacramento, California. IN - Clarke, Samuel O. University of California, Davis, Department of Emergency Medicine, Sacramento, California. IN - Roche, Bailey M. University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California. IN - Chenoweth, James A. University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California. IN - Gutierrez, Rory. University of California, Davis, Department of Pharmacy, Sacramento, California. IN - Albertson, Timothy E. University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California; University of California, Davis, Department of Internal Medicine, Sacramento, California. TI - The Changing Use of Intravenous Opioids in an Emergency Department. CM - Comment in: West J Emerg Med. 2015 Dec;16(7):1084-5; PMID: 26759659 SO - The Western Journal of Emergency Medicine. 16(7):1079-83, 2015 Dec AS - West J Emerg Med. 16(7):1079-83, 2015 Dec NJ - The western journal of emergency medicine VO - 16 IP - 7 PG - 1079-83 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703147 SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Drug Utilization/td [Trends] MH - *Emergency Service, Hospital/td [Trends] MH - *Emergency Treatment/td [Trends] MH - Female MH - Fentanyl/ad [Administration & Dosage] MH - Humans MH - Hydromorphone/ad [Administration & Dosage] MH - Infusions, Intravenous MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - Naloxone/ad [Administration & Dosage] MH - Retrospective Studies MH - Trauma Centers/sn [Statistics & Numerical Data] AB - INTRODUCTION: Government agencies are increasingly emphasizing opioid safety in hospitals. In 2012, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) started a sentinel event program, the "Safe Use of Opioids in Hospitals." We sought to determine if opioid use patterns in our emergency department (ED) changed from 2011, before the program began, to 2013, after start of the program. AB - METHODS: This was a retrospective study of all adult ED patients who received an intravenous opioid and had a serum creatinine measured. We recorded opioids used, dose prescribed, and serum creatinine. As an index of the safety of opioids, uses of naloxone after administration of an opioid was recorded. AB - RESULTS: Morphine is still the most commonly used opioid by doses given, but its percentage of opioids used decreased from 68.9% in 2011 to 52.8% in 2013. During the same period, use of hydromorphone increased from 27.5% to 42.9%, while the use of fentanyl changed little (3.6% to 4.3%). Naloxone administration was rare after an opioid had been given. Opioids were not dosed in an equipotent manner. AB - CONCLUSION: The use of hydromorphone in our ED increased by 56% (absolute increase of 15.4%), while the use of morphine decreased by 30.5% (absolute decrease 16.1%) of total opioid use from 2011 to 2013. The JCAHO program likely was at least indirectly responsible for this change in relative dosing of the opioids. Based on frequency of naloxone administered after administration of an opioid, the use of opioids was safe. RN - 0 (Analgesics, Opioid) RN - 36B82AMQ7N (Naloxone) RN - 76I7G6D29C (Morphine) RN - Q812464R06 (Hydromorphone) RN - UF599785JZ (Fentanyl) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2015.10.28454 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.5811/westjem.2015.10.28454 [doi] ID - wjem-16-1079 [pii] ID - PMC4703147 [pmc] PP - ppublish PH - 2015/08/16 [received] PH - 2015/10/21 [accepted] GI - No: UL1 TR000002 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English EP - 20151214 DP - 2015 Dec EZ - 2016/01/14 06:00 DA - 2016/10/12 06:00 DT - 2016/01/14 06:00 YR - 2015 ED - 20161011 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26759658 <186. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26614352 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tan Y AU - Shi Y AU - Ding H AU - Kong X AU - Zhou H AU - Tian J FA - Tan, Yuan FA - Shi, Yisa FA - Ding, Hui FA - Kong, Xiangbin FA - Zhou, Haijiao FA - Tian, Jinhui IN - Tan, Yuan. Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China. IN - Shi, Yisa. Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China. IN - Ding, Hui. Department of Urology, Lanzhou University Second Hospital, Lanzhou, China. IN - Kong, Xiangbin. Department of Urology, Lanzhou University Second Hospital, Lanzhou, China. IN - Zhou, Haijiao. Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China. IN - Tian, Jinhui. Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China. TI - mu-Opioid agonists for preventing emergence agitation under sevoflurane anesthesia in children: a meta-analysis of randomized controlled trials. SO - Paediatric Anaesthesia. 26(2):139-50, 2016 Feb AS - Paediatr Anaesth. 26(2):139-50, 2016 Feb NJ - Paediatric anaesthesia VO - 26 IP - 2 PG - 139-50 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - cg8, 9206575 IO - Paediatr Anaesth SB - Index Medicus CP - France MH - Alfentanil/pd [Pharmacology] MH - *Analgesics, Opioid/pd [Pharmacology] MH - *Anesthesia Recovery Period MH - *Anesthetics, Inhalation/ae [Adverse Effects] MH - Child MH - Fentanyl/pd [Pharmacology] MH - Humans MH - *Methyl Ethers/ae [Adverse Effects] MH - Piperidines/pd [Pharmacology] MH - *Psychomotor Agitation/pc [Prevention & Control] MH - Randomized Controlled Trials as Topic MH - Sufentanil/pd [Pharmacology] KW - alfentanil; emergence agitation; fentanyl; remifentanil; sevoflurane; sufentanil AB - BACKGROUND: Emergence agitation (EA) is an adverse effect after sevoflurane anesthesia in pediatric patients. The effectiveness of prophylactic mu-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil in preventing EA is debatable. AB - METHODS: A literature search was conducted to identify clinical trials that observed the effect of mu-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil on preventing EA in pediatric patients under sevoflurane anesthesia. The statistical software RevMan 5.3 was used for meta-analysis. Data from each study were combined using the relative ratio (RR), weighted mean differences, and their associated 95% confidence intervals. I(2) was used to evaluate heterogeneity. Subgroup analysis was conducted to investigate the possible influences of patient age, adenotonsillectomy, premedication, N2 O, propofol, and regional block/local anesthetics on preventing EA with prophylactic administration of mu-opioid agonists. Publication bias was checked using funnel plots and Begg's test. AB - RESULTS: This meta-analysis showed the inclusion of 19 randomized controlled trials with 1528 patients (857 patients received mu-opioid agonists therapy and 671 patients had placebo). The pooled data indicated that prophylactic mu-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil significantly decreased the incidence of EA [RR = 0.49 (0.38, 0.64), I(2) = 42%, P = 0.04; RR = 0.57 (0.33, 0.99), I(2) = 37%, P = 0.19; RR = 0.18 (0.08, 0.39), I(2) = 0%, P = 0.98; and RR = 0.56 (0.40, 0.78), I(2) = 6%, P = 0.34, respectively]. All subgroup analyses strengthened the proof for lower incidence of EA under sevoflurane anesthesia after fentanyl administration. A possibility of publication bias was detected in the fentanyl group. AB - CONCLUSIONS: This meta-analysis suggested that prophylactic mu-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil could significantly decrease the incidence of EA under sevoflurane anesthesia in children compared to placebo. Considering the limitations of the included studies, more clinical studies are required. Copyright © 2015 John Wiley & Sons Ltd. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Inhalation) RN - 0 (Methyl Ethers) RN - 0 (Piperidines) RN - 1N74HM2BS7 (Alfentanil) RN - 38LVP0K73A (sevoflurane) RN - AFE2YW0IIZ (Sufentanil) RN - P10582JYYK (remifentanil) RN - UF599785JZ (Fentanyl) ES - 1460-9592 IL - 1155-5645 DO - https://dx.doi.org/10.1111/pan.12815 PT - Journal Article PT - Meta-Analysis ID - 10.1111/pan.12815 [doi] PP - ppublish PH - 2015/10/04 [accepted] LG - English EP - 20151128 DP - 2016 Feb EZ - 2015/11/29 06:00 DA - 2016/10/08 06:00 DT - 2015/11/29 06:00 YR - 2016 ED - 20161007 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26614352 <187. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25991642 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rumbak DM AU - Mowrey W AU - W Schwartz S AU - Sarwahi V AU - Djukic A AU - Killinger JS AU - Katyal C FA - Rumbak, Dania M FA - Mowrey, Wenzhu FA - W Schwartz, Skai FA - Sarwahi, Vishal FA - Djukic, Aleksandra FA - Killinger, James S FA - Katyal, Chhavi IN - Rumbak, Dania M. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, USA Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA daniarumbak@gmail.com. IN - Mowrey, Wenzhu. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. IN - W Schwartz, Skai. Department of Epidemiology and Biostatistics, University of South Florida College of Public Health, Tampa, FL, USA. IN - Sarwahi, Vishal. Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA. IN - Djukic, Aleksandra. Division of Neurology and Tri-State Rett Syndrome Center, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA. IN - Killinger, James S. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, USA Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. IN - Katyal, Chhavi. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, USA. TI - Spinal Fusion for Scoliosis in Rett Syndrome With an Emphasis on Respiratory Failure and Opioid Usage. SO - Journal of Child Neurology. 31(2):153-8, 2016 Feb AS - J Child Neurol. 31(2):153-8, 2016 Feb NJ - Journal of child neurology VO - 31 IP - 2 PG - 153-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ia2, 8606714 IO - J. Child Neurol. SB - Index Medicus CP - United States MH - Adolescent MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - Female MH - Humans MH - Male MH - Methyl-CpG-Binding Protein 2/ge [Genetics] MH - *Postoperative Complications MH - Respiration, Artificial/ae [Adverse Effects] MH - *Respiratory Insufficiency/co [Complications] MH - Respiratory Insufficiency/ep [Epidemiology] MH - Respiratory Insufficiency/th [Therapy] MH - Retrospective Studies MH - *Rett Syndrome/co [Complications] MH - Rett Syndrome/ep [Epidemiology] MH - Rett Syndrome/ge [Genetics] MH - Scoliosis/co [Complications] MH - Scoliosis/dt [Drug Therapy] MH - Scoliosis/ep [Epidemiology] MH - *Scoliosis/su [Surgery] MH - Spinal Fusion/ae [Adverse Effects] MH - Spinal Fusion/mt [Methods] MH - *Spinal Fusion MH - Young Adult KW - Rett syndrome; comparative study; pediatric intensive care unit; scoliosis; ventilator-acquired pneumonia AB - Our objective was to characterize our experience with 8 patients with Rett syndrome undergoing scoliosis surgery in regard to rates of respiratory failure and rates of ventilator-acquired pneumonia in comparison to patients with neurologic scoliosis and adolescent idiopathic scoliosis. This study was a retrospective chart review of patients undergoing scoliosis surgery at a tertiary children's hospital. Patients were divided into 3 groups: (1) adolescent idiopathic scoliosis, (2) neurologic scoliosis, and (3) Rett syndrome. There were 133 patients with adolescent idiopathic scoliosis, 48 patients with neurologic scoliosis, and 8 patients with Rett syndrome. We found that patients with Rett syndrome undergoing scoliosis surgery have higher rates of respiratory failure and longer ventilation times in the postoperative period when compared with both adolescent idiopathic scoliosis and neurologic scoliosis patients. There is insufficient evidence to suggest a difference in the incidence of ventilator-acquired pneumonia between the Rett syndrome and the neurologic scoliosis group. We believe our findings are the first in the literature to show a statistically significant difference between these 3 groups in regard to incidence of respiratory failure. Copyright © The Author(s) 2015. RN - 0 (Analgesics, Opioid) RN - 0 (MECP2 protein, human) RN - 0 (Methyl-CpG-Binding Protein 2) ES - 1708-8283 IL - 0883-0738 DO - https://dx.doi.org/10.1177/0883073815585352 PT - Comparative Study PT - Journal Article ID - 0883073815585352 [pii] ID - 10.1177/0883073815585352 [doi] PP - ppublish PH - 2015/01/02 [received] PH - 2015/04/06 [accepted] LG - English EP - 20150519 DP - 2016 Feb EZ - 2015/05/21 06:00 DA - 2016/10/07 06:00 DT - 2015/05/21 06:00 YR - 2016 ED - 20161005 RD - 20161230 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25991642 <188. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25088538 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Seaman EL AU - Levy MJ AU - Jenkins JL AU - Godar CC AU - Seaman KG FA - Seaman, Elizabeth L FA - Levy, Mathew J FA - Jenkins, J Lee FA - Godar, Cassandra Chiras FA - Seaman, Kevin G IN - Seaman, Elizabeth L. 1Department of Behavioral and Community Health,School of Public Health,University of Maryland,College Park,MarylandUSA. IN - Levy, Mathew J. 2Department of Emergency Medicine,Johns Hopkins University School of Medicine,Baltimore,MarylandUSA. IN - Jenkins, J Lee. 2Department of Emergency Medicine,Johns Hopkins University School of Medicine,Baltimore,MarylandUSA. IN - Godar, Cassandra Chiras. 3Howard County,Department of Fire and Rescue Services,Columbia,MarylandUSA. IN - Seaman, Kevin G. 3Howard County,Department of Fire and Rescue Services,Columbia,MarylandUSA. TI - Assessing pediatric and young adult substance use through analysis of prehospital data. SO - Prehospital & Disaster Medicine. 29(5):468-72, 2014 Oct AS - Prehospital Disaster Med. 29(5):468-72, 2014 Oct NJ - Prehospital and disaster medicine VO - 29 IP - 5 PG - 468-72 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bdf, 8918173 IO - Prehosp Disaster Med SB - Health Technology Assessment Journals CP - United States MH - Adolescent MH - Adolescent Health Services MH - Adult MH - Age Factors MH - Child MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Maryland/ep [Epidemiology] MH - Retrospective Studies MH - Sex Factors MH - *Substance Abuse Detection/mt [Methods] MH - *Substance-Related Disorders/ep [Epidemiology] MH - Young Adult AB - INTRODUCTION: Substance use in young adults is a significant and growing problem. Emergency Medical Services (EMS) personnel often encounter this problem, yet the use of prehospital data to evaluate the prevalence and magnitude of substance abuse has been limited. AB - HYPOTHESIS/PROBLEM: This study evaluated drug and alcohol use through the use of prehospital and EMS data in one suburban county in Maryland (USA). The primary hypothesis was that the type of drug being abused is associated with age. The secondary hypothesis was substance abuse incidence is associated with location. The tertiary hypothesis was that substance abuse is associated with a history of mental illness. AB - METHODS: Deidentified patient care reports (PCRs) were obtained during a 24-month period from October 2010 through September 2012 for patients 0 through 25 years of age. Inclusion criteria included chief complaint of alcohol overdose, drug overdose, or the use of naloxone. AB - RESULTS: The primary hypothesis was supported that age was associated with drug category (P < .001). Younger adolescents were more likely to use household items, prescription drugs, or over-the-counter drugs, whereas older adolescents were more likely to use illicit drugs. The secondary hypothesis was supported that both alcohol (P < .001) and drugs (P < .001) were associated with location of call. Calls involving alcohol were more likely to be at a home or business, whereas calls involving drugs were more likely to be at home or at a public venue. The tertiary hypothesis was supported that both alcohol (P = .001) and drug use (P < .001) were associated with history of mental illness. Older adolescents were more likely to report a history of mental illness. Chi-squared tests indicated there were significant differences between genders and drug category (P = .002) and gender and current suicide attempt (P = .004). Females were more likely to use prescription drugs, whereas males were more likely to use illicit drugs. Calls involving younger adolescents under 18 were more likely to be at school or the mall, whereas calls involving older adolescents were likely to be at a prison, public venue, or a business. AB - CONCLUSION: All three hypotheses were supported: the type of substance being abused was associated with both age and location, and substance abuse was associated with a history of mental illness. This research has important implications for understanding how EMS resources are utilized for substance use. This information is valuable in not only the education and training of prehospital care providers, but also for the targeting of future public health interventions. ES - 1945-1938 IL - 1049-023X DO - https://dx.doi.org/10.1017/S1049023X1400079X PT - Journal Article ID - S1049023X1400079X [pii] ID - 10.1017/S1049023X1400079X [doi] PP - ppublish LG - English EP - 20140804 DP - 2014 Oct EZ - 2014/08/05 06:00 DA - 2016/09/30 06:00 DT - 2014/08/05 06:00 YR - 2014 ED - 20160929 RD - 20141018 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25088538 <189. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26658085 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pelissier F AU - Rouge Bugat ME AU - Nubukpo P AU - Franchitto N FA - Pelissier, Fanny FA - Rouge Bugat, Marie-Eve FA - Nubukpo, Philippe FA - Franchitto, Nicolas IN - Pelissier, Fanny. Poisons and Substance Abuse Treatment Centre Toulouse-Purpan University Hospital Toulouse, France Department of Primary Care Toulouse University Hospital University of Toulouse III and INSERM U 1027 Toulouse, France Department of Addiction Medicine Esquirol Hospital Limoges, France Poisons and Substance Abuse Treatment Centre Toulouse-Purpan University Hospital University of Toulouse III INSERM U 1027 Toulouse, France and Department of Addiction Medicine Toulouse-Purpan University Hospital Toulouse, France franchitto.n@chu-toulouse.fr. TI - Nalmefene Mistakenly Prescribed to Reduce Alcohol Consumption in Patients Under Buprenorphine Substitution Therapy Resulting in Acute Opioid Withdrawal: Management in an Emergency Setting. SO - Journal of Clinical Psychopharmacology. 36(1):100-3, 2016 Feb AS - J Clin Psychopharmacol. 36(1):100-3, 2016 Feb NJ - Journal of clinical psychopharmacology VO - 36 IP - 1 PG - 100-3 PI - Journal available in: Print PI - Citation processed from: Internet JC - hud, 8109496 IO - J Clin Psychopharmacol SB - Index Medicus CP - United States MH - Adult MH - *Alcohol Drinking/pc [Prevention & Control] MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Buprenorphine/ad [Administration & Dosage] MH - *Buprenorphine/ae [Adverse Effects] MH - Drug Interactions MH - Female MH - Humans MH - Middle Aged MH - Naltrexone/ad [Administration & Dosage] MH - Naltrexone/ae [Adverse Effects] MH - *Naltrexone/aa [Analogs & Derivatives] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/ae [Adverse Effects] MH - Opiate Substitution Treatment/mt [Methods] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Substance Withdrawal Syndrome/et [Etiology] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) RN - 5S6W795CQM (Naltrexone) RN - TOV02TDP9I (nalmefene) ES - 1533-712X IL - 0271-0749 DO - https://dx.doi.org/10.1097/JCP.0000000000000448 PT - Case Reports PT - Letter ID - 10.1097/JCP.0000000000000448 [doi] PP - ppublish LG - English DP - 2016 Feb EZ - 2015/12/15 06:00 DA - 2016/09/27 06:00 DT - 2015/12/15 06:00 YR - 2016 ED - 20160926 RD - 20151223 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26658085 <190. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26357683 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wilson JL AU - Poulin PA AU - Sikorski R AU - Nathan HJ AU - Taljaard M AU - Smyth C FA - Wilson, Jennifer Lc FA - Poulin, Patricia A FA - Sikorski, Robert FA - Nathan, Howard J FA - Taljaard, Monica FA - Smyth, Catherine TI - Opioid use among same-day surgery patients: Prevalence, management and outcomes. SO - Pain Research & Management. 20(6):300-4, 2015 Nov-Dec AS - Pain Res Manag. 20(6):300-4, 2015 Nov-Dec NJ - Pain research & management VO - 20 IP - 6 PG - 300-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9612504 IO - Pain Res Manag PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676499 SB - Index Medicus CP - United States MH - Adult MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Female MH - Humans MH - Length of Stay MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Pain Management MH - Pain Measurement MH - *Pain, Postoperative/dt [Drug Therapy] MH - Patient Compliance MH - Patient Readmission/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Statistics, Nonparametric MH - Young Adult AB - OBJECTIVES: To determine whether the prevalence of opioid use among patients requiring elective same-day admission (SDA) surgery is greater than the 2.5% prevalence found in the general population. Secondary objectives were to assess compliance with expert recommendations on acute pain management in opioid-tolerant patients and to examine clinical outcomes. AB - METHODS: A retrospective review of 812 systematically sampled adult SDA surgical cases between April 1, 2008 and March 31, 2009 was conducted. AB - RESULTS: Among 798 eligible patients, 148 (18.5% [95% CI 15.9% to 21.2%]) were prescribed opioids, with 4.4% prescribed long-acting opioids (95% CI 3.0% to 5.8%). Use of opioids was most prevalent among orthopedic and neurosurgery patients. Among the 35 patients on long-acting opioids who had a high likelihood of being tolerant, anesthesiologists correctly identified 33, but only 13 (37%) took their usual opioid preoperatively while 22 (63%) had opioids continued postoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered preoperatively in 18 (51%), 15 (43%) and 18 (51%) cases, respectively, while ketamine was used in 15 (43%) patients intraoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered postoperatively in 31 (89%), 15 (43%) and 17 (49%) of the cases, respectively. No differences in length of stay, readmissions and emergency room visits were found between opioid-tolerant and opioid-naive patients. AB - CONCLUSION: Opioid use is more common in SDA surgical patients than in the general population and is most prevalent within orthopedic and neurosurgery patients. Uptake of expert opinion on the management of acute pain in the opioid tolerant patient population is lacking. RN - 0 (Analgesics, Opioid) ES - 1918-1523 IL - 1203-6765 DI - 16939 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 16939 [pii] ID - PMC4676499 [pmc] PP - ppublish LG - English EP - 20150910 DP - 2015 Nov-Dec EZ - 2015/09/12 06:00 DA - 2016/09/22 06:00 DT - 2015/09/11 06:00 YR - 2015 ED - 20160920 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26357683 <191. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26824227 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Reyes-Gibby CC AU - Anderson KO AU - Todd KH FA - Reyes-Gibby, Cielito C FA - Anderson, Karen O FA - Todd, Knox H IN - Reyes-Gibby, Cielito C. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. IN - Anderson, Karen O. Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX. IN - Todd, Knox H. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. TI - Risk for Opioid Misuse Among Emergency Department Cancer Patients. SO - Academic Emergency Medicine. 23(2):151-8, 2016 Feb AS - Acad Emerg Med. 23(2):151-8, 2016 Feb NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 23 IP - 2 PG - 151-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Aged MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Clinical Decision-Making MH - Cross-Sectional Studies MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Neoplasms/ep [Epidemiology] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Predictive Value of Tests MH - Risk Assessment MH - Risk Factors MH - Socioeconomic Factors MH - Texas/ep [Epidemiology] MH - United States AB - OBJECTIVES: One of the most challenging areas of emergency medicine practice is the management and treatment of severe and persistent pain, including cancer-related pain. Emergency departments (EDs) in the United States frequently provide care for patients with cancer and an increasing concern is the potential for opioid misuse in this patient group. The authors determined the risk for opioid misuse among ED cancer patients with pain and assessed demographic and clinical factors associated with increased misuse risk. The Texas state prescription monitoring program was also queried for evidence of multiple opioid prescriptions for comparing low- and high-risk groups. AB - METHODS: The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) was administered to assess risk for opioid misuse among cancer patients presenting to the ED of a comprehensive cancer center in the United States. Eligibility criteria included: 1) presentation for treatment of chronic cancer-related pain while taking a prescribed schedule II opioid for analgesia, 2) age of 18 years or older, 3) ability to speak English, and 4) ability to understand the study and give written informed consent. AB - RESULTS: Of 934 ED patients screened for the study, 290 were eligible and 209 participated (72% response rate). On the basis of the recommended SOAPP-R cutoff score of 18, a total of 71 of the 209 patients (34%) were categorized as having a high risk of misuse. Of note, 15% and 4% of all patients reported past or current use of illicit substances, respectively. The total number of annual opioid prescriptions (17.8 vs. 12.6; p = 0.023) differed between the high- versus low-risk groups. Multivariable analyses showed that depression (odds ratio [OR] = 3.06, 95% confidence interval [CI] = 1.45 to 6.48; p = 0.003), poor coping (OR = 1.08, 95% CI = 1.03 to 1.13; p = 0.001), and illicit substance use (OR = 28.30, 95% CI = 2.97 to 269.24; p = 0.029) were significantly associated with high risk of opioid misuse. AB - CONCLUSIONS: The risk of opioid misuse among cancer patients is substantial. Screening for opioid misuse in the ED is feasible. Copyright © 2016 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12861 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1111/acem.12861 [doi] PP - ppublish PH - 2015/06/02 [received] PH - 2015/08/04 [revised] PH - 2015/08/07 [revised] PH - 2015/08/13 [accepted] LG - English EP - 20160129 DP - 2016 Feb EZ - 2016/01/30 06:00 DA - 2016/09/15 06:00 DT - 2016/01/30 06:00 YR - 2016 ED - 20160914 RD - 20160209 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26824227 <192. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26802501 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kea B AU - Fu R AU - Lowe RA AU - Sun BC FA - Kea, Bory FA - Fu, Rochelle FA - Lowe, Robert A FA - Sun, Benjamin C IN - Kea, Bory. Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR. IN - Kea, Bory. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. IN - Fu, Rochelle. Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR. IN - Fu, Rochelle. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. IN - Fu, Rochelle. Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR. IN - Lowe, Robert A. Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR. IN - Lowe, Robert A. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. IN - Lowe, Robert A. Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR. IN - Lowe, Robert A. Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR. IN - Sun, Benjamin C. Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR. IN - Sun, Benjamin C. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. TI - Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010. SO - Academic Emergency Medicine. 23(2):159-65, 2016 Feb AS - Acad Emerg Med. 23(2):159-65, 2016 Feb NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 23 IP - 2 PG - 159-65 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946851 OI - Source: NLM. NIHMS801462 [Available on 02/01/17] SB - Index Medicus CP - United States MH - Adult MH - Age Factors MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Health Care Surveys MH - Humans MH - Male MH - Middle Aged MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Patient Discharge/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Severity of Illness Index MH - Sex Factors MH - Socioeconomic Factors MH - Time Factors MH - United States AB - OBJECTIVES: Prescription opioid overdoses are a leading cause of death in the United States. Emergency departments (EDs) are potentially high-risk environments for doctor shopping and diversion. The hypothesis was that opioid prescribing rates from the ED have increased over time. AB - METHODS: The authors analyzed data on ED discharges from the 2006 through 2010 NHAMCS, a probability sample of all U.S. EDs. The outcome was documentation of an opioid prescription on discharge. The primary independent predictor was time. Covariates included severity of pain, a pain-related discharge diagnosis, age, sex, race, payer, hospital ownership, and geographic location of hospital. Up to three discharge diagnoses were available in NHAMCS to identify "pain-related" (e.g., back pain, fracture, dental/jaw pain, nephrolithiasis) ED visits. Multivariate logistic regression was performed to assess the independent associations between opioid prescribing and predictors. All analyses incorporated NHAMCS survey weights, and all results are presented as national estimates. AB - RESULTS: Opioids were prescribed for 18.7% (95% confidence interval = 17.7% to 19.7%) of all ED discharges, representing 18.8 million prescriptions per year. There were no significant temporal trends in opioid prescribing overall (adjusted p = 0.93). Pain-related discharge diagnoses that received the top three highest proportion of opioids prescriptions included nephrolithiasis (62.1%), neck pain (51.6%), and dental/jaw pain (49.7%). A pain-related discharge diagnosis, non-Hispanic white race, older age, male sex, uninsured status, and Western region were positively associated with opioid prescribing (p < 0.05). AB - CONCLUSIONS: No temporal trend toward increased prescribing from 2006 to 2012 was found. These results suggest that problems with opioid overprescribing are multifactorial and not solely rooted in the ED. Copyright © 2016 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12862 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1111/acem.12862 [doi] ID - PMC4946851 [pmc] ID - NIHMS801462 [mid] PP - ppublish PH - 2015/05/28 [received] PH - 2015/08/14 [revised] PH - 2015/08/20 [accepted] GI - No: K12 HL108974 Organization: (HL) *NHLBI NIH HHS* Country: United States LG - English EP - 20160123 DP - 2016 Feb EZ - 2016/01/24 06:00 DA - 2016/09/15 06:00 DT - 2016/01/24 06:00 YR - 2016 ED - 20160914 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26802501 <193. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26409674 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tadros A AU - Layman SM AU - Davis SM AU - Davidov DM AU - Cimino S FA - Tadros, Allison FA - Layman, Shelley M FA - Davis, Stephen M FA - Davidov, Danielle M FA - Cimino, Scott IN - Tadros, Allison. Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia. IN - Layman, Shelley M. Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia. IN - Davis, Stephen M. Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia. IN - Davidov, Danielle M. Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia. IN - Cimino, Scott. Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia. TI - Emergency Visits for Prescription Opioid Poisonings. CM - Comment in: Clin J Pain. 2016 May;32(5):459; PMID: 26626300 SO - Journal of Emergency Medicine. 49(6):871-7, 2015 Dec AS - J Emerg Med. 49(6):871-7, 2015 Dec NJ - The Journal of emergency medicine VO - 49 IP - 6 PG - 871-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760637 OI - Source: NLM. NIHMS758597 [Available on 12/01/16] SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/di [Diagnosis] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Patient Admission/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Risk Factors MH - Suicide, Attempted/sn [Statistics & Numerical Data] MH - United States/ep [Epidemiology] KW - emergency medicine; opioid; overdose AB - BACKGROUND: Prescription opioid abuse and overdose has steadily increased in the United States (US) over the past two decades, and current research has shown a dramatic increase in hospitalizations resulting from opioid poisonings. Still, much is unknown about the clinical and demographic features of patients presenting to emergency departments (EDs) for poisoning from prescription drugs. AB - OBJECTIVE: We sought to evaluate ED visits by adults for prescription opioids. AB - METHODS: This was a retrospective cohort study utilizing 2006-2011 data from the Nationwide Emergency Department Sample. Total number of admissions (weighted), disposition, gender, age, expected payer, income, geographic region, charges, and procedures performed were examined. AB - RESULTS: From 2006 through 2010, there were 259,093 ED visits by adults for poisoning by opioids, and 53.50% of these were unintentional. The overall mean age of patients was 45.5 years, with more visits made by females (52.37%). Patients who unintentionally overdosed were more likely to have Medicare (36.54%), whereas those who intentionally overdosed had private insurance (29.41%). The majority of patients resided in the South (40.93%) and came from lower-income neighborhoods. Approximately 108,504 patients were discharged, and 140,395 were admitted. AB - CONCLUSIONS: There were over 250,000 visits to US EDs from 2006 through 2011 with a primary diagnosis of poisoning by a prescription opioid. Females made the majority of visits, and over half were admitted to the hospital, resulting in over $4 billion in charges. Future studies should examine preventative measures, optimal screening, and intervention programs for these patients. Copyright © 2015 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(15)00644-7 DO - https://dx.doi.org/10.1016/j.jemermed.2015.06.035 PT - Journal Article ID - S0736-4679(15)00644-7 [pii] ID - 10.1016/j.jemermed.2015.06.035 [doi] ID - PMC4760637 [pmc] ID - NIHMS758597 [mid] PP - ppublish PH - 2014/04/29 [received] PH - 2015/02/13 [revised] PH - 2015/06/12 [accepted] GI - No: U54 GM104942 Organization: (GM) *NIGMS NIH HHS* Country: United States LG - English EP - 20150926 DP - 2015 Dec EZ - 2015/09/28 06:00 DA - 2016/09/09 06:00 DT - 2015/09/28 06:00 YR - 2015 ED - 20160908 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26409674 <194. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24439102 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Martinez Sanchez L AU - Almario Hernandez AF AU - Escuredo Argullos L AU - Macao P AU - Trenchs Sainz de la Maza V AU - Luaces Cubells C FA - Martinez Sanchez, L FA - Almario Hernandez, A F FA - Escuredo Argullos, L FA - Macao, P FA - Trenchs Sainz de la Maza, V FA - Luaces Cubells, C IN - Martinez Sanchez, L. Servicio de Urgencias de Pediatria, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Espana. Electronic address: lmartinez@hsjdbcn.org. IN - Almario Hernandez, A F. Servicio de Urgencias de Pediatria, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Espana. IN - Escuredo Argullos, L. Servicio de Urgencias de Pediatria, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Espana. IN - Macao, P. Servicio de Pediatria, Hospital Pediatrico de Coimbra, Coimbra, Portugal. IN - Trenchs Sainz de la Maza, V. Servicio de Urgencias de Pediatria, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Espana. IN - Luaces Cubells, C. Servicio de Urgencias de Pediatria, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Espana. TI - [Antidote use in a pediatric emergency department]. [Spanish] OT - Uso de antidotos en un servicio de urgencias pediatricas. CM - Comment in: An Pediatr (Barc). 2015 May;82(5):e260-1; PMID: 25529376 SO - Anales de Pediatria. 81(4):220-5, 2014 Oct AS - An Pediatr (Barc). 81(4):220-5, 2014 Oct NJ - Anales de pediatria (Barcelona, Spain : 2003) VO - 81 IP - 4 PG - 220-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101162596 IO - An Pediatr (Barc) SB - Index Medicus CP - Spain MH - Adolescent MH - *Antidotes/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - Emergency Service, Hospital MH - *Emergency Treatment MH - Female MH - Humans MH - Male MH - *Poisoning/dt [Drug Therapy] MH - Retrospective Studies KW - Antidotes; Antidotos; Children; Emergency medical services; Intoxicacion; Ninos; Poisoning; Urgencias AB - INTRODUCTION: Poisoning is an infrequent cause of consultation in a pediatric emergency department (PED), but it can be potentially serious. Pediatricians should know how to use the available antidotes properly. AB - OBJECTIVES: To analyze the use of antidotes in a PED and to assess the suitability of their indications. AB - MATERIALS AND METHODS: A retrospective review of antidote use in a PED between January 2008 and June 2012. Inclusion criteria were age younger than 18 years and consultation for suspicious poisoning by a substance that could be treated with an antidote. The adequacy of antidote indication was based on the recommendations of the Spanish Society of Pediatric Emergencies (SSPE). AB - RESULTS: A total of 1728 consultations for suspicious poisoning (0.4% of the total visits in the PED) were recorded. In 353 cases (20.4%) the involved poison could be treated with an antidote. Sixty-seven patients received an antidote (3.9% of consultations for suspicious poisoning), and a total of 69 administrations of an antidote were made: 100% oxygen (46), N-acetylcysteine (10), flumazenil (4), naloxone (3), deferoxamine (2), vitamin K (2), bicarbonate (1), and carnitine (1). In 3 cases there was no indication for administration: flumazenil without respiratory depression, and vitamin K following coumarin exposure. As side effects, agitation was noted after the use of flumazenil, and a decrease in the prothrombin time during infusion of N-acetylcysteine. AB - CONCLUSIONS: The administration of antidotes in this PED is uncommon and, mainly, in accordance with the SSPE recommendations, and without serious side effects. The use of flumazenil needs to be limited to the cases with a clear indication and without any contraindication. Copyright © 2013 Asociacion Espanola de Pediatria. Published by Elsevier Espana. All rights reserved. RN - 0 (Antidotes) ES - 1695-9531 IL - 1695-4033 DI - S1695-4033(13)00521-3 DO - https://dx.doi.org/10.1016/j.anpedi.2013.12.002 PT - English Abstract PT - Journal Article PT - Observational Study ID - S1695-4033(13)00521-3 [pii] ID - 10.1016/j.anpedi.2013.12.002 [doi] PP - ppublish PH - 2013/10/14 [received] PH - 2013/11/30 [revised] PH - 2013/12/02 [accepted] LG - Spanish EP - 20140116 DP - 2014 Oct EZ - 2014/01/21 06:00 DA - 2016/09/09 06:00 DT - 2014/01/21 06:00 YR - 2014 ED - 20160908 RD - 20141001 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24439102 <195. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26850293 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Helander A AU - Backberg M AU - Beck O FA - Helander, Anders FA - Backberg, Matilda FA - Beck, Olof IN - Helander, Anders. a Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden ; IN - Helander, Anders. b Department of Clinical Pharmacology , Karolinska University Laboratory , Stockholm , Sweden ; IN - Backberg, Matilda. c Swedish Poisons Information Centre , Stockholm , Sweden. IN - Beck, Olof. a Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden ; IN - Beck, Olof. b Department of Clinical Pharmacology , Karolinska University Laboratory , Stockholm , Sweden ; TI - Intoxications involving the fentanyl analogs acetylfentanyl, 4-methoxybutyrfentanyl and furanylfentanyl: results from the Swedish STRIDA project. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 54(4):324-32, 2016 AS - Clin Toxicol (Phila). 54(4):324-32, 2016 NJ - Clinical toxicology (Philadelphia, Pa.) VO - 54 IP - 4 PG - 324-32 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - Female MH - *Fentanyl/aa [Analogs & Derivatives] MH - *Fentanyl/po [Poisoning] MH - Humans MH - Male MH - *Psychotropic Drugs/po [Poisoning] MH - Referral and Consultation KW - 4-fluorobutyrfentanyl; 4-methoxybutyrfentanyl; Acetylfentanyl; Internet drug; butyrfentanyl; fentanyl analog; furanylfentanyl; mass spectrometry method; new psychoactive substances; opioid analgesic drug AB - BACKGROUND: Potent and potentially harmful new psychoactive substances (NPS) are continuously introduced on the recreational drugs market. This report from the Swedish STRIDA project describes analytically confirmed cases of intoxication involving the fentanyl analogs acetylfentanyl, 4-methoxybutyrfentanyl, and furanylfentanyl. AB - METHODS: Patients with suspected NPS exposure presenting in emergency departments and intensive care units in Sweden and requiring hospital care are invited to the STRIDA project. Toxicological analysis of serum and urine samples was performed by multi-component liquid chromatographic-mass spectrometric methods. Data on clinical features were retrieved from telephone consultations with the Swedish Poisons Information Centre and from medical records. AB - RESULTS: Between April and November 2015, 14 analytically confirmed intoxications involving acetylfentanyl (nine cases), 4-methoxybutyrfentanyl (3), furanylfentanyl (1), and 4-methoxybutyrfentanyl together with furanylfentanyl (1) were identified. The patients were aged 20-40 (mean 28.5) years and 86% were men. Twelve patients (86%) were admitted to intensive care, where two required intubation and mechanical ventilation. Typical clinical features were decreased consciousness, respiratory depression, and miosis. In eight cases, the antidote naloxone was administered to counter the effects. The serum acetylfentanyl concentration (N=7) was 0.6-51.6 (mean 18.3 and median 14.8) ng/mL, and in urine (N=8) 0.1-686 (mean 155 and median 66.6) ng/mmol creatinine. The serum 4-methoxybutyrfentanyl concentration (N=2) was 1.3 and 3.1ng/mL, and 5.1-51.3ng/mmol creatinine in urine (N=3). For furanylfentanyl, the serum concentrations were 4.4 and 148ng/mL and in urine 9.2 and 85ng/mmol creatinine, respectively. In 13 cases (93%), other NPS and/or classical drugs were also detected. Drug products brought to hospital by patients contained acetylfentanyl (nasal spray and pink tablet), 4-methoxybutyrfentanyl (green tablet), furanylfentanyl/traces of 4-methoxybutyrfentanyl (nasal spray), and 4-fluorobutyrfentanyl (purple tablet). AB - CONCLUSION: Potentially life-threatening opioid toxicity was seen in acute intoxications involving acetylfentanyl, 4-methoxybutyrfentanyl, and furanylfentanyl. Intensive care treatment for one month was necessary in one acetylfentanyl case and one acetylfentanyl patient died from cerebral hemorrhage. RN - 0 (Analgesics, Opioid) RN - 0 (Psychotropic Drugs) RN - 6DZ28538KS (N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide) RN - UF599785JZ (Fentanyl) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.3109/15563650.2016.1139715 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.3109/15563650.2016.1139715 [doi] PP - ppublish LG - English EP - 20160205 DP - 2016 EZ - 2016/02/07 06:00 DA - 2016/09/08 06:00 DT - 2016/02/07 06:00 YR - 2016 ED - 20160907 RD - 20160422 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26850293 <196. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26453108 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Berthelot JM AU - Darrieutort-Lafitte C AU - Le Goff B AU - Maugars Y FA - Berthelot, Jean-Marie FA - Darrieutort-Lafitte, Christelle FA - Le Goff, Benoit FA - Maugars, Yves IN - Berthelot, Jean-Marie. Service de rhumatologie, Hotel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France. Electronic address: jeanmarie.berthelot@chu-nantes.fr. IN - Darrieutort-Lafitte, Christelle. Service de rhumatologie, Hotel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France. IN - Le Goff, Benoit. Service de rhumatologie, Hotel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France. IN - Maugars, Yves. Service de rhumatologie, Hotel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France. TI - Strong opioids for noncancer pain due to musculoskeletal diseases: Not more effective than acetaminophen or NSAIDs. [Review] SO - Joint, Bone, Spine: Revue du Rhumatisme. 82(6):397-401, 2015 Dec AS - Joint Bone Spine. 82(6):397-401, 2015 Dec NJ - Joint, bone, spine : revue du rhumatisme VO - 82 IP - 6 PG - 397-401 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100938016, dld IO - Joint Bone Spine SB - Index Medicus CP - France MH - *Acetaminophen/tu [Therapeutic Use] MH - Analgesics, Opioid/pd [Pharmacology] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use] MH - Drug Tolerance MH - Humans MH - Morphine/pd [Pharmacology] MH - *Morphine/tu [Therapeutic Use] MH - *Musculoskeletal Pain/dt [Drug Therapy] MH - Musculoskeletal Pain/et [Etiology] MH - Time Factors MH - Treatment Outcome KW - Acetaminophen; Efficacy; Low back pain; Morphine; Morphine derivatives; Nonsteroidal anti-inflammatory drugs; Opioids; Osteoarthritis; Pain; Paracetamol; Placebo AB - The classification of morphine as a step III analgesic, based on pharmacological data, creates a strong bias toward a belief in the efficacy of this drug. However, double-blind emergency-room trials showed similar levels of pain relief with intravenous acetaminophen as with intravenous morphine in patients with renal colic, low back pain or acute limb pain. In patients with chronic noncancer low back pain, morphine and other strong opioids in dosages of up to 100mg/day were only slightly more effective than their placebos, no more effective than acetaminophen, and somewhat less effective than nonsteroidal anti-inflammatory drugs (NSAIDs). In patients with osteoarthritis, strong opioids were not more effective than NSAIDs and, in some studies, than placebos. The only randomized controlled trial in patients with sciatica found no difference with the placebo. Chronic use of strong opioids can induce hyperalgesia in some patients. Hyperpathia with increased sensitivity to cold leading the patient to request higher dosages should suggest opioid-induced hyperalgesia. Pain specialists in the US have issued a petition asking that strong opioids be used in dosages no higher than 100mg/day of morphine-equivalent, in an effort to decrease the high rate of mortality due to the misuse and abuse of strong opioids (10,000 deaths/year in the US). Healthcare providers often overestimate the efficacy of step III analgesics, despite pain score decreases of only 0.8 to 1.2 points. Copyright © 2015 Societe francaise de rhumatologie. Published by Elsevier SAS. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 362O9ITL9D (Acetaminophen) RN - 76I7G6D29C (Morphine) ES - 1778-7254 IL - 1297-319X DI - S1297-319X(15)00174-8 DO - https://dx.doi.org/10.1016/j.jbspin.2015.08.003 PT - Journal Article PT - Review ID - S1297-319X(15)00174-8 [pii] ID - 10.1016/j.jbspin.2015.08.003 [doi] PP - ppublish PH - 2015/03/03 [accepted] LG - English EP - 20151006 DP - 2015 Dec EZ - 2015/10/11 06:00 DA - 2016/09/08 06:00 DT - 2015/10/11 06:00 YR - 2015 ED - 20160907 RD - 20151127 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26453108 <197. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26581934 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cohen V AU - Motov S AU - Rockoff B AU - Smith A AU - Fromm C AU - Bosoy D AU - Hossain R AU - Likourezos A AU - Jellinek-Cohen SP AU - Marshall J FA - Cohen, Victor FA - Motov, Sergey FA - Rockoff, Bradley FA - Smith, Andrew FA - Fromm, Christian FA - Bosoy, Dimitri FA - Hossain, Rukhsana FA - Likourezos, Antonios FA - Jellinek-Cohen, Samantha P FA - Marshall, John IN - Cohen, Victor. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. vcohen@maimonidesmed.org. IN - Motov, Sergey. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. IN - Rockoff, Bradley. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. IN - Smith, Andrew. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. IN - Fromm, Christian. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. IN - Bosoy, Dimitri. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. IN - Hossain, Rukhsana. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. IN - Likourezos, Antonios. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. IN - Jellinek-Cohen, Samantha P. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. IN - Marshall, John. Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. TI - Development of an opioid reduction protocol in an emergency department. SO - American Journal of Health-System Pharmacy. 72(23):2080-6, 2015 Dec 01 AS - Am J Health-Syst Pharm. 72(23):2080-6, 2015 Dec 01 NJ - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists VO - 72 IP - 23 PG - 2080-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9503023, cbh IO - Am J Health Syst Pharm SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - Adult MH - *Analgesics/ad [Administration & Dosage] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Chronic Pain/dt [Drug Therapy] MH - *Emergency Service, Hospital MH - Humans MH - Ibuprofen/ad [Administration & Dosage] MH - Ketorolac/ad [Administration & Dosage] MH - Pain Measurement MH - Patient Satisfaction MH - Severity of Illness Index MH - Time Factors AB - PURPOSE: Results of a study of an opioid-sparing protocol for acute pain management in the emergency department (ED) are reported. AB - METHODS: The ED of a large hospital conducted a project, the "Opioid-Free Shift," to test a multimodal pharmacologic approach to analgesic therapy as an alternative to routine use of opioids. During a specified eight-hour period, all adults arriving at the ED with a complaint of pain were treated according to an opioid-sparing protocol based on principles of channel enzyme receptor-targeted analgesia (CERTA). Pain severity was assessed at baseline and at 30 and 60 minutes after analgesia administration using a validated rating scale. AB - RESULTS: Seventeen patients were treated in the ED for acute or chronic pain during the study period. The median pain score on the 11-point rating scale was 8 (range, 4-10) at baseline, declining to 6 (range, 0-10) at 30 minutes and to 5 (range, 1-10) at 60 minutes. At 30 minutes, 7 patients (41%) had a pain score reduction of >= 30% and 3 (18%) had a reduction of >= 50%. Six of the 15 patients (40%) reassessed at 60 minutes had a pain score reduction of >= 30%; 4 patients (27%) had a reduction of >= 50%. More than 80% of patients were satisfied with the pain relief provided through the CERTA-based protocol, and no adverse drug reactions were reported. AB - CONCLUSION: The 17 patients treated for acute or chronic pain during the opioid-free shift were managed mainly with i.v. ketorolac and oral ibuprofen, with only 1 patient requiring rescue opioid therapy. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) RN - WK2XYI10QM (Ibuprofen) RN - YZI5105V0L (Ketorolac) ES - 1535-2900 IL - 1079-2082 DO - https://dx.doi.org/10.2146/ajhp140903 PT - Journal Article ID - 72/23/2080 [pii] ID - 10.2146/ajhp140903 [doi] PP - ppublish LG - English DP - 2015 Dec 01 EZ - 2015/11/20 06:00 DA - 2016/09/07 06:00 DT - 2015/11/20 06:00 YR - 2015 ED - 20160906 RD - 20151120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26581934 <198. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26743334 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weiner SG AU - Horton LC AU - Green TC AU - Butler SF FA - Weiner, Scott G FA - Horton, Laura C FA - Green, Traci C FA - Butler, Stephen F IN - Weiner, Scott G. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States. Electronic address: sweiner@bwh.harvard.edu. IN - Horton, Laura C. Tufts University School of Medicine, Boston, MA, United States. Electronic address: laura.horton@tufts.edu. IN - Green, Traci C. Boston Medical Center and Boston University Department of Emergency Medicine Providence, RI Inflexxion, Inc., Newton, MA, United States. Electronic address: traci.c.green@gmail.com. IN - Butler, Stephen F. Inflexxion, Inc., Newton, MA, United States. Electronic address: sfbutler@inflexxion.com. TI - A comparison of an opioid abuse screening tool and prescription drug monitoring data in the emergency department. SO - Drug & Alcohol Dependence. 159:152-7, 2016 Feb 01 AS - Drug Alcohol Depend. 159:152-7, 2016 Feb 01 NJ - Drug and alcohol dependence VO - 159 PG - 152-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Adolescent MH - Adult MH - Aged MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Databases, Factual MH - *Drug Utilization/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/di [Diagnosis] MH - Opioid-Related Disorders/px [Psychology] MH - Pain/dt [Drug Therapy] MH - Psychometrics MH - Risk Assessment MH - *Risk-Taking MH - Young Adult KW - Emergency department; Opioids; Prescription drug monitoring program; Screening AB - OBJECTIVES: This study aimed to: (a) determine the percentage of ED patients receiving prescriptions for opioid pain medications that meet the criteria for "high-risk for abuse potential" on the Screener and Opioid Assessment for Patients with Pain (SOAPP()-R), (b) determine the percentage of patients with high-risk behavior on the state prescription drug monitoring program (PDMP) database, (c) compare the SOAPP-R with data from the PDMP, and (d) determine psychometric properties of SOAPP-R for ED patients AB - METHODS: Convenience sample of ED patients who were being considered for discharge with a prescription for an opioid pain medication. Subjects completed SOAPP-R on an electronic tablet and PDMP data was obtained. Scores on SOAPP-R >= 18 were defined as "at-risk", and PDMP data showing both >= 4 opioid prescriptions and >= 4 providers in 12 months was considered the criterion standard for high-risk behavior. AB - RESULTS: 82 patients (88.2%) provided consent. 32.9% (n=27) were determined to be "at-risk" (score >= 18) by SOAPP-R. 15.9% (n=13) subjects met PDMP criteria and 53.9% (n=7) of those had SOAPP-R scores >= 18 (sensitivity 54%, specificity 71%, positive predictive value 26%, negative predictive value 89%). The association of an at-risk SOAPP-R score and PDMP high-risk criteria was an adjusted odds ratio of 1.39 (95% confidence interval 0.73-3.68). AB - CONCLUSIONS: In our population, about one-third of patients being considered for discharge with an opioid prescription scored "at-risk" on SOAPP-R and 15.9% met the PDMP high-risk criteria. The high negative predictive value of SOAPP-R indicates it may be a useful screening tool for the ED patient population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(15)01822-0 DO - https://dx.doi.org/10.1016/j.drugalcdep.2015.12.007 PT - Comparative Study PT - Journal Article ID - S0376-8716(15)01822-0 [pii] ID - 10.1016/j.drugalcdep.2015.12.007 [doi] PP - ppublish PH - 2015/10/16 [received] PH - 2015/11/29 [revised] PH - 2015/12/09 [accepted] LG - English EP - 20151221 DP - 2016 Feb 01 EZ - 2016/01/09 06:00 DA - 2016/09/07 06:00 DT - 2016/01/09 06:00 YR - 2016 ED - 20160905 RD - 20160124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26743334 <199. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26709671 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Erdmann A AU - Werner D AU - Hugli O AU - Yersin B FA - Erdmann, Andreas FA - Werner, Dominique FA - Hugli, Olivier FA - Yersin, Bertrand IN - Erdmann, Andreas. mergency Department, University Hospital (CHUV), Lausanne, Switzerland; Angiology Department, University Hospital (CHUV), Lausanne, Switzerland. IN - Werner, Dominique. Laboratory of clinical chemistry, University Hospital (CHUV), Lausanne, Switzerland. IN - Hugli, Olivier. Emergency Department, University Hospital (CHUV), Lausanne, Switzerland. IN - Yersin, Bertrand. Emergency Department, University Hospital (CHUV), Lausanne, Switzerland. TI - Focused use of drug screening in overdose patients increases impact on management. SO - Swiss Medical Weekly. 145:w14242, 2015 AS - Swiss Med Wkly. 145:w14242, 2015 NJ - Swiss medical weekly VO - 145 PG - w14242 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Internet JC - d10, 100970884 IO - Swiss Med Wkly SB - Index Medicus CP - Switzerland MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Drug Overdose/di [Diagnosis] MH - *Drug Overdose/ur [Urine] MH - *Drug-Related Side Effects and Adverse Reactions/di [Diagnosis] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Switzerland MH - Young Adult AB - UNLABELLED: Drug poisoning is a common cause for attendance in the emergency department. Several toxicology centres suggest performing urinary drug screens, even though they rarely influence patient management. AB - STUDY OBJECTIVES: Measuring the impact on patient management, in a University Emergency Department with approximately 40 000 admissions annually, of a rapid urinary drug screening test using specifically focused indications. Drug screening was restricted to patients having a first psychotic episode or cases demonstrating respiratory failure, coma, seizures, a sympathomimetic toxidrome, severe opiate overdose necessitating naloxone, hypotension, ventricular arrhythmia, acquired long QT or QRS >100 ms, and high-degree heart block. AB - METHODS: Retrospective analysis of Triage TOX drug screen tests performed between September 2009 and November 2011, and between January 2013 and March 2014. AB - RESULTS: A total of 262 patients were included, mean age 35 +/- 14.6 (standard deviation) years, 63% men; 29% poisoning with alcohol, and 2.3% deaths. Indications for testing were as follows: 34% were first psychotic episodes; 20% had acute respiratory failure; 16% coma; 8% seizures; 8% sympathomimetic toxidromes; 7% severe opioid toxidromes; 4% hypotension; 3% ventricular arrhythmias or acquired long QT intervals on electrocardiogram. A total of 78% of the tests were positive (median two substances, maximum five). The test resulted in drug-specific therapy in 6.1%, drug specific diagnostic tests in 13.3 %, prolonged monitoring in 10.7% of methadone-positive tests, and psychiatric admission in 4.2%. Overall, 34.3% tests influenced patient management. AB - CONCLUSIONS: In contrast to previous studies showing modest effects of toxicological testing, restricted use of rapid urinary drug testing increases the impact on management of suspected overdose patients in the ED. ES - 1424-3997 IL - 0036-7672 DI - Swiss Med Wkly. 2015;145:w14242 DO - https://dx.doi.org/10.4414/smw.2015.14242 PT - Journal Article ID - 10.4414/smw.2015.14242 [doi] ID - smw-14242 [pii] PP - epublish LG - English EP - 20151228 DP - 2015 EZ - 2015/12/29 06:00 DA - 2016/09/02 06:00 DT - 2015/12/29 06:00 YR - 2015 ED - 20160901 RD - 20151229 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26709671 <200. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26654430 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Nambiar D AU - Agius PA AU - Stoove M AU - Hickman M AU - Dietze P FA - Nambiar, Dhanya FA - Agius, Paul A FA - Stoove, Mark FA - Hickman, Matthew FA - Dietze, Paul IN - Nambiar, Dhanya. Centre for Population Health, Burnet Institute, Melbourne, Australia. dhanya@burnet.edu.au. IN - Nambiar, Dhanya. Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia. dhanya@burnet.edu.au. IN - Agius, Paul A. Centre for Population Health, Burnet Institute, Melbourne, Australia. pagius@burnet.edu.au. IN - Agius, Paul A. Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia. pagius@burnet.edu.au. IN - Stoove, Mark. Centre for Population Health, Burnet Institute, Melbourne, Australia. stove@burnet.edu.au. IN - Stoove, Mark. Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia. stove@burnet.edu.au. IN - Hickman, Matthew. School of Social & Community Medicine, University of Bristol, Canynge Hall, Bristol, UK. Matthew.Hickman@bristol.ac.uk. IN - Dietze, Paul. Centre for Population Health, Burnet Institute, Melbourne, Australia. pauld@burnet.edu.au. IN - Dietze, Paul. Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia. pauld@burnet.edu.au. TI - Mortality in the Melbourne injecting drug user cohort study (MIX). SO - Harm Reduction Journal. 12:55, 2015 Dec 09 AS - Harm Reduct J. 12:55, 2015 Dec 09 NJ - Harm reduction journal VO - 12 PG - 55 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101153624 IO - Harm Reduct J SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Age Factors MH - Australia/ep [Epidemiology] MH - Cohort Studies MH - *Drug Overdose/mo [Mortality] MH - *Drug Users/sn [Statistics & Numerical Data] MH - Female MH - Harm Reduction MH - *Heroin Dependence/mo [Mortality] MH - Humans MH - Male MH - Risk Factors MH - *Substance Abuse, Intravenous/mo [Mortality] MH - Young Adult AB - BACKGROUND: There are few studies of mortality amongst people who inject drugs (PWID) in Australia. In this study, we estimate mortality in a cohort of PWID in Melbourne and examine predictors of mortality including health service use, demographic characteristics, drug use and personal wellbeing. AB - FINDINGS: We linked identifiers from the Melbourne injecting drug use cohort study (MIX; n=655) to the National Death Index from 2008 to 2012 to estimate standardised mortality ratios (SMRs). Cox regression was used to examine the bivariate relationship between exposures determined at baseline and subsequent mortality. There were 24 (3.6%) deaths over the study period. The mortality rate in the cohort was 1.0 per 100 PY (95% CI 0.71-1.57), with an SMR of 17.3 (95 % CI 11.6-25.8). Baseline reports of four or more lifetime incarcerations (HR 3.65, 95 % CI 1.16-11.52), past month ambulance attendance (HR 4.43, 95 % CI 1.76-11.17), past month emergency department presentation (HR 3.44, 95 % CI 1.47-8.03) and past 6-month self-reported heroin overdose (HR 3.14, 95 % CI 1.24-7.96) were associated with increased mortality risk. AB - CONCLUSIONS: Contact with emergency services, particularly for drug overdose, remains a lost opportunity to provide referrals for harm reduction and naloxone training programmes to PWID at greater risk of mortality. ES - 1477-7517 IL - 1477-7517 DO - https://dx.doi.org/10.1186/s12954-015-0089-3 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1186/s12954-015-0089-3 [doi] ID - 10.1186/s12954-015-0089-3 [pii] ID - PMC4674911 [pmc] PP - epublish PH - 2015/09/30 [received] PH - 2015/11/24 [accepted] GI - No: G1000021 Organization: *Medical Research Council* Country: United Kingdom GI - No: MR/K023233/1 Organization: *Medical Research Council* Country: United Kingdom LG - English EP - 20151209 DP - 2015 Dec 09 EZ - 2015/12/15 06:00 DA - 2016/09/01 06:00 DT - 2015/12/15 06:00 YR - 2015 ED - 20160831 RD - 20170922 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26654430 <201. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26947370 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weeks MA AU - Clark EP AU - Mycyk MB FA - Weeks, Matthew A FA - Clark, Erin P FA - Mycyk, Mark B IN - Weeks, Matthew A. Cook County Health and Hospitals System, 1900 West Polk Street, Department of Emergency Medicine, Chicago, IL 60612. IN - Clark, Erin P. Cook County Health and Hospitals System, 1900 West Polk Street, Department of Emergency Medicine, Chicago, IL 60612. IN - Mycyk, Mark B. Cook County Health and Hospitals System, 1900 West Polk Street, Department of Emergency Medicine, Chicago, IL 60612. Electronic address: mmycyk@cookcountyhhs.org. TI - Characteristics of heroin-dependent patients seeking asthma care in the ED. SO - American Journal of Emergency Medicine. 34(5):895-8, 2016 May AS - Am J Emerg Med. 34(5):895-8, 2016 May NJ - The American journal of emergency medicine VO - 34 IP - 5 PG - 895-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Asthma/co [Complications] MH - Asthma/th [Therapy] MH - Chicago MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Health Care Surveys MH - *Health Knowledge, Attitudes, Practice MH - *Heroin Dependence/co [Complications] MH - Humans MH - Male MH - Middle Aged MH - *Patient Acceptance of Health Care MH - Pilot Projects MH - Prospective Studies MH - Young Adult AB - BACKGROUND: Limited data suggest that heroin worsens asthma severity, but little is known about heroin-dependent patients who seek emergency department (ED) care for asthma. AB - OBJECTIVES: To describe what heroin-dependent patients know about their asthma and how they use health care resources. AB - METHODS: A prospective study of heroin-dependent patients seeking care for "asthma" at an urban ED with 130000 annual visits was conducted. Eligible subjects were English-speaking heroin-dependent adults seeking care for mild to moderate asthma symptoms. A closed-format survey instrument to assess opioid use, asthma knowledge, and health care use was developed by content experts, piloted for study performance, revised, and then administered to eligible patients prior to ED discharge. Descriptive analysis was done. AB - RESULTS: Thirty subjects participated. Mean age was 47.5 years; 21 (70%) were male. Most used heroin several times weekly. Intranasal was the most common route (93%). Almost half (47%) stated that their asthma was diagnosed in the ED, 13% by a primary care physician, 13% by a lung specialist, and 27% did not know how diagnosed. The ED was used as the primary source for asthma medications in 73% cases; 43% used the ED for breathing issues at least once per month. Most subjects (77%) felt that heroin worsened their asthma symptoms. Only 7 (23%) also abused prescription opioids, and only 7 (23%) knew about prescription naloxone. AB - CONCLUSION: Patients with heroin dependence frequently use the ED for their health care needs related to asthma. Most do not have other health care providers, most have limited health literacy, and all would benefit from referral to a primary care provider and substance abuse resources. Copyright © 2016 Elsevier Inc. All rights reserved. ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(16)00079-6 DO - https://dx.doi.org/10.1016/j.ajem.2016.02.005 PT - Journal Article ID - S0735-6757(16)00079-6 [pii] ID - 10.1016/j.ajem.2016.02.005 [doi] PP - ppublish PH - 2015/12/01 [received] PH - 2016/02/10 [revised] PH - 2016/02/10 [accepted] LG - English EP - 20160212 DP - 2016 May EZ - 2016/03/08 06:00 DA - 2016/08/30 06:00 DT - 2016/03/08 06:00 YR - 2016 ED - 20160829 RD - 20160418 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26947370 <202. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26248742 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hayes CJ AU - Hudson TJ AU - Phillips MM AU - Bursac Z AU - Williams JS AU - Austin MA AU - Edlund MJ AU - Martin BC FA - Hayes, Corey J FA - Hudson, Teresa J FA - Phillips, Martha M FA - Bursac, Zoran FA - Williams, James S FA - Austin, Mark A FA - Edlund, Mark J FA - Martin, Bradley C IN - Hayes, Corey J. Department of Pharmacy, Baptist Health Medical Center -Little Rock, AR, USA. IN - Hayes, Corey J. Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA. IN - Hudson, Teresa J. Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA. IN - Hudson, Teresa J. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA. IN - Phillips, Martha M. College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA. IN - Bursac, Zoran. Division of Biostatistics and Center for Population Sciences, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. IN - Williams, James S. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA. IN - Austin, Mark A. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA. IN - Edlund, Mark J. Behavioral Health Epidemiology Program, RTI International, NC, USA. IN - Edlund, Mark J. Behavioral Health Services, St. Luke's Health System, Twin Falls, ID, USA. IN - Martin, Bradley C. Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA. IN - Martin, Bradley C. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA. TI - The influence of propoxyphene withdrawal on opioid use in veterans. CM - Comment in: Pharmacoepidemiol Drug Saf. 2016 Apr;25(4):477-8; PMID: 27059545 CM - Comment in: Pharmacoepidemiol Drug Saf. 2016 Apr;25(4):476; PMID: 27059544 SO - Pharmacoepidemiology & Drug Safety. 24(11):1180-8, 2015 Nov AS - Pharmacoepidemiol Drug Saf. 24(11):1180-8, 2015 Nov NJ - Pharmacoepidemiology and drug safety VO - 24 IP - 11 PG - 1180-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - d0r, 9208369 IO - Pharmacoepidemiol Drug Saf SB - Index Medicus CP - England MH - Acetaminophen/ae [Adverse Effects] MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Cohort Studies MH - Databases, Factual MH - *Dextropropoxyphene/ad [Administration & Dosage] MH - Dextropropoxyphene/ae [Adverse Effects] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Retrospective Studies MH - *Safety-Based Drug Withdrawals MH - United States MH - Veterans MH - Young Adult KW - opioid discontinuation; pharmacoepidemiology; propoxyphene withdrawal AB - PURPOSE: Our aim is to determine if propoxyphene withdrawal from the US market was associated with opioid continuation, continued chronic opioid use, and secondary propoxyphene-related adverse events (emergency department visits, opioid-related events, and acetaminophen toxicity). AB - METHODS: Medical service use and pharmacy data from 19/11/08 to 19/11/11 were collected from the national Veterans Healthcare Administration healthcare databases. A quasi-experimental pre-post retrospective cohort design utilizing a historical comparison group provided the study framework. Logistic regression controlling for baseline covariates was used to estimate the effect of propoxyphene withdrawal. AB - RESULTS: There were 24,328 subjects (policy affected n=10,747; comparison n=13,581) meeting inclusion criteria. In the policy-affected cohort, 10.6% of users ceased using opioids, and 26.6% stopped chronic opioid use compared with 3.8% and 13.5% in the historical comparison cohort, respectively. Those in the policy-affected cohort were 2.7 (95%CI: 2.5-2.8) and 3.2 (95%CI: 2.9-3.6) times more likely than those in the historical comparison cohort to discontinue chronic opioid and any opioid use, respectively. Changes in adverse events and Emergency Department (ED) visits were not different between policy-affected and historical comparison cohorts (p>0.05). AB - CONCLUSIONS: The withdrawal of propoxyphene-containing products resulted in rapid and virtually complete elimination in propoxyphene prescribing in the veterans population; however, nearly 90% of regular users of propoxyphene switched to an alternate opioid, and three quarters continued to use opioids chronically. Copyright © 2015 John Wiley & Sons, Ltd. CI - None of the authors have conflicts of interest to declare. RN - 0 (Analgesics, Opioid) RN - 362O9ITL9D (Acetaminophen) RN - S2F83W92TK (Dextropropoxyphene) ES - 1099-1557 IL - 1053-8569 DO - https://dx.doi.org/10.1002/pds.3851 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - 10.1002/pds.3851 [doi] ID - PMC5305002 [pmc] ID - NIHMS825877 [mid] PP - ppublish PH - 2015/04/16 [received] PH - 2015/07/11 [revised] PH - 2015/07/13 [accepted] GI - No: R01 DA030300 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: UL1 RR029884 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: 1UL-1RR029884 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: R01-DA030300-01 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20150806 DP - 2015 Nov EZ - 2015/08/08 06:00 DA - 2016/08/30 06:00 DT - 2015/08/08 06:00 YR - 2015 ED - 20160829 RD - 20170224 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26248742 <203. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26626300 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ruan X AU - Bydalek K AU - Kaye AD FA - Ruan, Xiulu FA - Bydalek, Katherine FA - Kaye, Alan D IN - Ruan, Xiulu. *Department of Anesthesiology, Louisiana State University Health Science Center New Orleans, LA +College of Nursing, University of South Alabama, Mobile, AL. TI - Emergency Visits for Prescription Opioid Overdose. CM - Comment on: J Emerg Med. 2015 Dec;49(6):871-7; PMID: 26409674 SO - Clinical Journal of Pain. 32(5):459, 2016 May AS - Clin J Pain. 32(5):459, 2016 May NJ - The Clinical journal of pain VO - 32 IP - 5 PG - 459 PI - Journal available in: Print PI - Citation processed from: Internet JC - beg, 8507389 IO - Clin J Pain SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Overdose MH - Emergency Service, Hospital MH - Humans MH - Opioid-Related Disorders MH - Prescription Drugs MH - Prescriptions MH - United States RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1536-5409 IL - 0749-8047 DO - https://dx.doi.org/10.1097/AJP.0000000000000330 PT - Comment PT - Letter ID - 10.1097/AJP.0000000000000330 [doi] PP - ppublish LG - English DP - 2016 May EZ - 2015/12/03 06:00 DA - 2016/08/25 06:00 DT - 2015/12/03 06:00 YR - 2016 ED - 20160824 RD - 20160406 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26626300 <204. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26759659 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Terndrup T FA - Terndrup, Thomas IN - Terndrup, Thomas. Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio. TI - Opioid Considerations for Emergency Practice. CM - Comment on: West J Emerg Med. 2015 Dec;16(7):1079-83; PMID: 26759658 SO - The Western Journal of Emergency Medicine. 16(7):1084-5, 2015 Dec AS - West J Emerg Med. 16(7):1084-5, 2015 Dec NJ - The western journal of emergency medicine VO - 16 IP - 7 PG - 1084-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703170 SB - Index Medicus CP - United States MH - *Analgesics, Opioid MH - Emergency Service, Hospital MH - Humans MH - *Pain MH - Practice Patterns, Physicians' RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2015.12.29447 PT - Comment PT - Journal Article ID - 10.5811/westjem.2015.12.29447 [doi] ID - wjem-16-1084 [pii] ID - PMC4703170 [pmc] PP - ppublish PH - 2015/12/04 [received] PH - 2015/12/07 [revised] PH - 2015/12/07 [accepted] LG - English EP - 20151217 DP - 2015 Dec EZ - 2016/01/14 06:00 DA - 2016/08/25 06:00 DT - 2016/01/14 06:00 YR - 2015 ED - 20160824 RD - 20160115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26759659 <205. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26471158 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dailey M FA - Dailey, Michael IN - Dailey, Michael. Division of Prehospital and Operational Medicine, Albany Medical College-Emergency Medicine, Albany, NY, USA. TI - Commentary on Gjersing & Bretteville-Jensen (2015): EMS-treated opioid overdose--an important opportunity for saving lives. CM - Comment on: Addiction. 2015 Nov;110(11):1767-74; PMID: 26118947 SO - Addiction. 110(11):1775-6, 2015 Nov AS - Addiction. 110(11):1775-6, 2015 Nov NJ - Addiction (Abingdon, England) VO - 110 IP - 11 PG - 1775-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Overdose/ep [Epidemiology] MH - Emergency Medical Services MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] KW - Ambulance; CPR; EMS; naloxone; opioid overdose; prevention AB - Overdose reversal must be seen as an opportunity for intervention because of the elevated risk of death following the event. While emergency medical cardiac arrest care is a poor parallel for opioid overdose, the need for rigorous review and fiscally prudent solutions is similar. Efforts must be made to look for solutions to prevent and treat future overdose specifically in the population that has had an overdose event. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1360-0443 IL - 0965-2140 DO - https://dx.doi.org/10.1111/add.13093 PT - Comment PT - Journal Article ID - 10.1111/add.13093 [doi] PP - ppublish PH - 2015/07/19 [received] PH - 2015/08/06 [accepted] LG - English DP - 2015 Nov EZ - 2015/10/17 06:00 DA - 2016/08/25 06:00 DT - 2015/10/17 06:00 YR - 2015 ED - 20160824 RD - 20151016 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26471158 <206. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26913753 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Overdyk FJ AU - Dowling O AU - Marino J AU - Qiu J AU - Chien HL AU - Erslon M AU - Morrison N AU - Harrison B AU - Dahan A AU - Gan TJ FA - Overdyk, Frank J FA - Dowling, Oonagh FA - Marino, Joseph FA - Qiu, Jiejing FA - Chien, Hung-Lun FA - Erslon, Mary FA - Morrison, Neil FA - Harrison, Brooke FA - Dahan, Albert FA - Gan, Tong J IN - Overdyk, Frank J. Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, United States of America. IN - Overdyk, Frank J. North American Partners in Anesthesia, Melville, NY, United States of America. IN - Dowling, Oonagh. Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, United States of America. IN - Marino, Joseph. Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, United States of America. IN - Marino, Joseph. North American Partners in Anesthesia, Melville, NY, United States of America. IN - Qiu, Jiejing. Covidien Healthcare Economics and Outcomes Research, Mansfield, MA, United States of America. IN - Chien, Hung-Lun. Covidien Healthcare Economics and Outcomes Research, Mansfield, MA, United States of America. IN - Erslon, Mary. Covidien Respiratory and Monitoring Solutions, Boulder, CO, United States of America. IN - Morrison, Neil. Harrier Consultancy, Lancaster, United Kingdom. IN - Harrison, Brooke. Boulder Medical Writing, Boulder, CO, United States of America. IN - Dahan, Albert. Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands. IN - Gan, Tong J. Department of Anesthesiology, Stony Brook University (SUNY), Stony Brook, NY, United States of America. TI - Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database. SO - PLoS ONE [Electronic Resource]. 11(2):e0150214, 2016 AS - PLoS ONE. 11(2):e0150214, 2016 NJ - PloS one VO - 11 IP - 2 PG - e0150214 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Internet JC - 101285081 IO - PLoS ONE PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767404 SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesia/ae [Adverse Effects] MH - Analgesia/mt [Methods] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Cardiopulmonary Resuscitation/sn [Statistics & Numerical Data] MH - Cost of Illness MH - Databases, Factual MH - Female MH - *Heart Arrest/ci [Chemically Induced] MH - Heart Arrest/ec [Economics] MH - *Heart Arrest/ep [Epidemiology] MH - Hospital Records MH - Hospitalization MH - Humans MH - *Hypnotics and Sedatives/ae [Adverse Effects] MH - Hypnotics and Sedatives/tu [Therapeutic Use] MH - Length of Stay/ec [Economics] MH - Male MH - Middle Aged MH - Retrospective Studies MH - Risk MH - Risk Factors MH - Young Adult AB - BACKGROUND: While opioid use confers a known risk for respiratory depression, the incremental risk of in-hospital cardiopulmonary arrest, respiratory arrest, or cardiopulmonary resuscitation (CPRA) has not been studied. Our aim was to investigate the prevalence, outcomes, and risk profile of in-hospital CPRA for patients receiving opioids and medications with central nervous system sedating side effects (sedatives). AB - METHODS: A retrospective analysis of adult inpatient discharges from 2008-2012 reported in the Premier Database. Patients were grouped into four mutually exclusive categories: (1) opioids and sedatives, (2) opioids only, (3) sedatives only, and (4) neither opioids nor sedatives. AB - RESULTS: Among 21,276,691 inpatient discharges, 53% received opioids with or without sedatives. A total of 96,554 patients suffered CPRA (0.92 per 1000 hospital bed-days). Patients who received opioids and sedatives had an adjusted odds ratio for CPRA of 3.47 (95% CI: 3.40-3.54; p<0.0001) compared with patients not receiving opioids or sedatives. Opioids alone and sedatives alone were associated with a 1.81-fold and a 1.82-fold (p<0.0001 for both) increase in the odds of CPRA, respectively. In opioid patients, locations of CPRA were intensive care (54%), general care floor (25%), and stepdown units (15%). Only 42% of patients survived CPRA and only 22% were discharged home. Opioid patients with CPRA had mean increased hospital lengths of stay of 7.57 days and mean increased total hospital costs of $27,569. AB - CONCLUSIONS: Opioids and sedatives are independent and additive risk factors for in-hospital CPRA. The impact of opioid sparing analgesia, reduced sedative use, and better monitoring on CPRA incidence deserves further study. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) ES - 1932-6203 IL - 1932-6203 DO - https://dx.doi.org/10.1371/journal.pone.0150214 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1371/journal.pone.0150214 [doi] ID - PONE-D-15-42141 [pii] ID - PMC4767404 [pmc] PP - epublish PH - 2015/09/23 [received] PH - 2016/02/10 [accepted] LG - English EP - 20160225 DP - 2016 EZ - 2016/02/26 06:00 DA - 2016/08/09 06:00 DT - 2016/02/26 06:00 YR - 2016 ED - 20160808 RD - 20160310 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26913753 <207. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27295817 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - Innovative Program Targets Five Common Pain Syndromes With Non-opioid Alternatives. SO - ED Management. 28(6):61-6, 2016 Jun AS - ED Manag. 28(6):61-6, 2016 Jun NJ - ED management : the monthly update on emergency department management VO - 28 IP - 6 PG - 61-6 PI - Journal available in: Print PI - Citation processed from: Print JC - chx, 9425690 IO - ED Manag SB - Health Administration Journals CP - United States MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Chronic Pain/dt [Drug Therapy] MH - Emergency Service, Hospital MH - Humans MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - *Pain Management/mt [Methods] AB - To combat the prescription opioid problem, St. Joseph's Healthcare System in Paterson, NJ, has developed a new program that gives providers options they can use to effectively alleviate pain without resorting to highly addictive medication. Launched in January 2016 in the ED at St. Joseph's Regional Medical Center (SJRMC), the Alternatives to Opioids (ALTO) program utilizes protocols that primarily target five common conditions: renal colic, sciatica, headaches, musculoskeletal pain, and extremity fractures. Administrators say they have successfully treated more than 300 patients under the new program, and they see ALTO as a model other hospitals can duplicate. Among the alternative therapies called for in the ALTO program are trigger point injections, nitrous oxide, and ultrasound-guided nerve blocks. ALTO medications are specifically chosen because of how they affect the pain receptor sites for each different pain syndrome. While the primary goal of the program is to use alternatives to opioids when-ever possible, another important underlying goal is to stop acute pain from becoming chronic. While ALTO therapies typically take a bit longer to deliver than prescribing opioids, administrators note that this has not adversely affected patient flow in the ED. RN - 0 (Analgesics, Opioid) IS - 1044-9167 IL - 1044-9167 PT - Journal Article PP - ppublish LG - English DP - 2016 Jun EZ - 2016/06/15 06:00 DA - 2016/07/21 06:00 DT - 2016/06/15 06:00 YR - 2016 ED - 20160720 RD - 20160614 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27295817 <208. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27266000 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - New opioid prescribing guidelines favor non-opioid alternatives. SO - ED Management. 28(5):54-7, 2016 May AS - ED Manag. 28(5):54-7, 2016 May NJ - ED management : the monthly update on emergency department management VO - 28 IP - 5 PG - 54-7 PI - Journal available in: Print PI - Citation processed from: Print JC - chx, 9425690 IO - ED Manag SB - Health Administration Journals CP - United States MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Drug Overdose/pc [Prevention & Control] MH - Emergency Service, Hospital MH - *Guidelines as Topic MH - Humans MH - *Practice Patterns, Physicians' AB - Determined to make a dent in the growing problem of opioid addiction, the CDC has unveiled new guidelines for opioid prescribing for chronic pain. The recommendations urge providers to be more judicious in their prescribing, opting for opioids only after carefully weighing substantial risks and benefits. Public health authorities note the rampant use and misuse of opioids have "blurred the lines" between prescription opioids and illicit opioids. The new guidelines are designed to help frontline providers balance the need to manage their patients' chronic pain with the duty to curb dangerous prescribing practices. The recommendations are built around three principles: favor non-opioid alternatives for most cases of chronic pain, use the lowest effective dose when prescribing opioids, and exercise caution/monitor patients who are treated with opioids. RN - 0 (Analgesics, Opioid) IS - 1044-9167 IL - 1044-9167 PT - Journal Article PP - ppublish LG - English DP - 2016 May EZ - 2016/06/09 06:00 DA - 2016/07/21 06:00 DT - 2016/06/09 06:00 YR - 2016 ED - 20160720 RD - 20160607 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27266000 <209. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26370638 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Winston I AU - McDonald R AU - Tas B AU - Strang J FA - Winston, Ian FA - McDonald, Rebecca FA - Tas, Basak FA - Strang, John IN - Winston, Ian. Supervised Injectable Opiate Treatment Clinic, South London & Maudsley NHS Foundation Trust, London, UK. IN - McDonald, Rebecca. Addictions Department, King's College London, London, UK. IN - Tas, Basak. Addictions Department, King's College London, London, UK. IN - Strang, John. Addictions Department, King's College London, London, UK. TI - Heroin overdose resuscitation with naloxone: patient uses own prescribed supply to save the life of a peer. SO - BMJ Case Reports. 2015, 2015 Sep 14 AS - BMJ Case Rep. 2015, 2015 Sep 14 NJ - BMJ case reports VO - 2015 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101526291 IO - BMJ Case Rep SB - Index Medicus CP - England MH - *Drug Overdose/dt [Drug Therapy] MH - First Aid/mt [Methods] MH - *First Aid MH - Heroin Dependence MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Opioid-Related Disorders MH - *Resuscitation MH - Treatment Outcome AB - Opiate overdose is the primary cause of death among injection-drug users, representing a major public health concern worldwide. Opiate overdose can be reversed through timely administration of naloxone, and users have expressed willingness to carry the antidote for emergency use (take-home naloxone). In November 2014, new WHO guidelines identified that naloxone should be made available to anyone at risk of witnessing an overdose. We present the case of a 46-year-old man in opioid-maintenance treatment who used take-home naloxone to rescue an overdose victim. This is the first- ever account of a patient using dose titration of naloxone to restore respiratory function while minimising the risk of adverse effects. To improve the safety of take-home naloxone, the authors call for clinicians involved in the treatment of opiate users to: prescribe take-home naloxone to all patients; forewarn patients of potential side effects; and instruct patients in naloxone dose titration. Copyright 2015 BMJ Publishing Group Ltd. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1757-790X IL - 1757-790X DI - bcr2015210391 DO - https://dx.doi.org/10.1136/bcr-2015-210391 PT - Case Reports PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - bcr-2015-210391 [pii] ID - 10.1136/bcr-2015-210391 [doi] ID - PMC4577613 [pmc] PP - epublish LG - English EP - 20150914 DP - 2015 Sep 14 EZ - 2015/09/16 06:00 DA - 2016/07/21 06:00 DT - 2015/09/16 06:00 YR - 2015 ED - 20160720 RD - 20170914 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26370638 <210. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25929837 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weiner SG AU - Yannopoulos PF AU - Lu C FA - Weiner, Scott G FA - Yannopoulos, Paul F FA - Lu, Chao IN - Weiner, Scott G. Division of Health Policy Translation, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA. IN - Yannopoulos, Paul F. Tufts University School of Medicine, Boston, MA. IN - Lu, Chao. Craniofacial Pain Center, Tufts University School of Dental Medicine, Boston, MA. TI - Chronic Pain Patients' Impressions of an Emergency Department Opioid Prescribing Guideline Poster. SO - Pain Medicine. 16(9):1759-63, 2015 Sep AS - PAIN MED. 16(9):1759-63, 2015 Sep NJ - Pain medicine (Malden, Mass.) VO - 16 IP - 9 PG - 1759-63 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Chronic Pain/dt [Drug Therapy] MH - Cross-Sectional Studies MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - Pain Clinics MH - *Patient Education as Topic/mt [Methods] MH - Practice Guidelines as Topic MH - Surveys and Questionnaires KW - Opioids; Prescriptions AB - OBJECTIVE: To determine if an opioid prescribing guideline poster, meant to be posted in an emergency department (ED) triage area, would deter patients with chronic pain from seeking care. AB - METHODS: We prospectively enrolled patients presenting to a chronic craniofacial pain clinic affiliated with an urban academic Level I trauma center. Patients were surveyed with a close-ended, structured questionnaire. Included patients were aged 18 and older with pain lasting 12 weeks or longer. Patients were shown a sample pain poster. The primary outcome was determination if such a poster would prevent the patient from staying to receive care in the ED. AB - RESULTS: One hundred patients were surveyed. Most patients (77%) reported having been a patient in the ED in the past, and of these, 23% reported visiting the ED for worsening of chronic pain. After being shown the poster, 97% believed the recommendations in the poster were reasonable and 97% thought that the poster should be displayed in the ED. Seven patients (7%) reported that seeing the poster in the ED waiting room or triage area would intimidate them, and two patients within this group (2% of total sample) reported that it would prevent them from staying to get care. AB - CONCLUSIONS: The vast majority of patients with chronic pain in this cohort believes that a pain guideline poster is reasonable and should be posted in the ED. However, a small percentage of patients reported that they would feel intimidated by such a poster and that it would prevent them from staying to get care, a result meant to inform hospitals and policy-makers deciding if such posters should be displayed. Copyright Wiley Periodicals, Inc. RN - 0 (Analgesics, Opioid) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/pme.12776 PT - Journal Article ID - 10.1111/pme.12776 [doi] PP - ppublish PH - 2015/01/19 [received] PH - 2015/03/11 [revised] PH - 2015/03/25 [accepted] LG - English EP - 20150430 DP - 2015 Sep EZ - 2015/05/02 06:00 DA - 2016/07/21 06:00 DT - 2015/05/02 06:00 YR - 2015 ED - 20160720 RD - 20150916 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25929837 <211. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26937662 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kirwan A AU - Curtis M AU - van Beek IA AU - Cantwell K AU - Dietze PM FA - Kirwan, Amy FA - Curtis, Michael FA - van Beek, Ingrid A FA - Cantwell, Kate FA - Dietze, Paul M IN - Kirwan, Amy. Burnet Institute, Melbourne, VIC michael.curtis@burnet.edu.au. IN - Curtis, Michael. Burnet Institute, Melbourne, VIC. IN - van Beek, Ingrid A. Kirketon Road Centre, Sydney, NSW. IN - Cantwell, Kate. Burnet Institute, Melbourne, VIC. IN - Dietze, Paul M. Burnet Institute, Melbourne, VIC. TI - Take-home naloxone programs and calls to emergency services. SO - Medical Journal of Australia. 204(4):143, 2016 Mar 07 AS - Med J Aust. 204(4):143, 2016 Mar 07 NJ - The Medical journal of Australia VO - 204 IP - 4 PG - 143 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0400714, m26 IO - Med. J. Aust. SB - Index Medicus CP - Australia MH - *Drug Overdose/pc [Prevention & Control] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Home Care Services MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1326-5377 IL - 0025-729X PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.5694/mja15.00783 [pii] PP - ppublish PH - 2015/07/08 [received] PH - 2015/10/12 [accepted] LG - English DP - 2016 Mar 07 EZ - 2016/03/05 06:00 DA - 2016/07/14 06:00 DT - 2016/03/04 06:00 YR - 2016 ED - 20160713 RD - 20160304 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26937662 <212. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26428361 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ries R AU - Krupski A AU - West II AU - Maynard C AU - Bumgardner K AU - Donovan D AU - Dunn C AU - Roy-Byrne P FA - Ries, Richard FA - Krupski, Antoinette FA - West, Imara I FA - Maynard, Charles FA - Bumgardner, Kristin FA - Donovan, Dennis FA - Dunn, Chris FA - Roy-Byrne, Peter IN - Ries, Richard. Department of Psychiatry and Behavioral Sciences (RR, AK, IIW, KB, DD, CD, PRB), University of Washington at Harborview Medical Center, Seattle, WA; Department of Health Services (CM), University of Washington School of Public Health, Seattle, WA; and Alcohol and Drug Abuse Institute (DD), University of Washington, Seattle, WA. TI - Correlates of Opioid Use in Adults With Self-Reported Drug Use Recruited From Public Safety-Net Primary Care Clinics. SO - Journal of Addiction Medicine. 9(5):417-26, 2015 Sep-Oct AS - J Addict Med. 9(5):417-26, 2015 Sep-Oct NJ - Journal of addiction medicine VO - 9 IP - 5 PG - 417-26 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101306759 IO - J Addict Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606464 OI - Source: NLM. NIHMS702909 [Available on 10/01/16] SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Case-Control Studies MH - Cause of Death MH - Comorbidity MH - Female MH - Humans MH - Male MH - *Mental Disorders/ep [Epidemiology] MH - Mental Disorders/mo [Mortality] MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/px [Psychology] MH - Prescription Drug Misuse/mo [Mortality] MH - *Prescription Drug Misuse/px [Psychology] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - *Primary Health Care MH - Risk-Taking MH - *Self Report MH - Washington/ep [Epidemiology] AB - OBJECTIVES: The purpose of this study was to compare demographic, clinical, and survival characteristics of drug-using safety-net primary care patients who used or did not use opioids, and to examine treatment implications of our findings. AB - METHODS: The sample consisted of 868 adults who reported illicit drug use in the 90 days before study enrollment, 396 (45.6%) of whom were opioid users. AB - RESULTS: Multiple measures indicated that, as a group, opioid users were less physically and psychiatrically healthy than drug users who did not endorse using opioids, and were heavy users of medical services (eg, emergency departments, inpatient hospitals, and outpatient medical) at considerable public expense. After adjusting for age, they were 2.61 (confidence interval, 1.48-4.61) times more likely to die in the 1 to 5 years after study enrollment and more likely to die from accidental poisoning than nonopioid users. Subgroup analyses suggested patients using any nonprescribed opioids had more serious drug problems including more intravenous drug use and greater HIV risk than patients using opioids only as prescribed. AB - CONCLUSIONS: Use of opioids adds a dimension of severity over and above illicit drug use as it presents in the primary care setting. Opioid users may benefit from psychiatric and addiction care integrated into their primary care setting, naloxone overdose prevention kits, and prevention efforts such as clean needle exchanges. Addiction or primary care providers are in a key position to facilitate change among such patients, especially the third or more opioid users having a goal of abstinence from drugs. RN - 0 (Analgesics, Opioid) ES - 1935-3227 IL - 1932-0620 DO - https://dx.doi.org/10.1097/ADM.0000000000000151 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1097/ADM.0000000000000151 [doi] ID - 01271255-201510000-00011 [pii] ID - PMC4606464 [pmc] ID - NIHMS702909 [mid] PP - ppublish GI - No: R01 DA026014 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2015 Sep-Oct EZ - 2015/10/03 06:00 DA - 2016/07/12 06:00 DT - 2015/10/03 06:00 YR - 2015 ED - 20160711 RD - 20161025 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26428361 <213. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26342632 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ladha KS AU - Wanderer JP AU - Nanji KC FA - Ladha, Karim S FA - Wanderer, Jonathan P FA - Nanji, Karen C IN - Ladha, Karim S. Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA. Electronic address: karim.ladha@post.harvard.edu. IN - Wanderer, Jonathan P. Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University, Nashville, TN. IN - Nanji, Karen C. Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston MA. TI - Age as a predictor of rescue opioid administration immediately after the emergence of general anesthesia. SO - Journal of Clinical Anesthesia. 27(7):537-42, 2015 Nov AS - J Clin Anesth. 27(7):537-42, 2015 Nov NJ - Journal of clinical anesthesia VO - 27 IP - 7 PG - 537-42 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - an9, 8812166 IO - J Clin Anesth SB - Index Medicus CP - United States MH - Age Factors MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Anesthesia, General/mt [Methods] MH - *Arthroplasty, Replacement, Hip/mt [Methods] MH - *Arthroplasty, Replacement, Knee/mt [Methods] MH - Cohort Studies MH - Dose-Response Relationship, Drug MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Pain, Postoperative/dt [Drug Therapy] MH - Pain, Postoperative/ep [Epidemiology] MH - Retrospective Studies KW - Acute pain management; Geriatric anesthesia; Perioperative opioid use AB - BACKGROUND AND OBJECTIVES: While previous studies have shown that elderly patients require lower dosages of opioids, the literature suggests that pain is undertreated in the geriatric population, which may lead to postoperative pain and high rescue analgesia requirements. The purpose of this study is to determine whether elderly patients undergoing hip and knee arthroplasty require higher levels of postoperative rescue opioids than their younger counterparts early after emergence from anesthesia. AB - METHODS: Using a nonconcurrent retrospective cohort study design, patients who underwent hip or knee arthroplasty under general anesthesia at a tertiary academic hospital from 2007 to 2012 were identified. Demographic information and data regarding patients' anesthetic care were obtained from the institution's anesthesia information management system. To assess the presence of pain after the emergence of anesthesia, we used, as a proxy, opioid administration by the anesthesia provider after leaving the operating room and before the end of anesthesia care. AB - RESULTS: A total of 2731 patients met inclusion criteria, of which 487 (17.8%) received rescue opioids. Patients older than 80 years were less likely to receive opioids after leaving the operating room (odds ratio, 0.57; 95% confidence interval, 0.37-0.88; P = .01) and received 1.37 mg less of hydromorphone equivalent opioid compared to patients younger than the age of 50 years (95% confidence interval, 1.18-1.55; P < .001). The proportion of patients who received rescue opioids varied significantly between anesthesia providers from 0% to 38% (P < .001). AB - CONCLUSIONS: While elderly patients received lower doses of opioids intraoperatively, they were less likely to require rescue analgesia. The variability among providers in rescue opioid administration after emergence presents an opportunity for further research. Copyright © 2015 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1873-4529 IL - 0952-8180 DI - S0952-8180(15)00231-7 DO - https://dx.doi.org/10.1016/j.jclinane.2015.07.026 PT - Journal Article ID - S0952-8180(15)00231-7 [pii] ID - 10.1016/j.jclinane.2015.07.026 [doi] PP - ppublish PH - 2014/09/11 [received] PH - 2015/07/22 [accepted] LG - English EP - 20150903 DP - 2015 Nov EZ - 2015/09/08 06:00 DA - 2016/07/12 06:00 DT - 2015/09/07 06:00 YR - 2015 ED - 20160711 RD - 20151005 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26342632 <214. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26238183 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Thomas SH AU - Mumma S AU - Satterwhite A AU - Haas T AU - Arthur AO AU - Todd KH AU - Mace S AU - Diercks DB AU - Pollack CV FA - Thomas, Stephen H FA - Mumma, Shannon FA - Satterwhite, Amanda FA - Haas, Tyler FA - Arthur, Annette O FA - Todd, Knox H FA - Mace, Sharon FA - Diercks, Deborah B FA - Pollack, Charles V IN - Thomas, Stephen H. Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma. IN - Mumma, Shannon. Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma. IN - Satterwhite, Amanda. Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma. IN - Haas, Tyler. Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma. IN - Arthur, Annette O. Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma. IN - Todd, Knox H. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. IN - Mace, Sharon. Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, Ohio. IN - Diercks, Deborah B. Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California. IN - Pollack, Charles V. Department of Emergency Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania. TI - Variation Between Physicians and Mid-level Providers in Opioid Treatment for Musculoskeletal Pain in the Emergency Department. SO - Journal of Emergency Medicine. 49(4):415-23, 2015 Oct AS - J Emerg Med. 49(4):415-23, 2015 Oct NJ - The Journal of emergency medicine VO - 49 IP - 4 PG - 415-23 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - *Musculoskeletal Pain/dt [Drug Therapy] MH - Pain Management/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Prospective Studies MH - United States KW - analgesia; mid-level providers; musculoskeletal pain; opioids; physicians AB - BACKGROUND: Effective, appropriate, and safe opioid analgesia administration in the Emergency Department (ED) is a complex issue, with risks of both over- and underutilization of medications. AB - OBJECTIVE: To assess for possible association between practitioner status (physician [MD] vs. mid-level provider [MLP]) and use of opioids for in-ED treatment of musculoskeletal pain (MSP). AB - METHODS: This was a secondary, hypothesis-generating analysis of a subset of subjects who had ED analgesia noted as part of entry into a prospective registry trial of outpatient analgesia. The study was conducted at 12 U.S. academic EDs, 10 of which utilized MLPs. Patients were enrolled as a convenience sample from September 2012 through February 2014. Study patients were adults (>17 years of age) with acute MSP and eligibility for both nonsteroidal antiinflammatory drugs and opioids at ED discharge. The intervention of interest was whether patients received opioid therapy in the ED prior to discharge. AB - RESULTS: MDs were significantly more likely to order opioids than MLPs for ED patients with MSP. The association between MD/MLP status and likelihood of treatment with opioids was similar in both classical logistic regression (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1-4.5, p = 0.019) and in propensity-adjusted modeling (OR 2.1, 95% CI 1.0-4.5, p = 0.049). AB - CONCLUSIONS: In preliminary analysis, MD/MLP status was significantly associated with likelihood of provider treatment of MSP with opioids. A follow-up study is warranted to confirm the results of this hypothesis-testing analysis and to inform efforts toward consistency in opioid therapy in the ED. Copyright © 2015 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(15)00599-5 DO - https://dx.doi.org/10.1016/j.jemermed.2015.05.036 PT - Journal Article ID - S0736-4679(15)00599-5 [pii] ID - 10.1016/j.jemermed.2015.05.036 [doi] PP - ppublish PH - 2015/04/08 [received] PH - 2015/05/25 [revised] PH - 2015/05/31 [accepted] LG - English EP - 20150731 DP - 2015 Oct EZ - 2015/08/05 06:00 DA - 2016/07/09 06:00 DT - 2015/08/05 06:00 YR - 2015 ED - 20160708 RD - 20151013 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26238183 <215. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26125161 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Onifer DJ AU - Butler FK AU - Gross KR AU - Otten EJ AU - Patton R AU - Russell RJ AU - Stockinger Z AU - Burrell E FA - Onifer, Dana J FA - Butler, Frank K FA - Gross, Kirby R FA - Otten, Edward J FA - Patton, Robert FA - Russell, Robert J FA - Stockinger, Zsolt FA - Burrell, Elizabeth TI - Replacement of Promethazine With Ondansetron for Treatment of Opioid- and Trauma-Related Nausea and Vomiting in Tactical Combat Casualty Care. SO - Journal of Special Operations Medicine. 15(2):17-24, 2015 AS - J Spec Oper Med. 15(2):17-24, 2015 NJ - Journal of special operations medicine : a peer reviewed journal for SOF medical professionals VO - 15 IP - 2 PG - 17-24 PI - Journal available in: Print PI - Citation processed from: Print JC - 101158402 IO - J Spec Oper Med SB - Index Medicus CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - Antiemetics/ae [Adverse Effects] MH - *Antiemetics/tu [Therapeutic Use] MH - Emergency Service, Hospital MH - Humans MH - Military Medicine MH - *Nausea/dt [Drug Therapy] MH - Off-Label Use MH - *Ondansetron/tu [Therapeutic Use] MH - Promethazine/ae [Adverse Effects] MH - *Promethazine/tu [Therapeutic Use] MH - Retrospective Studies MH - Tablets MH - *Vomiting/dt [Drug Therapy] MH - Warfare MH - Wounds and Injuries/co [Complications] AB - The current Tactical Combat Casualty Care (TCCC) Guidelines recommend parenteral promethazine as the single agent for the treatment of opioid-induced nausea and/or vomiting and give a secondary indication of "synergistic analgesic effect." Promethazine, however, has a well-documented history of undesired side effects relating to impairment and dysregulation of the central and autonomic nervous systems, such as sedation, extrapyramidal symptoms, dystonia, impairment of psychomotor function, neuroleptic malignant syndrome, and hypotension. These may be particularly worrisome in the combat casualty. Additionally, since 16 September 2009, there has been a US Food and Drug Administration (FDA) black box warning for the injectable form of promethazine, due to "the risk of serious tissue injury when this drug is administered incorrectly." Conversely, ondansetron, which is now available in generic form, has a well-established favorable safety profile and demonstrated efficacy in undifferentiated nausea and vomiting in the emergency department and prehospital settings. It has none of the central and autonomic nervous system side effects noted with promethazine and carries no FDA black box warning. Ondansetron is available in parenteral form and an orally disintegrating tablet, providing multiple safe and effective routes of administration. Despite the fact that it is an off-label use, ondansetron is being increasingly given for acute, undifferentiated nausea and vomiting and is presently being used in the field on combat casualties by some US and Allied Forces. Considering the risks involved with promethazine use, and the efficacy and safety of ondansetron and ondansetron?s availability in a generic form, we recommend removing promethazine from the TCCC Guidelines and replacing it with ondansetron. Copyright 2015. RN - 0 (Analgesics, Opioid) RN - 0 (Antiemetics) RN - 0 (Tablets) RN - 4AF302ESOS (Ondansetron) RN - FF28EJQ494 (Promethazine) IS - 1553-9768 IL - 1553-9768 PT - Journal Article PP - ppublish PH - 2015/06/01 [accepted] LG - English DP - 2015 EZ - 2015/07/01 06:00 DA - 2016/07/09 06:00 DT - 2015/07/01 06:00 YR - 2015 ED - 20160708 RD - 20150701 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26125161 <216. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26402391 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ernst FR AU - Mills JR AU - Berner T AU - House J AU - Herndon C FA - Ernst, Frank R FA - Mills, J Rebecca FA - Berner, Todd FA - House, John FA - Herndon, Christopher IN - Ernst, Frank R. Indegene TTM, 222 Chastain Meadows Ct., Ste. 300, Kennesaw, GA 30144. fernst@indegenettm.com. TI - Opioid Medication Practices Observed in Chronic Pain Patients Presenting for All-Causes to Emergency Departments: Prevalence and Impact on Health Care Outcomes. SO - Journal of Managed Care & Specialty Pharmacy. 21(10):925-36, 2015 Oct AS - J Manag Care Spec Pharm. 21(10):925-36, 2015 Oct NJ - Journal of managed care & specialty pharmacy VO - 21 IP - 10 PG - 925-36 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101644425 IO - J Manag Care Spec Pharm SB - Index Medicus CP - United States MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ec [Economics] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Chronic Pain/dt [Drug Therapy] MH - Cohort Studies MH - Drug Interactions MH - Emergency Service, Hospital/ec [Economics] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Health Care Costs/sn [Statistics & Numerical Data] MH - Hospitalization/ec [Economics] MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Middle Aged MH - Patient Readmission/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians'/st [Standards] MH - Prevalence MH - Retrospective Studies AB - BACKGROUND: Chronic pain is a significant health problem that affects an estimated 100 million American adults (aged >=18 years). Chronic pain affects more individuals than heart disease, stroke, diabetes, and cancer combined. Chronic pain sufferers cost up to $635 billion annually in medical treatment and lost productivity. Opioids are commonly used to treat chronic pain, but their metabolic interactions with concurrently prescribed medications for concomitant disease burdens can affect potency and efficacy of pain therapy. Additionally, misuse of short-acting opioids (SAOs) for chronic pain versus breakthrough pain can create gaps in pain relief. These potentially suboptimal prescribing practices may contribute to the high economic impact associated with chronic pain. AB - OBJECTIVE: To examine the prevalence of suboptimal opioid therapy and the associated health care costs resulting from these prescribing practices in real-world patients presenting for all-causes to the emergency department (ED). AB - METHODS: This retrospective observational database cohort analysis used the linked Premier-Optum database and included patients with ED visits from 2006 to 2010 having >=60 days supply of opioids in the 75 days prior to the visit. Suboptimal prescribing practices were identified as patients with (a) drug-drug exposures (DDEs), defined as cytochrome P-450 (CYP-450)-metabolized opioids prescribed concurrently with CYP-450 inhibitors or inducers and/or (b) monotherapy with SAOs. Comorbid conditions and principal diagnoses were documented. Readmission rates to the ED and hospital within 72 hours as well as <=30, <=45, <=60, and <=90 days were computed. Total costs for health care were calculated, and reimbursement rates were normalized using 2011 Medicare severity diagnosis-related group (MS-DRG) and CPT-4 information. Nonparametric bootstrapping to adjust for patient comorbidities was applied to cost data. AB - RESULTS: Of the 9,214 patients identified with chronic pain, potentially suboptimal medication practices prior to the index ED visit were found for 8,539 (92.6%) patients. These appeared to be corrected in 345 (4.0%) patients before leaving the ED. Of 675 (7.3%) patients without prior DDE or exclusive use of SAOs, 345 (51.1%) patients were discharged with one of these. Of the 8,352 patients who left the ED with DDE or exclusive use of SAOs, 1,525 (18.3%) left with a DDE without exclusive SAO use; 4,812 (57.6%) left with both DDE and exclusive SAO use; and 2,015 (24.1%) left with only exclusive SAO use. Only 862 (9.3%) patients from the entire cohort left the ED without DDE or exclusive SAO use. Patients identified with suboptimal opioid use were aged 50+/-13.5 years and were predominantly female (64.0%). Hypertension (44.0%), fluid and electrolyte disorders (32.7%), chronic pulmonary disease (22.8%), depression (19.6%), diabetes without chronic complications (16.2%), and drug abuse (15.6%) were the most prevalent comorbid conditions identified. The most prevalent principal diagnoses involved symptoms and signs of ill-defined conditions (36.5%), injury and poisoning (18.2%), and diseases of the musculoskeletal system (13.2%). The majority of revisits to the ED and hospital admissions occurred within 72 hours (73.6%) of the index visit and within 30 days (70%), respectively. When adjusted total costs were compared for all patients whose opioid use included DDE versus those without, a significantly greater cost (P less than 0.05) was observed at every time period except <=72 hours. Respective mean increases in costs were $581, $689, $773, and $1,275 at 30, 45, 60, and 90 days. Exclusive SAO use with or without DDE resulted in a significant increase (P less than 0.05) in mean costs at all times: $214 at 72 hours; $836 at 30 days; $1,023 at 45 days; $1,022 at 60 days; and $1,536 at 90 days. AB - CONCLUSIONS: This study identified potentially suboptimal opioid prescribing practices in a real-world population presenting for all-causes to the ED. The observed rate of ED revisits and inpatient admissions in these patients was associated with increased health care costs. These findings suggest that the ED has the future potential to serve as an ideal setting to identify and correct such practices, thereby improving patient care and reducing resource use and beneficiary costs. RN - 0 (Analgesics, Opioid) ES - 2376-1032 PT - Journal Article ID - 2015(21)10: 925-936 [pii] ID - 10.18553/jmcp.2015.21.10.925 [doi] PP - ppublish LG - English DP - 2015 Oct EZ - 2015/09/25 06:00 DA - 2016/07/07 06:00 DT - 2015/09/25 06:00 YR - 2015 ED - 20160706 RD - 20150925 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26402391 <217. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26402390 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shei A AU - Rice JB AU - Kirson NY AU - Bodnar K AU - Enloe CJ AU - Birnbaum HG AU - Holly P AU - Ben-Joseph R FA - Shei, Amie FA - Rice, J Bradford FA - Kirson, Noam Y FA - Bodnar, Katharine FA - Enloe, Caroline J FA - Birnbaum, Howard G FA - Holly, Pamela FA - Ben-Joseph, Rami IN - Shei, Amie. Analysis Group, 111 Huntington Ave., Tenth Fl., Boston, MA 02199. ashei@analysisgroup.com. TI - Characteristics of High-Cost Patients Diagnosed with Opioid Abuse. SO - Journal of Managed Care & Specialty Pharmacy. 21(10):902-12, 2015 Oct AS - J Manag Care Spec Pharm. 21(10):902-12, 2015 Oct NJ - Journal of managed care & specialty pharmacy VO - 21 IP - 10 PG - 902-12 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101644425 IO - J Manag Care Spec Pharm SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/ec [Economics] MH - Child MH - Comorbidity MH - *Cost of Illness MH - Female MH - Health Care Costs MH - Humans MH - Male MH - Managed Care Programs/ec [Economics] MH - Mental Disorders/ep [Epidemiology] MH - Middle Aged MH - Multivariate Analysis MH - Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/ec [Economics] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Prescription Drug Misuse/ec [Economics] MH - Retrospective Studies MH - Young Adult AB - BACKGROUND: Prescription opioid abuse is associated with substantial economic burden, with estimates of incremental annual per-patient health care costs of diagnosed opioid abuse exceeding $10,000 in prior literature. A subset of patients diagnosed with opioid abuse has disproportionately high health care costs, but little is known about the characteristics of these patients. AB - OBJECTIVE: To describe the characteristics of a subset of patients diagnosed with opioid abuse with disproportionately high health care costs to assist physicians and managed care organizations in targeting interventions at the costliest patients. AB - METHODS: This retrospective claims data analysis identified patients aged 12 to 64 years diagnosed with opioid abuse/dependence in the OptumHealth Reporting and Insights medical and pharmacy claims database, Quarter 1 (Q1) 1999-Q1 2012. Inclusion criteria required that patients had a diagnosis of opioid abuse during or after Q1 2006, no prior diagnoses of opioid abuse, and continuous non-HMO coverage over an 18-month study period. The study period comprised a 12-month observation period centered on the date of the first opioid abuse diagnosis (index date) and a 6-month baseline period immediately preceding the observation period. Patients in the top 20% of total health care costs in the observation period were classified as "high-cost patients," and the remaining patients were classified as "lower-cost patients." Patient characteristics, comorbidities, health care resource use, and health care costs were compared between high-cost patients and lower-cost patients using chi-square tests for dichotomous variables and Wilcoxon rank-sum tests for continuous variables. In addition, multivariate regression was used to assess the relationship between patient characteristics in the baseline period and total health care costs in the observation period among all patients diagnosed with opioid abuse. AB - RESULTS: 9,291 patients diagnosed with opioid abuse met the inclusion criteria. The 20% of patients classified as high-cost patients accounted for approximately two thirds of the total health care costs of patients diagnosed with opioid abuse. Compared with lower-cost patients, high-cost patients were older (42.5 vs. 36.1; P less than 0.001) and more likely to be female (55.9% vs. 42.9%; P less than 0.001). They had a higher comorbidity burden at baseline, as reflected in the Charlson Comorbidity Index (0.8 vs. 0.2; P less than 0.001), and rates of conditions such as chronic pulmonary disease (12.9% vs. 5.6%; P less than 0.001) and mild/moderate diabetes (8.4% vs. 3.4%; P less than 0.001). High-cost patients also had higher rates of nonopioid substance abuse diagnoses (12.4% vs. 8.9%; P less than 0.001) and psychotic disorders (26.5% vs. 13.6%; P less than 0.001). In the observation period, high-cost patients continued to have higher rates of nonopioid substance abuse diagnoses (53.0% vs. 47.2%; P less than 0.001) and psychotic disorders (67.1% vs. 47.5%; P less than 0.001). In addition, they had greater medical resource use across all places of service (i.e., inpatient, emergency department, outpatient, drug/alcohol rehabilitation facility, and other) compared with lower-cost patients. The mean observation period health care costs of high-cost patients was $89,177 compared with $11,653 for lower-cost patients (P less than 0.001). High-cost patients had higher medical costs linked to claims with an opioid abuse diagnosis in absolute terms, but the share of total medical costs attributed to such claims was lower among high-cost patients than among lower-cost patients. While many baseline characteristics were found to have a statistically significant (P less than 0.05) association with observation period health care costs, only 27.3% of the variation in observation period health care costs was explained by patient characteristics in the baseline period. AB - CONCLUSIONS: This study found that the costliest patients diagnosed with opioid abuse had high rates of preexisting and concurrent chronic comorbidities and mental health conditions, suggesting potential indicators for targeted intervention and a need for greater awareness and screening of comorbid conditions. Opioid abuse may exacerbate existing conditions and make it difficult for patients to adhere to treatment plans for those underlying conditions. Baseline patient characteristics explained only a small share of the variation in observation period health care costs, however. Future research should explore the degree to which other factors not captured in administrative claims data (e.g., severity of abuse) can explain the wide variation in health care costs among opioid abusers. RN - 0 (Analgesics, Opioid) ES - 2376-1032 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 2015(21)10: 902-912 [pii] ID - 10.18553/jmcp.2015.21.10.902 [doi] PP - ppublish LG - English DP - 2015 Oct EZ - 2015/09/25 06:00 DA - 2016/07/07 06:00 DT - 2015/09/25 06:00 YR - 2015 ED - 20160706 RD - 20150925 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26402390 <218. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26590066 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Klimas J AU - Egan M AU - Tobin H AU - Coleman N AU - Bury G FA - Klimas, Jan FA - Egan, Mairead FA - Tobin, Helen FA - Coleman, Neil FA - Bury, Gerard IN - Klimas, Jan. Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. jan.klimas@ucd.ie. IN - Klimas, Jan. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada. jan.klimas@ucd.ie. IN - Klimas, Jan. c/o Coombe Family Practice, Dolphins barn, Dublin, Ireland. jan.klimas@ucd.ie. IN - Egan, Mairead. Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. mairead.egan@ucd.ie. IN - Tobin, Helen. Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. helen.tobin@ucd.ie. IN - Coleman, Neil. Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. neil.coleman@ucd.ie. IN - Bury, Gerard. Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. gerard.bury@ucd.ie. TI - Development and process evaluation of an educational intervention for overdose prevention and naloxone distribution by general practice trainees. SO - BMC Medical Education. 15:206, 2015 Nov 20 AS - BMC Med Educ. 15:206, 2015 Nov 20 NJ - BMC medical education VO - 15 PG - 206 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101088679 IO - BMC Med Educ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654915 SB - Index Medicus CP - England MH - Administration, Intranasal MH - Adult MH - *Caregivers/ed [Education] MH - Drug Overdose/di [Diagnosis] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/pc [Prevention & Control] MH - Education, Medical, Graduate MH - Family MH - Feasibility Studies MH - Female MH - Friends MH - *General Practice/ed [Education] MH - Health Education/mt [Methods] MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Ireland MH - Male MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Pilot Projects MH - Program Evaluation AB - BACKGROUND: Overdose is the most common cause of fatalities among opioid users. Naloxone is a life-saving medication for reversing opioid overdose. In Ireland, it is currently available to ambulance and emergency care services, but General Practitioners (GP) are in regular contact with opioid users and their families. This positions them to provide naloxone themselves or to instruct patients how to use it. The new Clinical Practice Guidelines of the Pre-hospital Emergency Care Council of Ireland allows trained bystanders to administer intranasal naloxone. We describe the development and process evaluation of an educational intervention, designed to help GP trainees identify and manage opioid overdose with intranasal naloxone. AB - METHODS: Participants (N=23) from one postgraduate training scheme in Ireland participated in a one-hour training session. The repeated-measures design, using the validated Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales, examined changes immediately after training. Acceptability and satisfaction with training were measured with a self-administered questionnaire. AB - RESULTS: Knowledge of the risks of overdose and appropriate actions to be taken increased significantly post-training [OOKS mean difference, 3.52 (standard deviation 4.45); P<0.001]; attitudes improved too [OOAS mean difference, 11.13 (SD 6.38); P<0.001]. The most and least useful delivery methods were simulation and video, respectively. AB - CONCLUSION: Appropriate training is a key requirement for the distribution of naloxone through general practice. In future studies, the knowledge from this pilot will be used to inform a train-the-trainer model, whereby healthcare professionals and other front-line service providers will be trained to instruct opioid users and their families in overdose prevention and naloxone use. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1472-6920 IL - 1472-6920 DO - https://dx.doi.org/10.1186/s12909-015-0487-y PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1186/s12909-015-0487-y [doi] ID - 10.1186/s12909-015-0487-y [pii] ID - PMC4654915 [pmc] PP - epublish PH - 2015/01/09 [received] PH - 2015/11/10 [accepted] LG - English EP - 20151120 DP - 2015 Nov 20 EZ - 2015/11/22 06:00 DA - 2016/07/05 06:00 DT - 2015/11/22 06:00 YR - 2015 ED - 20160704 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26590066 <219. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26143953 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Jones CM AU - McAninch JK FA - Jones, Christopher M FA - McAninch, Jana K IN - Jones, Christopher M. Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland. Electronic address: christopher.m.jones@fda.hhs.gov. IN - McAninch, Jana K. Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland. TI - Emergency Department Visits and Overdose Deaths From Combined Use of Opioids and Benzodiazepines. SO - American Journal of Preventive Medicine. 49(4):493-501, 2015 Oct AS - Am J Prev Med. 49(4):493-501, 2015 Oct NJ - American journal of preventive medicine VO - 49 IP - 4 PG - 493-501 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8704773, apl IO - Am J Prev Med SB - Index Medicus CP - Netherlands MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/po [Poisoning] MH - *Benzodiazepines/po [Poisoning] MH - Child MH - Drug Interactions MH - *Drug Overdose/mo [Mortality] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - United States/ep [Epidemiology] MH - Young Adult AB - INTRODUCTION: Opioid analgesics and benzodiazepines are the prescription drugs most commonly associated with drug overdose deaths. This study was conducted to assess trends in nonmedical use-related emergency department (ED) visits and drug overdose deaths that involved both opioid analgesics and benzodiazepines in the U.S. from 2004 to 2011. AB - METHODS: Opioid analgesic and benzodiazepine nonmedical use-related ED visits from the Drug Abuse Warning Network and drug overdose deaths from the National Vital Statistics System were analyzed for 2004-2011 to determine trends and demographic-specific rates. Data were analyzed from March 2014 to June 2014. AB - RESULTS: From 2004 to 2011, the rate of nonmedical use-related ED visits involving both opioid analgesics and benzodiazepines increased from 11.0 to 34.2 per 100,000 population (p-trend<0.0001). During the same period, drug overdose deaths involving both drugs increased from 0.6 to 1.7 per 100,000 (p-trend<0.0001). Statistically significant increases in ED visits occurred among males and females, non-Hispanic whites, non-Hispanic blacks, and Hispanics, and all age groups except 12- to 17-year-olds. For overdose deaths, statistically significant increases were seen in males and females, all three race/ethnicity groups, and all age groups except 12- to 17-year-olds. Benzodiazepine involvement in opioid analgesic overdose deaths increased each year, increasing from 18% of opioid analgesic overdose deaths in 2004 to 31% in 2011 (p-trend<0.0001). AB - CONCLUSIONS: ED visits and drug overdose deaths involving both opioid analgesics and benzodiazepines increased significantly between 2004 and 2011. Interventions to improve the appropriate prescribing and use of these medications are needed. Copyright Published by Elsevier Inc. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) ES - 1873-2607 IL - 0749-3797 DI - S0749-3797(15)00163-4 DO - https://dx.doi.org/10.1016/j.amepre.2015.03.040 PT - Journal Article ID - S0749-3797(15)00163-4 [pii] ID - 10.1016/j.amepre.2015.03.040 [doi] PP - ppublish PH - 2014/10/27 [received] PH - 2015/03/27 [revised] PH - 2015/03/27 [accepted] LG - English EP - 20150703 DP - 2015 Oct EZ - 2015/07/07 06:00 DA - 2016/07/02 06:00 DT - 2015/07/07 06:00 YR - 2015 ED - 20160701 RD - 20150919 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26143953 <220. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25468314 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ganem VJ AU - Mora AG AU - Varney SM AU - Bebarta VS FA - Ganem, Victoria J FA - Mora, Alejandra G FA - Varney, Shawn M FA - Bebarta, Vikhyat S IN - Ganem, Victoria J. Air Force En route Care Research Center, 59th Medical Wing Chief Scientist's Office, San Antonio Military Medical Center, San Antonio, TX, USA, ganemv@gmail.com. TI - Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 11(3):288-94, 2015 Sep AS - J Med Toxicol. 11(3):288-94, 2015 Sep NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 11 IP - 3 PG - 288-94 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547954 SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Chronic Pain/di [Diagnosis] MH - *Chronic Pain/dt [Drug Therapy] MH - Drug Prescriptions MH - Drug Utilization Review MH - Electronic Health Records/td [Trends] MH - *Emergency Service, Hospital/td [Trends] MH - Female MH - Hospitals, Military/td [Trends] MH - Humans MH - Male MH - *Pain Management/td [Trends] MH - *Practice Patterns, Physicians'/td [Trends] MH - Retrospective Studies MH - Tertiary Care Centers/td [Trends] MH - Time Factors AB - Chronic pain is a common reason for emergency department (ED) visits. Our objective was to describe opioid prescribing practices of ED providers when treating patients with chronic pain. We retrospectively evaluated opioid prescriptions from EDs at two tertiary care military hospitals. We queried the outpatient record database to obtain a list of opioid medications prescribed and ICD-9 codes associated with visits for chronic pain. We collected provider type and gender, number of pills, opioid type, and refills. We compared the incidence with chi-square or Fisher's exact tests. Wilcoxon test was used for non-parametric continuous variables. Over 3 years, 28,103 visits generated an opioid prescription. One thousand three hundred twenty-two visits were associated with chronic pain, and 443 (33 %) visits were associated with an opioid prescription. Providers were 79 % physicians, 19 % physician assistants (PAs), 81 % male, and 69 % active duty military. Medications were 43 % oxycodone, 30 % hydrocodone, 9.5 % tramadol, 2.5 % codeine, and 15 % other. The number of pills was 20 [interquartile range (IQR) 15-30] (range 1-240), morphine equivalents (M.E.) per pill was 7.5 [7.5-7.5] (2.5-120) and total M.E. per prescription was 150 [112.5-270] (15-6000). Physicians were more likely to prescribe a non-opioid than PAs (77 vs 45 %, p<0.0001). Civilian providers were more likely to prescribe an opioid than active duty providers (58 vs 42 %, p<0.0001). Providers prescribed a median of 20 pills per prescription and most commonly prescribed oxycodone. PAs were more likely to prescribe an opioid for chronic pain than physicians. Civilian providers were more likely to prescribe an opioid than active duty providers. RN - 0 (Analgesics, Opioid) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-014-0449-5 PT - Comparative Study PT - Journal Article ID - 10.1007/s13181-014-0449-5 [doi] ID - PMC4547954 [pmc] PP - ppublish LG - English DP - 2015 Sep EZ - 2014/12/04 06:00 DA - 2016/06/30 06:00 DT - 2014/12/04 06:00 YR - 2015 ED - 20160629 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25468314 <221. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27330340 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Carmichael AN AU - Morgan L AU - Del Fabbro E FA - Carmichael, Ashley-Nicole FA - Morgan, Laura FA - Del Fabbro, Egidio IN - Carmichael, Ashley-Nicole. School of Pharmacy, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA. IN - Morgan, Laura. School of Pharmacy, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA. IN - Del Fabbro, Egidio. Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA. TI - Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review. [Review] SO - Substance Abuse & Rehabilitation. 7:71-9, 2016 AS - Subst. abuse rehabil.. 7:71-9, 2016 NJ - Substance abuse and rehabilitation VO - 7 PG - 71-9 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Print JC - 101558476 IO - Subst Abuse Rehabil PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898427 CP - New Zealand KW - prescription drug-monitoring programs; screening questionnaires; urine drug screens AB - BACKGROUND: The misuse and abuse of opioid medications in many developed nations is a health crisis, leading to increased health-system utilization, emergency department visits, and overdose deaths. There are also increasing concerns about opioid abuse and diversion in patients with cancer, even at the end of life. AB - AIMS: To evaluate the current literature on opioid misuse and abuse, and more specifically the identification and assessment of opioid-abuse risk in patients with cancer. Our secondary aim is to offer the most current evidence of best clinical practice and suggest future directions for research. AB - MATERIALS AND METHODS: Our integrative review included a literature search using the key terms "identification and assessment of opioid abuse in cancer", "advanced cancer and opioid abuse", "hospice and opioid abuse", and "palliative care and opioid abuse". PubMed, PsycInfo, and Embase were supplemented by a manual search. AB - RESULTS: We found 691 articles and eliminated 657, because they were predominantly non cancer populations or specifically excluded cancer patients. A total of 34 articles met our criteria, including case studies, case series, retrospective observational studies, and narrative reviews. The studies were categorized into screening questionnaires for opioid abuse or alcohol, urine drug screens to identify opioid misuse or abuse, prescription drug-monitoring programs, and the use of universal precautions. AB - CONCLUSION: Screening questionnaires and urine drug screens indicated at least one in five patients with cancer may be at risk of opioid-use disorder. Several studies demonstrated associations between high-risk patients and clinical outcomes, such as aberrant behavior, prolonged opioid use, higher morphine-equivalent daily dose, greater health care utilization, and symptom burden. IS - 1179-8467 IL - 1179-8467 DO - https://dx.doi.org/10.2147/SAR.S85409 PT - Journal Article PT - Review ID - 10.2147/SAR.S85409 [doi] ID - sar-7-071 [pii] ID - PMC4898427 [pmc] PP - epublish LG - English EP - 20160602 DP - 2016 EZ - 2016/06/23 06:00 DA - 2016/06/23 06:01 DT - 2016/06/23 06:00 YR - 2016 ED - 20160622 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=27330340 <222. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26346210 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Corrigan M AU - Wilson SS AU - Hampton J FA - Corrigan, Megan FA - Wilson, Suprat Saely FA - Hampton, Jeremy IN - Corrigan, Megan. Megan Corrigan, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Department of Pharmacy, Advocate Illinois Masonic Medical Center, Chicago. Suprat Saely Wilson, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist Specialist, Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, MI. Jeremy Hampton, Pharm.D., BCPS, is Clinical Specialist Emergency Medicine, Truman Medical Center, Kansas City, MO, and Clinical Assistant Professor, School of Pharmacy, University of Missouri-Kansas City, Kansas City. IN - Wilson, Suprat Saely. Megan Corrigan, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Department of Pharmacy, Advocate Illinois Masonic Medical Center, Chicago. Suprat Saely Wilson, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist Specialist, Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, MI. Jeremy Hampton, Pharm.D., BCPS, is Clinical Specialist Emergency Medicine, Truman Medical Center, Kansas City, MO, and Clinical Assistant Professor, School of Pharmacy, University of Missouri-Kansas City, Kansas City. IN - Hampton, Jeremy. Megan Corrigan, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist, Department of Pharmacy, Advocate Illinois Masonic Medical Center, Chicago. Suprat Saely Wilson, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacist Specialist, Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, MI. Jeremy Hampton, Pharm.D., BCPS, is Clinical Specialist Emergency Medicine, Truman Medical Center, Kansas City, MO, and Clinical Assistant Professor, School of Pharmacy, University of Missouri-Kansas City, Kansas City. hamptonjp@umkc.edu. TI - Safety and efficacy of intranasally administered medications in the emergency department and prehospital settings. [Review] SO - American Journal of Health-System Pharmacy. 72(18):1544-54, 2015 Sep 15 AS - Am J Health-Syst Pharm. 72(18):1544-54, 2015 Sep 15 NJ - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists VO - 72 IP - 18 PG - 1544-54 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9503023, cbh IO - Am J Health Syst Pharm SB - Index Medicus CP - United States MH - *Administration, Intranasal MH - *Emergency Medical Services MH - *Emergency Service, Hospital MH - Humans MH - *Patient Safety MH - *Treatment Outcome AB - PURPOSE: The safety and efficacy of medications that may be administered via the intranasal route in adult patients in the prehospital and emergency department (ED) settings are reviewed. AB - SUMMARY: When medications of appropriate molecular character and concentration are delivered intranasally, they are quickly transported across this capillary network and delivered to the systemic circulation, thereby avoiding the absorption-limiting effects of first-pass metabolism. Therapeutic drug concentrations are rapidly attained in the cerebrospinal fluid, making intranasal administration a very effective mode of delivery. To optimize the bioavailability of intranasally administered drugs, providers must minimize the barriers to absorption, minimize the volume by maximizing the concentration, maximize the absorptive surface of the nasal mucosa, and use a delivery system that maximizes drug dispersion and minimizes drug runoff. Medications can be instilled into the nasal cavity with syringes or droppers by applying a few drops at a time or via atomization. The intranasal route of administration may be advantageous for patients who require analgesia, sedation, anxiolysis, termination of seizures, hypoglycemia management, narcotic reversal, and benzodiazepine reversal in the ED or prehospital settings. Medications that have been studied in the adult population include fentanyl, sufentanil, hydromorphone, ketamine, midazolam, haloperidol, naloxone, flumazenil, and glucagon. The available data do indicate, however, that intranasal administration may be a safe, effective, and well tolerated route of administration. AB - CONCLUSION: Based on the published literature, intranasal administration of fentanyl, sufentanil, ketamine, hydromorphone, midazolam, haloperidol, naloxone, glucagon, and, in limited cases, flumazenil may be a safe, effective, and well-tolerated alternative to intramuscular or intravenous administration in the prehospital and ED settings. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved. ES - 1535-2900 IL - 1079-2082 DO - https://dx.doi.org/10.2146/ajhp140630 PT - Journal Article PT - Review ID - 72/18/1544 [pii] ID - 10.2146/ajhp140630 [doi] PP - ppublish LG - English DP - 2015 Sep 15 EZ - 2015/09/09 06:00 DA - 2016/06/22 06:00 DT - 2015/09/09 06:00 YR - 2015 ED - 20160621 RD - 20150908 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26346210 <223. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26614581 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shenk E AU - Barton CA AU - Mah ND AU - Ran R AU - Hendrickson RG AU - Watters J FA - Shenk, Eleni FA - Barton, Cassie A FA - Mah, Nathan D FA - Ran, Ran FA - Hendrickson, Robert G FA - Watters, Jennifer IN - Shenk, Eleni. Department of Pharmacy, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239. Electronic address: elenikin@gmail.coma. IN - Barton, Cassie A. Department of Pharmacy, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239. Electronic address: bartonc@ohsu.edu. IN - Mah, Nathan D. Department of Pharmacy, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239. Electronic address: mahn@ohsu.edu. IN - Ran, Ran. Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239. Electronic address: ran@ohsu.edu. IN - Hendrickson, Robert G. Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239. Electronic address: hendriro@ohsu.edu. IN - Watters, Jennifer. Department of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239. Electronic address: wattersj@ohsu.edu. TI - Respiratory depression in the intoxicated trauma patient: are opioids to blame?. SO - American Journal of Emergency Medicine. 34(2):250-3, 2016 Feb AS - Am J Emerg Med. 34(2):250-3, 2016 Feb NJ - The American journal of emergency medicine VO - 34 IP - 2 PG - 250-3 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Ethanol/bl [Blood] MH - Female MH - Glasgow Coma Scale MH - Humans MH - *Hypnotics and Sedatives/tu [Therapeutic Use] MH - Incidence MH - Injury Severity Score MH - Male MH - *Pain Management/mt [Methods] MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Retrospective Studies MH - Risk Factors MH - Trauma Centers MH - *Wounds and Injuries/dt [Drug Therapy] AB - Providing effective pain management to acutely intoxicated trauma patients represents a challenge of balancing appropriate pain management with the risk of potential respiratory depression from opioid administration. The objective of this study was to quantify the incidence of respiratory depression in trauma patients acutely intoxicated with ethanol who received opioids as compared with those who did not and identify potential risk factors for respiratory depression in this population. Retrospective medical record review was conducted for subjects identified via the trauma registry who were admitted as a trauma activation and had a detectable serum ethanol level upon admission. Risk factors and characteristics compared included demographics, Injury Severity Score, Glasgow Coma Score, serum ethanol level upon arrival, urine drug screen results, incidence of respiratory depression, and opioid and other sedative medication use. A total of 233 patients were included (78.5% male). Patients who received opioids were more likely to have a higher Injury Severity Score and initial pain score on admission as compared with those who did not receive opioids. Blood ethanol content was higher in patients who did not receive opioids (0.205 vs 0.237 mg/dL, P = .015). Patients who did not receive opioids were more likely to be intubated within 4 hours of admission (1.7% vs 12.1%, P = .02). Opioid administration was not associated with increased risk of respiratory depression (19.7% vs 22.4%, P = .606). Increased cumulative fentanyl dose was associated with increased risk of respiratory depression. Increased cumulative fentanyl dose, but not opioid administration alone, was found to be a risk factor for respiratory depression. Copyright © 2015 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 3K9958V90M (Ethanol) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(15)00946-8 DO - https://dx.doi.org/10.1016/j.ajem.2015.10.053 PT - Journal Article ID - S0735-6757(15)00946-8 [pii] ID - 10.1016/j.ajem.2015.10.053 [doi] PP - ppublish PH - 2015/09/04 [received] PH - 2015/10/29 [revised] PH - 2015/10/30 [accepted] LG - English EP - 20151109 DP - 2016 Feb EZ - 2015/11/29 06:00 DA - 2016/06/21 06:00 DT - 2015/11/29 06:00 YR - 2016 ED - 20160620 RD - 20160213 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26614581 <224. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26471416 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Okunseri C AU - Dionne RA AU - Gordon SM AU - Okunseri E AU - Szabo A FA - Okunseri, Christopher FA - Dionne, Raymond A FA - Gordon, Sharon M FA - Okunseri, Elaye FA - Szabo, Aniko IN - Okunseri, Christopher. Department of Clinical Services, School of Dentistry, P.O. Box 1881, Marquette University, Milwaukee, WI 53201, United States. Electronic address: christopher.okunseri@marquette.edu. IN - Dionne, Raymond A. Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC 27834, United States; Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States. IN - Gordon, Sharon M. Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC 27834, United States. IN - Okunseri, Elaye. Department of Clinical Services, School of Dentistry, P.O. Box 1881, Marquette University, Milwaukee, WI 53201, United States. IN - Szabo, Aniko. Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, United States. TI - Prescription of opioid analgesics for nontraumatic dental conditions in emergency departments. SO - Drug & Alcohol Dependence. 156:261-266, 2015 Nov 01 AS - Drug Alcohol Depend. 156:261-266, 2015 Nov 01 NJ - Drug and alcohol dependence VO - 156 PG - 261-266 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633355 OI - Source: NLM. NIHMS730897 [Available on 11/01/16] SB - Index Medicus CP - Ireland MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - *Codeine/tu [Therapeutic Use] MH - Cross-Sectional Studies MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Health Care Surveys MH - Humans MH - *Hydrocodone/tu [Therapeutic Use] MH - *Inappropriate Prescribing/sn [Statistics & Numerical Data] MH - Infant MH - Male MH - Middle Aged MH - *Oxycodone/tu [Therapeutic Use] MH - *Tooth Diseases/dt [Drug Therapy] MH - *Toothache/dt [Drug Therapy] MH - United States MH - Young Adult KW - Dental care; Emergency departments; Opioid analgesic drugs AB - BACKGROUND: Opioid analgesics prescribed for nontraumatic dental conditions (NTDCs) by emergency physicians continue to receive attention because of the associated potential for misuse, abuse and addiction. This study examined rates of prescription of opioid analgesics and types of opioid analgesics prescribed for NTDC visits in U.S. emergency departments. AB - METHODS: Data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2010 were analyzed. Descriptive statistics and logistic regression analysis were performed and adjusted for the survey design. AB - RESULTS: NTDCs made up 1.7% of all ED visits from 2007 to 2010. The prescription of opioid analgesics was 50.3% for NTDC and 14.8% for non-NTDC visits. The overall rate of opioid analgesics prescribed for NTDCs remained fairly stable from 2007 through 2010. Prescription of opioids was highest among patients aged 19-33 years (56.8%), self-paying (57.1%), and non-Hispanic Whites (53.2%). The probability of being prescribed hydrocodone was highest among uninsured patients (68.7%) and for oxycodone, it was highest among private insurance patients (33.6%). Compared to 34-52 year olds, children 0-4 years were significantly more likely to be prescribed codeine and less likely to be prescribed oxycodone. Compared to non-Hispanic Whites, non-Hispanic Blacks had significantly higher odds of been prescribed codeine and somewhat lower odds of been prescribed oxycodone, but it was not statistically significant. AB - CONCLUSIONS: There was no significant change in the rates of opioid analgesics prescribed over time for NTDC visits to EDs. Age, payer type and race/ethnicity were significant predictors for the prescription of different opioid analgesics by emergency physicians for NTDC visits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - CD35PMG570 (Oxycodone) RN - Q830PW7520 (Codeine) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(15)01673-7 DO - https://dx.doi.org/10.1016/j.drugalcdep.2015.09.023 PT - Journal Article ID - S0376-8716(15)01673-7 [pii] ID - 10.1016/j.drugalcdep.2015.09.023 [doi] ID - PMC4633355 [pmc] ID - NIHMS730897 [mid] PP - ppublish PH - 2015/08/09 [received] PH - 2015/09/16 [revised] PH - 2015/09/17 [accepted] GI - No: R03 DE024494 Organization: (DE) *NIDCR NIH HHS* Country: United States LG - English EP - 20150928 DP - 2015 Nov 01 EZ - 2015/10/17 06:00 DA - 2016/06/21 06:00 DT - 2015/10/17 06:00 YR - 2015 ED - 20160620 RD - 20171002 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26471416 <225. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26454836 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Maughan BC AU - Bachhuber MA AU - Mitra N AU - Starrels JL FA - Maughan, Brandon C FA - Bachhuber, Marcus A FA - Mitra, Nandita FA - Starrels, Joanna L IN - Maughan, Brandon C. Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: bmaughan@gmail.com. IN - Bachhuber, Marcus A. Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: marcus.bachhuber@gmail.com. IN - Mitra, Nandita. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. Electronic address: nanditam@mail.med.upenn.edu. IN - Starrels, Joanna L. Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: jostarre@montefiore.org. TI - Prescription monitoring programs and emergency department visits involving opioids, 2004-2011. SO - Drug & Alcohol Dependence. 156:282-288, 2015 Nov 01 AS - Drug Alcohol Depend. 156:282-288, 2015 Nov 01 NJ - Drug and alcohol dependence VO - 156 PG - 282-288 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911899 OI - Source: NLM. NIHMS792691 [Available on 11/01/16] SB - Index Medicus CP - Ireland MH - Adolescent MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug and Narcotic Control/sn [Statistics & Numerical Data] MH - Drug and Narcotic Control/td [Trends] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Hospitals, Urban/ut [Utilization] MH - Humans MH - *Inappropriate Prescribing/sn [Statistics & Numerical Data] MH - Inappropriate Prescribing/td [Trends] MH - Male MH - Middle Aged MH - Referral and Consultation/td [Trends] MH - Referral and Consultation/ut [Utilization] MH - *Registries/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - United States MH - Urban Population/sn [Statistics & Numerical Data] MH - Utilization Review MH - Young Adult KW - Emergency departments; Opioids; Prescription drug abuse; Prescription drug monitoring programs AB - OBJECTIVE: To determine the association between prescription drug monitoring program (PDMP) implementation and emergency department (ED) visits involving opioid analgesics. AB - METHODS: Rates of ED visits involving opioid analgesics per 100,000 residents were estimated from the Drug Abuse Warning Network dataset for 11 geographically diverse metropolitan areas in the United States on a quarterly basis from 2004 to 2011. Generalized estimating equations assessed whether implementation of a prescriber-accessible PDMP was associated with a difference in ED visits involving opioid analgesics. Models were adjusted for calendar quarter, metropolitan area, metropolitan area-specific linear time trends, and unemployment rate. AB - RESULTS: Rates of ED visits involving opioid analgesics increased in all metropolitan areas. PDMP implementation was not associated with a difference in ED visits involving opioid analgesics (mean difference of 0.8 visits [95% CI: -3.7 to 5.2] per 100,000 residents per quarter). AB - CONCLUSIONS: During 2004-2011, PDMP implementation was not associated with a change in opioid-related morbidity, as measured by emergency department visits involving opioid analgesics. Urgent investigation is needed to determine the optimal PDMP structure and capabilities to improve opioid analgesic safety. Copyright Published by Elsevier Ireland Ltd. RN - 0 (Analgesics, Opioid) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(15)01674-9 DO - https://dx.doi.org/10.1016/j.drugalcdep.2015.09.024 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - S0376-8716(15)01674-9 [pii] ID - 10.1016/j.drugalcdep.2015.09.024 [doi] ID - PMC4911899 [pmc] ID - NIHMS792691 [mid] PP - ppublish PH - 2015/05/25 [received] PH - 2015/09/04 [revised] PH - 2015/09/22 [accepted] GI - No: K23 DA027719 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K23DA027719 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20150930 DP - 2015 Nov 01 EZ - 2015/10/12 06:00 DA - 2016/06/21 06:00 DT - 2015/10/12 06:00 YR - 2015 ED - 20160620 RD - 20171002 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26454836 <226. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25658022 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Singh JM AU - MacDonald RD AU - Ahghari M FA - Singh, Jeffrey M FA - MacDonald, Russell D FA - Ahghari, Mahvareh TI - Post-medication Hypotension after Administration of Sedatives and Opioids during Critical Care Transport. SO - Prehospital Emergency Care. 19(4):464-74, 2015 AS - Prehosp Emerg Care. 19(4):464-74, 2015 NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 19 IP - 4 PG - 464-74 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adult MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Cohort Studies MH - Confidence Intervals MH - Critical Care/mt [Methods] MH - Critical Illness/mo [Mortality] MH - Critical Illness/th [Therapy] MH - Drug Therapy, Combination MH - Emergency Medical Services/mt [Methods] MH - Female MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - *Hypnotics and Sedatives/ae [Adverse Effects] MH - *Hypotension/ci [Chemically Induced] MH - Hypotension/ep [Epidemiology] MH - Hypotension/pp [Physiopathology] MH - Male MH - Middle Aged MH - Odds Ratio MH - Ontario MH - Propensity Score MH - Retrospective Studies MH - Risk Assessment MH - Survival Rate MH - *Transportation of Patients/mt [Methods] MH - Treatment Outcome MH - Young Adult KW - adverse event; critical event; patient safety; patient transport AB - OBJECTIVE: Identification of modifiable risk factors for hypotension during critical care transport is important to optimize patient preparation, crew training, and patient safety. We set out to determine the incidence of hemodynamic deterioration after administration of opioids or sedatives during critical care transport, and identify patient- and transport-level predictors. AB - METHODS: We assembled a retrospective cohort of adults undergoing urgent critical care transport between January 1, 2005, and December 31, 2010. The primary outcome was post-medication hypotension, defined by new hypotension or new vasopressor within 10 minutes of medication administration. AB - RESULTS: Opioids or sedatives were administered 28,592 times in 8,328 patient transports, with 159 episodes of post-medication hypotension (0.6% of all medication administrations). Mechanical ventilation (adjusted odds ratio [OR] 4.9; 95% confidence interval [95%CI] 2.7-8.9), baseline vasopressor requirement (adjusted OR 2.1; 95%CI 1.3-3.4), transport duration (adjusted OR 1.5; 95%CI 1.1-2.2) per log unit increment of duration), surgical diagnosis (adjusted OR 4.1; 95%CI 1.6-10.7 compared to trauma), and ACP crew level (adjusted OR 2.4 compared to baseline of CCP; 95%CI 1.5-3.8) were all associated with an increased odds of post-medication hypotension. ACP crew level remained associated with increased post-medication hypotension in a sensitivity analysis of 1,242 propensity-matched pairs (crude OR for ACP vs. CCP 3.0; 95%CI 1.4-6.5). AB - CONCLUSIONS: Post-medication hypotension occurred once in every 160 drug administrations and was associated with mechanical ventilation, baseline hemodynamic instability, transport duration, surgical diagnosis, and ACP crew. These findings provide targets for improvements in patient preparation, crew training, and clinical practices. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2014.995848 PT - Comparative Study PT - Journal Article ID - 10.3109/10903127.2014.995848 [doi] PP - ppublish LG - English EP - 20150206 DP - 2015 EZ - 2015/02/07 06:00 DA - 2016/06/21 06:00 DT - 2015/02/07 06:00 YR - 2015 ED - 20160620 RD - 20150912 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25658022 <227. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27313804 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Varney SM AU - Bebarta VS AU - Mannina LM AU - Ramos RG AU - Ganem VJ AU - Carey KR FA - Varney, Shawn M FA - Bebarta, Vikhyat S FA - Mannina, Lisa M FA - Ramos, Rosemarie G FA - Ganem, Victoria J FA - Carey, Katherine R IN - Varney, Shawn M. Department of Emergency Medicine, University of Texas Health Science Center, San Antonio 78229, USA. IN - Bebarta, Vikhyat S. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora 80045, USA. IN - Mannina, Lisa M. Department of Emergency Medicine, Mike O'Callaghan Federal Medical Center, Nellis 89191, USA. IN - Ramos, Rosemarie G. Department of Emergency Medicine, University of Texas Health Science Center, San Antonio 78229, USA. IN - Ganem, Victoria J. Air Force Enroute Care Research Center, Fort Sam Houston 78208, USA; The Geneva Foundation, Tacoma 98402, USA. IN - Carey, Katherine R. The Geneva Foundation, Tacoma 98402, USA. TI - Emergency medicine providers' opioid prescribing practices stratified by gender, age, and years in practice. SO - World journal of emergency medicine. 7(2):106-10, 2016 AS - World J Emerg Med. 7(2):106-10, 2016 NJ - World journal of emergency medicine VO - 7 IP - 2 PG - 106-10 PI - Journal available in: Print PI - Citation processed from: Print JC - 101549691 IO - World J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905865 CP - China KW - Emergency medicine provider; Prescribing practices; Prescription opioid misuse AB - BACKGROUND: Emergency medicine providers (EMPs) prescribe about 25% of opioids, but the effect of EMP risk perception on decisions to prescribe opioids is unknown. This study was undertaken to identify factors that influence EMP risk and opioid prescribing practices. AB - METHODS: We distributed an anonymous questionnaire to EMPs at a military trauma and referral center. Response frequencies and distributions were assessed for independence using the Chi-square test. AB - RESULTS: Eighty-nine EMPs completed the questionnaire (100% response). Respondents were primarily younger male physicians (80%) in practice under five years (55%). Male EMPs were more likely to prescribe more opioid tablets than female ones both when and when not concerned for opioid misuse (P<0.001, P<0.007, respectively). Of the providers, 70% stated that patient age would influence their prescribing decisions. Hydrocodone and oxycodone were the opioids prescribed most frequently. About 60% of the providers reported changing their prescribing behavior would not prevent opioid misuse. Additionally, 40% of the providers believed at least 10% of patients seen at this military ED misused opioids. AB - CONCLUSION: Female EM providers reported prescribing fewer opioid tablets. Patient age influenced prescribing behavior, but the effect is unknown. Finally, EM providers reported that altering their prescribing behavior would not prevent prescription opioid misuse. IS - 1920-8642 DO - https://dx.doi.org/10.5847/wjem.j.1920-8642.2016.02.004 PT - Journal Article ID - 10.5847/wjem.j.1920-8642.2016.02.004 [doi] ID - WJEM-7-106 [pii] ID - PMC4905865 [pmc] PP - ppublish LG - English DP - 2016 EZ - 2016/06/18 06:00 DA - 2016/06/18 06:01 DT - 2016/06/18 06:00 YR - 2016 ED - 20160617 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=27313804 <228. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27120853 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Drennan IR AU - Orkin AM FA - Drennan, Ian R FA - Orkin, Aaron M TI - OPIOID CRISIS. Prehospital naloxone administration for opioid-related emergencies. SO - Journal of Emergency Medical Services. 41(3):36-9, 2016 Mar AS - J Emerg Med Serv JEMS. 41(3):36-9, 2016 Mar NJ - JEMS : a journal of emergency medical services VO - 41 IP - 3 PG - 36-9 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - Emergency Medical Services MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Naloxone/pd [Pharmacology] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/pd [Pharmacology] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - United States RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 PT - Journal Article PP - ppublish LG - English DP - 2016 Mar EZ - 2016/04/29 06:00 DA - 2016/06/16 06:00 DT - 2016/04/29 06:00 YR - 2016 ED - 20160615 RD - 20160428 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27120853 <229. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27303080 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Walczyk H AU - Liu CH AU - Alafris A AU - Cohen H FA - Walczyk, Heather FA - Liu, Cheuk H Michael FA - Alafris, Antonia FA - Cohen, Henry TI - Probable Tapentadol-Associated Serotonin Syndrome After Overdose. SO - Hospital Pharmacy. 51(4):320-7, 2016 Apr AS - Hosp Pharm. 51(4):320-7, 2016 Apr NJ - Hospital pharmacy VO - 51 IP - 4 PG - 320-7 PI - Journal available in: Print PI - Citation processed from: Print JC - g98, 0043175 IO - Hosp Pharm PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896335 CP - United States KW - serotonin syndrome; tapentadol AB - PURPOSE: Drug-induced serotonin syndrome is a potentially life-threatening condition. An Ovid MEDLINE, and PubMed search from 1950 to October 2015 revealed one published case report of suspected tapentadol-induced serotonin syndrome. We report a probable case of tapentadol-induced serotonin syndrome after overdose. AB - CASE SUMMARY: A 48-year-old male was found unresponsive after a witnessed overdose of medications including tapentadol. After administration of naloxone by emergency medical services, the patient became combative and presented with altered mental status. He was managed with physical and pharmacologic restraints in the emergency department. Other medications that could be implicated in the patient's presentation include duloxetine and amitriptyline. It was suspected that the opioid properties of tapentadol were masking the patient's signs and symptoms of serotonin syndrome. The patient was admitted to the medical intensive care unit, remained stable, and was discharged 2 days later. Currently, there is one published case report of suspected tapentadol-induced serotonin syndrome after an overdose. The manufacturer of tapentadol reported no cases of serotonin syndrome during clinical trials, but there have been postmarketing cases reported with co-administration of other serotonergic drugs. AB - CONCLUSION: We report a probable case of tapentadol-induced serotonin syndrome after overdose. Further research is needed to better understand the pharmacology and incidence behind this adverse event. IS - 0018-5787 IL - 0018-5787 DO - https://dx.doi.org/10.1310/hpj5104-320 PT - Journal Article ID - 10.1310/hpj5104-320 [doi] ID - PMC4896335 [pmc] PP - ppublish LG - English DP - 2016 Apr EZ - 2016/06/16 06:00 DA - 2016/06/16 06:01 DT - 2016/06/16 06:00 YR - 2016 ED - 20160615 RD - 20170403 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=27303080 <230. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26553282 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Genco EK AU - Forster JE AU - Flaten H AU - Goss F AU - Heard KJ AU - Hoppe J AU - Monte AA FA - Genco, Emma K FA - Forster, Jeri E FA - Flaten, Hanna FA - Goss, Foster FA - Heard, Kennon J FA - Hoppe, Jason FA - Monte, Andrew A IN - Genco, Emma K. Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO. Electronic address: emma.genco@ucdenver.edu. IN - Forster, Jeri E. Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO; VA VISN 19 Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO. IN - Flaten, Hanna. Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO. IN - Goss, Foster. Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO. IN - Heard, Kennon J. Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO. IN - Hoppe, Jason. Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO. IN - Monte, Andrew A. Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO. TI - Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department. SO - Annals of Emergency Medicine. 67(2):240-248.e3, 2016 Feb AS - Ann Emerg Med. 67(2):240-248.e3, 2016 Feb NJ - Annals of emergency medicine VO - 67 IP - 2 PG - 240-248.e3 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955849 OI - Source: NLM. NIHMS799495 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Adverse Drug Reaction Reporting Systems MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Decision Support Systems, Clinical MH - *Drug-Related Side Effects and Adverse Reactions/pc [Prevention & Control] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Medication Errors/pc [Prevention & Control] MH - Middle Aged MH - *Pharmacovigilance MH - Retrospective Studies AB - STUDY OBJECTIVE: We examine the characteristics of clinical decision support alerts triggered when opioids are prescribed, including alert type, override rates, adverse drug events associated with opioids, and preventable adverse drug events. AB - METHODS: This was a retrospective chart review study assessing adverse drug event occurrences for emergency department (ED) visits in a large urban academic medical center using a commercial electronic health record system with clinical decision support. Participants include those aged 18 to 89 years who arrived to the ED every fifth day between September 2012 and January 2013. The main outcome was characteristics of opioid drug alerts, including alert type, override rates, opioid-related adverse drug events, and adverse drug event preventability by clinical decision support. AB - RESULTS: Opioid drug alerts were more likely to be overridden than nonopioid alerts (relative risk 1.35; 95% confidence interval [CI] 1.21 to 1.50). Opioid drug-allergy alerts were twice as likely to be overridden (relative risk 2.24; 95% CI 1.74 to 2.89). Opioid duplicate therapy alerts were 1.57 times as likely to be overridden (95% CI 1.30 to 1.89). Fourteen of 4,581 patients experienced an adverse drug event (0.31%; 95% CI 0.15% to 0.47%), and 8 were due to opioids (57.1%). None of the adverse drug events were preventable by clinical decision support. However, 46 alerts were accepted for 38 patients that averted a potential adverse drug event. Overall, 98.9% of opioid alerts did not result in an actual or averted adverse drug event, and 96.3% of opioid alerts were overridden. AB - CONCLUSION: Overridden opioid alerts did not result in adverse drug events. Clinical decision support successfully prevented adverse drug events at the expense of generating a large volume of inconsequential alerts. To prevent 1 adverse drug event, providers dealt with more than 123 unnecessary alerts. It is essential to refine clinical decision support alerting systems to eliminate inconsequential alerts to prevent alert fatigue and maintain patient safety. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(15)01308-6 DO - https://dx.doi.org/10.1016/j.annemergmed.2015.09.020 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0196-0644(15)01308-6 [pii] ID - 10.1016/j.annemergmed.2015.09.020 [doi] ID - PMC4955849 [pmc] ID - NIHMS799495 [mid] PP - ppublish PH - 2015/06/17 [received] PH - 2015/09/10 [revised] PH - 2015/09/17 [accepted] GI - No: K23 GM110516 Organization: (GM) *NIGMS NIH HHS* Country: United States GI - No: R35 GM124939 Organization: (GM) *NIGMS NIH HHS* Country: United States GI - No: UL1 TR000154 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English EP - 20151106 DP - 2016 Feb EZ - 2015/11/11 06:00 DA - 2016/06/03 06:00 DT - 2015/11/11 06:00 YR - 2016 ED - 20160602 RD - 20171222 UP - 20171226 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=26553282 <231. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27180399 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Stempniak M FA - Stempniak, Marty TI - The Opioid Epidemic. SO - Hospitals & Health Networks. 90(3):22-4, 26-9, 2016 Mar AS - Hosp Health Netw. 90(3):22-4, 26-9, 2016 Mar NJ - Hospitals & health networks VO - 90 IP - 3 PG - 22-4, 26-9 PI - Journal available in: Print PI - Citation processed from: Print JC - bsq, 9312077 IO - Hosp Health Netw SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Awareness MH - Clinical Protocols MH - *Drug Overdose/ep [Epidemiology] MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/pc [Prevention & Control] MH - Emergency Service, Hospital/og [Organization & Administration] MH - Humans MH - Mass Screening MH - Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/mo [Mortality] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Practice Patterns, Physicians' MH - Primary Health Care/og [Organization & Administration] MH - Risk Factors RN - 0 (Analgesics, Opioid) IS - 1068-8838 IL - 1068-8838 PT - Journal Article PP - ppublish LG - English DP - 2016 Mar EZ - 2016/05/18 06:00 DA - 2016/06/03 06:00 DT - 2016/05/17 06:00 YR - 2016 ED - 20160602 RD - 20161018 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=27180399 <232. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26246148 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Meisel ZF AU - Smith RJ FA - Meisel, Zachary F FA - Smith, Robert J IN - Meisel, Zachary F. Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Ravdin Ground, 3400 Spruce St, Philadelphia, PA 19104, USA. IN - Meisel, Zachary F. Leonard Davis Institute of Health Economics, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, PA 19104, USA. IN - Smith, Robert J. Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Ravdin Ground, 3400 Spruce St, Philadelphia, PA 19104, USA. TI - Engaging patients around the risks of opioid misuse in the emergency department. SO - Pain Management. 5(5):323-6, 2015 Sep AS - Pain manag.. 5(5):323-6, 2015 Sep NJ - Pain management VO - 5 IP - 5 PG - 323-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101555934 IO - Pain Manag SB - Index Medicus CP - England MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Emergency Service, Hospital MH - Humans MH - *Pain Management MH - *Prescription Drug Misuse MH - Risk Factors KW - analgesic alternatives; emergency department; opioid misuse; pain management; patient engagement RN - 0 (Analgesics, Opioid) ES - 1758-1877 IL - 1758-1869 DO - https://dx.doi.org/10.2217/pmt.15.31 PT - Editorial PT - Research Support, U.S. Gov't, P.H.S. ID - 10.2217/pmt.15.31 [doi] PP - ppublish GI - No: P30 DA040500 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R18 HS021956 Organization: (HS) *AHRQ HHS* Country: United States LG - English EP - 20150806 DP - 2015 Sep EZ - 2015/08/08 06:00 DA - 2016/06/01 06:00 DT - 2015/08/07 06:00 YR - 2015 ED - 20160531 RD - 20170922 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26246148 <233. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26522794 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kuo YF AU - Raji MA AU - Chen NW AU - Hasan H AU - Goodwin JS FA - Kuo, Yong-Fang FA - Raji, Mukaila A FA - Chen, Nai-Wei FA - Hasan, Hunaid FA - Goodwin, James S IN - Kuo, Yong-Fang. Department of Internal Medicine, The University of Texas Medical Branch, Galveston; Sealy Center on Aging, The University of Texas Medical Branch, Galveston; Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston; Institute for Translational Science, The University of Texas Medical Branch, Galveston. Electronic address: yokuo@utmb.edu. IN - Raji, Mukaila A. Department of Internal Medicine, The University of Texas Medical Branch, Galveston; Sealy Center on Aging, The University of Texas Medical Branch, Galveston. IN - Chen, Nai-Wei. Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston. IN - Hasan, Hunaid. Department of Internal Medicine, The University of Texas Medical Branch, Galveston. IN - Goodwin, James S. Department of Internal Medicine, The University of Texas Medical Branch, Galveston; Sealy Center on Aging, The University of Texas Medical Branch, Galveston; Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston; Institute for Translational Science, The University of Texas Medical Branch, Galveston. TI - Trends in Opioid Prescriptions Among Part D Medicare Recipients From 2007 to 2012.[Erratum appears in Am J Med. 2017 May;130(5):615-616; PMID: 28431672] SO - American Journal of Medicine. 129(2):221.e21-30, 2016 Feb AS - Am J Med. 129(2):221.e21-30, 2016 Feb NJ - The American journal of medicine VO - 129 IP - 2 PG - 221.e21-30 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 0267200, 3ju IO - Am. J. Med. PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718856 OI - Source: NLM. NIHMS741262 [Available on 02/01/17] SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Aged MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Analgesics, Opioid MH - Chronic Pain/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - *Medicare Part D MH - *Pain Management/td [Trends] MH - *Practice Patterns, Physicians'/td [Trends] MH - Risk Factors MH - United States/ep [Epidemiology] KW - Medicare; Opioid; Overdose; Regulations AB - BACKGROUND: There is growing concern about potential overuse of, and toxicity from, opioid analgesics. No nationally representative study has examined inter-state variations in opioid use and impact of policy on opioid use among older adults. AB - METHODS: We used national Medicare data from 2007-2012 to assess temporal and geographic trends in rates of opioid prescription and relationship to opioid toxicity and different state regulations in Part D Medicare recipients. We excluded those with a cancer diagnosis. Multilevel, multivariable regression analyses evaluated rates of prolonged prescriptions for schedule II, schedule III, and combination II/III opioid for each state, adjusting for patient characteristics. AB - RESULTS: The percent of Part D recipients receiving prescriptions for combined schedule II/III opioid more than 90 days in a year increased from 4.62% in 2007 to 7.35% in 2012. Large variations existed among states in rates of opioid prescriptions: from 2.84% in New York to 10.93% in Utah, in 2012 data. The state variation was larger for schedule III than schedule II. Individual characteristics independently associated with prolonged use included older age, female gender, white race, low income, living in a lower-education area, and comorbidity of drug abuse, rheumatoid arthritis, and depression. Only state law regulating pain clinic was associated with reduction of schedule II opioid prescriptions. Prolonged opioid prescription use increased the odds of opioid overdose-related emergency room visits or hospitalization by 60%. AB - CONCLUSIONS: Analyses of Medicare Part D data demonstrated a substantial growth in opioid prescriptions from 2007 to 2011 and large variation in opioid prescriptions across states. Copyright © 2016 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1555-7162 IL - 0002-9343 DI - S0002-9343(15)00999-7 DO - https://dx.doi.org/10.1016/j.amjmed.2015.10.002 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. ID - S0002-9343(15)00999-7 [pii] ID - 10.1016/j.amjmed.2015.10.002 [doi] ID - PMC4718856 [pmc] ID - NIHMS741262 [mid] PP - ppublish PH - 2015/05/13 [received] PH - 2015/10/08 [revised] PH - 2015/10/10 [accepted] GI - No: R01-AG033134 Organization: (AG) *NIA NIH HHS* Country: United States GI - No: R24 HS022134 Organization: (HS) *AHRQ HHS* Country: United States GI - No: UL1TR001439 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: R24-HS022134 Organization: (HS) *AHRQ HHS* Country: United States GI - No: R01 AG033134 Organization: (AG) *NIA NIH HHS* Country: United States GI - No: P30 AG024832 Organization: (AG) *NIA NIH HHS* Country: United States GI - No: UL1 TR001439 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: P30-AG024832 Organization: (AG) *NIA NIH HHS* Country: United States LG - English EP - 20151111 DP - 2016 Feb EZ - 2015/11/03 06:00 DA - 2016/05/21 06:00 DT - 2015/11/03 06:00 YR - 2016 ED - 20160520 RD - 20171128 UP - 20171129 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=26522794 <234. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 27199787 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Ghitza UE FA - Ghitza, Udi E IN - Ghitza, Udi E. U.S. Department of Health and Human Services (HHS), Center for the Clinical Trials Network (CCTN), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) , Bethesda, MD , USA. TI - Overlapping Mechanisms of Stress-Induced Relapse to Opioid Use Disorder and Chronic Pain: Clinical Implications. [Review] SO - Frontiers in psychiatry Frontiers Research Foundation. 7:80, 2016 AS - Front Psychiatr. 7:80, 2016 NJ - Frontiers in psychiatry VO - 7 PG - 80 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Print JC - 101545006 IO - Front Psychiatry PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852181 CP - Switzerland KW - addiction; addiction treatment; chronic pain; opiate addiction; opiate dependence; opioid dependence; substance use disorder; substance use disorders AB - Over the past two decades, a steeply growing number of persons with chronic non-cancer pain have been using opioid analgesics chronically to treat it, accompanied by a markedly increased prevalence of individuals with opioid-related misuse, opioid use disorders, emergency department visits, hospitalizations, admissions to drug treatment programs, and drug overdose deaths. This opioid misuse and overdose epidemic calls for well-designed randomized-controlled clinical trials into more skillful and appropriate pain management and for developing effective analgesics that have lower abuse liability and are protective against stress induced by chronic non-cancer pain. However, incomplete knowledge regarding effective approaches to treat various types of pain has been worsened by an under-appreciation of overlapping neurobiological mechanisms of stress, stress-induced relapse to opioid use, and chronic non-cancer pain in patients presenting for care for these conditions. This insufficient knowledge base has unfortunately encouraged common prescription of conveniently available opioid pain-relieving drugs with abuse liability, as opposed to treating underlying problems using team-based multidisciplinary, patient-centered, collaborative-care approaches for addressing pain and co-occurring stress and risk for opioid use disorder. This paper reviews recent neurobiological findings regarding overlapping mechanisms of stress-induced relapse to opioid misuse and chronic non-cancer pain, and then discusses these in the context of key outstanding evidence gaps and clinical-treatment research directions that may be pursued to fill these gaps. Such research directions, if conducted through well-designed randomized-controlled trials, may substantively inform clinical practice in general medical settings on how to effectively care for patients presenting with pain-related distress and these common co-occurring conditions. IS - 1664-0640 IL - 1664-0640 DO - https://dx.doi.org/10.3389/fpsyt.2016.00080 PT - Journal Article PT - Review ID - 10.3389/fpsyt.2016.00080 [doi] ID - PMC4852181 [pmc] PP - epublish PH - 2016/03/15 [received] PH - 2016/04/18 [accepted] LG - English EP - 20160502 DP - 2016 EZ - 2016/05/21 06:00 DA - 2016/05/21 06:01 DT - 2016/05/21 06:00 YR - 2016 ED - 20160520 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=27199787 <235. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25889173 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ellis JJ AU - Sadosky AB AU - Ten Eyck LL AU - Mudumby P AU - Cappelleri JC AU - Ndehi L AU - Suehs BT AU - Parsons B FA - Ellis, Jeffrey J FA - Sadosky, Alesia B FA - Ten Eyck, Laura L FA - Mudumby, Pallavi FA - Cappelleri, Joseph C FA - Ndehi, Lilian FA - Suehs, Brandon T FA - Parsons, Bruce IN - Ellis, Jeffrey J. Comprehensive Health Insights Inc., 325 West Main Street WFP6W, Louisville, KY, 40202, USA. jellis21@humana.com. IN - Sadosky, Alesia B. Pfizer Inc., 235 East 42nd Street, NewYork, NY, 10017, USA. Alesia.Sadosky@pfizer.com. IN - Ten Eyck, Laura L. Formerly of Comprehensive Health Insights Inc., 325 West Main Street WFP6W, Louisville, KY, 40202, USA. lten_eyck@humana.com. IN - Mudumby, Pallavi. Comprehensive Health Insights Inc., 325 West Main Street WFP6W, Louisville, KY, 40202, USA. pmudumby@humana.com. IN - Cappelleri, Joseph C. Pfizer Inc., 235 East 42nd Street, NewYork, NY, 10017, USA. joseph.c.cappelleri@pfizer.com. IN - Ndehi, Lilian. Humana Inc., 323 West Main Street WFP-05C, Louisville, KY, 40202, USA. lndehi@humana.com. IN - Suehs, Brandon T. Comprehensive Health Insights Inc., 325 West Main Street WFP6W, Louisville, KY, 40202, USA. bsuehs6@humana.com. IN - Parsons, Bruce. Pfizer Inc., 235 East 42nd Street, NewYork, NY, 10017, USA. Bruce.Parsons@pfizer.com. TI - A retrospective, matched cohort study of potential drug-drug interaction prevalence and opioid utilization in a diabetic peripheral neuropathy population initiated on pregabalin or duloxetine. SO - BMC Health Services Research. 15:159, 2015 Apr 15 AS - BMC Health Serv Res. 15:159, 2015 Apr 15 NJ - BMC health services research VO - 15 PG - 159 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101088677 IO - BMC Health Serv Res PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422427 SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Analgesics, Opioid/ec [Economics] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cohort Studies MH - *Diabetic Neuropathies/dt [Drug Therapy] MH - Diabetic Neuropathies/ec [Economics] MH - *Drug Interactions MH - Duloxetine Hydrochloride/ec [Economics] MH - *Duloxetine Hydrochloride/tu [Therapeutic Use] MH - Female MH - Humans MH - Male MH - Medicare Part C/ec [Economics] MH - Middle Aged MH - *Pain/dt [Drug Therapy] MH - Pregabalin/ec [Economics] MH - *Pregabalin/tu [Therapeutic Use] MH - Prescription Drugs/ec [Economics] MH - *Prescription Drugs/tu [Therapeutic Use] MH - Prevalence MH - Retrospective Studies MH - United States MH - Young Adult AB - BACKGROUND: Anticipating and controlling drug-drug interactions (DDIs) in older patients with painful diabetic peripheral neuropaty (pDPN) presents a significant challenge to providers. The purpose of this study was to examine the impact of newly initiated pregabalin or duloxetine treatment on Medicare Advantage Prescription Drug (MAPD) plan pDPN patients' encounters with potential drug-drug interactions, the healthcare cost and utilization consequences of those interactions, and opioid utilization. AB - METHODS: Study subjects required a pregabalin or duloxetine pharmacy claim between 07/01/2008-06/30/2012 (index event), >=1 inpatient or >=2 outpatient medical claims with pDPN diagnosis between 01/01/2008-12/31/2012, and >=12 months pre- and >=6 post-index enrollment. Propensity score matching was used to balance the pregabalin and duloxetine cohorts on pre-index demographics and comorbidities. Potential DDIs were defined by Micromedex 2.0 and identified by prescription claims. Six-month post-index healthcare utilization (HCU) and costs were calculated using pharmacy and medical claims. AB - RESULTS: No significant differences in pre-index demographics or comorbidities were found between pregabalin subjects (n=446) and duloxetine subjects (n=446). Potential DDI prevalence was significantly greater (p<0.0001) among duoxetine subjects (56.7%) than among pregabalin subjects (2.9%). There were no significant differences in HCU or costs between pregablin subjects with and without a potential DDI. By contrast, duloxetine subjects with a potential DDI had higher mean all-cause costs ($13,908 vs. $9,830; p=0.001), more subjects with >=1 inpatient visits (35.6% vs 25.4%; p=0.02), and more subjects with >=1 emergency room visits (32.8% vs. 20.7%; p=0.005) in comparison to duloxetine subjects without a potential DDI. There was a trend toward a difference between pregabalin and duloxetine subjects in their respective pre-versus-post differences in milligrams (mg) of morphine equivalents/30 days used (60.2 mg and 176.9 mg, respectively; p=0.058). AB - CONCLUSION: The significantly higher prevalence of potential DDIs and potential cost impact found in pDPN duloxetine users, relative to pregabalin users, underscore the importance of considering DDIs when selecting a treatment. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) RN - 55JG375S6M (Pregabalin) RN - 9044SC542W (Duloxetine Hydrochloride) ES - 1472-6963 IL - 1472-6963 DO - https://dx.doi.org/10.1186/s12913-015-0829-9 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1186/s12913-015-0829-9 [doi] ID - 10.1186/s12913-015-0829-9 [pii] ID - PMC4422427 [pmc] PP - epublish PH - 2014/05/18 [received] PH - 2015/03/30 [accepted] LG - English EP - 20150415 DP - 2015 Apr 15 EZ - 2015/04/19 06:00 DA - 2016/05/18 06:00 DT - 2015/04/19 06:00 YR - 2015 ED - 20160516 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25889173 <236. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26552691 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Losvik OK AU - Murad MK AU - Skjerve E AU - Husum H FA - Losvik, Ole Kristian FA - Murad, Mudhafar Kareem FA - Skjerve, Eystein FA - Husum, Hans IN - Losvik, Ole Kristian. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, PO Box 6050 Langnes, Tromso, 9037, Norway. losvik@gmail.com. IN - Losvik, Ole Kristian. Tromso Mine Victim Resource Centre, University Hospital of North Norway, PO Box 80, Tromso, 9038, Norway. losvik@gmail.com. IN - Murad, Mudhafar Kareem. Trauma Care Foundation Iraq, Sulaymaniyah, Iraq. tcfiraq@yahoo.com. IN - Skjerve, Eystein. Norwegian University of Life Sciences, As, Norway. eystein.skjerve@nmbu.no. IN - Husum, Hans. Tromso Mine Victim Resource Centre, University Hospital of North Norway, PO Box 80, Tromso, 9038, Norway. husumhans@gmail.com. TI - Ketamine for prehospital trauma analgesia in a low-resource rural trauma system: a retrospective comparative study of ketamine and opioid analgesia in a ten-year cohort in Iraq. SO - Scandinavian Journal of Trauma, Resuscitation & Emergency Medicine. 23:94, 2015 Nov 09 AS - Scand J Trauma Resusc Emerg Med. 23:94, 2015 Nov 09 NJ - Scandinavian journal of trauma, resuscitation and emergency medicine VO - 23 PG - 94 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101477511 IO - Scand J Trauma Resusc Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640304 SB - Index Medicus CP - England MH - Adult MH - Analgesia/mt [Methods] MH - Analgesics/ad [Administration & Dosage] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Cohort Studies MH - *Emergency Medical Services/mt [Methods] MH - Female MH - Follow-Up Studies MH - Humans MH - Iraq MH - *Ketamine/ad [Administration & Dosage] MH - Male MH - Pain Management/mt [Methods] MH - Pain Measurement MH - Patient Safety MH - Retrospective Studies MH - Risk Assessment MH - Survival Rate MH - Time Factors MH - Trauma Severity Indices MH - Treatment Outcome MH - *Wounds and Injuries/di [Diagnosis] MH - *Wounds and Injuries/dt [Drug Therapy] MH - Wounds and Injuries/mo [Mortality] MH - Young Adult AB - BACKGROUND: Opioid analgesics are used in most trauma systems, and only a few studies report on the use of ketamine for prehospital analgesia. In a low-cost rural trauma system in Iraq paramedics have been using prehospital ketamine analgesia for ten years. This study aims to evaluate the effects of prehospital analgesia on physiologic trauma severity indicators and compare the effect of ketamine and pentazocine on those indicators. AB - METHODS: The investigation was conducted as a retrospective cohort study with parallel group design. Three subsamples of trauma patients were compared: no analgesia (n=275), pentazocine analgesia (n=888), and ketamine analgesia (n=713). Physiologic severity scores were calculated based on rated values for respiratory rate, blood pressure, and consciousness. The associations between outcomes and explanatory variables were assessed using a generalized linear model. AB - RESULTS: Paramedic administration of analgesia was associated with a better physiologic severity score (PSS) outcome (p=0.01). In the two subsamples receiving analgesia significantly better outcomes were observed for respiration (p<0.0001) and systolic blood pressure (p<0.0001). In patients with Injury Severity Score >8 ketamine was associated with a significantly better effect on the systolic blood pressure compared to opioid analgesia (p=0.03). AB - CONCLUSION: Prehospital analgesia for trauma victims improves physiologic severity indicators in a low-resource trauma system. Compared to pentazocine, ketamine was associated with improved blood pressure for patients with serious injuries. In a low-resource setting, ketamine seems to be a good choice for prehospital analgesia in trauma patients. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) RN - 690G0D6V8H (Ketamine) ES - 1757-7241 IL - 1757-7241 DO - https://dx.doi.org/10.1186/s13049-015-0176-1 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1186/s13049-015-0176-1 [doi] ID - 10.1186/s13049-015-0176-1 [pii] ID - PMC4640304 [pmc] PP - epublish PH - 2015/04/19 [received] PH - 2015/11/03 [accepted] LG - English EP - 20151109 DP - 2015 Nov 09 EZ - 2015/11/11 06:00 DA - 2016/05/14 06:00 DT - 2015/11/11 06:00 YR - 2015 ED - 20160513 RD - 20151112 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26552691 <237. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26731032 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Guay J AU - Kopp S FA - Guay, Joanne FA - Kopp, Sandra IN - Guay, Joanne. Department of Anesthesiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada. TI - Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. [Review][Update of Cochrane Database Syst Rev. 2012;(7):CD005059; PMID: 22786494] SO - Cochrane Database of Systematic Reviews. (1):CD005059, 2016 Jan 05 AS - Cochrane Database Syst Rev. (1):CD005059, 2016 Jan 05 NJ - The Cochrane database of systematic reviews IP - 1 PG - CD005059 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100909747 IO - Cochrane Database Syst Rev SB - Index Medicus CP - England MH - Adult MH - Aged MH - Analgesia, Epidural/ae [Adverse Effects] MH - *Analgesia, Epidural/mt [Methods] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Aorta, Abdominal/su [Surgery] MH - Cause of Death MH - Humans MH - Intubation, Intratracheal/sn [Statistics & Numerical Data] MH - Middle Aged MH - Myocardial Infarction/pc [Prevention & Control] MH - Pain Management/mt [Methods] MH - Pain Measurement MH - *Pain, Postoperative/pc [Prevention & Control] MH - Postoperative Complications/mo [Mortality] MH - Randomized Controlled Trials as Topic MH - Respiration, Artificial/ut [Utilization] MH - Time Factors AB - BACKGROUND: Epidural analgesia offers greater pain relief compared to systemic opioid-based medications, but its effect on morbidity and mortality is unclear. This review was originally published in 2006 and was updated in 2012 and again in 2016. AB - OBJECTIVES: To assess the benefits and harms of postoperative epidural analgesia in comparison with postoperative systemic opioid-based analgesia for adults undergoing elective abdominal aortic surgery. AB - SEARCH METHODS: In the updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and five trial registers in November 2014, together with reference checking to identify additional studies. AB - SELECTION CRITERIA: We included all randomized controlled trials comparing postoperative epidural analgesia and postoperative systemic opioid-based analgesia for adults who underwent elective open abdominal aortic surgery. AB - DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information and data when required. We assessed the level of evidence according to the scale provided by the GRADE working group. AB - MAIN RESULTS: We included 15 trials published from 1987 to 2009 with 1498 participants in this updated review. Participants had a mean age between 60.5 and 71.3 years. The percentage of women in the included studies varied from 0% to 28.1%. Adding an epidural to general anaesthesia for people undergoing abdominal aortic repair reduced myocardial infarction (risk ratio (RR) 0.54 (95% confidence interval (CI) 0.30 to 0.97); I(2) statistic = 0%; number needed to treat for one additional beneficial outcome (NNTB) 28 (95% CI 19 to 1423), visual or verbal analogical scale (VAS) scores up to three days after the surgery (mean difference (MD) -1.78 (95% CI -2.32 to -1.25); I(2) statistic = 0% for VAS scores on movement at postoperative day one), time to tracheal extubation (standardized mean difference (SMD) -0.42 (95% CI -0.70 to -0.15); I(2) statistic = 83%; equivalent to a mean reduction of 36 hours), postoperative respiratory failure (RR 0.69 (95% CI 0.56 to 0.85); I(2) statistic = 0%; NNTB 8 (95% CI 6 to 16)), gastrointestinal bleeding (OR 0.20 (95% CI 0.06 to 0.65); I(2) statistic = 0%; NNTB 32 (95% CI 27 to 74)) and time spent in the intensive care unit (SMD -0.23 (95% CI -0.41 to -0.06); I(2) statistic = 0%; equivalent to a mean reduction of six hours). We did not demonstrate a reduction in the mortality rate up to 30 days (RR 1.06 (95% CI 0.60 to 1.86); I(2) statistic = 0%). The level of evidence was low for mortality and time before tracheal extubation; moderate for myocardial infarction, respiratory failure and intensive care unit length of stay; and high for gastrointestinal bleeding and VAS scores. AB - AUTHORS' CONCLUSIONS: Epidural analgesia provided better pain management, reduced myocardial infarction, time to tracheal extubation, postoperative respiratory failure, gastrointestinal bleeding, and intensive care unit length of stay compared with systemic opioid-based drugs. For mortality, we did not find a difference at 30 days. RN - 0 (Analgesics, Opioid) ES - 1469-493X IL - 1361-6137 DO - https://dx.doi.org/10.1002/14651858.CD005059.pub4 PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Review ID - 10.1002/14651858.CD005059.pub4 [doi] PP - epublish LG - English EP - 20160105 DP - 2016 Jan 05 EZ - 2016/01/06 06:00 DA - 2016/05/11 06:00 DT - 2016/01/06 06:00 YR - 2016 ED - 20160510 RD - 20160602 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26731032 <238. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26670662 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Holsti L AU - Zwicker JG AU - Grunau RE FA - Holsti, Liisa FA - Zwicker, Jill G FA - Grunau, Ruth E IN - Holsti, Liisa. Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, B.C., Canada. TI - Comment on the Paper by van den Bosch et al. Entitled 'Prematurity, Opioid Exposure and Neonatal Pain: Do They Affect the Developing Brain': The Impact of Subtle Messaging. CM - Comment in: Neonatology. 2016;109(2):122-3; PMID: 26666420 CM - Comment on: Neonatology. 2015;108(1):8-15; PMID: 25871803 SO - Neonatology. 109(2):120-1, 2016 AS - Neonatology. 109(2):120-1, 2016 NJ - Neonatology VO - 109 IP - 2 PG - 120-1 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101286577 IO - Neonatology SB - Index Medicus CP - Switzerland MH - *Aging MH - Animals MH - *Brain/de [Drug Effects] MH - *Chronic Pain/dt [Drug Therapy] MH - Female MH - Humans MH - *Infant, Premature/gd [Growth & Development] MH - Male MH - *Morphine/ae [Adverse Effects] MH - *Morphine/tu [Therapeutic Use] MH - *Respiration, Artificial/mt [Methods] RN - 76I7G6D29C (Morphine) ES - 1661-7819 IL - 1661-7800 DO - https://dx.doi.org/10.1159/000442081 PT - Comment PT - Journal Article ID - 000442081 [pii] ID - 10.1159/000442081 [doi] PP - ppublish PH - 2015/08/11 [received] PH - 2015/11/02 [accepted] LG - English EP - 20151216 DP - 2016 EZ - 2015/12/17 06:00 DA - 2016/05/07 06:00 DT - 2015/12/17 06:00 YR - 2016 ED - 20160506 RD - 20160114 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26670662 <239. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26720742 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Larochelle MR AU - Liebschutz JM AU - Zhang F AU - Ross-Degnan D AU - Wharam JF FA - Larochelle, Marc R FA - Liebschutz, Jane M FA - Zhang, Fang FA - Ross-Degnan, Dennis FA - Wharam, J Frank TI - Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study. CM - Comment in: BMJ. 2016;352:h7010; PMID: 26729918 CM - Comment in: Ann Intern Med. 2016 Sep 6;165(5):376; PMID: 27595219 CM - Comment in: Ann Intern Med. 2016 Sep 6;165(5):376-7; PMID: 27595218 SO - Annals of Internal Medicine. 164(1):1-9, 2016 Jan 05 AS - Ann Intern Med. 164(1):1-9, 2016 Jan 05 NJ - Annals of internal medicine VO - 164 IP - 1 PG - 1-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 0372351 IO - Ann. Intern. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Benzodiazepines/tu [Therapeutic Use] MH - Buprenorphine/tu [Therapeutic Use] MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/et [Etiology] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/di [Diagnosis] MH - *Pain/dt [Drug Therapy] MH - Practice Patterns, Physicians' MH - Recurrence MH - Retrospective Studies MH - Time Factors MH - Young Adult AB - BACKGROUND: Nonfatal opioid overdose is an opportunity to identify and treat substance use disorders, but treatment patterns after the overdose are unknown. AB - OBJECTIVE: To determine prescribed opioid dosage after an opioid overdose and its association with repeated overdose. AB - DESIGN: Retrospective cohort study. AB - SETTING: A large U.S. health insurer. AB - PARTICIPANTS: 2848 commercially insured patients aged 18 to 64 years who had a nonfatal opioid overdose during long-term opioid therapy for noncancer pain between May 2000 and December 2012. AB - MEASUREMENTS: Nonfatal opioid overdose was identified using International Classification of Diseases, Ninth Revision, Clinical Modification, codes from emergency department or inpatient claims. The primary outcome was daily morphine-equivalent dosage (MED) of opioids dispensed from 60 days before to up to 730 days after the index overdose. We categorized dosages as large (>=100 mg MED), moderate (50 to <100 mg MED), low (<50 mg MED), or none (0 mg MED). Secondary outcomes included time to repeated overdose stratified by daily dosage as a time-varying covariate. AB - RESULTS: Over a median follow-up of 299 days, opioids were dispensed to 91% of patients after an overdose. Seven percent of patients (n = 212) had a repeated opioid overdose. At 2 years, the cumulative incidence of repeated overdose was 17% (95% CI, 14% to 20%) for patients receiving high dosages of opioids after the index overdose, 15% (CI, 10% to 21%) for those receiving moderate dosages, 9% (CI, 6% to 14%) for those receiving low dosages, and 8% (CI, 6% to 11%) for those receiving no opioids. AB - LIMITATION: The cohort was limited to commercially insured adults. AB - CONCLUSION: Almost all patients continue to receive prescription opioids after an overdose. Opioid discontinuation after overdose is associated with lower risk for repeated overdose. AB - PRIMARY FUNDING SOURCE: Health Resources and Services Administration. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 12794-10-4 (Benzodiazepines) RN - 40D3SCR4GZ (Buprenorphine) ES - 1539-3704 IL - 0003-4819 DO - https://dx.doi.org/10.7326/M15-0038 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - 2479117 [pii] ID - 10.7326/M15-0038 [doi] PP - ppublish GI - No: T32 HP10251 Organization: *PHS HHS* Country: United States GI - No: T32 HP12706 Organization: *PHS HHS* Country: United States LG - English EP - 20151229 DP - 2016 Jan 05 EZ - 2016/01/01 06:00 DA - 2016/05/05 06:00 DT - 2016/01/01 06:00 YR - 2016 ED - 20160504 RD - 20171206 UP - 20171206 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=26720742 <240. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25952503 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hoppe JA AU - Nelson LS AU - Perrone J AU - Weiner SG AU - Prescribing Opioids Safely in the Emergency Department (POSED) Study Investigators AU - Prescribing Opioids Safely in the Emergency Department POSED Study Investigators FA - Hoppe, Jason A FA - Nelson, Lewis S FA - Perrone, Jeanmarie FA - Weiner, Scott G FA - Prescribing Opioids Safely in the Emergency Department (POSED) Study Investigators FA - Prescribing Opioids Safely in the Emergency Department POSED Study Investigators IN - Hoppe, Jason A. Department of Emergency Medicine, University of Colorado, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO. IN - Nelson, Lewis S. Department of Emergency Medicine, New York University School of Medicine, New York, NY. IN - Perrone, Jeanmarie. Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. IN - Weiner, Scott G. Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: sgweiner@partners.org. IR - Rathlev NK IR - Sanchez LD IR - Babineau M IR - Griggs CA IR - Mitchell PM IR - Ma J IR - Hoch WB IR - Totten V IR - Salzman MS IR - Karmakar R IR - Iwanicki JL IR - Morgan BW IR - Pomerleau AC IR - Delgado J IR - Medoro A IR - Whiteley P IR - Offerman S IR - Hemmert K IR - Lank PM IR - Thundiyil JG IR - Thomas A IR - Chagani S IR - Beaudoin FL IR - Friedman FD IR - Cleveland N IR - Jayathilaka K IR - D'Onofrio G IR - Naftilan M IR - Koploy A TI - Opioid Prescribing in a Cross Section of US Emergency Departments. SO - Annals of Emergency Medicine. 66(3):253-259.e1, 2015 Sep AS - Ann Emerg Med. 66(3):253-259.e1, 2015 Sep NJ - Annals of emergency medicine VO - 66 IP - 3 PG - 253-259.e1 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550521 OI - Source: NLM. NIHMS675967 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Abdominal Pain/dt [Drug Therapy] MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Back Pain/dt [Drug Therapy] MH - Codeine/tu [Therapeutic Use] MH - Cross-Sectional Studies MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Fractures, Bone/dt [Drug Therapy] MH - Humans MH - Hydrocodone/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - Oxycodone/tu [Therapeutic Use] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - United States/ep [Epidemiology] MH - Young Adult AB - STUDY OBJECTIVE: Opioid pain reliever prescribing at emergency department (ED) discharge has increased in the past decade but specific prescription details are lacking. Previous ED opioid pain reliever prescribing estimates relied on national survey extrapolation or prescription databases. The main goal of this study is to use a research consortium to analyze the characteristics of patients and opioid prescriptions, using a national sample of ED patients. We also aim to examine the indications for opioid pain reliever prescribing, characteristics of opioids prescribed both in the ED and at discharge, and characteristics of patients who received opioid pain relievers compared with those who did not. AB - METHODS: This observational, multicenter, retrospective, cohort study assessed opioid pain reliever prescribing to consecutive patients presenting to the consortium EDs during 1 week in October 2012. The consortium study sites consisted of 19 EDs representing 1.4 million annual visits, varied geographically, and were predominantly academic centers. Medical records of all patients aged 18 to 90 years and discharged with an opioid pain reliever (excluding tramadol) were individually abstracted by standardized chart review by investigators for detailed analysis. Descriptive statistics were generated. AB - RESULTS: During the study week, 27,516 patient visits were evaluated in the consortium EDs; 19,321 patients (70.2%) were discharged and 3,284 (11.9% of all patients and 17.0% of discharged patients) received an opioid pain reliever prescription. For patients prescribed an opioid pain reliever, mean age was 41 years (SD 14 years) and 1,694 (51.6%) were women. Mean initial pain score was 7.7 (SD 2.4). The most common diagnoses associated with opioid pain reliever prescribing were back pain (10.2%), abdominal pain (10.1%), and extremity fracture (7.1%) or sprain (6.5%). The most common opioid pain relievers prescribed were oxycodone (52.3%), hydrocodone (40.9%), and codeine (4.8%). Greater than 99% of pain relievers were immediate release and 90.0% were combination preparations, and the mean and median number of pills was 16.6 (SD 7.6) and 15 (interquartile range 12 to 20), respectively. AB - CONCLUSION: In a study of ED patients treated during a single week across the country, 17% of discharged patients were prescribed opioid pain relievers. The majority of the prescriptions had small pill counts and almost exclusively immediate-release formulations. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - CD35PMG570 (Oxycodone) RN - Q830PW7520 (Codeine) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(15)00233-4 DO - https://dx.doi.org/10.1016/j.annemergmed.2015.03.026 PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. ID - S0196-0644(15)00233-4 [pii] ID - 10.1016/j.annemergmed.2015.03.026 [doi] ID - PMC4550521 [pmc] ID - NIHMS675967 [mid] PP - ppublish PH - 2015/01/21 [received] PH - 2015/03/18 [revised] PH - 2015/03/25 [accepted] GI - No: R49 CE001494 Organization: (CE) *NCIPC CDC HHS* Country: United States GI - No: UL1 RR025780 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: UL1 TR001082 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English EP - 20150504 DP - 2015 Sep EZ - 2015/05/09 06:00 DA - 2016/05/05 06:00 DT - 2015/05/09 06:00 YR - 2015 ED - 20160504 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25952503 <241. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25865093 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Smith RJ AU - Rhodes K AU - Paciotti B AU - Kelly S AU - Perrone J AU - Meisel ZF FA - Smith, Robert J FA - Rhodes, Karin FA - Paciotti, Breah FA - Kelly, Sheila FA - Perrone, Jeanmarie FA - Meisel, Zachary F IN - Smith, Robert J. Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. IN - Rhodes, Karin. Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. IN - Paciotti, Breah. Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. IN - Kelly, Sheila. Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. IN - Perrone, Jeanmarie. Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Medical Toxicology, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. IN - Meisel, Zachary F. Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: zfm@upenn.edu. TI - Patient Perspectives of Acute Pain Management in the Era of the Opioid Epidemic. CM - Comment in: Evid Based Nurs. 2016 Jul;19(3):88; PMID: 27009069 SO - Annals of Emergency Medicine. 66(3):246-252.e1, 2015 Sep AS - Ann Emerg Med. 66(3):246-252.e1, 2015 Sep NJ - Annals of emergency medicine VO - 66 IP - 3 PG - 246-252.e1 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - Adolescent MH - Adult MH - Aged MH - Communication MH - Decision Making MH - Emergency Service, Hospital MH - Female MH - Grounded Theory MH - Humans MH - Interviews as Topic MH - Male MH - Middle Aged MH - Opioid-Related Disorders/et [Etiology] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Pain Management/ae [Adverse Effects] MH - *Pain Management/mt [Methods] MH - Patient Participation/px [Psychology] MH - Young Adult AB - STUDY OBJECTIVE: To inform the development of interventions that could improve patient engagement around the risks and benefits of alternative approaches to pain management in the emergency department (ED), we seek to capture the perspectives and experiences of patients treated for pain in this setting. AB - METHODS: Three trained interviewers conducted semistructured open-ended telephone interviews with patients discharged from a single urban academic ED after presenting with acute pain related to fracture, renal colic, or musculoskeletal back injury. We recruited subjects until achieving thematic saturation according to periodic review of the interview transcripts. Interviews were audio recorded, professionally transcribed, and uploaded into QSR NVivo (version 10.0) for coding and analysis using modified grounded theory. An interdisciplinary team double coded the data and convened to review emerging themes, ensure interrater reliability, and establish consensus on discrepancies. AB - RESULTS: We had 23 completed subject interviews, the majority of which were women. Interrater reliability for coding exceeded 90%. The major themes elicited centered on domains of patient awareness of the potential for opioid dependence and patient-provider communication relating to pain management. From the patient perspective, emergency physicians typically do not present alternative pain management options or discuss the risks of opioid dependence. Patients with negative experiences related to pain management describe deficiencies in patient-provider communication leading to misunderstanding of clinical diagnoses, fragmentation of care among their health care providers, and a desire to be involved in the decisionmaking process around their pain management. Patients with positive experiences commented on regular communication with their care team, rapid pain management, and the empathetic nature of their care providers. Patients communicate fears about the risks of opioid addiction, beliefs that following a prescribed opioid regimen is protective of developing opioid dependence, and an understanding of the broader tensions that providers face relating to the prescription of opioid therapy. AB - CONCLUSION: Patients identified a deficit of communication around opioid risk and pain management options in the ED. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(15)00232-2 DO - https://dx.doi.org/10.1016/j.annemergmed.2015.03.025 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0196-0644(15)00232-2 [pii] ID - 10.1016/j.annemergmed.2015.03.025 [doi] PP - ppublish PH - 2015/02/18 [received] PH - 2015/03/19 [revised] PH - 2015/03/23 [accepted] LG - English EP - 20150409 DP - 2015 Sep EZ - 2015/04/14 06:00 DA - 2016/05/05 06:00 DT - 2015/04/14 06:00 YR - 2015 ED - 20160504 RD - 20170502 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25865093 <242. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26939351 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - As opioid overdose deaths reach record highs, call for systematic changes grows louder. SO - ED Management. 28(2):13-9, 2016 Feb AS - ED Manag. 28(2):13-9, 2016 Feb NJ - ED management : the monthly update on emergency department management VO - 28 IP - 2 PG - 13-9 PI - Journal available in: Print PI - Citation processed from: Print JC - chx, 9425690 IO - ED Manag SB - Health Administration Journals CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - Centers for Disease Control and Prevention (U.S.) MH - *Drug Overdose/mo [Mortality] MH - *Drug Overdose/pc [Prevention & Control] MH - *Emergency Service, Hospital/og [Organization & Administration] MH - Evidence-Based Medicine MH - Humans MH - Inappropriate Prescribing/sn [Statistics & Numerical Data] MH - *Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Population Surveillance MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Prescription Drug Misuse/pc [Prevention & Control] MH - Substance Abuse Detection MH - United States/ep [Epidemiology] AB - With deaths from opioid overdoses up sharply, a number of organizations are calling for systematic changes to curb the prescription of opioids while also making it easier for patients with addiction problems to access evidence- based treatment. New data from the National Center for Health Statistics un- derscore the scope of the problem: Deaths related to prescription overdoses reached an all-time high in 2014, nearing the 19,000 mark. Deaths linked to heroin reached 10,574, a three-fold increase from 2010. In response to the opioid problem, the CDC has unveiled draft guidelines directing physicians to consider alternative treatments for pain before turning to opioids. When opioids must be used, the guidelines encourage physicians to opt for shorter-acting versions rather than extended-release forms, and they suggest that physicians incorporate strategies to mitigate the risk of overdose, such as offering naloxone to patients in specific high-risk groups. The draft guidelines also call for physicians to ask patients to take urine tests before prescribing opioids, and to continue requiring the urine tests at least once per year if patients continue on the drugs. This is to identify patients who may be supplementing their prescribed dosages. New research reported in JAMA Internal Medicine suggests that the over-prescribing of opioids is a problem shared by a broad cross-section of health professionals, not a small subset, as some have suggested. A new report, led by researchers at the Johns Hopkins School of Public Health, recommends significant improvements in the way opioids are prescribed and dispensed as well as in the way patients with addictions or overdoses are identified and managed in the healthcare system. RN - 0 (Analgesics, Opioid) IS - 1044-9167 IL - 1044-9167 PT - Journal Article PP - ppublish LG - English DP - 2016 Feb EZ - 2016/03/05 06:00 DA - 2016/05/04 06:00 DT - 2016/03/05 06:00 YR - 2016 ED - 20160503 RD - 20160304 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26939351 <243. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26707531 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - Naloxone Prescriptions by Emergency Physicians. SO - Annals of Emergency Medicine. 67(1):149, 2016 Jan AS - Ann Emerg Med. 67(1):149, 2016 Jan NJ - Annals of emergency medicine VO - 67 IP - 1 PG - 149 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Emergency Medicine/sn [Statistics & Numerical Data] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Prescriptions/sn [Statistics & Numerical Data] MH - Societies, Medical MH - United States RN - 36B82AMQ7N (Naloxone) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(15)01511-5 DO - https://dx.doi.org/10.1016/j.annemergmed.2015.11.023 PT - Journal Article ID - S0196-0644(15)01511-5 [pii] ID - 10.1016/j.annemergmed.2015.11.023 [doi] PP - ppublish PH - 2015/11/12 [received] LG - English DP - 2016 Jan EZ - 2015/12/29 06:00 DA - 2016/05/03 06:00 DT - 2015/12/29 06:00 YR - 2016 ED - 20160502 RD - 20151228 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26707531 <244. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25805026 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Jhun P AU - Bright A AU - Herbert M FA - Jhun, Paul FA - Bright, Aaron FA - Herbert, Mel IN - Jhun, Paul. Department of Emergency Medicine, University of California San Francisco, San Francisco, CA. Electronic address: paul.jhun@ucsf.edu. IN - Bright, Aaron. Department of Emergency Medicine, University of Southern California, Los Angeles, CA. IN - Herbert, Mel. Department of Emergency Medicine, University of Southern California, Los Angeles, CA. TI - Serotonin syndrome and opioids--what's the deal?. SO - Annals of Emergency Medicine. 65(4):434-5, 2015 Apr AS - Ann Emerg Med. 65(4):434-5, 2015 Apr NJ - Annals of emergency medicine VO - 65 IP - 4 PG - 434-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Emergency Service, Hospital MH - Humans MH - *Serotonin Syndrome/ci [Chemically Induced] RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(14)01604-7 DO - https://dx.doi.org/10.1016/j.annemergmed.2014.12.021 PT - Journal Article ID - S0196-0644(14)01604-7 [pii] ID - 10.1016/j.annemergmed.2014.12.021 [doi] PP - ppublish LG - English DP - 2015 Apr EZ - 2015/03/26 06:00 DA - 2016/05/03 06:00 DT - 2015/03/26 06:00 YR - 2015 ED - 20160502 RD - 20150325 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25805026 <245. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25534653 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Beaudoin FL AU - Merchant RC AU - Janicki A AU - McKaig DM AU - Babu KM FA - Beaudoin, Francesca L FA - Merchant, Roland C FA - Janicki, Adam FA - McKaig, Donald M FA - Babu, Kavita M IN - Beaudoin, Francesca L. Department of Emergency Medicine, Rhode Island Hospital, the Alpert Medical School of Brown University, Providence, RI. Electronic address: francesca_beaudoin@brown.edu. IN - Merchant, Roland C. Department of Emergency Medicine, Rhode Island Hospital, the Alpert Medical School of Brown University, Providence, RI. IN - Janicki, Adam. Department of Emergency Medicine, Rhode Island Hospital, the Alpert Medical School of Brown University, Providence, RI. IN - McKaig, Donald M. Department of Medicine, Division of Clinical Pharmacology, Rhode Island Hospital, Providence, RI. IN - Babu, Kavita M. Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA. TI - Preventing iatrogenic overdose: a review of in-emergency department opioid-related adverse drug events and medication errors. SO - Annals of Emergency Medicine. 65(4):423-31, 2015 Apr AS - Ann Emerg Med. 65(4):423-31, 2015 Apr NJ - Annals of emergency medicine VO - 65 IP - 4 PG - 423-31 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Aged, 80 and over MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Drug Overdose/pc [Prevention & Control] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Iatrogenic Disease/ep [Epidemiology] MH - Iatrogenic Disease/pc [Prevention & Control] MH - Male MH - Medication Errors/pc [Prevention & Control] MH - *Medication Errors/sn [Statistics & Numerical Data] MH - Middle Aged MH - Naloxone/ae [Adverse Effects] MH - Retrospective Studies AB - STUDY OBJECTIVE: We describe characteristics of patients with in-emergency department (ED) opioid-related adverse drug events, medication errors, and harm resulting from medication errors; identify patient-, provider-, and system-based factors associated with in-ED opioid-related medication errors and harm; and create a list of strategies to prevent future events. AB - METHODS: This retrospective study was conducted at 2 urban academic EDs. Potential iatrogenic opioid overdoses were identified by querying the ED electronic medical record for cases when naloxone was administered after an opioid was administered in the ED. Cases involving medication errors resulting in harm were reviewed qualitatively for common patient-, provider-, and systems-based factors that might have contributed to the event. AB - RESULTS: Of 73 ED patients with in-ED opioid-related adverse events that required reversal with naloxone, 43 had a medication error resulting in harm. Patient-, provider-, and systems-based factors that might have contributed to the events included chronic health conditions that could predispose an individual to an opioid-related adverse event, failure to adjust opioid dosing in the elderly and for hepatic or renal impairment, multiple doses and routes of administration of opioids, coadministration of opioids with other sedating medications, and systems-based problems with patient handoffs and pharmacy oversight. AB - CONCLUSION: We identified patient-, provider-, and systems-based factors related to opioid-related adverse drug events and medication errors among ED patients who had received naloxone. The results from our assessment can be used to inform educational and policy initiatives aimed to prevent in-ED opioid-related adverse drug events and medication errors. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 36B82AMQ7N (Naloxone) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(14)01514-5 DO - https://dx.doi.org/10.1016/j.annemergmed.2014.11.016 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0196-0644(14)01514-5 [pii] ID - 10.1016/j.annemergmed.2014.11.016 [doi] PP - ppublish PH - 2014/07/16 [received] PH - 2014/11/06 [revised] PH - 2014/11/19 [accepted] LG - English EP - 20141218 DP - 2015 Apr EZ - 2014/12/24 06:00 DA - 2016/05/03 06:00 DT - 2014/12/24 06:00 YR - 2015 ED - 20160502 RD - 20150325 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25534653 <246. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26291177 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hunold KM AU - Smith SA AU - Platts-Mills TF FA - Hunold, Katherine M FA - Smith, Samantha A FA - Platts-Mills, Timothy F IN - Hunold, Katherine M. University of Virginia School of Medicine, Charlottesville, VA. IN - Smith, Samantha A. Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC. IN - Platts-Mills, Timothy F. Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC. IN - Platts-Mills, Timothy F. Department of Anesthesiology, University of North Carolina, Chapel Hill, NC. TI - Constipation Prophylaxis Is Rare for Adults Prescribed Outpatient Opioid Therapy From U.S. Emergency Departments. CM - Comment in: Acad Emerg Med. 2016 Jan;23(1):106; PMID: 26670717 CM - Comment in: Acad Emerg Med. 2016 Jan;23(1):107; PMID: 26670858 SO - Academic Emergency Medicine. 22(9):1118-21, 2015 Sep AS - Acad Emerg Med. 22(9):1118-21, 2015 Sep NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 22 IP - 9 PG - 1118-21 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Constipation/ci [Chemically Induced] MH - *Constipation/pc [Prevention & Control] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Health Care Surveys MH - Humans MH - *Laxatives/ad [Administration & Dosage] MH - Male MH - Middle Aged MH - *Outpatients MH - Patient Discharge MH - United States MH - Young Adult AB - OBJECTIVES: Constipation is a common and potentially serious side effect of oral opioids. Accordingly, most clinical guidelines suggest routine use of laxatives to prevent opioid-induced constipation. The objective was to characterize emergency provider prescribing of laxatives to prevent constipation among adults initiating outpatient opioid treatment. AB - METHODS: National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2010 were analyzed. Among visits by individuals aged 18 years and older discharged from the emergency department (ED) with opioid prescriptions, the authors estimated the survey-weighted proportion of visits in which laxatives were also prescribed. A subgroup analysis was conducted for individuals aged 65 years and older, as the potential risks associated with opioid-induced constipation are greater among older individuals. To examine a group expected to be prescribed laxative medication and confirm that NHAMCS captures prescriptions for these medications, the authors estimated the proportion of visits by individuals discharged with prescriptions for laxatives among those who presented with constipation. AB - RESULTS: Among visits in 2010 by adults aged 18 years and older discharged from the ED with opioid prescriptions, 0.9% (95% confidence interval [CI] = 0.7% to 1.3%, estimated total n = 191,203 out of 21,075,050) received prescriptions for laxatives. Among the subset of visits by adults aged 65 years and older, 1.0% (95% CI = 0.5% to 2.0%, estimated total n = 18,681 out of 1,904,411) received prescriptions for laxatives. In comparison, among visits by individuals aged 18 years and older with constipation as a reason for visit, 42% received prescriptions for laxatives. AB - CONCLUSIONS: In this nationally representative sample, laxatives were not routinely prescribed to adults discharged from the ED with prescriptions for opioid pain medications. Routine prescribing of laxatives for ED visits may improve the safety and effectiveness of outpatient opioid pain management. Copyright © 2015 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 0 (Laxatives) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12745 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1111/acem.12745 [doi] PP - ppublish PH - 2015/02/21 [received] PH - 2015/04/06 [revised] PH - 2015/04/15 [revised] PH - 2015/04/19 [accepted] GI - No: K23AG038548 Organization: (AG) *NIA NIH HHS* Country: United States LG - English EP - 20150820 DP - 2015 Sep EZ - 2015/08/21 06:00 DA - 2016/04/28 06:00 DT - 2015/08/21 06:00 YR - 2015 ED - 20160427 RD - 20160503 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26291177 <247. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26066921 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Davis CS AU - Carr D AU - Southwell JK AU - Beletsky L FA - Davis, Corey S FA - Carr, Derek FA - Southwell, Jessica K FA - Beletsky, Leo IN - Davis, Corey S. Derek Carr and Corey S. Davis are with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is with the Northeastern University School of Law and Bouve College of Health Sciences, Boston, MA. IN - Carr, Derek. Derek Carr and Corey S. Davis are with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is with the Northeastern University School of Law and Bouve College of Health Sciences, Boston, MA. IN - Southwell, Jessica K. Derek Carr and Corey S. Davis are with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is with the Northeastern University School of Law and Bouve College of Health Sciences, Boston, MA. IN - Beletsky, Leo. Derek Carr and Corey S. Davis are with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is with the Northeastern University School of Law and Bouve College of Health Sciences, Boston, MA. TI - Engaging Law Enforcement in Overdose Reversal Initiatives: Authorization and Liability for Naloxone Administration. SO - American Journal of Public Health. 105(8):1530-7, 2015 Aug AS - Am J Public Health. 105(8):1530-7, 2015 Aug NJ - American journal of public health VO - 105 IP - 8 PG - 1530-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 1254074, 3xw IO - Am J Public Health SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Drug Overdose/dt [Drug Therapy] MH - Humans MH - Liability, Legal MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Police/lj [Legislation & Jurisprudence] MH - *Police MH - United States AB - Opioid overdose is reversible through the timely administration of naloxone, which has been used by emergency medical services for decades. Law enforcement officers (LEOs) are often the first emergency responders to arrive at an overdose, but they are not typically equipped with naloxone. This is rapidly changing; more than 220 law enforcement agencies in 24 states now carry naloxone. However, rollout in some departments has been hampered by concerns regarding officer and agency liability. We systematically examined the legal risk associated with LEO naloxone administration. LEOs can be authorized to administer naloxone through a variety of mechanisms, and liability risks related to naloxone administration are similar to or lower than those of other activities in which LEOs commonly engage. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1541-0048 IL - 0090-0036 DO - https://dx.doi.org/10.2105/AJPH.2015.302638 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.2105/AJPH.2015.302638 [doi] ID - PMC4504282 [pmc] PP - ppublish LG - English EP - 20150611 DP - 2015 Aug EZ - 2015/06/13 06:00 DA - 2016/04/27 06:00 DT - 2015/06/13 06:00 YR - 2015 ED - 20160426 RD - 20170801 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26066921 <248. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25774010 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Grace PM AU - Shimizu K AU - Strand KA AU - Rice KC AU - Deng G AU - Watkins LR AU - Herson PS FA - Grace, Peter M FA - Shimizu, Kaori FA - Strand, Keith A FA - Rice, Kenner C FA - Deng, Guiying FA - Watkins, Linda R FA - Herson, Paco S IN - Grace, Peter M. Department of Psychology and The Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA. IN - Shimizu, Kaori. Department of Anesthesiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. IN - Strand, Keith A. Department of Psychology and The Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA. IN - Rice, Kenner C. Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA. IN - Deng, Guiying. Department of Pharmacology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. IN - Watkins, Linda R. Department of Psychology and The Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA. IN - Herson, Paco S. Department of Anesthesiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA; Department of Pharmacology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. Electronic address: paco.herson@ucdenver.edu. TI - (+)-Naltrexone is neuroprotective and promotes alternative activation in the mouse hippocampus after cardiac arrest/cardiopulmonary resuscitation. SO - Brain, Behavior, & Immunity. 48:115-22, 2015 Aug AS - Brain Behav Immun. 48:115-22, 2015 Aug NJ - Brain, behavior, and immunity VO - 48 PG - 115-22 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bbi, 8800478 IO - Brain Behav. Immun. SB - Index Medicus CP - Netherlands MH - Animals MH - Cardiopulmonary Resuscitation MH - *Cell Death/de [Drug Effects] MH - Heart Arrest/me [Metabolism] MH - *Heart Arrest/pa [Pathology] MH - *Hippocampus/de [Drug Effects] MH - Hippocampus/me [Metabolism] MH - Hippocampus/pa [Pathology] MH - Interleukin-10/me [Metabolism] MH - Male MH - Mice MH - Mice, Inbred C57BL MH - Microglia/de [Drug Effects] MH - Microglia/me [Metabolism] MH - Microglia/pa [Pathology] MH - *Naltrexone/pd [Pharmacology] MH - Neurons/de [Drug Effects] MH - Neurons/me [Metabolism] MH - Neurons/pa [Pathology] MH - *Neuroprotective Agents/pd [Pharmacology] KW - HIF1alpha; HIF2alpha; Ischemia; M2 macrophages; M2 microglia; Neurotoxicity; TLR4 AB - Despite dramatic improvement in cardiopulmonary resuscitation (CPR) and other techniques for cardiac arrest (CA), the majority of survivors continue to show signs of decreased memory or executive cognitive function. Such memory impairment may be due to hippocampal CA1 neuronal death, which is delayed by several days after CA/CPR. Classical microgliosis in the CA1 region may contribute to neuronal death, yet the role of a key activation receptor Toll Like Receptor 4 (TLR4) has not been previously investigated for such neuronal death after CA/CPR. We show that (+)-naltrexone was neuroprotective after CA/CPR. TLR4 blockade was associated with decreased expression of markers for microglial/macrophage activation and T cell and B cell infiltration, as well as decreased pro-inflammatory cytokine levels. Notably, IL-10 expression was elevated in response to CA/CPR, but was not attenuated by (+)-naltrexone, suggesting that the local monocyte/microglial phenotype had shifted towards alternative activation. This was confirmed by elevated expression of Arginase-1, and decreased expression of NFkappaB p65 subunit. Thus, (+)-naltrexone and other TLR4 antagonists may represent a novel therapeutic strategy to alleviate the substantial burden of memory or executive cognitive function impairment after CA/CPR. Copyright © 2015 Elsevier Inc. All rights reserved. RN - 0 (Neuroprotective Agents) RN - 130068-27-8 (Interleukin-10) RN - 5S6W795CQM (Naltrexone) ES - 1090-2139 IL - 0889-1591 DI - S0889-1591(15)00076-8 DO - https://dx.doi.org/10.1016/j.bbi.2015.03.005 PT - Journal Article PT - Research Support, N.I.H., Intramural PT - Research Support, Non-U.S. Gov't ID - S0889-1591(15)00076-8 [pii] ID - 10.1016/j.bbi.2015.03.005 [doi] ID - PMC5548128 [pmc] ID - NIHMS881288 [mid] PP - ppublish PH - 2014/10/02 [received] PH - 2015/03/05 [revised] PH - 2015/03/06 [accepted] GI - No: R01 NS080851 Organization: (NS) *NINDS NIH HHS* Country: United States GI - No: ZIA DA000527-09 Organization: *Intramural NIH HHS* Country: United States GI - Organization: *Intramural NIH HHS* Country: United States LG - English EP - 20150313 DP - 2015 Aug EZ - 2015/03/17 06:00 DA - 2016/04/14 06:00 DT - 2015/03/17 06:00 YR - 2015 ED - 20160413 RD - 20171205 UP - 20171206 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=25774010 <249. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26904909 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Asplund J FA - Asplund, Jon TI - FASTER RESPONSE. Hospitals backing increased use of opioid antidote. SO - Hospitals & Health Networks. 90(1):20, 22, 2, 2016 Jan AS - Hosp Health Netw. 90(1):20, 22, 2, 2016 Jan NJ - Hospitals & health networks VO - 90 IP - 1 PG - 20, 22, 2 PI - Journal available in: Print PI - Citation processed from: Print JC - bsq, 9312077 IO - Hosp Health Netw SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Service, Hospital MH - Humans MH - Indiana MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - United States AB - Hospitals are intensifying efforts to cut opioid abuse. One way is by donating a lifesaving drug to police departments. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 1068-8838 IL - 1068-8838 PT - News PP - ppublish LG - English DP - 2016 Jan EZ - 2016/02/26 06:00 DA - 2016/04/09 06:00 DT - 2016/02/25 06:00 YR - 2016 ED - 20160408 RD - 20161018 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26904909 <250. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26452510 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schaefer JA AU - Mlekoday TJ FA - Schaefer, Jared A FA - Mlekoday, Tamara J IN - Schaefer, Jared A. INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112. Electronic address: jared.a.schaefer@gmail.com. IN - Mlekoday, Tamara J. INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112. Electronic address: tamara.mlekoday@integrisok.com. TI - Time to opioid administration after implementation of an intranasal fentanyl protocol. SO - American Journal of Emergency Medicine. 33(12):1805-7, 2015 Dec AS - Am J Emerg Med. 33(12):1805-7, 2015 Dec NJ - The American journal of emergency medicine VO - 33 IP - 12 PG - 1805-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Administration, Intranasal MH - Adolescent MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Child MH - Child, Preschool MH - Clinical Protocols MH - *Emergency Service, Hospital MH - Female MH - *Fentanyl/ad [Administration & Dosage] MH - Historically Controlled Study MH - Humans MH - Infusions, Intravenous MH - Male MH - Pain/di [Diagnosis] MH - *Pain/dt [Drug Therapy] MH - Retrospective Studies MH - *Time-to-Treatment AB - BACKGROUND: Prompt and effective analgesia is a mainstay of emergency department (ED) medicine; however, it is often delayed in times of overcrowding and by the need to establish intravenous (IV) access. Thus, noninvasive analgesic administration by means of the intranasal route could potentially reduce time to analgesic administration by eliminating IV line insertion. AB - METHODS: This retrospective study evaluated time from physician entry into patient's room to opioid administration after implementation of an intranasal fentanyl protocol. Data were collected on pediatric patients who received intranasal fentanyl in the ED 225 days after protocol implementation. Time to opioid administration was then evaluated against historical controls given IV opioids in the same ED 90 days before protocol implementation. AB - RESULTS: Seven patients were included in the intranasal fentanyl group and were evaluated against 47 patients given IV opioids. Time from physician entry into patient's room to opioid administration was significantly reduced for intranasal fentanyl (20.43 +/- 11.54 minutes) vs IV opioids (42.04 +/- 31.55 minutes; P = .002), and IV line insertion was avoided in all 7 intranasal fentanyl patients. No significant differences in adverse events were noted. AB - CONCLUSION: This study provides evidence that administration of fentanyl via the intranasal route in the ED decreases time to administration of opioids in pediatric patients. Copyright © 2015 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - UF599785JZ (Fentanyl) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(15)00742-1 DO - https://dx.doi.org/10.1016/j.ajem.2015.08.050 PT - Journal Article ID - S0735-6757(15)00742-1 [pii] ID - 10.1016/j.ajem.2015.08.050 [doi] PP - ppublish PH - 2015/07/06 [received] PH - 2015/08/27 [revised] PH - 2015/08/31 [accepted] LG - English EP - 20150907 DP - 2015 Dec EZ - 2015/10/11 06:00 DA - 2016/04/09 06:00 DT - 2015/10/11 06:00 YR - 2015 ED - 20160408 RD - 20151215 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26452510 <251. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25842347 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Linnstaedt SD AU - Hu J AU - Bortsov AV AU - Soward AC AU - Swor R AU - Jones J AU - Lee D AU - Peak D AU - Domeier R AU - Rathlev N AU - Hendry P AU - McLean SA FA - Linnstaedt, Sarah D FA - Hu, JunMei FA - Bortsov, Andrey V FA - Soward, April C FA - Swor, Robert FA - Jones, Jeffrey FA - Lee, David FA - Peak, David FA - Domeier, Robert FA - Rathlev, Niels FA - Hendry, Phyllis FA - McLean, Samuel A IN - Linnstaedt, Sarah D. TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina. IN - Hu, JunMei. TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina. IN - Bortsov, Andrey V. TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina. IN - Soward, April C. TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina. IN - Swor, Robert. Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan. IN - Jones, Jeffrey. Department of Emergency Medicine, Spectrum Health Butterworth Campus, Grand Rapids, Michigan. IN - Lee, David. Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York. IN - Peak, David. Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts. IN - Domeier, Robert. Department of Emergency Medicine, St Joseph Mercy Hospital, Ann Arbor, Michigan. IN - Rathlev, Niels. Department of Emergency Medicine, Baystate Medical Center, Springfield, Massachusetts. IN - Hendry, Phyllis. Department of Emergency Medicine, University of Florida College of Medicine/Jacksonville, Jacksonville, Florida. IN - McLean, Samuel A. TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina; Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina. Electronic address: smclean@aims.unc.edu. TI - mu-Opioid Receptor Gene A118 G Variants and Persistent Pain Symptoms Among Men and Women Experiencing Motor Vehicle Collision. SO - Journal of Pain. 16(7):637-44, 2015 Jul AS - J PAIN. 16(7):637-44, 2015 Jul NJ - The journal of pain : official journal of the American Pain Society VO - 16 IP - 7 PG - 637-44 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100898657 IO - J Pain PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486521 OI - Source: NLM. NIHMS694234 SB - Index Medicus CP - United States MH - *Accidents, Traffic/px [Psychology] MH - Adult MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Female MH - Genotype MH - Humans MH - Hyperalgesia/ci [Chemically Induced] MH - Hyperalgesia/ge [Genetics] MH - Male MH - Middle Aged MH - Pain/co [Complications] MH - Pain/dt [Drug Therapy] MH - *Pain/ge [Genetics] MH - Pain Measurement MH - *Polymorphism, Single Nucleotide/ge [Genetics] MH - *Receptors, Opioid, mu/ge [Genetics] MH - *Sex Characteristics MH - Stress, Psychological/et [Etiology] MH - Stress, Psychological/ge [Genetics] MH - Young Adult KW - A118 G; Opioid-induced hyperalgesia; motor vehicle collision; pain; mu-opioid receptor 1 AB - UNLABELLED: The mu-opioid receptor 1 (OPRM1) binds endogenous opioids. Increasing evidence suggests that endogenous OPRM1 agonists released at the time of trauma may contribute to the development of posttraumatic musculoskeletal pain (MSP). In this prospective observational study, we evaluated the hypothesis that individuals with an AG or GG genotype at the OPRM1 A118 G allele, which results in a reduced response to opioids, would have less severe MSP 6 weeks after motor vehicle collision (MVC). Based on previous evidence, we hypothesized that this effect would be sex-dependent and most pronounced among women with substantial peritraumatic distress. European American men and women >= 18 years of age presenting to the emergency department after MVC and discharged to home after evaluation (N = 948) were enrolled. Assessments included genotyping and 6-week evaluation of overall MSP severity (0-10 numeric rating scale). In linear regression modeling, a significant A118 G Allele x Sex interaction was observed: an AG/GG genotype predicted reduced MSP severity among women with substantial peritraumatic distress (beta = -.925, P = .014) but not among all women. In contrast, men with an AG/GG genotype experienced increased MSP severity at 6 weeks (beta = .827, P = .019). Further studies are needed to understand the biologic mechanisms mediating observed sex differences in A118 G effects. AB - PERSPECTIVE: These results suggest a sex-dependent mechanism by which an emotional response to trauma (distress) contributes to a biologic mechanism (endogenous opioid release) that increases MSP in the weeks after stress exposure. These results also support the hypothesis that endogenous opioids influence pain outcomes differently in men and women. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (OPRM1 protein, human) RN - 0 (Receptors, Opioid, mu) ES - 1528-8447 IL - 1526-5900 DI - S1526-5900(15)00604-5 DO - https://dx.doi.org/10.1016/j.jpain.2015.03.011 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S1526-5900(15)00604-5 [pii] ID - 10.1016/j.jpain.2015.03.011 [doi] ID - PMC4486521 [pmc] ID - NIHMS694234 [mid] PP - ppublish PH - 2015/02/04 [received] PH - 2015/03/27 [revised] PH - 2015/03/27 [accepted] GI - No: R01 AR056328 Organization: (AR) *NIAMS NIH HHS* Country: United States GI - No: R01AR056328 Organization: (AR) *NIAMS NIH HHS* Country: United States LG - English EP - 20150402 DP - 2015 Jul EZ - 2015/04/07 06:00 DA - 2016/04/02 06:00 DT - 2015/04/06 06:00 YR - 2015 ED - 20160401 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25842347 <252. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25987910 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dwyer K AU - Walley AY AU - Langlois BK AU - Mitchell PM AU - Nelson KP AU - Cromwell J AU - Bernstein E FA - Dwyer, Kristin FA - Walley, Alexander Y FA - Langlois, Breanne K FA - Mitchell, Patricia M FA - Nelson, Kerrie P FA - Cromwell, John FA - Bernstein, Edward IN - Dwyer, Kristin. Boston University School of Medicine, Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts. IN - Walley, Alexander Y. Boston University School of Medicine, Boston Medical Center, Department of Medicine, Boston, Massachusetts. IN - Langlois, Breanne K. Boston University School of Medicine, Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts. IN - Mitchell, Patricia M. Boston University School of Medicine, Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts. IN - Nelson, Kerrie P. Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts. IN - Cromwell, John. Boston University School of Medicine, Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts. IN - Bernstein, Edward. Boston University School of Medicine, Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts ; Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts. TI - Opioid education and nasal naloxone rescue kits in the emergency department. SO - The Western Journal of Emergency Medicine. 16(3):381-4, 2015 May AS - West J Emerg Med. 16(3):381-4, 2015 May NJ - The western journal of emergency medicine VO - 16 IP - 3 PG - 381-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427207 SB - Index Medicus CP - United States MH - Administration, Intranasal MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - Cost-Benefit Analysis MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Users MH - Emergency Service, Hospital MH - Female MH - Follow-Up Studies MH - Health Education/og [Organization & Administration] MH - *Health Education MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Male MH - Naloxone/sd [Supply & Distribution] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/co [Complications] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - *Prescription Drug Misuse/ae [Adverse Effects] MH - Program Evaluation MH - Respiration MH - Retrospective Studies MH - United States/ep [Epidemiology] AB - INTRODUCTION: Emergency departments (EDs) may be high-yield venues to address opioid deaths with education on both overdose prevention and appropriate actions in a witnessed overdose. In addition, the ED has the potential to equip patients with nasal naloxone kits as part of this effort. We evaluated the feasibility of an ED-based overdose prevention program and described the overdose risk knowledge, opioid use, overdoses, and overdose responses among participants who received overdose education and naloxone rescue kits (OEN) and participants who received overdose education only (OE). AB - METHODS: Program participants were surveyed by telephone after their ED visit about their substance use, overdose risk knowledge, history of witnessed and personal overdoses, and actions in a witnessed overdose including use of naloxone. AB - RESULTS: A total of 415 ED patients received OE or OEN between January 1, 2011 and February 28, 2012. Among those, 51 (12%) completed the survey; 37 (73%) of those received a naloxone kit, and 14 (27%) received OE only. Past 30-day opioid use was reported by 35% OEN and 36% OE, and an overdose was reported by 19% OEN and 29% OE. Among 53% (27/51) of participants who witnessed another individual experiencing an overdose, 95% OEN and 88% OE stayed with victim, 74% OEN and 38% OE called 911, 26% OEN and 25% OE performed rescue breathing, and 32% OEN (n=6) used a naloxone kit to reverse the overdose. We did not detect statistically significant differences between OEN and OE-only groups in opioid use, overdose or response to a witnessed overdose. AB - CONCLUSION: This is the first study to demonstrate the feasibility of ED-based opioid overdose prevention education and naloxone distribution to trained laypersons, patients and their social network. The program reached a high-risk population that commonly witnessed overdoses and that called for help and used naloxone, when available, to rescue people. While the study was retrospective with a low response rate, it provides preliminary data for larger, prospective studies of ED-based overdose prevention programs. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2015.2.24909 PT - Journal Article ID - 10.5811/westjem.2015.2.24909 [doi] ID - wjem-16-381 [pii] ID - PMC4427207 [pmc] PP - ppublish PH - 2014/12/01 [received] PH - 2015/02/18 [revised] PH - 2015/02/25 [accepted] LG - English EP - 20150401 DP - 2015 May EZ - 2015/05/20 06:00 DA - 2016/03/30 06:00 DT - 2015/05/20 06:00 YR - 2015 ED - 20160329 RD - 20150521 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25987910 <253. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25987909 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dickason RM AU - Chauhan V AU - Mor A AU - Ibler E AU - Kuehnle S AU - Mahoney D AU - Armbrecht E AU - Dalawari P FA - Dickason, R Myles FA - Chauhan, Vijai FA - Mor, Astha FA - Ibler, Erin FA - Kuehnle, Sarah FA - Mahoney, Daren FA - Armbrecht, Eric FA - Dalawari, Preeti IN - Dickason, R Myles. New York Hospital Queens, Department of Emergency Medicine, Flushing, New York. IN - Chauhan, Vijai. Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, Missouri. IN - Mor, Astha. Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, Missouri. IN - Ibler, Erin. St. Luke's Roosevelt Hospital Center, Department of Surgery, New York, New York. IN - Kuehnle, Sarah. Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona. IN - Mahoney, Daren. University of Nevada School of Medicine, Department of Emergency Medicine, Las Vegas, Nevada. IN - Armbrecht, Eric. Saint Louis University Center for Outcomes Research, St. Louis, Missouri. IN - Dalawari, Preeti. Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, Missouri. TI - Racial differences in opiate administration for pain relief at an academic emergency department. [Review] SO - The Western Journal of Emergency Medicine. 16(3):372-80, 2015 May AS - West J Emerg Med. 16(3):372-80, 2015 May NJ - The western journal of emergency medicine VO - 16 IP - 3 PG - 372-80 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427206 SB - Index Medicus CP - United States MH - *African Americans/sn [Statistics & Numerical Data] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Back Pain/dt [Drug Therapy] MH - Drug Administration Schedule MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *European Continental Ancestry Group/sn [Statistics & Numerical Data] MH - Fractures, Bone/co [Complications] MH - Healthcare Disparities/sn [Statistics & Numerical Data] MH - *Healthcare Disparities MH - *Hispanic Americans/sn [Statistics & Numerical Data] MH - Humans MH - Midwestern United States MH - Migraine Disorders/dt [Drug Therapy] MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - Pain Measurement MH - Physician-Patient Relations MH - Practice Patterns, Physicians' MH - Retrospective Studies AB - INTRODUCTION: The decision to treat pain in the emergency department (ED) is a complex, idiosyncratic process. Prior studies have shown that EDs undertreat pain. Several studies demonstrate an association between analgesia administration and race. This is the first Midwest single institution study to address the question of race and analgesia, in addition to examining the effects of both patient and physician characteristics on race-based disparities in analgesia administration. AB - METHODS: This was a retrospective chart review of patients presenting to an urban academic ED with an isolated diagnosis of back pain, migraine, or long bone fracture (LBF) from January 1, 2007 to December 31, 2011. Demographic and medication administration information was collected from patient charts by trained data collectors blinded to the hypothesis of the study. The primary outcome was the proportion of African-Americans who received analgesia and opiates, as compared to Caucasians, using Pearson's chi-squared test. We developed a multiple logistic regression model to identify which physician and patient characteristics correlated with increased opiate administration. AB - RESULTS: Of the 2,461 patients meeting inclusion criteria, 57% were African-American and 30% Caucasian (n=2136). There was no statistically significant racial difference in the administration of any analgesia (back pain: 86% vs. 86%, p=0.81; migraine: 83% vs. 73%, p=0.09; LBF: 94% vs. 90%, p=0.17), or in opiate administration for migraine or LBF. African-Americans who presented with back pain were less likely to receive an opiate than Caucasians (50% vs. 72%, p<0.001). Secondary outcomes showed that higher acuity, older age, physician training in emergency medicine, and male physicians were positively associated with opiate administration. Neither race nor gender patient-physician congruency correlated with opiate administration. AB - CONCLUSION: No race-based disparity in overall analgesia administration was noted for all three conditions: LBF, migraine, and back pain at this institution. A race-based disparity in the likelihood of receiving opiate analgesia for back pain was observed in this ED. The etiology of this is likely multifactorial, but understanding physician and patient characteristics of institutions may help to decrease the disparity by raising awareness of practice patterns and can provide the basis for quality improvement projects. RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2015.3.23893 PT - Comparative Study PT - Journal Article PT - Review ID - 10.5811/westjem.2015.3.23893 [doi] ID - wjem-16-372 [pii] ID - PMC4427206 [pmc] PP - ppublish PH - 2015/10/09 [received] PH - 2015/03/24 [revised] PH - 2015/03/24 [accepted] LG - English EP - 20150421 DP - 2015 May EZ - 2015/05/20 06:00 DA - 2016/03/30 06:00 DT - 2015/05/20 06:00 YR - 2015 ED - 20160329 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25987909 <254. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25871803 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - van den Bosch GE AU - White T AU - El Marroun H AU - Simons SH AU - van der Lugt A AU - van der Geest JN AU - Tibboel D AU - van Dijk M FA - van den Bosch, Gerbrich E FA - White, Tonya FA - El Marroun, Hanan FA - Simons, Sinno H P FA - van der Lugt, Aad FA - van der Geest, Jos N FA - Tibboel, Dick FA - van Dijk, Monique IN - van den Bosch, Gerbrich E. Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. TI - Prematurity, Opioid Exposure and Neonatal Pain: Do They Affect the Developing Brain?. CM - Comment in: Neonatology. 2016;109(2):120-1; PMID: 26670662 CM - Comment in: Neonatology. 2016;109(2):122-3; PMID: 26666420 SO - Neonatology. 108(1):8-15, 2015 AS - Neonatology. 108(1):8-15, 2015 NJ - Neonatology VO - 108 IP - 1 PG - 8-15 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101286577 IO - Neonatology SB - Index Medicus CP - Switzerland MH - *Aging MH - Animals MH - Body Weight MH - *Brain/de [Drug Effects] MH - Child MH - *Chronic Pain/dt [Drug Therapy] MH - Female MH - Follow-Up Studies MH - Gestational Age MH - Humans MH - *Infant, Premature/gd [Growth & Development] MH - Magnetic Resonance Imaging MH - Male MH - *Morphine/ae [Adverse Effects] MH - *Morphine/tu [Therapeutic Use] MH - Neuropsychological Tests MH - Rats MH - *Respiration, Artificial/mt [Methods] AB - BACKGROUND: Traditionally, 10 years ago, children born preterm often routinely received morphine, especially during mechanical ventilation. Studies in neonatal rats, whose stage of brain development roughly corresponds to that of children born preterm, found negative long-term effects after pain and opioid exposure. AB - OBJECTIVES: We studied possible effects of prematurity, procedural pain and opioids in humans 10 years later. We hypothesized that these factors would negatively influence neurobiological, neuropsychological and sensory development later in life. AB - METHODS: We included 19 children born preterm who as neonates participated in an RCT on the short-term effects of morphine administration and who previously participated in our follow-up studies at ages 5 and 8/9 years. We assessed associations between brain morphology (n = 11), neuropsychological functioning (n = 19) and thermal sensitivity (n = 17) and prematurity, opioid exposure and neonatal pain. AB - RESULTS: Significant correlations (coefficients 0.60-0.85) of gestational age, number of painful procedures and morphine exposure with brain volumes were observed. Significant correlations between these factors and thermal sensitivity were not established. Neuropsychological outcome was significantly moderately correlated with morphine exposure in only two subtests, and children performed in general 'average' by Dutch norms. AB - CONCLUSIONS: Although prematurity, opioid exposure and neonatal pain were significantly associated with brain volume, no major associations with neuropsychological functioning or thermal sensitivity were detected. Our findings suggest that morphine administration during neonatal life does not affect neurocognitive performance or thermal sensitivity during childhood in children born preterm without brain damage during early life. Future studies with larger sample sizes are needed to confirm these findings. Copyright © 2015 S. Karger AG, Basel. RN - 76I7G6D29C (Morphine) ES - 1661-7819 IL - 1661-7800 DO - https://dx.doi.org/10.1159/000376566 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 000376566 [pii] ID - 10.1159/000376566 [doi] PP - ppublish PH - 2014/09/15 [received] PH - 2015/01/29 [accepted] LG - English EP - 20150411 DP - 2015 EZ - 2015/04/15 06:00 DA - 2016/03/26 06:00 DT - 2015/04/15 06:00 YR - 2015 ED - 20160325 RD - 20160505 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25871803 <255. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24902873 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kelty E AU - Hayes L AU - O'Neil G AU - Kyle S AU - Jeffrey GP AU - O'Neil G AU - Hendrie D AU - Mukhtar A AU - Hulse G FA - Kelty, Erin FA - Hayes, Lesleigh FA - O'Neil, Graeme FA - Kyle, Sarah FA - Jeffrey, Gary P FA - O'Neil, George FA - Hendrie, Delia FA - Mukhtar, Aqif FA - Hulse, Gary IN - Kelty, Erin. Fresh Start Recovery Programme, Subiaco, WA, Australia School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia erin.kelty@freshstart.org.au. IN - Hayes, Lesleigh. Fresh Start Recovery Programme, Subiaco, WA, Australia. IN - O'Neil, Graeme. Fresh Start Recovery Programme, Subiaco, WA, Australia. IN - Kyle, Sarah. Fresh Start Recovery Programme, Subiaco, WA, Australia. IN - Jeffrey, Gary P. School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia Western Australia Liver Transplantation Service, Sir Charles Gardiner Hospital, Nedlands, WA, Australia. IN - O'Neil, George. Fresh Start Recovery Programme, Subiaco, WA, Australia. IN - Hendrie, Delia. Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia. IN - Mukhtar, Aqif. Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia. IN - Hulse, Gary. School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia. TI - Changes in hospital and out-patient events and costs following implant naltrexone treatment for problematic alcohol use. SO - Journal of Psychopharmacology. 28(8):745-50, 2014 Aug AS - J Psychopharmacol. 28(8):745-50, 2014 Aug NJ - Journal of psychopharmacology (Oxford, England) VO - 28 IP - 8 PG - 745-50 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - cph, 8907828 IO - J. Psychopharmacol. (Oxford) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Alcohol Drinking/dt [Drug Therapy] MH - *Alcohol Drinking/ec [Economics] MH - Australia MH - Delayed-Action Preparations/ec [Economics] MH - Delayed-Action Preparations/tu [Therapeutic Use] MH - Drug Implants/ec [Economics] MH - Drug Implants/tu [Therapeutic Use] MH - Female MH - *Health Care Costs MH - *Hospitalization/ec [Economics] MH - Humans MH - Male MH - Mental Health Services/ec [Economics] MH - Middle Aged MH - Naltrexone/ad [Administration & Dosage] MH - *Naltrexone/ec [Economics] MH - Naltrexone/tu [Therapeutic Use] MH - *Outpatients/sn [Statistics & Numerical Data] MH - *Patient Acceptance of Health Care/sn [Statistics & Numerical Data] MH - Young Adult KW - Naltrexone implant; alcohol; cost; health services AB - The harmful use of alcohol places a considerable burden on the community, both socially and financially. The aim of this study was to determine if the use of implant naltrexone is associated with a reduction in health care events and costs in patients treated for problematic alcohol use. Ninety four patients (60.6% male) treated between 2002 and 2007 were matched against state hospital, emergency department (ED), mental health out-patients and mortality data sets for 6 months prior to and 6 months post treatment. The number of patients, events, and costs associated with each health event were compared before and after treatment. Overall health care events and costs were reduced from $509033 prior to treatment to $270001 following treatment. Costs associated with hospital admission showed the most significant reduction, falling from $424605 (82 admissions/36 patients) before treatment to $203462 (43 admission/24 patients) after. While costs associated with ED attendances also fell ($74885 to $54712), costs associated with mental health out-patient attendances increased ($9543 to $11827). The use of implant naltrexone was associated with a reduction health events and costs in patients with problematic alcohol use in the first 6 months following treatment. Copyright © The Author(s) 2014. RN - 0 (Delayed-Action Preparations) RN - 0 (Drug Implants) RN - 5S6W795CQM (Naltrexone) ES - 1461-7285 IL - 0269-8811 DO - https://dx.doi.org/10.1177/0269881114536791 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 0269881114536791 [pii] ID - 10.1177/0269881114536791 [doi] PP - ppublish LG - English EP - 20140605 DP - 2014 Aug EZ - 2014/06/07 06:00 DA - 2016/03/25 06:00 DT - 2014/06/07 06:00 YR - 2014 ED - 20160324 RD - 20150524 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24902873 <256. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26803896 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Faley B FA - Faley, Brian TI - Using Alternatives to Opioids In an Acute Care Setting. SO - Managed Care. 24(12):52, 2015 Dec AS - Manag Care. 24(12):52, 2015 Dec NJ - Managed care (Langhorne, Pa.) VO - 24 IP - 12 PG - 52 PI - Journal available in: Print PI - Citation processed from: Print JC - b7n, 9303583 IO - Manag Care SB - Health Administration Journals CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Substitution MH - *Drug-Related Side Effects and Adverse Reactions/pc [Prevention & Control] MH - *Emergency Service, Hospital MH - Humans MH - United States RN - 0 (Analgesics, Opioid) IS - 1062-3388 IL - 1062-3388 PT - Journal Article PP - ppublish LG - English DP - 2015 Dec EZ - 2016/01/26 06:00 DA - 2016/03/24 06:00 DT - 2016/01/26 06:00 YR - 2015 ED - 20160322 RD - 20160125 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26803896 <257. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26039379 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fareed A AU - Buchanan-Cummings AM AU - Crampton K AU - Grant A AU - Drexler K FA - Fareed, Ayman FA - Buchanan-Cummings, Ann Marie FA - Crampton, Kelli FA - Grant, Angela FA - Drexler, Karen IN - Fareed, Ayman. Atlanta VA Medical Center, Decatur, Georgia. IN - Fareed, Ayman. Department of Psychiatry, Emory University, Atlanta, Georgia. IN - Buchanan-Cummings, Ann Marie. Atlanta VA Medical Center, Decatur, Georgia. IN - Crampton, Kelli. Atlanta VA Medical Center, Decatur, Georgia. IN - Grant, Angela. Atlanta VA Medical Center, Decatur, Georgia. IN - Drexler, Karen. Atlanta VA Medical Center, Decatur, Georgia. IN - Drexler, Karen. Department of Psychiatry, Emory University, Atlanta, Georgia. TI - Reversal of overdose on fentanyl being illicitly sold as heroin with naloxone nasal spray: A case report. SO - American Journal on Addictions. 24(5):388-90, 2015 Aug AS - Am J Addict. 24(5):388-90, 2015 Aug NJ - The American journal on addictions VO - 24 IP - 5 PG - 388-90 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9208821 IO - Am J Addict SB - Index Medicus CP - England MH - Buprenorphine, Naloxone Drug Combination/ad [Administration & Dosage] MH - *Drug Overdose/dt [Drug Therapy] MH - *Fentanyl/to [Toxicity] MH - *First Aid MH - *Heroin/to [Toxicity] MH - Heroin Dependence/rh [Rehabilitation] MH - Humans MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - Nasal Sprays MH - Recurrence MH - *Street Drugs/to [Toxicity] MH - *Veterans/ed [Education] AB - BACKGROUND: This is a case report describing a reversal of fentanyl overdose with naloxone nasal spray. The patient was not aware that he overdosed on fentanyl being sold as heroin. AB - METHODS: The Veterans Health Administration (VHA) has implemented an initiative to provide education for veterans, their families, friends and significant others about opioid overdose and use of naloxone reversal kits. The Atlanta VA Medical Center adopted this program to reduce the risk of opioid overdose in high risk patients. AB - RESULTS: Over the past year, we provided educational sessions for 63 veterans and their families. We also prescribed 41 naloxone kits. We have received three reports of opioid overdose reversal with use of naloxone kits prescribed by the Atlanta VA Medical Center. AB - CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The authors recommend that public health administrators and policy makers advocate for the implementation of these programs to reduce the rising number of overdose death in the United States and worldwide. Copyright © American Academy of Addiction Psychiatry. RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - 0 (Nasal Sprays) RN - 0 (Street Drugs) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) RN - UF599785JZ (Fentanyl) ES - 1521-0391 IL - 1055-0496 DO - https://dx.doi.org/10.1111/ajad.12230 PT - Case Reports PT - Letter ID - 10.1111/ajad.12230 [doi] PP - ppublish PH - 2015/02/09 [received] PH - 2015/03/24 [revised] PH - 2015/03/28 [accepted] LG - English EP - 20150603 DP - 2015 Aug EZ - 2015/06/04 06:00 DA - 2016/03/05 06:00 DT - 2015/06/04 06:00 YR - 2015 ED - 20160302 RD - 20161020 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26039379 <258. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26929631 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Rizzardo A AU - Miceli L AU - Bednarova R AU - Guadagnin GM AU - Sbrojavacca R AU - Della Rocca G FA - Rizzardo, Alessandro FA - Miceli, Luca FA - Bednarova, Rym FA - Guadagnin, Giovanni Maria FA - Sbrojavacca, Rodolfo FA - Della Rocca, Giorgio IN - Rizzardo, Alessandro. Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, Italy. IN - Miceli, Luca. Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, Italy. IN - Bednarova, Rym. Pain Medicine and Palliative Care, Health Company Number 2, Gorizia, Italy. IN - Guadagnin, Giovanni Maria. Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, Italy. IN - Sbrojavacca, Rodolfo. Emergency Department, Academic Hospital of Udine, Udine, Italy. IN - Della Rocca, Giorgio. Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, Italy. TI - Low-back pain at the emergency department: still not being managed?. SO - Therapeutics & Clinical Risk Management. 12:183-7, 2016 AS - Ther Clin Risk Manag. 12:183-7, 2016 NJ - Therapeutics and clinical risk management VO - 12 PG - 183-7 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Print JC - 101253281 IO - Ther Clin Risk Manag PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758795 CP - New Zealand KW - cost analysis; emergency department; health policies; low-back pain AB - BACKGROUND: Low-back pain (LBP) affects about 40% of people at some point in their lives. In the presence of "red flags", further tests must be done to rule out underlying problems; however, biomedical imaging is currently overused. LBP involves large in-hospital and out-of-hospital economic costs, and it is also the most common musculoskeletal disorder seen in emergency departments (EDs). AB - PATIENTS AND METHODS: This retrospective observational study enrolled 1,298 patients admitted to the ED, including all International Classification of Diseases 10 diagnosis codes for sciatica, lumbosciatica, and lumbago. We collected patients' demographic data, medical history, lab workup and imaging performed at the ED, drugs administered at the ED, ED length of stay (LOS), numeric rating scale pain score, admission to ward, and ward LOS data. Thereafter, we performed a cost analysis. AB - RESULTS: Mean numeric rating scale scores were higher than 7/10. Home medication consisted of no drug consumption in up to 90% of patients. Oxycodone-naloxone was the strong opioid most frequently prescribed for the home. Once at the ED, nonsteroidal anti-inflammatory drugs and opiates were administered to up to 72% and 42% of patients, respectively. Imaging was performed in up to 56% of patients. Mean ED LOS was 4 hours, 14 minutes. A total of 43 patients were admitted to a ward. The expense for each non-ward-admitted patient was approximately 200 in the ED, while the mean expense for ward-admitted patients was 9,500, with a mean LOS of 15 days. AB - CONCLUSION: There is not yet a defined therapeutic care process for the patient with LBP with clear criteria for an ED visit. It is to this end that we need a clinical pathway for the prehospital management of LBP syndrome and consequently for an in-hospital time-saving therapeutic approach to the patient. IS - 1176-6336 IL - 1176-6336 DO - https://dx.doi.org/10.2147/TCRM.S91898 PT - Journal Article ID - 10.2147/TCRM.S91898 [doi] ID - tcrm-12-183 [pii] ID - PMC4758795 [pmc] PP - epublish LG - English EP - 20160212 DP - 2016 EZ - 2016/03/02 06:00 DA - 2016/03/02 06:01 DT - 2016/03/02 06:00 YR - 2016 ED - 20160301 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=26929631 <259. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26369569 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tsutaoka BT AU - Ho RY AU - Fung SM AU - Kearney TE FA - Tsutaoka, Ben T FA - Ho, Raymond Y FA - Fung, Stacey M FA - Kearney, Thomas E IN - Tsutaoka, Ben T. California Poison Control System, University of California San Francisco, San Francisco, CA, USA btsutaoka@calpoison.org. IN - Ho, Raymond Y. California Poison Control System, University of California San Francisco, San Francisco, CA, USA. IN - Fung, Stacey M. Medical Communications Genentech, A Member of the Roche Group, South San Francisco, CA, USA. IN - Kearney, Thomas E. California Poison Control System, University of California San Francisco, San Francisco, CA, USA. TI - Comparative Toxicity of Tapentadol and Tramadol Utilizing Data Reported to the National Poison Data System. SO - Annals of Pharmacotherapy. 49(12):1311-6, 2015 Dec AS - Ann Pharmacother. 49(12):1311-6, 2015 Dec NJ - The Annals of pharmacotherapy VO - 49 IP - 12 PG - 1311-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bbx, 9203131 IO - Ann Pharmacother SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Adverse Drug Reaction Reporting Systems MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Child MH - Child, Preschool MH - Drug Overdose/ep [Epidemiology] MH - Female MH - Humans MH - Infant MH - Male MH - Middle Aged MH - *Phenols/ae [Adverse Effects] MH - Poison Control Centers MH - Retrospective Studies MH - Risk MH - Seizures/ci [Chemically Induced] MH - *Tramadol/ae [Adverse Effects] MH - Vomiting/ci [Chemically Induced] MH - Young Adult KW - adverse effects; tapentadol; toxicity; tramadol AB - BACKGROUND: Tapentadol (TAP) and tramadol (TRA) provide pain relief through similar monoaminergic and opioid agonist properties. AB - OBJECTIVE: To compare clinical effects and medical outcomes between TAP and TRA exposures reported to the National Poison Data System of the American Association of Poison Control Centers. AB - METHODS: A retrospective cohort study was conducted analyzing national data for single medication TAP or TRA cases reported from June 2009 through December 2011. Case outcomes, dichotomized as severe versus mild; clinical effects; and use of naloxone were compared. AB - RESULTS: There were 217 TAP and 8566 TRA cases. Significantly more severe outcomes were associated with TAP exposures for an all-age comparison (relative risk [RR] = 1.24; 95% CI = 1.04-1.48), and for the <6-year-old age group (RR = 5.76; 95% CI = 2.20-15.11). Patients with TAP exposures had significantly greater risk of respiratory depression (RR = 5.56; 95% CI = 3.50-8.81), coma (RR = 4.16; 95% CI = 2.33-7.42), drowsiness/lethargy (RR = 1.38; 95% CI = 1.15-1.66), slurred speech (RR = 3.51; 95% CI = 1.98-6.23), hallucination/delusion (RR = 7.25; 95% CI = 3.61-14.57), confusion (RR = 2.54; 95% CI = 1.56-4.13) and use of naloxone (RR = 3.80; 95% CI = 2.96-4.88). TRA exposures had significantly greater risk of seizures (RR = 7.94; 95% CI = 2.99-20.91) and vomiting (RR = 1.96; 95% CI = 1.07-3.60). AB - CONCLUSION: TAP was associated with significantly more toxic clinical effects and severe outcomes consistent with an opioid agonist. TRA was associated with significantly higher rates of seizures and vomiting. Copyright © The Author(s) 2015. RN - 0 (Analgesics, Opioid) RN - 0 (Phenols) RN - 39J1LGJ30J (Tramadol) RN - H8A007M585 (tapentadol) ES - 1542-6270 IL - 1060-0280 DO - https://dx.doi.org/10.1177/1060028015604631 PT - Comparative Study PT - Journal Article ID - 1060028015604631 [pii] ID - 10.1177/1060028015604631 [doi] PP - ppublish LG - English EP - 20150914 DP - 2015 Dec EZ - 2015/09/16 06:00 DA - 2016/02/26 06:00 DT - 2015/09/16 06:00 YR - 2015 ED - 20160224 RD - 20151114 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26369569 <260. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26881149 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Crellin SJ AU - Katz KD FA - Crellin, Steven Jason FA - Katz, Kenneth D IN - Crellin, Steven Jason. Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, USF MCOM, Cedar Crest Boulevard and I-78, Allentown, PA 18103, USA. IN - Katz, Kenneth D. Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, USF MCOM, Cedar Crest Boulevard and I-78, Allentown, PA 18103, USA. TI - Pentobarbital Toxicity after Self-Administration of Euthasol Veterinary Euthanasia Medication. SO - Case Reports in Emergency Medicine Print. 2016:6270491, 2016 AS - case report. emerg. med.. 2016:6270491, 2016 NJ - Case reports in emergency medicine VO - 2016 PG - 6270491 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - 101591814 IO - Case Rep Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735920 CP - United States AB - Suicide attempt via sodium pentobarbital is uncommon. A 48-year-old woman with a history of depression and prior suicide attempt was found unresponsive by her veterinarian spouse near a syringe containing pink solution. Upon EMS' arrival, the patient was experiencing apnea, hypoxemia, and miotic pupils; her blood glucose level measured 73mg/dL. She was bradycardic and administered atropine with transient improvement in heart rate and transported to an emergency department; 2mg of intravenous naloxone was administered without effect. She was endotracheally intubated via rapid sequence intubation. Rapid urine drug screening detected both benzodiazepines and barbiturates. The patient was transferred to an intensive care unit where she demonstrated a nearly absent radial pulse. Emergent fasciotomy to the left forearm and carpal tunnel was performed for acute compartment syndrome; "Euthasol" had been self-administered into the antecubital fossa. Expanded toxicological analysis via liquid chromatography/mass spectroscopy detected caffeine, atropine, 7-aminoclonazepam, phenytoin, citalopram, and naproxen. The patient's coma resolved over 48 hours and she was successfully extubated without complication. Emergency physicians must closely monitor patients exposed to veterinary euthanasia agents who develop central nervous system and respiratory depression, hypothermia, bradycardia, hypotension, or skin injury. Consultation with a regional poison center and medical toxicologist is recommended. IS - 2090-648X IL - 2090-6498 DO - https://dx.doi.org/10.1155/2016/6270491 PT - Journal Article ID - 10.1155/2016/6270491 [doi] ID - PMC4735920 [pmc] PP - ppublish PH - 2015/09/14 [received] PH - 2015/12/14 [revised] PH - 2015/12/15 [accepted] LG - English EP - 20160103 DP - 2016 EZ - 2016/02/18 06:00 DA - 2016/02/18 06:01 DT - 2016/02/17 06:00 YR - 2016 ED - 20160216 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=26881149 <261. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24650810 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Moore C AU - Lloyd G AU - Oretti R AU - Russell I AU - Snooks H FA - Moore, Chris FA - Lloyd, Gregory FA - Oretti, Rossana FA - Russell, Ian FA - Snooks, Helen IN - Moore, Chris. Medical and Clinical Services Directorate, Welsh Ambulance Services NHS Trust, Blackweir Ambulance Station, Cardiff, UK. TI - Paramedic-supplied 'Take Home' Naloxone: protocol for cluster randomised feasibility study. SO - BMJ Open. 4(3):e004712, 2014 Mar 20 AS - BMJ Open. 4(3):e004712, 2014 Mar 20 NJ - BMJ open VO - 4 IP - 3 PG - e004712 PI - Journal available in: Electronic PI - Citation processed from: Print JC - 101552874 IO - BMJ Open PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963087 SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Allied Health Personnel/ed [Education] MH - *Allied Health Personnel MH - *Analgesics, Opioid/po [Poisoning] MH - Clinical Protocols MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/mt [Methods] MH - Feasibility Studies MH - Female MH - Humans MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Patient Selection MH - Research Design MH - Wales MH - Young Adult KW - Accident & Emergency Medicine; Public Health AB - INTRODUCTION: 'Take Home' Naloxone (THN) kits for use by peers in the event of an opioid overdose may reduce further overdose and deaths, but distribution through Drugs Services may not reach those at highest risk. Attendance by paramedics at emergency calls for patients who have suffered an overdose presents an opportunity to distribute THN kits. In this feasibility study we will assess the acceptability of this intervention, and gather data to inform definitive trial planning. AB - METHODS AND ANALYSIS: Cluster randomised trial with staggered allocation of paramedics (clusters) to groups. We will invite paramedics in an urban area of south Wales, UK to take part. We will randomly allocate those that accept to training sessions during the first 4 months of the trial. Patients attended by paramedics who have been trained and issued THN kits will fall into the intervention group. Patients attended by paramedics following usual practice (until they receive their training and THN kits) will fall into the control group. We will gather data about processes and outcomes of care: numbers of patients eligible for intervention, offered and accepted THN, attended emergency department, suffered further overdose, died within 3 months and about follow-up rates: numbers of patients consented, completed (postal or telephone) questionnaire. We will gather qualitative data about acceptability to patients and paramedics through interviews and focus groups. AB - ETHICS AND DISSEMINATION: Ethical approval for this study was granted on 7 December 2011, by South East Wales Research Ethics Committee, Panel C. Results of this study will be reported through peer-reviewed scientific journals, conference presentations and internal organisational report. We will also seek to report our findings through local and national substance misuse networks and publications. AB - TRIAL REGISTRATION NUMBER: ISRCTN98216498. NT - Original DateCompleted: 20140321 RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 2044-6055 IL - 2044-6055 DO - https://dx.doi.org/10.1136/bmjopen-2013-004712 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - bmjopen-2013-004712 [pii] ID - 10.1136/bmjopen-2013-004712 [doi] ID - PMC3963087 [pmc] PP - epublish GI - No: MR/K006525/1 Organization: *Medical Research Council* Country: United Kingdom LG - English EP - 20140320 DP - 2014 Mar 20 EZ - 2014/03/22 06:00 DA - 2014/03/22 06:01 DT - 2014/03/22 06:00 YR - 2014 ED - 20160127 RD - 20170922 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24650810 <262. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26472998 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lavonas EJ AU - Drennan IR AU - Gabrielli A AU - Heffner AC AU - Hoyte CO AU - Orkin AM AU - Sawyer KN AU - Donnino MW FA - Lavonas, Eric J FA - Drennan, Ian R FA - Gabrielli, Andrea FA - Heffner, Alan C FA - Hoyte, Christopher O FA - Orkin, Aaron M FA - Sawyer, Kelly N FA - Donnino, Michael W TI - Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. [Review][Erratum appears in Circulation. 2016 Aug 30;134(9):e122; PMID: 27572886] SO - Circulation. 132(18 Suppl 2):S501-18, 2015 Nov 03 AS - Circulation. 132(18 Suppl 2):S501-18, 2015 Nov 03 NJ - Circulation VO - 132 IP - 18 Suppl 2 PG - S501-18 PI - Journal available in: Print PI - Citation processed from: Internet JC - daw, 0147763 IO - Circulation SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Anaphylaxis/co [Complications] MH - Anaphylaxis/th [Therapy] MH - Cardiac Tamponade/co [Complications] MH - Cardiac Tamponade/th [Therapy] MH - Cardiopulmonary Resuscitation/mt [Methods] MH - *Cardiopulmonary Resuscitation/st [Standards] MH - Emergency Medical Services/mt [Methods] MH - *Emergency Medical Services/st [Standards] MH - Fat Emulsions, Intravenous/tu [Therapeutic Use] MH - Female MH - Heart Arrest/ci [Chemically Induced] MH - Heart Arrest/co [Complications] MH - *Heart Arrest/th [Therapy] MH - Humans MH - Hypothermia/co [Complications] MH - Hypothermia/th [Therapy] MH - Naloxone/tu [Therapeutic Use] MH - Near Drowning/co [Complications] MH - Near Drowning/th [Therapy] MH - Percutaneous Coronary Intervention MH - Pregnancy MH - Pregnancy Complications, Cardiovascular/th [Therapy] MH - Pulmonary Embolism/co [Complications] MH - Pulmonary Embolism/th [Therapy] MH - Water-Electrolyte Imbalance/co [Complications] MH - Water-Electrolyte Imbalance/th [Therapy] MH - Wounds and Injuries/co [Complications] MH - Wounds and Injuries/th [Therapy] KW - cardiac arrest; defibrillation; emergency RN - 0 (Fat Emulsions, Intravenous) RN - 36B82AMQ7N (Naloxone) ES - 1524-4539 IL - 0009-7322 DO - https://dx.doi.org/10.1161/CIR.0000000000000264 PT - Consensus Development Conference PT - Journal Article PT - Practice Guideline PT - Review ID - CIR.0000000000000264 [pii] ID - 10.1161/CIR.0000000000000264 [doi] PP - ppublish LG - English DP - 2015 Nov 03 EZ - 2015/10/17 06:00 DA - 2016/01/23 06:00 DT - 2015/10/17 06:00 YR - 2015 ED - 20160121 RD - 20160830 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26472998 <263. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26472859 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Travers AH AU - Perkins GD AU - Berg RA AU - Castren M AU - Considine J AU - Escalante R AU - Gazmuri RJ AU - Koster RW AU - Lim SH AU - Nation KJ AU - Olasveengen TM AU - Sakamoto T AU - Sayre MR AU - Sierra A AU - Smyth MA AU - Stanton D AU - Vaillancourt C AU - Basic Life Support Chapter Collaborators FA - Travers, Andrew H FA - Perkins, Gavin D FA - Berg, Robert A FA - Castren, Maaret FA - Considine, Julie FA - Escalante, Raffo FA - Gazmuri, Raul J FA - Koster, Rudolph W FA - Lim, Swee Han FA - Nation, Kevin J FA - Olasveengen, Theresa M FA - Sakamoto, Tetsuya FA - Sayre, Michael R FA - Sierra, Alfredo FA - Smyth, Michael A FA - Stanton, David FA - Vaillancourt, Christian FA - Basic Life Support Chapter Collaborators IR - Bierens JJ IR - Bourdon E IR - Brugger H IR - Buick JE IR - Charette ML IR - Chung SP IR - Couper K IR - Daya MR IR - Drennan IR IR - Grasner JT IR - Idris AH IR - Lerner EB IR - Lockhat H IR - Lofgren B IR - McQueen C IR - Monsieurs KG IR - Mpotos N IR - Orkin AM IR - Quan L IR - Raffay V IR - Reynolds JC IR - Ristagno G IR - Scapigliati A IR - Vadeboncoeur TF IR - Wenzel V IR - Yeung J TI - Part 3: Adult Basic Life Support and Automated External Defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. [Review] SO - Circulation. 132(16 Suppl 1):S51-83, 2015 Oct 20 AS - Circulation. 132(16 Suppl 1):S51-83, 2015 Oct 20 NJ - Circulation VO - 132 IP - 16 Suppl 1 PG - S51-83 PI - Journal available in: Print PI - Citation processed from: Internet JC - daw, 0147763 IO - Circulation SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Age Factors MH - Analgesics, Opioid/ae [Adverse Effects] MH - Cardiopulmonary Resuscitation/mt [Methods] MH - *Cardiopulmonary Resuscitation/st [Standards] MH - Child MH - *Defibrillators MH - Electric Countershock/mt [Methods] MH - *Electric Countershock/st [Standards] MH - Emergencies MH - Emergency Medical Services/mt [Methods] MH - *Emergency Medical Services/st [Standards] MH - Health Education MH - Heart Arrest/ci [Chemically Induced] MH - Heart Arrest/dt [Drug Therapy] MH - *Heart Arrest/th [Therapy] MH - Heart Massage/mt [Methods] MH - Heart Massage/st [Standards] MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - Near Drowning/th [Therapy] MH - Observational Studies as Topic MH - Randomized Controlled Trials as Topic MH - Ventricular Fibrillation/th [Therapy] KW - arrhythmia; cardiac arrest; cardiopulmonary resuscitation; emergency department; resuscitation AB - This review comprises the most extensive literature search and evidence evaluation to date on the most important international BLS interventions, diagnostics, and prognostic factors for cardiac arrest victims. It reemphasizes that the critical lifesaving steps of BLS are (1) prevention, (2) immediate recognition and activation of the emergency response system, (3) early high-quality CPR, and (4) rapid defibrillation for shockable rhythms. Highlights in prevention indicate the rational and judicious deployment of search-and-rescue operations in drowning victims and the importance of education on opioid-associated emergencies. Other 2015 highlights in recognition and activation include the critical role of dispatcher recognition and dispatch-assisted chest compressions, which has been demonstrated in multiple international jurisdictions with consistent improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS treatment recommendations, the importance of high quality was reemphasized across all measures of CPR quality: rate, depth, recoil, and minimal chest compression pauses, with a universal understanding that we all should be providing chest compressions to all victims of cardiac arrest. This review continued to focus on the interface of BLS sequencing and ensuring high-quality CPR with other important BLS interventions, such as ventilation and defibrillation. In addition, this consensus statement highlights the importance of EMS systems, which employ bundles of care focusing on providing high-quality chest compressions while extricating the patient from the scene to the next level of care. Highlights in defibrillation indicate the global importance of increasing the number of sites with public-access defibrillation programs. Whereas the 2010 ILCOR Consensus on Science provided important direction for the "what" in resuscitation (ie, what to do), the 2015 consensus has begun with the GRADE methodology to provide direction for the quality of resuscitation. We hope that resuscitation councils and other stakeholders will be able to translate this body of knowledge of international consensus statements to build their own effective resuscitation guidelines. RN - 0 (Analgesics, Opioid) RN - 36B82AMQ7N (Naloxone) ES - 1524-4539 IL - 0009-7322 DO - https://dx.doi.org/10.1161/CIR.0000000000000272 PT - Consensus Development Conference PT - Journal Article PT - Practice Guideline PT - Review ID - CIR.0000000000000272 [pii] ID - 10.1161/CIR.0000000000000272 [doi] PP - ppublish GI - No: PDF-2014-07-061 Organization: *Department of Health* Country: United Kingdom LG - English DP - 2015 Oct 20 EZ - 2015/10/17 06:00 DA - 2016/01/23 06:00 DT - 2015/10/17 06:00 YR - 2015 ED - 20160121 RD - 20171110 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26472859 <264. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25664538 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Daoust R AU - Paquet J AU - Lavigne G AU - Piette E AU - Chauny JM FA - Daoust, Raoul FA - Paquet, Jean FA - Lavigne, Gilles FA - Piette, Eric FA - Chauny, Jean-Marc TI - Impact of age, sex and route of administration on adverse events after opioid treatment in the emergency department: a retrospective study. SO - Pain Research & Management. 20(1):23-8, 2015 Jan-Feb AS - Pain Res Manag. 20(1):23-8, 2015 Jan-Feb NJ - Pain research & management VO - 20 IP - 1 PG - 23-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9612504 IO - Pain Res Manag PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325886 SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - Administration, Intravenous MH - Administration, Oral MH - Adult MH - Age Factors MH - Aged MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Sex Factors MH - Subcutaneous Absorption AB - BACKGROUND: The efficacy of opioids for acute pain relief in the emergency department (ED) is well recognized, but treatment with opioids is associated with adverse events ranging from minor discomforts to life-threatening events. AB - OBJECTIVE: To assess the impact of age, sex and route of administration on the incidence of adverse events due to opioid administration in the ED. AB - METHODS: Real-time archived data were analyzed retrospectively in a tertiary care urban hospital. All consecutive patients (>=16 years of age) who were assigned to an ED bed and received an opioid between March 2008 and December 2012 were included. Adverse events were defined as: nausea/vomiting (minor); systolic blood pressure (SBP) <90 mmHg, oxygen saturation (Sat) <92% and respiration rate <10 breaths/min (major) within 2 h of the first opioid doses. AB - RESULTS: In the study period, 31,742 patients were treated with opioids. The mean (+/- SD) age was 55.8+/-20.5 years, and 53% were female. The overall incidence of adverse events was 12.0% (95% CI 11.6% to 12.4%): 5.9% (95% CI 5.6% to 6.2%) experienced nausea/vomiting, 2.4% (95% CI 2.2% to 2.6%) SBP <90 mmHg, 4.7% (95% CI 4.5% to 4.9%) Sat that dropped to <92% and 0.09% respiration rate <10 breaths/min. After controlling for confounding factors, these adverse events were associated with: female sex (more nausea/vomiting, more SBP <90 mmHg, less Sat <92%); age >=65 years (less nausea/vomiting, more SBP <90 mmHg, more Sat <92%); and route of administration (intravenous > subcutaneous > oral). AB - CONCLUSIONS: The incidence of adverse events associated with opioid administration in the ED is generally low and is associated with age, sex and route of administration. RN - 0 (Analgesics, Opioid) ES - 1918-1523 IL - 1203-6765 PT - Journal Article ID - PMC4325886 [pmc] PP - ppublish LG - English DP - 2015 Jan-Feb EZ - 2015/02/11 06:00 DA - 2016/01/20 06:00 DT - 2015/02/10 06:00 YR - 2015 ED - 20160119 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25664538 <265. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25926584 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Doris MK AU - Sandilands EA FA - Doris, Mhairi K FA - Sandilands, Euan A IN - Doris, Mhairi K. NHS Lothian, Edinburgh, UK. IN - Sandilands, Euan A. National Poisons Information Service Edinburgh, NHS Lothian, Edinburgh, UK. TI - Life-threatening opioid toxicity from a fentanyl patch applied to eczematous skin. SO - BMJ Case Reports. 2015, 2015 Apr 29 AS - BMJ Case Rep. 2015, 2015 Apr 29 NJ - BMJ case reports VO - 2015 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101526291 IO - BMJ Case Rep SB - Index Medicus CP - England MH - Administration, Cutaneous MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/po [Poisoning] MH - Eczema/co [Complications] MH - Fentanyl/ad [Administration & Dosage] MH - *Fentanyl/po [Poisoning] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Self Medication/ae [Adverse Effects] MH - Transdermal Patch MH - Young Adult AB - A 19-year-old man with a history of eczema was admitted to the emergency department following collapsing at home. The paramedics found him unresponsive with poor respiratory effort and a widespread erythematous rash. Anaphylaxis, thought to be secondary to flucloxacillin he had recently been prescribed, was diagnosed. Epinephrine, steroids and antihistamines were administered without clinical improvement. On arrival to hospital, constricted pupils were noted prompting the emergency physicians to consider opiate toxicity. Intravenous naloxone brought about an immediate recovery. His father subsequently disclosed that he had given his son one of his own fentanyl patches to alleviate the distressing symptoms of eczema. Although the patient had removed the patch prior to collapsing, he had suffered life-threatening opioid toxicity likely due to enhanced opiate absorption through eczematous skin. This case highlights the risks associated with fentanyl patches in patients with chronic skin conditions. Copyright 2015 BMJ Publishing Group Ltd. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) ES - 1757-790X IL - 1757-790X DI - bcr2014208945 DO - https://dx.doi.org/10.1136/bcr-2014-208945 PT - Case Reports PT - Journal Article ID - bcr-2014-208945 [pii] ID - 10.1136/bcr-2014-208945 [doi] ID - PMC4422925 [pmc] PP - epublish LG - English EP - 20150429 DP - 2015 Apr 29 EZ - 2015/05/01 06:00 DA - 2016/01/16 06:00 DT - 2015/05/01 06:00 YR - 2015 ED - 20160115 RD - 20170430 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25926584 <266. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25128450 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mattos JL AU - Robison JG AU - Greenberg J AU - Yellon RF FA - Mattos, Jose L FA - Robison, Jacob G FA - Greenberg, Jesse FA - Yellon, Robert F IN - Mattos, Jose L. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. IN - Robison, Jacob G. Division of Pediatric Otolaryngology, St. Luke's Children's Hospital, Boise, ID 83712, USA. IN - Greenberg, Jesse. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. IN - Yellon, Robert F. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA. Electronic address: Robert.Yellon@chp.edu. TI - Acetaminophen plus ibuprofen versus opioids for treatment of post-tonsillectomy pain in children. SO - International Journal of Pediatric Otorhinolaryngology. 78(10):1671-6, 2014 Oct AS - Int J Pediatr Otorhinolaryngol. 78(10):1671-6, 2014 Oct NJ - International journal of pediatric otorhinolaryngology VO - 78 IP - 10 PG - 1671-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - gs2, 8003603 IO - Int. J. Pediatr. Otorhinolaryngol. SB - Index Medicus CP - Ireland MH - *Acetaminophen/tu [Therapeutic Use] MH - *Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - Dehydration MH - Drug Therapy, Combination MH - Emergency Service, Hospital MH - Female MH - Humans MH - *Ibuprofen/tu [Therapeutic Use] MH - Logistic Models MH - Male MH - Pain Measurement MH - *Pain, Postoperative/dt [Drug Therapy] MH - Postoperative Hemorrhage/pp [Physiopathology] MH - Retrospective Studies MH - Tertiary Care Centers MH - *Tonsillectomy KW - Bleeding; Children; Non-steroidal anti-inflammatory; Pain; Sleep disordered breathing; Tonsillectomy AB - OBJECTIVE: To determine the efficacy and safety of acetaminophen plus ibuprofen in treatment of post-tonsillectomy pain compared to acetaminophen plus opioids in children. AB - STUDY DESIGN: Retrospective medical record review. AB - SETTING: Tertiary-care children's hospital between September 2012 and March 2013. AB - SUBJECTS AND METHODS: All children undergoing total tonsillectomy (n=1065). Analysis included descriptive analysis, chi-square testing, and logistic regression controlling for age, diagnosis, trainee involvement, concurrent surgical procedures, and Coblator use for differences of outcomes: (1) post-operative bleeding, (2) emergency department (ED) visits for pain, dehydration, or bleeding, and (3) nurse phone calls from families. AB - RESULTS: All patients received acetaminophen. Seventy-four percent received ibuprofen (n=783) and 26.5% did not receive ibuprofen (n=282). In the ibuprofen group, 32.2% received opioids (n=252). Over eight percent of children had post-operative hemorrhage of any amount reported (n=89). Forty-eight percent of these required operative intervention (n=43). Ibuprofen prescription did not impact post-operative bleeding; operative intervention for bleeding, ED visits, or nurse phone calls either on chi-squared or logistic regression testing. Increasing age was found to increase bleeding risk as well as the likelihood of visiting the ED or calling the clinic nurses. All patients with multiple bleeding episodes were in the ibuprofen group. AB - CONCLUSION: Prescription of ibuprofen did not increase the risk of bleeding and did not increase the likelihood of a post-operative ED visit or nurse phone call. Ibuprofen prescription may possibly increase the risk of multiple bleeding episodes, but further prospective studies are needed. Increased age increases the risk of bleeding, ED visits, and nurse phone calls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 362O9ITL9D (Acetaminophen) RN - WK2XYI10QM (Ibuprofen) ES - 1872-8464 IL - 0165-5876 DI - S0165-5876(14)00406-6 DO - https://dx.doi.org/10.1016/j.ijporl.2014.07.017 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0165-5876(14)00406-6 [pii] ID - 10.1016/j.ijporl.2014.07.017 [doi] PP - ppublish PH - 2014/05/21 [received] PH - 2014/07/11 [revised] PH - 2014/07/14 [accepted] GI - No: UL1-TR-000005 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English EP - 20140721 DP - 2014 Oct EZ - 2014/08/17 06:00 DA - 2016/01/06 06:00 DT - 2014/08/17 06:00 YR - 2014 ED - 20160105 RD - 20170322 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25128450 <267. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25174015 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cobaugh DJ AU - Gainor C AU - Gaston CL AU - Kwong TC AU - Magnani B AU - McPherson ML AU - Painter JT AU - Krenzelok EP FA - Cobaugh, Daniel J FA - Gainor, Carl FA - Gaston, Cynthia L FA - Kwong, Tai C FA - Magnani, Barbarajean FA - McPherson, Mary Lynn FA - Painter, Jacob T FA - Krenzelok, Edward P IN - Cobaugh, Daniel J. Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh. dcobaugh@ashp.org. IN - Gainor, Carl. Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh. IN - Gaston, Cynthia L. Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh. IN - Kwong, Tai C. Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh. IN - Magnani, Barbarajean. Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh. IN - McPherson, Mary Lynn. Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh. IN - Painter, Jacob T. Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh. IN - Krenzelok, Edward P. Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh. TI - The opioid abuse and misuse epidemic: implications for pharmacists in hospitals and health systems. [Review] CM - Comment in: Am J Health Syst Pharm. 2014 Sep 15;71(18):1537; PMID: 25174014 SO - American Journal of Health-System Pharmacy. 71(18):1539-54, 2014 Sep 15 AS - Am J Health-Syst Pharm. 71(18):1539-54, 2014 Sep 15 NJ - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists VO - 71 IP - 18 PG - 1539-54 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9503023, cbh IO - Am J Health Syst Pharm SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Analgesics, Opioid/ur [Urine] MH - *Community Health Services MH - Drug Monitoring MH - *Drug Overdose/ep [Epidemiology] MH - Humans MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Pain Management MH - *Pharmacy Service, Hospital MH - *Prescription Drug Misuse/lj [Legislation & Jurisprudence] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Professional Role MH - Substance Abuse Detection MH - United States/ep [Epidemiology] AB - PURPOSE: The current epidemic of prescription opioid abuse and misuse in the United States is discussed, with an emphasis on the pharmacist's role in ensuring safe and effective opioid use. AB - SUMMARY: U.S. sales of prescription opioids increased fourfold from 1999 to 2010, with an alarming rise in deaths and emergency department visits associated with the use of fentanyl, hydrocodone, oxycodone, and other opioid medications. Signs and symptoms of opioid toxicity may include altered mental status, hypoventilation, decreased bowel motility, central nervous system and respiratory depression, peripheral vasodilation, pulmonary edema, hypotension, bradycardia, and seizures. In patients receiving long-term opioid therapy for chronic pain, urine drug testing is an important tool for monitoring and assessment of therapy; knowledge of opioid metabolic pathways and assay limitations is essential for appropriate use and interpretation of screening and confirmatory tests. In recent years, there has been an increase in federal enforcement actions against pharmacies and prescription drug wholesalers involved in improper opioid distribution, as well as increased reliance on state-level prescription drug monitoring programs to track patterns of opioid use and improper sales. Pharmacies are urged to implement or promote appropriate guidelines on opioid therapy, including the use of pain management agreement plans; policies to ensure adequate oversight of opioid prescribing, dispensing, and waste disposal; and educational initiatives targeting patients as well as hospital and pharmacy staff. AB - CONCLUSION: Pharmacists in hospitals and health systems can play a key role in recognizing the various forms of opioid toxicity and in preventing inappropriate prescribing and diversion of opioids. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1535-2900 IL - 1079-2082 DO - https://dx.doi.org/10.2146/ajhp140157 PT - Journal Article PT - Review ID - 71/18/1539 [pii] ID - 10.2146/ajhp140157 [doi] PP - ppublish LG - English DP - 2014 Sep 15 EZ - 2014/09/01 06:00 DA - 2015/12/23 06:00 DT - 2014/09/01 06:00 YR - 2014 ED - 20151222 RD - 20140901 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25174015 <268. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26306434 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bafuma PJ AU - Nandi A AU - Weisberg M FA - Bafuma, Patrick J FA - Nandi, Arun FA - Weisberg, Michael IN - Bafuma, Patrick J. Emergency Medicine, Columbia Memorial Hospital, 71 Prospect Avenue, Hudson, NY 12534. Electronic address: pbafuma@gmail.com. IN - Nandi, Arun. Emergency Medicine, Columbia Memorial Hospital, 71 Prospect Avenue, Hudson, NY 12534. Electronic address: nandia@ema.net. IN - Weisberg, Michael. Emergency Medicine, Columbia Memorial Hospital, 71 Prospect Avenue, Hudson, NY 12534. Electronic address: weisbergm@ema.net. TI - Opiate refractory pain from an intestinal obstruction responsive to an intravenous lidocaine infusion. SO - American Journal of Emergency Medicine. 33(10):1544.e3-4, 2015 Oct AS - Am J Emerg Med. 33(10):1544.e3-4, 2015 Oct NJ - The American journal of emergency medicine VO - 33 IP - 10 PG - 1544.e3-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Abdominal Pain/dg [Diagnostic Imaging] MH - *Abdominal Pain/dt [Drug Therapy] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Anesthetics, Local/ad [Administration & Dosage] MH - *Anesthetics, Local/tu [Therapeutic Use] MH - Antiemetics/tu [Therapeutic Use] MH - Colostomy MH - Diagnosis, Differential MH - Emergency Service, Hospital MH - Female MH - Humans MH - Hydromorphone/tu [Therapeutic Use] MH - Infusions, Intravenous MH - *Intestinal Obstruction/dg [Diagnostic Imaging] MH - Lidocaine/ad [Administration & Dosage] MH - *Lidocaine/tu [Therapeutic Use] MH - Metoclopramide/tu [Therapeutic Use] MH - Oxycodone/tu [Therapeutic Use] MH - Tomography, X-Ray Computed MH - Young Adult AB - A 24-year-old female patient presented to our community emergency department (ED) for abdominal pain that had progressively worsened over the last 28 hours. Of note, 1 month prior to her presentation, the patient had a colostomy due to a rectal abscess and required stoma revision 5 days prior to her visit to our ED. The patient's pain was refractory to opiate analgesia in our ED, but experienced significant relief after an intravenous lidocaine infusion. Computer tomography of the abdomen and pelvis ultimately revealed a large bowel obstruction just proximal to the colostomy site. Historically, options for ED management of severe pain have been limited beyond narcotic analgesia. For patients whom are refractory to opiates in the ED, or for whom opiates are contraindicated, lidocaine infusions have shown promise for a variety of both acute and chronic painful conditions. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Local) RN - 0 (Antiemetics) RN - 98PI200987 (Lidocaine) RN - CD35PMG570 (Oxycodone) RN - L4YEB44I46 (Metoclopramide) RN - Q812464R06 (Hydromorphone) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(15)00583-5 DO - https://dx.doi.org/10.1016/j.ajem.2015.07.027 PT - Case Reports PT - Journal Article ID - S0735-6757(15)00583-5 [pii] ID - 10.1016/j.ajem.2015.07.027 [doi] PP - ppublish PH - 2015/06/29 [received] PH - 2015/07/10 [accepted] LG - English EP - 20150721 DP - 2015 Oct EZ - 2015/08/27 06:00 DA - 2015/12/22 06:00 DT - 2015/08/27 06:00 YR - 2015 ED - 20151221 RD - 20161125 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26306434 <269. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26061280 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lindstrom HA AU - Clemency BM AU - Snyder R AU - Consiglio JD AU - May PR AU - Moscati RM FA - Lindstrom, Heather A FA - Clemency, Brian M FA - Snyder, Ryan FA - Consiglio, Joseph D FA - May, Paul R FA - Moscati, Ronald M IN - Lindstrom, Heather A. 1Department of Emergency Medicine,University at Buffalo,Buffalo,New YorkUSA. IN - Clemency, Brian M. 1Department of Emergency Medicine,University at Buffalo,Buffalo,New YorkUSA. IN - Snyder, Ryan. 1Department of Emergency Medicine,University at Buffalo,Buffalo,New YorkUSA. IN - Consiglio, Joseph D. 2Department of Mathematics and Computer Science,John Carroll University,Cleveland,OhioUSA. IN - May, Paul R. 1Department of Emergency Medicine,University at Buffalo,Buffalo,New YorkUSA. IN - Moscati, Ronald M. 1Department of Emergency Medicine,University at Buffalo,Buffalo,New YorkUSA. TI - Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study. SO - Prehospital & Disaster Medicine. 30(4):385-9, 2015 Aug AS - Prehospital Disaster Med. 30(4):385-9, 2015 Aug NJ - Prehospital and disaster medicine VO - 30 IP - 4 PG - 385-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - bdf, 8918173 IO - Prehosp Disaster Med SB - Health Technology Assessment Journals CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Child MH - Child, Preschool MH - *Drug Overdose/th [Therapy] MH - *Emergency Medical Services MH - Female MH - Heroin Dependence/th [Therapy] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Opioid-Related Disorders/th [Therapy] MH - *Public Health Surveillance/mt [Methods] MH - Retrospective Studies MH - Young Adult KW - CCF cross-correlation coefficient; ED emergency department; EMR electronic medical record; EMS Emergency Medical Services; Emergency Medical Services; IV intravenous; OD overdose; drug overdose; naloxone; opioid; surveillance AB - BACKGROUND: Abuse or unintended overdose (OD) of opiates and heroin may result in prehospital and emergency department (ED) care. Prehospital naloxone use has been suggested as a surrogate marker of community opiate ODs. The study objective was to verify externally whether prehospital naloxone use is a surrogate marker of community opiate ODs by comparing Emergency Medical Services (EMS) naloxone administration records to an independent database of ED visits for opiate and heroin ODs in the same community. AB - METHODS: A retrospective chart review of prehospital and ED data from July 2009 through June 2013 was conducted. Prehospital naloxone administration data obtained from the electronic medical records (EMRs) of a large private EMS provider serving a metropolitan area were considered a surrogate marker for suspected opiate OD. Comparison data were obtained from the regional trauma/psychiatric ED that receives the majority of the OD patients. The ED maintains a de-identified database of narcotic-related visits for surveillance of narcotic use in the metropolitan area. The ED database was queried for ODs associated with opiates or heroin. Cross-correlation analysis was used to test if prehospital naloxone administration was independent of ED visits for opiate/heroin ODs. AB - RESULTS: Naloxone was administered during 1,812 prehospital patient encounters, and 1,294 ED visits for opiate/heroin ODs were identified. The distribution of patients in the prehospital and ED datasets did not differ by gender, but it did differ by race and age. The frequency of naloxone administration by prehospital providers varied directly with the frequency of ED visits for opiate/heroin ODs. A monthly increase of two ED visits for opiate-related ODs was associated with an increase in one prehospital naloxone administration (cross-correlation coefficient [CCF]=0.44; P=.0021). A monthly increase of 100 ED visits for heroin-related ODs was associated with an increase in 94 prehospital naloxone administrations (CCF=0.46; P=.0012). AB - CONCLUSIONS: Frequency of naloxone administration by EMS providers in the prehospital setting varied directly with frequency of opiate/heroin OD-related ED visits. The data correlated both for short-term frequency and longer term trends of use. However, there was a marked difference in demographic data suggesting neither data source alone should be relied upon to determine which populations are at risk within the community. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1049-023X IL - 1049-023X DO - https://dx.doi.org/10.1017/S1049023X15004793 PT - Journal Article PT - Validation Studies ID - S1049023X15004793 [pii] ID - 10.1017/S1049023X15004793 [doi] PP - ppublish LG - English EP - 20150610 DP - 2015 Aug EZ - 2015/06/11 06:00 DA - 2015/12/15 06:00 DT - 2015/06/11 06:00 YR - 2015 ED - 20151214 RD - 20150812 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26061280 <270. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25279706 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Nielsen S AU - Lintzeris N AU - Bruno R AU - Campbell G AU - Larance B AU - Hall W AU - Hoban B AU - Cohen ML AU - Degenhardt L FA - Nielsen, Suzanne FA - Lintzeris, Nicholas FA - Bruno, Raimondo FA - Campbell, Gabrielle FA - Larance, Briony FA - Hall, Wayne FA - Hoban, Bianca FA - Cohen, Milton L FA - Degenhardt, Louisa IN - Nielsen, Suzanne. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, New South Wales, Australia. TI - Benzodiazepine use among chronic pain patients prescribed opioids: associations with pain, physical and mental health, and health service utilization. CM - Comment in: Pain Med. 2015 Feb;16(2):219-21; PMID: 25580877 SO - Pain Medicine. 16(2):356-66, 2015 Feb AS - PAIN MED. 16(2):356-66, 2015 Feb NJ - Pain medicine (Malden, Mass.) VO - 16 IP - 2 PG - 356-66 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Benzodiazepines/tu [Therapeutic Use] MH - *Chronic Pain/dt [Drug Therapy] MH - Cohort Studies MH - Female MH - Humans MH - Male MH - Mental Health MH - Middle Aged MH - Prospective Studies KW - Benzodiazepines; Chronic Noncancer Pain; Mental Health; Opioid AB - OBJECTIVE: Benzodiazepines (BZDs) are commonly used by chronic pain patients, despite limited evidence of any long-term benefits and concerns regarding adverse events and drug interactions, particularly in older patients. This article aims to: describe patterns of BZDs use; the demographic, physical, and mental health correlates of BZD use; and examine if negative health outcomes are associated with BZD use after controlling for confounders. AB - SUBJECTS: A national sample of 1,220 chronic noncancer pain (CNCP) patients prescribed long-term opioids. AB - METHODS: We report on baseline data from a prospective cohort study comparing four groups based on their current BZD use patterns. General demographics, pain, mental and physical comorbidity, and health service utilization were examined. AB - RESULTS: One-third (N=398, 33%) of participants reported BZD use in the past month, and 17% (N=212) reported daily BZD use. BZD use was associated with: 1) greater pain severity, pain interference with life, and lower feelings of self-efficacy with respect to their pain; 2) being prescribed "higher-risk" (>200mg oral morphine equivalent) doses of opioids; 3) using antidepressant and/or antipsychotic medications; 4) substance use (including more illicit and injection drug use, alcohol use disorder, and daily nicotine use); and 5) greater mental health comorbidity. After controlling for differences in demographic characteristics, physical and mental health, substance use, and opioid dose, BZD use was independently associated with greater past-month use of emergency health care such as ambulance or accident and emergency services. AB - CONCLUSIONS: CNCP patients using BZDs daily represent a high-risk group with multiple comorbid mental health conditions and higher rates of emergency health care use. The high prevalence of BZD use is inconsistent with guidelines for the management of CNCP or chronic mental health conditions. Copyright Wiley Periodicals, Inc. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/pme.12594 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1111/pme.12594 [doi] PP - ppublish LG - English EP - 20141003 DP - 2015 Feb EZ - 2014/10/04 06:00 DA - 2015/12/15 06:00 DT - 2014/10/04 06:00 YR - 2015 ED - 20151123 RD - 20150214 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25279706 <271. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25671013 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ogbu UC AU - Lotfipour S AU - Chakravarthy B FA - Ogbu, Uzor C FA - Lotfipour, Shahram FA - Chakravarthy, Bharath IN - Ogbu, Uzor C. University of California, Irvine, Department of Emergency Medicine, Orange, California. IN - Lotfipour, Shahram. University of California, Irvine, Department of Emergency Medicine, Orange, California. IN - Chakravarthy, Bharath. University of California, Irvine, Department of Emergency Medicine, Orange, California. TI - Polysubstance abuse: alcohol, opioids and benzodiazepines require coordinated engagement by society, patients, and physicians. SO - The Western Journal of Emergency Medicine. 16(1):76-9, 2015 Jan AS - West J Emerg Med. 16(1):76-9, 2015 Jan NJ - The western journal of emergency medicine VO - 16 IP - 1 PG - 76-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307731 SB - Index Medicus CP - United States MH - Alcohol-Related Disorders/co [Complications] MH - Alcohol-Related Disorders/ep [Epidemiology] MH - Alcohol-Related Disorders/pc [Prevention & Control] MH - Benzodiazepines MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/pc [Prevention & Control] MH - Humans MH - Opioid-Related Disorders/co [Complications] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - *Prescription Drug Misuse/pc [Prevention & Control] MH - Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Substance-Related Disorders/ep [Epidemiology] MH - *Substance-Related Disorders/pc [Prevention & Control] MH - United States/ep [Epidemiology] AB - The Centers for Disease Control and Prevention (CDC) has published significant data trends related to substance abuse involving opioid pain relievers (OPR), benzodiazepines and alcohol in the United States. The CDC describes opioid misuse and abuse as an epidemic, with the use of OPR surpassing that of illicit drugs. Alcohol has also been a persistent problem and is associated with a number of emergency department visits and deaths independent of other substances. The use of these drugs in combination creates an additive effect with increased central nervous system suppression and a heightened risk of an overdose. We present a summary of the findings from the Morbidity and Mortality Weekly Report (MMWR) with commentary on strategies to combat prescription drug and alcohol abuse. RN - 12794-10-4 (Benzodiazepines) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2014.11.24720 PT - Journal Article ID - 10.5811/westjem.2014.11.24720 [doi] ID - wjem-16-76 [pii] ID - PMC4307731 [pmc] PP - ppublish PH - 2014/11/19 [received] PH - 2014/11/25 [accepted] LG - English EP - 20141215 DP - 2015 Jan EZ - 2015/02/12 06:00 DA - 2015/11/11 06:00 DT - 2015/02/12 06:00 YR - 2015 ED - 20151110 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25671013 <272. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25671010 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ung L AU - Dvorkin R AU - Sattler S AU - Yens D FA - Ung, Lyncean FA - Dvorkin, Ronald FA - Sattler, Steven FA - Yens, David IN - Ung, Lyncean. Good Samaritan Hospital Medical Center, Department of Emergency Medicine, West Islip, New York. IN - Dvorkin, Ronald. Premier Care Physicians, Department of Emergency Medicine, Bellmore, New York. IN - Sattler, Steven. Good Samaritan Hospital Medical Center, Department of Emergency Medicine, West Islip, New York. IN - Yens, David. New York Colleges of Osteopathic Medicine Educational Consortium, New York, New York ; Touro College of Osteopathic Medicine, Middletown, New York. TI - Descriptive study of prescriptions for opioids from a suburban academic emergency department before New York's I-STOP Act. SO - The Western Journal of Emergency Medicine. 16(1):62-6, 2015 Jan AS - West J Emerg Med. 16(1):62-6, 2015 Jan NJ - The western journal of emergency medicine VO - 16 IP - 1 PG - 62-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307728 SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - *Drug and Narcotic Control/lj [Legislation & Jurisprudence] MH - Emergency Service, Hospital/lj [Legislation & Jurisprudence] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - New York MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Retrospective Studies AB - INTRODUCTION: Controlled prescription opioid use is perceived as a national problem attributed to all specialties. Our objective was to provide a descriptive analysis of prescriptions written for controlled opioids from a database of emergency department (ED) visits prior to the enactment of the I-STOP law, which requires New York prescribers to consult the Prescription Monitoring Program (PMP) prior to prescribing Schedule II, III, and IV controlled substances for prescriptions of greater than five days duration. AB - METHODS: We conducted a retrospective medical record review of patients 21 years of age and older, who presented to the ED between July 1, 2011 - June 30, 2012 and were given a prescription for a controlled opioid. Our primary purpose was to characterize each prescription as to the type of controlled substance, the quantity dispensed, and the duration of the prescription. We also looked at outliers, those patients who received prescriptions for longer than five days. AB - RESULTS: A total of 9,502 prescriptions were written for opioids out of a total 63,143 prescriptions for 69,500 adult patients. Twenty-six (0.27%) of the prescriptions for controlled opioids were written for greater than five days. Most prescriptions were for five days or less (99.7%, 95% CI [99.6 to 99.8%]). AB - CONCLUSION: The vast majority of opioid prescriptions in our ED prior to the I-STOP legislature were limited to a five-day or less supply. These new regulations were meant to reduce the ED's contribution to the rise of opioid related morbidity. This study suggests that the emergency physicians' usual prescribing practices were negligibly limited by the new restrictive regulations. The ED may not be primarily contributing to the increase in opioid-related overdoses and death. The effect of the I-STOP regulation on future prescribing patterns in the ED remains to be determined. RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2014.12.22669 PT - Journal Article ID - 10.5811/westjem.2014.12.22669 [doi] ID - wjem-16-62 [pii] ID - PMC4307728 [pmc] PP - ppublish PH - 2014/05/19 [received] PH - 2014/12/04 [accepted] LG - English EP - 20150106 DP - 2015 Jan EZ - 2015/02/12 06:00 DA - 2015/11/11 06:00 DT - 2015/02/12 06:00 YR - 2015 ED - 20151110 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25671010 <273. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25671003 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weiner SG AU - Horton LC AU - Green TC AU - Butler SF FA - Weiner, Scott G FA - Horton, Laura C FA - Green, Traci C FA - Butler, Stephen F IN - Weiner, Scott G. Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts. IN - Horton, Laura C. Tufts University School of Medicine, Boston, Massachusetts. IN - Green, Traci C. Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island ; Inflexxion, Inc. Newton, Massachusetts. IN - Butler, Stephen F. Inflexxion, Inc. Newton, Massachusetts. TI - Feasibility of tablet computer screening for opioid abuse in the emergency department. SO - The Western Journal of Emergency Medicine. 16(1):18-23, 2015 Jan AS - West J Emerg Med. 16(1):18-23, 2015 Jan NJ - The western journal of emergency medicine VO - 16 IP - 1 PG - 18-23 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307713 SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Computers, Handheld MH - Cross-Sectional Studies MH - *Emergency Service, Hospital MH - Feasibility Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - Opioid-Related Disorders/di [Diagnosis] MH - Opioid-Related Disorders/et [Etiology] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Patient Acceptance of Health Care/sn [Statistics & Numerical Data] MH - *Prescription Drug Misuse/pc [Prevention & Control] MH - Risk Assessment MH - Surveys and Questionnaires MH - Time Factors MH - Young Adult AB - INTRODUCTION: Tablet computer-based screening may have the potential for detecting patients at risk for opioid abuse in the emergency department (ED). Study objectives were a) to determine if the revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R), a 24-question previously paper-based screening tool for opioid abuse potential, could be administered on a tablet computer to an ED patient population; b) to demonstrate that >90% of patients can complete the electronic screener without assistance in <5 minutes and; c) to determine patient ease of use with screening on a tablet computer. AB - METHODS: This was a cross-sectional convenience sample study of patients seen in an urban academic ED. SOAPP-R was programmed on a tablet computer by study investigators. Inclusion criteria were patients ages >=18 years who were being considered for discharge with a prescription for an opioid analgesic. Exclusion criteria included inability to understand English or physical disability preventing use of the tablet. AB - RESULTS: 93 patients were approached for inclusion and 82 (88%) provided consent. Fifty-two percent (n=43) of subjects were male; 46% (n=38) of subjects were between 18-35 years, and 54% (n=44) were >35 years. One hundred percent of subjects completed the screener. Median time to completion was 148 (interquartile range 117.5-184.3) seconds, and 95% (n=78) completed in <5 minutes. 93% (n=76) rated ease of completion as very easy. AB - CONCLUSIONS: It is feasible to administer a screening tool to a cohort of ED patients on a tablet computer. The screener administration time is minimal and patient ease of use with this modality is high. RN - 0 (Analgesics, Opioid) ES - 1936-9018 IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2014.11.23316 PT - Evaluation Studies PT - Journal Article ID - 10.5811/westjem.2014.11.23316 [doi] ID - wjem-16-18 [pii] ID - PMC4307713 [pmc] PP - ppublish PH - 2014/07/29 [received] PH - 2014/10/17 [revised] PH - 2014/11/25 [accepted] LG - English EP - 20141217 DP - 2015 Jan EZ - 2015/02/12 06:00 DA - 2015/11/11 06:00 DT - 2015/02/12 06:00 YR - 2015 ED - 20151110 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25671003 <274. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26312960 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gupta S AU - Patel H AU - Scopel J AU - Mody RR FA - Gupta, Shaloo FA - Patel, Haridarshan FA - Scopel, Justin FA - Mody, Reema R IN - Gupta, Shaloo. Health Outcomes Practice, Kantar Health, Princeton, New Jersey. IN - Patel, Haridarshan. Consultant, Immensity Consulting, Inc., Chicago, Illinois. IN - Scopel, Justin. US Medical Affairs, Takeda Pharmaceuticals International, Inc., Deerfield, Illinois. IN - Mody, Reema R. Global Outcomes Research Department, Takeda Pharmaceuticals International, Inc., Deerfield, Illinois. TI - Impact of constipation on opioid therapy management among long-term opioid users, based on a patient survey. SO - Journal of Opioid Management. 11(4):325-38, 2015 Jul-Aug AS - J Opioid Manag. 11(4):325-38, 2015 Jul-Aug NJ - Journal of opioid management VO - 11 IP - 4 PG - 325-38 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid MH - Constipation/ci [Chemically Induced] MH - Constipation/di [Diagnosis] MH - Constipation/ep [Epidemiology] MH - Constipation/px [Psychology] MH - *Constipation MH - Cross-Sectional Studies MH - Female MH - Health Surveys MH - Humans MH - Male MH - Medication Adherence MH - Middle Aged MH - Pain/di [Diagnosis] MH - *Pain/dt [Drug Therapy] MH - Pain/ep [Epidemiology] MH - Pain/et [Etiology] MH - Pain Management/mt [Methods] MH - Pain Management/sn [Statistics & Numerical Data] MH - Pain Measurement MH - Patient Satisfaction MH - *Quality of Life MH - Severity of Illness Index MH - United States/ep [Epidemiology] AB - OBJECTIVE: The authors sought to characterize health-related quality of life (HRQoL), medication adherence, productivity losses, and treatment satisfaction associated with modifications to opioid therapy due to opioid-induced constipation (OIC). AB - DESIGN: A cross-sectional, between-subjects design was used to examine health outcomes among US noncancer participants currently taking opioids. AB - PATIENTS, PARTICIPANTS: Participants were adults in the 2012 US National Health and Wellness Survey, who reported currently using opioids (> 30 days) and experiencing constipation. Respondents were categorized as making modifications to opioid therapy due to OIC (modifiers, n = 244) or making no modifications (nonmodifiers, n = 247). AB - MAIN OUTCOME MEASURES: Patient Assessment of Constipation Quality of Life (PAC-QoL) and Symptoms (PAC-Sym), Morisky Medication Adherence Scale (MMAS-4), Work Productivity and Activity Impairment, and the Treatment Satisfaction Questionnaire for Medication (TSQM II) for OIC treatment were administered. Generalized linear models were adjusted to control for baseline characteristics (age, gender, comorbidities, opioid strength, etc). AB - RESULTS: Modifiers reported poorer HRQoL (PAC-QoL total: 1.74 vs 1.44, p < 0.001), worse constipation (PAC-Sym total: 1.56 vs 1.35, p = 0.003), more pain-related resource use (surgery: odds ratio (OR) = 3.72, p = 0.002; emergency room visits: OR = 1.88, p = 0.049; hospitalizations: OR = 2.47, p = 0.033), and lower adherence (MMAS-4 pain: OR = 0.12, p < 0.001; MMAS-4 OIC: OR = 0.39, p < 0.001) than nonmodifiers. Modifiers reported greater presenteeism (49.75 percent vs 38.28 percent, p = 0.038), but no significant differences were found for activity impairment or OIC treatment satisfaction. AB - CONCLUSIONS: Treating OIC effectively may help prevent inadequate pain management secondary to opioid therapy modification, help increase HRQoL, lessen OIC symptoms, decrease productivity loss, and improve adherence to opioid and OIC treatments. RN - 0 (Analgesics, Opioid) IS - 1551-7489 IL - 1551-7489 DI - jom.2015.0282 DO - https://dx.doi.org/10.5055/jom.2015.0282 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - jom.2015.0282 [pii] ID - 10.5055/jom.2015.0282 [doi] PP - ppublish LG - English DP - 2015 Jul-Aug EZ - 2015/08/28 06:00 DA - 2015/11/10 06:00 DT - 2015/08/28 06:00 YR - 2015 ED - 20151109 RD - 20150828 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26312960 <275. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25271659 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Samuels E FA - Samuels, Elizabeth IN - Samuels, Elizabeth. Resident in the Dept. of Emergency Medicine at the Rhode Island Hospital and Alpert Medical School of Brown University. TI - Emergency department naloxone distribution: a Rhode Island department of health, recovery community, and emergency department partnership to reduce opioid overdose deaths. SO - Rhode Island Medicine. 97(10):38-9, 2014 Oct 01 AS - R I Med. 97(10):38-9, 2014 Oct 01 NJ - Rhode Island medical journal (2013) VO - 97 IP - 10 PG - 38-9 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - bbe, 9203052, 101605827 IO - R I Med J (2013) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Community Health Services MH - Cooperative Behavior MH - Directive Counseling MH - Drug Overdose/ep [Epidemiology] MH - *Drug Overdose/pc [Prevention & Control] MH - *Emergency Medical Services/og [Organization & Administration] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Practice Guidelines as Topic MH - *Prescription Drug Misuse/pc [Prevention & Control] MH - Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Program Development MH - Referral and Consultation MH - Rhode Island/ep [Epidemiology] KW - emergency medicine; naloxone; opioid overdose prevention; peer coaching AB - In response to increasing rates of opioid overdose deaths in Rhode Island (RI), the RI Department of Health, RI emergency physicians, and Anchor Community Recovery Center designed an emergency department (ED) naloxone distribution and peer-recovery coach program for people at risk of opioid overdose. ED patients at risk for overdose are offered a take home naloxone kit, patient education video, and, when available, an Anchor peer recovery coach to provide recovery support and referral to treatment. In August 2014, the program launched at Kent, Miriam, and Rhode Island Hospital Emergency Departments. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 2327-2228 IL - 0363-7913 PT - Journal Article PP - epublish LG - English EP - 20141001 DP - 2014 Oct 01 EZ - 2014/10/02 06:00 DA - 2015/11/06 06:00 DT - 2014/10/02 06:00 YR - 2014 ED - 20151105 RD - 20141002 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25271659 <276. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25271658 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bowman S AU - Engelman A AU - Koziol J AU - Mahoney L AU - Maxwell C AU - McKenzie M FA - Bowman, Sarah FA - Engelman, Ariel FA - Koziol, Jennifer FA - Mahoney, Linda FA - Maxwell, Christopher FA - McKenzie, Michelle IN - Bowman, Sarah. Evaluator for Maternal and Child Home Visiting, Rhode Island Department of Health. She is a long-time staff member and now volunteers with Preventing Overdose and Naloxone Intervention (PONI), The Miriam Hospital. IN - Engelman, Ariel. Coordinator and Co-Founder of the Naloxone and Overdose Prevention Education Program of Rhode Island (NOPE-RI). She is a Critical Care Paramedic and has worked in public safety for the past ten years. IN - Koziol, Jennifer. Unintentional Injury Prevention Program Coordinator, Rhode Island Department of Health. She convenes the Drug Overdose Prevention and Rescue Coalition. IN - Mahoney, Linda. Administrator at the Department of Behavioral Health, Developmental Disabilities and Hospitals. She has 28 years of clinical experience as a RI provider in various behavioral health treatment settings. IN - Maxwell, Christopher. Director of Pharmacy Services for Butler Hospital. IN - McKenzie, Michelle. Director of Preventing Overdose and Naloxone Intervention (PONI), The Miriam Hospital. She is a Research Associate with the Department of Medicine, Warren Alpert Medical School, Brown University. TI - The Rhode Island community responds to opioid overdose deaths. SO - Rhode Island Medicine. 97(10):34-7, 2014 Oct 01 AS - R I Med. 97(10):34-7, 2014 Oct 01 NJ - Rhode Island medical journal (2013) VO - 97 IP - 10 PG - 34-7 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - bbe, 9203052, 101605827 IO - R I Med J (2013) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Community Networks/og [Organization & Administration] MH - Community Pharmacy Services MH - Cooperative Behavior MH - *Drug Overdose/mo [Mortality] MH - *Drug Overdose/pc [Prevention & Control] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Practice Patterns, Physicians' MH - Prescription Drug Misuse/mo [Mortality] MH - *Prescription Drug Misuse/pc [Prevention & Control] MH - *Preventive Health Services/og [Organization & Administration] MH - Rhode Island/ep [Epidemiology] KW - Opiate addiction; naloxone; opioid; overdose AB - The challenge of addressing the epidemic of opioid overdose in Rhode Island, and nationwide, is only possible through collaborative efforts among a wide breadth of stakeholders. This article describes the range of efforts by numerous partners that have come together to facilitate community, and treatment-related approaches to address opioid-involved overdose and substance use disorder. Strategies to address this crisis have largely focused on increasing access both to the opioid overdose antidote naloxone and to high quality and timely treatment and recovery services. [Full text available at http://rimed.org/rimedicaljournal-2014-10.asp, free with no login]. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 2327-2228 IL - 0363-7913 PT - Journal Article PP - epublish LG - English EP - 20141001 DP - 2014 Oct 01 EZ - 2014/10/02 06:00 DA - 2015/11/06 06:00 DT - 2014/10/02 06:00 YR - 2014 ED - 20151105 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25271658 <277. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25271657 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Green TC AU - Bratberg J AU - Dauria EF AU - Rich JD FA - Green, Traci C FA - Bratberg, Jef FA - Dauria, Emily F FA - Rich, Josiah D IN - Green, Traci C. Assistant Professor of Emergency Medicine and Epidemiology at the Warren Alpert Medical School of Brown University. She is an affiliated researcher at The Center for Prisoner Health and Human Rights at the Miriam Hospital and the Injury Prevention Center at Rhode Island Hospital. IN - Bratberg, Jef. Clinical Professor of Pharmacy Practice, University of Rhode Island College of Pharmacy. IN - Dauria, Emily F. Postdoctoral Fellow in the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University. IN - Rich, Josiah D. Attending Physician in the Division of Infectious Diseases, The Miriam Hospital, co-director of The Center for Health and Human Rights, and Professor of Medicine and Community Health at the Warren Alpert Medical School of Brown University. TI - Responding to opioid overdose in Rhode Island: where the medical community has gone and where we need to go. SO - Rhode Island Medicine. 97(10):29-33, 2014 Oct 01 AS - R I Med. 97(10):29-33, 2014 Oct 01 NJ - Rhode Island medical journal (2013) VO - 97 IP - 10 PG - 29-33 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - bbe, 9203052, 101605827 IO - R I Med J (2013) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/to [Toxicity] MH - Drug Overdose/ep [Epidemiology] MH - *Drug Overdose/pc [Prevention & Control] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - *Health Education/og [Organization & Administration] MH - Health Knowledge, Attitudes, Practice MH - Health Services Accessibility/sn [Statistics & Numerical Data] MH - Health Services Needs and Demand MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Practice Patterns, Physicians' MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Rhode Island/ep [Epidemiology] KW - Opiate addiction; healthcare professionals; opioid; overdose AB - The number of opioid overdose events in Rhode Island has increased dramatically/catastrophically in the last decade; Rhode Island now has one of the highest per capita overdose death rates in the country. Healthcare professionals have an important role to play in the reduction of unintentional opioid overdose events. This article explores the medical community's response to the local opioid overdose epidemic and proposes strategies to create a more collaborative and comprehensive response. We emphasize the need for improvements in preventing, identifying and treating opioid addiction, providing overdose education and ensuring access to the rescue medicine naloxone. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 2327-2228 IL - 0363-7913 PT - Journal Article PP - epublish GI - No: K24 DA022112 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20141001 DP - 2014 Oct 01 EZ - 2014/10/02 06:00 DA - 2015/11/06 06:00 DT - 2014/10/02 06:00 YR - 2014 ED - 20151105 RD - 20161025 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25271657 <278. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26109423 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wong A AU - Macleod D AU - Robinson J AU - Koutsogiannis Z AU - Graudins A AU - Greene SL FA - Wong, Anselm FA - Macleod, Dawson FA - Robinson, Jeff FA - Koutsogiannis, Zeff FA - Graudins, Andis FA - Greene, Shaun L IN - Wong, Anselm. Victorian Poisons Information Centre and Austin Toxicology Service, Austin Health , Heidelberg, Victoria , Australia. TI - Oxycodone/naloxone preparation can cause acute withdrawal symptoms when misused parenterally or taken orally. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 53(8):815-8, 2015 AS - Clin Toxicol (Phila). 53(8):815-8, 2015 NJ - Clinical toxicology (Philadelphia, Pa.) VO - 53 IP - 8 PG - 815-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Acute Disease MH - Administration, Oral MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/pk [Pharmacokinetics] MH - Child MH - Child, Preschool MH - Databases, Factual MH - Drug Combinations MH - Female MH - Humans MH - Incidence MH - Infant MH - Injections, Intravenous MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Naloxone/ae [Adverse Effects] MH - Naloxone/pk [Pharmacokinetics] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - Narcotic Antagonists/pk [Pharmacokinetics] MH - *Oxycodone/ad [Administration & Dosage] MH - *Oxycodone/ae [Adverse Effects] MH - Oxycodone/pk [Pharmacokinetics] MH - Poison Control Centers MH - Risk Factors MH - Substance Abuse, Intravenous/di [Diagnosis] MH - *Substance Abuse, Intravenous/ep [Epidemiology] MH - Substance Abuse, Intravenous/me [Metabolism] MH - Substance Withdrawal Syndrome/di [Diagnosis] MH - *Substance Withdrawal Syndrome/ep [Epidemiology] MH - Substance Withdrawal Syndrome/me [Metabolism] MH - Tablets MH - Victoria/ep [Epidemiology] MH - Young Adult KW - Antidote; Opioid; Therapeutic; poisoning AB - CONTEXT: Oral oxycodone/naloxone preparations are designed to reduce the incidence of constipation associated with oxycodone use. The low oral bioavailability (< 2%) of naloxone makes the precipitation of the acute opioid withdrawal symptoms unlikely following oral oxycodone/naloxone exposure. The incidence of acute opioid withdrawal symptoms following both oral and intravenous administration of oxycodone/naloxone preparations has not been described. AB - OBJECTIVE: The aim of the study was to investigate the incidence and circumstances associated with oxycodone/naloxone-induced acute opioid withdrawal. AB - METHODS: An observational case series of acute opioid withdrawal following oxycodone/naloxone administration were selected from all calls received by the Victoria Poisons Information Centre from January 2012 to December 2014. Data collected included patient demographics, reported symptoms, type of caller, intentional or accidental exposure and advice given. AB - RESULTS: There were 107 reported exposures to oxycodone/naloxone preparations. Route of exposure was oral in 92 (86%) and intravenous injection of crushed tablets in 14 (14%) of cases, respectively. Nine callers had a history of long-standing opioid treatment and developed withdrawal symptoms with oral oxycodone/naloxone. Temporal relationship between first dose, increased dose and chewing tablets was described. There were 14 exposures to crushed oxycodone/naloxone tablets injected intravenously; all precipitated an acute withdrawal state. AB - DISCUSSION: The development of opioid withdrawal symptoms with intravenous injection of oxycodone/naloxone is likely a result of bypassing first-pass metabolism. Withdrawal symptoms after ingesting increased dose, first dose or chewing oxycodone/naloxone suggests that there is a systemic absorption of naloxone in opioid-dependent callers. AB - CONCLUSION: Oxycodone with naloxone tablets can lead to acute opioid withdrawal symptoms if crushed and injected parentally. First dose, increased dose and chewing of these opioid-naloxone combination tablets in opioid-dependent people can also result in acute opioid withdrawal symptoms or diminished pain relief. RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 0 (Narcotic Antagonists) RN - 0 (Tablets) RN - 0 (oxycodone naloxone combination) RN - 36B82AMQ7N (Naloxone) RN - CD35PMG570 (Oxycodone) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.3109/15563650.2015.1060486 PT - Journal Article PT - Observational Study ID - 10.3109/15563650.2015.1060486 [doi] PP - ppublish LG - English EP - 20150625 DP - 2015 EZ - 2015/06/26 06:00 DA - 2015/11/04 06:00 DT - 2015/06/26 06:00 YR - 2015 ED - 20151103 RD - 20150817 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26109423 <279. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26462001 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Saloner B AU - Karthikeyan S FA - Saloner, Brendan FA - Karthikeyan, Shankar IN - Saloner, Brendan. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. IN - Karthikeyan, Shankar. Institute for Health and Social Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. TI - Changes in Substance Abuse Treatment Use Among Individuals With Opioid Use Disorders in the United States, 2004-2013. CM - Comment in: JAMA. 2015 Oct 13;314(14):1453-4; PMID: 26461995 SO - JAMA. 314(14):1515-7, 2015 Oct 13 AS - JAMA. 314(14):1515-7, 2015 Oct 13 NJ - JAMA VO - 314 IP - 14 PG - 1515-7 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Ambulatory Care Facilities/sn [Statistics & Numerical Data] MH - Child MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Hospitalization/sn [Statistics & Numerical Data] MH - Hospitals/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Mental Health Services/sn [Statistics & Numerical Data] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/th [Therapy] MH - Physicians' Offices/sn [Statistics & Numerical Data] MH - Prisons/sn [Statistics & Numerical Data] MH - Self-Help Groups/sn [Statistics & Numerical Data] MH - Time Factors MH - United States/ep [Epidemiology] MH - Young Adult ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2015.10345 PT - Journal Article ID - 2456156 [pii] ID - 10.1001/jama.2015.10345 [doi] PP - ppublish LG - English DP - 2015 Oct 13 EZ - 2015/10/16 06:00 DA - 2015/10/20 06:00 DT - 2015/10/14 06:00 YR - 2015 ED - 20151019 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26462001 <280. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26083809 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Backberg M AU - Beck O AU - Jonsson KH AU - Helander A FA - Backberg, Matilda FA - Beck, Olof FA - Jonsson, Karl-Henrik FA - Helander, Anders IN - Backberg, Matilda. Swedish Poisons Information Centre , Stockholm , Sweden. TI - Opioid intoxications involving butyrfentanyl, 4-fluorobutyrfentanyl, and fentanyl from the Swedish STRIDA project. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 53(7):609-17, 2015 AS - Clin Toxicol (Phila). 53(7):609-17, 2015 NJ - Clinical toxicology (Philadelphia, Pa.) VO - 53 IP - 7 PG - 609-17 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - Apnea/ci [Chemically Induced] MH - Apnea/dt [Drug Therapy] MH - Apnea/pa [Pathology] MH - Chromatography, Liquid MH - Dose-Response Relationship, Drug MH - Emergency Service, Hospital MH - *Fentanyl/po [Poisoning] MH - Humans MH - Intensive Care Units MH - Male MH - Mass Spectrometry MH - Naloxone/pd [Pharmacology] MH - Respiratory Insufficiency/ci [Chemically Induced] MH - Respiratory Insufficiency/dt [Drug Therapy] MH - Respiratory Insufficiency/pa [Pathology] MH - Retrospective Studies MH - Street Drugs/ur [Urine] MH - Sweden MH - Unconsciousness/ci [Chemically Induced] MH - Unconsciousness/dt [Drug Therapy] MH - Unconsciousness/pa [Pathology] MH - Young Adult KW - Butyrfentanyl; Butyrylfentanyl; Fentanyl analogue; Internet drugs; Mass spectrometry methods; NPS; New psychoactive substances; Opioid analgesic drug; para-Fluorobutyrfentanyl AB - BACKGROUND: The supply of unregulated "new psychoactive substances" (NPS) has shown a steady increase over the past six years. This report from the Swedish STRIDA project describes analytically confirmed non-fatal intoxications involving butyrfentanyl (butyrylfentanyl) or 4-fluorobutyrfentanyl (para-fluorobutyrfentanyl), two fentanyl analogues recently introduced as NPS opioids. AB - STUDY DESIGN: Observational case series of consecutive patients with suspected acute NPS exposure and requiring hospital care from all over Sweden. AB - PATIENTS AND METHODS: From May 2014 to January 2015, blood and urine samples were obtained from four intoxication cases involving butyrfentanyl and one case involving 4-fluorobutyrfentanyl (men, 19-30 years) presenting in emergency departments (ED) or intensive care units (ICU). Laboratory analysis of serum and/or urine samples was performed by multi-component liquid chromatography-mass spectrometry methods. Data on clinical features were collected during consultations with the Poisons Information Centre and retrieved from medical records. AB - CASE DETAILS: Of the five patients, two were discharged home from the ED and three were admitted to the ICU, of whom two required intubation and mechanical ventilation. Clinical features included typical opioid symptoms such as unconsciousness, respiratory depression, and apnea. In one case, naloxone successfully countered the effects. All patients were discharged the same or the following day. Butyrfentanyl was detected in two serum (0.6 and 0.9 ng/mL) and three urine (2.0-65.6 ng/mL) samples from three of four cases; three cases also contained fentanyl. In the 4-fluorobutyrfentanyl case, the substance was detected in serum (~15 ng/mL) and urine (~10 ng/mL). In four cases, other NPS and/or classical drugs were also detected. Analysis of two "butyrfentanyl" NPS products (nasal spray and powder) brought to hospital by patients showed that the 10-fold more potent fentanyl was the main active ingredient (~7.5-10-fold higher amount) in both. AB - CONCLUSION: Typical and potentially life-threatening opioid toxicity was seen in acute intoxications involving butyrfentanyl, 4F-butyrfentanyl, and fentanyl. The incorrect labelling of butyrfentanyl NPS products which instead mainly contained fentanyl is alarming, given the narrow range between a safe and a lethal dose for opioids. RN - 0 (Analgesics, Opioid) RN - 0 (Street Drugs) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.3109/15563650.2015.1054505 PT - Case Reports PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't ID - 10.3109/15563650.2015.1054505 [doi] PP - ppublish LG - English EP - 20150617 DP - 2015 EZ - 2015/06/18 06:00 DA - 2015/10/17 06:00 DT - 2015/06/18 06:00 YR - 2015 ED - 20151016 RD - 20150729 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26083809 <281. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26172937 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fulton-Kehoe D AU - Sullivan MD AU - Turner JA AU - Garg RK AU - Bauer AM AU - Wickizer TM AU - Franklin GM FA - Fulton-Kehoe, Deborah FA - Sullivan, Mark D FA - Turner, Judith A FA - Garg, Renu K FA - Bauer, Amy M FA - Wickizer, Thomas M FA - Franklin, Gary M IN - Fulton-Kehoe, Deborah. *Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health +Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine ++Department of Epidemiology, University of Washington School of Public Health, Seattle, WA Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH Department of Health Services, University of Washington School of Public Health and Community Medicine PWashington State Department of Labor and Industries #Department of Neurology, University of Washington School of Medicine, Seattle, WA. TI - Opioid poisonings in Washington State Medicaid: trends, dosing, and guidelines. SO - Medical Care. 53(8):679-85, 2015 Aug AS - Med Care. 53(8):679-85, 2015 Aug NJ - Medical care VO - 53 IP - 8 PG - 679-85 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0230027, lsm IO - Med Care SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/po [Poisoning] MH - *Chronic Pain/dt [Drug Therapy] MH - *Drug Overdose/di [Diagnosis] MH - Drug Overdose/ep [Epidemiology] MH - Drug Prescriptions/sn [Statistics & Numerical Data] MH - Drug-Related Side Effects and Adverse Reactions MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/di [Diagnosis] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Practice Guidelines as Topic MH - Washington AB - BACKGROUND: Opioid poisonings have increased as use of prescription opioid medications have increased. To reduce these poisonings, guidelines for chronic opioid use have been implemented. However, if opioid poisonings occur in individuals who do not have high prescribed doses and who are not chronic opioid users, the current guidelines may need revision. AB - OBJECTIVES: To examine changes in rates of methadone and other opioid poisonings after implementation of the WA State Opioid Guideline in 2007 and to examine the prescription history before poisonings. AB - METHODS: The study sample consisted of individuals who had at least 1 paid claim for an opioid prescription in the Medicaid fee-for-service system between April 2006 and December 2010 and had an emergency department or inpatient hospital claim for an opioid poisoning. AB - RESULTS: Methadone poisonings occurred at 10 times the rate of other prescription opioid poisonings and increased between 2006 and 2010. Rates of other prescription opioid poisonings appeared to level off after implementation of the WA opioid guideline in 2007. Among individuals with nonmethadone opioid poisonings, only 44% had chronic opioid use, 17% had prescribed doses in the week before the poisoning >120 mg/d morphine-equivalent dose (MED), 28% had doses <50 mg/d MED, and 48% had concurrent sedative prescriptions. AB - CONCLUSIONS: It may be prudent to revise guidelines to address opioid poisonings occurring at relatively low prescribed doses and with acute and intermittent opioid use. Research is needed to establish the best strategies to prevent opioid poisonings. RN - 0 (Analgesics, Opioid) ES - 1537-1948 IL - 0025-7079 DO - https://dx.doi.org/10.1097/MLR.0000000000000384 PT - Journal Article ID - 10.1097/MLR.0000000000000384 [doi] ID - 00005650-201508000-00004 [pii] PP - ppublish LG - English DP - 2015 Aug EZ - 2015/07/15 06:00 DA - 2015/10/01 06:00 DT - 2015/07/15 06:00 YR - 2015 ED - 20150930 RD - 20150716 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26172937 <282. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24863407 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Okunseri C AU - Okunseri E AU - Xiang Q AU - Thorpe JM AU - Szabo A FA - Okunseri, Christopher FA - Okunseri, Elaye FA - Xiang, Qun FA - Thorpe, Joshua M FA - Szabo, Aniko IN - Okunseri, Christopher. Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA. TI - Prescription of opioid and nonopioid analgesics for dental care in emergency departments: Findings from the National Hospital Ambulatory Medical Care Survey. SO - Journal of Public Health Dentistry. 74(4):283-92, 2014 AS - J Public Health Dent. 74(4):283-92, 2014 NJ - Journal of public health dentistry VO - 74 IP - 4 PG - 283-92 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - jv3, 0014207 IO - J Public Health Dent PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245386 OI - Source: NLM. NIHMS581851 SB - Dental Journals SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics/ad [Administration & Dosage] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Child MH - Child, Preschool MH - Data Collection MH - *Dental Health Services/og [Organization & Administration] MH - *Drug Prescriptions MH - *Emergency Service, Hospital MH - Humans MH - Infant MH - Infant, Newborn MH - Middle Aged MH - United States MH - Young Adult KW - dental care; dental health services; emergency physicians; nonopioid analgesics; nontraumatic dental conditions; opioid analgesics; toothache AB - OBJECTIVES: The aim of this study was to examine trends and associated factors in the prescription of opioid analgesics, nonopioid analgesics, opioid and nonopioid analgesic combinations, and no analgesics by emergency physicians for nontraumatic dental condition (NTDC)-related visits. Our secondary aim was to investigate whether race/ethnicity is a possible predictor of receiving a prescription for either type of medication for NTDC visits in emergency departments (EDs) after adjustment for potential covariates. AB - METHODS: We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997-2000 and 2003-2007, and used multinomial multivariate logistic regression to estimate the probability of receiving a prescription for opioid analgesics, nonopioid analgesics, or a combination of both, compared with receiving no analgesics for NTDC-related visits. AB - RESULTS: During 1997-2000 and 2003-2007, prescription of opioid analgesics and combinations of opioid and nonopioid analgesics increased, and that of no analgesics decreased over time. The prescription rates for opioid analgesics, nonopioid analgesics, opioid and nonopioid analgesic combinations, and no analgesics for NTDC-related visits in EDs were 43 percent, 20 percent, 12 percent, and 25 percent, respectively. Majority of patients categorized as having severe pain received prescriptions for opioids for NTDC-related visits in EDs. After adjusting for covariates, patients with self-reported dental reasons for visit and severe pain had a significantly higher probability of receiving prescriptions for opioid analgesics and opioid and nonopioid analgesic combinations. AB - CONCLUSIONS: Prescription of opioid analgesics increased over time. ED physicians were more likely to prescribe opioid analgesics and opioid and nonopioid analgesic combinations for NTDC-related visits with reported severe pain. Copyright © 2014 American Association of Public Health Dentistry. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) ES - 1752-7325 IL - 0022-4006 DO - https://dx.doi.org/10.1111/jphd.12055 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1111/jphd.12055 [doi] ID - PMC4245386 [pmc] ID - NIHMS581851 [mid] PP - ppublish PH - 2013/10/28 [received] PH - 2014/03/27 [accepted] GI - No: R15 DE021196 Organization: (DE) *NIDCR NIH HHS* Country: United States GI - No: 1R15DE021196-01 Organization: (DE) *NIDCR NIH HHS* Country: United States LG - English EP - 20140526 DP - 2014 EZ - 2014/05/28 06:00 DA - 2015/09/26 06:00 DT - 2014/05/28 06:00 YR - 2014 ED - 20150925 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24863407 <283. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25985807 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McCarthy DM AU - Cameron KA AU - Courtney DM AU - Adams JG AU - Engel KG FA - McCarthy, Danielle M FA - Cameron, Kenzie A FA - Courtney, D Mark FA - Adams, James G FA - Engel, Kirsten G IN - McCarthy, Danielle M. Professor and Chair, Department of Emergency Medicine, Northwestern University, Chicago, Illinois. IN - Cameron, Kenzie A. Assistant Professor, Department of Emergency Medicine, Northwestern University, Chicago, Illinois. IN - Courtney, D Mark. Assistant Professor, Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. IN - Adams, James G. Associate Professor, Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, Illinois. IN - Engel, Kirsten G. Associate Professor, Department of Emergency Medicine, Northwestern University, Chicago, Illinois. TI - Communication about opioid versus nonopioid analgesics in the emergency department. SO - Journal of Opioid Management. 11(3):229-36, 2015 May-Jun AS - J Opioid Manag. 11(3):229-36, 2015 May-Jun NJ - Journal of opioid management VO - 11 IP - 3 PG - 229-36 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Academic Medical Centers MH - Adult MH - Analgesics, Non-Narcotic/ae [Adverse Effects] MH - *Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Ankle Injuries/di [Diagnosis] MH - *Ankle Injuries/dt [Drug Therapy] MH - Back Pain/di [Diagnosis] MH - *Back Pain/dt [Drug Therapy] MH - *Communication MH - *Counseling MH - Craniocerebral Trauma/di [Diagnosis] MH - *Craniocerebral Trauma/dt [Drug Therapy] MH - Drug Administration Schedule MH - Drug Interactions MH - Drug Prescriptions MH - *Emergency Service, Hospital MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Lacerations/di [Diagnosis] MH - *Lacerations/dt [Drug Therapy] MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Patient Education as Topic MH - Polypharmacy MH - Risk Assessment MH - Risk Factors MH - Urban Health MH - Young Adult AB - OBJECTIVE: The Medication Communication Index (MCI) was used to compare counseling about opioids to nonopioid analgesics in the Emergency Department (ED) setting. AB - DESIGN: Secondary analysis of prospectively collected audio recordings of ED patient visits. AB - SETTING: Urban, academic medical center (>85,000 annual patient visits). AB - PARTICIPANTS: Patient participants aged >18 years with one of four low acuity diagnoses: ankle sprain, back pain, head injury, and laceration. ED clinician participants included resident and attending physicians, nursing staff, and ED technicians. AB - MAIN OUTCOME MEASURES: The MCI is a five-point index that assigns points for communicating the following: medication name (1), purpose (1), duration (1), adverse effects (1), number of tablets (0.5), and frequency of use (0.5). Recording transcripts were scored with the MCI, and total scores were compared between drug classes. AB - RESULTS: The 41 patients received 56 prescriptions (27 nonopioids, 29 opioids). Nonopioid median MCI score was 3 and opioid score was 4.5 (p=0.0008). Patients were counseled equally about name (nonopioid 100 percent, opioid 96.6 percent, p=0.34) and purpose (88.9 percent, 89.7 percent, p=0.93). However, patients receiving opioids were counseled more frequently about duration of use (nonopioid 40.7 percent, opioid 69.0 percent, p=0.03) and adverse effects (18.5 percent, 93.1 percent, p<0.001). In multivariable analysis, opioids (beta=0.54, p=0.04), number of medications prescribed (beta=-0.49, p=0.05), and time spent in the ED (beta=0.007, p=0.006) were all predictors of total MCI score. AB - CONCLUSIONS: The extent of counseling about analgesic medications in the ED differs by drug class. When counseling patients about all analgesic medications, providers should address not only medication name and purpose but also the less frequently covered topics of medication dosing, timing, and adverse effects. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) IS - 1551-7489 IL - 1551-7489 DI - jom.2015.0271 DO - https://dx.doi.org/10.5055/jom.2015.0271 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - jom.2015.0271 [pii] ID - 10.5055/jom.2015.0271 [doi] PP - ppublish LG - English DP - 2015 May-Jun EZ - 2015/05/20 06:00 DA - 2015/09/09 06:00 DT - 2015/05/20 06:00 YR - 2015 ED - 20150908 RD - 20150519 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25985807 <284. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25257660 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Secora AM AU - Dormitzer CM AU - Staffa JA AU - Dal Pan GJ FA - Secora, Alex M FA - Dormitzer, Catherine M FA - Staffa, Judy A FA - Dal Pan, Gerald J IN - Secora, Alex M. Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA. TI - Measures to quantify the abuse of prescription opioids: a review of data sources and metrics. [Review] SO - Pharmacoepidemiology & Drug Safety. 23(12):1227-37, 2014 Dec AS - Pharmacoepidemiol Drug Saf. 23(12):1227-37, 2014 Dec NJ - Pharmacoepidemiology and drug safety VO - 23 IP - 12 PG - 1227-37 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - d0r, 9208369 IO - Pharmacoepidemiol Drug Saf SB - Index Medicus CP - England MH - *Analgesics, Opioid MH - Humans MH - *Statistics as Topic/st [Standards] MH - Statistics as Topic/td [Trends] MH - *Substance-Related Disorders KW - abuse; data sources; diversion; measurement; metrics; pharmacoepidemiology; prescription opioid AB - PURPOSE: The abuse and nonmedical use of prescription opioids and its subsequent consequences are an important public health concern. This phenomenon has paralleled the increase in the therapeutic use of opioids for pain management. There is thus a need to measure prescription opioid abuse to understand trends over time and to compare abuse of one product to another. The purpose of this review is to provide an overview of the strengths and weaknesses of frequently used numerators and denominators in "abuse ratios" (ARs). AB - METHODS: For this review, we critically evaluated the various measures to quantify drug availability and the available data sources to measure prescription opioid abuse. AB - RESULTS: There are currently no commonly adopted metrics for measuring either the prevalence of opioid abuse, or abuse relative to drug availability. Because the settings, manifestations, and severity of abuse can vary from one person to the next, no one measure of abuse, abuse-related outcome, or drug exposure is ideal. Each measure of abuse captures a specific facet of abuse, but not the whole spectrum. Reliable estimation of population-adjusted or utilization-adjusted rates of abuse can be accomplished with a prescription opioid AR. This metric estimates the prevalence of abuse in a given population or abuse relative to how much drug is available, and, in certain cases, can be used to compare abuse among various opioid drugs. AR measurements in the literature vary in the inclusion of specific measures of abuse and availability, and there is little consensus in the field regarding which measures allow for the most appropriate approximation of the extent of abuse, and for comparisons among opioids. Crude numbers of outcomes related to abuse (e.g., emergency department visits, treatment admissions, and overdoses) cannot be properly understood without context as these may overestimate or underestimate the true scope and severity of prescription opioid abuse. They can, however, serve as numerators in properly constructed ARs. The denominator of the AR provides the necessary context by accounting for populations at risk or drug availability (e.g., prescriptions or tablets dispensed, unique recipients of dispensed drug, total patient days of therapy, or kilograms sold), and each comes with its own set of assumptions to consider. AB - CONCLUSIONS: Moving forward, it is important that there be a common understanding in the scientific community regarding how to select appropriate measures to serve as numerators and denominators in AR calculations, and how to interpret the resultant findings. There is no single best measure of abuse for use as a numerator in an AR, and each must be chosen and interpreted in the context of what it measures. For public health considerations, one must always look at both absolute numbers and adjusted numbers. When conducting multiple analyses using different measures of exposure as denominators, differences in ARs are not unexpected, but one should explore why there are differences and assess the appropriateness of each of the denominators. Copyright © 2014 John Wiley & Sons, Ltd. RN - 0 (Analgesics, Opioid) ES - 1099-1557 IL - 1053-8569 DO - https://dx.doi.org/10.1002/pds.3711 PT - Journal Article PT - Review ID - 10.1002/pds.3711 [doi] PP - ppublish PH - 2013/11/22 [received] PH - 2014/07/28 [revised] PH - 2014/08/18 [accepted] LG - English EP - 20140925 DP - 2014 Dec EZ - 2014/09/27 06:00 DA - 2015/09/05 06:00 DT - 2014/09/27 06:00 YR - 2014 ED - 20150904 RD - 20150911 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25257660 <285. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25111716 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McDonald DC AU - Carlson KE FA - McDonald, Douglas C FA - Carlson, Kenneth E IN - McDonald, Douglas C. US Health Division, Abt Associates Inc., Cambridge, MA, USA. TI - The ecology of prescription opioid abuse in the USA: geographic variation in patients' use of multiple prescribers ("doctor shopping"). SO - Pharmacoepidemiology & Drug Safety. 23(12):1258-67, 2014 Dec AS - Pharmacoepidemiol Drug Saf. 23(12):1258-67, 2014 Dec NJ - Pharmacoepidemiology and drug safety VO - 23 IP - 12 PG - 1258-67 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - d0r, 9208369 IO - Pharmacoepidemiol Drug Saf PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777341 OI - Source: NLM. NIHMS759314 SB - Index Medicus CP - England MH - Age Factors MH - Alaska/ep [Epidemiology] MH - Humans MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Practice Patterns, Physicians' MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - *Prescription Drugs/ad [Administration & Dosage] MH - Rhode Island/ep [Epidemiology] MH - Sex Factors MH - Small-Area Analysis MH - United States/ep [Epidemiology] KW - abuse; diversion; geographic variation; multiple prescribers; opioids; pharmacoepidemiology AB - PURPOSE: This study estimates the prevalence in US counties of opioid patients who use large numbers of prescribers, the amounts of opioids they obtain, and the extent to which their prevalence is predicted by ecological attributes of counties, including general medical exposure to opioids. AB - METHODS: Finite mixture models were used to estimate the size of an outlier subpopulation of patients with suspiciously large numbers of prescribers (probable doctor shoppers), using a sample of 146 million opioid prescriptions dispensed during 2008. Ordinary least squares regression models of county-level shopper rates included independent variables measuring ecological attributes of counties, including rates of patients prescribed opioids, socioeconomic characteristics of the resident population, supply of physicians, and measures of healthcare service utilization. AB - RESULTS: The prevalence of shoppers varied widely by county, with rates ranging between 0.6 and 2.5 per 1000 residents. Shopper prevalence was strongly correlated with opioid prescribing for the general population, accounting for 30% of observed county variation in shopper prevalence, after adjusting for physician supply, emergency department visits, in-patient hospital days, poverty rates, percent of county residents living in urban areas, and racial/ethnic composition of resident populations. Approximately 30% of shoppers obtained prescriptions in multiple states. AB - CONCLUSIONS: The correlation between prevalence of doctor shoppers and opioid patients in a county could indicate either that easy access to legitimate medical treatment raises the risk of abuse or that drug abusers take advantage of greater opportunities in places where access is easy. Approaches to preventing excessive use of different prescribers are discussed. Copyright © 2014 John Wiley & Sons, Ltd. RN - 0 (Prescription Drugs) ES - 1099-1557 IL - 1053-8569 DO - https://dx.doi.org/10.1002/pds.3690 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1002/pds.3690 [doi] ID - PMC4777341 [pmc] ID - NIHMS759314 [mid] PP - ppublish PH - 2013/12/09 [received] PH - 2014/05/19 [revised] PH - 2014/07/14 [accepted] GI - No: RC2 DA028920 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20140811 DP - 2014 Dec EZ - 2014/08/12 06:00 DA - 2015/09/05 06:00 DT - 2014/08/12 06:00 YR - 2014 ED - 20150904 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25111716 <286. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24960911 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - DOH issues emergency regulations on expanding use of Narcan to prevent opioid overdose deaths. SO - Rhode Island Medicine. 97(4):49, 2014 Apr AS - R I Med. 97(4):49, 2014 Apr NJ - Rhode Island medical journal (2013) VO - 97 IP - 4 PG - 49 PI - Journal available in: Print PI - Citation processed from: Internet JC - bbe, 9203052, 101605827 IO - R I Med J (2013) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - Drug Overdose/mo [Mortality] MH - *Drug Overdose/pc [Prevention & Control] MH - Humans MH - Legislation, Drug MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - United States MH - United States Dept. of Health and Human Services RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 2327-2228 IL - 0363-7913 PT - News PP - ppublish LG - English DP - 2014 Apr EZ - 2014/06/26 06:00 DA - 2015/09/05 06:00 DT - 2014/06/26 06:00 YR - 2014 ED - 20150904 RD - 20140624 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24960911 <287. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24960870 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - Lifespan adopts ED guidelines to curb opioid misuse and abuse. SO - Rhode Island Medicine. 97(1):56, 2014 Jan AS - R I Med. 97(1):56, 2014 Jan NJ - Rhode Island medical journal (2013) VO - 97 IP - 1 PG - 56 PI - Journal available in: Print PI - Citation processed from: Internet JC - bbe, 9203052, 101605827 IO - R I Med J (2013) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Delivery of Health Care MH - *Emergency Service, Hospital MH - Humans MH - *Opioid-Related Disorders/th [Therapy] MH - *Practice Guidelines as Topic MH - *Prescription Drug Misuse/pc [Prevention & Control] MH - Rhode Island RN - 0 (Analgesics, Opioid) ES - 2327-2228 IL - 0363-7913 PT - News PP - ppublish LG - English DP - 2014 Jan EZ - 2014/06/26 06:00 DA - 2015/09/05 06:00 DT - 2014/06/26 06:00 YR - 2014 ED - 20150904 RD - 20140624 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24960870 <288. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25483411 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Filippovych S FA - Filippovych, Sergii IN - Filippovych, Sergii. International HIV/AIDS Alliance, Ukraine. Electronic address: Fil2006@bigmir.net. TI - Impact of armed conflicts and warfare on opioid substitution treatment in Ukraine: responding to emergency needs. SO - International Journal of Drug Policy. 26(1):3-5, 2015 Jan AS - Int J Drug Policy. 26(1):3-5, 2015 Jan NJ - The International journal on drug policy VO - 26 IP - 1 PG - 3-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9014759 IO - Int. J. Drug Policy SB - Index Medicus CP - Netherlands MH - Emergency Treatment MH - HIV Infections/ep [Epidemiology] MH - HIV Infections/pc [Prevention & Control] MH - Health Services Needs and Demand MH - Humans MH - *Opiate Substitution Treatment/mt [Methods] MH - *Substance Abuse, Intravenous/rh [Rehabilitation] MH - Ukraine/ep [Epidemiology] MH - *Warfare ES - 1873-4758 IL - 0955-3959 DI - S0955-3959(14)00309-0 DO - https://dx.doi.org/10.1016/j.drugpo.2014.11.005 PT - Editorial ID - S0955-3959(14)00309-0 [pii] ID - 10.1016/j.drugpo.2014.11.005 [doi] PP - ppublish PH - 2014/10/09 [received] PH - 2014/11/06 [revised] PH - 2014/11/11 [accepted] LG - English EP - 20141118 DP - 2015 Jan EZ - 2014/12/09 06:00 DA - 2015/09/04 06:00 DT - 2014/12/09 06:00 YR - 2015 ED - 20150903 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25483411 <289. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25130869 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Richert T FA - Richert, Torkel IN - Richert, Torkel. Malmo University, S-205 06 Malmo, Sweden. Electronic address: torkel.richert@mah.se. TI - Wasted, overdosed, or beyond saving--to act or not to act? Heroin users' views, assessments, and responses to witnessed overdoses in Malmo, Sweden. SO - International Journal of Drug Policy. 26(1):92-9, 2015 Jan AS - Int J Drug Policy. 26(1):92-9, 2015 Jan NJ - The International journal on drug policy VO - 26 IP - 1 PG - 92-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9014759 IO - Int. J. Drug Policy SB - Index Medicus CP - Netherlands MH - Adult MH - *Attitude to Health MH - Drug Overdose/ep [Epidemiology] MH - *Drug Overdose/th [Therapy] MH - Female MH - *Heroin/po [Poisoning] MH - *Heroin Dependence/co [Complications] MH - Humans MH - Interviews as Topic MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Peer Group MH - Police MH - Sweden/ep [Epidemiology] MH - Young Adult KW - Heroin high; Heroin users; Overdose; Overdose prevention; Qualitative interviews AB - BACKGROUND: Overdose is a significant cause of death among heroin users. Frequently, other heroin users are present when an overdose occurs, which means the victim's life could be saved. There is a lack of studies that, based on heroin users own stories, examine their views, assessments, and responses to witnessed overdoses. AB - METHODS: The study is based on qualitative interviews with thirty-five heroin users who witnessed someone else's overdose. AB - RESULTS: The heroin users generally had a positive attitude towards assisting peers who had overdosed. A number of factors and circumstances, however, contribute to witnesses often experiencing resistance to or ambivalence about responding. The witness's own high, the difficulty in assessing the seriousness of the situation, an unwillingness to disturb someone else's high, uncertainty about the motive behind the overdose and whether the victim does or does not want assistance as well as fear of police involvement, were common factors that acted as barriers to adequate responses in overdose situations. AB - CONCLUSION: The fact that being high makes it difficult to respond to overdoses, using traditional methods, argues for simpler and more effective response techniques. This can include intranasal naloxone programs for heroin users. The findings regarding the uncertainty about the intention of the overdose victim and the sensitivity to the experience of a good high argue for more up-front communication and discussion amongst using peers so that they can make their intentions clear to each other. Issues like this can be addressed in overdose education interventions. Overdose prevention measures also need to address the fact that fear of the police acts as a barrier to call emergency services. Copyright © 2014 Elsevier B.V. All rights reserved. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1873-4758 IL - 0955-3959 DI - S0955-3959(14)00174-1 DO - https://dx.doi.org/10.1016/j.drugpo.2014.07.006 PT - Journal Article ID - S0955-3959(14)00174-1 [pii] ID - 10.1016/j.drugpo.2014.07.006 [doi] PP - ppublish PH - 2013/07/24 [received] PH - 2014/02/06 [revised] PH - 2014/07/11 [accepted] LG - English EP - 20140721 DP - 2015 Jan EZ - 2014/08/19 06:00 DA - 2015/09/04 06:00 DT - 2014/08/19 06:00 YR - 2015 ED - 20150903 RD - 20141226 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25130869 <290. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24828772 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Aljuhani OA AU - McKinney CB AU - Erstad BL FA - Aljuhani, Ohoud A FA - McKinney, Courtney B FA - Erstad, Brian L IN - Aljuhani, Ohoud A. Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson (Drs Aljuhani, McKinney, and Erstad); University of Arizona Medical Center, University Campus, Tucson (Drs Aljuhani and McKinney); Department of Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia (Dr Aljuhani); and Intermountain Medical Center, Murray, Utah (Dr McKinney). TI - Opioid requirements in mechanically ventilated trauma patients receiving dexmedetomidine versus propofol. SO - Journal of Trauma Nursing. 21(3):111-4, 2014 May-Jun AS - J Trauma Nurs. 21(3):111-4, 2014 May-Jun NJ - Journal of trauma nursing : the official journal of the Society of Trauma Nurses VO - 21 IP - 3 PG - 111-4 PI - Journal available in: Print PI - Citation processed from: Internet JC - cfl, 9512997 IO - J Trauma Nurs SB - Nursing Journal CP - United States MH - APACHE MH - Adult MH - Cohort Studies MH - Conscious Sedation/ae [Adverse Effects] MH - Conscious Sedation/mt [Methods] MH - Critical Care/mt [Methods] MH - *Dexmedetomidine/ad [Administration & Dosage] MH - Dexmedetomidine/ae [Adverse Effects] MH - Female MH - Follow-Up Studies MH - Humans MH - Intensive Care Units MH - Male MH - Middle Aged MH - *Propofol/ad [Administration & Dosage] MH - Propofol/ae [Adverse Effects] MH - *Respiration, Artificial/mt [Methods] MH - Retrospective Studies MH - Risk Assessment MH - Trauma Centers MH - Trauma Severity Indices MH - Treatment Outcome MH - *Ventilator Weaning/mt [Methods] MH - Wounds and Injuries/di [Diagnosis] MH - *Wounds and Injuries/th [Therapy] AB - Proponents of dexmedetomidine often cite the agent's analgesic properties as one of its main advantages over propofol and benzodiazepines. However, there are very limited studies utilizing endpoints such as analgesic requirements to provide supporting evidence for these claims. The primary purpose of this retrospective study was to compare opioid analgesic requirements in trauma patients receiving nonconcurrent dexmedetomidine and propofol for sedation while being weaned from mechanical ventilation. Total analgesic requirements were similar between dexmedetomidine and propofol within 48 hours of sedative initiation in adult trauma patients (P > .05). RN - 67VB76HONO (Dexmedetomidine) RN - YI7VU623SF (Propofol) IS - 1078-7496 IL - 1078-7496 DO - https://dx.doi.org/10.1097/JTN.0000000000000041 PT - Comparative Study PT - Journal Article ID - 10.1097/JTN.0000000000000041 [doi] ID - 00043860-201405000-00007 [pii] PP - ppublish LG - English DP - 2014 May-Jun EZ - 2014/05/16 06:00 DA - 2015/09/04 06:00 DT - 2014/05/16 06:00 YR - 2014 ED - 20150902 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24828772 <291. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26305657 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fiellin DA AU - O'Connor PG AU - D'Onofrio G FA - Fiellin, David A FA - O'Connor, Patrick G FA - D'Onofrio, Gail IN - Fiellin, David A. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. IN - O'Connor, Patrick G. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. IN - D'Onofrio, Gail. Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. TI - Opioid Dependence Treatment in the Emergency Department--Reply. CM - Comment on: JAMA. 2015 Aug 25;314(8):834-5; PMID: 26305656 CM - Comment on: JAMA. 2015 Apr 28;313(16):1636-44; PMID: 25919527 SO - JAMA. 314(8):835, 2015 Aug 25 AS - JAMA. 314(8):835, 2015 Aug 25 NJ - JAMA VO - 314 IP - 8 PG - 835 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Buprenorphine/tu [Therapeutic Use] MH - Female MH - Humans MH - Male MH - *Narcotic Antagonists/tu [Therapeutic Use] RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2015.8527 PT - Comment PT - Letter ID - 2429706 [pii] ID - 10.1001/jama.2015.8527 [doi] PP - ppublish LG - English DP - 2015 Aug 25 EZ - 2015/08/26 06:00 DA - 2015/08/28 06:00 DT - 2015/08/26 06:00 YR - 2015 ED - 20150827 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26305657 <292. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26305656 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Swartz AW FA - Swartz, Andrew W IN - Swartz, Andrew W. Yukon Kuskokwim Health Corp, Bethel, Alaska. TI - Opioid Dependence Treatment in the Emergency Department. CM - Comment in: JAMA. 2015 Aug 25;314(8):835; PMID: 26305657 CM - Comment on: JAMA. 2015 Apr 28;313(16):1636-44; PMID: 25919527 SO - JAMA. 314(8):834-5, 2015 Aug 25 AS - JAMA. 314(8):834-5, 2015 Aug 25 NJ - JAMA VO - 314 IP - 8 PG - 834-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Buprenorphine/tu [Therapeutic Use] MH - Female MH - Humans MH - Male MH - *Narcotic Antagonists/tu [Therapeutic Use] RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2015.8519 PT - Comment PT - Letter ID - 2429704 [pii] ID - 10.1001/jama.2015.8519 [doi] PP - ppublish LG - English DP - 2015 Aug 25 EZ - 2015/08/26 06:00 DA - 2015/08/28 06:00 DT - 2015/08/26 06:00 YR - 2015 ED - 20150827 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26305656 <293. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25075734 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Meyer R AU - Patel AM AU - Rattana SK AU - Quock TP AU - Mody SH FA - Meyer, Roxanne FA - Patel, Anisha M FA - Rattana, Stacy K FA - Quock, Tiffany P FA - Mody, Samir H IN - Meyer, Roxanne. 1 Janssen Scientific Affairs , Raritan, New Jersey. TI - Prescription opioid abuse: a literature review of the clinical and economic burden in the United States. [Review] SO - Population Health Management. 17(6):372-87, 2014 Dec AS - Popul Health Manag. 17(6):372-87, 2014 Dec NJ - Population health management VO - 17 IP - 6 PG - 372-87 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101481266 IO - Popul Health Manag PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273187 SB - Index Medicus CP - United States MH - Adult MH - Analgesics, Opioid/po [Poisoning] MH - *Analgesics, Opioid MH - *Cost of Illness MH - Female MH - Health Care Costs/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/mo [Mortality] MH - *Prescription Drugs MH - United States/ep [Epidemiology] AB - Between 2002 and 2007, the nonmedical use of prescription pain relievers grew from 11.0 million to 12.5 million people in the United States. Societal costs attributable to prescription opioid abuse were estimated at $55.7 billion in 2007. The purpose of this study was to comprehensively review the recent clinical and economic evaluations of prescription opioid abuse. A comprehensive literature search was conducted for studies published from 2002 to 2012. Articles were included if they were original research studies in English that reported the clinical and economic burden associated with prescription opioid abuse. A total of 23 studies (183 unique citations identified, 54 articles subjected to full text review) were included in this review and analysis. Findings from the review demonstrated that rates of opioid overdose-related deaths ranged from 5528 deaths in 2002 to 14,800 in 2008. Furthermore, overdose reportedly results in 830,652 years of potential life lost before age 65. Opioid abusers were generally more likely to utilize medical services, such as emergency department, physician outpatient visits, and inpatient hospital stays, relative to non-abusers. When compared to a matched control group (non-abusers), mean annual excess health care costs for opioid abusers with private insurance ranged from $14,054 to $20,546. Similarly, the mean annual excess health care costs for opioid abusers with Medicaid ranged from $5874 to $15,183. The issue of opioid abuse has significant clinical and economic consequences for patients, health care providers, commercial and government payers, and society as a whole. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1942-7905 IL - 1942-7891 DO - https://dx.doi.org/10.1089/pop.2013.0098 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review ID - 10.1089/pop.2013.0098 [doi] ID - PMC4273187 [pmc] PP - ppublish LG - English DP - 2014 Dec EZ - 2014/07/31 06:00 DA - 2015/08/26 06:00 DT - 2014/07/31 06:00 YR - 2014 ED - 20150825 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25075734 <294. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25731073 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McCarthy DM AU - Wolf MS AU - McConnell R AU - Sears J AU - Chevrier A AU - Ahlstrom E AU - Engel KG AU - Cameron KA AU - Adams JG AU - Courtney DM FA - McCarthy, Danielle M FA - Wolf, Michael S FA - McConnell, Ryan FA - Sears, Jill FA - Chevrier, Allison FA - Ahlstrom, Eric FA - Engel, Kirsten G FA - Cameron, Kenzie A FA - Adams, James G FA - Courtney, D Mark IN - McCarthy, Danielle M. The Department of Emergency Medicine, Northwestern University, Chicago, IL. TI - Improving patient knowledge and safe use of opioids: a randomized controlled trial. SO - Academic Emergency Medicine. 22(3):331-9, 2015 Mar AS - Acad Emerg Med. 22(3):331-9, 2015 Mar NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 22 IP - 3 PG - 331-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Academic Medical Centers MH - Acetaminophen/ad [Administration & Dosage] MH - *Acetaminophen/tu [Therapeutic Use] MH - Adolescent MH - Adult MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Double-Blind Method MH - Drug Combinations MH - Emergency Service, Hospital MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Health Literacy MH - Humans MH - Hydrocodone/ad [Administration & Dosage] MH - *Hydrocodone/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - *Pain/dt [Drug Therapy] MH - Patient Discharge MH - *Patient Education as Topic/mt [Methods] MH - Prospective Studies MH - United States MH - Young Adult AB - OBJECTIVES: The use of opioid analgesics in the United States has significantly increased in recent years. However, there is minimal consensus on what discharge counseling should accompany these high-risk prescriptions and large variations in what is done in practice. The objective of this study was to evaluate the effect of a dual-modality (written and spoken) literacy-appropriate educational strategy on patients' knowledge of and safe use of opioid analgesics. AB - METHODS: This was a prospective, randomized controlled trial. Consecutive discharged patients at an urban academic ED (>88,000 visits) with new prescriptions for hydrocodone-acetaminophen were enrolled. Patients were randomized to receive either usual care or the educational intervention. The educational intervention was a one-page information sheet about hydrocodone-acetaminophen, which was both given to the patients and read aloud by the research assistant (nonblinded). Follow-up phone calls were conducted 4 to 7 days after the visit to assess patient knowledge about the medication and self-report of activities associated with safety of use (e.g., double-dipping with acetaminophen, storage, use with alcohol or while driving). AB - RESULTS: A total of 274 patients were enrolled; 210 completed follow-up (110 usual care and 100 intervention). No significant differences in baseline characteristics emerged between the study arms; 42% were male, and 51% were white, with a median age of 43 years. Half of patients had non-back pain orthopedic injuries (49.5%). On follow-up, overall knowledge was poor, with only 28% able to name both active ingredients in the medication. The intervention group had better knowledge of precautions related to taking additional acetaminophen (usual care 18.2%, 95% confidence interval [CI] = 10.9% to 25.5% vs. intervention 38%, 95% CI = 28.3% to 47.7%; difference = 27.6, 95% CI of difference = 21.5 to 33.7) and knowledge of side effects (usual care median = 1, interquartile range [IQR] 0 to 2 vs. intervention median = 2, IQR = 1 to 2; p < 0.0001). Additionally, those who received the intervention were less likely to have reported driving within 6 hours after taking hydrocodone (usual care 13.6%, 95% CI = 7.2% to 20% vs. intervention 3%, 95% CI = -0.3% to 6.3%; difference = 10.6, 95% CI of difference = 3.4 to 17.9). There was no difference between groups related to knowledge about drinking alcohol while taking hydrocodone (overall 18.1%) or knowledge that the opioid could be addictive (overall 72.4%). AB - CONCLUSIONS: This simple strategy improved several, but not all, aspects of patient knowledge and resulted in fewer patients in the intervention arm driving while taking hydrocodone. Integration of a patient education document into conversations about opioids holds promise for improving patient knowledge about these high-risk medications. Copyright © 2015 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 0 (acetaminophen, hydrocodone drug combination) RN - 362O9ITL9D (Acetaminophen) RN - 6YKS4Y3WQ7 (Hydrocodone) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12600 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 10.1111/acem.12600 [doi] PP - ppublish PH - 2014/08/12 [received] PH - 2014/10/22 [revised] PH - 2014/10/24 [accepted] LG - English EP - 20150302 DP - 2015 Mar EZ - 2015/03/04 06:00 DA - 2015/08/13 06:00 DT - 2015/03/04 06:00 YR - 2015 ED - 20150812 RD - 20150310 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25731073 <295. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25905856 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Faul M AU - Dailey MW AU - Sugerman DE AU - Sasser SM AU - Levy B AU - Paulozzi LJ FA - Faul, Mark FA - Dailey, Michael W FA - Sugerman, David E FA - Sasser, Scott M FA - Levy, Benjamin FA - Paulozzi, Len J IN - Faul, Mark. Mark Faul, David E. Sugerman, Benjamin Levy, and Len J. Paulozzi are with the Centers for Disease Control and Prevention, Atlanta, GA. Michael W. Dailey is with the Department of Emergency Medicine, Albany Medical Center, NY. Scott M. Sasser is with the Department of Emergency Medicine, Greenville Health System, SC. TI - Disparity in naloxone administration by emergency medical service providers and the burden of drug overdose in US rural communities. SO - American Journal of Public Health. 105 Suppl 3:e26-32, 2015 Jul AS - Am J Public Health. 105 Suppl 3:e26-32, 2015 Jul NJ - American journal of public health VO - 105 Suppl 3 PG - e26-32 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 1254074, 3xw IO - Am J Public Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455515 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Risk Factors MH - Rural Health Services MH - Rural Population MH - United States/ep [Epidemiology] AB - OBJECTIVES: We determined the factors that affect naloxone (Narcan) administration in drug overdoses, including the certification level of emergency medical technicians (EMTs). AB - METHODS: In 2012, 42 states contributed all or a portion of their ambulatory data to the National Emergency Medical Services Information System. We used a logistic regression model to measure the association between naloxone administration and emergency medical services certification level, age, gender, geographic location, and patient primary symptom. AB - RESULTS: The odds of naloxone administration were much higher among EMT-intermediates than among EMT-basics (adjusted odds ratio [AOR]=5.4; 95% confidence interval [CI]=4.5, 6.5). Naloxone use was higher in suburban areas than in urban areas (AOR=1.41; 95% CI=1.3, 1.5), followed by rural areas (AOR=1.23; 95% CI=1.1, 1.3). Although the odds of naloxone administration were 23% higher in rural areas than in urban areas, the opioid drug overdose rate is 45% higher in rural communities. AB - CONCLUSIONS: Naloxone is less often administered by EMT-basics, who are more common in rural areas. In most states, the scope-of-practice model prohibits naloxone administration by basic EMTs. Reducing this barrier could help prevent drug overdose death. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1541-0048 IL - 0090-0036 DO - https://dx.doi.org/10.2105/AJPH.2014.302520 PT - Journal Article ID - 10.2105/AJPH.2014.302520 [doi] ID - PMC4455515 [pmc] PP - ppublish LG - English EP - 20150423 DP - 2015 Jul EZ - 2015/04/24 06:00 DA - 2015/08/11 06:00 DT - 2015/04/24 06:00 YR - 2015 ED - 20150810 RD - 20160701 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25905856 <296. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25868207 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Takebe S AU - Inoue K AU - Kawanishi H AU - Nakamura H AU - Ohnishi A AU - Ohnishi J AU - Yatsu Y AU - Nagai A AU - Matsuda R AU - Hirasaki A FA - Takebe, Sawako FA - Inoue, Kazuyoshi FA - Kawanishi, Hiroyuki FA - Nakamura, Hitoshi FA - Ohnishi, Ai FA - Ohnishi, Junji FA - Yatsu, Yuichi FA - Nagai, Akihiro FA - Matsuda, Rikiya FA - Hirasaki, Akihito TI - [Delayed emergence from general anesthesia in a dementia patient with Lewy bodies]. [Japanese] SO - Masui - Japanese Journal of Anesthesiology. 64(1):81-3, 2015 Jan AS - Masui. 64(1):81-3, 2015 Jan NJ - Masui. The Japanese journal of anesthesiology VO - 64 IP - 1 PG - 81-3 PI - Journal available in: Print PI - Citation processed from: Print JC - khr, 0413707 IO - Masui SB - Index Medicus CP - Japan MH - Aged MH - *Anesthesia, General/ae [Adverse Effects] MH - Awareness MH - Dementia/co [Complications] MH - *Dementia MH - Humans MH - *Lewy Bodies MH - Male AB - A 73-year-old man (164cm height 51 kg body weight) with a history of Parkinson's disease and dementia was scheduled for a cervical lymph node biopsy under general anesthesia. We induced anesthesia with thiamylal and fentanyl, and maintained with sevoflurane and remifentanil without any incident. The patient did not emerge from anesthesia after the surgery. He developed coma and did not respond to painful stimuli. However, his breathing was spontaneous with stable hemodynamics. Although naloxone was given, he was still comatose. His clinical neurological findings showed no organic abnormalities. Forty minutes after the surgery, he suddenly woke up and followed instructions. We learned that previously he had been diagnosed with dementia with Lewy bodies. IS - 0021-4892 IL - 0021-4892 PT - Case Reports PT - English Abstract PT - Journal Article PP - ppublish LG - Japanese DP - 2015 Jan EZ - 2015/04/15 06:00 DA - 2015/08/11 06:00 DT - 2015/04/15 06:00 YR - 2015 ED - 20150810 RD - 20150414 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25868207 <297. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25951656 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weiss RC AU - Bazalo GR AU - Thomson H AU - Edwards E FA - Weiss, Richard C FA - Bazalo, Gary R FA - Thomson, Heather FA - Edwards, Eric TI - Economic impact of a novel naloxone autoinjector on third-party payers. SO - Managed Care. 24(2):41-8, 2015 Feb AS - Manag Care. 24(2):41-8, 2015 Feb NJ - Managed care (Langhorne, Pa.) VO - 24 IP - 2 PG - 41-8 PI - Journal available in: Print PI - Citation processed from: Print JC - b7n, 9303583 IO - Manag Care SB - Health Administration Journals CP - United States MH - Humans MH - *Insurance, Health, Reimbursement MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Self Administration/ec [Economics] MH - *Self Administration/is [Instrumentation] MH - United States AB - BACKGROUND: Patient overdoses on prescription opioid analgesics in the United States continue to rise, resulting in increased emergency department and hospitalization costs. Opioid overdose is readily reversible with naloxone, a fast-acting opioid antagonist. A new naloxone autoinjector (NAI), Evzio, which does not require medical training to use, was approved by the FDA in April 2014. Payers must decide on reimbursement policies for this product. AB - PURPOSE: To demonstrate to payer decision makers the costs and potential medical resource cost offsets associated with the utilization of a new NAI. AB - DESIGN: A deterministic model using matched controls. AB - METHODOLOGY: An Excel-based cost model was developed for a hypothetical health plan with 1 million adult members. Costs of prescription opioid overdose events for patients appropriately dispensed NAI were compared with matched controls. AB - RESULTS: NAI prescriptions increased from 218 in Year 1 to 2,527 in Year 3. In Year 3, 86 NAI patients (and their matched controls) experienced opioid overdose events. For this period, fatal overdoses in the NAI cohort totaled 11.1 vs. 14.7 for the control group. In Year 3, 2.5 deaths (10.1-7.6) were avoided. NAI acquisition costs rose from $125,000 in Year 1 (PMPM = $0.01) to nearly $1.5 million in Year 3 (PMPM = $0.12).This cost was offset by medical resource savings of approximately $84,000 in Year 1, increasing to $975,000 in Year 3. The total net cost (NAI less offsets) in Year 3, when NAI uptake was assumed to plateau, was $481,000 (PMPM = $0.04). AB - CONCLUSION: A deterministic model demonstrated that NAI acquisition costs can be offset through medical cost reductions with improved timely access to naloxone. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1062-3388 IL - 1062-3388 PT - Comparative Study PT - Journal Article PP - ppublish LG - English DP - 2015 Feb EZ - 2015/05/09 06:00 DA - 2015/07/17 06:00 DT - 2015/05/09 06:00 YR - 2015 ED - 20150716 RD - 20150508 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25951656 <298. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 26058121 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Swenson O FA - Swenson, Orel TI - Accidental methadone intoxication masquerading as asthma exacerbation with respiratory arrest in a six-year-old boy. SO - Delaware Medical Journal. 87(5):147-9, 2015 May AS - Del Med J. 87(5):147-9, 2015 May NJ - Delaware medical journal VO - 87 IP - 5 PG - 147-9 PI - Journal available in: Print PI - Citation processed from: Print JC - e0b, 0370077 IO - Del Med J SB - Index Medicus CP - United States MH - *Asthma/di [Diagnosis] MH - Bradycardia/ci [Chemically Induced] MH - Child MH - Diagnosis, Differential MH - *Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - Humans MH - Male MH - *Methadone/po [Poisoning] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Respiratory Insufficiency/ci [Chemically Induced] AB - A 6-year-old boy is brought to the emergency department of a level 1 trauma center by emergency medical services (EMS) for presumed asthma exacerbation with subsequent unresponsiveness and transient bradycardia. The initial physician exam was remarkable for an unresponsive child, with diffusely diminished breath sounds bilaterally, accompanied by diffuse wheezing, as well as pinpoint pupils. This last observation led to the recommendation to attempt a dose of naloxone for a possible overdose prior to proceeding with intubation for the altered mental status. The child had a brisk response to the naloxone, was subsequently placed on a naloxone drip, and admitted to the hospital. Initial provider thoughts were that the naloxone had worked on an accidental overdose of over-the-counter dextromethorphan containing medication. These suspicions were later proven incorrect after mass spectrometry yielded a positive methadone presence in the urine. The child was ultimately discharged home with ongoing input from child protective services, without further medical complications. The increased utilization of methadone for the treatment of both opioid withdrawal, as well as for chronic pain management demands, heightened awareness of the clinicians, as cases such as this will continue to appear. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) IS - 0011-7781 IL - 0011-7781 PT - Journal Article PP - ppublish LG - English DP - 2015 May EZ - 2015/06/11 06:00 DA - 2015/07/15 06:00 DT - 2015/06/11 06:00 YR - 2015 ED - 20150709 RD - 20150610 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=26058121 <299. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25491712 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Choo EK AU - Douriez C AU - Green T FA - Choo, Esther K FA - Douriez, Carole FA - Green, Traci IN - Choo, Esther K. Department of Emergency Medicine, Warren Alpert Medical School, Providence, RI; School of Public Health, Brown University, Providence, RI. TI - Gender and prescription opioid misuse in the emergency department. SO - Academic Emergency Medicine. 21(12):1493-8, 2014 Dec AS - Acad Emerg Med. 21(12):1493-8, 2014 Dec NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 21 IP - 12 PG - 1493-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266134 OI - Source: NLM. NIHMS601437 SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Prescription Drugs MH - Prevalence MH - Sex Characteristics MH - Sex Distribution MH - Treatment Outcome MH - United States MH - Young Adult AB - OBJECTIVES: To the best of the authors' knowledge, gender differences in nonmedical opioid presentations to the emergency department (ED) have not been studied. The objective was to explore gender differences in ED visits related to nonmedical prescription opioid use in a nationally representative sample. AB - METHODS: Data from the 2011 U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network (DAWN) were analyzed to compare visit characteristics between women and men. Logistic regression models were developed to examine the association between gender and specific drug presentations and clinical outcomes. AB - RESULTS: There were an estimated 426,010 DAWN-defined visits involving prescription opioid use in 2011. The prevalence of drugs in opioid-involved visits was similar between women and men. Ingestion of another drug along with opioids was associated with increased odds of hospital admission for both women and men, and types of opioids ingested were similar between women and men. However, gender differences were noted in clinical outcomes, depending on the specific drug combination. AB - CONCLUSIONS: Gender differences exist in ED presentations related to prescription opioids. Further research is needed to understand these differences and any implications for gender-specific emergency care and brief interventions. Copyright © 2014 by the Society for Academic Emergency Medicine. RN - 0 (Prescription Drugs) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12547 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1111/acem.12547 [doi] ID - PMC4266134 [pmc] ID - NIHMS601437 [mid] PP - ppublish PH - 2014/03/11 [received] PH - 2014/04/30 [revised] PH - 2014/05/01 [accepted] GI - No: K23 DA031881 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: 1K23DA031881-01 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2014 Dec EZ - 2014/12/11 06:00 DA - 2015/07/07 06:00 DT - 2014/12/11 06:00 YR - 2014 ED - 20150706 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25491712 <300. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25749404 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Perrone J AU - Nelson LS AU - Yealy DM FA - Perrone, Jeanmarie FA - Nelson, Lewis S FA - Yealy, Donald M IN - Perrone, Jeanmarie. Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. IN - Nelson, Lewis S. Department of Emergency Medicine, New York University, New York, NY. Electronic address: Lewis.Nelson@nyumc.org. IN - Yealy, Donald M. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA. TI - Choosing Analgesics Wisely: What We Know (and Still Need to Know) About Long-Term Consequences of Opioids. CM - Comment on: Ann Emerg Med. 2015 May;65(5):493-499.e4; PMID: 25534654 SO - Annals of Emergency Medicine. 65(5):500-2, 2015 May AS - Ann Emerg Med. 65(5):500-2, 2015 May NJ - Annals of emergency medicine VO - 65 IP - 5 PG - 500-2 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/et [Etiology] MH - *Pain/dt [Drug Therapy] MH - *Prescription Drugs/tu [Therapeutic Use] RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(15)00081-5 DO - https://dx.doi.org/10.1016/j.annemergmed.2015.01.021 PT - Comment PT - Editorial ID - S0196-0644(15)00081-5 [pii] ID - 10.1016/j.annemergmed.2015.01.021 [doi] PP - ppublish PH - 2015/01/12 [received] LG - English EP - 20150306 DP - 2015 May EZ - 2015/03/10 06:00 DA - 2015/06/27 06:00 DT - 2015/03/10 06:00 YR - 2015 ED - 20150626 RD - 20150427 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25749404 <301. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25534654 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hoppe JA AU - Kim H AU - Heard K FA - Hoppe, Jason A FA - Kim, Howard FA - Heard, Kennon IN - Hoppe, Jason A. Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO. Electronic address: jason.hoppe@ucdenver.edu. IN - Kim, Howard. Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Denver Health Residency in Emergency Medicine, Denver, CO. IN - Heard, Kennon. Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO. TI - Association of emergency department opioid initiation with recurrent opioid use. CM - Comment in: Ann Emerg Med. 2015 May;65(5):500-2; PMID: 25749404 SO - Annals of Emergency Medicine. 65(5):493-499.e4, 2015 May AS - Ann Emerg Med. 65(5):493-499.e4, 2015 May NJ - Annals of emergency medicine VO - 65 IP - 5 PG - 493-499.e4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cohort Studies MH - Colorado MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Odds Ratio MH - *Opioid-Related Disorders/et [Etiology] MH - *Pain/dt [Drug Therapy] MH - *Prescription Drugs/tu [Therapeutic Use] MH - Retrospective Studies MH - Risk Factors MH - Young Adult AB - STUDY OBJECTIVE: Acute pain complaints are commonly treated in the emergency department (ED). Short courses of opioids are presumed to be safe for acute pain; however, the risk of recurrent opioid use after receipt of an ED opioid prescription is unknown. We describe the risk of recurrent opioid use in patients receiving an opioid prescription from the ED for an acute painful condition. AB - METHODS: This is a retrospective cohort study of all patients discharged from an urban academic ED with an acute painful condition during a 5-month period. Clinical information was linked to data from Colorado's prescription drug monitoring program. We compared opioid-naive patients (no opioid prescription during the year before the visit) who filled an opioid prescription or received a prescription but did not fill it to those who did not receive a prescription. The primary outcome was the rate of recurrent opioid use, defined as filling an opioid prescription within 60 days before or after the first anniversary of the ED visit. AB - RESULTS: Four thousand eight hundred one patients were treated for an acute painful condition; of these, 52% were opioid naive and 48% received an opioid prescription. Among all opioid-naive patients, 775 (31%) received and filled an opioid prescription, and 299 (12%) went on to recurrent use. For opioid-naive patients who filled a prescription compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 1.8 (95% confidence interval 1.3 to 2.3). For opioid-naive patients who received a prescription but did not fill it compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 0.8 (95% confidence interval 0.5 to 1.3). AB - CONCLUSION: Opioid-naive ED patients prescribed opioids for acute pain are at increased risk for additional opioid use at 1 year. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(14)01513-3 DO - https://dx.doi.org/10.1016/j.annemergmed.2014.11.015 PT - Evaluation Studies PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Video-Audio Media ID - S0196-0644(14)01513-3 [pii] ID - 10.1016/j.annemergmed.2014.11.015 [doi] PP - ppublish PH - 2014/04/28 [received] PH - 2014/11/11 [revised] PH - 2014/11/13 [accepted] GI - No: UL1 RR025780 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English EP - 20141218 DP - 2015 May EZ - 2014/12/24 06:00 DA - 2015/06/26 06:00 DT - 2014/12/24 06:00 YR - 2015 ED - 20150625 RD - 20150427 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25534654 <302. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25039586 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McCarthy DM AU - Cameron KA AU - King JP AU - Mullen RJ AU - Bailey SC AU - Jacobson KL AU - Di Francesco L AU - Davis TC AU - Parker RM AU - Wolf MS FA - McCarthy, Danielle M FA - Cameron, Kenzie A FA - King, Jennifer P FA - Mullen, Rebecca J FA - Bailey, Stacy Cooper FA - Jacobson, Kara L FA - Di Francesco, Lorenzo FA - Davis, Terry C FA - Parker, Ruth M FA - Wolf, Mike S IN - McCarthy, Danielle M. Health Literacy and Learning Program, Feinberg School of Medicine, Northwestern University, Chicago, USA; Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA. TI - Patient recall of health care provider counseling for opioid-acetaminophen prescriptions. SO - Pain Medicine. 15(10):1750-6, 2014 Oct AS - PAIN MED. 15(10):1750-6, 2014 Oct NJ - Pain medicine (Malden, Mass.) VO - 15 IP - 10 PG - 1750-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - *Acetaminophen/ae [Adverse Effects] MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Counseling/sn [Statistics & Numerical Data] MH - Cross-Sectional Studies MH - Drug Combinations MH - Female MH - *Health Personnel MH - Humans MH - Male MH - Mental Recall MH - Middle Aged MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Pain/dt [Drug Therapy] MH - Prescriptions KW - Acetaminophen; Hydrocodone; Medication Counseling; Opioids AB - OBJECTIVE: The aim of this study was to determine the frequency and nature of physician, nurse, and pharmacist verbal counseling at the time of a new prescription for an opioid-acetaminophen containing medication as recalled by patients. AB - DESIGN: A mixed methods approach with data from cross sectional, structured interviews was used. AB - SETTING: The settings were one academic emergency department in Chicago, IL and one outpatient pharmacy at a public hospital in Atlanta, GA. AB - PATIENTS: One hundred forty-nine patients receiving a new prescription for an opioid-acetaminophen medication were enrolled. AB - METHODS: Interviews assessed patient recall of counseling they received from their physician, nurse, and pharmacist upon receiving the new prescription. Their responses were unitized and assigned to categories. AB - RESULTS: One hundred forty-nine patients were enrolled; 61.1% African American and 58.4% female. Seven major categories of responses were noted; frequencies of patient recall for counseling in these categories were reported. Four categories related to the content of the counseling discussion were (1) details of administration (patient recall counseling from: physician/nurse only 44.3%, pharmacist only 5.4%, both providers 12.8%); (2) activities to avoid and side effects (36.2%, 4.7%, 8.7%); (3) medication indication (32.9%, 4%, 4%); and (4) addictive potential (9.3%, 1.3%, 0%). Three categories describe patients' recall of the interaction in broad terms: (5) being referred to print informational material accompanying the prescription (MD/RN only 7.4%, pharmacist only 20.1%, both providers 2.7%); (6) having questions solicited (0%, 11.4%, 0%); (7) having no interaction relating to medication counseling (3.4%, 32.2%, 1.3%). AB - CONCLUSIONS: Patients infrequently recall counseling from providers on topics that are important to prevent harm from opioid-acetaminophen prescriptions. Future patient-centered clinical research should target identifying optimal strategies to convey these critical messages. Copyright Wiley Periodicals, Inc. RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 362O9ITL9D (Acetaminophen) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/pme.12499 PT - Journal Article ID - 10.1111/pme.12499 [doi] PP - ppublish LG - English EP - 20140707 DP - 2014 Oct EZ - 2014/07/22 06:00 DA - 2015/06/17 06:00 DT - 2014/07/22 06:00 YR - 2014 ED - 20150616 RD - 20171216 UP - 20171218 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=25039586 <303. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25139712 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hasegawa K AU - Espinola JA AU - Brown DF AU - Camargo CA Jr FA - Hasegawa, Kohei FA - Espinola, Janice A FA - Brown, David F M FA - Camargo, Carlos A Jr IN - Hasegawa, Kohei. Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA. TI - Trends in U.S. emergency department visits for opioid overdose, 1993-2010. SO - Pain Medicine. 15(10):1765-70, 2014 Oct AS - PAIN MED. 15(10):1765-70, 2014 Oct NJ - Pain medicine (Malden, Mass.) VO - 15 IP - 10 PG - 1765-70 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - Child MH - *Drug Overdose/ep [Epidemiology] MH - *Emergency Service, Hospital/td [Trends] MH - Female MH - Health Care Surveys MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Sex Distribution MH - United States/ep [Epidemiology] MH - Young Adult KW - Emergency Department; Epidemiology; Opioids; Overdose; Time Trend AB - OBJECTIVE: Emergency department (ED) visits for opioid overdose provide an important marker of acute morbidity. We sought to evaluate national trends of ED visits for opioid overdose. AB - DESIGN, SETTING, AND PARTICIPANTS: The National Hospital Ambulatory Medical Care Survey, 1993-2010, was used to identify ED visits for opioid overdose. AB - OUTCOME MEASURES: Outcome measures were national ED visit rates for opioid overdose per 100,000 U.S. population and per 100,000 ED visits. AB - RESULTS: From 1993 to 2010, there were approximately 731,000 ED visits (95% CI, 586,000-877,000 visits) for opioid overdose, representing an overall rate of 14 ED visits (95% CI, 12-17 visits) per 100,000 population and 37 ED visits (95% CI, 31-45 visits) per 100,000 ED visits. Of these, 41% (95% CI, 33-50%) were for prescription opioid overdose. Between 1993 and 2010, the national visit rate increased from 7 to 27 per 100,000 population (+307%; Ptrend =0.03), and from 19 to 63 per 100,000 ED visits (+235%; Ptrend <0.001). Stratified analyses of the visit rate per population showed upward, but nonsignificant, trends across multiple demographic groups and U.S. regions. In stratified analyses of the visit rate per 100,000 ED visits, the rate increased significantly in several groups: age <20 years (+1188%; Ptrend =0.002), age 20-29 years (+155%; Ptrend =0.04), age >=50 years (+231%; Ptrend =0.04), female (+234%; Ptrend =0.001), male (+80%; Ptrend =0.04), whites (+187%; Ptrend <0.001), and patients in the South (+371%; Ptrend <0.001). AB - CONCLUSION: In a nationally representative database of U.S. ED visits, we found that the ED visit rate for opioid overdose quadrupled from 1993 to 2010. Our findings suggest that previous prevention measures may not be adequate. Copyright Wiley Periodicals, Inc. ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/pme.12461 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1111/pme.12461 [doi] PP - ppublish LG - English EP - 20140819 DP - 2014 Oct EZ - 2014/08/21 06:00 DA - 2015/06/17 06:00 DT - 2014/08/21 06:00 YR - 2014 ED - 20150616 RD - 20141023 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25139712 <304. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24831102 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Koller AC AU - Salcido DD AU - Menegazzi JJ FA - Koller, Allison C FA - Salcido, David D FA - Menegazzi, James J TI - Physician and nonphysician health-care provider perspectives on resuscitation of suspected drug-related out-of-hospital cardiac arrest. SO - Prehospital Emergency Care. 18(4):483-8, 2014 Oct-Dec AS - Prehosp Emerg Care. 18(4):483-8, 2014 Oct-Dec NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 18 IP - 4 PG - 483-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adult MH - Aged MH - *Cardiopulmonary Resuscitation MH - *Drug Overdose/th [Therapy] MH - *Emergency Medical Services MH - Female MH - *Health Personnel/px [Psychology] MH - Health Surveys MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - *Out-of-Hospital Cardiac Arrest/th [Therapy] MH - *Physicians/px [Psychology] MH - Surveys and Questionnaires MH - United States KW - EMS system; cardiac arrest; drug overdose; resuscitation AB - INTRODUCTION: In the United States, out-of-hospital cardiac arrest from drug overdose (OD-OHCA) caused over 38,000 deaths in 2010. A study in Pittsburgh found that OD-OHCA patients differed demographically and in the resuscitation treatments they received, despite identical AHA resuscitation guidelines. We hypothesized that health-care provider perceptions affect decision-making in the treatment of OD-OHCA versus non-OD OHCA. AB - METHODS: We conducted this survey at the National Association of EMS Physicians 2013 Scientific Assembly. Physicians and non-physician health-care providers were given one of two surveys containing 19 questions pertaining to the respondents' affiliated EMS agencies, the estimated proportion of OD-OHCA as well as the drugs involved, and the respondents' belief about the treatments for OD versus non-OD OHCA. AB - RESULTS: One hundred ninety-three respondents participated in this survey. Of the 193, 144 (75%) were physicians and 49 (25%) were nonphysicians. Seventy-nine percent of physicians identified current status as a medical director and 76% of nonphysicians identified as a paramedic. Participants estimated the average monthly proportion of all OHCA due to OD to be 9.4%. Participants ranked opioids, alcohol, antidepressants, and benzodiazepines as the most commonly utilized agents in OD-OHCA. The majority of physicians (42%) felt that the incidence of OD-OHCA was not changing while the majority of nonphysicians (53%) felt the incidence was increasing. Eighty-four percent of all respondents reported the use of naloxone during OD-OHCA resuscitation, while 13% reported administering naloxone during non-OD OHCA resuscitation. Eighty-nine percent of physicians and 67% of nonphysicians indicated that OD-OHCA patients had different demographics than non-OD OHCA, with primary reported differences being age, comorbidities, and socioeconomic status. Sixty-three percent of physicians and 71% of nonphysicians felt that OD-OHCA patients should be treated differently, with primary differences being the incorporation of etiology-specific treatments, performing different CPR with a focus on airway support, and transporting earlier. AB - CONCLUSIONS: When surveyed, physicians and nonphysician providers report perceiving OD-OHCA treatment, outcomes, and patient demographics differently than non-OD OHCA and making different treatment decisions based on these perceptions. This may result in etiology-oriented resuscitation in the out-of-hospital setting, despite the lack of OD-specific resuscitation guidelines. ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2014.897780 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.3109/10903127.2014.897780 [doi] PP - ppublish GI - No: 1R21HL104440-01A1 Organization: (HL) *NHLBI NIH HHS* Country: United States LG - English EP - 20140515 DP - 2014 Oct-Dec EZ - 2014/05/17 06:00 DA - 2015/06/10 06:00 DT - 2014/05/17 06:00 YR - 2014 ED - 20150609 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24831102 <305. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24830404 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Zuckerman M AU - Weisberg SN AU - Boyer EW FA - Zuckerman, Matthew FA - Weisberg, Stacy N FA - Boyer, Edward W TI - Pitfalls of intranasal naloxone. SO - Prehospital Emergency Care. 18(4):550-4, 2014 Oct-Dec AS - Prehosp Emerg Care. 18(4):550-4, 2014 Oct-Dec NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 18 IP - 4 PG - 550-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863654 OI - Source: NLM. NIHMS784430 SB - Index Medicus CP - England MH - Administration, Intranasal MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Apnea/ci [Chemically Induced] MH - *Apnea/dt [Drug Therapy] MH - Biological Availability MH - Blood Pressure/de [Drug Effects] MH - *Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services MH - *Fentanyl/ae [Adverse Effects] MH - Heart Rate/de [Drug Effects] MH - Humans MH - Infusions, Intravenous MH - Male MH - Miosis/dt [Drug Therapy] MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/ae [Adverse Effects] MH - Respiratory Distress Syndrome, Adult/ci [Chemically Induced] MH - *Respiratory Distress Syndrome, Adult/dt [Drug Therapy] MH - Respiratory Rate/de [Drug Effects] KW - intranasal naloxone; overdose; prescription opioids AB - We present a case of failed prehospital treatment of fentanyl induced apnea with intranasal (IN) naloxone. While IN administration of naloxone is becoming more common in both lay and pre-hospital settings, older EMS protocols utilized intravenous (IV) administration. Longer-acting, higher potency opioids, such as fentanyl, may not be as easily reversed as heroin, and studies evaluating IN administration in this population are lacking. In order to contribute to our understanding of the strengths and limitations of IN administration of naloxone, we present a case where it failed to restore ventilation. We also describe peer reviewed literature that supports the use of IV naloxone following heroin overdose and explore possible limitations of generalizing this literature to opioids other than heroin and to IN routes of administration. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2014.896961 PT - Case Reports PT - Journal Article ID - 10.3109/10903127.2014.896961 [doi] ID - PMC4863654 [pmc] ID - NIHMS784430 [mid] PP - ppublish GI - No: K24 DA037109 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20140515 DP - 2014 Oct-Dec EZ - 2014/05/17 06:00 DA - 2015/06/10 06:00 DT - 2014/05/17 06:00 YR - 2014 ED - 20150609 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24830404 <306. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24973558 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Koller AC AU - Salcido DD AU - Callaway CW AU - Menegazzi JJ FA - Koller, Allison C FA - Salcido, David D FA - Callaway, Clifton W FA - Menegazzi, James J IN - Koller, Allison C. Department of Emergency Medicine, University of Pittsburgh, School of Medicine, United States. Electronic address: ack40@pitt.edu. IN - Salcido, David D. Department of Emergency Medicine, University of Pittsburgh, School of Medicine, United States. IN - Callaway, Clifton W. Department of Emergency Medicine, University of Pittsburgh, School of Medicine, United States. IN - Menegazzi, James J. Department of Emergency Medicine, University of Pittsburgh, School of Medicine, United States. TI - Resuscitation characteristics and outcomes in suspected drug overdose-related out-of-hospital cardiac arrest. SO - Resuscitation. 85(10):1375-9, 2014 Oct AS - Resuscitation. 85(10):1375-9, 2014 Oct NJ - Resuscitation VO - 85 IP - 10 PG - 1375-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Adult MH - Aged MH - *Drug Overdose/co [Complications] MH - Emergency Medical Services MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Out-of-Hospital Cardiac Arrest/ci [Chemically Induced] MH - Out-of-Hospital Cardiac Arrest/mo [Mortality] MH - *Out-of-Hospital Cardiac Arrest/th [Therapy] MH - *Resuscitation MH - Retrospective Studies MH - Survival Rate MH - Treatment Outcome KW - Cardiac arrest; Drug overdose; Resuscitation AB - INTRODUCTION: We sought to compare characteristics of emergency medical services-treated out-of-hospital cardiac arrests resulting from suspected drug overdose with non-overdose cases and test the relationship between suspected overdose and survival to hospital discharge. AB - METHODS: Data from emergency medical services-treated, non-traumatic out-of-hospital cardiac arrests from 2006 to 2008 and late 2009 to 2011 were obtained from four EMS agencies in the Pittsburgh, Pennsylvania metropolitan area. Case definition for suspected drug overdose was naloxone administration, indication on the patient care report and/or indication by a review of hospital records. Resuscitation parameters included chest compression fraction, rate, and depth and the administration of resuscitation drugs. Demographic and outcome variables compared by suspected overdose status included age, sex, and survival to hospital discharge. AB - RESULTS: From 2342 treated out-of-hospital cardiac arrests, 180 were suspected overdose cases (7.7%) and were compared to 2162 non-overdose cases. Suspected overdose cases were significantly younger (45 vs. 65, p<0.001), less likely to be witnessed by a bystander (29% vs. 41%, p<0.005), and had a higher rate of survival to hospital discharge (19% vs. 12%, p=0.014) than non-overdoses. Suspected overdose cases had a higher overall chest compression fraction (0.69 vs. 0.67, p=0.018) and higher probability of adrenaline, sodium bicarbonate, and atropine administration (p<0.001). Suspected overdose status was predictive of survival to hospital discharge when controlling for other variables (p<0.001). AB - CONCLUSION: Patients with suspected overdose-related out-of-hospital cardiac arrest were younger, received different resuscitative care, and survived more often than non-overdose cases. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. ES - 1873-1570 IL - 0300-9572 DI - S0300-9572(14)00581-4 DO - https://dx.doi.org/10.1016/j.resuscitation.2014.05.036 PT - Evaluation Studies PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0300-9572(14)00581-4 [pii] ID - 10.1016/j.resuscitation.2014.05.036 [doi] ID - PMC4164578 [pmc] ID - NIHMS615243 [mid] PP - ppublish PH - 2014/04/02 [received] PH - 2014/05/19 [revised] PH - 2014/05/30 [accepted] GI - No: UL1 TR000005 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: U01 HL077871 Organization: (HL) *NHLBI NIH HHS* Country: United States GI - No: R21 HL104440 Organization: (HL) *NHLBI NIH HHS* Country: United States GI - No: 5U01 HL077863 Organization: (HL) *NHLBI NIH HHS* Country: United States GI - No: 1R21HL104440-01A1 Organization: (HL) *NHLBI NIH HHS* Country: United States LG - English EP - 20140626 DP - 2014 Oct EZ - 2014/06/29 06:00 DA - 2015/06/02 06:00 DT - 2014/06/29 06:00 YR - 2014 ED - 20150601 RD - 20180319 UP - 20180319 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=24973558 <307. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25377395 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Beaudoin FL AU - Lin C AU - Guan W AU - Merchant RC FA - Beaudoin, Francesca L FA - Lin, Charlie FA - Guan, Wentao FA - Merchant, Roland C IN - Beaudoin, Francesca L. The Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI. TI - Low-dose ketamine improves pain relief in patients receiving intravenous opioids for acute pain in the emergency department: results of a randomized, double-blind, clinical trial. SO - Academic Emergency Medicine. 21(11):1193-202, 2014 Nov AS - Acad Emerg Med. 21(11):1193-202, 2014 Nov NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 21 IP - 11 PG - 1193-202 PI - Journal available in: Print PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Acute Pain/di [Diagnosis] MH - *Acute Pain/dt [Drug Therapy] MH - Adult MH - *Analgesia/mt [Methods] MH - Analgesics/ad [Administration & Dosage] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Dose-Response Relationship, Drug MH - Double-Blind Method MH - *Emergency Service, Hospital MH - Female MH - Follow-Up Studies MH - Humans MH - Infusions, Intravenous MH - Injections, Intravenous MH - *Ketamine/ad [Administration & Dosage] MH - Male MH - *Pain Management/mt [Methods] MH - Pain Measurement MH - Pilot Projects MH - Retrospective Studies MH - Time Factors MH - Treatment Outcome AB - OBJECTIVES: Low-dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). The aim of this study was to determine the effectiveness of low-dose ketamine as an adjunct to morphine versus standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients. AB - METHODS: A double-blind, randomized, placebo-controlled trial with three study groups was conducted at a large, urban academic ED over a 10-month period. Eligible patients were 18 to 65 years old with acute moderate to severe pain (score of at least 5 out of 10 on the numerical pain rating scale [NRS] and pain duration < 7 days) who were deemed by their treating physician to require IV opioids. The three study groups were: 1) morphine and normal saline placebo (standard care group), 2) morphine and 0.15 mg/kg ketamine (group 1), or 3) morphine and 0.3 mg/kg ketamine (group 2). Participants were assessed at 30, 60, and 120 minutes after study medication administration and received rescue analgesia as needed to target a 50% reduction in pain. The primary outcome measure of pain relief, or pain intensity reduction, was derived using the NRS and calculated as the summed pain-intensity (SPID) difference over 2 hours. The amount and timing of rescue opioid analgesia was evaluated as a secondary outcome. The occurrence of adverse events was also measured. AB - RESULTS: Sixty patients were enrolled (n = 20 in each group). There were no differences between study groups with respect to age, sex, race/ethnicity, preenrollment analgesia, or baseline NRS. Over the 2-hour poststudy medication administration period, the SPIDs were higher (greater pain relief) for the ketamine study groups than the control group (standard care 4.0, interquartile range [IQR] = 1.8 to 6.5; group 1 7.0, IQR = 4.3 to 10.8; and group 2 7.8, IQR = 4.8 to 12.8; p < 0.02). The SPIDs for the ketamine groups were similar (p < 0.46). When compared to standard care, group 2 sustained the reduction in pain intensity up to 2 hours, whereas group 1 was similar to standard care by 2 hours. Similar numbers of patients received rescue analgesia: standard care group, seven of 20, 35%; group 1, four of 20, 20%; and group 2, four of 20, 20% (p = 0.48). Among those receiving rescue analgesia, those in the standard care group received analgesia sooner than either low-dose ketamine group, on average. More participants in the low-dose ketamine groups reported dysphoria and dizziness. AB - CONCLUSIONS: Low-dose ketamine is a viable analgesic adjunct to morphine for the treatment of moderate to severe acute pain. Dosing of 0.3 mg/kg is possibly more effective than 0.15 mg/kg, but may be associated with minor adverse events. Future studies should evaluate additional outcomes, optimum dosing, and use in specific populations. Copyright © 2014 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) RN - 690G0D6V8H (Ketamine) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12510 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 10.1111/acem.12510 [doi] PP - ppublish PH - 2014/05/01 [received] PH - 2014/07/18 [revised] PH - 2014/06/26 [accepted] LG - English DP - 2014 Nov EZ - 2014/11/08 06:00 DA - 2015/05/13 06:00 DT - 2014/11/08 06:00 YR - 2014 ED - 20150512 RD - 20141107 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25377395 <308. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25702255 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pap A AU - Hegedus K FA - Pap, Agota FA - Hegedus, Katalin IN - Pap, Agota. Semmelweis Egyetem, Altalanos Orvostudomanyi Kar Magatartastudomanyi Intezet Budapest Nagyvarad ter 4. 1089. IN - Hegedus, Katalin. Semmelweis Egyetem, Altalanos Orvostudomanyi Kar Magatartastudomanyi Intezet Budapest Nagyvarad ter 4. 1089. TI - [The message from heroin overdoses]. [Review] [Hungarian] OT - A herointuladagolasok uzenete. SO - Orvosi Hetilap. 156(9):352-7, 2015 Mar 01 AS - Orv Hetil. 156(9):352-7, 2015 Mar 01 NJ - Orvosi hetilap VO - 156 IP - 9 PG - 352-7 PI - Journal available in: Print PI - Citation processed from: Print JC - ol8, 0376412 IO - Orv Hetil SB - Index Medicus CP - Hungary MH - Drug Overdose/et [Etiology] MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/pc [Prevention & Control] MH - Drug Overdose/px [Psychology] MH - *Drug Overdose MH - Emergency Medical Services/mt [Methods] MH - *Emergency Treatment/mt [Methods] MH - Europe/ep [Epidemiology] MH - Fear MH - Friends MH - Heroin/ad [Administration & Dosage] MH - *Heroin/po [Poisoning] MH - *Heroin Dependence/co [Complications] MH - Heroin Dependence/ep [Epidemiology] MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotics/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] MH - Police MH - Prisoners/sn [Statistics & Numerical Data] MH - Resuscitation MH - *Suicide, Attempted/pc [Prevention & Control] MH - United States/ep [Epidemiology] KW - death; drog; drug; halal; heroin overdose; opiates; opioidok; tuladagolas AB - Drug use can be defined as a kind of self destruction, and it is directly linked to attitudes toward death and suicide occurring in a significant number of users of different narcotics. The aim of the authors was to look for the background of this relationship between drug and death and examine the origin, development, and motives behind heroin overdose based on an analysis of previous studies. It seems clear that pure heroin overdose increased gradually over the years. The fear of the police is the inhibitory factor of the overdose prevention and notification of emergency health care service. Signs of suicide could be the own home as the chosen location for heroin overdose and the presence of partners ("moment of death companion"). Interventions should include simple techniques such as first aid, naloxone administration, resuscitation, prevention of relapse of prisoners and social network extension involving maintenance programs. OA - Publisher: A droghasznalatot onmagaban is ondestrukcionak tekinthetjuk, igy kozvetve kotodik a halallal kapcsolatos attitudhoz, es jelentos szamban fordul elo kulonbozo, a narkotikumok altal okozott suicidium a droghasznalok koreben. A tanulmany celja, hogy feltarja a drog-halal kapcsolat eredetet, hatteret, es azon belul a heroin okozta tuladagolasok okait a temaval foglalkozo tanulmanyok elemzesevel, eredmenyeik osszefoglalasaval. A tiszta heroinos tuladagolok eletkora az evek folyaman fokozatosan no. A rendorsegtol valo felelem a tuladagolas megelozeset es a mentok ertesiteset gatlo tenyezo. Az ongyilkossag szandekossagara utalo jel lehet a sajat otthon mint valasztott hely, vagy a tarsak jelenlete, ami a halal pillanataban biztositott tarsat jelentheti. (Azt, hogy nincsenek egyedul a tuladagolas pillanataban.) Ezert a segitsegnyujtas egyszerubb technikait kell bevezetni: elsosegelynyujtas, naloxonbeadas, ujraelesztes, a bortonviseltek visszaesesenek megelozese, a szocialis halo kiterjesztese, a fenntarto programokba valo bevonas. Orv. Hetil., 2015, 156(9), 352-357.; Language: Hungarian RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 0030-6002 IL - 0030-6002 DO - https://dx.doi.org/10.1556/OH.2015.30091 PT - English Abstract PT - Journal Article PT - Review ID - G362X56136077X41 [pii] ID - 10.1556/OH.2015.30091 [doi] PP - ppublish LG - Hungarian DP - 2015 Mar 01 EZ - 2015/02/24 06:00 DA - 2015/05/09 06:00 DT - 2015/02/23 06:00 YR - 2015 ED - 20150508 RD - 20150223 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25702255 <309. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25919527 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - D'Onofrio G AU - O'Connor PG AU - Pantalon MV AU - Chawarski MC AU - Busch SH AU - Owens PH AU - Bernstein SL AU - Fiellin DA FA - D'Onofrio, Gail FA - O'Connor, Patrick G FA - Pantalon, Michael V FA - Chawarski, Marek C FA - Busch, Susan H FA - Owens, Patricia H FA - Bernstein, Steven L FA - Fiellin, David A IN - D'Onofrio, Gail. Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. IN - O'Connor, Patrick G. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. IN - Pantalon, Michael V. Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. IN - Chawarski, Marek C. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut. IN - Busch, Susan H. Yale School of Public Health, New Haven, Connecticut. IN - Owens, Patricia H. Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. IN - Bernstein, Steven L. Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. IN - Fiellin, David A. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut4Yale School of Public Health, New Haven, Connecticut. TI - Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. CM - Comment in: JAMA. 2015 Aug 25;314(8):835; PMID: 26305657 CM - Comment in: JAMA. 2015 Aug 25;314(8):834-5; PMID: 26305656 SO - JAMA. 313(16):1636-44, 2015 Apr 28 AS - JAMA. 313(16):1636-44, 2015 Apr 28 NJ - JAMA VO - 313 IP - 16 PG - 1636-44 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527523 OI - Source: NLM. NIHMS711412 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Buprenorphine/tu [Therapeutic Use] MH - Emergency Service, Hospital MH - Female MH - HIV Infections/ep [Epidemiology] MH - Health Services/ut [Utilization] MH - Hospitals, Teaching MH - Hospitals, Urban MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - Referral and Consultation MH - Risk MH - Young Adult AB - IMPORTANCE: Opioid-dependent patients often use the emergency department (ED) for medical care. AB - OBJECTIVE: To test the efficacy of 3 interventions for opioid dependence: (1) screening and referral to treatment (referral); (2) screening, brief intervention, and facilitated referral to community-based treatment services (brief intervention); and (3) screening, brief intervention, ED-initiated treatment with buprenorphine/naloxone, and referral to primary care for 10-week follow-up (buprenorphine). AB - DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial involving 329 opioid-dependent patients who were treated at an urban teaching hospital ED from April 7, 2009, through June 25, 2013. AB - INTERVENTIONS: After screening, 104 patients were randomized to the referral group, 111 to the brief intervention group, and 114 to the buprenorphine treatment group. AB - MAIN OUTCOMES AND MEASURES: Enrollment in and receiving addiction treatment 30 days after randomization was the primary outcome. Self-reported days of illicit opioid use, urine testing for illicit opioids, human immunodeficiency virus (HIV) risk, and use of addiction treatment services were the secondary outcomes. AB - RESULTS: Seventy-eight percent of patients in the buprenorphine group (89 of 114 [95% CI, 70%-85%]) vs 37% in the referral group (38 of 102 [95% CI, 28%-47%]) and 45% in the brief intervention group (50 of 111 [95% CI, 36%-54%]) were engaged in addiction treatment on the 30th day after randomization (P<.001). The buprenorphine group reduced the number of days of illicit opioid use per week from 5.4 days (95% CI, 5.1-5.7) to 0.9 days (95% CI, 0.5-1.3) vs a reduction from 5.4 days (95% CI, 5.1-5.7) to 2.3 days (95% CI, 1.7-3.0) in the referral group and from 5.6 days (95% CI, 5.3-5.9) to 2.4 days (95% CI, 1.8-3.0) in the brief intervention group (P<.001 for both time and intervention effects; P=.02 for the interaction effect). The rates of urine samples that tested negative for opioids did not differ statistically across groups, with 53.8% (95% CI, 42%-65%) in the referral group, 42.9% (95% CI, 31%-55%) in the brief intervention group, and 57.6% (95% CI, 47%-68%) in the buprenorphine group (P=.17). There were no statistically significant differences in HIV risk across groups (P=.66). Eleven percent of patients in the buprenorphine group (95% CI, 6%-19%) used inpatient addiction treatment services, whereas 37% in the referral group (95% CI, 27%-48%) and 35% in the brief intervention group (95% CI, 25%-37%) used inpatient addiction treatment services (P<.001). AB - CONCLUSIONS AND RELEVANCE: Among opioid-dependent patients, ED-initiated buprenorphine treatment vs brief intervention and referral significantly increased engagement in addiction treatment, reduced self-reported illicit opioid use, and decreased use of inpatient addiction treatment services but did not significantly decrease the rates of urine samples that tested positive for opioids or of HIV risk. These findings require replication in other centers before widespread adoption. AB - TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00913770. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2015.3474 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural ID - 2279713 [pii] ID - 10.1001/jama.2015.3474 [doi] ID - PMC4527523 [pmc] ID - NIHMS711412 [mid] PP - ppublish SI - ClinicalTrials.gov SA - ClinicalTrials.gov/NCT00913770 SL - https://clinicaltrials.gov/search/term=NCT00913770 GI - No: R01 DA025991 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: 5R01DA025991 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2015 Apr 28 EZ - 2015/04/29 06:00 DA - 2015/05/07 06:00 DT - 2015/04/29 06:00 YR - 2015 ED - 20150506 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25919527 <310. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25253604 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lindeman E AU - Backberg M AU - Personne M AU - Helander A FA - Lindeman, Erik FA - Backberg, Matilda FA - Personne, Mark FA - Helander, Anders IN - Lindeman, Erik. Lakemedelsverket - Giftinformationscentralen Stockholm, Sweden Lakemedelsverket - Giftinformationscentralen Stockholm, Sweden. IN - Backberg, Matilda. Lakemedelsverket - Giftinformationscentralen Stockholm, Sweden Lakemedelsverket - Giftinformationscentralen Stockholm, Sweden. IN - Personne, Mark. - Stockholm, Sweden - Stockholm, Sweden. IN - Helander, Anders. Karolinska Institutet - Labmed Stockholm, Sweden Karolinska Institutet - Labmed Stockholm, Sweden. TI - [MT-45--a dangerous and potentially ototoxic internet drug]. [Swedish] OT - MT-45 - en livsfarlig och potentiellt ototoxisk internetdrog. SO - Lakartidningen. 111(40):1712-5, 2014 Sep 11 AS - Lakartidningen. 111(40):1712-5, 2014 Sep 11 NJ - Lakartidningen VO - 111 IP - 40 PG - 1712-5 PI - Journal available in: Electronic PI - Citation processed from: Print JC - l0n, 0027707 IO - Lakartidningen SB - Index Medicus CP - Sweden MH - Adolescent MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Designer Drugs/po [Poisoning] MH - *Hearing Loss, Sensorineural/ci [Chemically Induced] MH - Humans MH - Internet MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Piperazines/po [Poisoning] MH - Poison Control Centers/sn [Statistics & Numerical Data] MH - *Psychotropic Drugs/po [Poisoning] MH - Respiratory Insufficiency/ci [Chemically Induced] MH - Street Drugs/po [Poisoning] MH - Young Adult AB - During the last years several synthetic opioids have been introduced on Internet sites selling new psychoactive substances (NPS). One of these, called MT-45, a piperazine derivative originally synthesized as a therapeutic drug candidate in the 1970s, has recently been detected in 21 deaths, according to unpublished data from the Swedish National Board of Forensic Medicine. We present clinical data from 12 analytically confirmed hospital cases of MT-45 poisoning. The cases demonstrate that MT-45, like other opioids, can induce potentially life threatening respiratory depression and loss of consciousness in users and that symptoms are usually reversed by standard doses of the opioid receptor antagonist naloxone. Significant auditory symptoms with transient tinnitus and hearing loss occurred in two cases and a pronounced sensorineural hearing loss still present at two weeks follow-up in one case. This indicates that MT-45 may be an ototoxic substance, illustrating the ubiquitous risk of unintended adverse effects NPSs pose to users. RN - 0 (Analgesics, Opioid) RN - 0 (Designer Drugs) RN - 0 (Narcotic Antagonists) RN - 0 (Piperazines) RN - 0 (Psychotropic Drugs) RN - 0 (Street Drugs) RN - 36B82AMQ7N (Naloxone) IS - 0023-7205 IL - 0023-7205 DI - CZR4 PT - Case Reports PT - English Abstract PT - Journal Article ID - CZR4 [pii] PP - epublish LG - Swedish EP - 20140911 DP - 2014 Sep 11 EZ - 2014/09/26 06:00 DA - 2015/04/30 06:00 DT - 2014/09/26 06:00 YR - 2014 ED - 20150429 RD - 20140925 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25253604 <311. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25667245 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mathias MD AU - McCavit TL FA - Mathias, Melissa D FA - McCavit, Timothy L IN - Mathias, Melissa D. Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York; IN - McCavit, Timothy L. Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and Center for Cancer and Blood Disorders, Children's Medical Center Dallas, Dallas, Texas tim.mccavit@childrens.com. TI - Timing of opioid administration as a quality indicator for pain crises in sickle cell disease. SO - Pediatrics. 135(3):475-82, 2015 Mar AS - Pediatrics. 135(3):475-82, 2015 Mar NJ - Pediatrics VO - 135 IP - 3 PG - 475-82 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Anemia, Sickle Cell/co [Complications] MH - Child MH - Child, Preschool MH - Dose-Response Relationship, Drug MH - Drug Administration Schedule MH - Emergency Service, Hospital MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - Pain Measurement MH - *Quality Indicators, Health Care MH - Retrospective Studies MH - Time Factors MH - Treatment Outcome KW - pain score; quality of care; sickle cell disease; time to opioids; vaso-occlusive crisis AB - BACKGROUND AND OBJECTIVE: Time to opioid administration (TTO) has been suggested as a quality of care measure for sickle cell disease patients with vaso-occlusive crisis (VOC). We sought to determine whether TTO was associated with outcomes of emergency department (ED) visits for VOC. AB - METHODS: We conducted a single-center retrospective cohort study of ED visits for VOC. The primary outcome was hospital admission, with secondary outcomes of change between the first 2 pain scores, area under the curve (AUC) for pain scores at 4 hours (pain score AUC), total ED length of stay, and total intravenous opioids. In both univariate and multivariate analyses, mixed regression (logistic for admission, linear for secondary outcome variables) was used to evaluate association of TTO with outcome. AB - RESULTS: In 177 subjects, 414 ED visits for VOC were identified. Inpatient admission occurred in 53% of visits. The median TTO for admitted patients was 86 minutes vs 87 minutes for those not admitted. TTO was not associated with inpatient admission in either univariate or multivariate analyses. In multivariate analyses with secondary outcomes, decreased TTO was associated with greater improvement between the first 2 pain scores, decreased pain score AUC, decreased total ED length of stay, and increased total opioids. AB - CONCLUSIONS: Although TTO was not associated with admission, it was independently associated with 4 important secondary outcomes: change in initial pain scores, pain score AUC, total ED length of stay, and total intravenous opioids. The association of a process measure, TTO, with these outcomes encourages the institution of TTO reduction efforts in the ED. Copyright © 2015 by the American Academy of Pediatrics. RN - 0 (Analgesics, Opioid) ES - 1098-4275 IL - 0031-4005 DO - https://dx.doi.org/10.1542/peds.2014-2874 PT - Journal Article ID - peds.2014-2874 [pii] ID - 10.1542/peds.2014-2874 [doi] PP - ppublish LG - English EP - 20150209 DP - 2015 Mar EZ - 2015/02/11 06:00 DA - 2015/04/29 06:00 DT - 2015/02/11 06:00 YR - 2015 ED - 20150428 RD - 20150303 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25667245 <312. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25034899 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McCauley JL AU - Mercer MA AU - Barth KS AU - Brady KT AU - Back SE FA - McCauley, Jenna L FA - Mercer, Mary Ashley FA - Barth, Kelly S FA - Brady, Kathleen T FA - Back, Sudie E IN - McCauley, Jenna L. Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States. Electronic address: mccaule@musc.edu. IN - Mercer, Mary Ashley. Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States. IN - Barth, Kelly S. Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States. IN - Brady, Kathleen T. Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States. IN - Back, Sudie E. Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States. TI - Pain management perceptions among prescription opioid dependent individuals. SO - Drug & Alcohol Dependence. 142:354-8, 2014 Sep 01 AS - Drug Alcohol Depend. 142:354-8, 2014 Sep 01 NJ - Drug and alcohol dependence VO - 142 PG - 354-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127153 OI - Source: NLM. NIHMS608891 SB - Index Medicus CP - Ireland MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Depression/px [Psychology] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/px [Psychology] MH - *Pain/dt [Drug Therapy] MH - *Pain Management/px [Psychology] MH - Pain Measurement MH - *Perception MH - Treatment Outcome KW - Addictive behaviors; Pain management; Prescription opioid; Substance abuse AB - BACKGROUND: Nearly two-thirds of prescription opioid dependent individuals report chronic pain conditions as both an initial and current motivation for prescription opioid use. However, to date, limited information exists regarding perceptions of the adequacy of pain management and pain management behaviors among prescription opioid dependent individuals with a history of treatment for chronic pain. AB - METHODS: The current study examined perceptions of the medical management of chronic pain among community-recruited individuals (N=39) who met DSM-IV-TR criteria for current prescription opioid dependence and reported a history of treatment for chronic pain. Prescription opioid dependence, symptoms of depression, and pain management perceptions were assessed using the Structured Clinical Interview for DSM disorders, Beck Depression Inventory, and the Pain Management Questionnaire, respectively. AB - RESULTS: Reports of insufficient pain management were common (46.2%), as was utilization of emergency room services for pain management (56.4%). Nearly half reported a physician as their initial source (46.2%) and pain management as their primary initial reason for prescription opioid use (53.8%), whereas 35.9% reported pain relief as their primary reason for current prescription opioid use. Symptoms of depression were common (51.3%), as was comorbid abuse of other substances and history of treatment for substance abuse. AB - CONCLUSIONS: Results highlight the complicated clinical presentation and prevalent perception of the under-treatment of pain among this population. Findings underscore the importance of interdisciplinary approaches to managing the complex presentation of chronic pain patients with comorbid prescription opioid dependence. Implications for future research are discussed. Copyright Published by Elsevier Ireland Ltd. RN - 0 (Analgesics, Opioid) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(14)00946-6 DO - https://dx.doi.org/10.1016/j.drugalcdep.2014.06.024 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0376-8716(14)00946-6 [pii] ID - 10.1016/j.drugalcdep.2014.06.024 [doi] ID - PMC4127153 [pmc] ID - NIHMS608891 [mid] PP - ppublish PH - 2014/01/06 [received] PH - 2014/06/09 [revised] PH - 2014/06/16 [accepted] GI - No: UL1 RR029880 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: KL2 RR029880 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: K12 DA031794 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R25 DA020537 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K23 DA021228 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: U10 DA013727 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20140625 DP - 2014 Sep 01 EZ - 2014/07/19 06:00 DA - 2015/04/24 06:00 DT - 2014/07/19 06:00 YR - 2014 ED - 20150423 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25034899 <313. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24412267 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Jeffrey Kao MC AU - Minh LC AU - Huang GY AU - Mitra R AU - Smuck M FA - Jeffrey Kao, Ming-Chih FA - Minh, Lyly Cao FA - Huang, Grace Y FA - Mitra, Raj FA - Smuck, Matthew IN - Jeffrey Kao, Ming-Chih. Department of Orthopaedics, Stanford Hospital & Clinics, Palo Alto, CA(*). IN - Minh, Lyly Cao. Department of Orthopaedics, Stanford Hospital & Clinics, Palo Alto, CA(+). IN - Huang, Grace Y. Department of Orthopaedics, University of California San Francisco, San Francisco, CA(++). IN - Mitra, Raj. Department of Rehabilitation, University of Kansas Medical Center, Kansas City, MO(). IN - Smuck, Matthew. Department of Orthopaedics, Stanford Hospital & Clinics, Palo Alto, CA(P). Electronic address: msmuck@stanford.edu. TI - Trends in ambulatory physician opioid prescription in the United States, 1997-2009. SO - Pm & R. 6(7):575-82.e4, 2014 Jul AS - PM R. 6(7):575-82.e4, 2014 Jul NJ - PM & R : the journal of injury, function, and rehabilitation VO - 6 IP - 7 PG - 575-82.e4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101491319 IO - PM R SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Ambulatory Care/mt [Methods] MH - *Analgesics, Opioid/pd [Pharmacology] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Female MH - Follow-Up Studies MH - Health Care Surveys MH - Humans MH - Male MH - Middle Aged MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - *Practice Patterns, Physicians' MH - Retrospective Studies MH - United States MH - Young Adult AB - OBJECTIVE: To describe the changing practice pattern of opioid medication prescription by health care providers and its relationship to shifts in the incidence of back pain, demographics, and health care access. AB - DESIGN: Retrospective analysis of nationally representative databases. AB - SETTING: In silico. AB - PARTICIPANTS: Patients who presented at a set of randomly selected health care facilities on the days of data collection. AB - METHODS: Nationally representative surveys from the Centers for Disease Control and Prevention (National Hospital and Ambulatory Medical Center Survey and National Ambulatory Medical Center Survey) were investigated for 3 ambulatory settings-emergency department (ED), primary care physician (PCP), and specialist physician offices-between the years 1997 and 2009. Diagnoses, prescription medications, insurance source, and demographics were determined. Weighted logistic regression modeling with the SAS program (SAS Institute, Cary, NC) was used to estimate 5-year odds ratios (ORs) and covariate effects. AB - MAIN OUTCOME MEASUREMENTS: Diagnoses, prescription medications, insurance source, and demographics were measured. The relationships between opioid medication prescription and (1) the chief complaint and (2) back pain diagnoses were studied. Domain analysis was used to properly account for the stochasticity introduced by subset analyses. AB - RESULTS: From 1997 to 2009, increasing all-diagnosis opioid prescription was accompanied by significant shifts in patient demographics and insurance access. For all-diagnosis opioid prescription, after we adjusted for age, gender, race, and insurance source, the increase persisted at a 5-year OR of 1.33, 1.29, and 1.53 for ED, PCP clinics, and specialist clinics (95% confidence interval 1.26-1.41, 1.19-1.40, and 1.37-1.69), respectively. The increasing prevalence of back pain diagnosis was eclipsed by increasing opioid prescriptions, estimated at 5-year ORs of 1.35, 1.38, and 1.75 for ED, PCP clinics, and specialist clinics (95% confidence interval 1.22-1.48, 1.19-1.61, 1.40-2.19), respectively. AB - CONCLUSIONS: In the United States, from 1997-2009, (1) variable increases in opioid prescription across ambulatory care settings were not accounted for by changing demographics and health care access; (2) significant disparities existed in opioid prescription as a function of age, gender, race/ethnicity, and payer source; and (3) for back pain, increasing opioid prescription was not accounted for by changing incidence. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1934-1563 IL - 1934-1482 DI - S1934-1482(14)00012-4 DO - https://dx.doi.org/10.1016/j.pmrj.2013.12.015 PT - Journal Article PT - Multicenter Study ID - S1934-1482(14)00012-4 [pii] ID - 10.1016/j.pmrj.2013.12.015 [doi] PP - ppublish PH - 2013/04/18 [received] PH - 2013/12/29 [revised] PH - 2013/12/31 [accepted] LG - English EP - 20140109 DP - 2014 Jul EZ - 2014/01/15 06:00 DA - 2015/04/22 06:00 DT - 2014/01/14 06:00 YR - 2014 ED - 20150421 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24412267 <314. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25017821 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Poon SJ AU - Greenwood-Ericksen MB FA - Poon, Sabrina J FA - Greenwood-Ericksen, Margaret B IN - Poon, Sabrina J. Harvard Affiliated Emergency Medicine Residency-Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA. Electronic address: sjpoon@partners.org. IN - Greenwood-Ericksen, Margaret B. Harvard Affiliated Emergency Medicine Residency-Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA. TI - The opioid prescription epidemic and the role of emergency medicine. SO - Annals of Emergency Medicine. 64(5):490-5, 2014 Nov AS - Ann Emerg Med. 64(5):490-5, 2014 Nov NJ - Annals of emergency medicine VO - 64 IP - 5 PG - 490-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Medicine MH - Emergency Service, Hospital/st [Standards] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Epidemics/pc [Prevention & Control] MH - *Epidemics MH - Humans MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Pain Management/ae [Adverse Effects] MH - Pain Management/mt [Methods] MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians' MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(14)00527-7 DO - https://dx.doi.org/10.1016/j.annemergmed.2014.06.016 PT - Journal Article ID - S0196-0644(14)00527-7 [pii] ID - 10.1016/j.annemergmed.2014.06.016 [doi] PP - ppublish PH - 2014/03/03 [received] PH - 2014/06/10 [revised] PH - 2014/06/13 [accepted] LG - English EP - 20140711 DP - 2014 Nov EZ - 2014/07/16 06:00 DA - 2015/04/22 06:00 DT - 2014/07/15 06:00 YR - 2014 ED - 20150420 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25017821 <315. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24743100 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kilaru AS AU - Gadsden SM AU - Perrone J AU - Paciotti B AU - Barg FK AU - Meisel ZF FA - Kilaru, Austin S FA - Gadsden, Sarah M FA - Perrone, Jeanmarie FA - Paciotti, Breah FA - Barg, Frances K FA - Meisel, Zachary F IN - Kilaru, Austin S. Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. IN - Gadsden, Sarah M. Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. IN - Perrone, Jeanmarie. Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. IN - Paciotti, Breah. Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. IN - Barg, Frances K. Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. IN - Meisel, Zachary F. Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: zfm@upenn.edu. TI - How do physicians adopt and apply opioid prescription guidelines in the emergency department? A qualitative study. SO - Annals of Emergency Medicine. 64(5):482-489.e1, 2014 Nov AS - Ann Emerg Med. 64(5):482-489.e1, 2014 Nov NJ - Annals of emergency medicine VO - 64 IP - 5 PG - 482-489.e1 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197115 OI - Source: NLM. NIHMS586385 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Emergency Service, Hospital/st [Standards] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital MH - Female MH - Guideline Adherence/sn [Statistics & Numerical Data] MH - *Guideline Adherence MH - Humans MH - Interviews as Topic MH - Male MH - Middle Aged MH - Pain Management/mt [Methods] MH - Pain Management/st [Standards] MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians' MH - Qualitative Research MH - United States/ep [Epidemiology] AB - STUDY OBJECTIVE: An increase in prescriptions for opioid pain medications has coincided with increasing opioid overdose deaths. Guidelines designed to optimize opioid prescriptions written in the emergency department have been implemented, with substantial controversy. Little is known about how physicians perceive and apply these guidelines. We seek to identify key themes about emergency physicians' definition, awareness, use, and opinions of opioid-prescribing guidelines. AB - METHODS: We conducted semistructured qualitative interviews with a convenience sample of 61 emergency physicians attending the American College of Emergency Physicians Scientific Assembly (October 2012, Denver, CO). Participants varied with respect to age, sex, geographic region, practice setting, and years of practice experience. We analyzed the interview content with modified grounded theory, an iterative coding process to identify patterns of responses and derive key themes. The study team examined discrepancies in the coding process to ensure reliability and establish consensus. AB - RESULTS: When aware of opioid-prescribing guidelines, emergency physicians often defined them as policies developed by individual hospitals that sometimes reflected guidelines at the state or national level. Guidelines were primarily used by physicians to communicate decisions to limit prescriptions to patients on discharge rather than as tools for decisionmaking. Attitudes toward guidelines varied with regard to general attitudes toward opioid medications, as well as the perceived effects of guidelines on physician autonomy, public health, liability, and patient diversion. AB - CONCLUSION: These exploratory findings suggest that hospital-based opioid guidelines complement and occasionally supersede state and national guidelines and that emergency physicians apply guidelines primarily as communication tools. The perspectives of providers should inform future policy actions that seek to address the problem of opioid abuse and overdose through practice guidelines. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(14)00221-2 DO - https://dx.doi.org/10.1016/j.annemergmed.2014.03.015 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. ID - S0196-0644(14)00221-2 [pii] ID - 10.1016/j.annemergmed.2014.03.015 [doi] ID - PMC4197115 [pmc] ID - NIHMS586385 [mid] PP - ppublish PH - 2013/11/10 [received] PH - 2014/03/13 [revised] PH - 2014/03/17 [accepted] GI - No: KM1 CA156715 Organization: (CA) *NCI NIH HHS* Country: United States GI - No: R18 HS021956 Organization: (HS) *AHRQ HHS* Country: United States GI - No: KM1 CA156715-01 Organization: (CA) *NCI NIH HHS* Country: United States GI - No: R18 HS021956-01 Organization: (HS) *AHRQ HHS* Country: United States LG - English EP - 20140416 DP - 2014 Nov EZ - 2014/04/20 06:00 DA - 2015/04/22 06:00 DT - 2014/04/19 06:00 YR - 2014 ED - 20150420 RD - 20161228 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24743100 <316. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25812292 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Furlano E FA - Furlano, Emma TI - Naloxone's basic benefit. Why the overdose-reversal drug is worth expanding beyond just ALS providers. SO - EMS world. 43(10):28-30, 32-4, 2014 Oct AS - EMS World. 43(10):28-30, 32-4, 2014 Oct NJ - EMS world VO - 43 IP - 10 PG - 28-30, 32-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 101547538 IO - EMS World SB - Health Administration Journals CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - United States RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 2158-7833 IL - 2158-7833 PT - Journal Article PP - ppublish LG - English DP - 2014 Oct EZ - 2015/03/31 06:00 DA - 2015/04/18 06:00 DT - 2015/03/28 06:00 YR - 2014 ED - 20150417 RD - 20150602 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25812292 <317. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24511985 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tkacz J AU - Pesa J AU - Vo L AU - Kardel PG AU - Un H AU - Volpicelli JR AU - Ruetsch C FA - Tkacz, Joseph FA - Pesa, Jacqueline FA - Vo, Lien FA - Kardel, Peter G FA - Un, Hyong FA - Volpicelli, Joseph R FA - Ruetsch, Charles IN - Tkacz, Joseph. 9200 Rumsey Rd, Ste 215, Columbia, MD 21045. E-mail: joseph.tkacz@healthanalytic.com. TI - Opioid analgesic-treated chronic pain patients at risk for problematic use. SO - American Journal of Managed Care. 19(11):871-80, 2013 Nov AS - Am J Manag Care. 19(11):871-80, 2013 Nov NJ - The American journal of managed care VO - 19 IP - 11 PG - 871-80 PI - Journal available in: Print PI - Citation processed from: Internet JC - cw0, 9613960 IO - Am J Manag Care SB - Health Administration Journals CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Case-Control Studies MH - *Chronic Pain/dt [Drug Therapy] MH - *Chronic Pain/ec [Economics] MH - Cross-Sectional Studies MH - Female MH - Health Expenditures/sn [Statistics & Numerical Data] MH - Health Services/ec [Economics] MH - *Health Services/ut [Utilization] MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ec [Economics] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Retrospective Studies MH - United States AB - OBJECTIVES: To characterize potentially problematic opioid use (PPOU) among opioid analgesic-treated chronic pain (OAT-CP) patients and to compare their healthcare service utilization and expenditures with those of a control group of OAT-CP patients not exhibiting these behaviors. AB - STUDY DESIGN: Cross-sectional, retrospective analysis of health claims data. AB - METHODS: Members of a national health plan (n = 3891) with chronic pain and an opioid prescription were categorized into 3 groups: PPOU group (n = 1499), those displaying evidence of doctor shopping or rapid opioid dose escalation; buprenorphine/naloxone group (n =199), those who filled a prescription for buprenorphine/naloxone, which served as a proxy for opioid dependence; and control group (n = 2193), those not meeting either of the above criteria. Groups were compared on 1-year healthcare service utilization and costs. AB - RESULTS: The PPOU group made up more than one-third of the study sample. Compared with the control group, they incurred significantly greater 1-year adjusted mean pharmacy costs ($6573 vs $6160), office costs ($5705 vs $4479), emergency department (ED) costs ($835 vs $388), inpatient costs ($15,646 vs $7445), and total healthcare costs ($39,048 vs $26,171) (all P <.05). The buprenorphine/naloxone group incurred significantly greater 1-year pharmacy costs ($6981 vs $6160) and ED costs ($1126 vs $388) (both P <.05) than the control group. AB - CONCLUSIONS: The PPOU group had the highest healthcare service utilization and costs. Although drivers of elevated service utilization and cost among this population are not clear, health plans may want to focus on PPOU case identification and development of interventions. RN - 0 (Analgesics, Opioid) ES - 1936-2692 IL - 1088-0224 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 85247 [pii] PP - ppublish LG - English DP - 2013 Nov EZ - 2014/02/12 06:00 DA - 2015/04/14 06:00 DT - 2014/02/12 06:00 YR - 2013 ED - 20150413 RD - 20140211 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24511985 <318. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24083312 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Huffman A FA - Huffman, Alan TI - Voluntary guidelines for emergency physicians: clarifying New York city's efforts to curb opioid misuse. SO - Annals of Emergency Medicine. 62(2):13A-14A, 2013 Aug AS - Ann Emerg Med. 62(2):13A-14A, 2013 Aug NJ - Annals of emergency medicine VO - 62 IP - 2 PG - 13A-14A PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Medicine/st [Standards] MH - Humans MH - *Inappropriate Prescribing/pc [Prevention & Control] MH - New York City MH - *Practice Guidelines as Topic RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 PT - News PP - ppublish LG - English DP - 2013 Aug EZ - 2013/10/02 06:00 DA - 2015/04/14 06:00 DT - 2013/10/02 06:00 YR - 2013 ED - 20150413 RD - 20130930 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24083312 <319. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25581341 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Reuben DB AU - Alvanzo AA AU - Ashikaga T AU - Bogat GA AU - Callahan CM AU - Ruffing V AU - Steffens DC FA - Reuben, David B FA - Alvanzo, Anika A H FA - Ashikaga, Takamaru FA - Bogat, G Anne FA - Callahan, Christopher M FA - Ruffing, Victoria FA - Steffens, David C TI - National Institutes of Health Pathways to Prevention Workshop: the role of opioids in the treatment of chronic pain. SO - Annals of Internal Medicine. 162(4):295-300, 2015 Feb 17 AS - Ann Intern Med. 162(4):295-300, 2015 Feb 17 NJ - Annals of internal medicine VO - 162 IP - 4 PG - 295-300 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0372351 IO - Ann. Intern. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Biomedical Research MH - Chronic Pain/di [Diagnosis] MH - *Chronic Pain/dt [Drug Therapy] MH - Drug Administration Schedule MH - Humans MH - Opioid-Related Disorders/et [Etiology] MH - Primary Health Care MH - Research Design MH - Risk Assessment MH - Triage AB - This National Institutes of Health (NIH) Pathways to Prevention Workshop was cosponsored by the NIH Office of Disease Prevention (ODP), the NIH Pain Consortium, the National Institute on Drug Abuse, and the National Institute of Neurological Disorders and Stroke. A multidisciplinary working group developed the workshop agenda, and an evidence-based practice center prepared an evidence report through a contract with the Agency for Healthcare Research and Quality to facilitate the workshop discussion. During the 1.5-day workshop, invited experts discussed the body of evidence, and attendees had opportunities to provide comments during open discussion periods. After weighing evidence from the evidence report, expert presentations, and public comments, an unbiased, independent panel prepared a draft report that identified research gaps and future research priorities. The report was posted on the ODP Web site for 2 weeks for public comment. This article is an abridged version of the panel's full report, which is available at https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/opioids-chronic-pain/workshop-resources#final report. RN - 0 (Analgesics, Opioid) ES - 1539-3704 IL - 0003-4819 DO - https://dx.doi.org/10.7326/M14-2775 PT - Consensus Development Conference, NIH PT - Journal Article ID - 2089371 [pii] ID - 10.7326/M14-2775 [doi] PP - ppublish LG - English DP - 2015 Feb 17 EZ - 2015/01/13 06:00 DA - 2015/04/10 06:00 DT - 2015/01/13 06:00 YR - 2015 ED - 20150409 RD - 20151020 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25581341 <320. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24661485 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Noble KA AU - Pasero C FA - Noble, Kim A FA - Pasero, Chris TI - Opioid-induced ventilatory impairment (OIVI). SO - Journal of PeriAnesthesia Nursing. 29(2):143-51, 2014 Apr AS - J Perianesth Nurs. 29(2):143-51, 2014 Apr NJ - Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses VO - 29 IP - 2 PG - 143-51 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9610507, CKX IO - J. Perianesth. Nurs. SB - Nursing Journal CP - United States MH - Aged MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Female MH - Humans MH - *Respiration, Artificial RN - 0 (Analgesics, Opioid) ES - 1532-8473 IL - 1089-9472 DI - S1089-9472(14)00006-9 DO - https://dx.doi.org/10.1016/j.jopan.2014.01.003 PT - Case Reports PT - Journal Article ID - S1089-9472(14)00006-9 [pii] ID - 10.1016/j.jopan.2014.01.003 [doi] PP - ppublish PH - 2014/01/03 [received] PH - 2014/01/07 [accepted] LG - English DP - 2014 Apr EZ - 2014/03/26 06:00 DA - 2015/04/10 06:00 DT - 2014/03/26 06:00 YR - 2014 ED - 20150409 RD - 20161020 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24661485 <321. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23734342 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Wermeling DP FA - Wermeling, Daniel P IN - Wermeling, Daniel P. Professor, University of Kentucky College of Pharmacy, 789 South Limestone Street, Lexington, KY USA, 40536-0596. TI - A response to the opioid overdose epidemic: naloxone nasal spray. SO - Drug Delivery & Translational Research. 3(1):63-74, 2013 Feb 01 AS - Drug deliv. transl. res.. 3(1):63-74, 2013 Feb 01 NJ - Drug delivery and translational research VO - 3 IP - 1 PG - 63-74 PI - Journal available in: Print PI - Citation processed from: Print JC - 101540061 IO - Drug Deliv Transl Res PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668569 OI - Source: NLM. NIHMS398056 CP - United States KW - Antidote; Intranasal; Naloxone; Opioid; Overdose AB - Opioid overdose morbidity and mortality is recognized to have epidemic proportions. Medical and public health agencies are adopting opioid harm reduction strategies to reduce the morbidity and mortality associated with overdose. One strategy developed by emergency medical services and public health agencies is to deliver the opioid antidote naloxone injection intranasally to reverse the effects of opioids. Paramedics have used this route to quickly administer naloxone in a needle-free system and avoiding needle-stick injuries and contracting a blood-born pathogen disease such as hepatitis or human immunodeficiency virus. Public health officials advocate broader lay person access since civilians are likely witnesses or first responders to an opioid overdose in a time-acute setting. The barrier to greater use of naloxone is that a suitable and optimized needlefree drug delivery system is unavailable. The scientific basis for design and study of an intranasal naloxone product is described. Lessons from nasal delivery of opioid analgesics are applied to the consideration of naloxone nasal spray. IS - 2190-393X IL - 2190-393X DO - https://dx.doi.org/10.1007/s13346-012-0092-0 PT - Journal Article ID - 10.1007/s13346-012-0092-0 [doi] ID - PMC3668569 [pmc] ID - NIHMS398056 [mid] PP - ppublish GI - No: R42 DA030001 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2013 Feb 01 EZ - 2013/06/05 06:00 DA - 2013/06/05 06:01 DT - 2013/06/05 06:00 YR - 2013 ED - 20150320 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=23734342 <322. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25283253 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Doyon S AU - Aks SE AU - Schaeffer S AU - American Academy of Clinical Toxicology AU - American College of Medical Toxicology AU - American Association of Poison Control Centers FA - Doyon, Suzanne FA - Aks, Steven E FA - Schaeffer, Scott FA - American Academy of Clinical Toxicology FA - American College of Medical Toxicology FA - American Association of Poison Control Centers IN - Doyon, Suzanne. American Academy of Clinical Toxicology , USA. TI - Expanding access to naloxone in the United States. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 52(10):989-92, 2014 Dec AS - Clin Toxicol (Phila). 52(10):989-92, 2014 Dec NJ - Clinical toxicology (Philadelphia, Pa.) VO - 52 IP - 10 PG - 989-92 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Caregivers/st [Standards] MH - Drug Overdose/di [Diagnosis] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/mo [Mortality] MH - Drug and Narcotic Control MH - Emergency Medical Services/st [Standards] MH - Health Services Accessibility/lj [Legislation & Jurisprudence] MH - *Health Services Accessibility/st [Standards] MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Naloxone/sd [Supply & Distribution] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/sd [Supply & Distribution] MH - *Opioid-Related Disorders/co [Complications] MH - Opioid-Related Disorders/mo [Mortality] MH - United States RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.3109/15563650.2014.968657 PT - Journal Article PT - Practice Guideline ID - 10.3109/15563650.2014.968657 [doi] PP - ppublish LG - English EP - 20141006 DP - 2014 Dec EZ - 2014/10/07 06:00 DA - 2015/03/07 06:00 DT - 2014/10/07 06:00 YR - 2014 ED - 20150305 RD - 20141224 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25283253 <323. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24581795 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - DeVries A AU - Koch T AU - Wall E AU - Getchius T AU - Chi W AU - Rosenberg A FA - DeVries, Andrea FA - Koch, Thomas FA - Wall, Eric FA - Getchius, Thomas FA - Chi, Winnie FA - Rosenberg, Alan IN - DeVries, Andrea. HealthCore, Inc., Wilmington, Delaware. Electronic address: adevries@healthcore.com. IN - Koch, Thomas. American Academy of Pediatrics, Elk Grove Village, Illinois. IN - Wall, Eric. American Academy of Family Physicians, Leawood, Kansas. IN - Getchius, Thomas. American Academy of Neurology, Minneapolis, Minnesota. IN - Chi, Winnie. HealthCore, Inc., Wilmington, Delaware. IN - Rosenberg, Alan. WellPoint, Inc., Indianapolis, Indiana. TI - Opioid use among adolescent patients treated for headache. SO - Journal of Adolescent Health. 55(1):128-33, 2014 Jul AS - J Adolesc Health. 55(1):128-33, 2014 Jul NJ - The Journal of adolescent health : official publication of the Society for Adolescent Medicine VO - 55 IP - 1 PG - 128-33 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - a0j, 9102136 IO - J Adolesc Health SB - Index Medicus CP - United States MH - Acute Disease MH - Adolescent MH - *Adolescent Health Services/sn [Statistics & Numerical Data] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Chronic Disease MH - Comorbidity MH - Drug Utilization Review/sn [Statistics & Numerical Data] MH - Headache Disorders/di [Diagnosis] MH - *Headache Disorders/dt [Drug Therapy] MH - Headache Disorders/ep [Epidemiology] MH - Humans MH - Insurance Claim Review MH - Logistic Models MH - Male MH - Migraine Disorders/di [Diagnosis] MH - Migraine Disorders/dt [Drug Therapy] MH - Migraine Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/et [Etiology] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Retrospective Studies KW - Administrative claims; Adolescent headache; Computed tomography scan; Headache diagnosis; Pediatric headache; Recurrent headache AB - PURPOSE: To determine the pervasiveness of opioid prescribing for adolescents with headache and patient and provider characteristics associated with likelihood of opioid prescribing. AB - METHODS: This observational cohort analysis used commercial medical and pharmacy claims between January 1, 2007 and December 31, 2008. Included were adolescents (13-17 years of age) with newly diagnosed headache, >=2 distinct claims for headache, and >=12 months health plan eligibility preindex and postindex. Adolescents with a trauma diagnosis at any point were excluded. The primary outcome was current practice patterns, measured by a number of opioid claims, a percentage of patients prescribed opioids, a number of opioid prescriptions per year, a length of opioid therapy, and a frequency of specific comorbidities. A secondary outcome characterized providers and practice settings, comparing patients who received opioids with those who did not. AB - RESULTS AND CONCLUSIONS: Of 8,373 adolescents with headache, 46% (3,859 patients) received an opioid prescription. Nearly half (48%) received one opioid prescription during follow-up; 29% received >=3 opioid prescriptions. Of those with opioid prescriptions, 25% (977 patients) had a migraine diagnosis at index date. Among adolescents who received opioids, 28% (1,076 adolescents) had an emergency department (ED) visit for headache during follow-up versus 14% (608 adolescents) who did not receive opioids (p < .01). ED visits with a headache diagnosis during follow-up were strongly correlated with opioid use after adjusting for other covariates (odds ratio, 2.02; 95% confidence interval, 1.79-2.29). Despite the treatment guidelines recommending against their use, a large proportion of adolescents with headache were prescribed opioids. ED visits were strongly correlated with opioid prescriptions. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1879-1972 IL - 1054-139X DI - S1054-139X(13)00834-3 DO - https://dx.doi.org/10.1016/j.jadohealth.2013.12.014 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S1054-139X(13)00834-3 [pii] ID - 10.1016/j.jadohealth.2013.12.014 [doi] PP - ppublish PH - 2013/09/18 [received] PH - 2013/12/11 [revised] PH - 2013/12/11 [accepted] LG - English EP - 20140225 DP - 2014 Jul EZ - 2014/03/04 06:00 DA - 2015/02/27 06:00 DT - 2014/03/04 06:00 YR - 2014 ED - 20150226 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24581795 <324. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25347221 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Yokell MA AU - Delgado MK AU - Zaller ND AU - Wang NE AU - McGowan SK AU - Green TC FA - Yokell, Michael A FA - Delgado, M Kit FA - Zaller, Nickolas D FA - Wang, N Ewen FA - McGowan, Samuel K FA - Green, Traci Craig IN - Yokell, Michael A. Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California. IN - Delgado, M Kit. Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia3Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia. IN - Zaller, Nickolas D. Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island5Department of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island6currently affiliated with Boozman College of Public Health, Univer. IN - Wang, N Ewen. Division of Emergency Medicine, Stanford University School of Medicine and Stanford Hospital, Stanford, California. IN - McGowan, Samuel K. Department of Medicine, Rush Medical College, Chicago, Illinois. IN - Green, Traci Craig. Department of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island9Department of Emergency Medicine, Rhode Island Hospital, Providence. TI - Presentation of prescription and nonprescription opioid overdoses to US emergency departments. SO - JAMA Internal Medicine. 174(12):2034-7, 2014 Dec AS - JAMA Intern Med. 174(12):2034-7, 2014 Dec NJ - JAMA internal medicine VO - 174 IP - 12 PG - 2034-7 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101589534 IO - JAMA Intern Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/di [Diagnosis] MH - *Drug Overdose/ep [Epidemiology] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Humans MH - Nonprescription Drugs MH - *Prescription Drugs MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) RN - 0 (Nonprescription Drugs) RN - 0 (Prescription Drugs) ES - 2168-6114 IL - 2168-6106 DO - https://dx.doi.org/10.1001/jamainternmed.2014.5413 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. ID - 1918924 [pii] ID - 10.1001/jamainternmed.2014.5413 [doi] PP - ppublish GI - No: 5K12HL109009 Organization: (HL) *NHLBI NIH HHS* Country: United States GI - No: R21 CE002165-01 Organization: (CE) *NCIPC CDC HHS* Country: United States GI - No: UL1 RR025744 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English DP - 2014 Dec EZ - 2014/10/28 06:00 DA - 2015/02/26 06:00 DT - 2014/10/28 06:00 YR - 2014 ED - 20150225 RD - 20141202 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25347221 <325. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25378248 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Strang J AU - Bird SM AU - Dietze P AU - Gerra G AU - McLellan AT FA - Strang, John FA - Bird, Sheila M FA - Dietze, Paul FA - Gerra, Gilberto FA - McLellan, A Thomas IN - Strang, John. National Addiction Centre (Institute of Psychiatry and The Maudsley), King's College London, London SE5 8AF, UK john.strang@kcl.ac.uk. IN - Bird, Sheila M. MRC Biostatistics Unit, Cambridge CB2 0SR, UK. IN - Dietze, Paul. Burnet Institute, Melbourne, Australia. IN - Gerra, Gilberto. Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, Vienna, Austria. IN - McLellan, A Thomas. Treatment Research Institute, Philadelphia, PA 19106, USA. TI - Take-home emergency naloxone to prevent deaths from heroin overdose. SO - BMJ. 349:g6580, 2014 Nov 04 AS - BMJ. 349:g6580, 2014 Nov 04 NJ - BMJ (Clinical research ed.) VO - 349 PG - g6580 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 8900488, bmj, 101090866 IO - BMJ SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/mo [Mortality] MH - Emergencies MH - *Heroin Dependence/dt [Drug Therapy] MH - Heroin Dependence/mo [Mortality] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - United Kingdom/ep [Epidemiology] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1756-1833 IL - 0959-535X DO - https://dx.doi.org/10.1136/bmj.g6580 PT - Editorial PT - Research Support, Non-U.S. Gov't PP - epublish GI - No: MC_U105260794 Organization: *Medical Research Council* Country: United Kingdom LG - English EP - 20141104 DP - 2014 Nov 04 EZ - 2014/11/08 06:00 DA - 2015/02/24 06:00 DT - 2014/11/08 06:00 YR - 2014 ED - 20150223 RD - 20171110 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25378248 <326. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25445857 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mannina L AU - Varney SM AU - Bebarta VS AU - Ganem VJ AU - Carey KR AU - Ramos RG FA - Mannina, Lisa FA - Varney, Shawn M FA - Bebarta, Vikhyat S FA - Ganem, Victoria J FA - Carey, Kathy R FA - Ramos, Rose G IN - Mannina, Lisa. SAUSHEC Emergency Medicine PGYII, San Antonio Military Medical Center, San Antonio, TX. Electronic address: mannina.1@gmail.com. IN - Varney, Shawn M. Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX. Electronic address: smvarney@gmail.com. IN - Bebarta, Vikhyat S. Department of Emergency Medicine, San Antonio Military Medical Center and Air Force Enroute Care Research Center, San Antonio, TX. Electronic address: vikbebarta@yahoo.com. IN - Ganem, Victoria J. Department of Emergency Medicine, San Antonio Military Medical Center and Air Force Enroute Care Research Center, San Antonio, TX. Electronic address: victoria.j.ganem.vol@mail.mil. IN - Carey, Kathy R. The Geneva Foundation, San Antonio, TX. Electronic address: KCarey@genevausa.org. IN - Ramos, Rose G. Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX. Electronic address: rosemarieramos@hotmail.com. TI - "Hard" and "soft" patient cues that influence ED prescribing for potential opioid misusers. SO - American Journal of Emergency Medicine. 33(1):109-11, 2015 Jan AS - Am J Emerg Med. 33(1):109-11, 2015 Jan NJ - The American journal of emergency medicine VO - 33 IP - 1 PG - 109-11 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Cues MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/di [Diagnosis] MH - *Pain/dt [Drug Therapy] MH - *Practice Patterns, Nurses'/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Surveys and Questionnaires RN - 0 (Analgesics, Opioid) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(14)00689-5 DO - https://dx.doi.org/10.1016/j.ajem.2014.09.034 PT - Letter PT - Research Support, U.S. Gov't, Non-P.H.S. ID - S0735-6757(14)00689-5 [pii] ID - 10.1016/j.ajem.2014.09.034 [doi] PP - ppublish PH - 2014/07/14 [received] PH - 2014/09/26 [revised] PH - 2014/09/26 [accepted] LG - English EP - 20141005 DP - 2015 Jan EZ - 2014/12/03 06:00 DA - 2015/02/18 06:00 DT - 2014/12/03 06:00 YR - 2015 ED - 20150217 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25445857 <327. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24680219 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lavonas EJ AU - Severtson SG AU - Martinez EM AU - Bucher-Bartelson B AU - Le Lait MC AU - Green JL AU - Murrelle LE AU - Cicero TJ AU - Kurtz SP AU - Rosenblum A AU - Surratt HL AU - Dart RC FA - Lavonas, Eric J FA - Severtson, S Geoffrey FA - Martinez, Erin M FA - Bucher-Bartelson, Becki FA - Le Lait, Marie-Claire FA - Green, Jody L FA - Murrelle, Lenn E FA - Cicero, Theodore J FA - Kurtz, Steven P FA - Rosenblum, Andrew FA - Surratt, Hilary L FA - Dart, Richard C IN - Lavonas, Eric J. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA. Electronic address: eric.lavonas@rmpdc.org. IN - Severtson, S Geoffrey. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA. Electronic address: geoff.severtson@rmpdc.org. IN - Martinez, Erin M. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA. Electronic address: erin.martinez@rmpdc.org. IN - Bucher-Bartelson, Becki. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA. Electronic address: Becki.Bucher-Bartelson@rmpdc.org. IN - Le Lait, Marie-Claire. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA. Electronic address: marie-claire.lelait@rmpdc.org. IN - Green, Jody L. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA. Electronic address: jody.green@rmpdc.org. IN - Murrelle, Lenn E. Venebio Group, LLC, 7400 Beaufont Springs Drive, Suite 300, Richmond, VA 23225, USA. Electronic address: lenn.murrelle@venebio.com. IN - Cicero, Theodore J. Department of Psychiatry, Washington University in St. Louis, One Brookings Drive, Campus Box 8134, St. Louis, MO 63130 USA. Electronic address: cicerot@psychiatry.wustl.edu. IN - Kurtz, Steven P. Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 2 NE 40th Street, Suite 404, Miami, FL 33137 USA. Electronic address: steven.kurtz@nova.edu. IN - Rosenblum, Andrew. Institute for Treatment and Services Research, National Development and Research Institutes, 71 West 23rd Street, 4th floor, New York, NY 10010 USA. Electronic address: rosenblum@ndri.org. IN - Surratt, Hilary L. Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 2 NE 40th Street, Suite 404, Miami, FL 33137 USA. Electronic address: surratt@nova.edu. IN - Dart, Richard C. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA. Electronic address: richard.dart@rmpdc.org. TI - Abuse and diversion of buprenorphine sublingual tablets and film. SO - Journal of Substance Abuse Treatment. 47(1):27-34, 2014 Jul AS - J Subst Abuse Treat. 47(1):27-34, 2014 Jul NJ - Journal of substance abuse treatment VO - 47 IP - 1 PG - 27-34 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - kai, 8500909 IO - J Subst Abuse Treat SB - Index Medicus CP - United States MH - Administration, Sublingual MH - Buprenorphine/ad [Administration & Dosage] MH - *Buprenorphine MH - Humans MH - Narcotics/ad [Administration & Dosage] MH - *Narcotics MH - Opiate Substitution Treatment/sn [Statistics & Numerical Data] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Poison Control Centers/sn [Statistics & Numerical Data] MH - *Prescription Drug Diversion/sn [Statistics & Numerical Data] MH - Surveys and Questionnaires MH - Tablets MH - United States/ep [Epidemiology] MH - Universities/sn [Statistics & Numerical Data] KW - Buprenorphine; Drug abuse; Drug formulations; Substance-related disorders AB - Buprenorphine abuse is common worldwide. Rates of abuse and diversion of three sublingual buprenorphine formulations (single ingredient tablets; naloxone combination tablets and film) were compared. Data were obtained from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System Poison Center, Drug Diversion, Opioid Treatment (OTP), Survey of Key Informants' Patients (SKIP), and College Survey Programs through December 2012. To control for drug availability, event ratios (rates) were calculated quarterly, based on the number of patients filling prescriptions for each formulation ("unique recipients of a dispensed drug," URDD) and averaged and compared using negative binomial regression. Abuse rates in the OTP, SKIP, and College Survey Programs were greatest for single ingredient tablets, and abuse rates in the Poison Center Program and illicit diversion rates were greatest for the combination tablets. Combination film rates were significantly less than rates for either tablet formulation in all programs. No geographic pattern could be discerned. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved. RN - 0 (Narcotics) RN - 0 (Tablets) RN - 40D3SCR4GZ (Buprenorphine) ES - 1873-6483 IL - 0740-5472 DI - S0740-5472(14)00035-X DO - https://dx.doi.org/10.1016/j.jsat.2014.02.003 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - S0740-5472(14)00035-X [pii] ID - 10.1016/j.jsat.2014.02.003 [doi] PP - ppublish PH - 2013/08/14 [received] PH - 2014/02/12 [revised] PH - 2014/02/17 [accepted] GI - No: UL1 TR000154 Organization: (TR) *NCATS NIH HHS* Country: United States LG - English EP - 20140303 DP - 2014 Jul EZ - 2014/04/01 06:00 DA - 2015/02/11 06:00 DT - 2014/04/01 06:00 YR - 2014 ED - 20150207 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24680219 <328. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24712399 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Blake D AU - Dalton S AU - Gunja N FA - Blake, Danielle FA - Dalton, Sarah FA - Gunja, Naren IN - Blake, Danielle. Newborn and Paediatric Emergency Transport Service, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia. TI - Transporting children with toxicological emergencies. SO - Emergency Medicine Australasia. 26(3):279-85, 2014 Jun AS - Emerg Med Australas. 26(3):279-85, 2014 Jun NJ - Emergency medicine Australasia : EMA VO - 26 IP - 3 PG - 279-85 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101199824 IO - Emerg Med Australas SB - Index Medicus CP - Australia MH - Adolescent MH - Age Distribution MH - Ambulances/sn [Statistics & Numerical Data] MH - Child MH - Child, Preschool MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Infant MH - Male MH - New South Wales/ep [Epidemiology] MH - *Patient Transfer/sn [Statistics & Numerical Data] MH - Pharmaceutical Preparations MH - *Poisoning/ep [Epidemiology] MH - Referral and Consultation/sn [Statistics & Numerical Data] MH - Retrospective Studies KW - child; critical care; poisoning; transportation AB - OBJECTIVE: Each year, the Newborn and Paediatric Emergency Transport Service (NETS) receives over 3600 calls from health professionals regarding the management and transportation of critically ill children across New South Wales, with toxicological emergencies making up 1.5% of these calls. The aim of the present study is to describe the characteristics of patients transported for toxicological emergencies and their retrieval management. AB - METHODS: A retrospective review of patients referred for management of a toxicological emergency between 2007 and 2011. Extracted data included patient demographics, substances involved, consultation with toxicological expertise, interventions performed and major adverse outcomes. AB - RESULTS: Two hundred and thirty patients, with 307 toxicological exposures, were referred to NETS, of whom 169 (73.5%) were subsequently transported. Pharmaceutical poisonings (223, 72.6%) were the most common, followed by non-pharmaceutical poisonings (61, 19.9%) and envenomation (23, 7.5%). Psychotropics, analgesics and chemicals were the most frequently ingested substances. The most common source of accidentally ingested pharmaceuticals was a family member. The most frequently given therapies were specific antidotes, in particular naloxone and N-acetylcysteine. Nearly half (43.2%) of transported children required only non-invasive monitoring. There was one death during the retrieval process. AB - CONCLUSIONS: Many children with toxicological emergencies require only non-invasive monitoring, which could be provided by trained ambulance crews in select scenarios. Involvement of a toxicologist in the initial consultation to identify these patients might reduce retrieval numbers and costs. Children on regular medication and those living with family members on psychotropic or cardiac drugs were identified as high-risk groups that should be targeted for medication safety education. Copyright © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. RN - 0 (Pharmaceutical Preparations) ES - 1742-6723 IL - 1742-6723 DO - https://dx.doi.org/10.1111/1742-6723.12221 PT - Journal Article ID - 10.1111/1742-6723.12221 [doi] PP - ppublish PH - 2014/01/27 [accepted] LG - English EP - 20140408 DP - 2014 Jun EZ - 2014/04/10 06:00 DA - 2015/02/05 06:00 DT - 2014/04/10 06:00 YR - 2014 ED - 20150204 RD - 20140604 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24712399 <329. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25632384 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Sadeghi-Bojd S AU - Khajeh A FA - Sadeghi-Bojd, Simin FA - Khajeh, Ali IN - Sadeghi-Bojd, Simin. Department of Pediatrics, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran. IN - Khajeh, Ali. Children and Adolescents Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. TI - Chronological variations of children poisoning causes in zahedan, South of iran. SO - International Journal of High Risk Behaviors & Addiction. 3(3):e19223, 2014 Sep AS - Int. j. high risk behav. addict.. 3(3):e19223, 2014 Sep NJ - International journal of high risk behaviors & addiction VO - 3 IP - 3 PG - e19223 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Print JC - 101589648 IO - Int J High Risk Behav Addict PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295125 CP - Netherlands KW - Chronology; Emergency Medical Services; Poisoning AB - BACKGROUND: Poisoning is a common pediatric emergency among children and adolescents in the Emergency Department of Zahedan University of Medical Sciences hospital. AB - OBJECTIVES: The aim of this study was comparing the characteristics and variations of pediatric poisoning between two retrospective studies (1998 and 2008). We hypothesized that the epidemiology of pediatric patients admitted for poisoning is related to variations of environmental agents and drug usage. AB - PATIENTS AND METHODS: Records of 170 patients from 1998 and 147 from 2008 with acute poisoning were retrospectively evaluated and compared. AB - RESULTS: Poisoning mostly occurred in children younger than five years old via oral route (72.94%-87%) and by single exposure (94.12%-96.6%). It was also noted that 86.8%-90% of cases were accidentally poisoned. Drugs were the most common poisoning agents in both studies (52.94% and 37.41%, respectively) and analgesics-antipyretics were the most common poisoning drugs. Drug poisoning was more common among children under five years old in both the studies. Neurological signs including lethargy and coma were the main presenting signs. About 80%-95% of cases were referred to the hospital within three hours of poisoning and supportive-symptomatic therapy was provided to them; charcoal/naloxone was administered for most of the patients (26.2% in 2008 and 21% in 1998). Mortality rate due to drug poisoning was 3-4 cases in both studies; but, non-drug poisoning mortality rate was higher. AB - CONCLUSIONS: Preventable accidental poisoning is a significant cause of morbidity in children in developing countries. The study provided information on evolving trends and the need for increasing awareness about potential toxins as well as appropriate storage of toxins in the house to reduce the occurrence of accidental poisoning. IS - 2251-8711 IL - 2251-8711 DO - https://dx.doi.org/10.5812/ijhrba.19223 PT - Journal Article ID - 10.5812/ijhrba.19223 [doi] ID - PMC4295125 [pmc] PP - epublish PH - 2014/04/18 [received] PH - 2014/05/01 [revised] PH - 2014/05/11 [accepted] LG - English EP - 20140705 DP - 2014 Sep EZ - 2015/01/30 06:00 DA - 2015/01/30 06:01 DT - 2015/01/30 06:00 YR - 2014 ED - 20150129 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=25632384 <330. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23809064 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Xie L AU - Joshi AV AU - Schaaf D AU - Mardekian J AU - Harnett J AU - Shah ND AU - Baser O FA - Xie, Lin FA - Joshi, Ashish V FA - Schaaf, David FA - Mardekian, Jack FA - Harnett, James FA - Shah, Nilay D FA - Baser, Onur IN - Xie, Lin. STATinMED Research, Ann Arbor, Michigan, U.S.A. TI - Differences in healthcare utilization and associated costs between patients prescribed vs. nonprescribed opioids during an inpatient or emergency department visit. SO - Pain Practice. 14(5):446-56, 2014 Jun AS - Pain pract.. 14(5):446-56, 2014 Jun NJ - Pain practice : the official journal of World Institute of Pain VO - 14 IP - 5 PG - 446-56 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101130835 IO - Pain Pract SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/ec [Economics] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - Cohort Studies MH - *Drug Prescriptions/ec [Economics] MH - *Emergency Service, Hospital/ec [Economics] MH - Emergency Service, Hospital/td [Trends] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Health Care Costs/td [Trends] MH - *Health Care Costs MH - *Hospitalization/ec [Economics] MH - Hospitalization/td [Trends] MH - Humans MH - Male MH - Middle Aged MH - Opioid-Related Disorders/di [Diagnosis] MH - Opioid-Related Disorders/ec [Economics] MH - Retrospective Studies MH - Young Adult KW - healthcare costs; healthcare utilization; opioid abuse; opioid-related disorders; opioids AB - OBJECTIVES: Compare healthcare resource utilization (HCRU) and costs between patients prescribed opioids (RxOP) and those who were not (NoRxOP) during an emergency department (ED) or inpatient visit. AB - METHODS: Retrospective cohort analysis was performed (January 2006 to September 2010). Continuously eligible RxOP patients in ED/inpatient settings (January 2007 to September 2009) were included if age was >= 12 years by initial prescription date (or random date between first ED/inpatient admission and September 30, 2009 [NoRxOP patients]). Healthcare resource utilization and costs for 12 months after initial prescription were compared. Univariate descriptive analyses were performed for baseline and outcome variables and compared using appropriate tests. Risk adjustment compared HCRU between RxOP and NoRxOP cohorts for the postindex period. AB - RESULTS: Of 27,599 eligible patients, RxOP patients (n = 18,819) were younger, less likely to be male, more likely to reside in southern United States and to have Preferred Provider Organization health plans, and had lower comorbidity index scores, compared with NoRxOP patients (n = 8,780). RxOP patients were less likely to have nonpain-related comorbidities and more frequently diagnosed with pain-related comorbidities. Unmatched and propensity-matched RxOP patients experienced higher HCRU and costs in all subcategories (total, inpatient, outpatient ED, physician, pharmacy, other outpatient settings). Opioid abuse frequency was low in patients with common diagnoses/procedures within 3 months before initial prescription (0.48%). Average time to abuse was < 1 year (201 days). AB - CONCLUSION: Most patients were prescribed opioids initially during ED/inpatient visits and incurred higher HCRU than those not prescribed opioids. Among those with diagnosed opioid abuse after initiating opioids, time to diagnosis was rapid (range: 14 to 260 days) for patients with common diseases and procedures. Copyright © 2013 World Institute of Pain. RN - 0 (Analgesics, Opioid) ES - 1533-2500 IL - 1530-7085 DO - https://dx.doi.org/10.1111/papr.12098 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1111/papr.12098 [doi] PP - ppublish PH - 2013/01/18 [received] PH - 2013/05/06 [accepted] LG - English EP - 20130630 DP - 2014 Jun EZ - 2013/07/03 06:00 DA - 2015/01/27 06:00 DT - 2013/07/02 06:00 YR - 2014 ED - 20150126 RD - 20140603 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=23809064 <331. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24232306 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Uprety D AU - Baber A AU - Foy M FA - Uprety, Dipesh FA - Baber, Aurangzeb FA - Foy, Maria IN - Uprety, Dipesh. Internal Medicine, Abington Memorial Hospital, Abington, PA, USA, upretydipesh@gmail.com. TI - Ketamine infusion for sickle cell pain crisis refractory to opioids: a case report and review of literature. [Review] SO - Annals of Hematology. 93(5):769-71, 2014 May AS - Ann Hematol. 93(5):769-71, 2014 May NJ - Annals of hematology VO - 93 IP - 5 PG - 769-71 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - a2p, 9107334 IO - Ann. Hematol. SB - Index Medicus CP - Germany MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Anemia, Sickle Cell/co [Complications] MH - *Anemia, Sickle Cell/dt [Drug Therapy] MH - Humans MH - Infusions, Intravenous MH - *Ketamine/ad [Administration & Dosage] MH - Male MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - *Pain Management/mt [Methods] AB - This article reports a rare case of the use of low-dose ketamine infusion as an adjuvant to opioids to treat pain in sickle cell disease. A 31-year-old African-American male with history of sickle cell disease presented to the emergency department with complaints of chest tightness, multiple joint pain, and headache for 1 week. His vital signs and physical examination were unremarkable. His admission lab included hemoglobin of 8.4 g/dl, reticulocyte count of 16.3%, bilirubin of 1.7 mg/dl, and LDH of 1,267 U/l. Chest X-ray showed middle and lower lobe opacity and interstitial thickening. He was treated for acute pain crisis and community-acquired pneumonia with intravenous fluids, supplemental oxygen, and intravenous levofloxacin. He was placed on fentanyl patient-controlled analgesia (PCA), oxycodone, ketorolac, and methadone with co-analgesic gabapentin and venlafaxine. Over the course of his hospitalization, his chest pain resolved, but the joint pains continued. He was then transferred to the ICU and was discharged a day later after 7 days of ketamine infusion. Ketamine is a noncompetitive antagonist at the N-methyl-D-aspartate (NMDA) receptor. This property has been shown to modulate opioid tolerance and opioid-induced hyperalgesia. There have been a very few published reports on the use of low-dose ketamine in sickle cell pain management. A PubMed search revealed four published articles (Table 1). Fourteen out of the 17 cases (82.35%) who received ketamine infusion showed improvement in self-reported pain intensity and significant reduction in opioid dosage. Only one patient (5.9%) developed serious side effect leading to discontinuation of the drug. A low-dose ketamine can be an option for pain control in sickle cell disease. Randomized trial is required to establish this benefit of ketamine over currently available therapies. RN - 0 (Analgesics, Opioid) RN - 690G0D6V8H (Ketamine) ES - 1432-0584 IL - 0939-5555 DO - https://dx.doi.org/10.1007/s00277-013-1954-3 PT - Case Reports PT - Journal Article PT - Review ID - 10.1007/s00277-013-1954-3 [doi] PP - ppublish PH - 2013/10/24 [received] PH - 2013/11/04 [accepted] LG - English EP - 20131115 DP - 2014 May EZ - 2013/11/16 06:00 DA - 2015/01/24 06:00 DT - 2013/11/16 06:00 YR - 2014 ED - 20150123 RD - 20141025 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24232306 <332. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25424235 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Coluzzi F AU - Ruggeri M FA - Coluzzi, Flaminia FA - Ruggeri, Matteo TI - [Clinical and economical evaluation of new analgesics for the management of chronic pain]. [Review] [Italian] OT - Valutazione clinica ed economica di nuovi analgesici per la gestione del dolore cronico. SO - Recenti Progressi in Medicina. 105(11):415-9, 2014 Nov AS - Recenti Prog Med. 105(11):415-9, 2014 Nov NJ - Recenti progressi in medicina VO - 105 IP - 11 PG - 415-9 PI - Journal available in: Print PI - Citation processed from: Print JC - r1t, 0401271 IO - Recenti Prog Med SB - Index Medicus CP - Italy MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/ec [Economics] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Chronic Pain/dt [Drug Therapy] MH - Chronic Pain/ec [Economics] MH - Cost-Benefit Analysis MH - Drug Combinations MH - Drug Costs MH - Economics, Pharmaceutical MH - Humans MH - Models, Economic MH - Naloxone/ae [Adverse Effects] MH - Naloxone/ec [Economics] MH - *Naloxone/tu [Therapeutic Use] MH - Oxycodone/ae [Adverse Effects] MH - Oxycodone/ec [Economics] MH - *Oxycodone/tu [Therapeutic Use] MH - Phenols/ae [Adverse Effects] MH - Phenols/ec [Economics] MH - *Phenols/tu [Therapeutic Use] MH - Quality of Life MH - Quality-Adjusted Life Years AB - The management of chronic pain still represent a challenge for physicians. Opioids are the main stem in the treatment of chronic severe pain, not only for their potency, but as they act as central drugs. The main limit to their utilization in clinical practice is the prevalence of side effects, in particular in the gastrointestinal tract, whose constipation represents the most common. Two new formulations are nowadays available on the market: tapentadol PR (TAP PR) and oxycodone/naloxone (OXN). A recent meta-analysis showed that both drugs have a better tolerability profile than a tradizional opioid, such as oxycodone CR (OXY CR), but TAP PR reduces by 47% (RR=0.53) the percentage of patients discontinuing treatment because of side effects, compared to 24% (RR=0.76) of OXN. A similar advantage has been reported in the reduction of the risk of developing nausea and/or vomiting: TAP PR reduces the risk by 47% (RR=0.53), while OXN reduces the risk by only by 10% (RR=0.90). Both drugs reduced by about 40% the risk of constipation (RR=0.61 for TAP PR and for OXN). These results have been recently confirmed by a direct comparison of the two formulations (TAP PR vs OXN) in patients with chronic low back pain with neuropathic component. Both drugs were reported to be effective in reducing pain intensity and neuropathic symptoms, however TAP PR resulted superior to OXN in terms of analgesic efficacy, quality of life, and tolerability, in particular regarding constipation and adherence to treatment. A pharmacoeconomic analysis can be useful to understand the costs of these clinical advantages, and can be done by using a probabilistic analisys and by populating a Markov model that simulates the transition in time of 100 patients through 4 different possible health states: 1) still on treatment; 2) presence of adverse events; 3) discontinuation; 4) death. Both treatments (TAP PR and OXN) have been shown to have an excellent cost-effectiveness profile. In the case of OXN, in one year, 0.29 QALYs were gained compared to the use of OXY CR at an additional cost of 138 resulting in a cost per QALY gained of 475 ( 138/0.29). In the case of TAP PR, instead, 0.31 QALYs were gained with additional savings due to the reduction of drug side effects, hospitalizations and emergency department access. Therefore, the use of TAP PR implies an average saving of 31.6 per patient. These data are the results of a pharmacoeconomic model and require a further validation in clinical practice. RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 0 (Phenols) RN - 0 (oxycodone naloxone combination) RN - 36B82AMQ7N (Naloxone) RN - CD35PMG570 (Oxycodone) RN - H8A007M585 (tapentadol) IS - 0034-1193 IL - 0034-1193 DO - https://dx.doi.org/10.1701/1680.18402 PT - English Abstract PT - Journal Article PT - Review ID - 10.1701/1680.18402 [doi] PP - ppublish LG - Italian DP - 2014 Nov EZ - 2014/11/27 06:00 DA - 2015/01/16 06:00 DT - 2014/11/27 06:00 YR - 2014 ED - 20150115 RD - 20141126 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25424235 <333. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24761818 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pergolizzi JV Jr AU - Ma L AU - Foster DR AU - Overholser BR AU - Sowinski KM AU - Taylor R Jr AU - Summers KH FA - Pergolizzi, Joseph V Jr FA - Ma, Larry FA - Foster, David R FA - Overholser, Brian R FA - Sowinski, Kevin M FA - Taylor, Robert Jr FA - Summers, Kent H IN - Pergolizzi, Joseph V Jr. 840 111th Ave., N., Ste. 9, Naples, FL 34108. jpjmd@msn.com. TI - The prevalence of opioid-related major potential drug-drug interactions and their impact on health care costs in chronic pain patients. SO - Journal of Managed Care & Specialty Pharmacy. 20(5):467-76, 2014 May AS - J Manag Care Spec Pharm. 20(5):467-76, 2014 May NJ - Journal of managed care & specialty pharmacy VO - 20 IP - 5 PG - 467-76 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101644425 IO - J Manag Care Spec Pharm SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/ec [Economics] MH - Analgesics, Opioid/pk [Pharmacokinetics] MH - Biotransformation MH - Chi-Square Distribution MH - Chronic Pain/di [Diagnosis] MH - *Chronic Pain/dt [Drug Therapy] MH - *Chronic Pain/ec [Economics] MH - Chronic Pain/ep [Epidemiology] MH - Cost Savings MH - Cytochrome P-450 Enzyme Inhibitors/ae [Adverse Effects] MH - Cytochrome P-450 Enzyme System/me [Metabolism] MH - Drug Costs MH - *Drug Interactions MH - *Health Care Costs MH - Humans MH - Least-Squares Analysis MH - Linear Models MH - *Managed Care Programs/ec [Economics] MH - Multivariate Analysis MH - Polypharmacy MH - Prevalence MH - Propensity Score MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - United States/ep [Epidemiology] AB - BACKGROUND: Literature has shown that chronic pain patients prescribed opioids are at an increased risk for experiencing drug-drug interactions as a result of polypharmacy. In addition, chronic, noncancer pain patients who experience drug-drug interactions have been shown to have greater health care utilization and costs. However, no study has focused on the health economics of major clinically significant drug-drug interactions associated with long-acting opioids. AB - OBJECTIVES: To (a) estimate the prevalence of major drug-drug interactions among patients prescribed a long-acting opioid and (b) evaluate the potential impact of major drug-drug interactions on health care costs. AB - METHODS: This study was a retrospective cohort analysis using claims data from the MarketScan Commercial Claims and Encounter Database between 2008 and 2010. Patients with at least 1 prescription for a long-acting opioid for >= 30 days were placed into cohorts according to the expected clinical impact of the potential drug-drug interaction: major versus none. Propensity score matching was used to mitigate differences in baseline characteristics between the cohorts. Health care costs were based on payments for all covered health care services, which consisted of inpatient and outpatient medical, emergency department, and outpatient prescription costs. AB - RESULTS: Among 57,752 chronic, noncancer pain patients who met all inclusion and exclusion criteria, 5.7% (3,302) were exposed to a potential major drug-drug interaction. The costs associated with a potential interaction versus no potential interaction were significantly more after baseline characteristics of the cohorts were normalized by propensity score matching. Monthly health care costs in the 90-day post-index period were significantly greater ($3,366 vs. $2,757, a $609 difference) in patients exposed to a potential drug-drug interaction of major clinical significance, compared with those not exposed to a drug-drug interaction. The higher health care costs were mainly driven by outpatient and inpatient medical costs. AB - CONCLUSIONS: Exposure to potential drug-drug interactions may result in unnecessary and unintended health care costs. Physicians should be made aware of commonly administered cytochrome P450 (CYP450) metabolized drugs in the chronic pain patient and consider prescribing non-CYP450 metabolized opioid and nonopioid analgesics. Managed care's use of utilization management tools to avoid these exposures may reduce costs. RN - 0 (Analgesics, Opioid) RN - 0 (Cytochrome P-450 Enzyme Inhibitors) RN - 9035-51-2 (Cytochrome P-450 Enzyme System) ES - 2376-1032 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 2014(20)5: 467-476 [pii] ID - 10.18553/jmcp.2014.20.5.467 [doi] PP - ppublish LG - English DP - 2014 May EZ - 2014/04/26 06:00 DA - 2015/01/15 06:00 DT - 2014/04/26 06:00 YR - 2014 ED - 20150114 RD - 20140425 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24761818 <334. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24256365 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dertadian GC AU - Maher L FA - Dertadian, George C FA - Maher, Lisa IN - Dertadian, George C. Institute for Culture and Society, University of Western Sydney, Penrith, Australia. TI - From oxycodone to heroin: two cases of transitioning opioid use in young Australians. SO - Drug & Alcohol Review. 33(1):102-4, 2014 Jan AS - Drug Alcohol Rev. 33(1):102-4, 2014 Jan NJ - Drug and alcohol review VO - 33 IP - 1 PG - 102-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9015440 IO - Drug Alcohol Rev SB - Index Medicus CP - Australia MH - Administration, Intravenous MH - Adult MH - Australia MH - *Drug Users/px [Psychology] MH - Female MH - *Heroin/ad [Administration & Dosage] MH - Humans MH - Male MH - Methadone/ad [Administration & Dosage] MH - *Opioid-Related Disorders/px [Psychology] MH - *Oxycodone/ad [Administration & Dosage] MH - *Self Medication MH - *Substance Abuse, Intravenous/px [Psychology] MH - Young Adult KW - heroin; injecting; oxycodone; pharmaceutical opioid; transition AB - INTRODUCTION AND AIMS: The non-medical use of pharmaceutical opioids is associated with a range of negative health consequences, including the development of dependence, emergency room presentations and overdose deaths. AB - DESIGN AND METHODS: Drawing on life history data from a broader qualitative study of the non-medical use of painkillers, this brief report presents two cases of transitions from recreational or non-medical pharmaceutical opioid use to intravenous heroin use by young adults in Australia. AB - RESULTS: Although our study was not designed to assess whether recreational oxycodone use is causally linked to transitions to intravenous use, polyopioid use places individuals at high risk for progression to heroin and injecting. Our first case, Jake, used a range of analgesics before he transitioned to intravenous use, and the first drug he injected was methadone. Our second case, Emma, engaged in a broad spectrum of polydrug use, involving a range of opioid preparations, as well as benzodiazepines, cannabis and alcohol. Both cases transitioned from oral to intravenous pharmaceutical opioids use and subsequent intravenous heroin use. AB - DISCUSSION AND CONCLUSIONS: These cases represent the first documented reports of transitions from the non-medical or recreational use of oxycodone to intravenous heroin use in Australia. As such, they represent an important starting point for the examination of pharmaceutical opioids as a pathway to injecting drug use among young Australians and highlight the need for further research designed to identify pharmaceutical opioids users at risk of transitions to injecting and to develop interventions designed to prevent or delay these transitions. Copyright © 2013 Australasian Professional Society on Alcohol and other Drugs. RN - 70D95007SX (Heroin) RN - CD35PMG570 (Oxycodone) RN - UC6VBE7V1Z (Methadone) ES - 1465-3362 IL - 0959-5236 DO - https://dx.doi.org/10.1111/dar.12093 PT - Case Reports PT - Journal Article ID - 10.1111/dar.12093 [doi] PP - ppublish PH - 2013/09/25 [received] PH - 2013/10/30 [accepted] LG - English EP - 20131121 DP - 2014 Jan EZ - 2013/11/22 06:00 DA - 2015/01/08 06:00 DT - 2013/11/22 06:00 YR - 2014 ED - 20150107 RD - 20140109 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24256365 <335. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24667804 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Holman JE AU - Stoddard GJ AU - Horwitz DS AU - Higgins TF FA - Holman, Joel E FA - Stoddard, Gregory J FA - Horwitz, Daniel S FA - Higgins, Thomas F IN - Holman, Joel E. *Department of Orthopaedics, University of Utah, Salt Lake City, UT; and +Geisinger Medical Center, Danville, PA. TI - The effect of preoperative counseling on duration of postoperative opiate use in orthopaedic trauma surgery: a surgeon-based comparative cohort study. SO - Journal of Orthopaedic Trauma. 28(9):502-6, 2014 Sep AS - J Orthop Trauma. 28(9):502-6, 2014 Sep NJ - Journal of orthopaedic trauma VO - 28 IP - 9 PG - 502-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - jh4, 8807705 IO - J Orthop Trauma SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - *Counseling MH - Female MH - Humans MH - Male MH - Middle Aged MH - Musculoskeletal System/in [Injuries] MH - *Musculoskeletal System/su [Surgery] MH - *Pain, Postoperative/dt [Drug Therapy] MH - Practice Patterns, Physicians' MH - Preoperative Care MH - Retrospective Studies MH - Time Factors MH - Trauma Centers MH - Young Adult AB - OBJECTIVE: The prudent use of prescription opiates is a central aspect of current postsurgical pain management, but surgeons have no guidelines on appropriate duration of opiate treatment. Furthermore, there are no established data on the effect of physician counseling on the duration of opiate use postoperatively. AB - DESIGN: Retrospective surgeon-controlled cohort study. AB - SETTING: Level I regional academic trauma center. AB - PATIENTS: All Utah residents admitted to the orthopaedic trauma service with isolated operative musculoskeletal injury. AB - INTERVENTION: One group of patients was instructed at the time of index procedure that they would receive prescription opiates for a maximum of 6 weeks. The remaining patients were not counseled preoperatively on duration of opiate use postoperatively. AB - MAIN OUTCOME MEASURES: The presence and frequency of prescription opiate use before injury, cessation of opiate use by 6 weeks postoperatively, cessation of opiates by 12 weeks postoperatively, and continuation of prescription opiates greater than 12 weeks postoperatively. AB - RESULTS: Six hundred thirteen patients met inclusion criteria. Those counseled preoperatively to cease opiate use by 6 weeks were significantly more likely to do so than those who did not receive counseling (73% and 64%, respectively; P = 0.012). By 12 weeks, this effect was no longer seen, and patients were just as likely to have stopped (80% and 80%, respectively; P = 0.90). AB - CONCLUSIONS: The orthopaedic trauma population is significantly more likely than the general population to be using prescription opiates before injury. Physician discussion of 6-week opiate prescription limitation at the time of injury seems to lead to a lower rate of use at the 6-week postoperative mark but has no effect on rates of longer-term use. Twenty percent of patients in either group will continue to use opiates after 12 weeks, compared with 15% before injury. Given the scope of prescription opiate use in the United States, surgeons may want to consider preoperative discussion of this issue, but it may not have any effect on usage rates at longer intervals. AB - LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. RN - 0 (Analgesics, Opioid) ES - 1531-2291 IL - 0890-5339 DO - https://dx.doi.org/10.1097/BOT.0000000000000085 PT - Comparative Study PT - Journal Article ID - 10.1097/BOT.0000000000000085 [doi] PP - ppublish LG - English DP - 2014 Sep EZ - 2014/03/29 06:00 DA - 2015/01/07 06:00 DT - 2014/03/27 06:00 YR - 2014 ED - 20150106 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24667804 <336. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25308142 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Davis CS AU - Southwell JK AU - Niehaus VR AU - Walley AY AU - Dailey MW FA - Davis, Corey S FA - Southwell, Jessica K FA - Niehaus, Virginia Radford FA - Walley, Alexander Y FA - Dailey, Michael W IN - Davis, Corey S. The Network for Public Health Law-Southeastern Region, Carrboro, NC. TI - Emergency medical services naloxone access: a national systematic legal review. [Review] SO - Academic Emergency Medicine. 21(10):1173-7, 2014 Oct AS - Acad Emerg Med. 21(10):1173-7, 2014 Oct NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 21 IP - 10 PG - 1173-7 PI - Journal available in: Print PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Certification MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/lj [Legislation & Jurisprudence] MH - Female MH - Guam MH - Humans MH - Male MH - Naloxone/sd [Supply & Distribution] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/sd [Supply & Distribution] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Puerto Rico MH - United States AB - OBJECTIVES: Fatal opioid overdose in the United States is at epidemic levels. Naloxone, an effective opioid antidote, is commonly administered by advanced emergency medical services (EMS) personnel in the prehospital setting. While states are rapidly moving to increase access to naloxone for community bystanders, the EMS system remains the primary source for out-of-hospital naloxone access. Many communities have limited advanced EMS response capability and therefore may not have prehospital access to the medication indicated for opioid overdose reversal. The goal of this research was to determine the authority of different levels of EMS personnel to administer naloxone for the reversal of opioid overdose in the United States, Guam, and Puerto Rico. AB - METHODS: The authors systematically reviewed the scope of practice of EMS personnel regarding administration of naloxone for the reversal of opioid overdose. All relevant laws, regulations, and policies from the 50 U. S. states, the District of Columbia, Guam, and Puerto Rico in effect in November 2013 were identified, reviewed, and coded to determine the authority of EMS personnel at four levels (in increasing order of training: emergency medical responders [EMRs], emergency medical technicians [EMTs], intermediate/advanced EMTs, and paramedics) to administer naloxone. Where available, protocols governing route and dose of administration were also identified and analyzed. AB - RESULTS: All 53 jurisdictions license or certify EMS personnel at the paramedic level, and all permit paramedics to administer naloxone. Of the 48 jurisdictions with intermediate-level EMS personnel, all but one authorized those personnel to administer naloxone as of November 2013. Twelve jurisdictions explicitly permitted EMTs and two permitted EMRs to administer naloxone. At least five jurisdictions modified law or policy to expand EMT access to naloxone in 2013. There is wide variation between states regarding EMS naloxone dosing protocol and route of administration. AB - CONCLUSIONS: Naloxone administration is standard for paramedic and intermediate-level EMS personnel, but most states do not allow basic life support (BLS) personnel to administer this medication. Standards consistent with available medical evidence for naloxone administration, dosing, and route of administration should be implemented at each EMS level of certification. Copyright © 2014 by the Society for Academic Emergency Medicine. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12485 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Review ID - 10.1111/acem.12485 [doi] PP - ppublish PH - 2014/03/07 [received] PH - 2014/05/14 [revised] PH - 2014/05/29 [accepted] GI - No: 1R43DA033746-J Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2014 Oct EZ - 2014/10/14 06:00 DA - 2014/12/17 06:00 DT - 2014/10/14 06:00 YR - 2014 ED - 20141211 RD - 20141013 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25308142 <337. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24651218 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mazer-Amirshahi M AU - Mullins PM AU - Rasooly IR AU - van den Anker J AU - Pines JM FA - Mazer-Amirshahi, Maryann FA - Mullins, Peter M FA - Rasooly, Irit R FA - van den Anker, John FA - Pines, Jesse M IN - Mazer-Amirshahi, Maryann. From the *Department of Emergency Medicine, The George Washington University; +The George Washington University School of Medicine and Health Sciences; ++Department of Pediatrics, The George Washington University; and Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC. TI - Trends in prescription opioid use in pediatric emergency department patients. SO - Pediatric Emergency Care. 30(4):230-5, 2014 Apr AS - Pediatr Emerg Care. 30(4):230-5, 2014 Apr NJ - Pediatric emergency care VO - 30 IP - 4 PG - 230-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Adolescent MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Health Surveys MH - Humans MH - Male MH - *Pain/dt [Drug Therapy] MH - *Pain Management/td [Trends] MH - Pediatrics MH - Young Adult AB - OBJECTIVE: In recent years, there has been increased emphasis on treating pain in emergency departments (EDs), coinciding with mounting concerns regarding the abuse potential of prescription opioids. In this study, we describe trends in opioid prescribing in pediatric patients in the US EDs over the past decade. AB - METHODS: Data from the 2001-2010 National Hospital Ambulatory Medical Care Survey were analyzed and pain-related visits were identified. Pain-related ED visits by pediatric patients (<=19 y) where an opioid analgesic was administered or prescribed were tabulated by age category and year. Specific opioids analyzed included codeine, hydrocodone, hydromorphone, morphine, and oxycodone. The use patterns of nonopioid pain relievers were also investigated. Results were further stratified by Drug Enforcement Agency schedule and pain-related diagnosis. AB - RESULTS: The overall use of opioid analgesics in pain-related pediatric ED visits increased from 11.2% to 14.5% between 2001 and 2010 (P = 0.015). The use of Drug Enforcement Agency schedule II agents doubled from 3.6% in 2001 to 7.0% in 2010 (P < 0.001), whereas there was no significant increase in the use of schedule III, IV, and V agents (P = 0.34). Hydrocodone was the most frequently prescribed opioid analgesic. Increased opioid use was most dramatic in ED visits that involved adolescents. There was no significant increase in the use of nonopioid analgesics in pediatric ED patients (P = 0.086). AB - CONCLUSIONS: Opioid use for pain-related pediatric ED visits has increased significantly from 2001 to 2010, particularly among adolescents. Emergency department providers must be vigilant in balancing pain relief with minimizing the adverse effects of opioid analgesics. RN - 0 (Analgesics, Opioid) ES - 1535-1815 IL - 0749-5161 DO - https://dx.doi.org/10.1097/PEC.0000000000000102 PT - Journal Article ID - 10.1097/PEC.0000000000000102 [doi] PP - ppublish LG - English DP - 2014 Apr EZ - 2014/03/22 06:00 DA - 2014/12/17 06:00 DT - 2014/03/22 06:00 YR - 2014 ED - 20141211 RD - 20140403 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24651218 <338. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25299603 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Jones CM AU - Paulozzi LJ AU - Mack KA AU - Centers for Disease Control and Prevention (CDC) FA - Jones, Christopher M FA - Paulozzi, Leonard J FA - Mack, Karin A FA - Centers for Disease Control and Prevention (CDC) TI - Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse-related emergency department visits and drug-related deaths - United States, 2010. SO - MMWR - Morbidity & Mortality Weekly Report. 63(40):881-5, 2014 Oct 10 AS - MMWR Morb Mortal Wkly Rep. 63(40):881-5, 2014 Oct 10 NJ - MMWR. Morbidity and mortality weekly report VO - 63 IP - 40 PG - 881-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - ne8, 7802429 IO - MMWR Morb. Mortal. Wkly. Rep. SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Alcohol Drinking/ep [Epidemiology] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Benzodiazepines/ad [Administration & Dosage] MH - Child MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prescription Drug Misuse/mo [Mortality] MH - *Prescription Drug Misuse MH - *Substance-Related Disorders/ep [Epidemiology] MH - Substance-Related Disorders/mo [Mortality] MH - United States/ep [Epidemiology] MH - Young Adult AB - The abuse of prescription drugs has led to a significant increase in emergency department (ED) visits and drug-related deaths over the past decade. Opioid pain relievers (OPRs) and benzodiazepines are the prescription drugs most commonly involved in these events. Excessive alcohol consumption also accounts for a significant health burden and is common among groups that report high rates of prescription drug abuse. When taken with OPRs or benzodiazepines, alcohol increases central nervous system depression and the risk for overdose. Data describing alcohol involvement in OPR or benzodiazepine abuse are limited. To quantify alcohol involvement in OPR and benzodiazepine abuse and drug-related deaths and to inform prevention efforts, the Food and Drug Administration (FDA) and CDC analyzed 2010 data for drug abuse-related ED visits in the United States and drug-related deaths that involved OPRs and alcohol or benzodiazepines and alcohol in 13 states. The analyses showed alcohol was involved in 18.5% of OPR and 27.2% of benzodiazepine drug abuse-related ED visits and 22.1% of OPR and 21.4% of benzodiazepine drug-related deaths. These findings indicate that alcohol plays a significant role in OPR and benzodiazepine abuse. Interventions to reduce the abuse of alcohol and these drugs alone and in combination are needed. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) ES - 1545-861X IL - 0149-2195 PT - Journal Article ID - mm6340a1 [pii] PP - ppublish LG - English DP - 2014 Oct 10 EZ - 2014/10/10 06:00 DA - 2014/12/15 06:00 DT - 2014/10/10 06:00 YR - 2014 ED - 20141204 RD - 20141010 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25299603 <339. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25154346 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Klimas J AU - O'Reilly M AU - Egan M AU - Tobin H AU - Bury G FA - Klimas, Jan FA - O'Reilly, Martin FA - Egan, Mairead FA - Tobin, Helen FA - Bury, Gerard IN - Klimas, Jan. Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. Electronic address: jan.klimas@ucd.ie. IN - O'Reilly, Martin. Dublin Fire Brigade, Dublin, Ireland. IN - Egan, Mairead. Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. IN - Tobin, Helen. Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. IN - Bury, Gerard. Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. TI - Urban overdose hotspots: a 12-month prospective study in Dublin ambulance services. SO - American Journal of Emergency Medicine. 32(10):1168-73, 2014 Oct AS - Am J Emerg Med. 32(10):1168-73, 2014 Oct NJ - The American journal of emergency medicine VO - 32 IP - 10 PG - 1168-73 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - *Ambulances/sn [Statistics & Numerical Data] MH - Analgesics, Opioid/po [Poisoning] MH - Antidepressive Agents/po [Poisoning] MH - Benzodiazepines/po [Poisoning] MH - Central Nervous System Depressants/po [Poisoning] MH - Child MH - Child, Preschool MH - Cohort Studies MH - *Drug Overdose/ep [Epidemiology] MH - Drug Overdose/et [Etiology] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Ethanol/po [Poisoning] MH - Female MH - *Geographic Information Systems MH - Geographic Mapping MH - *Health Services Accessibility/sn [Statistics & Numerical Data] MH - Humans MH - Ireland/ep [Epidemiology] MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/rh [Rehabilitation] MH - Prospective Studies MH - Sex Distribution MH - Substance Abuse Treatment Centers/sd [Supply & Distribution] MH - Substance-Related Disorders/ep [Epidemiology] MH - Substance-Related Disorders/rh [Rehabilitation] MH - *Urban Population/sn [Statistics & Numerical Data] MH - Young Adult AB - BACKGROUND: Opioid overdose (OD) is the primary cause of death among drug users globally. Personal and social determinants of overdose have been studied before, but the environmental factors lacked research attention. Area deprivation or presence of addiction clinics may contribute to overdose. AB - OBJECTIVES: The objective of the study is to examine the baseline incidence of all new ODs in an ambulance service and their relationship with urban deprivation and presence of addiction services. AB - METHODS: A prospective chart review of prehospital advanced life support patients was performed on confirmed OD calls. Demographic, geographic, and clinical information, that is, presentation, treatment, and outcomes, was collected for each call. The census data were used to calculate deprivation. Geographical information software mapped the urban deprivation and addiction services against the overdose locations. AB - RESULTS: There were 469 overdoses, 13 of which were fatal; most were male (80%), of a young age (32 years), with a high rate of repeated overdoses (26%) and common polydrug use (9.6%). Most occurred in daytime (275) and on the streets (212). Overdoses were more likely in more affluent areas (r = .15; P < .05) and in a 1000-m radius of addiction services. Residential overdoses were in more deprived areas than street overdoses (mean difference, 7.8; t170 = 3.99; P < .001). Street overdoses were more common in the city center than suburbs (chi(2)(1) = 33.04; P < .001). AB - CONCLUSIONS: The identified clusters of increased incidence-urban overdose hotspots-suggest a link between environment characteristics and overdoses. This highlights a need to establish overdose education and naloxone distribution in the overdose hotspots. Copyright © 2014 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Antidepressive Agents) RN - 0 (Central Nervous System Depressants) RN - 12794-10-4 (Benzodiazepines) RN - 3K9958V90M (Ethanol) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(14)00510-5 DO - https://dx.doi.org/10.1016/j.ajem.2014.07.017 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0735-6757(14)00510-5 [pii] ID - 10.1016/j.ajem.2014.07.017 [doi] PP - ppublish PH - 2014/06/06 [received] PH - 2014/06/26 [revised] PH - 2014/07/02 [accepted] LG - English EP - 20140731 DP - 2014 Oct EZ - 2014/08/27 06:00 DA - 2014/12/15 06:00 DT - 2014/08/27 06:00 YR - 2014 ED - 20141204 RD - 20141006 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25154346 <340. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24013693 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Watanabe T AU - Watanabe Y AU - Takizawa D AU - Hiraoka H AU - Petrenko AB AU - Baba H FA - Watanabe, Tatsunori FA - Watanabe, Yoshiko FA - Takizawa, Daisuke FA - Hiraoka, Haruhiko FA - Petrenko, Andrey B FA - Baba, Hiroshi IN - Watanabe, Tatsunori. Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan, tatsu-w@med.niigata-u.ac.jp. TI - Prolonged apnea, caused by remifentanil, during awakening from anesthesia for emergency ventriculoperitoneal shunt placement. SO - Journal of Anesthesia. 28(2):320-1, 2014 Apr AS - J. ANESTH.. 28(2):320-1, 2014 Apr NJ - Journal of anesthesia VO - 28 IP - 2 PG - 320-1 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8905667 IO - J Anesth SB - Index Medicus CP - Japan MH - Aged MH - *Anesthesia/ae [Adverse Effects] MH - *Anesthetics, Intravenous/ae [Adverse Effects] MH - *Apnea/ci [Chemically Induced] MH - Apnea/dt [Drug Therapy] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Piperidines/ae [Adverse Effects] MH - Ventriculoperitoneal Shunt RN - 0 (Anesthetics, Intravenous) RN - 0 (Narcotic Antagonists) RN - 0 (Piperidines) RN - 36B82AMQ7N (Naloxone) RN - P10582JYYK (remifentanil) ES - 1438-8359 IL - 0913-8668 DO - https://dx.doi.org/10.1007/s00540-013-1707-4 PT - Case Reports PT - Letter ID - 10.1007/s00540-013-1707-4 [doi] PP - ppublish PH - 2013/03/15 [received] PH - 2013/08/26 [accepted] LG - English EP - 20130908 DP - 2014 Apr EZ - 2013/09/10 06:00 DA - 2014/12/15 06:00 DT - 2013/09/10 06:00 YR - 2014 ED - 20141125 RD - 20171011 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24013693 <341. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25091873 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mazer-Amirshahi M AU - Dewey K AU - Mullins PM AU - van den Anker J AU - Pines JM AU - Perrone J AU - Nelson L FA - Mazer-Amirshahi, Maryann FA - Dewey, Kayla FA - Mullins, Peter M FA - van den Anker, John FA - Pines, Jesse M FA - Perrone, Jeanmarie FA - Nelson, Lewis IN - Mazer-Amirshahi, Maryann. Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC. Electronic address: maryannmazer@gmail.com. IN - Dewey, Kayla. Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC. IN - Mullins, Peter M. The George Washington University, School of Medicine and Health Sciences, Washington, DC. IN - van den Anker, John. Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University, Washington, DC; Intensive Care, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Pediatric Pharmacology, University Children's Hospital Basel, Switzerland. IN - Pines, Jesse M. The George Washington University, School of Medicine and Health Sciences, Washington, DC; Department of Emergency Medicine, the George Washington University, Washington, DC. IN - Perrone, Jeanmarie. Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA. IN - Nelson, Lewis. Department of Emergency Medicine, New York University, New York, NY. TI - Trends in opioid analgesic use for headaches in US emergency departments. SO - American Journal of Emergency Medicine. 32(9):1068-73, 2014 Sep AS - Am J Emerg Med. 32(9):1068-73, 2014 Sep NJ - The American journal of emergency medicine VO - 32 IP - 9 PG - 1068-73 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Analgesics/tu [Therapeutic Use] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/td [Trends] MH - Female MH - *Headache/dt [Drug Therapy] MH - Health Care Surveys MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - United States/ep [Epidemiology] MH - Young Adult AB - OBJECTIVE: Although not recommended as first line therapy by consensus guidelines, opioid analgesics are commonly used to treat headaches. This study evaluates trends in opioid use for headaches in US emergency departments (EDs). AB - METHODS: We performed a retrospective review of the National Hospital Ambulatory Medical Care Survey, 2001 through 2010. Adult headache-related visits were identified. Medications (opioid and nonopioid) used for the treatment of headache were categorized based on medication class. Trends in ED use of the most common opioids (codeine, hydrocodone, hydromorphone, morphine, and oxycodone) were explored. The proportion of visits for which each medication was used was tabulated, and trends were analyzed using survey-weighted logistic regression. AB - RESULTS: Headache visits during which any opioid was used increased between 2001 (20.6%; 95% confidence interval [CI], 18.1-23.4) and 2010 (35.0%; 95% CI, 31.8-38.4; P < .001). Prescribing of hydromorphone, morphine, and oxycodone increased, with the largest relative increase (461.1%) in hydromorphone (2001, 1.8% [95% CI, 1.2-2.6]; 2010, 10.1% [95% CI, 8.2-12.4]). Codeine use declined, and hydrocodone use remained stable. Use of opioid alternatives, including acetaminophen, butalbital, and triptans did not change over the study period, whereas use of nonsteroidal anti-inflammatory drugs increased from 26.2% (95% CI, 23.0-29.7) to 31.4% (95% CI, 28.6-34.3). Prescribing of antiemetic agents decreased from 24.1% (95% CI, 19.6-29.2) to 23.5% (95% CI, 21.1-26.0). Intravenous fluid use increased from 20.0% (95% CI, 17.0-23.4) to 34.5% (95% CI, 31.0-38.2) of visits. AB - CONCLUSIONS: Despite limited endorsement by consensus guidelines, there was increased use of opioid analgesics to treat headaches in US EDs over the past decade. Copyright © 2014 Elsevier Inc. All rights reserved. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(14)00492-6 DO - https://dx.doi.org/10.1016/j.ajem.2014.07.001 PT - Journal Article ID - S0735-6757(14)00492-6 [pii] ID - 10.1016/j.ajem.2014.07.001 [doi] PP - ppublish PH - 2014/06/02 [received] PH - 2014/06/27 [revised] PH - 2014/07/02 [accepted] LG - English EP - 20140710 DP - 2014 Sep EZ - 2014/08/06 06:00 DA - 2014/12/15 06:00 DT - 2014/08/06 06:00 YR - 2014 ED - 20141124 RD - 20140908 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25091873 <342. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24658483 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Atluri S AU - Sudarshan G AU - Manchikanti L FA - Atluri, Sairam FA - Sudarshan, Gururau FA - Manchikanti, Laxmaiah IN - Manchikanti, Laxmaiah. Tri-State Spine Care Institute, Cincinnati, OH; Cincinnati Pain Management Consultants, Cincinnati, OH; Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY. TI - Assessment of the trends in medical use and misuse of opioid analgesics from 2004 to 2011. SO - Pain Physician. 17(2):E119-28, 2014 Mar-Apr AS - Pain physician. 17(2):E119-28, 2014 Mar-Apr NJ - Pain physician VO - 17 IP - 2 PG - E119-28 PI - Journal available in: Print PI - Citation processed from: Internet JC - 100954394 IO - Pain Physician SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Databases, Factual/sn [Statistics & Numerical Data] MH - Humans MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Pain/dt [Drug Therapy] MH - Retrospective Studies MH - *Substance Abuse Detection/mt [Methods] MH - *Substance Abuse Detection/td [Trends] AB - BACKGROUND: The epidemic of medical use and abuse of opioid analgesics is linked to the economic burden of opioid-related abuse and fatalities in the United States. Multiple studies have estimated the extent to which prescription opioid analgesics contribute to the national drug abuse problem; studies also assessing the trends in medical use and abuse of opioid analgesics have confirmed the relationship between increasing medical use of opioids and increasing fatalities.The available data is limited until 2002. AB - STUDY DESIGN: Retrospective analysis of data from 2004 to 2011 from 2 databases: Automation of Reports and Consolidated Orders System (ARCOS) for opioid use data and Drug Abuse Warning Network (DAWN) for drug misuse data. AB - OBJECTIVE: To determine the proportion of drug abuse related to opioid analgesics and the various trends in the medical use and abuse of 8 opioid analgesics commonly used to treat pain: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone. AB - METHODS: The data obtained from DAWN is a nationally representative sample of hospital emergency department admissions resulting from drug abuse. Main outcome measure was the identification of trends in the medical use and misuse of opioid analgesics from 2004 to 2011. AB - RESULTS: From 2004 to 2011, there was an increase in the medical use of all opioids except for a 20% decrease in codeine. The abuse of all opioids including codeine increased during this period. Increases in medical use ranged from 2,318% for buprenorphine to 35% for fentanyl, including 140% for hydromorphone, 117% for oxycodone, 73% for hydrocodone, 64% for morphine, and 37% for methadone. The misuse increased 384% for buprenorphine with available data from 2006 to 2011, whereas from 2004 to 2011, it increased 438% for hydromorphone, 263% for oxycodone, 146% for morphine, 107% for hydrocodone, 104% for fentanyl, 82% for methadone, and 39% for codeine. Comparison of opioid use showed an overall increase of 1,448% from 1996 to 2011, with increases of 690% from 1996 to 2004 and 100% from 2004 to 2011. In contrast, misuse increased more dramatically: 4,680% from 1996 to 2011, with increases of 1,372% from 1996 through 2004 and 245% from 2004 to 2011. The number of patients seeking rehabilitation for substance abuse also increased 187% for opioids, whereas it increased 87% for heroin, 40% for marijuana, and decreased 7% for cocaine. AB - LIMITATIONS: Limitations of this assessment include the lack of data from 2003, lack of data available on meperidine, and that the aggregate data systems used in the study did not identify specific formulations or commercial products. AB - CONCLUSION: The present trend of continued increase in the medical use of opioid analgesics appears to contribute to increases in misuse, resulting in multiple health consequences. RN - 0 (Analgesics, Opioid) ES - 2150-1149 IL - 1533-3159 PT - Journal Article PP - ppublish LG - English DP - 2014 Mar-Apr EZ - 2014/03/25 06:00 DA - 2014/11/18 06:00 DT - 2014/03/25 06:00 YR - 2014 ED - 20141117 RD - 20140324 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24658483 <343. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23841538 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Inocencio TJ AU - Carroll NV AU - Read EJ AU - Holdford DA FA - Inocencio, Timothy J FA - Carroll, Norman V FA - Read, Edward J FA - Holdford, David A IN - Inocencio, Timothy J. Avalere Health, Washington, DC. TI - The economic burden of opioid-related poisoning in the United States. SO - Pain Medicine. 14(10):1534-47, 2013 Oct AS - PAIN MED. 14(10):1534-47, 2013 Oct NJ - Pain medicine (Malden, Mass.) VO - 14 IP - 10 PG - 1534-47 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - *Analgesics, Opioid/po [Poisoning] MH - *Health Care Costs MH - Humans MH - *Opioid-Related Disorders/ec [Economics] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Prevalence MH - United States KW - Costs; Heroin; Opiate; Opioid; Overdose; Poisoning AB - OBJECTIVE: To estimate the yearly economic burden of opioid-related poisoning in the United States. AB - BACKGROUND: Rates of opioid poisoning and related mortality have increased substantially over the past decade. Although previous studies have measured the costs of misuse and abuse, costs related specifically to opioid poisoning have not been quantified. This study quantifies the economic burden of opioid poisoning in the United States to help evaluate the economic case for efforts to reverse or prevent opioid poisoning and its associated morbidity and mortality. AB - METHODS: Mean costs and prevalence estimates were estimated using publically available datasets. A societal perspective was assumed and accordingly estimated direct medical and productivity costs. Direct medical costs included treatment for opioid poisoning in the emergency department (ED) and inpatient settings, along with emergency transport and drug costs. Productivity costs were estimated using the human capital method and included lost wages due to mortality and absenteeism costs from ED visits and hospitalizations. All costs were inflated to 2011 U.S. dollars. AB - RESULTS: In 2009, total costs were estimated at approximately $20.4 billion with indirect costs constituting 89% of the total. Direct medical costs were approximately $2.2 billion. ED costs and inpatient costs were estimated to be $800 million and $1.3 billion, respectively. Absenteeism costs were $335 million and lost future earnings due to mortality were $18.2 billion. AB - CONCLUSION: Opioid-related poisoning causes a substantial burden to the United States each year. Costs related to mortality account for the majority of costs. Interventions designed to prevent or reverse opioid-related poisoning can have significant impacts on cost, especially where death is prevented. Copyright Wiley Periodicals, Inc. RN - 0 (Analgesics, Opioid) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/pme.12183 PT - Journal Article ID - 10.1111/pme.12183 [doi] PP - ppublish LG - English EP - 20130710 DP - 2013 Oct EZ - 2013/07/12 06:00 DA - 2014/11/13 06:00 DT - 2013/07/12 06:00 YR - 2013 ED - 20141112 RD - 20140304 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23841538 <344. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23993938 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tsung AH AU - Slish JH AU - Lisenbee NP AU - Allen BR FA - Tsung, Ann H FA - Slish, John H FA - Lisenbee, Nathaniel P FA - Allen, Brandon R IN - Tsung, Ann H. Department of Emergency Medicine, University of Florida Health, Gainesville, Florida. TI - Postobstructive pulmonary edema in a 40-year-old man after suffocation by a swimming pool cover. SO - Journal of Emergency Medicine. 45(5):670-3, 2013 Nov AS - J Emerg Med. 45(5):670-3, 2013 Nov NJ - The Journal of emergency medicine VO - 45 IP - 5 PG - 670-3 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Airway Obstruction/co [Complications] MH - *Asphyxia/co [Complications] MH - Humans MH - Male MH - Noninvasive Ventilation MH - Positive-Pressure Respiration MH - *Pulmonary Edema/et [Etiology] MH - *Pulmonary Edema/th [Therapy] KW - negative pressure pulmonary edema; noncardiogenic pulmonary edema; noninvasive positive pressure ventilation; postobstructive pulmonary edema; suffocation; upper airway obstruction AB - BACKGROUND: Postobstructive pulmonary edema (POPE) is a form of sudden onset, noncardiogenic pulmonary edema that can occur after the relief of an upper airway obstruction. AB - OBJECTIVE: Since POPE is an uncommon diagnosis made in the emergency department (ED), this case is presented to increase emergency physicians' awareness of the etiology, pathophysiology, and management of this type of edema. AB - CASE REPORT: This is a case of bilateral POPE in a 40-year-old man with no history of cardiac or pulmonary disease who experienced near suffocation due to the vacuum effect of a swimming pool cover. On presentation to the ED, the patient's symptoms included bilateral pleuritic pain over the anterior chest, shortness of breath, and inspiratory cough. He was tachycardic and tachypneic, with an oxygen saturation of 92% on room air. Pertinent physical examination findings included shallow breathing and right-sided rhonchi. The initial arterial blood gas on room air demonstrated a PaO2/FiO2 ratio of 304 mm Hg. Cardiac enzymes and the electrocardiogram result were normal. The patient's chest radiograph was interpreted as having marked bilateral pulmonary edema. The patient was admitted to the Medicine Intensive Care Unit and placed on noninvasive positive pressure ventilation (NIPPV). The patient was clinically asymptomatic and was discharged after 72 h. AB - CONCLUSIONS: Emergency physicians should consider the diagnosis of POPE in a symptomatic patient if there is evidence of pulmonary edema immediately after a history of hanging, suffocation, strangulation, choking, naloxone administration, or other forms of upper airway obstruction. Rapid initiation of NIPPV with or without diuretics, steroids, or fluid restriction can lead to symptom resolution within 24 to 48 h. Copyright Published by Elsevier Inc. IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(13)00603-3 DO - https://dx.doi.org/10.1016/j.jemermed.2013.04.045 PT - Case Reports PT - Journal Article ID - S0736-4679(13)00603-3 [pii] ID - 10.1016/j.jemermed.2013.04.045 [doi] PP - ppublish PH - 2012/10/29 [received] PH - 2013/03/18 [revised] PH - 2013/04/30 [accepted] LG - English EP - 20130830 DP - 2013 Nov EZ - 2013/09/03 06:00 DA - 2014/11/07 06:00 DT - 2013/09/03 06:00 YR - 2013 ED - 20141106 RD - 20131111 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23993938 <345. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25204112 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Goodloe JM AU - Dailey MW AU - Heightman AJ FA - Goodloe, Jeffrey M FA - Dailey, Michael W FA - Heightman, A J TI - Armed with naloxone. SO - Journal of Emergency Medical Services. 39(8):28-33, 2014 Aug AS - J Emerg Med Serv JEMS. 39(8):28-33, 2014 Aug NJ - JEMS : a journal of emergency medical services VO - 39 IP - 8 PG - 28-33 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Emergency Medical Services/og [Organization & Administration] MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/th [Therapy] MH - United States/ep [Epidemiology] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 PT - Journal Article PP - ppublish LG - English DP - 2014 Aug EZ - 2014/09/11 06:00 DA - 2014/11/05 06:00 DT - 2014/09/11 06:00 YR - 2014 ED - 20141103 RD - 20140910 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25204112 <346. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25175898 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Helander A AU - Backberg M AU - Beck O FA - Helander, A FA - Backberg, M FA - Beck, O IN - Helander, A. Department of Laboratory Medicine, Karolinska Institutet , Stockholm , Sweden. TI - MT-45, a new psychoactive substance associated with hearing loss and unconsciousness. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 52(8):901-4, 2014 Sep-Oct AS - Clin Toxicol (Phila). 52(8):901-4, 2014 Sep-Oct NJ - Clinical toxicology (Philadelphia, Pa.) VO - 52 IP - 8 PG - 901-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - Chromatography, Liquid MH - Emergency Service, Hospital MH - *Hearing Loss/ci [Chemically Induced] MH - Humans MH - Male MH - *Piperazines/po [Poisoning] MH - Street Drugs/po [Poisoning] MH - Sweden MH - Tandem Mass Spectrometry MH - *Unconsciousness/ci [Chemically Induced] MH - Young Adult KW - Hearing loss; Legal highs; MT-45; New psychoactive substance; Opioid analgesic drug AB - BACKGROUND: MT-45 (1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) is an opioid analgesic drug candidate developed in the 1970s that has recently been introduced as a new psychoactive substance (NPS) on the "recreational" drug market. We describe a case series of non-fatal intoxications associated with MT-45 within the Swedish STRIDA project. AB - STUDY DESIGN: Observational case series of consecutive patients with admitted or suspected intake of NPS presenting to hospitals in Sweden from November 2013 to February 2014. AB - PATIENTS AND METHODS: Blood and urine samples were collected from intoxicated patients presenting to emergency departments and intensive care units over the country. NPS analysis was performed by an LC-MS/MS multi-component method. Clinical data were collected when caregivers consulted the Poisons Information Centre and also retrieved from medical records. CASE SERIES. Among nine intoxications where MT-45 was detected in the biological samples, four cases were indicated to only involve MT-45, while one or several psychoactive substances were found along with MT-45 in the others. All patients were men aged 17-32 years and they commonly presented with opioid-like adverse symptoms, such as unconsciousness and respiratory depression. Naloxone appeared to have utility in the treatment of MT-45 intoxication in several cases. Three patients complained of bilateral hearing loss that in one case persisted after two weeks. AB - CONCLUSION: MT-45 should be added to the growing list of harmful NPS causing life-threatening poisonings, and rapid actions taken to make it a controlled substance. RN - 0 (Analgesics, Opioid) RN - 0 (Piperazines) RN - 0 (Street Drugs) RN - 52694-55-0 ((+,-)-1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.3109/15563650.2014.943908 PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't ID - 10.3109/15563650.2014.943908 [doi] PP - ppublish LG - English EP - 20140901 DP - 2014 Sep-Oct EZ - 2014/09/02 06:00 DA - 2014/11/02 06:00 DT - 2014/09/02 06:00 YR - 2014 ED - 20141031 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25175898 <347. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25092371 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Berge KH AU - Burkle CM FA - Berge, Keith H FA - Burkle, Christopher M IN - Berge, Keith H. Mayo Clinic, Rochester, MN. IN - Burkle, Christopher M. Mayo Clinic, Rochester, MN. TI - In reply--The contribution of patient satisfaction to the opiate abuse epidemic. CM - Comment on: Mayo Clin Proc. 2014 Aug;89(8):1168; PMID: 25092370 CM - Comment on: Mayo Clin Proc. 2014 Apr;89(4):437-9; PMID: 24629442 SO - Mayo Clinic Proceedings. 89(8):1168, 2014 Aug AS - Mayo Clin Proc. 89(8):1168, 2014 Aug NJ - Mayo Clinic proceedings VO - 89 IP - 8 PG - 1168 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0405543, lly IO - Mayo Clin. Proc. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Cause of Death MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1942-5546 IL - 0025-6196 DI - S0025-6196(14)00526-6 DO - https://dx.doi.org/10.1016/j.mayocp.2014.06.007 PT - Comment PT - Letter ID - S0025-6196(14)00526-6 [pii] ID - 10.1016/j.mayocp.2014.06.007 [doi] PP - ppublish PH - 2014/06/12 [received] PH - 2014/06/12 [accepted] LG - English DP - 2014 Aug EZ - 2014/08/06 06:00 DA - 2014/10/31 06:00 DT - 2014/08/06 06:00 YR - 2014 ED - 20141030 RD - 20140805 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25092371 <348. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25092370 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hirsch RL FA - Hirsch, Ronald Lauren IN - Hirsch, Ronald Lauren. Chicago, Ilinois. TI - The contribution of patient satisfaction to the opiate abuse epidemic. CM - Comment in: Mayo Clin Proc. 2014 Aug;89(8):1168; PMID: 25092371 CM - Comment on: Mayo Clin Proc. 2014 Apr;89(4):437-9; PMID: 24629442 SO - Mayo Clinic Proceedings. 89(8):1168, 2014 Aug AS - Mayo Clin Proc. 89(8):1168, 2014 Aug NJ - Mayo Clinic proceedings VO - 89 IP - 8 PG - 1168 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0405543, lly IO - Mayo Clin. Proc. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Cause of Death MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1942-5546 IL - 0025-6196 DI - S0025-6196(14)00525-4 DO - https://dx.doi.org/10.1016/j.mayocp.2014.06.006 PT - Comment PT - Letter ID - S0025-6196(14)00525-4 [pii] ID - 10.1016/j.mayocp.2014.06.006 [doi] PP - ppublish PH - 2014/04/13 [received] PH - 2014/06/12 [accepted] LG - English DP - 2014 Aug EZ - 2014/08/06 06:00 DA - 2014/10/31 06:00 DT - 2014/08/06 06:00 YR - 2014 ED - 20141030 RD - 20140805 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25092370 <349. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25156157 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kea B AU - Fu R AU - Deyo RA AU - Sun BC FA - Kea, Bory FA - Fu, Rochelle FA - Deyo, Richard A FA - Sun, Benjamin C IN - Kea, Bory. Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. kea@ohsu.edu. TI - Are discharge prescriptions of opioids from the emergency department truly rising?. CM - Comment in: Acad Emerg Med. 2014 Aug;21(8):947; PMID: 25154412 CM - Comment on: Acad Emerg Med. 2014 Mar;21(3):236-43; PMID: 24628748 SO - Academic Emergency Medicine. 21(8):946, 2014 Aug AS - Acad Emerg Med. 21(8):946, 2014 Aug NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 21 IP - 8 PG - 946 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - *Pain/dt [Drug Therapy] MH - *Practice Patterns, Physicians'/td [Trends] RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12425 PT - Comment PT - Letter ID - 10.1111/acem.12425 [doi] PP - ppublish LG - English EP - 20140825 DP - 2014 Aug EZ - 2014/08/27 06:00 DA - 2014/10/21 06:00 DT - 2014/08/27 06:00 YR - 2014 ED - 20141020 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25156157 <350. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24200890 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Yang L AU - Zhao X AU - Sun M AU - Sun X AU - Yao L AU - Yu D AU - Ding Q AU - Gao C AU - Chai W FA - Yang, Lu FA - Zhao, Xiaoyong FA - Sun, Meiyan FA - Sun, Xude FA - Yao, Linong FA - Yu, Daihua FA - Ding, Qian FA - Gao, Changjun FA - Chai, Wei IN - Yang, Lu. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province 710038, China. IN - Zhao, Xiaoyong. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province 710038, China. IN - Sun, Meiyan. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province 710038, China. IN - Sun, Xude. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province 710038, China. IN - Yao, Linong. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province 710038, China. IN - Yu, Daihua. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province 710038, China. IN - Ding, Qian. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province 710038, China. IN - Gao, Changjun. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province 710038, China. Electronic address: gaocj74@163.com. IN - Chai, Wei. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province 710038, China. Electronic address: tdmzka@fmmu.edu.cn. TI - Delta opioid receptor agonist BW373U86 attenuates post-resuscitation brain injury in a rat model of asphyxial cardiac arrest. SO - Resuscitation. 85(2):299-305, 2014 Feb AS - Resuscitation. 85(2):299-305, 2014 Feb NJ - Resuscitation VO - 85 IP - 2 PG - 299-305 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Animals MH - *Asphyxia/th [Therapy] MH - *Benzamides/pd [Pharmacology] MH - Blotting, Western MH - Brain Damage, Chronic/me [Metabolism] MH - Brain Damage, Chronic/pa [Pathology] MH - *Brain Damage, Chronic/pc [Prevention & Control] MH - CREB-Binding Protein/me [Metabolism] MH - *Cardiopulmonary Resuscitation MH - Disease Models, Animal MH - *Heart Arrest/th [Therapy] MH - Immunoenzyme Techniques MH - Male MH - Naltrexone/aa [Analogs & Derivatives] MH - Naltrexone/pd [Pharmacology] MH - *Neuroprotective Agents/pd [Pharmacology] MH - *Piperazines/pd [Pharmacology] MH - Rats, Sprague-Dawley KW - Asphyxial cardiac arrest; Delta opioid receptor; Neuroprotection; cAMP response element-binding protein AB - OBJECTIVE: The aim of this study was to investigate whether the DOR agonist BW373U86 conferred neuroprotection following ACA when given after resuscitation and to determine the long-term effects of chronic BW373U86 treatment on ACA-elicited brain injury. AB - METHODS: Animals were divided into acute and chronic treatment groups. Each group consisted of four sub-groups, including Sham, ACA, BW373U86 (BW373U86+ACA), and Naltrindole groups (Naltrindole and BW373U86+ACA). The DOR antagonist Naltrindole was used to confirm the possible receptor-dependent effects of BW373U86. ACA was induced by 8min of asphyxiation followed by resuscitation. All drugs were administered either immediately after the restoration of spontaneous circulation (ROSC) in acute-treatment groups or over 6 consecutive days in chronic-treatment groups. Alterations of cAMP response element-binding protein (CREB) and phosphorylated CREB (pCREB) were analyzed by western blot and immunohistochemistry. Neurological functions were assessed by neurological deficit score (NDS) and Morris Water Maze performance. Neurodegeneration was monitored by immunofluorescence and Nissl staining. AB - RESULTS: ACA induced massive neuron loss and serious neurological function deficits. BW373U86 significantly reduced both of these negative effects and increased CREB and pCREB expression in the hippocampus; these effects were reversed with acute Naltrindole treatment. The protective effects of BW373U86 persisted until 28d post-ROSC with chronic treatment, but these effects were not reversed by Naltrindole. AB - CONCLUSIONS: BW373U86 attenuates global cerebral ischemic injury induced by ACA through both DOR-dependent and DOR-independent mechanisms. CREB might be an important molecule in mediating these neuroprotective effects. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Benzamides) RN - 0 (Neuroprotective Agents) RN - 0 (Piperazines) RN - 150428-54-9 (BW 373U86) RN - 5S6W795CQM (Naltrexone) RN - EC 2-3-1-48 (CREB-Binding Protein) RN - EC 2-3-1-48 (Crebbp protein, rat) RN - G167Z38QA4 (naltrindole) ES - 1873-1570 IL - 0300-9572 DI - S0300-9572(13)00825-3 DO - https://dx.doi.org/10.1016/j.resuscitation.2013.10.022 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0300-9572(13)00825-3 [pii] ID - 10.1016/j.resuscitation.2013.10.022 [doi] PP - ppublish PH - 2013/02/18 [received] PH - 2013/09/21 [revised] PH - 2013/10/22 [accepted] LG - English EP - 20131105 DP - 2014 Feb EZ - 2013/11/10 06:00 DA - 2014/10/21 06:00 DT - 2013/11/09 06:00 YR - 2014 ED - 20141020 RD - 20161125 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24200890 <351. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25123823 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lynch FL AU - McCarty D AU - Mertens J AU - Perrin NA AU - Green CA AU - Parthasarathy S AU - Dickerson JF AU - Anderson BM AU - Pating D FA - Lynch, Frances L FA - McCarty, Dennis FA - Mertens, Jennifer FA - Perrin, Nancy A FA - Green, Carla A FA - Parthasarathy, Sujaya FA - Dickerson, John F FA - Anderson, Bradley M FA - Pating, David IN - Lynch, Frances L. Kaiser Permanente Center for Health Research, 3800 N, Interstate Avenue, Portland, OR 97227, USA. frances.lynch@kpchr.org. TI - Costs of care for persons with opioid dependence in commercial integrated health systems. SO - Addiction Science & Clinical Practice. 9:16, 2014 Aug 14 AS - Addict Sci Clin Pract. 9:16, 2014 Aug 14 NJ - Addiction science & clinical practice VO - 9 PG - 16 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101316917 IO - Addict Sci Clin Pract PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142137 SB - Index Medicus CP - England MH - Adult MH - *Buprenorphine/ec [Economics] MH - *Buprenorphine/tu [Therapeutic Use] MH - Cohort Studies MH - *Combined Modality Therapy/ec [Economics] MH - *Commerce/ec [Economics] MH - *Cost of Illness MH - Counseling/ec [Economics] MH - *Delivery of Health Care, Integrated/ec [Economics] MH - Delivery of Health Care, Integrated/ut [Utilization] MH - Female MH - Health Care Costs/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ec [Economics] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Retrospective Studies MH - United States MH - Utilization Review AB - BACKGROUND: When used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems. AB - METHODS: The objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007-2008 were included. Propensity scores were used to help adjust for group differences. AB - RESULTS: Patients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment=$13,578; vs. mean health care costs with no addiction treatment=$31,055; p<.0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p=.5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p<.001), other medical visits (p=.001), and emergency services (p=.020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p<.001), and had significantly more PC visits (p=.001), other medical visits (p=.005), and mental health visits (p=.002). AB - CONCLUSIONS: Buprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives. RN - 40D3SCR4GZ (Buprenorphine) ES - 1940-0640 IL - 1940-0632 DO - https://dx.doi.org/10.1186/1940-0640-9-16 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 1940-0640-9-16 [pii] ID - 10.1186/1940-0640-9-16 [doi] ID - PMC4142137 [pmc] PP - epublish PH - 2013/07/25 [received] PH - 2014/06/24 [accepted] GI - No: R01 DA016341 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R33 DA035640 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20140814 DP - 2014 Aug 14 EZ - 2014/08/16 06:00 DA - 2014/10/15 06:00 DT - 2014/08/16 06:00 YR - 2014 ED - 20141014 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=25123823 <352. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24628748 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mazer-Amirshahi M AU - Mullins PM AU - Rasooly I AU - van den Anker J AU - Pines JM FA - Mazer-Amirshahi, Maryann FA - Mullins, Peter M FA - Rasooly, Irit FA - van den Anker, John FA - Pines, Jesse M IN - Mazer-Amirshahi, Maryann. The Department of Emergency Medicine, The George Washington University, Washington, DC; The Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC. TI - Rising opioid prescribing in adult U.S. emergency department visits: 2001-2010. CM - Comment in: Acad Emerg Med. 2014 Aug;21(8):946; PMID: 25156157 CM - Comment in: Acad Emerg Med. 2014 Aug;21(8):947; PMID: 25154412 SO - Academic Emergency Medicine. 21(3):236-43, 2014 Mar AS - Acad Emerg Med. 21(3):236-43, 2014 Mar NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 21 IP - 3 PG - 236-43 PI - Journal available in: Print PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Health Care Surveys MH - Humans MH - Hydrocodone/tu [Therapeutic Use] MH - Hydromorphone/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - Morphine/tu [Therapeutic Use] MH - Oxycodone/tu [Therapeutic Use] MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Patient Discharge MH - *Practice Patterns, Physicians'/td [Trends] MH - United States AB - OBJECTIVES: The objective was to describe trends in opioid and nonopioid analgesia prescribing for adults in U.S. emergency departments (EDs) over the past decade. AB - METHODS: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2001 through 2010 were analyzed. ED visits for adult patients (>=18 years of age) during which an analgesic was prescribed were included. Trends in the use of six commonly prescribed opioids, stratified by Drug Enforcement Agency (DEA) schedule, as well as nonopioid analgesics were explored, along with the frequency of pain-related ED visits. For 2005 through 2010, data were further divided by whether the opioid was administered in the ED versus prescribed at discharge. AB - RESULTS: Between 2001 and 2010, the percentage of overall ED visits (pain-related and non-pain-related) where any opioid analgesic was prescribed increased from 20.8% to 31.0%, an absolute increase of 10.2% (95% confidence interval [CI] = 7.0% to 13.4%) and a relative increase of 49.0%. Use of DEA schedule II analgesics increased from 7.6% in 2001 to 14.5% in 2010, an absolute increase of 6.9% (95% CI = 5.2% to 8.5%) and a relative increase of 90.8%. Use of schedule III through V agents increased from 12.6% in 2001 to 15.6% in 2010, an absolute increase of 3.0% (95% CI = 2.0% to 5.7%) and a relative increase of 23.8%. Prescribing of hydrocodone, hydromorphone, morphine, and oxycodone all increased significantly, while codeine and meperidine use declined. Prescribing of nonopioid analgesics was unchanged, 26.2% in 2001 and 27.3% in 2010 (95% CI = -1.0% to 3.4%). Hydromorphone and oxycodone had the greatest increase in ED administration between 2005 and 2010, while oxycodone and hydrocodone had the greatest increases in discharge prescriptions. There was no difference in discharge prescriptions for nonopioid analgesics. The percentage of visits for painful conditions during the period increased from 47.1% in 2001 to 51.1% in 2010, an absolute increase of 4.0% (95% CI = 2.3% to 5.8%). AB - CONCLUSIONS: There has been a dramatic increase in prescribing of opioid analgesics in U.S. EDs in the past decade, coupled with a modest increase in pain-related complaints. Prescribing of nonopioid analgesics did not significantly change. Copyright © 2014 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - 76I7G6D29C (Morphine) RN - CD35PMG570 (Oxycodone) RN - Q812464R06 (Hydromorphone) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12328 PT - Journal Article ID - 10.1111/acem.12328 [doi] PP - ppublish PH - 2013/06/13 [received] PH - 2013/08/20 [revised] PH - 2013/09/25 [revised] PH - 2013/10/10 [accepted] LG - English DP - 2014 Mar EZ - 2014/03/19 06:00 DA - 2014/09/30 06:00 DT - 2014/03/18 06:00 YR - 2014 ED - 20140929 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24628748 <353. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23872995 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bounes V AU - Jouanjus E AU - Roussin A AU - Lapeyre-Mestre M FA - Bounes, Vincent FA - Jouanjus, Emilie FA - Roussin, Anne FA - Lapeyre-Mestre, Maryse IN - Bounes, Vincent. aPharmacoepidemiology, UMR1027, INSERM, Toulouse University III bDepartment of Clinical Pharmacology, Pharmacodependence-Evaluation and Information Center (CEIP-A) cEmergency Department, University Hospital of Toulouse, Toulouse, France. TI - Acute pain management for patients under opioid maintenance treatment: what physicians do in emergency departments?. SO - European Journal of Emergency Medicine. 21(1):73-6, 2014 Feb AS - Eur J Emerg Med. 21(1):73-6, 2014 Feb NJ - European journal of emergency medicine : official journal of the European Society for Emergency Medicine VO - 21 IP - 1 PG - 73-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - cl2, 9442482 IO - Eur J Emerg Med SB - Index Medicus CP - England MH - Acetaminophen/tu [Therapeutic Use] MH - Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use] MH - Buprenorphine/tu [Therapeutic Use] MH - Cross-Sectional Studies MH - Drug Utilization MH - Emergency Service, Hospital MH - Health Care Surveys MH - Humans MH - Methadone/tu [Therapeutic Use] MH - *Opiate Substitution Treatment MH - Pain Management MH - Pain Threshold MH - *Practice Patterns, Physicians' AB - The aim of this study was to analyze the current practices on acute pain management of patients under opioid maintenance treatment (OMT), that is, buprenorphine or methadone. A total of 706 physicians were solicited through a national network to answer a survey about pain perception and analgesic strategies. Among the prescribers, 323 (46%) answered the survey: 131 (40%) physicians estimated that patients under OMT when exposed to an acute painful event feel more pain than other patients and 170 (53%) estimated that the patients felt the same amount of pain. Use of WHO step 1 analgesics was reported by 283 (88%) prescribers [264 (82%) prescribers reported use of paracetamol and 178 (55%) reported use of NSAIDs]. Among the second-line analgesic drugs, the WHO step 3 analgesics (mainly morphine) were the most commonly reported [221 physicians (68%)]. Overall, the results demonstrate the misconceptions of physicians on the pain tolerance of patients under OMT. Clinical studies and evidence-based guidelines are necessary to improve the therapeutic strategies for such patients in an emergency setting. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 362O9ITL9D (Acetaminophen) RN - 40D3SCR4GZ (Buprenorphine) RN - UC6VBE7V1Z (Methadone) ES - 1473-5695 IL - 0969-9546 DO - https://dx.doi.org/10.1097/MEJ.0b013e328363c9e0 PT - Journal Article ID - 10.1097/MEJ.0b013e328363c9e0 [doi] PP - ppublish LG - English DP - 2014 Feb EZ - 2013/07/23 06:00 DA - 2014/09/30 06:00 DT - 2013/07/23 06:00 YR - 2014 ED - 20140929 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=23872995 <354. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24922133 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Davis CS AU - Ruiz S AU - Glynn P AU - Picariello G AU - Walley AY FA - Davis, Corey S FA - Ruiz, Sarah FA - Glynn, Patrick FA - Picariello, Gerald FA - Walley, Alexander Y IN - Davis, Corey S. Corey S. Davis is with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Sarah Ruiz is with the Massachusetts Department of Health, Bureau of Substance Abuse Services, Boston. Patrick Glynn is with the Special Investigations and Narcotics Unit, Quincy, MA, Police Department. Gerald Picariello is with the Revere, MA, Fire Department. Alexander Y. Walley is with the Clinical Addiction Research and Education Unit, Boston University School of Medicine and the Massachusetts Department of Health, Opioid Overdose Prevention Pilot Program, Boston. TI - Expanded access to naloxone among firefighters, police officers, and emergency medical technicians in Massachusetts. SO - American Journal of Public Health. 104(8):e7-9, 2014 Aug AS - Am J Public Health. 104(8):e7-9, 2014 Aug NJ - American journal of public health VO - 104 IP - 8 PG - e7-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 1254074, 3xw IO - Am J Public Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103249 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - Drug Overdose/dt [Drug Therapy] MH - Emergencies MH - *Emergency Medical Technicians MH - *Firefighters MH - Humans MH - Massachusetts MH - *Naloxone/sd [Supply & Distribution] MH - Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/sd [Supply & Distribution] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Police AB - Naloxone is a medication that reverses respiratory depression from opioid overdose if given in time. Paramedics routinely administer naloxone to opioid overdose victims in the prehospital setting, and many states are moving to increase access to the medication. Several jurisdictions have expanded naloxone administration authority to nonparamedic first responders, and others are considering that step. We report here on policy change in Massachusetts, where several communities have equipped emergency medical technicians, law enforcement officers, and firefighters with naloxone. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1541-0048 IL - 0090-0036 DO - https://dx.doi.org/10.2105/AJPH.2014.302062 PT - Journal Article ID - 10.2105/AJPH.2014.302062 [doi] ID - PMC4103249 [pmc] PP - ppublish LG - English EP - 20140612 DP - 2014 Aug EZ - 2014/06/13 06:00 DA - 2014/09/27 06:00 DT - 2014/06/13 06:00 YR - 2014 ED - 20140926 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24922133 <355. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24436437 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Jann M AU - Kennedy WK AU - Lopez G FA - Jann, Michael FA - Kennedy, William Klugh FA - Lopez, Gaylord IN - Jann, Michael. Mercer University, Atlanta, GA, USA. TI - Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. SO - Journal of Pharmacy Practice. 27(1):5-16, 2014 Feb AS - J Pharm Pract. 27(1):5-16, 2014 Feb NJ - Journal of pharmacy practice VO - 27 IP - 1 PG - 5-16 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8900945 IO - J Pharm Pract SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/pk [Pharmacokinetics] MH - Benzodiazepines/ad [Administration & Dosage] MH - *Benzodiazepines/ae [Adverse Effects] MH - Benzodiazepines/pk [Pharmacokinetics] MH - Drug Interactions MH - Drug Overdose MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Humans MH - Practice Patterns, Physicians'/st [Standards] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Prescription Drug Misuse MH - Respiratory Insufficiency/ci [Chemically Induced] MH - Respiratory Insufficiency/pp [Physiopathology] MH - United States KW - benzodiazepines; opioid analgesics; overdose; prescription drugs; unintentional AB - The misuse and abuse of prescription medications in the United States continues to increase despite interventions by health care professionals, regulatory, and law enforcement agencies. Opioid analgesics are the leading class of prescription drugs that have caused unintentional overdose deaths. Benzodiazepines when taken alone are relatively safe agents in overdose. However, a 5-fold increase in deaths attributed to benzodiazepines occurred from 1999 to 2009. Emergency department visits related to opioid analgesics increased by 111% followed by benzodiazepines 89%. During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. The combination prescribing of benzodiazepines and opioid analgesics commonly takes place. The pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex. The pharmacodynamic actions of these agents differ as their combined effects produce significant respiratory depression. Physician and pharmacy shopping by patients occurs, and prescription drug-monitoring programs can provide important information on benzodiazepine and opioid analgesic prescribing patterns and patient usage. Health care professionals need to inform patients and work closely with regulatory agencies and legislatures to stem the increasing fatalities from prescription drug unintentional overdoses. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) ES - 1531-1937 IL - 0897-1900 DO - https://dx.doi.org/10.1177/0897190013515001 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 27/1/5 [pii] ID - 10.1177/0897190013515001 [doi] PP - ppublish LG - English DP - 2014 Feb EZ - 2014/01/18 06:00 DA - 2014/09/16 06:00 DT - 2014/01/18 06:00 YR - 2014 ED - 20140915 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24436437 <356. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24106748 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wieder R AU - Delarosa N AU - Bryan M AU - Hill AM AU - Amadio WJ FA - Wieder, Robert FA - Delarosa, Nila FA - Bryan, Margarette FA - Hill, Ann Marie FA - Amadio, William J IN - Wieder, Robert. Department of Medicine and the New Jersey Medical School Cancer Center, Rutgers New Jersey Medical School, Newark, New Jersey, USA. TI - Prescription coverage in indigent patients affects the use of long-acting opioids in the management of cancer pain. SO - Pain Medicine. 15(1):42-51, 2014 Jan AS - PAIN MED. 15(1):42-51, 2014 Jan NJ - Pain medicine (Malden, Mass.) VO - 15 IP - 1 PG - 42-51 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947034 OI - Source: NLM. NIHMS520473 SB - Index Medicus CP - England MH - Adult MH - Alcoholism/ep [Epidemiology] MH - *Chronic Pain/dt [Drug Therapy] MH - Delayed-Action Preparations MH - Drug Utilization MH - Ethnic Groups MH - Female MH - Hospitals, University/ec [Economics] MH - Hospitals, University/sn [Statistics & Numerical Data] MH - Humans MH - *Insurance, Pharmaceutical Services/sn [Statistics & Numerical Data] MH - Male MH - Medicaid MH - *Medical Indigency MH - Medication Adherence MH - Middle Aged MH - Minority Groups MH - Narcotics/ec [Economics] MH - *Narcotics/tu [Therapeutic Use] MH - *Neoplasms/pp [Physiopathology] MH - Neoplasms/th [Therapy] MH - New Jersey/ep [Epidemiology] MH - *Pain Management/ec [Economics] MH - Pain Measurement MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Smoking/ep [Epidemiology] MH - Substance-Related Disorders/ep [Epidemiology] MH - United States MH - Urban Population KW - Analgesic; Cancer Pain; Disparities; Ethnic; Indigent; Narcotics; Pain Management; Racial AB - PURPOSE: We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain. AB - MATERIALS AND METHODS: We conducted a chart review of 360 patients treated in the Oncology Practice at University of Medicine and Dentistry of New Jersey University Hospital, who were prescribed opiate pain medications. Half the patients were charity care or self-pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow-up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled emergency department visits, and unscheduled hospitalizations. AB - RESULTS: There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use, and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups. AB - CONCLUSION: Appropriate use of long-acting opiates for equivalent levels of cancer pain was influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients. Copyright Wiley Periodicals, Inc. RN - 0 (Delayed-Action Preparations) RN - 0 (Narcotics) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/pme.12238 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - 10.1111/pme.12238 [doi] ID - PMC3947034 [pmc] ID - NIHMS520473 [mid] PP - ppublish GI - No: U10 CA128506 Organization: (CA) *NCI NIH HHS* Country: United States GI - No: 1U10CA128506 Organization: (CA) *NCI NIH HHS* Country: United States LG - English EP - 20130923 DP - 2014 Jan EZ - 2013/10/11 06:00 DA - 2014/09/13 06:00 DT - 2013/10/11 06:00 YR - 2014 ED - 20140912 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24106748 <357. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24750050 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Telfer P AU - Bahal N AU - Lo A AU - Challands J FA - Telfer, Paul FA - Bahal, Nawal FA - Lo, Alice FA - Challands, Joanne IN - Telfer, Paul. Department of Haematology, Royal London Hospital, Barts Health NHS Trust, London, UK. TI - Management of the acute painful crisis in sickle cell disease- a re-evaluation of the use of opioids in adult patients. [Review] SO - British Journal of Haematology. 166(2):157-64, 2014 Jul AS - Br J Haematol. 166(2):157-64, 2014 Jul NJ - British journal of haematology VO - 166 IP - 2 PG - 157-64 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - axc, 0372544 IO - Br. J. Haematol. SB - Index Medicus CP - England MH - *Acute Pain/dt [Drug Therapy] MH - Acute Pain/ep [Epidemiology] MH - *Acute Pain/et [Etiology] MH - Adolescent MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Anemia, Sickle Cell/co [Complications] MH - Anemia, Sickle Cell/ep [Epidemiology] MH - England/ep [Epidemiology] MH - Evidence-Based Medicine/mt [Methods] MH - Humans MH - Pain Management/mt [Methods] MH - Patient Satisfaction MH - Transition to Adult Care KW - fentanyl; morphine; oxycodone; pain; sickle AB - Management of the acute painful crisis (APC) of sickle cell disease (SCD) remains unsatisfactory despite advances in the understanding and management of acute pain in other clinical settings. One reason for this is an unsophisticated approach to the use of opioid analgesics for pain management. This applies to haematologists who are responsible for developing acute sickle pain management protocols for their patients, and to health care staff in the acute care setting. The objective of this article is to evaluate the evidence for use of opioids in APC management. We have highlighted the possibilities for improving management by using alternatives to morphine, and intranasal (IN) or transmucosal routes of administration for rapid onset of analgesia in the emergency department (ED). We suggest how experience gained in managing acute sickle pain in children could be extrapolated to adolescents and young adults. We have also questioned whether patients given strong opioids in the acute setting are being safely monitored and what resources are required to ensure efficacy, safety and patient satisfaction. We also identify aspects of care where there are significant differences of opinion, which require further study by randomized controlled trial. Copyright © 2014 John Wiley & Sons Ltd. RN - 0 (Analgesics, Opioid) ES - 1365-2141 IL - 0007-1048 DO - https://dx.doi.org/10.1111/bjh.12879 PT - Journal Article PT - Review ID - 10.1111/bjh.12879 [doi] PP - ppublish PH - 2013/12/13 [received] PH - 2014/02/10 [accepted] LG - English EP - 20140418 DP - 2014 Jul EZ - 2014/04/23 06:00 DA - 2014/09/12 06:00 DT - 2014/04/23 06:00 YR - 2014 ED - 20140911 RD - 20140702 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24750050 <358. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24130046 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Davis JM AU - Severtson SG AU - Bucher-Bartelson B AU - Dart RC FA - Davis, Jonathan M FA - Severtson, Stevan G FA - Bucher-Bartelson, Becki FA - Dart, Richard C IN - Davis, Jonathan M. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA. TI - Using poison center exposure calls to predict prescription opioid abuse and misuse-related emergency department visits. SO - Pharmacoepidemiology & Drug Safety. 23(1):18-25, 2014 Jan AS - Pharmacoepidemiol Drug Saf. 23(1):18-25, 2014 Jan NJ - Pharmacoepidemiology and drug safety VO - 23 IP - 1 PG - 18-25 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - d0r, 9208369 IO - Pharmacoepidemiol Drug Saf SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - *Emergency Service, Hospital/td [Trends] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/di [Diagnosis] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Poison Control Centers/td [Trends] MH - Population Surveillance/mt [Methods] MH - Predictive Value of Tests MH - *Prescription Drug Misuse/td [Trends] MH - Prescription Drugs/ae [Adverse Effects] MH - *Prescription Drugs/tu [Therapeutic Use] MH - Young Adult KW - emergency department visits; pharmacoepidemiology; poison center calls; prescription drug abuse AB - BACKGROUND: Prescription drug abuse is a critical problem in the USA and has been linked to more deaths than automobile accidents. Despite this growing epidemic, the USA lacks a timely early warning system. Poison centers (PCs) have the potential to act as sentinel reporting entities for prescription drug abuse and misuse due to near-real-time data reporting and abundant coverage in the USA. AB - METHODS: Data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System PC program were compared with data from the Drug Abuse Warning Network (DAWN) from 2004 through 2010. Population rates of PC call mentions regarding abuse and misuse of prescription opioids were compared with population rates of emergency department visit mentions of the same using linear regression. Products included in the analysis were the following: buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone. AB - RESULTS: The strength of association between RADARS System PC data and DAWN emergency department visits regarding all opioids in aggregate was strong (R2 =0.81, p<0.001). The correlations between the two programs at the drug class level also were strong for buprenorphine, hydrocodone, hydromorphone, methadone, and oxycodone (all R2>0.70, all p<0.01), significant for fentanyl (p=0.05), and moderate for morphine (p=0.09). AB - CONCLUSIONS: Data on prescription opioid drug abuse from the RADARS System PC program correlates well with emergency room data from DAWN. Due to timeliness of data, geographic coverage and strong associations with other warning systems, PC data can be used for sentinel reporting on prescription drug abuse and misuse in the USA. Copyright © 2013 John Wiley & Sons, Ltd. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1099-1557 IL - 1053-8569 DO - https://dx.doi.org/10.1002/pds.3533 PT - Journal Article ID - 10.1002/pds.3533 [doi] PP - ppublish PH - 2013/05/09 [received] PH - 2013/09/04 [revised] PH - 2013/09/23 [accepted] LG - English EP - 20131016 DP - 2014 Jan EZ - 2013/10/17 06:00 DA - 2014/09/03 06:00 DT - 2013/10/17 06:00 YR - 2014 ED - 20140902 RD - 20140107 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24130046 <359. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24134543 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Brown KM AU - Hirshon JM AU - Alcorta R AU - Weik TS AU - Lawner B AU - Ho S AU - Wright JL FA - Brown, Kathleen M FA - Hirshon, Jon Mark FA - Alcorta, Richard FA - Weik, Tasmeen S FA - Lawner, Ben FA - Ho, Shiu FA - Wright, Joseph L IN - Brown, Kathleen M. from the Department of Pediatrics and Emergency Medicine, George Washington School of Medicine , Washington, DC (KMB) ; Emergency Department, Children's National Medical Center , Washington, DC (KMB) ; Maryland Institute for Emergency Medical Services Systems , Baltimore, Maryland (RA) ; Health Resources and Services Administration/Maternal and Child Health Bureau , Rockville, Maryland (TSW) ; Department of Emergency Medicine, University of Maryland School of Medicine , Baltimore, Maryland (BL) ; Baltimore City Fire Department , Baltimore Maryland (BL) ; Shock Trauma and Anesthesiology Research-Organized Research Center, University of Maryland School of Medicine , Baltimore Maryland (SH) ; Department of Pediatrics, Emergency Medicine, and Health Policy, George Washington University School of Medicine and Public Health , Washington, DC (JLW) ; Child Health Advocacy Institute, Children's National Medical Center , Washington, DC (JLW) ; and Department of Emergency Medicine, Department of Epidemiology and Public Health, University of Maryland , Baltimore, Maryland (JMH) . TI - The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services. SO - Prehospital Emergency Care. 18 Suppl 1:45-51, 2014 AS - Prehosp Emerg Care. 18 Suppl 1:45-51, 2014 NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 18 Suppl 1 PG - 45-51 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - *Acute Pain/dt [Drug Therapy] MH - Acute Pain/et [Etiology] MH - Adolescent MH - Adult MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/st [Standards] MH - Burns/co [Complications] MH - *Burns/dt [Drug Therapy] MH - Clinical Protocols MH - Emergency Medical Services/mt [Methods] MH - Emergency Medical Services/og [Organization & Administration] MH - *Emergency Medical Services/st [Standards] MH - Evidence-Based Emergency Medicine/mt [Methods] MH - Evidence-Based Emergency Medicine/og [Organization & Administration] MH - *Evidence-Based Emergency Medicine/st [Standards] MH - Female MH - Humans MH - Male MH - Maryland MH - Middle Aged MH - *Morphine/ad [Administration & Dosage] MH - Morphine/st [Standards] MH - Pain Management/mt [Methods] MH - *Pain Management/st [Standards] MH - Pain Measurement/mt [Methods] MH - Pain Measurement/st [Standards] MH - Pain Measurement/ut [Utilization] MH - Practice Guidelines as Topic/st [Standards] MH - Program Development MH - Program Evaluation MH - Sex Distribution MH - Wounds and Injuries/co [Complications] MH - *Wounds and Injuries/dt [Drug Therapy] MH - Young Adult AB - BACKGROUND: In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. AB - METHODS: An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. AB - RESULTS: No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. AB - CONCLUSIONS: We demonstrated that the implementation of a revised statewide prehospital pain management protocol based on an EBG developed using the National Prehospital Evidence-based Guideline Model Process was associated with an increase in dosing of narcotic pain medication consistent with that recommended by the EBG. No differences were seen in the percentage of patients receiving opiate analgesia or in the documentation of pain scores. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2013.831510 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.3109/10903127.2013.831510 [doi] PP - ppublish LG - English EP - 20131017 DP - 2014 EZ - 2013/10/19 06:00 DA - 2014/08/26 06:00 DT - 2013/10/19 06:00 YR - 2014 ED - 20140825 RD - 20131216 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24134543 <360. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24807739 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Harlow W AU - Happell B AU - Browne G AU - Browne M FA - Harlow, Warren FA - Happell, Brenda FA - Browne, Graeme FA - Browne, Matthew IN - Harlow, Warren. Central Queensland University Australia, Institute for Health and Social Science Research, Building 5, Bruce Highway Rockhampton, Qld 4702, Australia. Email: . IN - Happell, Brenda. Central Queensland University Australia, Institute for Health and Social Science Research, Building 5, Bruce Highway Rockhampton, Qld 4702, Australia. Email: . IN - Browne, Graeme. University of Newcastle Port Macquarie, University Drive, Callaghan, NSW 2308, Australia. Email: IN - Browne, Matthew. Central Queensland University Australia, Institute for Health and Social Science Research, Building 5, Bruce Highway Rockhampton, Qld 4702, Australia. Email: . TI - Can monitoring consumer requests for opioid-replacement therapy improve access to treatment?. SO - Australian Health Review. 38(3):312-7, 2014 Jun AS - Aust Health Rev. 38(3):312-7, 2014 Jun NJ - Australian health review : a publication of the Australian Hospital Association VO - 38 IP - 3 PG - 312-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 9gc, 8214381 IO - Aust Health Rev SB - Health Administration Journals CP - Australia MH - Female MH - *Health Services Accessibility MH - Humans MH - Male MH - *Opiate Substitution Treatment MH - Queensland MH - Retrospective Studies MH - Statistics as Topic MH - Substance Abuse Treatment Centers MH - *Substance-Related Disorders/dt [Drug Therapy] MH - Triage/sn [Statistics & Numerical Data] MH - Triage/td [Trends] AB - OBJECTIVE: This study examined data recorded by one urban publicly funded opioid-replacement therapy clinic (from 2009 to 2011) to identify whether these data could be used to inform the rostering of clinicians more effectively to improve access to treatment. AB - METHODS: Data analysis incorporated descriptive and inferential methods. AB - RESULTS: There were trends in the times of the year consumers seek opioid-replacement therapy, similarity and differences between gender requests for treatment and variation in consumer wait time on triage. AB - CONCLUSIONS: National reporting of opioid-replacement therapy triages would help gain a better understanding of the number of people in need of treatment. If opioid-replacement therapy providers monitored consumer triages, they could roster more effectively, have gender-specific clinicians available, acknowledge and inform consumers of wait time on triage and allow re-orientation of services to lower wait time. IS - 0156-5788 IL - 0156-5788 DO - https://dx.doi.org/10.1071/AH13212 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - AH13212 [pii] ID - 10.1071/AH13212 [doi] PP - ppublish PH - 2013/11/01 [received] PH - 2014/01/28 [accepted] LG - English DP - 2014 Jun EZ - 2014/05/09 06:00 DA - 2014/08/22 06:00 DT - 2014/05/09 06:00 YR - 2014 ED - 20140821 RD - 20140610 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24807739 <361. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23846749 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chang AK AU - Bijur PE AU - Davitt M AU - Gallagher EJ FA - Chang, Andrew K FA - Bijur, Polly E FA - Davitt, Michelle FA - Gallagher, E John IN - Chang, Andrew K. Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. achang3@yahoo.com TI - Randomized clinical trial of an intravenous hydromorphone titration protocol versus usual care for management of acute pain in older emergency department patients. SO - Drugs & Aging. 30(9):747-54, 2013 Sep AS - Drugs Aging. 30(9):747-54, 2013 Sep NJ - Drugs & aging VO - 30 IP - 9 PG - 747-54 PI - Journal available in: Print PI - Citation processed from: Internet JC - bek, 9102074 IO - Drugs Aging PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758665 OI - Source: NLM. NIHMS505111 SB - Index Medicus CP - New Zealand MH - *Acute Pain/dt [Drug Therapy] MH - Administration, Intravenous MH - Aged MH - *Emergency Service, Hospital MH - Female MH - Humans MH - *Hydromorphone/ad [Administration & Dosage] MH - Hydromorphone/ae [Adverse Effects] MH - *Hydromorphone/tu [Therapeutic Use] MH - Male MH - Time Factors AB - BACKGROUND AND OBJECTIVES: Opioid titration is an effective strategy for treating pain; however, titration is generally impractical in the busy emergency department (ED) setting. Our objective was to test a rapid, two-step, hydromorphone titration protocol against usual care in older patients presenting to the ED with acute severe pain. AB - METHODS: This was a prospective, randomized clinical trial of patients 65 years of age and older presenting to an adult, urban, academic ED with acute severe pain. The study was registered at http://www.clinicaltrials.gov (NCT01429285). Patients randomized to the hydromorphone titration protocol initially received 0.5 mg intravenous hydromorphone. Patients randomized to usual care received any dose of any intravenous opioid. At 15 min, patients in both groups were asked, 'Do you want more pain medication?' Patients in the hydromorphone titration group who answered 'yes' received a second dose of 0.5 mg intravenous hydromorphone. Patients in the usual care group who answered 'yes' had their ED attending physician notified, who then could administer any (or no) additional medication. The primary efficacy outcome was satisfactory analgesia defined a priori as the patient declining additional analgesia at least once when asked at 15 or 60 min after administration of the initial opioid. Dose was calculated in morphine equivalent units (MEU: 1 mg hydromorphone = 7 mg morphine). The need for naloxone to reverse adverse opioid effects was the primary safety outcome. AB - RESULTS: 83.0 % of 153 patients in the hydromorphone titration group achieved satisfactory analgesia compared with 82.5 % of 166 patients in the usual care group (p = 0.91). Patients in the hydromorphone titration group received lower mean initial doses of opioids at baseline than patients in the usual care group (3.5 MEU vs. 4.7 MEU, respectively; p <= 0.001) and lower total opioids through 60 min (5.3 MEU vs. 6.0 MEU; p = 0.03). No patient needed naloxone. AB - CONCLUSIONS: Low-dose titration of intravenous hydromorphone in increments of 0.5 mg provides comparable analgesia to usual care with less opioid over 60 min. RN - Q812464R06 (Hydromorphone) ES - 1179-1969 IL - 1170-229X DO - https://dx.doi.org/10.1007/s40266-013-0103-y PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural ID - 10.1007/s40266-013-0103-y [doi] ID - PMC3758665 [pmc] ID - NIHMS505111 [mid] PP - ppublish SI - ClinicalTrials.gov SA - ClinicalTrials.gov/NCT01429285 SL - https://clinicaltrials.gov/search/term=NCT01429285 GI - No: K23 AG033100 Organization: (AG) *NIA NIH HHS* Country: United States GI - No: K23 AG033100-01A2 Organization: (AG) *NIA NIH HHS* Country: United States LG - English DP - 2013 Sep EZ - 2013/07/13 06:00 DA - 2014/08/15 06:00 DT - 2013/07/13 06:00 YR - 2013 ED - 20140813 RD - 20161215 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23846749 <362. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23925802 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Simon L FA - Simon, Lorna IN - Simon, Lorna. Center for Mental Health Services Research, University of Massachusetts Medical School, Worcester, MA, 01655, USA, Lorna.simon@umassmed.edu. TI - Capsule commentary on Joynt et al., The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. CM - Comment on: J Gen Intern Med. 2013 Dec;28(12):1604-10; PMID: 23797920 SO - Journal of General Internal Medicine. 28(12):1647, 2013 Dec AS - J Gen Intern Med. 28(12):1647, 2013 Dec NJ - Journal of general internal medicine VO - 28 IP - 12 PG - 1647 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8605834 IO - J Gen Intern Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832712 SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ec [Economics] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Continental Population Groups/eh [Ethnology] MH - *Emergency Service, Hospital/ec [Economics] MH - Female MH - Humans MH - Male MH - *Practice Patterns, Physicians'/ec [Economics] MH - *Residence Characteristics RN - 0 (Analgesics, Opioid) ES - 1525-1497 IL - 0884-8734 DO - https://dx.doi.org/10.1007/s11606-013-2547-5 PT - Comment PT - Journal Article ID - 10.1007/s11606-013-2547-5 [doi] ID - PMC3832712 [pmc] PP - ppublish LG - English DP - 2013 Dec EZ - 2013/08/09 06:00 DA - 2014/08/13 06:00 DT - 2013/08/09 06:00 YR - 2013 ED - 20140812 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23925802 <363. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23797920 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Joynt M AU - Train MK AU - Robbins BW AU - Halterman JS AU - Caiola E AU - Fortuna RJ FA - Joynt, Michael FA - Train, Meghan K FA - Robbins, Brett W FA - Halterman, Jill S FA - Caiola, Enrico FA - Fortuna, Robert J TI - The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. CM - Comment in: J Gen Intern Med. 2013 Dec;28(12):1647; PMID: 23925802 SO - Journal of General Internal Medicine. 28(12):1604-10, 2013 Dec AS - J Gen Intern Med. 28(12):1604-10, 2013 Dec NJ - Journal of general internal medicine VO - 28 IP - 12 PG - 1604-10 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8605834 IO - J Gen Intern Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832731 SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/ec [Economics] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Continental Population Groups/eh [Ethnology] MH - Cross-Sectional Studies MH - *Emergency Service, Hospital/ec [Economics] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Pain/dt [Drug Therapy] MH - Pain/ec [Economics] MH - Pain/eh [Ethnology] MH - Poverty/ec [Economics] MH - Poverty/eh [Ethnology] MH - *Practice Patterns, Physicians'/ec [Economics] MH - *Residence Characteristics MH - Social Class MH - United States/eh [Ethnology] MH - Young Adult AB - BACKGROUND: Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. AB - OBJECTIVES: (1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine if racial disparities in opioid prescribing persist after accounting for SES. AB - DESIGN: We used cross-sectional data from the National Hospital Ambulatory Medical Care Survey between 2006 and 2009 to examine the prescribing of opioids to patients presenting with moderate to severe pain (184 million visits). We used logistic regression to examine the association between the prescribing of opioids, SES, and race. Models were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region. AB - MAIN MEASURES: Our primary outcome measure was whether an opioid was prescribed during a visit for moderate to severe pain. SES was determined based on income, percent poverty, and educational level within a patient's zip code. AB - RESULTS: Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001), household income (47.3 % vs. 40.7 %, P<0.001), and educational level (46.3 % vs. 42.5 %, P=0.01). Black patients were prescribed opioids less frequently than white patients across all measures of SES. In adjusted models, black patients (AOR 0.73; 95 % CI 0.66-0.81) and patients from poorer areas (AOR 0.76; 95 % CI 0.68-0.86) were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates. AB - CONCLUSIONS: Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas. Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES. RN - 0 (Analgesics, Opioid) ES - 1525-1497 IL - 0884-8734 PT - Journal Article ID - 10.1007/s11606-013-2516-z [doi] ID - PMC3832731 [pmc] PP - ppublish PH - 2012/12/07 [received] PH - 2013/05/15 [accepted] PH - 2013/04/12 [revised] LG - English DP - 2013 Dec EZ - 2013/06/26 06:00 DA - 2014/08/13 06:00 DT - 2013/06/26 06:00 YR - 2013 ED - 20140812 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23797920 <364. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24738737 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Even KM AU - Armsby CC AU - Bateman ST FA - Even, K M FA - Armsby, C C FA - Bateman, S T IN - Even, K M. University of Massachusetts Medical School , Worcester, MA , USA. TI - Poisonings requiring admission to the pediatric intensive care unit: A 5-year review. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 52(5):519-24, 2014 Jun AS - Clin Toxicol (Phila). 52(5):519-24, 2014 Jun NJ - Clinical toxicology (Philadelphia, Pa.) VO - 52 IP - 5 PG - 519-24 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Academic Medical Centers MH - Accidents/sn [Statistics & Numerical Data] MH - Adolescent MH - Age Distribution MH - *Antidotes/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - Drug Overdose MH - Electronic Health Records MH - Female MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Infant MH - *Intensive Care Units, Pediatric/sn [Statistics & Numerical Data] MH - Length of Stay MH - Male MH - New England MH - *Poisoning/ep [Epidemiology] MH - *Respiration, Artificial/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Suicide, Attempted/sn [Statistics & Numerical Data] KW - Drug overdose; Pediatric intensive care unit; Poisoning; Polypharmacy; Suicide AB - BACKGROUND: Poisonings represent a significant number of preventable admissions to the pediatric intensive care unit (PICU), but data about poisonings requiring PICU-level care are limited. AB - OBJECTIVES: To identify the demographics of patients admitted with poisonings and characterize their clinical courses related to their poisoning. AB - METHODS: All poisonings over a 5-year period (2008-2012) at an academic medical center in New England were retrospectively reviewed using electronic medical records in an observational case series. Poisonings were identified using key search terms within an admissions database. AB - RESULTS: There were 273 admissions for poisonings, which represent 8% of total PICU admissions over this time period. The poisonings were unintentional in 148 (54%) cases and intentional in 125 (46%). The vast majority of poisonings occurred in patients either 3 years or below (N = 121, 44%) or 13 years or above (N = 124, 45%). Most (96%) admissions were for less than 48 h and 41% were for less than 24 h. Mean PICU length of stay was 1.2 + 0.7 days. A total of 468 substances were ingested in 54 different drug classes, with analgesics and antidepressants being the most common. Eighty-five (31%) poisonings were polypharmaceutical. The most commonly used therapies were naloxone, activated charcoal, and benzodiazepines. Twenty-seven patients (10%) received mechanical ventilation. There was one fatality, an adolescent with a polypharmacy overdose in a suicide attempt. AB - CONCLUSION: Pediatric poisonings are a significant percentage of admissions to the PICU. The majority of poisonings are non-fatal, require supportive care, close monitoring, and some specific treatment. Drug classes causing poisonings have changed to a higher percentage of opioids in younger patients and atypical antidepressants in adolescents. RN - 0 (Antidotes) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.3109/15563650.2014.909601 PT - Journal Article ID - 10.3109/15563650.2014.909601 [doi] PP - ppublish LG - English EP - 20140417 DP - 2014 Jun EZ - 2014/04/18 06:00 DA - 2014/08/07 06:00 DT - 2014/04/18 06:00 YR - 2014 ED - 20140806 RD - 20140610 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24738737 <365. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24726759 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Beaudoin FL AU - Straube S AU - Lopez J AU - Mello MJ AU - Baird J FA - Beaudoin, Francesca L FA - Straube, Steven FA - Lopez, Jason FA - Mello, Michael J FA - Baird, Janette IN - Beaudoin, Francesca L. Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA. Electronic address: flb@brown.edu. IN - Straube, Steven. Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA. IN - Lopez, Jason. Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA. IN - Mello, Michael J. Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA. IN - Baird, Janette. Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA. TI - Prescription opioid misuse among ED patients discharged with opioids. SO - American Journal of Emergency Medicine. 32(6):580-5, 2014 Jun AS - Am J Emerg Med. 32(6):580-5, 2014 Jun NJ - The American journal of emergency medicine VO - 32 IP - 6 PG - 580-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Patient Discharge/sn [Statistics & Numerical Data] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Prospective Studies MH - Risk Factors MH - Young Adult AB - STUDY OBJECTIVES: The purposes of this study were to determine the prevalence of prescription opioid misuse in a cohort of discharged emergency department (ED) patients who received prescription opioids and to examine factors predictive of misuse. AB - METHODS: This prospective observational study enrolled a sample of ED patients aged 18 to 55 years who were discharged with a prescription opioid. Participants completed surveys at baseline in the ED, then 3 and 30 days later. Follow-up surveys contained questions about opioid use and misuse, including screening questions from the National Epidemiologic Survey on Alcohol and Related Conditions. Patients were categorized as misusers if they (1) self-escalated their dose, (2) obtained additional prescription opioids without a prescription, or (3) used for a reason besides pain. AB - RESULTS: Of the 85 patients who completed follow-ups, 36 (42%) reported misuse at either 3 or 30 days. There was no difference in demographic variables, pain scores, analgesic treatment, or discharge diagnoses between misusers and nonmisusers. Self-escalation of dose was the most common category of misuse (33/36; 92%). Taking prescription opioids without a doctor's prescription was reported by 39% (14/36), and taking pain medications for a reason other than pain was reported by 36% (13/36). The presence of disability, chronic pain, preexisting prescription opioid use, oxycodone use, and past 12-month risk of substance abuse were associated with misuse. AB - CONCLUSIONS: Prescription opioid misuse was prevalent among this cohort of ED patients. A heterogeneous mixture of behaviors was captured. Future research should focus on the etiologies of misuse with directed screening and interventions to decrease misuse. Copyright © 2014 Elsevier Inc. All rights reserved. ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(14)00121-1 DO - https://dx.doi.org/10.1016/j.ajem.2014.02.030 PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - S0735-6757(14)00121-1 [pii] ID - 10.1016/j.ajem.2014.02.030 [doi] PP - ppublish PH - 2013/12/23 [received] PH - 2014/01/29 [revised] PH - 2014/02/19 [accepted] LG - English EP - 20140226 DP - 2014 Jun EZ - 2014/04/15 06:00 DA - 2014/08/05 06:00 DT - 2014/04/15 06:00 YR - 2014 ED - 20140804 RD - 20140530 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24726759 <366. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23994199 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kapadia VS AU - Wyckoff MH FA - Kapadia, Vishal S FA - Wyckoff, Myra H IN - Kapadia, Vishal S. Department of Pediatrics, Division of Neonatal-Perinatal Medicine, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA. Electronic address: vishal.kapadia@utsouthwestern.edu. TI - Drugs during delivery room resuscitation--what, when and why?. [Review] SO - Seminars In Fetal & Neonatal Medicine. 18(6):357-61, 2013 Dec AS - Semin Fetal Neonatal Med. 18(6):357-61, 2013 Dec NJ - Seminars in fetal & neonatal medicine VO - 18 IP - 6 PG - 357-61 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101240003 IO - Semin Fetal Neonatal Med SB - Index Medicus CP - Netherlands MH - Asphyxia Neonatorum/dt [Drug Therapy] MH - *Asphyxia Neonatorum/th [Therapy] MH - *Epinephrine/tu [Therapeutic Use] MH - Humans MH - Infant, Newborn MH - *Resuscitation/mt [Methods] MH - *Vasoconstrictor Agents/tu [Therapeutic Use] KW - Adrenaline; Asphyxia; Cardiopulmonary resuscitation; Epinephrine; Neonatal resuscitation; Volume infusion AB - Although seldom needed, the short list of medications used for delivery room resuscitation of the newborn includes epinephrine and volume expanders. Naloxone, sodium bicarbonate and the use of other vasopressors are no longer considered helpful during acute resuscitation and are more often administered in the post-resuscitative period under special circumstances. This review examines the existing literature for the two commonly used medications in neonatal resuscitation and identifies the many knowledge gaps requiring further research. Copyright © 2013 Elsevier Ltd. All rights reserved. RN - 0 (Vasoconstrictor Agents) RN - YKH834O4BH (Epinephrine) ES - 1878-0946 IL - 1744-165X DI - S1744-165X(13)00064-4 DO - https://dx.doi.org/10.1016/j.siny.2013.08.001 PT - Journal Article PT - Review ID - S1744-165X(13)00064-4 [pii] ID - 10.1016/j.siny.2013.08.001 [doi] PP - ppublish LG - English EP - 20130830 DP - 2013 Dec EZ - 2013/09/03 06:00 DA - 2014/08/01 06:00 DT - 2013/09/03 06:00 YR - 2013 ED - 20140731 RD - 20131119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23994199 <367. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24937916 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Goodloe JM FA - Goodloe, Jeffrey M TI - Not so fast on naloxone? There's growing support for non-paramedic use, but keep these cautions in mind. SO - EMS world. 43(5):51-2, 2014 May AS - EMS World. 43(5):51-2, 2014 May NJ - EMS world VO - 43 IP - 5 PG - 51-2 PI - Journal available in: Print PI - Citation processed from: Print JC - 101547538 IO - EMS World SB - Health Administration Journals CP - United States MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Substance-Related Disorders/dt [Drug Therapy] MH - United States RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 2158-7833 IL - 2158-7833 PT - Journal Article PP - ppublish LG - English DP - 2014 May EZ - 2014/06/19 06:00 DA - 2014/07/30 06:00 DT - 2014/06/19 06:00 YR - 2014 ED - 20140729 RD - 20150602 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24937916 <368. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24178902 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wiegand T AU - Wax P AU - Smith E AU - Hart K AU - Brent J FA - Wiegand, Timothy FA - Wax, Paul FA - Smith, Eric FA - Hart, Katherine FA - Brent, Jeffrey IN - Wiegand, Timothy. The University of Rochester Medical Center and Strong Memorial Hospital, Rochester, USA, Timothy_Wiegand@URMC.Rochester.edu. TI - The Toxicology Investigators Consortium Case Registry--the 2012 experience. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 9(4):380-404, 2013 Dec AS - J Med Toxicol. 9(4):380-404, 2013 Dec NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 9 IP - 4 PG - 380-404 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3846972 SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Australia/ep [Epidemiology] MH - Canada/ep [Epidemiology] MH - Child MH - Child, Preschool MH - Cooperative Behavior MH - Data Mining MH - Female MH - Humans MH - Infant MH - International Cooperation MH - Israel/ep [Epidemiology] MH - Male MH - Middle Aged MH - Poisoning/di [Diagnosis] MH - Poisoning/mo [Mortality] MH - Poisoning/th [Therapy] MH - *Poisoning MH - *Registries MH - Risk Factors MH - Societies, Medical MH - Time Factors MH - *Toxicology/td [Trends] MH - Treatment Outcome MH - United States MH - Young Adult AB - In 2010, the American College of Medical Toxicology (ACMT) established its Case Registry, the Toxicology Investigators Consortium (ToxIC). All cases are entered prospectively and include only suspected and confirmed toxic exposures cared for at the bedside by board-certified or board-eligible medical toxicologists at its participating sites. The primary aims of establishing this Registry include the development of a realtime toxico-surveillance system in order to identify and describe current or evolving trends in poisoning and to develop a research tool in toxicology. ToxIC allows for extraction of data from medical records from multiple sites across a national and international network. All cases seen by medical toxicologists at participating institutions were entered into the database. Information characterizing patients entered in 2012 was tabulated and data from the previous years including 2010 and 2011 were included so that cumulative numbers and trends could be described as well. The current report includes data through December 31st, 2012. During 2012, 38 sites with 68 specific institutions contributed a total of 7,269 cases to the Registry. The total number of cases entered into the Registry at the end of 2012 was 17,681. Emergency departments remained the most common source of consultation in 2012, accounting for 61 % of cases. The most common reason for consultation was for pharmaceutical overdose, which occurred in 52 % of patients including intentional (41 %) and unintentional (11 %) exposures. The most common classes of agents were sedative-hypnotics (1,422 entries in 13 % of cases) non-opioid analgesics (1,295 entries in 12 % of cases), opioids (1,086 entries in 10 % of cases) and antidepressants (1,039 entries in 10 % of cases). N-acetylcysteine (NAC) was the most common antidote administered in 2012, as it was in previous years, followed by the opioid antagonist naloxone, sodium bicarbonate, physostigmine and flumazenil. Anti-crotalid Fab fragments were administered in 109 cases or 82 % of cases in which a snake envenomation occurred. There were 57 deaths reported in the Registry in 2012. The most common associated agent alone or in combination was the non-opioid analgesic acetaminophen, being reported in 10 different cases. Other common agents and agent classes involved in death cases included ethanol, opioids, the anti-diabetic agent metformin, sedatives-hypnotics and cardiovascular agents, in particular amlodipine. There were significant trends identified during 2012. Abuse of over-the-counter medications such as dextromethorphan remains prevalent. Cases involving dextromethorphan continued to be reported at frequencies higher than other commonly abused drugs including many stimulants, phencyclidine, synthetic cannabinoids and designer amphetamines such as bath salts. And, while cases involving synthetic cannabinoids and psychoactive bath salts remained relatively constant from 2011 to 2012 several designer amphetamines and novel psychoactive substances were first reported in the Registry in 2012 including the NBOME compounds or "N-bomb" agents. LSD cases also spiked dramatically in 2012 with an 18-fold increase from 2011 although many of these cases are thought to be ultra-potent designer amphetamines misrepresented as "synthetic" LSD. The 2012 Registry included over 400 Adverse Drug Reactions (ADRs) involving 4 % of all Registry cases with 106 agents causing at least 2 ADRs. Additional data including supportive cares, decontamination, and chelating agent use are also included in the 2012 annual report. The Registry remains a valuable toxico-surveillance and research tool. The ToxIC Registry is a unique tool for identifying and characterizing confirmed cases of significant or potential toxicity or complexity to require bedside care by a medical toxicologist. ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-013-0352-5 PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't ID - 10.1007/s13181-013-0352-5 [doi] ID - PMC3846972 [pmc] PP - ppublish LG - English DP - 2013 Dec EZ - 2013/11/02 06:00 DA - 2014/07/30 06:00 DT - 2013/11/02 06:00 YR - 2013 ED - 20140728 RD - 20150422 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24178902 <369. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 25024850 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Kugasia IR AU - Shabarek N FA - Kugasia, Irfanali R FA - Shabarek, Nehad IN - Kugasia, Irfanali R. Department of Internal Medicine, Lincoln Medical and Mental Health Center, 234 East 149th Street, Bronx, NY 10451, USA. IN - Shabarek, Nehad. Department of Internal Medicine, Lincoln Medical and Mental Health Center, 234 East 149th Street, Bronx, NY 10451, USA. TI - Opiate withdrawal complicated by tetany and cardiac arrest. SO - Case Reports in Critical Care Print. 2014:295401, 2014 AS - case report. crit. care. 2014:295401, 2014 NJ - Case reports in critical care VO - 2014 PG - 295401 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - 101598416 IO - Case Rep Crit Care PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082874 CP - United States AB - Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status. IS - 2090-6420 IL - 2090-6420 DO - https://dx.doi.org/10.1155/2014/295401 PT - Journal Article ID - 10.1155/2014/295401 [doi] ID - PMC4082874 [pmc] PP - ppublish PH - 2014/02/14 [received] PH - 2014/05/26 [accepted] LG - English EP - 20140615 DP - 2014 EZ - 2014/07/16 06:00 DA - 2014/07/16 06:01 DT - 2014/07/16 06:00 YR - 2014 ED - 20140715 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=25024850 <370. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24295630 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Termine C AU - Selvini C AU - Rossi G AU - Balottin U FA - Termine, Cristiano FA - Selvini, Claudia FA - Rossi, Giorgio FA - Balottin, Umberto IN - Termine, Cristiano. Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy. Electronic address: pmir@us.es. TI - Emerging treatment strategies in Tourette syndrome: what's in the pipeline?. [Review] SO - International Review of Neurobiology. 112:445-80, 2013 AS - Int Rev Neurobiol. 112:445-80, 2013 NJ - International review of neurobiology VO - 112 PG - 445-80 PI - Journal available in: Print PI - Citation processed from: Internet JC - guj, 0374740 IO - Int. Rev. Neurobiol. SB - Index Medicus CP - United States MH - Electroconvulsive Therapy MH - *Emergency Medical Services MH - Humans MH - Neurotransmitter Agents/tu [Therapeutic Use] MH - *Tourette Syndrome/th [Therapy] MH - Transcranial Magnetic Stimulation KW - Atypical neuroleptics; Electroconvulsive therapy; Newest atypical antipsychotic agents; Pharmacotherapy; Repetitive transcranial magnetic stimulation; Tourette syndrome AB - Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple motor/phonic tics and a wide spectrum of behavioral problems (e.g., complex tic-like symptoms, attention deficit hyperactivity disorder, and obsessive-compulsive disorder). TS can be a challenging condition even for the specialists, because of the complexity of the clinical picture and the potential adverse effects of the most commonly prescribed medications. Expert opinions and consensus guidelines on the assessment and treatment of tic disorders have recently been published in Europe and Canada. All pharmacological treatment options are mere symptomatic treatments that alleviate, but do not cure, the tics. We still lack evidence of their effects on the natural long-term course and on the prognosis of TS and how these treatments may influence the natural course of brain development. The most commonly prescribed drugs are dopamine antagonists, such as typical (e.g., haloperidol, pimozide) and atypical neuroleptics (e.g., risperidone, aripiprazole), and alpha-2-adrenoreceptor agonists (e.g., clonidine). However, several studies have investigated the efficacy and tolerability of alternative pharmacological agents that may be efficacious, including the newest atypical antipsychotic agents (e.g., paliperidone, sertindole), tetrabenazine, drugs that modulate acetylcholine (e.g., nicotine) and GABA (e.g., baclofen, levetiracetam), tetrahydrocannabinol, botulinum toxin injections, anticonvulsant drugs (e.g., topiramate, carbamazepine), naloxone, lithium, norepinephrine, steroid 5alpha reductase, and other neuroactive agents (buspirone, metoclopramide, phytostigmine, and spiradoline mesylate). As regards nonpharmacological interventions, some of the more recent treatments that have been studied include electroconvulsive therapy and repetitive transcranial magnetic stimulation. This review focuses primarily on the efficacy and safety of these emerging treatment strategies in TS. Copyright © 2013 Elsevier Inc. All rights reserved. RN - 0 (Neurotransmitter Agents) ES - 2162-5514 IL - 0074-7742 DI - B978-0-12-411546-0.00015-9 DO - https://dx.doi.org/10.1016/B978-0-12-411546-0.00015-9 PT - Journal Article PT - Review ID - B978-0-12-411546-0.00015-9 [pii] ID - 10.1016/B978-0-12-411546-0.00015-9 [doi] PP - ppublish LG - English DP - 2013 EZ - 2013/12/04 06:00 DA - 2014/07/16 06:00 DT - 2013/12/04 06:00 YR - 2013 ED - 20140714 RD - 20131203 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24295630 <371. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24868924 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mettner J FA - Mettner, Jeanne TI - Reversing tragedy. Proposed legislation will increase access to an antidote to opioid overdose. SO - Minnesota Medicine. 97(4):10-1, 2014 Apr AS - Minn Med. 97(4):10-1, 2014 Apr NJ - Minnesota medicine VO - 97 IP - 4 PG - 10-1 PI - Journal available in: Print PI - Citation processed from: Print JC - nby, 8000173 IO - Minn Med SB - Index Medicus CP - United States MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/lj [Legislation & Jurisprudence] MH - *Health Services Accessibility/lj [Legislation & Jurisprudence] MH - *Heroin/po [Poisoning] MH - Minnesota MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 0026-556X IL - 0026-556X PT - Journal Article PP - ppublish LG - English DP - 2014 Apr EZ - 2014/05/30 06:00 DA - 2014/06/27 06:00 DT - 2014/05/30 06:00 YR - 2014 ED - 20140626 RD - 20140529 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24868924 <372. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24051061 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Green TC AU - Zaller N AU - Palacios WR AU - Bowman SE AU - Ray M AU - Heimer R AU - Case P FA - Green, Traci C FA - Zaller, Nickolas FA - Palacios, Wilson R FA - Bowman, Sarah E FA - Ray, Madeline FA - Heimer, Robert FA - Case, Patricia IN - Green, Traci C. Rhode Island Hospital, Department of Emergency Medicine, 55 Claverick St.-2nd flr, Providence, RI 02903, USA; The Warren Alpert Medical School at Brown University, Providence, RI, USA. Electronic address: traci.c.green@gmail.com. TI - Law enforcement attitudes toward overdose prevention and response. SO - Drug & Alcohol Dependence. 133(2):677-84, 2013 Dec 01 AS - Drug Alcohol Depend. 133(2):677-84, 2013 Dec 01 NJ - Drug and alcohol dependence VO - 133 IP - 2 PG - 677-84 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947507 OI - Source: NLM. NIHMS522054 SB - Index Medicus CP - Ireland MH - *Attitude MH - Connecticut/ep [Epidemiology] MH - *Drug Overdose/pc [Prevention & Control] MH - *Drug Overdose/th [Therapy] MH - Emergency Medical Services MH - Empathy MH - Epidemics MH - Hospital Rapid Response Team MH - Humans MH - *Law Enforcement MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Narcotics/po [Poisoning] MH - Opioid-Related Disorders/px [Psychology] MH - *Police MH - Prescription Drug Misuse MH - Rhode Island/ep [Epidemiology] KW - Law enforcement; Naloxone; Overdose; Police; Prescription opioid abuse AB - BACKGROUND: Law enforcement is often the first to respond to medical emergencies in the community, including overdose. Due to the nature of their job, officers have also witnessed first-hand the changing demographic of drug users and devastating effects on their community associated with the epidemic of nonmedical prescription opioid use in the United States. Despite this seminal role, little data exist on law enforcement attitudes toward overdose prevention and response. AB - METHODS: We conducted key informant interviews as part of a 12-week Rapid Assessment and Response (RAR) process that aimed to better understand and prevent nonmedical prescription opioid use and overdose deaths in locations in Connecticut and Rhode Island experiencing overdose "outbreaks." Interviews with 13 law enforcement officials across three study sites were analyzed to uncover themes on overdose prevention and naloxone. AB - RESULTS: Findings indicated support for law enforcement involvement in overdose prevention. Hesitancy around naloxone administration by laypersons was evident. Interview themes highlighted officers' feelings of futility and frustration with their current overdose response options, the lack of accessible local drug treatment, the cycle of addiction, and the pervasiveness of easily accessible prescription opioid medications in their communities. Overdose prevention and response, which for some officers included law enforcement-administered naloxone, were viewed as components of community policing and good police-community relations. AB - CONCLUSION: Emerging trends, such as existing law enforcement medical interventions and Good Samaritan Laws, suggest the need for broader law enforcement engagement around this pressing public health crisis, even in suburban and small town locations, to promote public safety. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(13)00334-7 DO - https://dx.doi.org/10.1016/j.drugalcdep.2013.08.018 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. ID - S0376-8716(13)00334-7 [pii] ID - 10.1016/j.drugalcdep.2013.08.018 [doi] ID - PMC3947507 [pmc] ID - NIHMS522054 [mid] PP - ppublish PH - 2013/03/11 [received] PH - 2013/08/22 [revised] PH - 2013/08/22 [accepted] GI - No: R01 DA023408 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R21 CE001846 Organization: (CE) *NCIPC CDC HHS* Country: United States GI - No: R21CE001846 Organization: (CE) *NCIPC CDC HHS* Country: United States LG - English EP - 20130902 DP - 2013 Dec 01 EZ - 2013/09/21 06:00 DA - 2014/06/24 06:00 DT - 2013/09/21 06:00 YR - 2013 ED - 20140623 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24051061 <373. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23932843 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Treloar C AU - Rance J AU - Grebely J AU - Dore GJ FA - Treloar, Carla FA - Rance, Jake FA - Grebely, Jason FA - Dore, Gregory J IN - Treloar, Carla. National Centre in HIV Social Research, The University of New South Wales, Australia. Electronic address: c.treloar@unsw.edu.au. TI - Client and staff experiences of a co-located service for hepatitis C care in opioid substitution treatment settings in New South Wales, Australia. SO - Drug & Alcohol Dependence. 133(2):529-34, 2013 Dec 01 AS - Drug Alcohol Depend. 133(2):529-34, 2013 Dec 01 NJ - Drug and alcohol dependence VO - 133 IP - 2 PG - 529-34 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Adult MH - Attitude of Health Personnel MH - Confidentiality MH - Female MH - Health Facilities MH - Health Personnel MH - Hepatitis C/co [Complications] MH - *Hepatitis C/th [Therapy] MH - Humans MH - Male MH - Middle Aged MH - New South Wales MH - Opiate Substitution Treatment/ec [Economics] MH - *Opiate Substitution Treatment/mt [Methods] MH - Patient Satisfaction MH - Privacy MH - Professional-Patient Relations MH - Social Stigma MH - Substance Abuse Treatment Centers MH - Substance Abuse, Intravenous/co [Complications] MH - Substance Abuse, Intravenous/th [Therapy] MH - Transportation of Patients KW - HCV; Integrated care; Opioid substitution treatment; People who use drugs; Qualitative research AB - BACKGROUND: Internationally, there are ongoing efforts to increase access to hepatitis C (HCV) assessment and treatment to counter a generally low uptake of treatment among people with a history of injecting drug use. The aim of this qualitative study was to examine client and staff attitudes towards and experience of co-location of HCV and opioid substitution treatment (OST) services. AB - METHODS: In-depth interviews were conducted with 57 clients and 19 staff from four NSW clinics participating in the Australian ETHOS study. AB - RESULTS: Client and staff participants typically welcomed integrated treatment, citing issues of convenience, reduced travel time and costs, persistent cues to engagement and immediacy of access to care. Positive attitudes towards the initiative were expressed even by clients who had not engaged with HCV care. Providing co-located care largely avoided the negative, stigmatising or discriminatory experiences that participants reported encountering in settings less familiar with people who use drugs. A minority of client participants expressed concerns about the lack of privacy and/or confidentiality available in the co-located model, preferring to seek HCV care elsewhere. AB - CONCLUSIONS: The co-location of HCV care in OST clinics was welcomed by the large majority of participants in this study. Besides issues of convenience, the appeal of the co-located service centred on the familiarity of existing relationships between clients and staff in the OST setting. While some clients remained distrustful of OST and chose not to take up HCV care in this setting, the co-located treatment model was overwhelmingly successful amongst both client and staff participants. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(13)00288-3 DO - https://dx.doi.org/10.1016/j.drugalcdep.2013.07.023 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0376-8716(13)00288-3 [pii] ID - 10.1016/j.drugalcdep.2013.07.023 [doi] PP - ppublish PH - 2013/05/29 [received] PH - 2013/07/18 [revised] PH - 2013/07/18 [accepted] LG - English EP - 20130802 DP - 2013 Dec 01 EZ - 2013/08/13 06:00 DA - 2014/06/24 06:00 DT - 2013/08/13 06:00 YR - 2013 ED - 20140623 RD - 20131104 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23932843 <374. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24036518 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schaper A FA - Schaper, A IN - Schaper, A. GIZ-Nord (Giftinformationszentrum-Nord der Lander Bremen, Hamburg, Niedersachsen und Schleswig-Holstein), Zentrum Pharmakologie und Toxikologie , Universitatsmedizin Gottingen, Georg-August-Universitat, Robert-Koch-Str. 40, 37075, Gottingen, Deutschland, aschaper@giz-nord.de. TI - [Charcoal, cocaine and rattlesnakes: evidence-based treatment of poisoning]. [Review] [German] OT - Kohle, Koks und Klapperschlangen : Evidenzbasierte Behandlung von Vergiftungen. SO - Anaesthesist. 62(10):824-31, 2013 Oct AS - Anaesthesist. 62(10):824-31, 2013 Oct NJ - Der Anaesthesist VO - 62 IP - 10 PG - 824-31 PI - Journal available in: Print PI - Citation processed from: Internet JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Animals MH - *Antidotes/tu [Therapeutic Use] MH - *Charcoal/tu [Therapeutic Use] MH - *Cocaine/po [Poisoning] MH - Crotalus MH - Emergency Medicine MH - Evidence-Based Medicine MH - Germany MH - Hemoperfusion MH - Humans MH - Immune Sera MH - *Information Centers/og [Organization & Administration] MH - Intubation, Intratracheal MH - *Poison Control Centers/og [Organization & Administration] MH - Renal Dialysis MH - *Snake Bites/th [Therapy] MH - Snake Venoms/ai [Antagonists & Inhibitors] MH - Therapeutic Irrigation MH - Toxicology AB - BACKGROUND: Since ancient times poisoning has been treated medicinally. Clinical toxicology, in the narrow sense of the term, developed from the foundation of specialized medical treatment units for poisoning and the formation of the first poison information centers in the second half of the twentieth century. Historically, the first poison information centers were often localized at pediatric clinics or departments of internal medicine. It became increasingly more obvious that this pooling of competences made sense. AB - AIM: This article gives a general introduction in clinical toxicology and presents the functions and key activities of emergency poison centers. AB - MATERIAL AND METHODS: The organisation and work of a poisons centre is demonstrated on the basis of the Poisons Information Center (GIZ) North annual report for 2011. In a short summary the basic principles of clinical toxicology are elucidated: the primary removal of poisons by gastric lavage and administration of activated charcoal, secondary removal of poisons by enhanced elimination using hemodialysis, hemoperfusion, multi-dose activated charcoal and molecular adsorbent recirculating systems (MARS) and the indications for administration of specific antidotes or antivenins (antisera against poisoning by poisonous animals). AB - RESULTS: Gastric lavage is indicated within 1 h after ingestion of a potentially life-threatening dose of a poison. In cases of poisoning with substances which penetrate the central nervous system (CNS) gastric lavage should be performed only after endotracheal intubation due to the risk of aspiration. The basic management of poisoned patients by emergency medicine personnel out of hospital and on the way to hospital is presented. The Bremen list, a compilation of the five antidotes, atropine, 4-dimethylaminophenol (4-DMAP), tolonium chloride, naloxone and activated charcoal for out of hospital treatment by emergency doctors is presented. AB - CONCLUSION: In all, even questionable cases of poisoning consultation at emergency poison centers is recommended. An extensive list of all German speaking poison information centers is available on the homepage of GIZ-Nord (http://www.giz-nord.de). RN - 0 (Antidotes) RN - 0 (Immune Sera) RN - 0 (Snake Venoms) RN - 16291-96-6 (Charcoal) RN - I5Y540LHVR (Cocaine) ES - 1432-055X IL - 0003-2417 DO - https://dx.doi.org/10.1007/s00101-013-2229-z PT - English Abstract PT - Journal Article PT - Review ID - 10.1007/s00101-013-2229-z [doi] PP - ppublish LG - German DP - 2013 Oct EZ - 2013/09/17 06:00 DA - 2014/06/19 06:00 DT - 2013/09/17 06:00 YR - 2013 ED - 20140618 RD - 20170916 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24036518 <375. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23633090 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Strang J AU - Bird SM AU - Parmar MK FA - Strang, John FA - Bird, Sheila M FA - Parmar, Mahesh K B IN - Strang, John. King's College London, National Addiction Centre (Institute of Psychiatry and The Maudsley), London, SE5 8AF, UK, john.strang@kcl.ac.uk. TI - Take-home emergency naloxone to prevent heroin overdose deaths after prison release: rationale and practicalities for the N-ALIVE randomized trial. SO - Journal of Urban Health. 90(5):983-96, 2013 Oct AS - J Urban Health. 90(5):983-96, 2013 Oct NJ - Journal of urban health : bulletin of the New York Academy of Medicine VO - 90 IP - 5 PG - 983-96 PI - Journal available in: Print PI - Citation processed from: Internet JC - c5l, 9809909 IO - J Urban Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795186 SB - Index Medicus CP - United States MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/mo [Mortality] MH - Emergencies MH - *Heroin Dependence/dt [Drug Therapy] MH - Heroin Dependence/mo [Mortality] MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - Patient Acceptance of Health Care MH - *Prisons AB - The naloxone investigation (N-ALIVE) randomized trial commenced in the UK in May 2012, with the preliminary phase involving 5,600 prisoners on release. The trial is investigating whether heroin overdose deaths post-prison release can be prevented by prior provision of a take-home emergency supply of naloxone. Heroin contributes disproportionately to drug deaths through opiate-induced respiratory depression. Take-home emergency naloxone is a novel preventive measure for which there have been encouraging preliminary reports from community schemes. Overdoses are usually witnessed, and drug users themselves and also family members are a vast intervention workforce who are willing to intervene, but whose responses are currently often inefficient or wrong. Approximately 10% of provided emergency naloxone is thought to be used in subsequent emergency resuscitation but, as yet, there have been no definitive studies. The period following release from prison is a time of extraordinarily high mortality, with heroin overdose deaths increased more than sevenfold in the first fortnight after release. Of prisoners with a previous history of heroin injecting who are released from prison, 1 in 200 will die of a heroin overdose within the first 4 weeks. There are major scientific and logistical challenges to assessing the impact of take-home naloxone. Even in recently released prisoners, heroin overdose death is a relatively rare event: hence, large numbers of prisoners need to enter the trial to assess whether take-home naloxone significantly reduces the overdose death rate. The commencement of pilot phase of the N-ALIVE trial is a significant step forward, with prisoners being randomly assigned either to treatment-as-usual or to treatment-as-usual plus a supply of take-home emergency naloxone. The subsequent full N-ALIVE trial (contingent on a successful pilot) will involve 56,000 prisoners on release, and will give a definitive conclusion on lives saved in real-world application. Advocates call for implementation, while naysayers raise concerns. The issue does not need more public debate; it needs good science. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1468-2869 IL - 1099-3460 DO - https://dx.doi.org/10.1007/s11524-013-9803-1 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 10.1007/s11524-013-9803-1 [doi] ID - PMC3795186 [pmc] PP - ppublish GI - No: MC_U105260794 Organization: *Medical Research Council* Country: United Kingdom GI - Organization: *Medical Research Council* Country: United Kingdom LG - English DP - 2013 Oct EZ - 2013/05/02 06:00 DA - 2014/05/28 06:00 DT - 2013/05/02 06:00 YR - 2013 ED - 20140527 RD - 20170922 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23633090 <376. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23400316 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mercadante S AU - Prestia G AU - Ranieri M AU - Giarratano A AU - Casuccio A FA - Mercadante, Sebastiano FA - Prestia, Giovanna FA - Ranieri, Maurizio FA - Giarratano, Antonello FA - Casuccio, Alessandra IN - Mercadante, Sebastiano. Pain relief and palliative care unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy. terapiadeldolore@lamaddalenanet.it TI - Opioid use and effectiveness of its prescription at discharge in an acute pain relief and palliative care unit. SO - Supportive Care in Cancer. 21(7):1853-9, 2013 Jul AS - Support Care Cancer. 21(7):1853-9, 2013 Jul NJ - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer VO - 21 IP - 7 PG - 1853-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9302957, b1l IO - Support Care Cancer SB - Index Medicus CP - Germany MH - *Acute Pain/dt [Drug Therapy] MH - Acute Pain/et [Etiology] MH - Adult MH - Aged MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Breakthrough Pain/dt [Drug Therapy] MH - Breakthrough Pain/et [Etiology] MH - Continuity of Patient Care MH - Drug Prescriptions MH - Female MH - Humans MH - Male MH - Morphine/ad [Administration & Dosage] MH - *Neoplasms/co [Complications] MH - Pain Measurement/de [Drug Effects] MH - *Palliative Care/mt [Methods] MH - Patient Discharge AB - The aim of this study was to present how opioids are used in an acute pain relief and palliative care unit (APRPCU), where many patients with difficult pain conditions are admitted from GPs, home palliative care programs, oncology departments, other hospitals or emergency units, and other regional places. From a consecutive sample of cancer patients admitted to an APRPCU for a period of 6 months, patients who had been administered opioids were included in this survey. Basic information was collected as well as opioid therapy prescribed at admission and, subsequently, during admission and at time of discharge. Patients were discharged once stabilization of pain and symptoms were obtained and the treatment was considered to be optimized. One week after being discharged, patients or relatives were contacted by phone to gather information about the availability of opioids at dosages prescribed at time of discharge. One hundred eighty six of 231 patients were specifically admitted for uncontrolled pain, with a mean pain intensity of 6.8 (SD 2.5). The mean dose of oral morphine equivalents in patients receiving opioids before admission was 45 mg/day (range 10-500 mg). One hundred seventy five patients (75.7 %) were prescribed around the clock opioids at admission. About one third of patients changed treatment (opioid or route). Forty two of 175 (24 %), 27/58 (46.5 %), 10/22 (45.4 %), and 2/4 (50 %) patients were receiving more than 200 mg of oral morphine equivalents, as maximum dose of the first, second, third, and fourth opioid prescriptions, respectively. The pattern of opioids changed, with the highest doses administered with subsequent line options. The mean final dose of opioids, expressed as oral morphine equivalents, for all patients was 318 mg/day (SD 798), that is more than six times the doses of pre-admission opioid doses. One hundred eighty six patients (80.5 %) were prescribed a breakthrough cancer pain (BTcP) medication at admission. Sixty five patients changed their BTcP prescription, and further 27 patients changed again. Finally, eight patients were prescribed a fourth BTcP medication. Of 46 patients available for interview, the majority of them (n = 39, 84 %) did not have problems with their GPs, who facilitated prescription and availability of opioids at the dosages prescribed at discharge. For patients with severe distress, APRPCUs may guarantee a high-level support to optimize pain and symptom intensities providing intensive approach and resolving highly distressing situations in a short time by optimizing the use of opioids. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1433-7339 IL - 0941-4355 DO - https://dx.doi.org/10.1007/s00520-013-1740-8 PT - Journal Article ID - 10.1007/s00520-013-1740-8 [doi] PP - ppublish PH - 2012/09/25 [received] PH - 2013/01/28 [accepted] LG - English EP - 20130212 DP - 2013 Jul EZ - 2013/02/13 06:00 DA - 2014/05/27 06:00 DT - 2013/02/13 06:00 YR - 2013 ED - 20140526 RD - 20171011 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23400316 <377. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24629443 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hasegawa K AU - Brown DF AU - Tsugawa Y AU - Camargo CA Jr FA - Hasegawa, Kohei FA - Brown, David F M FA - Tsugawa, Yusuke FA - Camargo, Carlos A Jr IN - Hasegawa, Kohei. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: khasegawa1@partners.org. IN - Brown, David F M. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. IN - Tsugawa, Yusuke. Harvard Interfaculty Initiative in Health Policy, Cambridge, MA. IN - Camargo, Carlos A Jr. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. TI - Epidemiology of emergency department visits for opioid overdose: a population-based study. CM - Comment in: Mayo Clin Proc. 2014 Apr;89(4):437-9; PMID: 24629442 SO - Mayo Clinic Proceedings. 89(4):462-71, 2014 Apr AS - Mayo Clin Proc. 89(4):462-71, 2014 Apr NJ - Mayo Clinic proceedings VO - 89 IP - 4 PG - 462-71 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 0405543, lly IO - Mayo Clin. Proc. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/po [Poisoning] MH - California MH - *Cause of Death MH - Cohort Studies MH - Confidence Intervals MH - Databases, Factual MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/th [Therapy] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Florida MH - Humans MH - Kaplan-Meier Estimate MH - Male MH - Middle Aged MH - Multivariate Analysis MH - *Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/th [Therapy] MH - Population Surveillance MH - Prevalence MH - Risk Assessment MH - Sex Distribution MH - Survival Analysis MH - Young Adult AB - OBJECTIVES: To evaluate the rate of emergency department (ED) visits for opioid overdose and to examine whether frequent ED visits for opioid overdose are associated with more hospitalizations, near-fatal events, and health care spending. AB - PATIENTS AND METHODS: Retrospective cohort study of adults with at least 1 ED visit for opioid overdose between January 1, 2010, and December 31, 2011, derived from population-based data of State Emergency Department Databases and State Inpatient Databases for 2 large and diverse states: California and Florida. Main outcome measures were hospitalizations for opioid overdose, near-fatal events (overdose involving mechanical ventilation), and hospital charges during the year after the first ED visit. AB - RESULTS: The analytic cohort comprised 19,831 unique patients with 21,609 ED visits for opioid overdose. During a 1-year period, 7% (95% CI, 7%-7%; n=1389 patients) of the patients had frequent (2 or more) ED visits, accounting for 15% (95% CI, 14%-15%; n=3167) of all opioid overdose ED visits. Middle age, male sex, public insurance, lower household income, and comorbidities (such as chronic pulmonary disease and neurological diseases) were associated with frequent ED visits (all P<.01). Overall, 53% (95% CI, 52%-54%; n=11,412) of the ED visits for opioid overdose resulted in hospitalizations; patients with frequent ED visits for opioid overdose had a higher likelihood of hospitalization (adjusted odds ratio, 3.98; 95% CI, 3.38-4.69). In addition, 10.0% (95% CI, 10%-10%; n=2161) of the ED visits led to near-fatal events; patients with frequent ED visits had a higher likelihood of a near-fatal event (adjusted odds ratio, 2.27; 95% CI, 1.96-2.66). Total charges in Florida were $208 million (95% CI, $200-$219 million). AB - CONCLUSION: In this population-based cohort, we found that frequent ED visits for opioid overdose were associated with a higher likelihood of future hospitalizations and near-fatal events. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1942-5546 IL - 0025-6196 DI - S0025-6196(13)01117-8 DO - https://dx.doi.org/10.1016/j.mayocp.2013.12.008 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0025-6196(13)01117-8 [pii] ID - 10.1016/j.mayocp.2013.12.008 [doi] PP - ppublish PH - 2013/09/19 [received] PH - 2013/11/19 [revised] PH - 2013/12/02 [accepted] LG - English EP - 20140311 DP - 2014 Apr EZ - 2014/03/19 06:00 DA - 2014/05/23 06:00 DT - 2014/03/18 06:00 YR - 2014 ED - 20140522 RD - 20140401 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24629443 <378. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24629442 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Berge KH AU - Burkle CM FA - Berge, Keith H FA - Burkle, Christopher M IN - Berge, Keith H. Department of Anesthesiology, Mayo Clinic, Rochester, MN. Electronic address: berge.keith@mayo.edu. IN - Burkle, Christopher M. Department of Anesthesiology, Mayo Clinic, Rochester, MN. TI - Opioid overdose: when good drugs break bad. CM - Comment in: Mayo Clin Proc. 2014 Aug;89(8):1168; PMID: 25092370 CM - Comment in: Mayo Clin Proc. 2014 Aug;89(8):1168; PMID: 25092371 CM - Comment on: Mayo Clin Proc. 2014 Apr;89(4):462-71; PMID: 24629443 SO - Mayo Clinic Proceedings. 89(4):437-9, 2014 Apr AS - Mayo Clin Proc. 89(4):437-9, 2014 Apr NJ - Mayo Clinic proceedings VO - 89 IP - 4 PG - 437-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 0405543, lly IO - Mayo Clin. Proc. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Cause of Death MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1942-5546 IL - 0025-6196 DI - S0025-6196(14)00185-2 DO - https://dx.doi.org/10.1016/j.mayocp.2014.02.007 PT - Comment PT - Editorial ID - S0025-6196(14)00185-2 [pii] ID - 10.1016/j.mayocp.2014.02.007 [doi] PP - ppublish PH - 2014/02/17 [received] PH - 2014/02/17 [accepted] LG - English EP - 20140311 DP - 2014 Apr EZ - 2014/03/19 06:00 DA - 2014/05/23 06:00 DT - 2014/03/18 06:00 YR - 2014 ED - 20140522 RD - 20140918 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24629442 <379. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24120973 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Jones HE AU - Deppen K AU - Hudak ML AU - Leffert L AU - McClelland C AU - Sahin L AU - Starer J AU - Terplan M AU - Thorp JM Jr AU - Walsh J AU - Creanga AA FA - Jones, Hendree E FA - Deppen, Krisanna FA - Hudak, Mark L FA - Leffert, Lisa FA - McClelland, Carol FA - Sahin, Leyla FA - Starer, Jacquelyn FA - Terplan, Mishka FA - Thorp, John M Jr FA - Walsh, James FA - Creanga, Andreea A IN - Jones, Hendree E. UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC. Electronic address: hendree_jones@med.unc.edu. IN - Deppen, Krisanna. Department of Family Medicine, Grant Medical Center, Columbus, OH. IN - Hudak, Mark L. Department of Pediatrics, University of Florida College of Medicine-Jacksonville, FL. IN - Leffert, Lisa. Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA. IN - McClelland, Carol. UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC. IN - Sahin, Leyla. Pediatric and Maternal Health Staff, Maternal Health Team, Office of New Drugs, Food and Drug Administration, Silver Spring, MD. IN - Starer, Jacquelyn. Addiction Recovery Program, Brigham and Women's Faulkner Hospital, Boston, MA. IN - Terplan, Mishka. Department of Obstetrics, Gynecology & Reproductive Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD. IN - Thorp, John M Jr. UNC Horizons Program, Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC. IN - Walsh, James. Addiction Recovery Service, Swedish Medical Center, Seattle, WA. IN - Creanga, Andreea A. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA. TI - Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers. SO - American Journal of Obstetrics & Gynecology. 210(4):302-310, 2014 Apr AS - Am J Obstet Gynecol. 210(4):302-310, 2014 Apr NJ - American journal of obstetrics and gynecology VO - 210 IP - 4 PG - 302-310 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 3ni, 0370476 IO - Am. J. Obstet. Gynecol. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Buprenorphine/tu [Therapeutic Use] MH - Confidentiality MH - Dose-Response Relationship, Drug MH - Emergency Service, Hospital MH - Female MH - Humans MH - Labor Pain/dt [Drug Therapy] MH - Labor, Obstetric MH - Mental Disorders/di [Diagnosis] MH - Methadone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Opiate Substitution Treatment MH - *Opioid-Related Disorders/co [Complications] MH - Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/th [Therapy] MH - Pain, Postoperative/dt [Drug Therapy] MH - *Physician-Patient Relations MH - Postnatal Care MH - Pregnancy MH - Pregnancy Complications/di [Diagnosis] MH - *Pregnancy Complications/th [Therapy] MH - Prenatal Care MH - Referral and Consultation MH - Triage KW - opioid use; opioid-agonist; substance use AB - We review clinical care issues that are related to illicit and therapeutic opioid use among pregnant women and women in the postpartum period and outline the major responsibilities of obstetrics providers who care for these patients during the antepartum, intrapartum, and postpartum periods. Selected patient treatment issues are highlighted, and case examples are provided. Securing a strong rapport and trust with these patients is crucial for success in delivering high-quality obstetric care and in coordinating services with other specialists as needed. Obstetrics providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment for patients with drug use disorders. Opioid-dependent pregnant women often can be treated effectively with methadone or buprenorphine. These medications are classified as pregnancy category C medications by the Food and Drug Administration, and their use in the treatment of opioid-dependent pregnant patients should not be considered "off-label." Except in rare special circumstances, medication-assisted withdrawal during pregnancy should be discouraged because of a high relapse rate. Acute pain management in this population deserves special consideration because patients who use opioids can be hypersensitive to pain and because the use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, pregnant women who use opioids do not require more intense medical care than other pregnant patients to ensure adequate treatment and the best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for pregnant women who use opioids and women who use opioids in the postpartum period. Copyright © 2014 Mosby, Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) RN - UC6VBE7V1Z (Methadone) ES - 1097-6868 IL - 0002-9378 DI - S0002-9378(13)01058-2 DO - https://dx.doi.org/10.1016/j.ajog.2013.10.010 PT - Journal Article ID - S0002-9378(13)01058-2 [pii] ID - 10.1016/j.ajog.2013.10.010 [doi] PP - ppublish PH - 2013/07/29 [received] PH - 2013/10/04 [revised] PH - 2013/10/08 [accepted] LG - English EP - 20131010 DP - 2014 Apr EZ - 2013/10/15 06:00 DA - 2014/05/21 06:00 DT - 2013/10/15 06:00 YR - 2014 ED - 20140520 RD - 20170609 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24120973 <380. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23370078 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Koeppe J AU - Lyda K AU - Armon C FA - Koeppe, John FA - Lyda, Karen FA - Armon, Carl IN - Koeppe, John. Divisions of *General Internal Medicine +Infectious Diseases, Department of Medicine, School of Medicine, University of Colorado, CO ++Department of Epidemiology, Children's Hospital Colorado, Aurora. TI - Association between opioid use and health care utilization as measured by emergency room visits and hospitalizations among persons living with HIV. SO - Clinical Journal of Pain. 29(11):957-61, 2013 Nov AS - Clin J Pain. 29(11):957-61, 2013 Nov NJ - The Clinical journal of pain VO - 29 IP - 11 PG - 957-61 PI - Journal available in: Print PI - Citation processed from: Internet JC - beg, 8507389 IO - Clin J Pain SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Databases, Factual/sn [Statistics & Numerical Data] MH - *Delivery of Health Care/ut [Utilization] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - *HIV Infections/th [Therapy] MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - *Pain/dt [Drug Therapy] AB - BACKGROUND: Epidemiologic studies in the non-human immunodeficiency virus (HIV) positive population have shown greater health care utilization among persons with chronic non-cancer pain on opioid therapy. However, we are not aware of any similar data in the HIV positive population. AB - METHODS: We evaluated health care utilization, as measured by emergency room (ER) visits and hospitalizations, among persons with HIV and chronic pain seen at an academic medical center, during the calendar year 2005. We compared these outcomes between patients on chronic opioid therapy with those not on opioids. AB - RESULTS: In univariate models chronic opioid therapy was associated with both ER visits and hospitalization: ER visits odds ratio (OR)=2.18 (95% confidence interval [CI], 1.30-3.66), hospitalization OR=1.90 (95% CI, 1.03-3.51). After multivariate analyses only nonsignificant trends remain: ER visits OR=1.71 (95% CI, 0.95-3.08); hospitalization OR=1.28 (95% CI, 0.66-2.49). AB - CONCLUSIONS: In our study HIV positive individuals with chronic pain were more likely to be seen in the ER and be hospitalized if they were on opioids. However, after controlling for other variables, the association with opioids no longer remained significant. RN - 0 (Analgesics, Opioid) ES - 1536-5409 IL - 0749-8047 DO - https://dx.doi.org/10.1097/AJP.0b013e31827c7b05 PT - Journal Article ID - 10.1097/AJP.0b013e31827c7b05 [doi] PP - ppublish LG - English DP - 2013 Nov EZ - 2013/02/02 06:00 DA - 2014/05/21 06:00 DT - 2013/02/02 06:00 YR - 2013 ED - 20140520 RD - 20131008 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23370078 <381. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24033733 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hunold KM AU - Esserman DA AU - Isaacs CG AU - Dickey RM AU - Pereira GF AU - Fillingim RB AU - Sloane PD AU - McLean SA AU - Platts-Mills TF FA - Hunold, Katherine M FA - Esserman, Denise A FA - Isaacs, Cameron G FA - Dickey, Ryan M FA - Pereira, Greg F FA - Fillingim, Roger B FA - Sloane, Philip D FA - McLean, Samuel A FA - Platts-Mills, Timothy F IN - Hunold, Katherine M. Department of Biostatistics, University of North Carolina Chapel Hill, Chapel Hill, NC. TI - Side effects from oral opioids in older adults during the first week of treatment for acute musculoskeletal pain. SO - Academic Emergency Medicine. 20(9):872-9, 2013 Sep AS - Acad Emerg Med. 20(9):872-9, 2013 Sep NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 20 IP - 9 PG - 872-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Acetaminophen/ae [Adverse Effects] MH - Acetaminophen/tu [Therapeutic Use] MH - Aged MH - Analgesics, Non-Narcotic/ae [Adverse Effects] MH - Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Cross-Sectional Studies MH - Emergency Service, Hospital MH - Female MH - Humans MH - Ibuprofen/ae [Adverse Effects] MH - Ibuprofen/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - *Musculoskeletal Pain/dt [Drug Therapy] MH - North Carolina MH - Pain Measurement MH - Propensity Score MH - Treatment Outcome AB - OBJECTIVES: The authors sought to describe the frequency of short-term side effects experienced by older adults initiating treatment with opioid-containing analgesics for acute musculoskeletal pain. AB - METHODS: This was a cross-sectional study of individuals age 65 years or older initiating analgesic treatment following emergency department (ED) visits for acute musculoskeletal pain. Patients were called by phone 4 to 7 days after their ED visits to assess the intensity of six common opioid-related side effects using a 0 to 10 scale and to assess medication discontinuation due to side effects. Propensity score matching was used to compare side effects among patients initiating treatment with any opioid-containing analgesics to side effects among those initiating treatment with only nonopioids. AB - RESULTS: Of 104 older patients initiating analgesic treatment following ED visits for musculoskeletal pain, 71 patients took opioid-containing analgesics, 15 took acetaminophen, and 18 took ibuprofen. Among the patients who took opioids, at least one side effect of moderate or severe intensity (score >= 4) was reported by 62%. Among patients with matching propensity scores, those taking opioids were more likely to have had moderate or severe side effects than those taking only nonopioids (62%, 95% confidence interval [CI] = 48% to 74% vs. 4%, 95% CI = 1% to 20%) and were also more likely to have discontinued treatment due to side effects (16%, 95% CI = 8% to 29% vs. 0%, 95% CI = 0% to 13%). The most common side effects due to opioids were tiredness, nausea, and constipation. AB - CONCLUSIONS: Among older adults initiating treatment with opioid-containing analgesics for musculoskeletal pain, side effects were common and sometimes resulted in medication discontinuation. Copyright © 2013 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 362O9ITL9D (Acetaminophen) RN - WK2XYI10QM (Ibuprofen) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12212 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - 10.1111/acem.12212 [doi] ID - PMC3936201 [pmc] ID - NIHMS555883 [mid] PP - ppublish PH - 2012/10/29 [received] PH - 2013/02/21 [revised] PH - 2013/04/02 [accepted] GI - No: K23 AG038548 Organization: (AG) *NIA NIH HHS* Country: United States GI - No: UL1 TR000083 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: KL2 TR000084 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: 5T35AG038047-02 Organization: (AG) *NIA NIH HHS* Country: United States GI - No: T35 AG038047 Organization: (AG) *NIA NIH HHS* Country: United States LG - English EP - 20130827 DP - 2013 Sep EZ - 2013/09/17 06:00 DA - 2014/05/16 06:00 DT - 2013/09/17 06:00 YR - 2013 ED - 20140515 RD - 20180311 UP - 20180312 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=24033733 <382. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24194796 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Muller D AU - Desel H FA - Muller, Dieter FA - Desel, Herbert IN - Muller, Dieter. GIZ-Nord Poisons Center, University Medical Center Gottingen-Georg-August-Universitat. TI - Common causes of poisoning: etiology, diagnosis and treatment. [Review] CM - Comment in: Dtsch Arztebl Int. 2014 Feb 7;111(6):100; PMID: 24622609 CM - Comment in: Dtsch Arztebl Int. 2014 Feb 7;111(6):100; PMID: 24622608 SO - Deutsches Arzteblatt International. 110(41):690-9; quiz 700, 2013 Oct AS - Dtsch. Arztebl. int.. 110(41):690-9; quiz 700, 2013 Oct NJ - Deutsches Arzteblatt international VO - 110 IP - 41 PG - 690-9; quiz 700 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101475967 IO - Dtsch Arztebl Int PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813891 SB - Index Medicus CP - Germany MH - *Antidotes/tu [Therapeutic Use] MH - *Critical Care/mt [Methods] MH - *Emergency Medical Services/mt [Methods] MH - Humans MH - *Poisoning/di [Diagnosis] MH - Poisoning/et [Etiology] MH - *Poisoning/th [Therapy] MH - *Toxicity Tests/mt [Methods] AB - BACKGROUND: In 2011, German hospitals treated approximately 205 000 patients suffering from acute poisoning. Change is seen over time both in the types of poisoning that occur and in the indications for specific treatment. AB - METHODS: This article is based on a selective review of the literature, with special attention to the health reports of the German federal government, the annual reports of the GIZ-Nord Poisons Center (the poison information center for the four northwestern states of Germany, i.e. Bremen, Hamburg, Lower Saxony and Schleswig-Holstein), and the recommendations of international medical associations. AB - RESULTS: From 1996 to 2011, the GIZ-Nord Poisons Center answered more than 450 000 inquiries, most of which involved exposures to medical drugs, chemicals, plants, foods, or cosmetics. Poisoning was clinically manifest in only a fraction of these cases. Ethanol intoxication is the commonest type of acute poisoning and suicide by medical drug overdose is the commonest type of suicide by poisoning. Death from acute poisoning is most commonly the result of either smoke inhalation or illegal drug use. Severe poisoning is only rarely due to the ingestion of chemicals (particularly detergents and cleaning products), cosmetics, or plant matter. Medical procedures that are intended to reduce the absorption of a poison or enhance its elimination are now only rarely indicated. Antidotes (e.g., atropine, 4-dimethylaminophenol, naloxone, toluidine blue) are available for only a few kinds of poisoning. Randomized clinical trials of treatment have been carried out for only a few substances. AB - CONCLUSION: Most exposures to poisons can be treated with general emergency care and, if necessary, with symptomatic intensive-care measures. Poison information centers help ensure that cases of poisoning are dealt with efficiently. The data they collect are a useful aid to toxicological assessment and can serve as a point of departure for research projects. RN - 0 (Antidotes) ES - 1866-0452 IL - 1866-0452 DO - https://dx.doi.org/10.3238/arztebl.2013.0690 PT - Journal Article PT - Review ID - 10.3238/arztebl.2013.0690 [doi] ID - PMC3813891 [pmc] PP - ppublish PH - 2013/04/02 [received] PH - 2013/07/31 [accepted] LG - English EP - 20131011 DP - 2013 Oct EZ - 2013/11/07 06:00 DA - 2014/05/16 06:00 DT - 2013/11/07 06:00 YR - 2013 ED - 20140515 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24194796 <383. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23879214 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chandwani HS AU - Strassels SA AU - Rascati KL AU - Lawson KA AU - Wilson JP FA - Chandwani, Hitesh S FA - Strassels, Scott A FA - Rascati, Karen L FA - Lawson, Kenneth A FA - Wilson, James P IN - Chandwani, Hitesh S. University of Texas at Austin College of Pharmacy, Austin, Texas, USA. chandwanihitesh@utexas.edu TI - Estimates of charges associated with emergency department and hospital inpatient care for opioid abuse-related events. SO - Journal of Pain & Palliative Care Pharmacotherapy. 27(3):206-13, 2013 Aug AS - J Pain Pall Care Pharmacother. 27(3):206-13, 2013 Aug NJ - Journal of pain & palliative care pharmacotherapy VO - 27 IP - 3 PG - 206-13 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101125608 IO - J Pain Palliat Care Pharmacother SB - Index Medicus CP - England MH - Adult MH - Cost of Illness MH - *Emergency Service, Hospital/ec [Economics] MH - Female MH - *Hospital Charges/sn [Statistics & Numerical Data] MH - Hospital Costs/sn [Statistics & Numerical Data] MH - *Hospitalization/ec [Economics] MH - Humans MH - Insurance, Health/ec [Economics] MH - Male MH - Medicaid/ec [Economics] MH - Medicare/ec [Economics] MH - Opioid-Related Disorders/co [Complications] MH - *Opioid-Related Disorders/ec [Economics] MH - Patient Admission MH - Regression Analysis MH - United States AB - The economic burden of prescription opioid abuse is substantial; however, no study has estimated the monetary burden of hospital services (emergency department [ED] and inpatient) using a single, nationally representative database. We sought to estimate total and average (adjusted for demographic and clinical factors) charges billed for opioid abuse-related events, and magnitude of difference in charges between ED visits resulting in inpatient admission to the same hospital and treat-and-release ED visits in the United States. We used the 2006, 2007, and 2008 files of the Healthcare Cost and Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to identify events and charges assigned opioid abuse, dependence, or poisoning ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02, 965.09). Using methods to account for the complex sampling design of the NEDS and a log-linked gamma regression model, we estimated national total and mean charges (in 2010 USD). Total charges were $9.8, $9.6, and $9.5 billion for 2006, 2007, and 2008, respectively. Medicaid-covered events had the highest total charges ($3 billion), followed by events covered by Medicare ($2 billion) for each year. The national estimate of adjusted, mean, per-event charges, was $18,891 (95% confidence interval [CI] = $18,167-$19,616). Compared with events covered by private insurance, mean charges for Medicare- and Medicaid-covered events were higher (t = 28.14, P < .001; t = 6.42, P < .001, respectively), whereas self-paid events had significantly lower charges (t = -11.14, P < .001). ED visits resulting in subsequent inpatient admission had approximately 6 times higher charges than treat-and-release visits. This study provides estimates of differences in hospital costs of opioid abuse by insurance status, resulting in a better understanding of the economic burden of opioid abuse on the health care system. ES - 1536-0539 IL - 1536-0288 DO - https://dx.doi.org/10.3109/15360288.2013.803511 PT - Journal Article ID - 10.3109/15360288.2013.803511 [doi] PP - ppublish LG - English EP - 20130723 DP - 2013 Aug EZ - 2013/07/25 06:00 DA - 2014/05/08 06:00 DT - 2013/07/25 06:00 YR - 2013 ED - 20140507 RD - 20130905 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23879214 <384. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23960053 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Teo AI AU - Cooper JG FA - Teo, A I C FA - Cooper, J G IN - Teo, A I C. Emergency Department, Aberdeen Royal Infirmary, UK. alison.teo.05@aberdeen.ac.uk TI - The epidemiology and management of adult poisonings admitted to the short-stay ward of a large Scottish emergency department. SO - Scottish Medical Journal. 58(3):149-53, 2013 Aug AS - Scott Med J. 58(3):149-53, 2013 Aug NJ - Scottish medical journal VO - 58 IP - 3 PG - 149-53 PI - Journal available in: Print PI - Citation processed from: Internet JC - ujk, 2983335r IO - Scott Med J SB - Index Medicus CP - Scotland MH - Acetaminophen/po [Poisoning] MH - Acetylcysteine/tu [Therapeutic Use] MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Analgesics, Non-Narcotic/po [Poisoning] MH - Antidotes/tu [Therapeutic Use] MH - *Central Nervous System Depressants/po [Poisoning] MH - Charcoal/tu [Therapeutic Use] MH - *Drug Overdose/ep [Epidemiology] MH - Drug Overdose/px [Psychology] MH - *Drug Overdose/th [Therapy] MH - Emergency Service, Hospital MH - *Ethanol/po [Poisoning] MH - Female MH - Follow-Up Studies MH - Free Radical Scavengers/tu [Therapeutic Use] MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Length of Stay MH - Male MH - Mental Disorders MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Patient Admission MH - Patient Discharge MH - *Public Health MH - Retrospective Studies MH - Scotland/ep [Epidemiology] MH - *Self-Injurious Behavior/ep [Epidemiology] MH - Self-Injurious Behavior/px [Psychology] MH - Self-Injurious Behavior/th [Therapy] KW - Poisonings; alcohol; overdose; paracetamol; self-harm AB - BACKGROUND AND AIMS: The emergency department of Aberdeen Royal Infirmary receives around 68,000 new adult admissions annually. All poisoning cases are admitted to a 14-bedded short-stay ward, except those admitted to intensive care or immediately discharged. This study aimed to analyse epidemiological trends and management of short-stay ward admissions for poisonings. AB - METHOD AND RESULTS: Adult (>13 years) poisoning presentations admitted to the emergency department short-stay ward of Aberdeen Royal Infirmary from 1 January-31 December 2009 were retrospectively reviewed using patient discharge summaries. During 2009, there were 1062 poisoning cases, of which repeat episodes were responsible for 15%. The mean age of presentation was 33.9 years (SD 14.4) and there was a female preponderance (62%). Almost half of poisonings were polypharmacy, alcohol was involved in 40% of cases and overdoses most commonly involved paracetamol (43%). Management involved basic observations only (66%), N-acetylcysteine (24%), naloxone (4%) and activated charcoal (1%). Liaison psychiatry reviewed 84% presentations and admitted 9% to the psychiatric unit. AB - CONCLUSIONS: The short-stay ward is important for acute management of poisonings and the data gained from this study should help to direct patient services appropriately. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Antidotes) RN - 0 (Central Nervous System Depressants) RN - 0 (Free Radical Scavengers) RN - 0 (Narcotic Antagonists) RN - 16291-96-6 (Charcoal) RN - 362O9ITL9D (Acetaminophen) RN - 36B82AMQ7N (Naloxone) RN - 3K9958V90M (Ethanol) RN - WYQ7N0BPYC (Acetylcysteine) IS - 0036-9330 IL - 0036-9330 DO - https://dx.doi.org/10.1177/0036933013496951 PT - Journal Article ID - 58/3/149 [pii] ID - 10.1177/0036933013496951 [doi] PP - ppublish LG - English DP - 2013 Aug EZ - 2013/08/21 06:00 DA - 2014/05/06 06:00 DT - 2013/08/21 06:00 YR - 2013 ED - 20140505 RD - 20130820 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23960053 <385. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24037012 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Martins HS AU - Koike MK AU - Velasco IT FA - Martins, Herlon S FA - Koike, Marcia K FA - Velasco, Irineu T IN - Martins, Herlon S. Faculdade de Medicina da Universidade de Sao Paulo, Department of Emergency Medicine, Research Laboratory, Sao PauloSP, Brazil. TI - Effects of terlipressin and naloxone compared with epinephrine in a rat model of asphyxia-induced cardiac arrest. SO - Clinics (Sao Paulo, Brazil). 68(8):1146-51, 2013 AS - Clinics. 68(8):1146-51, 2013 NJ - Clinics (Sao Paulo, Brazil) VO - 68 IP - 8 PG - 1146-51 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101244734, 16240140r IO - Clinics (Sao Paulo) PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752630 SB - Index Medicus CP - Brazil MH - Animals MH - Arterial Pressure/de [Drug Effects] MH - Asphyxia/co [Complications] MH - Cardiopulmonary Resuscitation MH - Epinephrine/me [Metabolism] MH - *Epinephrine/pd [Pharmacology] MH - *Heart Arrest/dt [Drug Therapy] MH - Heart Arrest/et [Etiology] MH - Heart Arrest/pp [Physiopathology] MH - Hemodynamics/de [Drug Effects] MH - *Lypressin/aa [Analogs & Derivatives] MH - Lypressin/me [Metabolism] MH - Lypressin/pd [Pharmacology] MH - Male MH - *Models, Animal MH - Naloxone/me [Metabolism] MH - *Naloxone/pd [Pharmacology] MH - Random Allocation MH - Rats MH - Rats, Wistar MH - Reference Values MH - Reproducibility of Results MH - Time Factors MH - Vasoconstrictor Agents/me [Metabolism] MH - *Vasoconstrictor Agents/pd [Pharmacology] AB - OBJECTIVE: To evaluate the hemodynamic and metabolic effects of terlipressin and naloxone in cardiac arrest. AB - METHODS: Cardiac arrest in rats was induced by asphyxia and maintained for 3.5 minutes. Animals were then resuscitated and randomized into one of six groups: placebo (n = 7), epinephrine (0.02 mg/kg; n = 7), naloxone (1 mg/kg; n = 7) or terlipressin, of which three different doses were tested: 50 micro g/kg (TP50; n = 7), 100 micro g/kg (TP100; n = 7) and 150 micro g/kg (TP150; n = 7). Hemodynamic variables were measured at baseline and at 10 (T10), 20 (T20), 30 (T30), 45 (T45) and 60 (T60) minutes after cardiac arrest. Arterial blood samples were collected at T10, T30 and T60. AB - RESULTS: The mean arterial pressure values in the TP50 group were higher than those in the epinephrine group at T10 (165 vs. 112 mmHg), T20 (160 vs. 82 mmHg), T30 (143 vs. 66 mmHg), T45 (119 vs. 67 mmHg) and T60 (96 vs. 66.8 mmHg). The blood lactate level was lower in the naloxone group than in the epinephrine group at T10 (5.15 vs. 10.5 mmol/L), T30 (2.57 vs. 5.24 mmol/L) and T60 (2.1 vs. 4.1 mmol/L). AB - CONCLUSIONS: In this rat model of asphyxia-induced cardiac arrest, terlipressin and naloxone were effective vasopressors in cardiopulmonary resuscitation and presented better metabolic profiles than epinephrine. Terlipressin provided better hemodynamic stability than epinephrine. RN - 0 (Vasoconstrictor Agents) RN - 36B82AMQ7N (Naloxone) RN - 50-57-7 (Lypressin) RN - 7Z5X49W53P (terlipressin) RN - YKH834O4BH (Epinephrine) ES - 1980-5322 IL - 1807-5932 DI - S1807-59322013000801146 DO - https://dx.doi.org/10.6061/clinics/2013(08)14 PT - Comparative Study PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S1807-59322013000801146 [pii] ID - 10.6061/clinics/2013(08)14 [doi] ID - PMC3752630 [pmc] PP - ppublish PH - 2013/03/08 [received] PH - 2013/04/02 [accepted] LG - English DP - 2013 EZ - 2013/09/17 06:00 DA - 2014/05/03 06:00 DT - 2013/09/17 06:00 YR - 2013 ED - 20140502 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24037012 <386. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24553557 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Field CA AU - Cochran G AU - Caetano R AU - Foreman M AU - Brown CV FA - Field, Craig A FA - Cochran, Gerald FA - Caetano, Raul FA - Foreman, Michael FA - Brown, Carlos V R IN - Field, Craig A. From the University of Texas at Austin (C.A.F.); and University Medical Center at Brackenridge (C.V.R.B.), Austin; and University of Texas School of Public Health and University of Texas Southwestern Medical Center (R.C.); and Baylor University Medical Center (M.F.), Dallas, Texas; University of Pittsburgh (G.C.), Pittsburgh, Pennsylvania. TI - Postdischarge nonmedical use of prescription opioids in at-risk drinkers admitted to urban level I trauma centers. SO - The Journal of Trauma and Acute Care Surgery. 76(3):833-9, 2014 Mar AS - J Trauma Acute Care Surg. 76(3):833-9, 2014 Mar NJ - The journal of trauma and acute care surgery VO - 76 IP - 3 PG - 833-9 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101570622 IO - J Trauma Acute Care Surg SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Alcoholism/co [Complications] MH - Alcoholism/pc [Prevention & Control] MH - Alcoholism/px [Psychology] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Female MH - Hospitals, Urban/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Motivational Interviewing MH - Patient Discharge/sn [Statistics & Numerical Data] MH - *Prescription Drug Misuse/sn [Statistics & Numerical Data] MH - Risk Factors MH - *Trauma Centers/sn [Statistics & Numerical Data] AB - BACKGROUND: Nonmedical use of prescription opioids (NM-POs) has reached epidemic proportions in the United States. Unintentional overdose deaths involving prescription opioids have quadrupled since 1999. Herein, we examine NM-POs and their associated risk factors among two cohorts of trauma patients with at-risk drinking. AB - METHODS: This secondary analysis examines NM-PO from two separate randomized trials that delivered brief alcohol interventions to patients in urban Level I trauma centers. In the first study, data were collected from 1,493 injured patients at a single trauma center, and in the second study, data were collected from 596 injured patients at two trauma centers. All participants were considered at-risk drinkers because they were admitted for an alcohol related injury as indicated by a positive blood alcohol concentration and/or self-reported heavy drinking. AB - RESULTS: In Study 1, NM-PO nearly doubled from 5.2% before admission to 9.8% at 6 months after discharge. At 12 months after discharge, those who reported NM-PO (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.28-4.15) and drug use (OR, 2.62, 95% CI, 1.70-4.04) before admission had the highest odds for postdischarge NM-PO. In Study 2, NM-PO increased from 5.2% before admission to 6.8% at 12 months after discharge. At 12 months after discharge, those who reported NM-PO (OR, 2.71; 95% CI, 1.10-6.66) or drug use (OR, 4.05; 95% CI, 2.00-8.21) before admission had the highest odds for postdischarge NM-PO. AB - CONCLUSION: The results suggest that there is an increased risk of postdischarge NM-PO among injured patients with at-risk drinking, particularly among those with a recent history of drug use or NM-PO. Cautious, evidence-based opioid prescribing may reduce exposure to prescription opioids in high-risk patients, risk of subsequent misuse, and possible diversion. AB - LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level II. RN - 0 (Analgesics, Opioid) ES - 2163-0763 IL - 2163-0755 DO - https://dx.doi.org/10.1097/TA.0000000000000100 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural ID - 10.1097/TA.0000000000000100 [doi] ID - 01586154-201403000-00039 [pii] PP - ppublish GI - No: R01 AA015439 Organization: (AA) *NIAAA NIH HHS* Country: United States GI - No: R01AA013824 Organization: (AA) *NIAAA NIH HHS* Country: United States GI - No: T32DA007209 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2014 Mar EZ - 2014/02/21 06:00 DA - 2014/05/03 06:00 DT - 2014/02/21 06:00 YR - 2014 ED - 20140501 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24553557 <387. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23860727 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Peoc'h K AU - Megarbane B FA - Peoc'h, Katell FA - Megarbane, Bruno IN - Peoc'h, Katell. INSERM U705, Lariboisiere Hospital, Paris-Diderot University, Paris, France. TI - Can mu-opioid receptor A118G gene polymorphism be predictive of acute poisoning severity in the emergency department?. CM - Comment on: J Med Toxicol. 2013 Jun;9(2):148-54; PMID: 23318993 SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 9(3):292-3, 2013 Sep AS - J Med Toxicol. 9(3):292-3, 2013 Sep NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 9 IP - 3 PG - 292-3 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3770990 SB - Index Medicus CP - United States MH - *Benzodiazepines/to [Toxicity] MH - *Drug Overdose/ge [Genetics] MH - Female MH - Humans MH - Male MH - *Narcotics/to [Toxicity] MH - *Polymorphism, Single Nucleotide MH - *Receptors, Opioid, mu/ge [Genetics] MH - *Sympathomimetics/to [Toxicity] RN - 0 (Narcotics) RN - 0 (Receptors, Opioid, mu) RN - 0 (Sympathomimetics) RN - 12794-10-4 (Benzodiazepines) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-013-0317-8 PT - Comment PT - Letter ID - 10.1007/s13181-013-0317-8 [doi] ID - PMC3770990 [pmc] PP - ppublish LG - English DP - 2013 Sep EZ - 2013/07/19 06:00 DA - 2014/04/29 06:00 DT - 2013/07/18 06:00 YR - 2013 ED - 20140428 RD - 20150423 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23860727 <388. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23769424 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sauber-Schatz EK AU - Mack KA AU - Diekman ST AU - Paulozzi LJ FA - Sauber-Schatz, Erin K FA - Mack, Karin A FA - Diekman, Shane T FA - Paulozzi, Leonard J IN - Sauber-Schatz, Erin K. Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., Mailstop F62, Atlanta, GA 30341, United States. Electronic address: ige7@cdc.gov. TI - Associations between pain clinic density and distributions of opioid pain relievers, drug-related deaths, hospitalizations, emergency department visits, and neonatal abstinence syndrome in Florida. SO - Drug & Alcohol Dependence. 133(1):161-6, 2013 Nov 01 AS - Drug Alcohol Depend. 133(1):161-6, 2013 Nov 01 NJ - Drug and alcohol dependence VO - 133 IP - 1 PG - 161-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Age Distribution MH - *Analgesics, Opioid/to [Toxicity] MH - Cause of Death MH - *Drug Overdose/mo [Mortality] MH - *Drug Utilization/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Florida/ep [Epidemiology] MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - *Models, Statistical MH - *Neonatal Abstinence Syndrome/ep [Epidemiology] MH - *Pain Clinics/sn [Statistics & Numerical Data] KW - Drug overdose death; Drug-related hospitalization; Florida; Neonatal abstinence syndrome; Pain clinic; Pill mill AB - BACKGROUND: Community-level associations between pain clinics and drug-related outcomes have not been empirically demonstrated. AB - METHODS: To explore these associations we correlated overdose death rates, hospital-discharge rates for drug-related hospitalizations including neonatal abstinence syndrome, and emergency department rates for drug-related visits with registered pain clinic density and rate of opioid pills dispensed per person at the county-level Florida in 2009. Negative binomial regression was used to model the crude associations and associations adjusted for exposure measures and county demographic characteristics. AB - RESULTS: An estimated 732 pain clinics operated in Florida in 2009, a rate of 3.9/100,000 people. Among the 67 counties in Florida, 23 (34.3%) had no pain clinics, and three had 90 or more. Adjusted negative binomial regression determined no significant association between pain clinic rate and drug-related outcomes. However, rates of drug-caused, opioid-caused, and oxycodone-caused death correlated significantly with rates of opioid and oxycodone pills dispensed per person in adjusted analyses. For every increase of one pill in the rate of oxycodone pills per person, there was a 6% increase in the rate of oxycodone-related overdose death. AB - CONCLUSIONS: Although pain clinics, some of which are "pill mills," are clearly a source of drugs used nonmedically, their impact on health outcomes might be difficult to quantify because the pills they prescribe might be consumed in other counties or states. The impact of "pill mill" laws might be better measured by more proximal measures such as the number of such facilities. Copyright Published by Elsevier Ireland Ltd. RN - 0 (Analgesics, Opioid) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(13)00192-0 DO - https://dx.doi.org/10.1016/j.drugalcdep.2013.05.017 PT - Journal Article ID - S0376-8716(13)00192-0 [pii] ID - 10.1016/j.drugalcdep.2013.05.017 [doi] PP - ppublish PH - 2013/01/12 [received] PH - 2013/04/03 [revised] PH - 2013/05/13 [accepted] LG - English EP - 20130614 DP - 2013 Nov 01 EZ - 2013/06/19 06:00 DA - 2014/04/29 06:00 DT - 2013/06/18 06:00 YR - 2013 ED - 20140428 RD - 20130927 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23769424 <389. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24765257 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Sittambalam CD AU - Vij R AU - Ferguson RP FA - Sittambalam, Charmian D FA - Vij, Radhika FA - Ferguson, Robert P IN - Sittambalam, Charmian D. Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA. IN - Vij, Radhika. Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA. IN - Ferguson, Robert P. Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA. TI - Buprenorphine Outpatient Outcomes Project: can Suboxone be a viable outpatient option for heroin addiction?. SO - Journal of Community Hospital Internal Medicine Perspectives. 4, 2014 AS - J Community Hosp Intern Med Perspect. 4, 2014 NJ - Journal of community hospital internal medicine perspectives VO - 4 PI - Journal available in: Electronic-eCollection PI - Citation processed from: Print JC - 101601396 IO - J Community Hosp Intern Med Perspect PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992357 CP - United States KW - Suboxone; heroin abuse; quality of life; substance abuse treatment AB - BACKGROUND: Opioid dependence treatment traditionally involves methadone clinics, for which dispensing schedules can be cumbersome. Buprenorphine, a partial agonist of the mu receptor and antagonist of the kappa receptor, is a potential outpatient alternative to methadone. Funded by a grant from the State of Maryland's Community Health Resources Commission (CHRC), the Buprenorphine Outpatient Outcomes Project (BOOP) evaluates the outcome of Suboxone (buprenorphine/naloxone) treatment on abstinence from heroin use, rates of emergency room visits and hospitalizations, legal issues, and quality of life. AB - METHODS: Active heroin users were recruited between June 2007 and June 2010 and induction therapy with Suboxone was instituted during hospitalization. Once discharged, patients were followed as outpatients for maintenance treatment and counseling. Data were collected from electronic medical records, Maryland state legal records, and SF-36() Health Surveys regarding several parameters and patients were categorized according to duration of treatment with Suboxone into one of three groups: <1 month, 1-3 months, and >3 months. AB - RESULTS: A total of 220 participants were included in the study. The age range of participants was 18-67 years with most being African American males. Eighty-three (38%) remained in the study for at least 1 month, with 37 of the 83 (45%) remaining in treatment for >3 months. Ten of the 37 (27%) never relapsed after their longest period of abstinence from heroin. During the first year after initiating treatment with Suboxone, hospitalization and emergency room visit rates for all 220 participants decreased by 45 and 23%, respectively, as compared to the year prior to starting treatment. The number of legal charges for drug possession decreased from 70 to 62. Anecdotally, the quality of life seemed to improve in those who were treated with Suboxone for longer periods of time and received regular counseling. AB - CONCLUSION: Overall, Suboxone is an effective treatment method for heroin addiction and is a viable outpatient therapy option. Individualized treatment plans and counseling must be implemented for maximum benefits to be seen. Retention of patients for a long duration of therapy was difficult, but for those who did remain, benefits were seen in overall health, abstinence from heroin use, cognition, and quality of life. IS - 2000-9666 IL - 2000-9666 DO - https://dx.doi.org/10.3402/jchimp.v4.22902 PT - Journal Article ID - 10.3402/jchimp.v4.22902 [doi] ID - 22902 [pii] ID - PMC3992357 [pmc] PP - epublish PH - 2013/09/24 [received] PH - 2014/02/01 [revised] PH - 2014/02/07 [accepted] LG - English EP - 20140414 DP - 2014 EZ - 2014/04/26 06:00 DA - 2014/04/26 06:01 DT - 2014/04/26 06:00 YR - 2014 ED - 20140425 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=24765257 <390. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23688843 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schuman-Olivier Z AU - Hoeppner BB AU - Weiss RD AU - Borodovsky J AU - Shaffer HJ AU - Albanese MJ FA - Schuman-Olivier, Zev FA - Hoeppner, Bettina B FA - Weiss, Roger D FA - Borodovsky, Jacob FA - Shaffer, Howard J FA - Albanese, Mark J IN - Schuman-Olivier, Zev. Harvard Medical School, United States; Massachussets General Hospital, United States. Electronic address: zschuman@partners.org. TI - Benzodiazepine use during buprenorphine treatment for opioid dependence: clinical and safety outcomes. SO - Drug & Alcohol Dependence. 132(3):580-6, 2013 Oct 01 AS - Drug Alcohol Depend. 132(3):580-6, 2013 Oct 01 NJ - Drug and alcohol dependence VO - 132 IP - 3 PG - 580-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916951 OI - Source: NLM. NIHMS472006 SB - Index Medicus CP - Ireland MH - Accidents/td [Trends] MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Benzodiazepines/ae [Adverse Effects] MH - *Benzodiazepines/tu [Therapeutic Use] MH - *Buprenorphine/tu [Therapeutic Use] MH - Emergency Medical Services/td [Trends] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opiate Substitution Treatment/mt [Methods] MH - Opiate Substitution Treatment/td [Trends] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Retrospective Studies MH - Treatment Outcome KW - Accident; Benzodiazepine; Buprenorphine; Female; Opioid dependence; Utilization AB - BACKGROUND: Prescribing benzodiazepines during buprenorphine treatment is a topic of active discussion. Clinical benefit is unclear. Overdose, accidental injury, and benzodiazepine misuse remain concerns. We examine the relationship between benzodiazepine misuse history, benzodiazepine prescription, and both clinical and safety outcomes during buprenorphine treatment. AB - METHODS: We retrospectively examined outpatient buprenorphine treatment records, classifying patients by past-year benzodiazepine misuse history and approved benzodiazepine prescription at intake. Primary clinical outcomes included 12-month treatment retention and urine toxicology for illicit opioids. Primary safety outcomes included total emergency department (ED) visits and odds of an ED visit related to overdose or accidental injury during treatment. AB - RESULTS: The 12-month treatment retention rate for the sample (N=328) was 40%. Neither benzodiazepine misuse history nor benzodiazepine prescription was associated with treatment retention or illicit opioid use. Poisson regressions of ED visits during buprenorphine treatment revealed more ED visits among those with a benzodiazepine prescription versus those without (p<0.001); benzodiazepine misuse history had no effect. The odds of an accidental injury-related ED visit during treatment were greater among those with a benzodiazepine prescription (OR: 3.7, p<0.01), with an enhanced effect among females (OR: 4.7, p<0.01). Overdose was not associated with benzodiazepine misuse history or prescription. AB - CONCLUSIONS: We found no effect of benzodiazepine prescriptions on opioid treatment outcomes; however, benzodiazepine prescription was associated with more frequent ED visits and accidental injuries, especially among females. When prescribing benzodiazepines during buprenorphine treatment, patients need more education about accidental injury risk. Alternative treatments for anxiety should be considered when possible, especially among females. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) RN - 40D3SCR4GZ (Buprenorphine) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(13)00133-6 DO - https://dx.doi.org/10.1016/j.drugalcdep.2013.04.006 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - S0376-8716(13)00133-6 [pii] ID - 10.1016/j.drugalcdep.2013.04.006 [doi] ID - PMC3916951 [pmc] ID - NIHMS472006 [mid] PP - ppublish PH - 2013/01/22 [received] PH - 2013/04/02 [revised] PH - 2013/04/04 [accepted] GI - No: U10 DA015831 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K24DA022288 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: L30 DA027330 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: UL1RR025758 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: K01 DA027097 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: U10 DA15831 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K24 DA022288 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: UL1 RR025758 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: K01DA027097 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20130518 DP - 2013 Oct 01 EZ - 2013/05/22 06:00 DA - 2014/04/23 06:00 DT - 2013/05/22 06:00 YR - 2013 ED - 20140422 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23688843 <391. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23527666 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sandoval M AU - Coleman P AU - Govani R AU - Siddiqui S AU - Todd KH FA - Sandoval, Marcelo FA - Coleman, Patricia FA - Govani, Rahim FA - Siddiqui, Saima FA - Todd, Knox H IN - Sandoval, Marcelo. Department of Emergency Medicine, MD Anderson Cancer Center, Houston, Texas, USA. msandoval@mdsanderson.org TI - Pilot study of human recombinant hyaluronidase-enhanced subcutaneous hydration and opioid administration for sickle cell disease acute pain episodes. SO - Journal of Pain & Palliative Care Pharmacotherapy. 27(1):10-8, 2013 Mar AS - J Pain Pall Care Pharmacother. 27(1):10-8, 2013 Mar NJ - Journal of pain & palliative care pharmacotherapy VO - 27 IP - 1 PG - 10-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101125608 IO - J Pain Palliat Care Pharmacother SB - Index Medicus CP - England MH - *Acute Pain/co [Complications] MH - *Acute Pain/dt [Drug Therapy] MH - *Acute Pain/th [Therapy] MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Anemia, Sickle Cell/co [Complications] MH - Combined Modality Therapy/mt [Methods] MH - Female MH - Humans MH - Hyaluronoglucosaminidase/ad [Administration & Dosage] MH - *Hyaluronoglucosaminidase/tu [Therapeutic Use] MH - Hydromorphone/ad [Administration & Dosage] MH - *Hydromorphone/tu [Therapeutic Use] MH - *Hypodermoclysis/mt [Methods] MH - Injections, Subcutaneous MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - *Morphine/tu [Therapeutic Use] MH - Pain Measurement/de [Drug Effects] MH - Patient Satisfaction MH - Pilot Projects MH - Recombinant Proteins/ad [Administration & Dosage] MH - Recombinant Proteins/tu [Therapeutic Use] AB - The objective of this study was to determine the feasibility of protocol-driven human recombinant hyaluronidase (rHuPH20)-enhanced subcutaneous (SC) hydration and opioid administration in adults presenting to the emergency department (ED) with sickle cell disease acute pain episodes (SCDAPE). Adults with SCDAPE were given 150 U of rHuPH20 and normal saline subcutaneously. Opioids were administered SC every 15 minutes for 4 hours until numerical rating scale (NRS) pain intensity scores fell to <5, or Ramsay Sedation Scores were >4. Pain intensity and pain relief were recorded hourly. Total morphine equivalents and fluid volume, total pain relief (TOTPAR), patient- and physician-perceived global efficacy, patient-perceived global SC needle discomfort, physician-rated ease of needle placement, and adverse effects were noted. Ten patients (6 males, 4 females), mean age 32.9 years (23-56 years) completed the trial. Mean pain intensity scores fell 25% (from 9.2 to 6.9) from baseline and mean 4-hour TOTPAR score was 4 (maximum: 16). A mean total of 119 mg (70-170 mg) morphine equivalents and 846 mL (200-1650 mL) normal saline were administered. Mean patient and physician global perceived efficacy ratings were 3.4 and 4.2 (of 5). Patient global discomfort of SC needle presence was 2.7 (of 10), and ease of needle placement was physician rated at 4 (of 4; easiest). Patients experienced mild swelling and stinging at the SC site, and no infusion required discontinuation. The authors conclude that rHuPH20-enhanced subcutaneous hydration and opioid administration appear feasible from this pilot study. These results need confirmation in a controlled clinical trial. RN - 0 (Analgesics, Opioid) RN - 0 (Recombinant Proteins) RN - 76I7G6D29C (Morphine) RN - EC 3-2-1-35 (Hyaluronoglucosaminidase) RN - Q812464R06 (Hydromorphone) ES - 1536-0539 IL - 1536-0288 DO - https://dx.doi.org/10.3109/15360288.2012.758683 PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.3109/15360288.2012.758683 [doi] PP - ppublish LG - English DP - 2013 Mar EZ - 2013/03/27 06:00 DA - 2014/04/22 06:00 DT - 2013/03/27 06:00 YR - 2013 ED - 20140421 RD - 20130326 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23527666 <392. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23489089 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Soyka M FA - Soyka, Michael IN - Soyka, Michael. Department of Psychiatry, University of Munich, Germany. Michael.Soyka@privatklinik-meiringen.ch TI - Buprenorphine and buprenorphine/naloxone intoxication in children - how strong is the risk?. [Review] SO - Current Drug Abuse Reviews. 6(1):63-70, 2013 Mar AS - Curr Drug Abuse Rev. 6(1):63-70, 2013 Mar NJ - Current drug abuse reviews VO - 6 IP - 1 PG - 63-70 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101468123 IO - Curr Drug Abuse Rev SB - Index Medicus CP - United Arab Emirates MH - Age Factors MH - *Buprenorphine/po [Poisoning] MH - Drug Therapy, Combination/ae [Adverse Effects] MH - Drug Therapy, Combination/mo [Mortality] MH - Humans MH - *Naloxone/po [Poisoning] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - *Opiate Substitution Treatment/ae [Adverse Effects] MH - Opiate Substitution Treatment/mo [Mortality] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Pharmacovigilance MH - Prescription Drug Diversion/sn [Statistics & Numerical Data] AB - Opioid maintenance therapy with methadone or buprenorphine is an established and first-line treatment for opioid dependence. Risk of diversion and toxicity of opioid prescription drugs, including buprenorphine, causes significant concerns. This is particularly the case in the United States, where the number of related emergency visits is increasing, especially in children. A systematic literature research (Medline, Pubmed) was performed to assess the risk associated with buprenorphine. The search, which was not limited to particular publication years, was performed with the key words buprenorphine AND toxicity (114 counts ) AND children (4 counts) and buprenorphine AND mortality AND children (5 counts). In addition, the author obtained information from relevant websites (NIDA, SAMSHA) and pharmacovigilance data from the manufacturer of buprenorphine. Clinical and toxicological data suggest a low risk for fatal intoxications associated with bupreorphine in adults. Data from emergency units indicate a dramatic, 20-fold increase in buprenorphine exposure in children over the past decade, mostly in those under 6. The US 'Researched Abuse, Diversion and Addiction-Related Surveillance' (RADARS) system indicates a lower risk of severe opioid intoxications with buprenorphine than with other opioids, with no fatal outcomes recorded. Correspondingly, data from spontaneous reports to the surveillance programme of the manufacturer of buprenorphine (13,600 buprenorphine exposures, 4879 of these in children under six) show a serious medical outcome in 34% of children under the age of six but only one fatal outcome. Although exposure to buprenorphine and other opioids remains a significant concern in children, the drug seems rather to be safe with respect to severe outcomes, in particular death. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) ES - 1874-4745 IL - 1874-4737 PT - Journal Article PT - Review ID - CDAR-EPUB-20130311-1 [pii] PP - ppublish PH - 2012/11/19 [received] PH - 2013/02/18 [revised] PH - 2013/03/11 [accepted] LG - English DP - 2013 Mar EZ - 2013/03/16 06:00 DA - 2014/04/22 06:00 DT - 2013/03/16 06:00 YR - 2013 ED - 20140421 RD - 20130626 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23489089 <393. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24091764 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hawkins EJ AU - Malte CA AU - Grossbard J AU - Saxon AJ AU - Imel ZE AU - Kivlahan DR FA - Hawkins, Eric J FA - Malte, Carol A FA - Grossbard, Joel FA - Saxon, Andrew J FA - Imel, Zac E FA - Kivlahan, Daniel R IN - Hawkins, Eric J. From the Health Services Research & Development (EJH, CAM, JG, DRK), Seattle, WA; Center of Excellence in Substance Abuse Treatment and Education (EJH, CAM, AJS, DRK), VA Puget Sound Health Care System, Seattle, WA; Department Psychiatry and Behavioral Sciences (EJH, AJS, DRK), University of Washington, Seattle; and Department of Educational Psychology (ZEI), University of Utah, Salt Lake City, UT. TI - Comparative safety of benzodiazepines and opioids among veterans affairs patients with posttraumatic stress disorder. SO - Journal of Addiction Medicine. 7(5):354-62, 2013 Sep-Oct AS - J Addict Med. 7(5):354-62, 2013 Sep-Oct NJ - Journal of addiction medicine VO - 7 IP - 5 PG - 354-62 PI - Journal available in: Print PI - Citation processed from: Print JC - 101306759 IO - J Addict Med SB - Index Medicus CP - United States MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid MH - Benzodiazepines/ad [Administration & Dosage] MH - Benzodiazepines/ae [Adverse Effects] MH - *Benzodiazepines MH - Drug Interactions MH - Drug Monitoring/mt [Methods] MH - Drug-Related Side Effects and Adverse Reactions/di [Diagnosis] MH - Drug-Related Side Effects and Adverse Reactions/ep [Epidemiology] MH - Drug-Related Side Effects and Adverse Reactions/et [Etiology] MH - Drug-Related Side Effects and Adverse Reactions/pc [Prevention & Control] MH - *Drug-Related Side Effects and Adverse Reactions MH - Female MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Middle Aged MH - Psychotropic Drugs/ad [Administration & Dosage] MH - Psychotropic Drugs/ae [Adverse Effects] MH - Retrospective Studies MH - Risk Factors MH - Serotonin Uptake Inhibitors/ad [Administration & Dosage] MH - Serotonin Uptake Inhibitors/ae [Adverse Effects] MH - Stress Disorders, Post-Traumatic/dt [Drug Therapy] MH - Stress Disorders, Post-Traumatic/ep [Epidemiology] MH - Stress Disorders, Post-Traumatic/et [Etiology] MH - Stress Disorders, Post-Traumatic/px [Psychology] MH - *Stress Disorders, Post-Traumatic MH - United States/ep [Epidemiology] MH - *Veterans/px [Psychology] MH - Veterans/sn [Statistics & Numerical Data] MH - Veterans Health/sn [Statistics & Numerical Data] AB - OBJECTIVES: Although Veterans Affairs (VA) patients with posttraumatic stress disorder (PTSD) are prescribed benzodiazepines and opioids in addition to recommended pharmacotherapies, little is known about the safety of these medications. This study compared the 2-year incidence of adverse events among VA patients with PTSD exposed to combinations of selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and opioids. AB - METHODS: This retrospective cohort study used VA administrative data from 2004 to 2010 to identify and follow 5236 VA patients with PTSD with new episodes of (1) SSRIs/SNRIs only; (2) concurrent SSRIs/SNRIs and benzodiazepines; and (3) concurrent SSRIs/SNRIs, benzodiazepines, and opioids. Outcome measures were the 2-year incidence and adjusted hazard ratios (AHR) of mental health and medicine/surgery hospitalizations, emergency department visits, harmful events (eg, injuries and death), and any adverse event after adjustment for demographics, clinical covariates, and adverse event history. AB - RESULTS: Compared with SSRIs/SNRIs only, the adjusted risk of mental health hospitalizations (AHR: 1.87; 95% confidence interval [CI]: 1.37-2.53) was greater among patients prescribed SSRIs/SNRIs and benzodiazepines concurrently. The AHR of mental health hospitalizations (AHR: 2.00; 95% CI: 1.35-2.98), medicine/surgery hospitalizations (AHR: 4.86; 95% CI: 3.30-7.14), emergency department visits (AHR: 2.01; 95% CI: 1.53-2.65), any harmful event (2.92; 95% CI: 2.21-3.84), and any adverse event (AHR: 2.65; 95% CI: 2.18-3.23) were all significantly greater among patients prescribed SSRIs/SNRIs, benzodiazepines, and opioids than among those prescribed SSRIs/SNRIs only. AB - CONCLUSIONS: Concurrently prescribing SSRIs/SNRIs, benzodiazepines, and opioids among patients with PTSD is associated with adverse events. Although efforts are warranted to monitor patients who are prescribed combinations of these medications to prevent adverse events, these results should be interpreted with caution until they are replicated. RN - 0 (Analgesics, Opioid) RN - 0 (Psychotropic Drugs) RN - 0 (Serotonin Uptake Inhibitors) RN - 12794-10-4 (Benzodiazepines) IS - 1932-0620 IL - 1932-0620 DO - https://dx.doi.org/10.1097/ADM.0b013e31829e3957 PT - Comparative Study PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. ID - 10.1097/ADM.0b013e31829e3957 [doi] ID - 01271255-201309000-00008 [pii] PP - ppublish LG - English DP - 2013 Sep-Oct EZ - 2013/10/05 06:00 DA - 2014/04/20 06:00 DT - 2013/10/05 06:00 YR - 2013 ED - 20140418 RD - 20131010 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24091764 <394. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24741549 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Saligram S AU - Bielefeldt K FA - Saligram, Shreyas FA - Bielefeldt, Klaus IN - Saligram, Shreyas. Departments of Medicine and Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA ; Department of Gastroenterology, Kansas University School of Medicine, Kansas City, Missouri, USA. IN - Bielefeldt, Klaus. Departments of Medicine and Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. TI - The two sides of opioids in cyclical vomiting syndrome. SO - North American Journal of Medical Sciences. 6(3):114-8, 2014 Mar AS - N A J Med Sci (Hamilt). 6(3):114-8, 2014 Mar NJ - North American journal of medical sciences VO - 6 IP - 3 PG - 114-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 101521411 IO - N Am J Med Sci PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978933 CP - India KW - Coalescing attacks; Cyclical vomiting syndrome; Opioids AB - BACKGROUND: Cyclical vomiting syndrome is increasingly recognized in adults, with recent reports suggesting 'coalescing attacks' in one third of the patients. We hypothesized that the common need for opioid treatment may contribute to coalescing attacks through development of opioid dependence and withdrawal, triggering cyclical vomiting syndrome. AB - AIM: This study was to review iatrogenic opioid dependence as the potential cause for triggering cyclical vomiting syndrome. AB - MATERIALS AND METHODS: A retrospective review was performed to identify patients treated for cyclical vomiting syndrome by a single physician between Jan and December of 2010. Demographic data, clinical presentation, treatment, cumulative opioid prescription during hospitalizations and emergency room visits and days of inpatient stay were abstracted from the chart. AB - RESULTS: Forty-one patients (mean age 37.5.6 +/- 2.6 years; 66% female) were seen within this timeframe. In eleven patients (27%) with ongoing opioid use, the initial cyclical illness had progressed and eventually coalesced. A cohort of 23 patients was followed for at least 6 months (12.3 +/- 1.7 months). The best single predictor of repeat hospitalizations was the cumulative opioid dosage. AB - CONCLUSION: Continued use of opioid therapy is a poor prognostic marker of cyclical vomiting syndrome and may contribute to disease coalescence, with dependence and withdrawal triggering recurrent episodes. IS - 2250-1541 IL - 1947-2714 DO - https://dx.doi.org/10.4103/1947-2714.128472 PT - Journal Article ID - 10.4103/1947-2714.128472 [doi] ID - NAJMS-6-114 [pii] ID - PMC3978933 [pmc] PP - ppublish LG - English DP - 2014 Mar EZ - 2014/04/18 06:00 DA - 2014/04/18 06:01 DT - 2014/04/18 06:00 YR - 2014 ED - 20140417 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=24741549 <395. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24528948 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Doyon S FA - Doyon, Suzanne IN - Doyon, Suzanne. Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD. TI - A performance improvement prescribing guideline reduces opioid prescriptions for emergency department dental pain patients. CM - Comment in: Ann Emerg Med. 2014 Mar;63(3):371-2; PMID: 24528949 CM - Comment on: Ann Emerg Med. 2013 Sep;62(3):237-40; PMID: 23374416 SO - Annals of Emergency Medicine. 63(3):371, 2014 Mar AS - Ann Emerg Med. 63(3):371, 2014 Mar NJ - Annals of emergency medicine VO - 63 IP - 3 PG - 371 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Practice Guidelines as Topic MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Toothache/dt [Drug Therapy] ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(13)01483-2 DO - https://dx.doi.org/10.1016/j.annemergmed.2013.09.033 PT - Comment PT - Letter ID - S0196-0644(13)01483-2 [pii] ID - 10.1016/j.annemergmed.2013.09.033 [doi] PP - ppublish PH - 2013/09/25 [received] PH - 2013/09/25 [revised] PH - 2013/09/27 [accepted] LG - English DP - 2014 Mar EZ - 2014/02/18 06:00 DA - 2014/04/15 06:00 DT - 2014/02/18 06:00 YR - 2014 ED - 20140414 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24528948 <396. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24654482 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Healy D AU - English F AU - Daniels A AU - Ryan CA FA - Healy, D FA - English, F FA - Daniels, A FA - Ryan, C A TI - Emergence of opiate-induced neonatal abstinence syndrome. SO - Irish Medical Journal. 107(2):46, 2014 Feb AS - Ir Med J. 107(2):46, 2014 Feb NJ - Irish medical journal VO - 107 IP - 2 PG - 46 PI - Journal available in: Print PI - Citation processed from: Print JC - gxd, 0430275 IO - Ir Med J SB - Index Medicus CP - Ireland MH - Adult MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Infant, Newborn MH - Ireland/ep [Epidemiology] MH - Male MH - Mothers MH - *Narcotics/ae [Adverse Effects] MH - *Neonatal Abstinence Syndrome/ep [Epidemiology] MH - Neonatal Abstinence Syndrome/et [Etiology] MH - *Opioid-Related Disorders/co [Complications] MH - Pregnancy MH - *Pregnancy Complications MH - Prognosis MH - Retrospective Studies MH - Young Adult AB - Neonatal abstinence syndrome (NAS) is the clinical picture of infants withdrawing from in-utero substance exposure. The incidence of NAS rose in Dublin maternity hospitals in the 1970's and '80's in parallel with increasing in opiate abuse in that city. The purpose of this study was to determine if a similar pattern was emerging in Cork University Maternity Hospital. Data from the Erinville Hospital (2000-2007) and CUMH (2008-2011) were compared. Sixteen cases of NAS were identified, two at Erinville Hospital (22,987 deliveries; incidence = 0.09/1000 deliveries) and 14 at CUMH (37,414 deliveries; incidence = 0.38/1000 deliveries; p < 0.01). Five of the 16 mothers were using heroin, while ten were on methadone maintenance. All were multi-drug abusers. Newborns requiring pharmacotherapy for NAS (5/16) had prolonged hospitalisations compared to those requiring supportive care. NAS in Cork is increasing. Primary, secondary and tertiary preventative measures are warranted to prevent further escalation. RN - 0 (Narcotics) IS - 0332-3102 IL - 0332-3102 PT - Comparative Study PT - Journal Article PT - Multicenter Study PP - ppublish LG - English DP - 2014 Feb EZ - 2014/03/25 06:00 DA - 2014/04/09 06:00 DT - 2014/03/25 06:00 YR - 2014 ED - 20140408 RD - 20140324 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24654482 <397. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24014692 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ishiyama D AU - Jones J FA - Ishiyama, David FA - Jones, Jeffrey IN - Ishiyama, David. Grand Rapids Medical Education Program/Michigan State University, East Lansing, Michigan, USA. TI - Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: Is nebulised naloxone effective in opioid overdose?. [Review] SO - Emergency Medicine Journal. 30(10):860, 2013 Oct AS - Emerg Med J. 30(10):860, 2013 Oct NJ - Emergency medicine journal : EMJ VO - 30 IP - 10 PG - 860 PI - Journal available in: Print PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J SB - Index Medicus CP - England MH - Administration, Inhalation MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/dt [Drug Therapy] MH - Evidence-Based Emergency Medicine MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Nebulizers and Vaporizers AB - A shortcut review was carried out to establish whether nebulised naloxone is a safe and effective alternative to intravenous naloxone in patients with suspected opioid overdose. 18 papers were found using the reported searches, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that nebulised naloxone is a safe and effective firstline alternative to parenteral naloxone in spontaneously breathing patients with suspected opioid overdose. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1472-0213 IL - 1472-0205 DO - https://dx.doi.org/10.1136/emermed-2013-203100.3 PT - Journal Article PT - Review ID - emermed-2013-203100.3 [pii] ID - 10.1136/emermed-2013-203100.3 [doi] PP - ppublish LG - English DP - 2013 Oct EZ - 2013/09/10 06:00 DA - 2014/03/29 06:00 DT - 2013/09/10 06:00 YR - 2013 ED - 20140326 RD - 20130909 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24014692 <398. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23647815 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McCormick Z AU - Chu SK AU - Chang-Chien GC AU - Joseph P FA - McCormick, Zachary FA - Chu, Samuel K FA - Chang-Chien, George C FA - Joseph, Petra IN - McCormick, Zachary. The Rehabilitation Institute of Chicago/Northwestern McGaw Medical Center, Department of Physical Medicine and Rehabilitation, Chicago, Illinois, USA. zmccormi@gmail.com TI - Acute pain control challenges with buprenorphine/naloxone therapy in a patient with compartment syndrome secondary to McArdle's disease: a case report and review. SO - Pain Medicine. 14(8):1187-91, 2013 Aug AS - PAIN MED. 14(8):1187-91, 2013 Aug NJ - Pain medicine (Malden, Mass.) VO - 14 IP - 8 PG - 1187-91 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - Acetaminophen/tu [Therapeutic Use] MH - *Acute Pain/dt [Drug Therapy] MH - *Acute Pain/et [Etiology] MH - Analgesia, Patient-Controlled MH - Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Buprenorphine/tu [Therapeutic Use] MH - *Compartment Syndromes/dt [Drug Therapy] MH - *Compartment Syndromes/et [Etiology] MH - Creatine Kinase/bl [Blood] MH - Drug Combinations MH - *Glycogen Storage Disease Type V/co [Complications] MH - Humans MH - Hydromorphone/ad [Administration & Dosage] MH - Hydromorphone/tu [Therapeutic Use] MH - Injections, Intramuscular MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/co [Complications] MH - Pain Measurement MH - Rhabdomyolysis/et [Etiology] KW - Buprenorphine/Naloxone; Compartment Syndrome; McArdle's Disease; Rhabdomyolysis; Suboxone AB - OBJECTIVE: We report the first case of non-iatrogentic exertional rhabdomyolysis leading to acute compartment syndrome in a patient with McArdle's disease. We describe considerations of concurrent buprenorphine/naloxone therapy during episodes of severe acute pain. AB - DESIGN: Case report. AB - CASE PRESENTATION: A 50-year-old male with a history of McArdle's disease, taking buprenorphine/naloxone for chronic pain and opioid dependence, presented to the Emergency Department with severe bilateral anterior thigh pain. Over the following 8 hours, he was given a total of 12mg of intravenous hydromorphone with minimal pain relief. The decision was made to initiate patient-controlled analgesia (PCA) with hydromorphone started at 0.5mg as needed with a 15-minute lockout. Subsequently, the patient's anterior thighs were found to be extremely tense. His creatine kinase level rose to 198,688 units/L and compartment pressures were greater than 90mmHg bilaterally. The patient was taken for emergent bilateral fasciotomies. The hydromorphone PCA was increased to 0.8mg as needed with a 15-minute lockout and a basal rate of 0.5mg/h. The patient's reported pain plateaued at 3/10 intensity 2 days after surgery, and he was transitioned to oxycodone and hydrocodone/acetaminophen. He followed up with his pain management physician 2 months later who restarted suboxone and a buphrenorphine transdermal patch. AB - DISCUSSION: Buprenorphine/naloxone is being prescribed off-label with increasing frequency for pain management in patients with or without a history of opioid abuse. Severe acute pain is more difficult to control with opioid analgesics in patients taking buprenorphine/naloxone, requiring higher than usual doses. If buprenorphine/naloxone is discontinued to better treat acute pain with other opioids, monitoring for overdose must take place for at least 72 hours. Copyright Wiley Periodicals, Inc. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 0 (Narcotic Antagonists) RN - 362O9ITL9D (Acetaminophen) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) RN - EC 2-7-3-2 (Creatine Kinase) RN - Q812464R06 (Hydromorphone) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/pme.12135 PT - Case Reports PT - Journal Article ID - 10.1111/pme.12135 [doi] PP - ppublish LG - English EP - 20130503 DP - 2013 Aug EZ - 2013/05/08 06:00 DA - 2014/03/19 06:00 DT - 2013/05/08 06:00 YR - 2013 ED - 20140317 RD - 20130819 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23647815 <399. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23399467 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Modarai F AU - Mack K AU - Hicks P AU - Benoit S AU - Park S AU - Jones C AU - Proescholdbell S AU - Ising A AU - Paulozzi L FA - Modarai, F FA - Mack, K FA - Hicks, P FA - Benoit, S FA - Park, S FA - Jones, C FA - Proescholdbell, S FA - Ising, A FA - Paulozzi, L IN - Modarai, F. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Hwy, Mailstop F-62, Atlanta, GA 30341, United States. vqy8@cdc.gov TI - Relationship of opioid prescription sales and overdoses, North Carolina. SO - Drug & Alcohol Dependence. 132(1-2):81-6, 2013 Sep 01 AS - Drug Alcohol Depend. 132(1-2):81-6, 2013 Sep 01 NJ - Drug and alcohol dependence VO - 132 IP - 1-2 PG - 81-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Analgesics, Opioid/ec [Economics] MH - *Analgesics, Opioid/sd [Supply & Distribution] MH - Cluster Analysis MH - Commerce MH - Data Interpretation, Statistical MH - *Drug Overdose/ep [Epidemiology] MH - Humans MH - Linear Models MH - North Carolina/ep [Epidemiology] MH - Population Density MH - Prescription Drugs/ec [Economics] MH - *Prescription Drugs/sd [Supply & Distribution] MH - Rural Population MH - Urban Population KW - Drug; North Carolina; Opiates; Opiods; Overdoses; Prescription drugs AB - BACKGROUND: In the United States, fatal drug overdoses have tripled since 1991. This escalation in deaths is believed to be driven primarily by prescription opioid medications. This investigation compared trends and patterns in sales of opioids, opioid drug overdoses treated in emergency departments (EDs), and unintentional overdose deaths in North Carolina (NC). AB - METHODS: Our ecological study compared rates of opioid sales, opioid related ED overdoses, and unintentional drug overdose deaths in NC. Annual sales data, provided by the Drug Enforcement Administration, for select opioids were converted into morphine equivalents and aggregated by zip code. These opioid drug sales rates were trended from 1997 to 2010. In addition, opioid sales were correlated and compared to opioid related ED visits, which came from a Centers for Disease Control and Prevention syndromic surveillance system, and unintentional overdose deaths, which came from NC Vital Statistics, from 2008 to 2010. Finally, spatial cluster analysis was performed and rates were mapped by zip code in 2010. AB - RESULTS: Opioid sales increased substantially from 1997 to 2010. From 2008 to 2010, the quarterly rates of opioid drug overdoses treated in EDs and opioid sales correlated (r=0.68, p=0.02). Specific regions of the state, particularly in the southern and western corners, had both high rates of prescription opioid sales and overdoses. AB - CONCLUSIONS: Temporal trends in sales of prescription opioids correlate with trends in opioid related ED visits. The spatial correlation of opioid sales with ED visit rates shows that opioid sales data may be a timely way to identify high-risk communities in the absence of timely ED data. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(13)00018-5 DO - https://dx.doi.org/10.1016/j.drugalcdep.2013.01.006 PT - Journal Article ID - S0376-8716(13)00018-5 [pii] ID - 10.1016/j.drugalcdep.2013.01.006 [doi] PP - ppublish PH - 2012/09/26 [received] PH - 2013/01/05 [revised] PH - 2013/01/12 [accepted] LG - English EP - 20130208 DP - 2013 Sep 01 EZ - 2013/02/13 06:00 DA - 2014/03/15 06:00 DT - 2013/02/13 06:00 YR - 2013 ED - 20140314 RD - 20130819 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23399467 <400. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23357743 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cerda M AU - Ransome Y AU - Keyes KM AU - Koenen KC AU - Tracy M AU - Tardiff KJ AU - Vlahov D AU - Galea S FA - Cerda, Magdalena FA - Ransome, Yusuf FA - Keyes, Katherine M FA - Koenen, Karestan C FA - Tracy, Melissa FA - Tardiff, Kenneth J FA - Vlahov, David FA - Galea, Sandro IN - Cerda, Magdalena. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA. mc3226@columbia.edu TI - Prescription opioid mortality trends in New York City, 1990-2006: examining the emergence of an epidemic. SO - Drug & Alcohol Dependence. 132(1-2):53-62, 2013 Sep 01 AS - Drug Alcohol Depend. 132(1-2):53-62, 2013 Sep 01 NJ - Drug and alcohol dependence VO - 132 IP - 1-2 PG - 53-62 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748247 OI - Source: NLM. NIHMS440471 SB - Index Medicus CP - Ireland MH - Adolescent MH - Adult MH - Age Factors MH - Analgesics, Opioid/po [Poisoning] MH - Data Interpretation, Statistical MH - *Drug Overdose/mo [Mortality] MH - Epidemics MH - Ethnic Groups MH - Female MH - Heroin Dependence/mo [Mortality] MH - Humans MH - Hypnotics and Sedatives/po [Poisoning] MH - Male MH - Methadone/po [Poisoning] MH - Middle Aged MH - Narcotics/po [Poisoning] MH - New York City/ep [Epidemiology] MH - *Prescription Drugs/po [Poisoning] MH - Psychotropic Drugs/po [Poisoning] MH - Sex Factors MH - Socioeconomic Factors MH - Substance-Related Disorders/mo [Mortality] MH - Young Adult KW - Epidemiology; Methadone; Mortality; Opioid analgesics; Overdose; Prescription drugs; Urban health AB - BACKGROUND: The drug overdose mortality rate tripled between 1990 and 2006; prescription opioids have driven this epidemic. We examined the period 1990-2006 to inform our understanding of how the current prescription opioid overdose epidemic emerged in urban areas. AB - METHODS: We used data from the Office of the Chief Medical Examiner to examine changes in demographic and spatial patterns in overdose fatalities induced by prescription opioids (i.e., analgesics and methadone) in New York City (NYC) in 1990-2006, and what factors were associated with death from prescription opioids vs. heroin, historically the most prevalent form of opioid overdose in urban areas. AB - RESULTS: Analgesic-induced overdose fatalities were the only types of overdose fatalities to increase in 1990-2006 in NYC; the fatality rate increased sevenfold from 0.39 in 1990 to 2.7 per 100,000 persons in 2006. Whites and Latinos were the only racial/ethnic groups to exhibit an increase in overdose-related mortality. Relative to heroin overdose decedents, analgesic and methadone overdose decedents were more likely to be female and to concurrently use psychotherapeutic drugs, but less likely to concurrently use alcohol or cocaine. Analgesic overdose decedents were less likely to be Black or Hispanic, while methadone overdose decedents were more likely to be Black or Hispanic in contrast to heroin overdose decedents. AB - CONCLUSIONS: The distinct epidemiologic profiles exhibited by analgesic and methadone overdose fatalities highlight the need to define drug-specific public health prevention efforts. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 0 (Narcotics) RN - 0 (Prescription Drugs) RN - 0 (Psychotropic Drugs) RN - UC6VBE7V1Z (Methadone) ES - 1879-0046 IL - 0376-8716 DI - S0376-8716(13)00003-3 DO - https://dx.doi.org/10.1016/j.drugalcdep.2012.12.027 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. ID - S0376-8716(13)00003-3 [pii] ID - 10.1016/j.drugalcdep.2012.12.027 [doi] ID - PMC3748247 [pmc] ID - NIHMS440471 [mid] PP - ppublish PH - 2012/09/26 [received] PH - 2012/12/29 [revised] PH - 2012/12/29 [accepted] GI - No: DA06534 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: T32 DA007233 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K01 DA030449 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: 1K01DA030449-01 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R49 CE002096 Organization: (CE) *NCIPC CDC HHS* Country: United States GI - No: R01 DA006534 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: 1 R49 CE002096-01 Organization: (CE) *NCIPC CDC HHS* Country: United States LG - English EP - 20130126 DP - 2013 Sep 01 EZ - 2013/01/30 06:00 DA - 2014/03/15 06:00 DT - 2013/01/30 06:00 YR - 2013 ED - 20140314 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23357743 <401. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23669129 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lee S AU - Klein-Schwartz W AU - Welsh C AU - Doyon S FA - Lee, Samantha FA - Klein-Schwartz, Wendy FA - Welsh, Christopher FA - Doyon, Suzanne IN - Lee, Samantha. University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. TI - Medical outcomes associated with nonmedical use of methadone and buprenorphine. SO - Journal of Emergency Medicine. 45(2):199-205, 2013 Aug AS - J Emerg Med. 45(2):199-205, 2013 Aug NJ - The Journal of emergency medicine VO - 45 IP - 2 PG - 199-205 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Buprenorphine/po [Poisoning] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Intensive Care Units/sn [Statistics & Numerical Data] MH - Male MH - *Methadone/po [Poisoning] MH - Middle Aged MH - *Narcotic Antagonists/po [Poisoning] MH - *Narcotics/po [Poisoning] MH - *Poison Control Centers/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Young Adult KW - buprenorphine; methadone; nonmedical use AB - BACKGROUND: There exists a significant amount of misinformation regarding methadone and buprenorphine, and a belief that toxicity associated with nonmedical use of methadone and nonmedical use of buprenorphine is similar in severity and outcomes. AB - OBJECTIVE: The objective of this study is to compare outcomes associated with nonmedical use of methadone vs. nonmedical use of buprenorphine in patients presenting to the Emergency Department (ED) and reported to poison centers. AB - METHODS: This was a retrospective cohort study using data from the American Association of Poison Control Centers from January 1, 2003 to December 31, 2009 (7 years). Inclusion criteria were nonmedical use of methadone or buprenorphine (or buprenorphine/naloxone) as a single substance by history, age 18 years or older, ingestions only, evaluated in an ED. Outcome measures were clinical effects, treatments, disposition, and final medical outcomes. AB - RESULTS: Of 1,920 cases, 1,594 were in the methadone group and 326 were in the buprenorphine group. Frequently reported clinical effects were lethargy, 59.2% vs. 29.4%, and respiratory depression, 28.7% vs. 2.5%, for methadone and buprenorphine groups, respectively. Hospitalization rates were 67.4% in the methadone group and 32.2% in the buprenorphine group. Half of all patients in the methadone group were admitted to the intensive care unit (ICU) vs. only 15% of all the patients in the buprenorphine group. Twenty-six patients in the methadone group died vs. no deaths in the buprenorphine group. There were significant differences in the distribution of clinical effects, disposition, and medical outcomes (p < 0.001). AB - CONCLUSIONS: Patients who use methadone nonmedically have higher hospitalization rates, greater ICU utilization rates, and considerably worse medical outcomes when compared with patients who use buprenorphine nonmedically. Copyright © 2013 Elsevier Inc. All rights reserved. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 40D3SCR4GZ (Buprenorphine) RN - UC6VBE7V1Z (Methadone) IS - 0736-4679 IL - 0736-4679 DI - S0736-4679(13)00137-6 DO - https://dx.doi.org/10.1016/j.jemermed.2012.11.104 PT - Journal Article ID - S0736-4679(13)00137-6 [pii] ID - 10.1016/j.jemermed.2012.11.104 [doi] PP - ppublish PH - 2012/03/13 [received] PH - 2012/06/18 [revised] PH - 2012/11/06 [accepted] LG - English EP - 20130511 DP - 2013 Aug EZ - 2013/05/15 06:00 DA - 2014/03/13 06:00 DT - 2013/05/15 06:00 YR - 2013 ED - 20140312 RD - 20130805 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23669129 <402. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23874923 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McDonald DC AU - Carlson KE FA - McDonald, Douglas C FA - Carlson, Kenneth E IN - McDonald, Douglas C. US Health Division, Abt Associates Inc., Cambridge, Massachusetts, USA. doug_mcdonald@abtassoc.com TI - Estimating the prevalence of opioid diversion by "doctor shoppers" in the United States. SO - PLoS ONE [Electronic Resource]. 8(7):e69241, 2013 AS - PLoS ONE. 8(7):e69241, 2013 NJ - PloS one VO - 8 IP - 7 PG - e69241 PI - Journal available in: Electronic-Print PI - Citation processed from: Internet JC - 101285081 IO - PLoS ONE PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714248 SB - Index Medicus CP - United States MH - Humans MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Practice Patterns, Physicians' MH - Prevalence MH - United States/ep [Epidemiology] AB - BACKGROUND: Abuse of prescription opioid analgesics is a serious threat to public health, resulting in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. Absent adequate patient information systems, "doctor shopping" patients can obtain multiple opioid prescriptions for nonmedical use from different unknowing physicians. Our study estimates the prevalence of doctor shopping in the US and the amounts and types of opioids involved. AB - METHODS AND FINDINGS: The sample included records for 146.1 million opioid prescriptions dispensed during 2008 by 76% of US retail pharmacies. Prescriptions were linked to unique patients and weighted to estimate all prescriptions and patients in the nation. Finite mixture models were used to estimate different latent patient populations having different patterns of using prescribers. On average, patients in the extreme outlying population (0.7% of purchasers), presumed to be doctor shoppers, obtained 32 opioid prescriptions from 10 different prescribers. They bought 1.9% of all opioid prescriptions, constituting 4% of weighed amounts dispensed. AB - CONCLUSIONS: Our data did not provide information to make a clinical diagnosis of individuals. Very few of these patients can be classified with certainty as diverting drugs for nonmedical purposes. However, even patients with legitimate medical need for opioids who use large numbers of prescribers may signal dangerously uncoordinated care. To close the information gap that makes doctor shopping and uncoordinated care possible, states have created prescription drug monitoring programs to collect records of scheduled drugs dispensed, but the majority of physicians do not access this information. To facilitate use by busy practitioners, most monitoring programs should improve access and response time, scan prescription data to flag suspicious purchasing patterns and alert physicians and pharmacists. Physicians could also prevent doctor shopping by adopting procedures to screen new patients for their risk of abuse and to monitor patients' adherence to prescribed treatments. ES - 1932-6203 IL - 1932-6203 DO - https://dx.doi.org/10.1371/journal.pone.0069241 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1371/journal.pone.0069241 [doi] ID - PONE-D-13-13564 [pii] ID - PMC3714248 [pmc] PP - epublish PH - 2013/04/02 [received] PH - 2013/06/12 [accepted] GI - No: RC2 DA028920 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20130717 DP - 2013 EZ - 2013/07/23 06:00 DA - 2014/03/07 06:00 DT - 2013/07/23 06:00 YR - 2013 ED - 20140306 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23874923 <403. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24404674 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Brandenburg MA AU - Subera L AU - Doran-Redus A AU - Archer P AU - Oklahoma Workgroup FA - Brandenburg, Mark A FA - Subera, Layne FA - Doran-Redus, Avy FA - Archer, Pam FA - Oklahoma Workgroup IN - Brandenburg, Mark A. Bristow Medical Center, 700 W. 7th St., Bristow, Oklahoma 74010, USA. mbrand2435@aol.com IR - Brandenburg M IR - Archer P IR - Bruce D IR - Carter L IR - Clarkson L IR - Davis P IR - Foust J IR - Frische E IR - Guthrie C IR - Hawkins J IR - Herndon M IR - Hill T IR - Kelsey L IR - Kirkpatrick C IR - Mack R IR - Malling H IR - McNeill D IR - Nguyen C IR - Onuorah Y IR - Patten T IR - Petty L IR - Redus A IR - Rogers S IR - Schuble M IR - Subera L IR - Woodward M TI - Opioid prescribing guidelines for Oklahoma emergency departments (ED) and urgent care clinics (UCC). SO - Journal - Oklahoma State Medical Association. 106(10):391-7, 2013 Oct AS - J Okla State Med Assoc. 106(10):391-7, 2013 Oct NJ - The Journal of the Oklahoma State Medical Association VO - 106 IP - 10 PG - 391-7 PI - Journal available in: Print PI - Citation processed from: Print JC - jh3, 7503043 IO - J Okla State Med Assoc SB - Index Medicus CP - United States MH - *Ambulatory Care Facilities/st [Standards] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Emergency Service, Hospital/st [Standards] MH - Humans MH - Inappropriate Prescribing MH - Oklahoma MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] RN - 0 (Analgesics, Opioid) IS - 0030-1876 IL - 0030-1876 PT - Journal Article PT - Practice Guideline PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish GI - No: 2B01DP009043-12 Organization: (DP) *NCCDPHP CDC HHS* Country: United States LG - English DP - 2013 Oct EZ - 2014/01/11 06:00 DA - 2014/02/22 06:00 DT - 2014/01/11 06:00 YR - 2013 ED - 20140220 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24404674 <404. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23734988 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Knowlton A AU - Weir BW AU - Hazzard F AU - Olsen Y AU - McWilliams J AU - Fields J AU - Gaasch W FA - Knowlton, Amy FA - Weir, Brian W FA - Hazzard, Frank FA - Olsen, Yngvild FA - McWilliams, Junette FA - Fields, Julie FA - Gaasch, Wade IN - Knowlton, Amy. Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 , USA. aknowlto@jhsph.edu TI - EMS runs for suspected opioid overdose: implications for surveillance and prevention. SO - Prehospital Emergency Care. 17(3):317-29, 2013 Jul-Sep AS - Prehosp Emerg Care. 17(3):317-29, 2013 Jul-Sep NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 17 IP - 3 PG - 317-29 PI - Journal available in: Print PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682796 OI - Source: NLM. NIHMS467207 SB - Index Medicus CP - England MH - *Analgesics, Opioid/po [Poisoning] MH - Baltimore/ep [Epidemiology] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services/ut [Utilization] MH - Female MH - Humans MH - Incidence MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Retrospective Studies MH - Risk Factors MH - *Substance-Related Disorders/dt [Drug Therapy] MH - Substance-Related Disorders/ep [Epidemiology] MH - Treatment Outcome AB - BACKGROUND: Opioid (including prescription opiate) abuse and overdose rates in the United States have surged in the past decade. The dearth and limitations of opioid abuse and overdose surveillance systems impede the development of interventions to address this epidemic. Objective. We explored evidence to support the validity of emergency medical services (EMS) data on naloxone administration as a possible proxy for estimating incidence of opioid overdose. AB - METHODS: We reviewed data from Baltimore City Fire Department EMS patient records matched with dispatch records over a 13-month time period (2008-2009) based on 2008 Census data. We calculated incidence rates and patient demographic and temporal patterns of naloxone administration, and examined patient evaluation data associated with naloxone administration. Results were compared with the demographic distributions of the EMS patient and city populations and with prior study findings. AB - RESULTS: Of 116,910 EMS incidents during the study period for patients aged 15 years and older, EMS providers administered naloxone 1,297 times (1.1% of incidents), an average of 100 administrations per month. The overall incidence was 1.87 administrations per 1,000 residents per year. Findings indicated that naloxone administration peaked in the summer months (31% of administrations), on weekends (32%), and in the late afternoon (4:00-5:00 pm [8%]); and there was a trend toward peaking in the first week of the month. The incidence of suspected opioid overdose was highest among male patients, white patients, and those in the 45-54-year age group. Findings on temporal patterns were comparable with findings from prior studies. Demographic patterns of suspected opioid overdose were similar to medical examiner reports of demographic patterns of fatal drug- or alcohol-related overdoses in Baltimore in 2008-2009 (88% of which involved opioids). The findings on patient evaluation data suggest some inconsistencies with previously recommended clinical indications of opioid overdose. AB - CONCLUSIONS: While our findings suggest limitations of EMS naloxone administration data as a proxy indicator of opioid overdose, the results provide partial support for using these data for estimating opioid overdose incidence and suggest ways to improve such data. The study findings have implications for an EMS role in conducting real-time surveillance and treatment and prevention of opioid abuse and overdose. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2013.792888 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. ID - 10.3109/10903127.2013.792888 [doi] ID - PMC3682796 [pmc] ID - NIHMS467207 [mid] PP - ppublish GI - No: F31 DA026763 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA019413 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R34 DA034314 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01DA019413 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2013 Jul-Sep EZ - 2013/06/06 06:00 DA - 2014/02/22 06:00 DT - 2013/06/06 06:00 YR - 2013 ED - 20140220 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23734988 <405. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24510187 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kuehn BM FA - Kuehn, Bridget M TI - Back from the brink: groups urge wide use of opioid antidote to avert overdoses. SO - JAMA. 311(6):560-1, 2014 Feb 12 AS - JAMA. 311(6):560-1, 2014 Feb 12 NJ - JAMA VO - 311 IP - 6 PG - 560-1 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services/st [Standards] MH - Health Policy MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2014.481 PT - News ID - 1829642 [pii] ID - 10.1001/jama.2014.481 [doi] PP - ppublish LG - English DP - 2014 Feb 12 EZ - 2014/02/11 06:00 DA - 2014/02/18 06:00 DT - 2014/02/11 06:00 YR - 2014 ED - 20140217 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med8&AN=24510187 <406. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23713906 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wattana MK AU - Nelson LS AU - Todd KH FA - Wattana, Monica K FA - Nelson, Lewis S FA - Todd, Knox H IN - Wattana, Monica K. Oncologic Emergency Medicine at The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. TI - Prescription opioid guidelines and the emergency department. SO - Journal of Pain & Palliative Care Pharmacotherapy. 27(2):155-62, 2013 Jun AS - J Pain Pall Care Pharmacother. 27(2):155-62, 2013 Jun NJ - Journal of pain & palliative care pharmacotherapy VO - 27 IP - 2 PG - 155-62 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101125608 IO - J Pain Palliat Care Pharmacother SB - Index Medicus CP - England MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Emergency Service, Hospital MH - Humans MH - New York City MH - *Pain/dt [Drug Therapy] MH - Pain Management/mt [Methods] MH - *Practice Guidelines as Topic MH - Practice Patterns, Physicians' AB - On January 10, 2013, Mayor Michael Bloomberg announced a set of recommendations intended to guide opioid analgesic prescribing in New York City emergency departments. The intent and scope of these guidelines are discussed through an interview by an emergency medicine fellow with an expert in emergency medicine pain management and one of the authors of the guidelines. The guidelines are appended to the commentary. RN - 0 (Analgesics, Opioid) ES - 1536-0539 IL - 1536-0288 DO - https://dx.doi.org/10.3109/15360288.2013.788602 PT - Journal Article ID - 10.3109/15360288.2013.788602 [doi] PP - ppublish LG - English EP - 20130529 DP - 2013 Jun EZ - 2013/05/30 06:00 DA - 2014/02/11 06:00 DT - 2013/05/30 06:00 YR - 2013 ED - 20140210 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23713906 <407. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23993866 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Borron SW AU - Woolard R AU - Watts S FA - Borron, Stephen W FA - Woolard, Robert FA - Watts, Susan IN - Borron, Stephen W. Division of Medical Toxicology, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso TX 79905, USA; Department of Emergency Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso TX 79905, USA. TI - Fatal heat stroke associated with topiramate therapy. SO - American Journal of Emergency Medicine. 31(12):1720.e5-6, 2013 Dec AS - Am J Emerg Med. 31(12):1720.e5-6, 2013 Dec NJ - The American journal of emergency medicine VO - 31 IP - 12 PG - 1720.e5-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Anticonvulsants/ae [Adverse Effects] MH - *Epilepsy/dt [Drug Therapy] MH - Fatal Outcome MH - Fructose/ae [Adverse Effects] MH - *Fructose/aa [Analogs & Derivatives] MH - *Heat Stroke/ci [Chemically Induced] MH - Humans MH - Male AB - A 40-year-old man with diabetes and seizure disorder was found at home unresponsive and "very hot to touch" by his father 40 minutes before emergency medical services arrival. His usual medications included topiramate, divalproex sodium, and rosiglitazone/metformin. Paramedics administered oxygen, intravenous fluids, and naloxone. They did not witness or report seizure activity. Upon emergency department arrival, the patient was unresponsive (Glasgow Coma Scale 3), hypotensive (94/50 mm Hg), and tachypneic (32 breaths per minute), with a heart rate of 60 beats per minute and elevated rectal temperature peaking at 43.2degreeC. His skin was hot and dry, without rash; physical examination was otherwise normal. Laboratory studies revealed severe metabolic acidosis with acute renal failure and rhabdomyolysis. In spite of sedation, intubation, and aggressive cooling measures, the patient had cardiac arrest and died approximately 2 hours after arrival. Serum topiramate and valproate concentrations were within therapeutic ranges at 8.8 mug/mL (therapeutic 2-12) and 97 mug/mL (therapeutic 50-100), respectively. RN - 0 (Anticonvulsants) RN - 0H73WJJ391 (topiramate) RN - 30237-26-4 (Fructose) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(13)00455-5 DO - https://dx.doi.org/10.1016/j.ajem.2013.07.013 PT - Case Reports PT - Journal Article ID - S0735-6757(13)00455-5 [pii] ID - 10.1016/j.ajem.2013.07.013 [doi] PP - ppublish PH - 2013/07/09 [received] PH - 2013/07/15 [accepted] LG - English EP - 20130829 DP - 2013 Dec EZ - 2013/09/03 06:00 DA - 2014/01/29 06:00 DT - 2013/09/03 06:00 YR - 2013 ED - 20140128 RD - 20131206 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23993866 <408. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23695059 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Finocchi C AU - Viani E FA - Finocchi, Cinzia FA - Viani, Erica IN - Finocchi, Cinzia. Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, University of Genova, Largo Daneo 3, 16132 Genova, Italy. cfinocchi@neurologia.unige.it TI - Opioids can be useful in the treatment of headache. SO - Neurological Sciences. 34 Suppl 1:S119-24, 2013 May AS - Neurol Sci. 34 Suppl 1:S119-24, 2013 May NJ - Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology VO - 34 Suppl 1 PG - S119-24 PI - Journal available in: Print PI - Citation processed from: Internet JC - drb, 100959175 IO - Neurol. Sci. SB - Index Medicus CP - Italy MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Humans MH - *Migraine Disorders/dt [Drug Therapy] MH - Substance-Related Disorders/ep [Epidemiology] MH - Substance-Related Disorders/et [Etiology] AB - The use of opioids in headache treatment is very controversial. In the migraine acute attack use of short-acting opioids is not recommended by the principal guidelines but is frequent in North American emergency departments. Their efficacy in migraine acute attack has not been extensively studied but seems to be similar to non-steroidal anti-inflammatory drugs and metoclopramide. Opioids have been never compared to triptans. The principal concerns about the use of opioids regard the possible association with an increased risk of medication-overuse headache and chronic migraine and the risk of abuse and dependence. These risks have to be considered but not overestimated. The association between frequent use and increased risk of chronic migraine has been observed for almost all categories of acute migraine attack drugs. Compared to the reference category of acetaminophen, risk of chronic migraine for opioid use is only moderately higher (with an OR = 1.48). In some cases, when treatment with triptans, non-steroidal anti-inflammatory drugs, or ergotamines is contraindicated or simply ineffective, a judicious prescription of a short-acting opioid for severe migraine attacks can be considered. Chronic migraine is a highly disabling condition. Although the options for prophylaxis therapy of migraine have expanded and improved considerably over recent years, chronic migraine remains very difficult to treat. The results coming from small clinical series are described, suggesting that in expert hands daily long-acting opioids provide an option for the treatment of some individuals with chronic intractable headaches. RN - 0 (Analgesics, Opioid) ES - 1590-3478 IL - 1590-1874 DO - https://dx.doi.org/10.1007/s10072-013-1416-7 PT - Journal Article ID - 10.1007/s10072-013-1416-7 [doi] PP - ppublish LG - English DP - 2013 May EZ - 2013/05/25 06:00 DA - 2014/01/22 06:00 DT - 2013/05/23 06:00 YR - 2013 ED - 20140121 RD - 20171013 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23695059 <409. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24167166 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Whiteside LK AU - Walton MA AU - Bohnert AS AU - Blow FC AU - Bonar EE AU - Ehrlich P AU - Cunningham RM FA - Whiteside, Lauren K FA - Walton, Maureen A FA - Bohnert, Amy S B FA - Blow, Frederic C FA - Bonar, Erin E FA - Ehrlich, Peter FA - Cunningham, Rebecca M IN - Whiteside, Lauren K. Harborview Medical Center, 325 9th Ave, Box 359702, Seattle, WA 98104-2499. laurenkw@u.washington.edu. TI - Nonmedical prescription opioid and sedative use among adolescents in the emergency department. SO - Pediatrics. 132(5):825-32, 2013 Nov AS - Pediatrics. 132(5):825-32, 2013 Nov NJ - Pediatrics VO - 132 IP - 5 PG - 825-32 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813392 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adolescent Behavior/px [Psychology] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Cross-Sectional Studies MH - *Emergency Service, Hospital/td [Trends] MH - Female MH - Humans MH - *Hypnotics and Sedatives/ad [Administration & Dosage] MH - Male MH - Pilot Projects MH - Prescription Drug Misuse/px [Psychology] MH - *Prescription Drug Misuse/td [Trends] MH - Retrospective Studies MH - Risk Factors MH - Self Report MH - *Substance-Related Disorders/di [Diagnosis] MH - Substance-Related Disorders/ep [Epidemiology] MH - Substance-Related Disorders/px [Psychology] MH - Young Adult KW - adolescent medicine; emergency medicine; prescription drug misuse AB - OBJECTIVES: Nonmedical prescription opiate use (NPOU) and nonmedical prescription sedative use (NPSU) are serious public health concerns. The objectives of this study were to determine the prevalence and emergency department (ED) visit characteristics and other correlates associated with past-year NPOU and NPSU among adolescents and young adults using the ED. AB - METHODS: Participants aged 14 to 20 presenting to the ED at the University of Michigan Medical Center between September 2010 and September 2011 were systematically recruited. A computerized self-report screening survey with validated items measuring past-year NPOU, NPSU, substance use, and violence was delivered to participants, and a retrospective chart review was performed. AB - RESULTS: Of the 2135 participants (86.0% response rate), 222 (10.4%) reported either NPOU or NPSU. Among the 185 (8.7%) participants that reported NPOU, 14.6% had a current home prescription for an opioid and among the 115 (5.4%) with NPSU, 12.3% had a current home prescription for a sedative. After controlling for demographics (age, gender, race, public assistance), correlates of NPOU or NPSU included other substance use, and drinking and driving or riding with a drinking driver. Additional correlates of NPOU included receiving an intravenous opioid in the ED and for NPSU, dating violence, presenting to the ED for a noninjury complaint, and previous ED visit in the past year. AB - CONCLUSIONS: Nearly 1 in 10 young people who use the ED for care report NPOU or NPSU, and only 12.3% and 14.6% report having current home prescriptions for sedatives and opioids. The ED represents a key location for screening and intervention efforts. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) ES - 1098-4275 IL - 0031-4005 DO - https://dx.doi.org/10.1542/peds.2013-0721 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural ID - peds.2013-0721 [pii] ID - 10.1542/peds.2013-0721 [doi] ID - PMC3813392 [pmc] PP - ppublish GI - No: R01 AA018122 Organization: (AA) *NIAAA NIH HHS* Country: United States GI - No: 5 R01 AA018122 04 Organization: (AA) *NIAAA NIH HHS* Country: United States LG - English EP - 20131028 DP - 2013 Nov EZ - 2013/10/30 06:00 DA - 2014/01/15 06:00 DT - 2013/10/30 06:00 YR - 2013 ED - 20140114 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24167166 <410. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 24088238 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Markun S FA - Markun, Stefan IN - Markun, Stefan. Horten-Zentrum fur praxisorientierte Forschung und Wissenstransfer, Universitatsspital Zurich. TI - [Therapy of acute pain with opiates - titrate or bolus administration?]. [German] OT - Therapie akuter Schmerzen mit Opiaten - Titrieren oder Bolus geben? CM - Comment on: Ann Emerg Med. 2013 Oct;62(4):304-10; PMID: 23694801 SO - Praxis. 102(20):1261-2, 2013 Oct 02 AS - Praxis (Bern 1994). 102(20):1261-2, 2013 Oct 02 NJ - Praxis VO - 102 IP - 20 PG - 1261-2 PI - Journal available in: Print PI - Citation processed from: Print JC - 101468093 IO - Praxis (Bern 1994) SB - Index Medicus CP - Switzerland MH - *Acute Pain/dt [Drug Therapy] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - *Hydromorphone/tu [Therapeutic Use] MH - Male MH - *Pain Management/mt [Methods] RN - 0 (Analgesics, Opioid) RN - Q812464R06 (Hydromorphone) IS - 1661-8157 IL - 1661-8157 DO - https://dx.doi.org/10.1024/1661-8157/a001413 PT - Comment PT - Journal Article ID - W8432T0511H16231 [pii] ID - 10.1024/1661-8157/a001413 [doi] PP - ppublish LG - German DP - 2013 Oct 02 EZ - 2013/10/04 06:00 DA - 2014/01/15 06:00 DT - 2013/10/04 06:00 YR - 2013 ED - 20140114 RD - 20131003 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=24088238 <411. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23993129 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lavonas EJ AU - Banner W AU - Bradt P AU - Bucher-Bartelson B AU - Brown KR AU - Rajan P AU - Murrelle L AU - Dart RC AU - Green JL FA - Lavonas, Eric J FA - Banner, William FA - Bradt, Pamela FA - Bucher-Bartelson, Becki FA - Brown, Kimberly R FA - Rajan, Pradeep FA - Murrelle, Lenn FA - Dart, Richard C FA - Green, Jody L IN - Lavonas, Eric J. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO. Electronic address: eric.lavonas@rmpdc.org. TI - Root causes, clinical effects, and outcomes of unintentional exposures to buprenorphine by young children. SO - Journal of Pediatrics. 163(5):1377-83.e1-3, 2013 Nov AS - J Pediatr. 163(5):1377-83.e1-3, 2013 Nov NJ - The Journal of pediatrics VO - 163 IP - 5 PG - 1377-83.e1-3 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - jlz, 0375410 IO - J. Pediatr. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Administration, Sublingual MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/po [Poisoning] MH - *Buprenorphine/ae [Adverse Effects] MH - *Buprenorphine/po [Poisoning] MH - Central Nervous System/de [Drug Effects] MH - Child, Preschool MH - Cross-Sectional Studies MH - Drug Packaging MH - Female MH - Humans MH - Infant MH - Male MH - Pharmacovigilance MH - Poison Control Centers MH - Registries MH - Regression Analysis MH - Retrospective Studies MH - Tablets MH - United States KW - AE; Adverse event; MedDRA; Medical Dictionary for Regulatory Activities; RADARS; REMS; Researched Abuse, Diversion, and Addiction-Related Surveillance; Risk evaluation and mitigation strategies; URDD; Unique recipients of a dispensed drug AB - OBJECTIVE: To characterize the rates, root causes, and clinical effects of unintentional exposures to buprenorphine sublingual formulations among young children and to determine whether exposure characteristics differ between formulations. AB - STUDY DESIGN: Unintentional exposures to buprenorphine-containing products among children 28 days to less than 6 years old were collected from the Researched Abuse, Diversion, and Addiction-Related Surveillance System Poison Center Program and Reckitt Benckiser Pharmaceuticals' pharmacovigilance system from October 2009-March 2012. After adjustment for drug availability, negative binomial regression was used to estimate average exposure rates. Root cause assessment was conducted, and an expert clinician panel adjudicated causality and severity of moderate to severe adverse events (AEs). AB - RESULTS: A total of 2380 cases were reviewed, including 4 deaths. Exposures to buprenorphine-naloxone combination film were significantly less frequent than exposures to buprenorphine tablets (rate ratio 3.5 [95% CI, 2.7-4.5]) and buprenorphine-naloxone combination tablets (rate ratio 8.8 [7.2-10.6]). The most commonly identified root causes were medication stored in sight, accessed from a bag or purse, and not stored in the original packaging. Among 536 panel review cases, the most common AEs reported for all formulations were lethargy, respiratory depression, miosis, and vomiting. The highest level AE severity did not differ significantly by formulation. AB - CONCLUSIONS: Unintentional exposure to buprenorphine can cause central nervous system depression, respiratory depression, and death in young children. Exposure rates to film formulations are significantly less than to tablet formulations. Package and storage deficiencies contribute to unintentional exposures in young children. Copyright © 2013 Mosby, Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Tablets) RN - 40D3SCR4GZ (Buprenorphine) ES - 1097-6833 IL - 0022-3476 DI - S0022-3476(13)00817-2 DO - https://dx.doi.org/10.1016/j.jpeds.2013.06.058 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0022-3476(13)00817-2 [pii] ID - 10.1016/j.jpeds.2013.06.058 [doi] PP - ppublish PH - 2013/04/19 [received] PH - 2013/05/29 [revised] PH - 2013/06/24 [accepted] LG - English EP - 20130829 DP - 2013 Nov EZ - 2013/09/03 06:00 DA - 2014/01/01 06:00 DT - 2013/09/03 06:00 YR - 2013 ED - 20131230 RD - 20131028 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23993129 <412. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23647168 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Green TC AU - Bowman SE AU - Zaller ND AU - Ray M AU - Case P AU - Heimer R FA - Green, Traci C FA - Bowman, Sarah E FA - Zaller, Nickolas D FA - Ray, Madeline FA - Case, Patricia FA - Heimer, Robert IN - Green, Traci C. The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA. traci.c.green@brown.edu TI - Barriers to medical provider support for prescription naloxone as overdose antidote for lay responders. SO - Substance Use & Misuse. 48(7):558-67, 2013 May AS - Subst Use Misuse. 48(7):558-67, 2013 May NJ - Substance use & misuse VO - 48 IP - 7 PG - 558-67 PI - Journal available in: Print PI - Citation processed from: Internet JC - cgg, 9602153 IO - Subst Use Misuse SB - Index Medicus CP - England MH - *Analgesics, Opioid/po [Poisoning] MH - *Attitude of Health Personnel MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Prescriptions MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - New England AB - Poisonings are the leading cause of adult injury death in the United States. Over 12 weeks in 2011, 143 key informant interviews were conducted using a structured interview guide in three study sites in New England. This analysis focuses on the 24 interviews with emergency department providers, substance use treatment providers, pain specialists, and generalist/family medicine practitioners. Using an iterative coding process, we analyzed statements regarding support and concern about naloxone prescription for pain patients and drug users. The study's implications and limitations are discussed and future research suggested. The Centers for Disease Control and Prevention funded this study. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1532-2491 IL - 1082-6084 DO - https://dx.doi.org/10.3109/10826084.2013.787099 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. ID - 10.3109/10826084.2013.787099 [doi] PP - ppublish LG - English DP - 2013 May EZ - 2013/05/08 06:00 DA - 2013/12/20 06:00 DT - 2013/05/08 06:00 YR - 2013 ED - 20131219 RD - 20130507 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23647168 <413. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23680561 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pentin PL FA - Pentin, Pamela L IN - Pentin, Pamela L. University of Washington School of Medicine, Seattle, WA, USA. TI - Drug seeking or pain crisis? Responsible prescribing of opioids in the emergency department. SO - The Virtual Mentor. 15(5):410-5, 2013 May 01 AS - Virtual Mentor. 15(5):410-5, 2013 May 01 NJ - The virtual mentor : VM VO - 15 IP - 5 PG - 410-5 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101141858 IO - Virtual Mentor SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Clinical Competence MH - Emergency Service, Hospital/es [Ethics] MH - *Emergency Service, Hospital MH - Humans MH - *Pain/dt [Drug Therapy] MH - Pain Management/es [Ethics] MH - *Pain Management MH - *Prescriptions MH - Social Responsibility MH - *Substance-Related Disorders RN - 0 (Analgesics, Opioid) ES - 1937-7010 IL - 1937-7010 DI - virtualmentor.2013.15.5.ecas2-1305 DO - https://dx.doi.org/10.1001/virtualmentor.2013.15.5.ecas2-1305 PT - Journal Article ID - virtualmentor.2013.15.5.ecas2-1305 [pii] ID - 10.1001/virtualmentor.2013.15.5.ecas2-1305 [doi] PP - epublish LG - English EP - 20130501 DP - 2013 May 01 EZ - 2013/05/18 06:00 DA - 2013/12/19 06:00 DT - 2013/05/18 06:00 YR - 2013 ED - 20131218 RD - 20130517 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23680561 <414. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23318993 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Manini AF AU - Jacobs MM AU - Vlahov D AU - Hurd YL FA - Manini, A F FA - Jacobs, M M FA - Vlahov, D FA - Hurd, Y L IN - Manini, A F. Division of Medical Toxicology, Department of Emergency Medicine, Mount Sinai School of Medicine, Elmhurst Hospital Center, New York, NY 10029, USA. alex.manini@mountsinai.org TI - Opioid receptor polymorphism A118G associated with clinical severity in a drug overdose population. CM - Comment in: J Med Toxicol. 2013 Sep;9(3):292-3; PMID: 23860727 SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 9(2):148-54, 2013 Jun AS - J Med Toxicol. 9(2):148-54, 2013 Jun NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 9 IP - 2 PG - 148-54 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648633 OI - Source: NLM. NIHMS436216 SB - Index Medicus CP - United States MH - Adult MH - Alternative Splicing MH - Amino Acid Substitution MH - *Benzodiazepines/to [Toxicity] MH - Cohort Studies MH - Drug Overdose/bl [Blood] MH - *Drug Overdose/ge [Genetics] MH - Drug Overdose/me [Metabolism] MH - Drug Overdose/pp [Physiopathology] MH - Female MH - Follow-Up Studies MH - Genetic Association Studies MH - Genetic Predisposition to Disease MH - Heart Arrest/et [Etiology] MH - Humans MH - Male MH - *Narcotics/to [Toxicity] MH - Pilot Projects MH - *Polymorphism, Single Nucleotide MH - Prospective Studies MH - *Receptors, Opioid, mu/ge [Genetics] MH - Receptors, Opioid, mu/me [Metabolism] MH - Respiratory Insufficiency/et [Etiology] MH - Severity of Illness Index MH - *Sympathomimetics/to [Toxicity] MH - United States AB - Genetic variations in the human mu-opioid receptor gene (OPRM1) mediate individual differences in response to pain and opiate addiction. We studied whether the common A118G (rs1799971) mu-opioid receptor single nucleotide polymorphism (SNP) was associated with overdose severity in humans. In addition, we examined an SNP responsible for alternative splicing of OPRM1 (rs2075572). We assessed allele frequencies of the above SNPs and associations with clinical severity in patients presenting to the emergency department (ED) with acute drug overdose. This work was designed as an observational cohort study over a 12-month period at an urban teaching hospital. Participants consisted of consecutive adult ED patients with suspected acute drug overdose for whom discarded blood samples were available for analysis. Specimens were linked with clinical variables (demographics, urine toxicology screens, clinical outcomes) then deidentified prior to genetic SNP analysis. Blinded genotyping was performed after standard DNA purification and whole genome amplification. In-hospital severe outcomes were defined as either respiratory arrest (RA; defined by mechanical ventilation) or cardiac arrest (CA; defined by loss of pulse). We analyzed 179 patients (61% male, median age 32) who overall suffered 15 RAs and four CAs, of whom three died. The 118G allele conferred 5.3-fold increased odds of CA/RA (p<0.05), while the rs2075572 variant allele was not associated with CA/RA. The 118G variant allele in the OPRM1 gene is associated with worse clinical severity in patients with acute drug overdose. These findings mark the first time that the 118G variant allele is linked with clinical drug overdose vulnerability. RN - 0 (Narcotics) RN - 0 (OPRM1 protein, human) RN - 0 (Receptors, Opioid, mu) RN - 0 (Sympathomimetics) RN - 12794-10-4 (Benzodiazepines) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-012-0286-3 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1007/s13181-012-0286-3 [doi] ID - PMC3648633 [pmc] ID - NIHMS436216 [mid] PP - ppublish GI - No: R01 DA015446 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: DA15446 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2013 Jun EZ - 2013/01/16 06:00 DA - 2013/12/18 06:00 DT - 2013/01/16 06:00 YR - 2013 ED - 20131217 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23318993 <415. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23541629 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weiner SG AU - Perrone J AU - Nelson LS FA - Weiner, Scott G FA - Perrone, Jeanmarie FA - Nelson, Lewis S TI - Centering the pendulum: the evolution of emergency medicine opioid prescribing guidelines. CM - Comment on: Ann Emerg Med. 2013 Sep;62(3):237-40; PMID: 23374416 SO - Annals of Emergency Medicine. 62(3):241-3, 2013 Sep AS - Ann Emerg Med. 62(3):241-3, 2013 Sep NJ - Annals of emergency medicine VO - 62 IP - 3 PG - 241-3 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Practice Guidelines as Topic MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Toothache/dt [Drug Therapy] ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(13)00206-0 DO - https://dx.doi.org/10.1016/j.annemergmed.2013.02.028 PT - Comment PT - Editorial ID - S0196-0644(13)00206-0 [pii] ID - 10.1016/j.annemergmed.2013.02.028 [doi] PP - ppublish PH - 2013/01/29 [received] PH - 2013/02/22 [revised] PH - 2013/02/28 [accepted] LG - English EP - 20130328 DP - 2013 Sep EZ - 2013/04/02 06:00 DA - 2013/12/16 06:00 DT - 2013/04/02 06:00 YR - 2013 ED - 20131211 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23541629 <416. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23374416 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fox TR AU - Li J AU - Stevens S AU - Tippie T FA - Fox, Timothy R FA - Li, James FA - Stevens, Sandra FA - Tippie, Tracy IN - Fox, Timothy R. Department of Emergency Medicine, Miles Memorial Hospital, Damariscotta, ME, USA. TI - A performance improvement prescribing guideline reduces opioid prescriptions for emergency department dental pain patients. CM - Comment in: Ann Emerg Med. 2013 Sep;62(3):241-3; PMID: 23541629 CM - Comment in: Ann Emerg Med. 2014 Mar;63(3):371-2; PMID: 24528949 CM - Comment in: Ann Emerg Med. 2014 Mar;63(3):371; PMID: 24528948 SO - Annals of Emergency Medicine. 62(3):237-40, 2013 Sep AS - Ann Emerg Med. 62(3):237-40, 2013 Sep NJ - Annals of emergency medicine VO - 62 IP - 3 PG - 237-40 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital MH - Female MH - Health Services Misuse/pc [Prevention & Control] MH - Humans MH - Male MH - Middle Aged MH - Opioid-Related Disorders/pc [Prevention & Control] MH - *Practice Guidelines as Topic MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Prescriptions MH - *Toothache/dt [Drug Therapy] MH - Young Adult AB - STUDY OBJECTIVE: In an effort to reduce prescription opioid abuse originating from our institution, we implement and measure the effect of a prescribing guideline on the rate of emergency department (ED) opioid prescriptions written for patients presenting with dental pain, a complaint previously associated with drug-seeking behavior. AB - METHODS: After implementing a departmental guideline on controlled substance prescriptions, we performed a structured before-and-after chart review of dental pain patients aged 16 and older. AB - RESULTS: Before the guideline, the rate of opioid prescription was 59% (302/515). After implementation, the rate was 42% (65/153). The absolute decrease in rates was 17% (95% confidence interval 7% to 25%). Additionally, in comparing the 12-month period before and after implementation, the dental pain visit rate decreased from 26 to 21 per 1,000 ED visits (95% confidence interval of decrease 2 to 9 visits/1,000). AB - CONCLUSION: A performance improvement program involving a departmental prescribing guideline was associated with a reduction in the rate of opioid prescriptions and visits for ED patients presenting with dental pain. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(12)01810-0 DO - https://dx.doi.org/10.1016/j.annemergmed.2012.11.020 PT - Journal Article ID - S0196-0644(12)01810-0 [pii] ID - 10.1016/j.annemergmed.2012.11.020 [doi] PP - ppublish PH - 2012/07/28 [received] PH - 2012/10/10 [revised] PH - 2012/11/26 [accepted] LG - English EP - 20130130 DP - 2013 Sep EZ - 2013/02/05 06:00 DA - 2013/12/16 06:00 DT - 2013/02/05 06:00 YR - 2013 ED - 20131211 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23374416 <417. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23240117 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fahim A AU - Johnson AO FA - Fahim, A FA - Johnson, A O IN - Fahim, A. Department of Respiratory, Medicine, New Cross Hospital, Wolverhampton Road, Wolverhampton WV10 0QP, UK. ahmedfahim@doctors.org.uk TI - Chronic opioid use: a risk factor for central sleep apnoea and successful therapy with adaptive pressure support servo-ventilation. SO - Journal of the Royal College of Physicians of Edinburgh. 42(4):314-6, 2012 AS - J R Coll Physicians Edinb. 42(4):314-6, 2012 NJ - The journal of the Royal College of Physicians of Edinburgh VO - 42 IP - 4 PG - 314-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101144324 IO - J R Coll Physicians Edinb SB - Index Medicus CP - Scotland MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Chronic Pain/dt [Drug Therapy] MH - Continuous Positive Airway Pressure MH - Humans MH - Male MH - Middle Aged MH - *Obesity/co [Complications] MH - *Respiration MH - *Respiration, Artificial/mt [Methods] MH - Risk Factors MH - *Sleep MH - *Sleep Apnea, Central/et [Etiology] MH - *Sleep Apnea, Central/th [Therapy] MH - Ventilators, Mechanical AB - Sleep apnoea is a global health problem with significant morbidity. Obesity is a well-known risk factor for this condition, however chronic intake of opioids as a risk factor for central sleep apnoea is under-recognised. We report a case of a 47-year-old man who developed significant sleep-disordered breathing secondary to opioid use for chronic pain. A sleep study demonstrated a picture of complex sleep apnoea with a prominent central sleep apnoea component. He had no significant improvement with conventional continuous positive airway pressure therapy. However, adaptive servo-ventilation had a dramatic effect on his symptoms and compliance. This case highlights the significant risk of central sleep apnoea with opioid use and illustrates the importance of adaptive servo-ventilation in the management of sleep-disordered breathing secondary to impaired central respiratory drive. RN - 0 (Analgesics, Opioid) ES - 2042-8189 IL - 1478-2715 DO - https://dx.doi.org/10.4997/JRCPE.2012.407 PT - Case Reports PT - Journal Article ID - 10.4997/JRCPE.2012.407 [doi] PP - ppublish LG - English DP - 2012 EZ - 2012/12/15 06:00 DA - 2013/12/16 06:00 DT - 2012/12/15 06:00 YR - 2012 ED - 20131204 RD - 20121214 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23240117 <418. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22925410 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Islam MM AU - Topp L AU - Conigrave KM AU - Day CA FA - Islam, M Mofizul FA - Topp, Libby FA - Conigrave, Katherine M FA - Day, Carolyn A IN - Islam, M Mofizul. School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. mikhokan143@yahoo.com TI - Opioid substitution therapy clients' preferences for targeted versus general primary health-care outlets. SO - Drug & Alcohol Review. 32(2):211-4, 2013 Mar AS - Drug Alcohol Rev. 32(2):211-4, 2013 Mar NJ - Drug and alcohol review VO - 32 IP - 2 PG - 211-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9015440 IO - Drug Alcohol Rev SB - Index Medicus CP - Australia MH - Adult MH - *Ambulatory Care Facilities MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opiate Substitution Treatment/mt [Methods] MH - *Opiate Substitution Treatment/px [Psychology] MH - *Patient Preference/px [Psychology] MH - *Primary Health Care/mt [Methods] MH - Self Report MH - *Substance Abuse Treatment Centers/mt [Methods] MH - Young Adult AB - INTRODUCTION AND AIMS: Opioid substitution therapy (OST) ideally constitutes a window of opportunity for the provision of essential primary health care (PHC) for OST clients. In the absence of such opportunities, however, OST clients access PHC from existing outlets, either general services or those targeted to specific groups. This study examined OST clients' current main source and preferred future outlets of PHC services and correlates of preferences. AB - DESIGN AND METHODS: Anonymous interviews conducted with n=257 clients of two public OST clinics in Sydney's inner-west. AB - RESULTS: Overall, 61% (n=158) of participants reported currently accessing PHC primarily from general outlets (general practitioners or medical centres: 51%, hospital/emergence departments: 10%) and the remainder (39%, n=99) from outlets that target specific groups (e.g. Aboriginal Medical Services, OST prescriber/clinics, drug user-targeted PHCs). Twenty-two percent reported discomfort disclosing drug use to their current PHC providers. However, the majority were satisfied with the care they received and reported a preference to remain with their current PHC providers for a range of reasons, most commonly familiarity with and trust in staff (56%) and not feeling judged about their drug use (49%). Nevertheless, 28% reported that they would access PHC through their OST clinic if it were available. AB - DISCUSSION AND CONCLUSIONS: PHC outlets that target specific groups appear to have an ongoing and important role in providing accessible health care to OST clients. Copyright © 2012 Australasian Professional Society on Alcohol and other Drugs. ES - 1465-3362 IL - 0959-5236 DO - https://dx.doi.org/10.1111/j.1465-3362.2012.00498.x PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't ID - 10.1111/j.1465-3362.2012.00498.x [doi] PP - ppublish PH - 2012/02/29 [received] PH - 2012/08/02 [accepted] LG - English EP - 20120827 DP - 2013 Mar EZ - 2012/08/29 06:00 DA - 2013/12/16 06:00 DT - 2012/08/29 06:00 YR - 2013 ED - 20131126 RD - 20130306 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22925410 <419. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23127198 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Harlow W AU - Happell BM AU - Browne G AU - Choudhury J AU - Pinchin D FA - Harlow, Warren FA - Happell, Brenda Mary FA - Browne, Graeme FA - Choudhury, Jahar FA - Pinchin, David IN - Harlow, Warren. School of Nursing and Midwifery, Central Queensland University, Rockhampton, Australia. warren_harlow@health.qld.gov.au TI - Triage in opioid replacement therapy: what's the wait?. SO - Substance Use & Misuse. 48(1-2):137-46, 2013 Jan AS - Subst Use Misuse. 48(1-2):137-46, 2013 Jan NJ - Substance use & misuse VO - 48 IP - 1-2 PG - 137-46 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - cgg, 9602153 IO - Subst Use Misuse SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Australia MH - Female MH - Health Services Accessibility MH - Health Services Needs and Demand MH - Humans MH - Male MH - Middle Aged MH - Opiate Substitution Treatment/mt [Methods] MH - *Opiate Substitution Treatment/sn [Statistics & Numerical Data] MH - *Triage MH - *Waiting Lists AB - In Australia, a wait for Opioid Replacement Therapy (ORT) has been reported although the magnitude is unknown. This study examined data recorded by one urban publicly funded ORT clinic (from 2009 to 2011) to identify if people (n = 803) were waiting for ORT assessment appointments and to explore how triage influences access to ORT. Data analysis incorporated descriptive methods and the use of Kaplan-Meier estimator of the cumulative incidence function. The implications and limitations of this study are included with further research suggestions. ES - 1532-2491 IL - 1082-6084 DO - https://dx.doi.org/10.3109/10826084.2012.736050 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.3109/10826084.2012.736050 [doi] PP - ppublish LG - English EP - 20121105 DP - 2013 Jan EZ - 2012/11/07 06:00 DA - 2013/12/16 06:00 DT - 2012/11/07 06:00 YR - 2013 ED - 20131125 RD - 20130201 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23127198 <420. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23823882 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Leece PN AU - Hopkins S AU - Marshall C AU - Orkin A AU - Gassanov MA AU - Shahin RM FA - Leece, Pamela N FA - Hopkins, Shaun FA - Marshall, Chantel FA - Orkin, Aaron FA - Gassanov, Margaret A FA - Shahin, Rita M IN - Leece, Pamela N. Public Health and Preventive Medicine Residency Program, University of Toronto, Toronto, ON, Canada. TI - Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario. SO - Canadian Journal of Public Health. Revue Canadienne de Sante Publique. 104(3):e200-4, 2013 Apr 18 AS - Can J Public Health. 104(3):e200-4, 2013 Apr 18 NJ - Canadian journal of public health = Revue canadienne de sante publique VO - 104 IP - 3 PG - e200-4 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - ck6, 0372714 IO - Can J Public Health SB - Index Medicus CP - Canada MH - *Analgesics, Opioid/po [Poisoning] MH - *Community Health Services/og [Organization & Administration] MH - Drug Overdose/mo [Mortality] MH - *Drug Overdose/pc [Prevention & Control] MH - Health Education MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Needle-Exchange Programs MH - Ontario/ep [Epidemiology] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/mo [Mortality] MH - *Program Development MH - Program Evaluation MH - Public Health Practice MH - Resuscitation/mt [Methods] KW - Naloxone; narcotic antagonists; opioid-related disorders; overdose; prevention & control; resuscitation AB - OBJECTIVES: We describe the development of the first community-based opioid overdose prevention and response program with naloxone distribution offered by a public health unit in Canada (Prevent Overdose in Toronto, POINT). AB - PARTICIPANTS: The target population is people who use opioids by any route, throughout the City of Toronto. AB - SETTING: The POINT program is operated by the needle exchange program at Toronto Public Health (The Works) and offered at over 40 partner agency sites throughout Toronto. AB - INTERVENTION: POINT is a comprehensive program of overdose prevention and response training, including naloxone dispensing. Clients are instructed by public health staff on overdose risk factors, recognizing signs and symptoms of overdose, calling 911, naloxone administration, stimulation and chest compressions, and post-overdose care. Training is offered to clients one-on-one or in small groups. Clients receive a naloxone kit including two 1 mL ampoules of naloxone hydrochloride (0.4 mg/mL) and are advised to return to The Works for a refill and debriefing if the naloxone kit is used. AB - OUTCOMES: In the first 8 months of the program, 209 clients were trained. Clients have reported 17 administrations of naloxone, and all overdose victims have reportedly survived. Client demand for POINT training has been high, and Toronto Public Health has expanded its capacity to provide training. Overall, reception to the program has been overwhelmingly positive. AB - CONCLUSION: We are encouraged by the initial development and implementation experience with the naloxone program and its potential to save lives in Toronto. We have planned short-, intermediate-, and long-term process and outcome evaluations. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1920-7476 IL - 0008-4263 PT - Journal Article PP - epublish PH - 2012/12/02 [received] PH - 2013/03/13 [accepted] PH - 2013/03/02 [revised] LG - English EP - 20130418 DP - 2013 Apr 18 EZ - 2013/07/05 06:00 DA - 2013/11/19 06:00 DT - 2013/07/05 06:00 YR - 2013 ED - 20131118 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23823882 <421. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23972442 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shadnia S AU - Rahimi M AU - Hassanian-Moghaddam H AU - Soltaninejad K AU - Noroozi A FA - Shadnia, S FA - Rahimi, M FA - Hassanian-Moghaddam, H FA - Soltaninejad, K FA - Noroozi, A IN - Shadnia, S. Toxicological Research Center, Loghman-Hakim Hospital, Department of Clinical Toxicology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences , Tehran , Iran. TI - Methadone toxicity: comparing tablet and syrup formulations during a decade in an academic poison center of Iran. CM - Comment in: Clin Toxicol (Phila). 2014 Feb;52(2):154; PMID: 24456579 CM - Comment in: Clin Toxicol (Phila). 2014 Feb;52(2):152; PMID: 24446968 SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 51(8):777-82, 2013 Sep-Oct AS - Clin Toxicol (Phila). 51(8):777-82, 2013 Sep-Oct NJ - Clinical toxicology (Philadelphia, Pa.) VO - 51 IP - 8 PG - 777-82 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - Child MH - Cross-Sectional Studies MH - Drug Overdose MH - Female MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Iran/ep [Epidemiology] MH - Male MH - Methadone/ad [Administration & Dosage] MH - *Methadone/po [Poisoning] MH - Middle Aged MH - Narcotics/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] MH - Opiate Substitution Treatment/mt [Methods] MH - *Poison Control Centers/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Severity of Illness Index MH - *Suicide, Attempted/sn [Statistics & Numerical Data] MH - Tablets MH - Time Factors MH - Young Adult AB - CONTEXT: Due to an increase in the number of methadone maintenance clinics in the past decade in Iran, acute methadone overdose has become one of the common poisonings in our society. AB - OBJECTIVE: To compare the characteristics of methadone poisoning between syrup and tablet formulation as well as to discuss the relative advantages and disadvantages of poisoning from the perspective of toxicity. AB - MATERIAL AND METHODS: In a retrospective cross-sectional study from 2000 to 2010, sampled data of all hospitalized methadone-overdosed patients were collected through chart review of hospital records. Concurrently, the total number of methadone sales was gathered. AB - RESULTS: A total of 1426 patients with methadone poisoning had been hospitalized, including 1072 cases who consumed syrup or tablet solely. Mean +/- SD milligram ingested dose of syrup and tablet were 153 +/- 339 and 88 +/- 274, respectively (p < 0.001). The mean time elapsed since ingestion was 9 +/- 9 and 7 +/- 7 h, respectively. Most of the accidental poisoning cases occurred as a result of syrup formulation, particularly by children under 12 years old after being mistaken for cough mixture or water. Conversely, exposure to methadone tablets was more common in patients with suicidal intent. There was no statistically significant difference between the rates of intubation and death between the two groups. AB - DISCUSSION: Higher doses of methadone in the syrup form appear to exert a similar severity of poisoning and outcomes compared to lesser doses of that in the tablet form. Similarities in outcomes, despite differences in exposure history, may reflect relatively prompt transfer to hospital and adequate provision of clinical care, including supportive care and naloxone. AB - CONCLUSION: In order to reduce the rate of poisoning, we recommend the use of child-resistant containers for dispensing syrup, reduction in methadone concentration, adding a coloring agent, special flavor, and education of patients on the safe storage of methadone in their home in order to reduce the occurrence of accidental poisonings. RN - 0 (Narcotics) RN - 0 (Tablets) RN - UC6VBE7V1Z (Methadone) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.3109/15563650.2013.830732 PT - Comparative Study PT - Journal Article ID - 10.3109/15563650.2013.830732 [doi] PP - ppublish LG - English EP - 20130823 DP - 2013 Sep-Oct EZ - 2013/08/27 06:00 DA - 2013/11/14 06:00 DT - 2013/08/27 06:00 YR - 2013 ED - 20131113 RD - 20140314 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23972442 <422. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23937527 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Krayeva YV AU - Brusin KM AU - Bushuev AV AU - Kondrashov DL AU - Sentsov VG AU - Hovda KE FA - Krayeva, Yulia V FA - Brusin, Konstantin M FA - Bushuev, Alexander V FA - Kondrashov, Dmitriy L FA - Sentsov, Valentin G FA - Hovda, Knut Erik IN - Krayeva, Yulia V. Department of Toxicology, Ural State Medical Academy , Yekaterinburg , Russia. TI - Pre-hospital management and outcome of acute poisonings by ambulances in Yekaterinburg, Russia. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 51(8):752-60, 2013 Sep-Oct AS - Clin Toxicol (Phila). 51(8):752-60, 2013 Sep-Oct NJ - Clinical toxicology (Philadelphia, Pa.) VO - 51 IP - 8 PG - 752-60 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Ambulances/sn [Statistics & Numerical Data] MH - Antidotes/tu [Therapeutic Use] MH - Cohort Studies MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Gastric Lavage/mt [Methods] MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Poisoning/ep [Epidemiology] MH - *Poisoning/th [Therapy] MH - Prospective Studies MH - Russia/ep [Epidemiology] MH - *Suicide, Attempted/sn [Statistics & Numerical Data] MH - Treatment Outcome MH - Young Adult AB - INTRODUCTION: Large, prospective pre-hospital studies of acute poisonings are scarce. We present the epidemiology of the pre-hospital poisonings, the treatment given, the complications of the poisoning itself and the treatment, predictors for hospitalization, and the safety of the present approach in a large industrial Russian city. AB - METHODS: Data were collected from March 2009 to March 2010. All adult (>= 16 years) acute poisonings in the city of Yekaterinburg, Russia were included. The prospective cohort inclusion of data included age, gender, simple clinical features (including consciousness, respiratory status, circulatory status, convulsions, etc.), main toxic agent, reason why poisoning was suspected, treatment given, and outcome. Multivariate logistic regression analysis was used to identify the factors associated with hospitalization of the patients. AB - RESULTS: In total, 1795/2536 patients (71%) were brought to hospitals, 736/2536 (29%) were discharged by the ambulance, and 5/2536 (0.2%) died on scene. The most frequent main agents were opioids (25%), ethanol (9%), benzodiazepines (8%), corrosive substances (7%), carbon monoxide (5%), and neuroleptics (5%). Pre-hospital treatment was given to 73% of patients; 3% were intubated, and antidotes were given in 27% (naloxone 24%, atropine 2%, and flumazenil 0.2%). Gastric lavage was performed in 34%, but only 20% within the first hour after ingestion; 49% had a Glasgow Coma Scale (GCS)< 15, but only 6% of them were intubated in the ambulance. Activated charcoal was given to two patients, both with a GCS = 15. A suicidal behavior was the strongest predictor for hospitalization. AB - CONCLUSION: This study reveals current practice differing from the common treatment practice in most places, especially concerning the use of gastric lavage. Whether the current practice led to an increased morbidity and mortality is uncertain, but it justifies the need for thorough evaluation of clinical practice. These findings highlight the importance of studies like the present to improve diagnostics, triage, and treatment in acute poisonings. RN - 0 (Antidotes) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.3109/15563650.2013.827707 PT - Journal Article ID - 10.3109/15563650.2013.827707 [doi] PP - ppublish LG - English EP - 20130812 DP - 2013 Sep-Oct EZ - 2013/08/14 06:00 DA - 2013/11/14 06:00 DT - 2013/08/14 06:00 YR - 2013 ED - 20131113 RD - 20130923 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23937527 <423. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23906621 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gugelmann H AU - Shofer FS AU - Meisel ZF AU - Perrone J FA - Gugelmann, Hallam FA - Shofer, Frances S FA - Meisel, Zachary F FA - Perrone, Jeanmarie IN - Gugelmann, Hallam. Department of Emergency Medicine, Hospital of the University of Pennsylvania. Electronic address: hallamg@gmail.com. TI - Multidisciplinary intervention decreases the use of opioid medication discharge packs from 2 urban EDs. SO - American Journal of Emergency Medicine. 31(9):1343-8, 2013 Sep AS - Am J Emerg Med. 31(9):1343-8, 2013 Sep NJ - The American journal of emergency medicine VO - 31 IP - 9 PG - 1343-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Decision Support Techniques MH - *Emergency Medicine/ed [Education] MH - Emergency Service, Hospital/og [Organization & Administration] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital MH - Female MH - Hospitals, Urban MH - Humans MH - Male MH - Medical Order Entry Systems/og [Organization & Administration] MH - Middle Aged MH - Opioid-Related Disorders/pc [Prevention & Control] MH - *Patient Care Team MH - Patient Discharge/sn [Statistics & Numerical Data] MH - *Patient Discharge MH - Prospective Studies MH - Risk Factors AB - INTRODUCTION: Prescription opioid overdoses and deaths constitute a public health epidemic, and recent studies show that emergency department (ED) prescribers may contribute to this crisis. We hypothesized that a multidisciplinary educational intervention would decrease ED opioid packs dispensed at discharge. AB - METHODS: This prospective study implemented a "bundle" of interdisciplinary educational modalities: lectures, journal clubs, case discussions, and an electronic medical record decision support tool. Implementation occurred in 2 urban EDs in the same health system at different times ("affiliate," September 2011; "primary," January 2012) to better distinguish its effects. The primary outcome was preintervention/postintervention change in opioid discharge packs dispensed to all patients treated and discharged through August 2012 and was assessed by 2-way analysis of variance. The secondary outcome was bivariate analysis (using Fisher exact test) of change in opioid dispensing among patients with known risk factors for prescription opioid dependence: age less than 65 years, history of substance abuse, chronic pain, or psychiatric disorders. AB - RESULTS: A total of 71,512 and 45,746 patients were evaluated and discharged from primary and affiliate EDs, respectively. Orders for opioid discharge packs decreased from 13.9% to 8.4% and 4.7% to 1.9% at the primary and affiliate hospitals (P < .0001). Dispensing among individuals at risk for opioid dependence at the primary ED decreased from 21.8% to 13.9%. AB - CONCLUSIONS: A staged, multidisciplinary intervention targeting nurses, residents, nurse practitioners, and attending physicians was associated with decreased orders for opioid discharge packs in 2 urban EDs. Opioid discharge pack orders decreased slightly more among patients with risk factors for prescription opioid dependence. Copyright © 2013. RN - 0 (Analgesics, Opioid) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(13)00373-2 DO - https://dx.doi.org/10.1016/j.ajem.2013.06.002 PT - Journal Article ID - S0735-6757(13)00373-2 [pii] ID - 10.1016/j.ajem.2013.06.002 [doi] PP - ppublish PH - 2013/05/21 [received] PH - 2013/06/06 [accepted] LG - English EP - 20130730 DP - 2013 Sep EZ - 2013/08/03 06:00 DA - 2013/11/14 06:00 DT - 2013/08/03 06:00 YR - 2013 ED - 20131113 RD - 20130910 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23906621 <424. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22765968 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bailey FA AU - Williams BR AU - Goode PS AU - Woodby LL AU - Redden DT AU - Johnson TM 2nd AU - Taylor JW AU - Burgio KL FA - Bailey, F Amos FA - Williams, Beverly R FA - Goode, Patricia S FA - Woodby, Lesa L FA - Redden, David T FA - Johnson, Theodore M 2nd FA - Taylor, Janice W FA - Burgio, Kathryn L IN - Bailey, F Amos. Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL, USA. TI - Opioid pain medication orders and administration in the last days of life. SO - Journal of Pain & Symptom Management. 44(5):681-91, 2012 Nov AS - J Pain Symptom Manage. 44(5):681-91, 2012 Nov NJ - Journal of pain and symptom management VO - 44 IP - 5 PG - 681-91 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8605836, ijj IO - J Pain Symptom Manage SB - Index Medicus CP - United States MH - Advance Directives MH - Aged MH - Aged, 80 and over MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Family MH - Female MH - Hospitals, Veterans MH - Humans MH - Male MH - Middle Aged MH - *Pain, Intractable/dt [Drug Therapy] MH - Resuscitation Orders MH - Socioeconomic Factors MH - *Terminal Care/sn [Statistics & Numerical Data] MH - United States MH - United States Department of Veterans Affairs AB - CONTEXT: Most patients with serious and life-limiting illness experience pain at some point in the illness trajectory. AB - OBJECTIVES: To describe baseline pain management practices for imminently dying patients in Veterans Administration Medical Centers (VAMCs) and examine factors associated with these processes, including presence of opioid orders at the time of death and medication administration in the last seven days, 48 hours, and 24 hours of life. AB - METHODS: Data on orders and administration of opioid pain medication at the end of life were abstracted from the medical records of veterans who died in six VAMC hospitals in 2005. AB - RESULTS: Of 1068 patient records, 686 (64.2%) had an active order for an opioid medication at the time of death. Of these, 69.8% of patients had received the medication at some time within the last seven days of life, 61.2% within the last 48 hours, and 47.0% within the last 24 hours. In multivariable models, presence of an order for opioid pain medication at the time of death and administration within the last 24 hours were both significantly associated with having a Do Not Resuscitate (DNR) order (P < 0.0001/0.0002), terminal condition (P < 0.0001/< 0.0001), family presence (P < 0.0001/0.0023), location of death (P = 0.003/0.0005), and having pain noted in the care plan (P = 0.0073/0.0007). AB - CONCLUSION: Findings indicate a need for improving availability of opioids for end-of-life care in the inpatient setting. Modifiable factors, such as family presence and goals-of-care discussions, suggest potential targets for intervention to improve recognition of the dying process and proactive planning for pain control. Copyright Published by Elsevier Inc. RN - 0 (Analgesics, Opioid) ES - 1873-6513 IL - 0885-3924 DI - S0885-3924(12)00170-4 DO - https://dx.doi.org/10.1016/j.jpainsymman.2011.11.006 PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. ID - S0885-3924(12)00170-4 [pii] ID - 10.1016/j.jpainsymman.2011.11.006 [doi] PP - ppublish PH - 2011/05/25 [received] PH - 2011/11/16 [revised] PH - 2011/11/29 [accepted] LG - English EP - 20120704 DP - 2012 Nov EZ - 2012/07/07 06:00 DA - 2013/11/07 06:00 DT - 2012/07/07 06:00 YR - 2012 ED - 20131106 RD - 20121107 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22765968 <425. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23758305 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Beaudoin FL AU - Haran JP AU - Liebmann O FA - Beaudoin, Francesca L FA - Haran, John P FA - Liebmann, Otto IN - Beaudoin, Francesca L. Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI, USA. Francesca_Beaudoin@brown.edu TI - A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. SO - Academic Emergency Medicine. 20(6):584-91, 2013 Jun AS - Acad Emerg Med. 20(6):584-91, 2013 Jun NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 20 IP - 6 PG - 584-91 PI - Journal available in: Print PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Aged MH - Aged, 80 and over MH - Analgesia/mt [Methods] MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Cohort Studies MH - *Emergency Medical Services/mt [Methods] MH - Female MH - *Femoral Nerve/dg [Diagnostic Imaging] MH - *Hip Fractures/co [Complications] MH - Humans MH - Infusions, Parenteral MH - Male MH - Middle Aged MH - *Morphine/ad [Administration & Dosage] MH - *Nerve Block/mt [Methods] MH - Pain/et [Etiology] MH - *Pain/pc [Prevention & Control] MH - *Pain Management/mt [Methods] MH - Ultrasonography AB - OBJECTIVES: The primary objective was to compare the efficacy of ultrasound (US)-guided three-in-one femoral nerve blocks to standard treatment with parenteral opioids for pain control in elderly patients with hip fractures in the emergency department (ED). AB - METHODS: A randomized controlled trial was conducted at a large urban academic ED over an 18-month period. A convenience sample of older adults (age >= 55 years) with confirmed hip fractures and moderate to severe pain (numeric rating score >= 5) were randomized to one of two treatment arms: US-guided three-in-one femoral nerve block plus morphine (FNB group) or standard care, consisting of placebo (sham injection) plus morphine (SC group). Intravenous (IV) morphine was prescribed and dosed at the discretion of the treating physician; physicians were advised to target a 50% reduction in pain or per-patient request. The primary outcome measure of pain relief, or pain intensity reduction, was derived using the 11-point numerical rating scale (NRS) and calculated as the summed pain-intensity difference (SPID) over 4 hours. Secondary outcome measures included the amount of rescue analgesia and occurrence of adverse events (respiratory depression, hypotension, nausea, or vomiting). Outcome measures were compared between groups using analysis of variance for continuous variables and Fisher's exact test for categorical data. AB - RESULTS: Thirty-six patients (18 in each arm) completed the study. There was no difference between treatment groups with respect to age, sex, fracture type, vital signs (baseline and at 4 hours), ED length of stay (LOS), pre-enrollment analgesia, or baseline pain intensity. In comparing pain intensity at the end of the study period, NRS scores at 4 hours were significantly lower in the FNB group (p < 0.001). Over the 4-hour study period, patients in the FNB group experienced significantly greater overall pain relief than those in the SC group, with a median SPID of 11.0 (interquartile range [IQR] = 4.0 to 21.8) in the FNB group versus 4.0 (IQR = -2.0 to 5.8) in the SC group (p = 0.001). No patient in the SC group achieved a clinically significant reduction in pain. Moreover, patients in the SC group received significantly more IV morphine than those in the FNB group (5.0 mg, IQR = 2.0 to 8.4 mg vs. 0.0 mg, IQR = 0.0 to 1.5 mg; p = 0.028). There was no difference in adverse events between groups. AB - CONCLUSIONS: Ultrasound-guided femoral nerve block as an adjunct to SC resulted in 1) significantly reduced pain intensity over 4 hours, 2) decreased amount of rescue analgesia, and 3) no appreciable difference in adverse events when compared with SC alone. Furthermore, standard pain management with parenteral opioids alone provided ineffective pain control in our study cohort of patients with severe pain from their hip fractures. Regional anesthesia has a role in the ED, and US-guided femoral nerve blocks for pain management in older adults with hip fractures should routinely be considered, particularly in cases of refractory or severe pain. Copyright © 2013 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12154 PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 10.1111/acem.12154 [doi] PP - ppublish PH - 2012/09/25 [received] PH - 2012/11/30 [revised] PH - 2012/12/12 [revised] PH - 2012/12/12 [accepted] LG - English DP - 2013 Jun EZ - 2013/06/14 06:00 DA - 2013/10/22 06:00 DT - 2013/06/14 06:00 YR - 2013 ED - 20131021 RD - 20161125 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23758305 <426. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23701339 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Miner JR AU - Moore JC AU - Plummer D AU - Gray RO AU - Patel S AU - Ho JD FA - Miner, James R FA - Moore, Johanna C FA - Plummer, David FA - Gray, Richard O FA - Patel, Sagar FA - Ho, Jeffrey D IN - Miner, James R. Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA. miner015@umn.edu TI - Randomized clinical trial of the effect of supplemental opioids in procedural sedation with propofol on serum catecholamines. SO - Academic Emergency Medicine. 20(4):330-7, 2013 Apr AS - Acad Emerg Med. 20(4):330-7, 2013 Apr NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 20 IP - 4 PG - 330-7 PI - Journal available in: Print PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Alfentanil/ad [Administration & Dosage] MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Anesthetics, Combined/ad [Administration & Dosage] MH - Biomarkers/bl [Blood] MH - *Catecholamines/bl [Blood] MH - *Conscious Sedation/mt [Methods] MH - Emergency Medical Services/mt [Methods] MH - Female MH - Fractures, Bone/co [Complications] MH - Fractures, Bone/th [Therapy] MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - Male MH - Middle Aged MH - Pain/co [Complications] MH - Pain/pc [Prevention & Control] MH - Pilot Projects MH - *Propofol/ad [Administration & Dosage] MH - *Stress, Physiological/de [Drug Effects] MH - Young Adult AB - OBJECTIVES: The objective was to assess the effect on stress biomarkers of supplemental opioid to a standard propofol dosing protocol for emergency department (ED) procedural sedation (PS). The hypothesis was that there is no difference in the change in serum catecholamines between PS using propofol with or without supplemental alfentanil. AB - METHODS: This was a randomized, nonblinded pilot study of adult patients undergoing PS in the ED for the reduction of fractures and dislocations. Patients with pain before the procedure were treated with intravenous (IV) morphine sulfate until their pain was adequately treated for at least 20 minutes before starting the procedure. Patients were randomized to receive either 10 mug/kg alfentanil followed by 1 mg/kg propofol, followed by 0.5 mg/kg every 3 minutes as needed, or propofol only, dosed in similar fashion without supplemental alfentanil. Doses, vital signs, nasal end-tidal CO2 (ETCO2), pulse oximetry, and bispectral electroencephalogram (EEG) analysis scores were recorded. Subclinical respiratory depression was defined as a change in ETCO2 > 10 mm Hg, an oxygen saturation of < 92% at any time, or an absent ETCO2 waveform at any time. Clinical events related to respiratory depression were noted during the procedure, including the addition of or increase in the flow rate of supplemental oxygen, the use of a bag-valve-mask apparatus, airway repositioning, or stimulation to induce breathing. Blood was drawn 1 minute prior to the administration of the medications for PS and again 1 minute after completion of the procedure for which the patient was sedated. Serum was tested for total catecholamines, epinephrine, norepinephrine, and dopamine. Postprocedure, patients were asked to report any pain perceived during the procedure. Data were analyzed using descriptive statistics, Wilcoxon rank sum tests, and chi-square tests, as appropriate. AB - RESULTS: Twenty patients were enrolled; 10 received propofol and 10 received propofol with alfentanil. No clinically significant complications were noted. Subclinical respiratory depression was seen in four of 10 (40%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = -10%, 95% confidence interval [CI] = -53% to 33%). There was no difference in the rate of clinical signs of respiratory depression between the two groups. Pain during the procedure was reported by two of 10 (20%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = -30%, 95% CI = -70% to 10%). Recall of some part of the procedure was reported by 0 of 10 (0%) patients in the propofol group and five of 10 (50%) of patients in the propofol/alfentanil group (effect size = -50%, 95% CI = -81% to -19%). There was no difference in the baseline or postprocedure catecholamine levels between the groups. AB - CONCLUSIONS: No difference in serum catecholamines was detected immediately after PS between patients who receive propofol with and without supplemental opioid in this small pilot study. PS using propofol only without supplemental opioid did not appear to induce markers of physiologic stress in this small pilot study. Copyright © 2013 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Combined) RN - 0 (Biomarkers) RN - 0 (Catecholamines) RN - 0 (Hypnotics and Sedatives) RN - 1N74HM2BS7 (Alfentanil) RN - YI7VU623SF (Propofol) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12110 PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial ID - 10.1111/acem.12110 [doi] PP - ppublish PH - 2012/08/10 [received] PH - 2012/10/03 [revised] PH - 2012/10/05 [accepted] LG - English DP - 2013 Apr EZ - 2013/05/25 06:00 DA - 2013/10/19 06:00 DT - 2013/05/25 06:00 YR - 2013 ED - 20131018 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23701339 <427. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23632597 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Logan J AU - Liu Y AU - Paulozzi L AU - Zhang K AU - Jones C FA - Logan, Joseph FA - Liu, Ying FA - Paulozzi, Leonard FA - Zhang, Kun FA - Jones, Christopher IN - Logan, Joseph. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, GA 30341-3724, USA. ffa3@cdc.gov TI - Opioid prescribing in emergency departments: the prevalence of potentially inappropriate prescribing and misuse. SO - Medical Care. 51(8):646-53, 2013 Aug AS - Med Care. 51(8):646-53, 2013 Aug NJ - Medical care VO - 51 IP - 8 PG - 646-53 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0230027, lsm IO - Med Care SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Benzodiazepines/ad [Administration & Dosage] MH - Delayed-Action Preparations MH - Drug Combinations MH - *Drug Utilization/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - *Inappropriate Prescribing/sn [Statistics & Numerical Data] MH - Insurance Claim Review/sn [Statistics & Numerical Data] MH - Male MH - Middle Aged MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - United States MH - Young Adult AB - OBJECTIVE: Emergency departments (EDs) routinely provide care for patients seeking treatment for painful conditions; however, they are also targeted by people seeking opioid analgesics for nonmedical use. This study determined the prevalence of indicators of potential ED opioid misuse and inappropriate prescription practices by ED providers in a large, commercially insured, adult population. AB - RESEARCH DESIGN AND INDICATORS: We analyzed the 2009 Truven Health MarketScan Research Databases to examine the ED visits of enrollees aged 18-64 years. Indicators used to mark potential inappropriate use included opioid prescriptions overlapping by one week or more; overlapping opioid and benzodiazepine prescriptions; high daily doses (>=100 morphine milligram equivalents); long-acting/extended-release (LA/ER) opioids for acute pain, and overlapping LA/ER opioids. Analyses were stratified by sex. AB - RESULTS: We identified 400,288 enrollees who received at least one ED opioid prescription. At least one indicator applied to 10.3% of enrollees: 7.7% had high daily doses; 2.0% had opioid overlap; 1.0% had opioid-benzodiazepine overlap. Among LA/ER opioid prescriptions, 21.7% were for acute pain, and 14.6% were overlapping. Females were more likely to have at least one indicator. AB - CONCLUSIONS: In some instances, the prescribing of opioid analgesics in EDs might not be optimal in terms of minimizing the risk of their misuse. Guidelines for the cautious use of opioid analgesics in EDs and timely data from prescription drug monitoring programs could help EDs treat patients with pain while reducing the risk of nonmedical use. RN - 0 (Analgesics, Opioid) RN - 0 (Delayed-Action Preparations) RN - 0 (Drug Combinations) RN - 12794-10-4 (Benzodiazepines) ES - 1537-1948 IL - 0025-7079 DO - https://dx.doi.org/10.1097/MLR.0b013e318293c2c0 PT - Journal Article ID - 10.1097/MLR.0b013e318293c2c0 [doi] PP - ppublish LG - English DP - 2013 Aug EZ - 2013/05/02 06:00 DA - 2013/09/24 06:00 DT - 2013/05/02 06:00 YR - 2013 ED - 20130923 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23632597 <428. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22771872 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rungatscher A AU - Linardi D AU - Giacomazzi A AU - Tessari M AU - Menon T AU - Mazzucco A AU - Faggian G FA - Rungatscher, Alessio FA - Linardi, Daniele FA - Giacomazzi, Alice FA - Tessari, Maddalena FA - Menon, Tiziano FA - Mazzucco, Alessandro FA - Faggian, Giuseppe IN - Rungatscher, Alessio. Department of Surgery, Division of Cardiac Surgery, University of Verona, Verona, Italy. alessio.rungatscher@univr.it TI - Cardioprotective effect of delta-opioid receptor agonist vs. mild therapeutic hypothermia in a rat model of cardiac arrest with extracorporeal life support. SO - Resuscitation. 84(2):244-8, 2013 Feb AS - Resuscitation. 84(2):244-8, 2013 Feb NJ - Resuscitation VO - 84 IP - 2 PG - 244-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Advanced Cardiac Life Support/mt [Methods] MH - Animals MH - *Enkephalin, Leucine-2-Alanine/tu [Therapeutic Use] MH - *Heart Arrest/th [Therapy] MH - Hypothermia, Induced/mt [Methods] MH - *Hypothermia, Induced MH - Male MH - Rats MH - Rats, Wistar MH - *Receptors, Opioid, delta/ag [Agonists] AB - BACKGROUND: To compare the effect of delta-opioid receptor agonist, d-Ala2-d-Leu5 enkephalin (DADLE) with normothermic control and therapeutic hypothermia on post resuscitation myocardial function in a model of extracorporeal life support (ECLS). AB - METHODS: Ventricular fibrillation (VF) was induced in male Wistar rats. After 10 min of untreated VF, venoarterial ECLS was instituted for 60 min. At the beginning of ECLS animals were randomized to three groups of ten: normothermia, hypothermia (32 degreeC) and DADLE intravenous infusion (1 mg/kg/h). Cooling to 32 degreeC or normothermia or drug infusion lasted for the entire ECLS. Plasma samples and myocardial biopsies were obtained and left-ventricular (LV) function was assessed by a conductance catheter at baseline and after weaning from ECLS. AB - RESULTS: DADLE administration resulted in a significantly enhanced recovery of LV systolic function expressed by slope of the LV end-systolic pressure volume relationship (Ees) and preload recruitable stroke work (PRSW) than hypothermia and normothermia. LV stiffness indicated by end-diastolic pressure volume relationship (EDPVR) was significantly lower after DADLE administration (P<0.01). LV relaxation described by Tau was preserved after DADLE treatment but not after normothermia or mild hypothermia (P<0.01). Plasma lactate concentrations were lower in DADLE group (P<0.05). DADLE and not conventional hypothermia significantly increased phosphorylation of the kinases ERK1 and 2 (3.9+/-0.3 and 3.1+/-0.5 vs. 0.4+/-0.1 and 0.3+/-0.1-fold of baseline levels) (P<0.001). Both DADLE and hypothermia but not normothermia increase phosphorylation of Akt. AB - CONCLUSIONS: DADLE was more effective than mild therapeutic hypothermia in recovering myocardial function and activation of the pro-survival kinases Akt and ERK after ECLS. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Receptors, Opioid, delta) RN - 63631-40-3 (Enkephalin, Leucine-2-Alanine) ES - 1873-1570 IL - 0300-9572 DI - S0300-9572(12)00319-X DO - https://dx.doi.org/10.1016/j.resuscitation.2012.06.016 PT - Comparative Study PT - Journal Article ID - S0300-9572(12)00319-X [pii] ID - 10.1016/j.resuscitation.2012.06.016 [doi] PP - ppublish PH - 2012/03/09 [received] PH - 2012/06/11 [revised] PH - 2012/06/20 [accepted] LG - English EP - 20120705 DP - 2013 Feb EZ - 2012/07/10 06:00 DA - 2013/09/24 06:00 DT - 2012/07/10 06:00 YR - 2013 ED - 20130923 RD - 20130307 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22771872 <429. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23747259 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lee JA FA - Lee, Justine A IN - Lee, Justine A. Pet Poison Helpline, a division of SafetyCall International, PPLC, 3600 American Boulevard West, Suite 725, Minneapolis, MN 55431, USA. jlee@safetycall.com TI - Emergency management and treatment of the poisoned small animal patient. [Review] SO - Veterinary Clinics of North America - Small Animal Practice. 43(4):757-71, 2013 Jul AS - Vet Clin North Am Small Anim Pract. 43(4):757-71, 2013 Jul NJ - The Veterinary clinics of North America. Small animal practice VO - 43 IP - 4 PG - 757-71 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - xbi, 7809942 IO - Vet. Clin. North Am. Small Anim. Pract. SB - Index Medicus CP - United States MH - Animals MH - Charcoal/ad [Administration & Dosage] MH - Charcoal/tu [Therapeutic Use] MH - *Emergency Medical Services MH - Emetics/ad [Administration & Dosage] MH - Emetics/tu [Therapeutic Use] MH - Female MH - Fluid Therapy/ve [Veterinary] MH - Gastric Lavage/ve [Veterinary] MH - Male MH - *Monitoring, Physiologic/ve [Veterinary] MH - Poisoning/th [Therapy] MH - *Poisoning/ve [Veterinary] AB - This article reviews management of the acutely poisoned veterinary patient, including initial telephone triage, appropriate communication and history gathering from the pet owner, decontamination methods (including the use of appropriate emetic agents and dosing of activated charcoal), and general treatment of the poisoned patient. Symptomatic and supportive care of the poisoned patient includes the use of fluid therapy, gastrointestinal support (eg, antacids), central nervous system support (eg, muscle relaxants, anticonvulsants), sedatives/reversal agents (eg, phenothiazines, naloxone, flumazenil), hepatoprotectants, and miscellaneous antidotal therapy. Copyright © 2013 Elsevier Inc. All rights reserved. RN - 0 (Emetics) RN - 16291-96-6 (Charcoal) ES - 1878-1306 IL - 0195-5616 DI - S0195-5616(13)00062-4 DO - https://dx.doi.org/10.1016/j.cvsm.2013.03.010 PT - Journal Article PT - Review ID - S0195-5616(13)00062-4 [pii] ID - 10.1016/j.cvsm.2013.03.010 [doi] PP - ppublish LG - English EP - 20130429 DP - 2013 Jul EZ - 2013/06/12 06:00 DA - 2013/09/21 06:00 DT - 2013/06/11 06:00 YR - 2013 ED - 20130920 RD - 20130610 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23747259 <430. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23472794 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Taghaddosinejad F AU - Arefi M AU - Fayaz AF AU - Tanhaeivash R FA - Taghaddosinejad, Fakhreddin FA - Arefi, Mohammad FA - Fayaz, Amir Farshid FA - Tanhaeivash, Roozbeh IN - Taghaddosinejad, Fakhreddin. Department of Forensic Medicine, Tehran University of Medical Sciences, P.O. Box 13185-1678, Tehran, Iran. TI - Determination of substance overdose in two Iranian centers: comparison between opioids and non-opioids. SO - Journal of Forensic & Legal Medicine. 20(3):155-7, 2013 Apr AS - J Forensic Leg Med. 20(3):155-7, 2013 Apr NJ - Journal of forensic and legal medicine VO - 20 IP - 3 PG - 155-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101300022 IO - J Forensic Leg Med SB - Index Medicus CP - England MH - Administration, Inhalation MH - Adult MH - Age Distribution MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Drug Overdose/ep [Epidemiology] MH - Educational Status MH - Emergency Service, Hospital MH - Female MH - Humans MH - Iran/ep [Epidemiology] MH - Male MH - Marital Status/sn [Statistics & Numerical Data] MH - Middle Aged MH - Narcotics/ad [Administration & Dosage] MH - *Narcotics/ae [Adverse Effects] MH - Sex Distribution MH - Substance-Related Disorders/ep [Epidemiology] MH - Young Adult AB - Recently, new trend toward non-opioid substances is observed in Iran. This is, therefore, to compare overdose of opioids and non-opioids origin. We performed this investigation to provide more detailed information so that preventive actions are taken in future. Over 18 month, 1876 individuals with opioid (opium, heroin, compact-heroin, buprenorphine and opiates) or non-opioid (MDMA (ecstasy), LSD, hashish and cocaine) overdose were selected. They have been compared regarding sex, age, reason of overdose, method of substance use, occupation, marital status, history of addiction in parents/siblings, duration of hospital admission and educational level. There were 1782 and 94 persons with opioid and non-opioid, respectively. Inhalation was the method of choice and women were found to have more tendencies to hallucinogens rather opioids. Moreover, use of non-opioids was observed more in individuals with university education and moreover in whom none of whose parents/siblings was addict. Policies should be planned by the governments to prevent further addictions especially to non-opioids. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotics) ES - 1878-7487 IL - 1752-928X DI - S1752-928X(12)00151-5 DO - https://dx.doi.org/10.1016/j.jflm.2012.06.012 PT - Comparative Study PT - Journal Article ID - S1752-928X(12)00151-5 [pii] ID - 10.1016/j.jflm.2012.06.012 [doi] PP - ppublish PH - 2012/01/03 [received] PH - 2012/05/12 [revised] PH - 2012/06/17 [accepted] LG - English EP - 20120719 DP - 2013 Apr EZ - 2013/03/12 06:00 DA - 2013/09/21 06:00 DT - 2013/03/12 06:00 YR - 2013 ED - 20130919 RD - 20130311 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23472794 <431. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22875840 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Thanacoody RH AU - Aldridge G AU - Laing W AU - Dargan PI AU - Nash S AU - Thompson JP AU - Vale A AU - Bateman N AU - Thomas S FA - Thanacoody, Ruben H K FA - Aldridge, Gloria FA - Laing, Willie FA - Dargan, Paul I FA - Nash, Stephen FA - Thompson, John P FA - Vale, Allister FA - Bateman, Nick FA - Thomas, Simon IN - Thanacoody, Ruben H K. National Poisons Information Unit (Newcastle), 24 Claremont Road, Newcastle-upon-Tyne NE2 4HH, UK. ruben.thanacoody@nuth.nhs.uk TI - National audit of antidote stocking in acute hospitals in the UK. SO - Emergency Medicine Journal. 30(5):393-6, 2013 May AS - Emerg Med J. 30(5):393-6, 2013 May NJ - Emergency medicine journal : EMJ VO - 30 IP - 5 PG - 393-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J SB - Index Medicus CP - England MH - *Antidotes/sd [Supply & Distribution] MH - *Emergency Service, Hospital MH - *Guideline Adherence MH - Humans MH - *Pharmacy Service, Hospital/st [Standards] MH - Pharmacy Service, Hospital/sn [Statistics & Numerical Data] MH - Practice Guidelines as Topic MH - Surveys and Questionnaires MH - United Kingdom AB - BACKGROUND: Inadequate stocking of essential antidotes in hospitals for the treatment of poisoned patients has been reported worldwide. Joint National Poisons Information Service (NPIS)/College of Emergency Medicine (CEM) guidelines for antidote stocking in UK emergency departments and acute hospitals were published in 2008. AB - AIM: To determine the impact of these guidelines by surveying the availability of antidotes in acute hospitals in the UK. AB - METHODS: A two-page questionnaire consisting of antidote stocking information was distributed in 2010 to the Chief Pharmacist in all acute hospitals in the UK. The availability of 28 antidotes in the NPIS/CEM antidote guidelines as well as that of Intralipid was surveyed. AB - RESULTS: Surveys were completed for 196 of the 224 (87.5%) hospitals. Over 90% of hospitals had acetylcysteine, activated charcoal, dantrolene, desferrioxamine, naloxone, flumazenil and vitamin K available within the recommended time period. Pralidoxime was reported to be held in only 33% of hospitals, though pralidoxime is supplied by the Department of Health to 95 hospitals in the UK that act as holding centres. Cyproheptadine and viper venom antiserum were held in around 50% of acute hospitals. For the treatment of cyanide and toxic alcohol poisoning, more than one antidote is available. For cyanide poisoning, most hospitals held at least one antidote (usually dicobalt edetate) but 9 (5%) held none of the four antidotes. For toxic alcohol and glycol poisoning, most hospitals held ethanol for intravenous use but not fomepizole and 30 (15%) did not stock any antidote for toxic alcohol poisoning. AB - CONCLUSION: Stocking of less commonly used antidotes is inconsistent. This is likely to result in delayed access to treatment and worse patient outcomes. RN - 0 (Antidotes) ES - 1472-0213 IL - 1472-0205 DO - https://dx.doi.org/10.1136/emermed-2012-201224 PT - Journal Article ID - emermed-2012-201224 [pii] ID - 10.1136/emermed-2012-201224 [doi] PP - ppublish LG - English EP - 20120808 DP - 2013 May EZ - 2012/08/10 06:00 DA - 2013/09/17 06:00 DT - 2012/08/10 06:00 YR - 2013 ED - 20130916 RD - 20161125 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22875840 <432. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23298996 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McCabe SE AU - West BT AU - Boyd CJ FA - McCabe, Sean Esteban FA - West, Brady T FA - Boyd, Carol J IN - McCabe, Sean Esteban. Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109-1290, USA. plius@umich.edu TI - Leftover prescription opioids and nonmedical use among high school seniors: a multi-cohort national study. SO - Journal of Adolescent Health. 52(4):480-5, 2013 Apr AS - J Adolesc Health. 52(4):480-5, 2013 Apr NJ - The Journal of adolescent health : official publication of the Society for Adolescent Medicine VO - 52 IP - 4 PG - 480-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - a0j, 9102136 IO - J Adolesc Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608842 OI - Source: NLM. NIHMS409006 SB - Index Medicus CP - United States MH - Adolescent MH - *Analgesics, Opioid MH - Cohort Studies MH - Cross-Sectional Studies MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/px [Psychology] MH - *Prescription Drug Misuse MH - Students/px [Psychology] MH - *Students/sn [Statistics & Numerical Data] MH - Surveys and Questionnaires MH - United States AB - PURPOSE: To (1) estimate the proportion of nonmedical users of prescription opioids (i.e., used prescription opioids in the past year without a doctor's orders) who used leftover medications from their own previous prescriptions; (2) assess substance use behaviors as a function of diversion source; and (3) identify the sources for these prescribed opioids. AB - METHODS: We analyzed data collected via self-administered questionnaires from nationally representative samples of high school seniors (modal age, 18 years) as a part of the Monitoring the Future (MTF) study. The sample consisted of four cohorts (senior years of 2007-2010, n = 8,888), including 647 high school seniors who reported past-year nonmedical use of prescription opioids, of whom 53% were estimated to be women. AB - RESULTS: An estimated 36.9% of past-year nonmedical users of prescription opioids obtained these opioid medications from their own previous prescriptions. Logistic regression analyses indicated that nonmedical users who used leftover medications from their previous prescriptions were primarily motivated to relieve physical pain, whereas nonmedical users who obtained medications from other sources had significantly higher odds of prescription opioid abuse and other substance use behaviors. Based on a subanalysis of nonmedical users who obtained prescription opioids from their previous prescriptions in 2010 (n = 51), approximately 27.1% obtained them from a dentist, 45.0% obtained them from an emergency room physician, and 38.3% obtained them from another physician. AB - CONCLUSIONS: Leftover prescription opioids from previous prescriptions represent a major source of nonmedical use of prescription opioids among high school seniors. These findings indicate that enhanced vigilance is needed when prescribing and monitoring prescription opioids among adolescents, to reduce leftover medications and nonmedical use. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1879-1972 IL - 1054-139X DI - S1054-139X(12)00350-3 DO - https://dx.doi.org/10.1016/j.jadohealth.2012.08.007 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S1054-139X(12)00350-3 [pii] ID - 10.1016/j.jadohealth.2012.08.007 [doi] ID - PMC3608842 [pmc] ID - NIHMS409006 [mid] PP - ppublish PH - 2012/04/09 [received] PH - 2012/08/20 [revised] PH - 2012/08/21 [accepted] GI - No: R01 DA001411 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: T32 DA007267 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01DA01411 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01DA031160 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01DA024678 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA024678 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA031160 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20121122 DP - 2013 Apr EZ - 2013/01/10 06:00 DA - 2013/09/14 06:00 DT - 2013/01/10 06:00 YR - 2013 ED - 20130913 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23298996 <433. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23820967 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Centers for Disease Control and Prevention (CDC) FA - Centers for Disease Control and Prevention (CDC) TI - Vital signs: overdoses of prescription opioid pain relievers and other drugs among women--United States, 1999-2010. SO - MMWR - Morbidity & Mortality Weekly Report. 62(26):537-42, 2013 Jul 05 AS - MMWR Morb Mortal Wkly Rep. 62(26):537-42, 2013 Jul 05 NJ - MMWR. Morbidity and mortality weekly report VO - 62 IP - 26 PG - 537-42 PI - Journal available in: Print PI - Citation processed from: Internet JC - ne8, 7802429 IO - MMWR Morb. Mortal. Wkly. Rep. SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/mo [Mortality] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Middle Aged MH - *Prescription Drugs/po [Poisoning] MH - United States/ep [Epidemiology] MH - Young Adult AB - BACKGROUND: Overdose deaths have increased steadily over the past decade. This report describes drug-related deaths and emergency department (ED) visits among women. AB - METHODS: CDC analyzed rates of fatal drug overdoses and drug misuse- or abuse-related ED visits among women using data from the National Vital Statistics System (1999-2010) and the Drug Abuse Warning Network (2004-2010). AB - RESULTS: In 2010, a total of 15,323 deaths among women were attributed to drug overdose, a rate of 9.8 per 100,000 population. Deaths from opioid pain relievers (OPRs) increased fivefold between 1999 and 2010 for women; OPR deaths among men increased 3.6 times. In 2010, there were 943,365 ED visits by women for drug misuse or abuse. The highest ED visit rates were for cocaine or heroin (147.2 per 100,000 population), benzodiazepines (134.6), and OPR (129.6). ED visits related to misuse or abuse of OPR among women more than doubled between 2004 and 2010. AB - CONCLUSIONS: Although more men die from drug overdoses than women, the percentage increase in deaths since 1999 is greater among women. More women have died each year from drug overdoses than from motor vehicle-related injuries since 2007. Deaths and ED visits related to OPR continue to increase among women. The prominent involvement of psychotherapeutic drugs, such as benzodiazepines, among overdoses provides insight for prevention opportunities. AB - IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Health-care providers should follow guidelines for responsible prescribing, including screening and monitoring for substance abuse and mental health problems, when prescribing OPR. Health-care providers who treat women for pain should use their state's prescription drug monitoring program and regularly screen patients for psychological disorders and use of psychotherapeutic drugs, with or without a prescription. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1545-861X IL - 0149-2195 PT - Journal Article ID - mm6226a3 [pii] PP - ppublish LG - English DP - 2013 Jul 05 EZ - 2013/07/04 06:00 DA - 2013/08/29 06:00 DT - 2013/07/04 06:00 YR - 2013 ED - 20130828 RD - 20130703 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23820967 <434. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23406078 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chang AK AU - Bijur PE AU - Lupow JB AU - John Gallagher E FA - Chang, Andrew K FA - Bijur, Polly E FA - Lupow, Jason B FA - John Gallagher, E IN - Chang, Andrew K. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA. ACHANG@montefiore.org TI - Randomized clinical trial of efficacy and safety of a single 2-mg intravenous dose of hydromorphone versus usual care in the management of acute pain. SO - Academic Emergency Medicine. 20(2):185-92, 2013 Feb AS - Acad Emerg Med. 20(2):185-92, 2013 Feb NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 20 IP - 2 PG - 185-92 PI - Journal available in: Print PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Female MH - Humans MH - *Hydromorphone/ad [Administration & Dosage] MH - Hydromorphone/ae [Adverse Effects] MH - Male MH - Middle Aged MH - *Pain Management/mt [Methods] MH - Pain Measurement MH - Treatment Outcome MH - Young Adult AB - OBJECTIVES: The objective was to test the efficacy and safety of 2 mg of intravenous (IV) hydromorphone (Dilaudid) against "usual care" in emergency department (ED) patients with acute severe pain. AB - METHODS: This was a randomized clinical trial. Patients allocated to 2 mg of IV hydromorphone received their medication in a single dose. Those randomized to usual care received any IV opioid, with type, dose, and frequency chosen by the ED attending. All patients received 2 L/min. nasal cannula oxygen. The primary outcome was the difference in the proportion of patients who achieved clinically satisfactory analgesia by 30 minutes. This was defined as the patient declining additional analgesia when asked the question, "Do you want more pain medicine?" A 10% absolute difference was chosen a priori as the minimum difference considered clinically significant. AB - RESULTS: Of 175 subjects randomized to each group, 164 in the 2 mg hydromorphone group and 161 in the usual care group had sufficient data for analysis. Additional pain medication was declined by 77.4% of patients in the 2 mg hydromorphone group at 30 minutes, compared to 65.8% in the usual care group. This difference of 11.6% was statistically and clinically significant (95% confidence interval [CI] = 1.8% to 21.1%). Safety profiles were similar and no patient required naloxone. There was more pruritus in the hydromorphone group (18.3% vs. 8.7%; difference = 9.6%, 95% CI = 2.6% to 16.6%). AB - CONCLUSIONS: Using a simple dichotomous patient-centered endpoint in which a difference of 10% in proportion obtaining adequate analgesia was considered clinically significant, 2 mg of hydromorphone in a single IV dose is clinically and statistically more efficacious when compared to usual care for acute pain management in the ED. Copyright © 2013 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - Q812464R06 (Hydromorphone) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/acem.12071 PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial ID - 10.1111/acem.12071 [doi] PP - ppublish PH - 2012/05/24 [received] PH - 2012/08/15 [revised] PH - 2012/08/17 [accepted] SI - ClinicalTrials.gov SA - ClinicalTrials.gov/NCT01429298 SL - https://clinicaltrials.gov/search/term=NCT01429298 LG - English DP - 2013 Feb EZ - 2013/02/15 06:00 DA - 2013/08/13 06:00 DT - 2013/02/15 06:00 YR - 2013 ED - 20130812 RD - 20140408 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23406078 <435. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23822044 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Snyder SR AU - Kivlehan SM AU - Collopy KT FA - Snyder, Scott R FA - Kivlehan, Sean M FA - Collopy, Kevin T IN - Snyder, Scott R. Public Safety Training Center in the Emergency Care Program, Santa Rosa Junior College, CA, USA. scottrsnyder@me.com TI - Understanding overdose. Opioids are a secret and leading cause of death. SO - EMS world. 42(6):57-61, 2013 Jun AS - EMS World. 42(6):57-61, 2013 Jun NJ - EMS world VO - 42 IP - 6 PG - 57-61 PI - Journal available in: Print PI - Citation processed from: Print JC - 101547538 IO - EMS World SB - Health Administration Journals CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - Cause of Death MH - *Drug Overdose/di [Diagnosis] MH - *Drug Overdose/mo [Mortality] MH - Drug Overdose/th [Therapy] MH - Emergency Medical Services MH - Humans MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) IS - 2158-7833 IL - 2158-7833 PT - Journal Article PP - ppublish LG - English DP - 2013 Jun EZ - 2013/07/05 06:00 DA - 2013/08/09 06:00 DT - 2013/07/05 06:00 YR - 2013 ED - 20130808 RD - 20150602 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23822044 <436. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23567867 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rosenau AM FA - Rosenau, Alex M IN - Rosenau, Alex M. Lehigh Valley Health Network, Allentown, PA 18103, USA. alex.rosenau@gmail.com TI - Guidelines for opioid prescription: the devil is in the details. SO - Annals of Internal Medicine. 158(11):843-4, 2013 Jun 04 AS - Ann Intern Med. 158(11):843-4, 2013 Jun 04 NJ - Annals of internal medicine VO - 158 IP - 11 PG - 843-4 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0372351 IO - Ann. Intern. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Analgesics, Opioid MH - Chronic Pain/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/pc [Prevention & Control] MH - *Drug Prescriptions MH - *Emergency Service, Hospital MH - Evidence-Based Medicine MH - Humans MH - New York City MH - Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Patient Discharge MH - *Practice Guidelines as Topic MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1539-3704 IL - 0003-4819 DO - https://dx.doi.org/10.7326/0003-4819-158-11-201306040-00632 PT - Journal Article ID - 1676186 [pii] ID - 10.7326/0003-4819-158-11-201306040-00632 [doi] PP - ppublish LG - English DP - 2013 Jun 04 EZ - 2013/04/10 06:00 DA - 2013/08/03 06:00 DT - 2013/04/10 06:00 YR - 2013 ED - 20130802 RD - 20130604 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23567867 <437. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23567824 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kunins HV AU - Farley TA AU - Dowell D FA - Kunins, Hillary V FA - Farley, Thomas A FA - Dowell, Deborah IN - Kunins, Hillary V. New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA. TI - Guidelines for opioid prescription: why emergency physicians need support. SO - Annals of Internal Medicine. 158(11):841-2, 2013 Jun 04 AS - Ann Intern Med. 158(11):841-2, 2013 Jun 04 NJ - Annals of internal medicine VO - 158 IP - 11 PG - 841-2 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0372351 IO - Ann. Intern. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Analgesics, Opioid MH - Chronic Pain/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - *Drug Prescriptions MH - *Emergency Service, Hospital MH - Evidence-Based Medicine MH - Humans MH - New York City MH - Opioid-Related Disorders/ep [Epidemiology] MH - Patient Discharge MH - *Practice Guidelines as Topic MH - United States/ep [Epidemiology] RN - 0 (Analgesics, Opioid) ES - 1539-3704 IL - 0003-4819 DO - https://dx.doi.org/10.7326/0003-4819-158-11-201306040-00631 PT - Journal Article ID - 1676185 [pii] ID - 10.7326/0003-4819-158-11-201306040-00631 [doi] PP - ppublish LG - English DP - 2013 Jun 04 EZ - 2013/04/10 06:00 DA - 2013/08/03 06:00 DT - 2013/04/10 06:00 YR - 2013 ED - 20130802 RD - 20130604 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23567824 <438. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23245927 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schaper A AU - Ceschi A AU - Deters M AU - Kaiser G FA - Schaper, Andreas FA - Ceschi, Alessandro FA - Deters, Michael FA - Kaiser, Guido IN - Schaper, Andreas. GIZ-Nord Poisons Centre, University Medical Centre Gottingen, Robert-Koch-Strase 40, 37075 Gottingen, Germany. aschaper@giz-nord.de TI - Of pills, plants, and paraquat: the relevance of poison centers in emergency medicine. [Review] SO - European Journal of Internal Medicine. 24(2):104-9, 2013 Mar AS - EUR. J. INTERN. MED.. 24(2):104-9, 2013 Mar NJ - European journal of internal medicine VO - 24 IP - 2 PG - 104-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9003220 IO - Eur. J. Intern. Med. SB - Index Medicus CP - Netherlands MH - *Antidotes/tu [Therapeutic Use] MH - *Emergency Medicine/og [Organization & Administration] MH - *Gastric Lavage/mt [Methods] MH - Humans MH - *Poison Control Centers/og [Organization & Administration] MH - *Poisoning/th [Therapy] MH - *Sorption Detoxification/mt [Methods] AB - The organization and work of a poisons center are demonstrated on the basis of GIZ-Nord Poisons Center Annual Report for 2011. In a short summary the basic principles of clinical toxicology are elucidated: the indications for gastric lavage and the application of activated charcoal. Moreover the means of enhanced elimination are presented: hemodialysis, hemoperfusion, multi-dose activated charcoal and molecular absorbent recirculating system (MARS). Gastric lavage is indicated within one hour after ingestion of a life-threatening dose of a poison. In intoxications with CNS penetrating substances gastric lavage should be performed only after endotracheal intubation due to the risk of aspiration. The basic management of the intoxicated patient by emergency medicine personnel out of hospital and on the way into the hospital is presented. The "Bremen List", a compilation of five antidotes (atropine, 4-DMAP, tolonium chloride, naloxone, activated charcoal) for the out of hospital treatment by emergency doctors is introduced. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. RN - 0 (Antidotes) ES - 1879-0828 IL - 0953-6205 DI - S0953-6205(12)00300-7 DO - https://dx.doi.org/10.1016/j.ejim.2012.11.013 PT - Journal Article PT - Review ID - S0953-6205(12)00300-7 [pii] ID - 10.1016/j.ejim.2012.11.013 [doi] PP - ppublish PH - 2012/11/02 [received] PH - 2012/11/21 [accepted] LG - English EP - 20121212 DP - 2013 Mar EZ - 2012/12/19 06:00 DA - 2013/07/31 06:00 DT - 2012/12/19 06:00 YR - 2013 ED - 20130730 RD - 20130212 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23245927 <439. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23241479 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kelty E AU - Ngo H AU - Hulse G FA - Kelty, Erin FA - Ngo, Hanh FA - Hulse, Gary IN - Kelty, Erin. School of Psychiatry and Clinical Neuroscience, The University of Western Australia, Perth, WA 6009, Australia. erin.kelty@freshstart.org.au TI - Assessing the usefulness of health data linkage in obtaining adverse event data in a randomised controlled trial of oral and implant naltrexone in the treatment of heroin dependence. SO - Clinical Trials. 10(1):170-80, 2013 Feb AS - Clin. trials. 10(1):170-80, 2013 Feb NJ - Clinical trials (London, England) VO - 10 IP - 1 PG - 170-80 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101197451 IO - Clin Trials SB - Index Medicus CP - England MH - Administration, Oral MH - *Adverse Drug Reaction Reporting Systems MH - *Data Collection MH - Drug Implants MH - Drug-Related Side Effects and Adverse Reactions MH - Female MH - Follow-Up Studies MH - *Heroin Dependence/dt [Drug Therapy] MH - Humans MH - Male MH - *Naltrexone/ad [Administration & Dosage] MH - *Randomized Controlled Trials as Topic/mt [Methods] MH - Self Report AB - BACKGROUND: The completeness of self-reported serious adverse events (SAEs) in clinical trials can be reduced by inaccuracies in subject reporting and lost to follow-up. AB - PURPOSE: This study assesses the usefulness of a health data linkage system in obtaining SAE data in a randomised controlled study of oral and implant naltrexone. AB - METHODS: SAEs were collected from 68 heroin-dependent subjects during a randomised controlled trial of oral and implant naltrexone with follow-up to 26 weeks. Patient self-report data were cross-matched against hospital and emergency department (ED) attendances for the same period using a health data linkage system. AB - RESULTS: A total of 29 hospital admissions and 74 ED attendances were identified using health data linkage. Of these, 12 (41.4%) hospital admissions and 50 (67.7%) of ED attendances had not been reported as SAE in the randomised controlled trial. In subjects participating in the trial at the time of the event, there was a 1.25-fold increase in the number of hospital admissions and a 2.25-fold increase in the number of ED attendances recorded using data linkage. Overall (including withdrawn subjects or those lost to follow-up), there was a 1.71-fold increase in hospital admission and a 3.09-fold increase in ED attendance recorded. AB - LIMITATIONS: The use of data linkage should not be used as a replacement for thorough follow-up, as the datasets can take substantial periods to update, making them a poor substitute for real-time follow-up. Additionally, some SAEs such as life-threatening events that do not involve ED or hospital attendance may be overlooked as would SAEs that occurred outside the dataset's range, for example, interstate or overseas. AB - CONCLUSIONS: Health data linkage can be used to effectively reduce the extent of missing health data in a clinical trial. RN - 0 (Drug Implants) RN - 5S6W795CQM (Naltrexone) ES - 1740-7753 IL - 1740-7745 DO - https://dx.doi.org/10.1177/1740774512467237 PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 1740774512467237 [pii] ID - 10.1177/1740774512467237 [doi] PP - ppublish LG - English EP - 20121214 DP - 2013 Feb EZ - 2012/12/18 06:00 DA - 2013/07/31 06:00 DT - 2012/12/18 06:00 YR - 2013 ED - 20130730 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23241479 <440. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23828953 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Huffman A FA - Huffman, Alan TI - Controlling opioid abuse in the emergency department: legitimate public policy or "legislative medicine"?. SO - Annals of Emergency Medicine. 61(6):13A-15A, 2013 Jun AS - Ann Emerg Med. 61(6):13A-15A, 2013 Jun NJ - Annals of emergency medicine VO - 61 IP - 6 PG - 13A-15A PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/lj [Legislation & Jurisprudence] MH - Humans MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Public Policy MH - United States RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 PT - News PP - ppublish LG - English DP - 2013 Jun EZ - 2013/07/06 06:00 DA - 2013/07/23 06:00 DT - 2013/07/06 06:00 YR - 2013 ED - 20130722 RD - 20130703 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23828953 <441. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22947223 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McLean SA AU - Platts-Mills TF AU - Hunold KM FA - McLean, Samuel A FA - Platts-Mills, Timothy F FA - Hunold, Katherine M TI - Response to: who receives opioids for acute pain in emergency departments? Considering evidence, patient and provider preferences. CM - Comment on: Pain. 2012 May;153(5):941-2; PMID: 22445292 CM - Comment on: Pain. 2012 May;153(5):967-73; PMID: 22386895 SO - Pain. 153(11):2300-1, 2012 Nov AS - Pain. 153(11):2300-1, 2012 Nov NJ - Pain VO - 153 IP - 11 PG - 2300-1 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - opf, 7508686 IO - Pain SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Utilization MH - Female MH - Humans MH - Male MH - *Practice Patterns, Physicians' RN - 0 (Analgesics, Opioid) ES - 1872-6623 IL - 0304-3959 DI - S0304-3959(12)00470-8 DO - https://dx.doi.org/10.1016/j.pain.2012.07.036 PT - Comment PT - Letter ID - S0304-3959(12)00470-8 [pii] ID - 10.1016/j.pain.2012.07.036 [doi] PP - ppublish PH - 2012/06/27 [received] PH - 2012/07/31 [accepted] LG - English EP - 20120901 DP - 2012 Nov EZ - 2012/09/06 06:00 DA - 2013/07/17 06:00 DT - 2012/09/06 06:00 YR - 2012 ED - 20130715 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22947223 <442. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22847602 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lankenau SE AU - Wagner KD AU - Silva K AU - Kecojevic A AU - Iverson E AU - McNeely M AU - Kral AH FA - Lankenau, Stephen E FA - Wagner, Karla D FA - Silva, Karol FA - Kecojevic, Aleksandar FA - Iverson, Ellen FA - McNeely, Miles FA - Kral, Alex H IN - Lankenau, Stephen E. Department of Community Health and Prevention, School of Public Health, Drexel University, Philadelphia, PA 19102, USA. sel59@drexel.edu TI - Injection drug users trained by overdose prevention programs: responses to witnessed overdoses. SO - Journal of Community Health. 38(1):133-41, 2013 Feb AS - J Community Health. 38(1):133-41, 2013 Feb NJ - Journal of community health VO - 38 IP - 1 PG - 133-41 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7600747, hut IO - J Community Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516627 OI - Source: NLM. NIHMS397519 SB - Index Medicus CP - Netherlands MH - Adult MH - *Drug Overdose/pc [Prevention & Control] MH - Drug Overdose/px [Psychology] MH - Drug Overdose/th [Therapy] MH - Educational Measurement MH - Emergency Medical Services/ut [Utilization] MH - Female MH - Humans MH - Interviews as Topic MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Patient Education as Topic/mt [Methods] MH - Resuscitation/ed [Education] MH - Risk Factors MH - Substance Abuse, Intravenous/pc [Prevention & Control] MH - *Substance Abuse, Intravenous/px [Psychology] MH - Young Adult AB - In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPPs), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when responding to a drug overdose. IDUs (n = 30) trained by two OPPs in Los Angeles were interviewed in 2010-2011 about responses to their most recently witnessed drug overdose using an instrument containing both open and closed-ended questions. Among the 30 witnessed overdose events, the victim recovered in 29 cases while the outcome was unknown in one case. Participants responded to overdoses using a variety of techniques taught by OPPs. Injecting the victim with naloxone was the most commonly recommended response while other recommended responses included stimulating the victim with knuckles, calling 911, and giving rescue breathing. Barriers preventing participants from employing recommended response techniques in certain circumstances included prior successes using folk remedies to revive a victim, concerns over attracting police to the scene, and issues surrounding access to or use of naloxone. Practical solutions, such as developing booster sessions to augment OPPs, are encouraged to increase the likelihood that trained participants respond to a drug overdose with the full range of recommended techniques. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1573-3610 IL - 0094-5145 DO - https://dx.doi.org/10.1007/s10900-012-9591-7 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1007/s10900-012-9591-7 [doi] ID - PMC3516627 [pmc] ID - NIHMS397519 [mid] PP - ppublish GI - No: T32DA023356 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R21DA026789 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K01 DA031031 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K01DA031031 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: T32 DA023356 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R21 DA026789 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2013 Feb EZ - 2012/08/01 06:00 DA - 2013/07/16 06:00 DT - 2012/08/01 06:00 YR - 2013 ED - 20130712 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22847602 <443. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23000499 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sanaei-Zadeh H FA - Sanaei-Zadeh, Hossein TI - Is discharge-on-scene policy really safe after naloxone reversal of acute long-acting opioid toxicity?. CM - Comment on: Resuscitation. 2011 Nov;82(11):1414-8; PMID: 21745532 SO - Resuscitation. 84(1):e15, 2013 Jan AS - Resuscitation. 84(1):e15, 2013 Jan NJ - Resuscitation VO - 84 IP - 1 PG - e15 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - *Emergency Medical Services MH - Humans MH - *Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/th [Therapy] MH - *Opium/po [Poisoning] MH - *Patient Discharge RN - 8008-60-4 (Opium) ES - 1873-1570 IL - 0300-9572 DI - S0300-9572(12)00802-7 DO - https://dx.doi.org/10.1016/j.resuscitation.2011.11.037 PT - Comment PT - Letter ID - S0300-9572(12)00802-7 [pii] ID - 10.1016/j.resuscitation.2011.11.037 [doi] PP - ppublish PH - 2011/11/01 [received] PH - 2011/11/05 [accepted] LG - English EP - 20120919 DP - 2013 Jan EZ - 2012/09/25 06:00 DA - 2013/07/09 06:00 DT - 2012/09/25 06:00 YR - 2013 ED - 20130708 RD - 20121224 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23000499 <444. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23132396 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anand KJ AU - Clark AE AU - Willson DF AU - Berger J AU - Meert KL AU - Zimmerman JJ AU - Harrison R AU - Carcillo JA AU - Newth CJ AU - Bisping S AU - Holubkov R AU - Dean JM AU - Nicholson CE AU - Eunice Kennedy Shriver National Institute of Child Health AU - Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN) FA - Anand, Kanwaljeet J S FA - Clark, Amy E FA - Willson, Douglas F FA - Berger, John FA - Meert, Kathleen L FA - Zimmerman, Jerry J FA - Harrison, Rick FA - Carcillo, Joseph A FA - Newth, Christopher J L FA - Bisping, Stephanie FA - Holubkov, Richard FA - Dean, J Michael FA - Nicholson, Carol E FA - Eunice Kennedy Shriver National Institute of Child Health FA - Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN) IN - Anand, Kanwaljeet J S. Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA. kanand@uthsc.edu IR - Anand KJ IR - Phil D IR - Prodhan P IR - Sanders RC Jr IR - Hefley G IR - Korehbandi P IR - Dean JM IR - Burr J IR - Clark A IR - Holubkov R IR - Bisping S IR - Liu T IR - Enriquez R IR - Yearley J IR - Berger J IR - Wratney A IR - Reardon J IR - Carcillo J IR - Bell M IR - Abraham A IR - Geyser A IR - Jones J IR - Springs L IR - Meert KL IR - Heidemann S IR - Pawluszka A IR - Zimmerman J IR - Jardine D IR - Barker R IR - Newth CJ IR - Fajardo JF IR - Harrison R IR - Willson DF IR - Nicholson C IR - Jenkins T TI - Opioid analgesia in mechanically ventilated children: results from the multicenter Measuring Opioid Tolerance Induced by Fentanyl study. CM - Comment in: Pediatr Crit Care Med. 2013 Jan;14(1):101-2; PMID: 23295838 SO - Pediatric Critical Care Medicine. 14(1):27-36, 2013 Jan AS - Pediatr Crit Care Med. 14(1):27-36, 2013 Jan NJ - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies VO - 14 IP - 1 PG - 27-36 PI - Journal available in: Print PI - Citation processed from: Internet JC - 100954653 IO - Pediatr Crit Care Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581608 OI - Source: NLM. NIHMS435493 SB - Index Medicus CP - United States MH - Adolescent MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Child MH - Child, Preschool MH - Confidence Intervals MH - Female MH - *Fentanyl/ad [Administration & Dosage] MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - Infant MH - Infant, Newborn MH - Intensive Care Units, Pediatric MH - Kaplan-Meier Estimate MH - Male MH - Midazolam/ad [Administration & Dosage] MH - *Morphine/ad [Administration & Dosage] MH - Multivariate Analysis MH - Odds Ratio MH - Prospective Studies MH - *Respiration, Artificial/mt [Methods] MH - Sex Factors MH - Time Factors AB - OBJECTIVE: To examine the clinical factors associated with increased opioid dose among mechanically ventilated children in the pediatric intensive care unit. AB - DESIGN: Prospective, observational study with 100% accrual of eligible patients. AB - SETTING: Seven pediatric intensive care units from tertiary-care children's hospitals in the Collaborative Pediatric Critical Care Research Network. AB - PATIENTS: Four hundred nineteen children treated with morphine or fentanyl infusions. AB - INTERVENTIONS: None. AB - MEASUREMENTS AND MAIN RESULTS: Data on opioid use, concomitant therapy, demographic and explanatory variables were collected. Significant variability occurred in clinical practices, with up to 100-fold differences in baseline opioid doses, average daily or total doses, or peak infusion rates. Opioid exposure for 7 or 14 days required doubling of the daily opioid dose in 16% patients (95% confidence interval 12%-19%) and 20% patients (95% confidence interval 16%-24%), respectively. Among patients receiving opioids for longer than 3 days (n = 225), this occurred in 28% (95% confidence interval 22%-33%) and 35% (95% confidence interval 29%-41%) by 7 or 14 days, respectively. Doubling of the opioid dose was more likely to occur following opioid infusions for 7 days or longer (odds ratio 7.9, 95% confidence interval 4.3-14.3; p < 0.001) or co-therapy with midazolam (odds ratio 5.6, 95% confidence interval 2.4-12.9; p < 0.001), and it was less likely to occur if morphine was used as the primary opioid (vs. fentanyl) (odds ratio 0.48, 95% confidence interval 0.25-0.92; p = 0.03), for patients receiving higher initial doses (odds ratio 0.96, 95% confidence interval 0.95-0.98; p < 0.001), or if patients had prior pediatric intensive care unit admissions (odds ratio 0.37, 95% confidence interval 0.15-0.89; p = 0.03). AB - CONCLUSIONS: Mechanically ventilated children require increasing opioid doses, often associated with prolonged opioid exposure or the need for additional sedation. Efforts to reduce prolonged opioid exposure and clinical practice variation may prevent the complications of opioid therapy. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 76I7G6D29C (Morphine) RN - R60L0SM5BC (Midazolam) RN - UF599785JZ (Fentanyl) IS - 1529-7535 IL - 1529-7535 DO - https://dx.doi.org/10.1097/PCC.0b013e318253c80e PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural ID - 10.1097/PCC.0b013e318253c80e [doi] ID - PMC3581608 [pmc] ID - NIHMS435493 [mid] PP - ppublish GI - No: U10HD049945 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U01HD049934 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: UL1 TR000005 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: U10 HD050012 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10 HD050009 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10 HD049945 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10HD049981 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: UG1 HD050096 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10 HD049981 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10 HD050096 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10 HD049983 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10HD050096 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10HD049983 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U01 HD049934 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10HD500009 Organization: (HD) *NICHD NIH HHS* Country: United States GI - No: U10HD050012 Organization: (HD) *NICHD NIH HHS* Country: United States LG - English DP - 2013 Jan EZ - 2012/11/08 06:00 DA - 2013/07/06 06:00 DT - 2012/11/08 06:00 YR - 2013 ED - 20130705 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23132396 <445. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23709299 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Black RA AU - Trudeau KJ AU - Cassidy TA AU - Budman SH AU - Butler SF FA - Black, Ryan A FA - Trudeau, Kimberlee J FA - Cassidy, Theresa A FA - Budman, Simon H FA - Butler, Stephen F IN - Black, Ryan A. Nova Southeastern University, Ft. Lauderdale, FL, USA. TI - Associations between public health indicators and injecting prescription opioids by prescription opioid abusers in substance abuse treatment. SO - Journal of Opioid Management. 9(1):5-17, 2013 Jan-Feb AS - J Opioid Manag. 9(1):5-17, 2013 Jan-Feb NJ - Journal of opioid management VO - 9 IP - 1 PG - 5-17 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Adult MH - Chemistry, Pharmaceutical MH - Cost of Illness MH - Cross-Sectional Studies MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/th [Therapy] MH - *Drug Users MH - Emergency Service, Hospital/ut [Utilization] MH - Female MH - HIV Infections/ep [Epidemiology] MH - HIV Infections/th [Therapy] MH - Homeless Persons MH - Humans MH - Injections, Intravenous MH - Linear Models MH - Liver Diseases/ep [Epidemiology] MH - Liver Diseases/th [Therapy] MH - Logistic Models MH - Male MH - Odds Ratio MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Pain Management/ut [Utilization] MH - Prescription Drugs MH - *Public Health MH - *Substance Abuse Treatment Centers MH - Substance Abuse, Intravenous/ep [Epidemiology] MH - *Substance Abuse, Intravenous/rh [Rehabilitation] MH - Surveys and Questionnaires MH - Unemployment MH - United States/ep [Epidemiology] AB - OBJECTIVE: To determine what, if any, public health and societal impacts are associated specifically with injection of prescription opioids. AB - DESIGN: Cross-sectional observational study. AB - SETTING: Five hundred forty treatment facilities in 35 states across the United States performing Addiction Severity Index-Multimedia Version (ASI-MV) assessments. AB - PARTICIPANTS: Adult patients (29,459) who reported past 30-day abuse of any prescription opioid on the ASI-MV assessment between January 2007 and January 2011. AB - MAIN OUTCOME MEASURES: The public health indicators selected for this study were liver disease, HIV/AIDS status, recent visit to an emergency room, treatment for pain, treatment for overdosing, homelessness, residence with alcohol/substance abuser, and unemployment. AB - RESULTS: Prescription opioid injection was significantly associated with health problems, psychosocial problems, and utilization of medical services. AB - CONCLUSIONS: This study demonstrates an approach to measure the potential impact of injecting prescription opioids on public health indicators. Findings indicate a positive association between injection of prescription opioids and public health indicators suggesting a need for prescription opioid formulations that may inhibit injection of these medications. RN - 0 (Prescription Drugs) IS - 1551-7489 IL - 1551-7489 DI - jom.2013.0142 DO - https://dx.doi.org/10.5055/jom.2013.0142 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - jom.2013.0142 [pii] ID - 10.5055/jom.2013.0142 [doi] PP - ppublish PH - 2012/05/07 [received] PH - 2012/10/19 [revised] PH - 2012/12/19 [accepted] LG - English DP - 2013 Jan-Feb EZ - 2013/05/28 06:00 DA - 2013/06/28 06:00 DT - 2013/05/28 06:00 YR - 2013 ED - 20130626 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23709299 <446. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22944354 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Drummond GB AU - Dhonneur G AU - Kirov K AU - Duvaldestin P FA - Drummond, Gordon B FA - Dhonneur, Gilles FA - Kirov, Krassen FA - Duvaldestin, Philippe IN - Drummond, Gordon B. Departement d'Anesthesie et Reanimation, Hopital Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France. g.b.drummond@ed.ac.uk TI - Effects of an opioid on respiratory movements and expiratory activity in humans during isoflurane anaesthesia. SO - Respiratory Physiology & Neurobiology. 185(2):425-34, 2013 Jan 15 AS - Respir Physiolo Neurobiol. 185(2):425-34, 2013 Jan 15 NJ - Respiratory physiology & neurobiology VO - 185 IP - 2 PG - 425-34 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101140022 IO - Respir Physiol Neurobiol SB - Index Medicus CP - Netherlands MH - *Abdominal Muscles/de [Drug Effects] MH - Adult MH - Airway Obstruction/pp [Physiopathology] MH - Airway Resistance/de [Drug Effects] MH - *Analgesics, Opioid/pd [Pharmacology] MH - Anesthetics, Inhalation/pd [Pharmacology] MH - Drug Interactions MH - *Exhalation/de [Drug Effects] MH - Female MH - Humans MH - Isoflurane/pd [Pharmacology] MH - Male MH - Middle Aged MH - Models, Biological MH - Naloxone/pd [Pharmacology] MH - Narcotic Antagonists/pd [Pharmacology] MH - Pulmonary Gas Exchange MH - Respiration, Artificial MH - *Respiratory Mechanics/de [Drug Effects] MH - *Respiratory Muscles/de [Drug Effects] MH - *Thoracic Wall/de [Drug Effects] MH - Tidal Volume/de [Drug Effects] AB - Opioids increase abdominal muscle activity during anaesthesia. We proposed that opioid activity during anaesthesia would change chest wall size and movement, and contribute to ventilation. Using an optical system to measure chest wall volume, we studied 10 patients during isoflurane anaesthesia, first under the influence of an opioid and then after reversal with naloxone. Measurements were made during quiet breathing and with carbon dioxide stimulation. Airway occlusion pressure was measured to assess inspiratory and expiratory muscle activity. Chest wall volume decreased with the onset of spontaneous breathing, and decreased further when breathing was stimulated by carbon dioxide. Reversal of opioid activity increased chest wall volume. Breathing movements were predominantly abdominal. Opioid action affected the timing and amplitude of breathing but the pattern of abdominal movement was not affected. Since opioids augment abdominal muscle action during expiration, the unchanged pattern of movement can be attributed to both diaphragm and abdominal activity displacing the abdominal wall reciprocally, in the inspiratory and expiratory phases of the respiratory cycle, respectively. Copyright © 2012 Elsevier B.V. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Inhalation) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - CYS9AKD70P (Isoflurane) ES - 1878-1519 IL - 1569-9048 DI - S1569-9048(12)00245-5 DO - https://dx.doi.org/10.1016/j.resp.2012.08.016 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S1569-9048(12)00245-5 [pii] ID - 10.1016/j.resp.2012.08.016 [doi] PP - ppublish PH - 2012/04/21 [received] PH - 2012/08/19 [revised] PH - 2012/08/20 [accepted] LG - English EP - 20120825 DP - 2013 Jan 15 EZ - 2012/09/05 06:00 DA - 2013/06/08 06:00 DT - 2012/09/05 06:00 YR - 2013 ED - 20130607 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22944354 <447. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22505303 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wichmann S AU - Nielsen SL AU - Siersma VD AU - Rasmussen LS FA - Wichmann, Sine FA - Nielsen, Soren Loumann FA - Siersma, Volkert Dirk FA - Rasmussen, Lars S IN - Wichmann, Sine. Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. sinewichmann@gmail.com TI - Risk factors for 48-hours mortality after prehospital treatment of opioid overdose. SO - Emergency Medicine Journal. 30(3):223-5, 2013 Mar AS - Emerg Med J. 30(3):223-5, 2013 Mar NJ - Emergency medicine journal : EMJ VO - 30 IP - 3 PG - 223-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J SB - Index Medicus CP - England MH - Adult MH - Age Factors MH - Denmark/ep [Epidemiology] MH - *Drug Overdose/mo [Mortality] MH - *Emergency Medical Services MH - *Emergency Treatment MH - Female MH - Humans MH - Logistic Models MH - Male MH - *Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/th [Therapy] MH - Prospective Studies MH - Risk Factors AB - INTRODUCTION: Opioid overdose is commonly treated by prehospital emergency services and the majority of the patients are discharged immediately after treatment and a short observation period. There is a minor risk for rebound opioid toxicity and other life-threatening conditions might occur after such episodes. The authors describe the short-term outcome and identify risk factors for death within 48 h after prehospital treatment of opioid overdose in Copenhagen, the capital of Denmark. AB - METHODS: Data on all cases of opioid overdose treated by the medical emergency care unit between 1994 and 2003 were recorded prospectively. Risk factors for death within 48 h after initial medical emergency care unit contact were analysed in a multivariable logistic regression analysis. AB - RESULTS: The authors recorded 4762 episodes of opioid overdose, covering 1967 unique identified patients. A total of 78 patients (8.4%, 95% CI 7.0 to 10.4) died within 48 h in the period 1999-2003, and 85% (66/78) of these had cardiac arrest and died. The authors found age >50 years and overdose during the weekend significantly associated with 48-h mortality. Gender, former episodes of opioid overdose, time of the day, month or year were not significantly associated with increased mortality. AB - CONCLUSIONS: The author found a 48-hours mortality of 8.4%. Advanced age and opioid overdose in the weekends were significant risk factors. Release on scene after treatment was associated with a very small risk. ES - 1472-0213 IL - 1472-0205 DO - https://dx.doi.org/10.1136/emermed-2012-201124 PT - Journal Article ID - emermed-2012-201124 [pii] ID - 10.1136/emermed-2012-201124 [doi] PP - ppublish LG - English EP - 20120413 DP - 2013 Mar EZ - 2012/04/17 06:00 DA - 2013/05/28 06:00 DT - 2012/04/17 06:00 YR - 2013 ED - 20130524 RD - 20130215 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22505303 <448. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23687544 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Hoppe JA AU - Houghland J AU - Yaron M AU - Heard K FA - Hoppe, Jason A FA - Houghland, John FA - Yaron, Michael FA - Heard, Kennon IN - Hoppe, Jason A. Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado. TI - Prescription history of emergency department patients prescribed opioids. SO - The Western Journal of Emergency Medicine. 14(3):247-52, 2013 May AS - West J Emerg Med. 14(3):247-52, 2013 May NJ - The western journal of emergency medicine VO - 14 IP - 3 PG - 247-52 PI - Journal available in: Print PI - Citation processed from: Print JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656706 CP - United States AB - INTRODUCTION: To use Colorado's prescription drug monitoring program (PDMP) to describe the recent opioid prescription history of patients discharged from our emergency department (ED) with a prescription for opioid pain medications. AB - METHODS: Retrospective cohort study of 300 adult ED patients who received an opioid prescription. We abstracted prescription histories for the six months prior to the ED visit from the PDMP, and abstracted clinical and demographic variables from the chart. AB - RESULTS: There were 5,379 ED visits during the study month, 3,732 of which were discharged. Providers wrote 1,165 prescriptions for opioid analgesics to 1,124/3,732 (30%) of the patients. Median age was 36 years. Thirty-nine percent were male. Patients were 46% Caucasian, 26% African American, 22% Hispanic, 2% Asian and 4% other. These were similar to our overall ED population. There was substantial variability in the number of prescriptions, prescribers and total number of pills. A majority (205/296) of patients had zero or one prescription. The 90th percentile for number of prescriptions was seven, while the 10th percentile was zero. Patients in the highest decile tended to be older, with a higher proportion of Caucasians and females. Patients in the lowest decile resembled the general ED population. The most common diagnoses associated with opioid prescriptions were abdominal pain (11.5%), cold/flu symptoms (9.5%), back pain (5.4%), flank pain (5.0%) and motor vehicle crash (4.7%). AB - CONCLUSION: Substantial variability exists in the opioid prescription histories of ED patients, but a majority received zero or one prescription in the preceding six months. The top decile of patients averaged more than two prescriptions per month over the six months prior to ED visit, written by more than 6 different prescribers. There was a trend toward these patients being older, Caucasian and female. IS - 1936-900X IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2012.2.6915 PT - Journal Article ID - 10.5811/westjem.2012.2.6915 [doi] ID - PMC3656706 [pmc] PP - ppublish PH - 2011/10/14 [received] PH - 2012/01/17 [revised] PH - 2012/02/20 [accepted] GI - No: K08 DA020573 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2013 May EZ - 2013/05/21 06:00 DA - 2013/05/21 06:01 DT - 2013/05/21 06:00 YR - 2013 ED - 20130521 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=23687544 <449. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23055125 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Neven DE AU - Sabel JC AU - Howell DN AU - Carlisle RJ FA - Neven, Darin E FA - Sabel, Jennifer C FA - Howell, Donelle N FA - Carlisle, Russell J IN - Neven, Darin E. Program of Excellence in the Addictions, Washington State University College of Nursing, PO Box 1495, Spokane, WA 99210-1495, USA. darin.neven@wsu.edu TI - The development of the Washington State emergency department opioid prescribing guidelines. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 8(4):353-9, 2012 Dec AS - J Med Toxicol. 8(4):353-9, 2012 Dec NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 8 IP - 4 PG - 353-9 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550252 SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Prescriptions/st [Standards] MH - *Drug Utilization/st [Standards] MH - *Emergency Service, Hospital/st [Standards] MH - *Guidelines as Topic MH - Humans MH - Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/pp [Physiopathology] MH - Patient Education as Topic/mt [Methods] MH - Washington RN - 0 (Analgesics, Opioid) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-012-0267-6 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. ID - 10.1007/s13181-012-0267-6 [doi] ID - PMC3550252 [pmc] PP - ppublish GI - No: U17CE0248110 Organization: (CE) *NCIPC CDC HHS* Country: United States LG - English DP - 2012 Dec EZ - 2012/10/12 06:00 DA - 2013/05/03 06:00 DT - 2012/10/12 06:00 YR - 2012 ED - 20130502 RD - 20161114 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23055125 <450. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23055123 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wiegand TJ AU - Wax PM AU - Schwartz T AU - Finkelstein Y AU - Gorodetsky R AU - Brent J AU - Toxicology Investigators Consortium Case Registry Investigators FA - Wiegand, Timothy J FA - Wax, Paul M FA - Schwartz, Tayler FA - Finkelstein, Yaron FA - Gorodetsky, Rachel FA - Brent, Jeffrey FA - Toxicology Investigators Consortium Case Registry Investigators IN - Wiegand, Timothy J. University of Rochester Medical Center & Strong Memorial Hospital, Rochester, NY, USA. Timothy_Wiegand@URMC.Rochester.edu IR - Burns-Ewald M IR - Beuhler M IR - Kleinschmidt K IR - Wax P IR - Brent J IR - Heard K IR - Leikin J IR - Riley B IR - Judge B IR - Donovan J IR - McKay C IR - Bentur Y IR - Froberg B IR - Rusyniak D IR - Wasserman G IR - Lowry J IR - Algren DA IR - Su M IR - Gummin D IR - Kostic M IR - Hernandez S IR - Manini A IR - Smith S IR - Nelson L IR - Geib AJ IR - Marcus S IR - Kirschner R IR - McKeown N IR - Levine M IR - Ruha AM IR - Pizon A IR - Wills B IR - Wiegand T IR - Gorodetsky R IR - Varney S IR - Bebarta V IR - Smollin C IR - Stellpflug S IR - Engebretsen K IR - Finkelstein Y IR - Rhyee S IR - Bird S TI - The Toxicology Investigators Consortium Case Registry--the 2011 experience. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 8(4):360-77, 2012 Dec AS - J Med Toxicol. 8(4):360-77, 2012 Dec NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 8 IP - 4 PG - 360-77 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550266 SB - Index Medicus CP - United States MH - Acetaminophen/po [Poisoning] MH - Acetylcysteine/tu [Therapeutic Use] MH - Adolescent MH - Adult MH - Aged MH - Analgesics, Non-Narcotic/po [Poisoning] MH - *Analgesics, Opioid/po [Poisoning] MH - Antidepressive Agents/po [Poisoning] MH - Child MH - Child, Preschool MH - Databases, Factual MH - *Drug Overdose/ep [Epidemiology] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - Oxycodone/po [Poisoning] MH - Prospective Studies MH - *Psychotropic Drugs/po [Poisoning] MH - *Registries MH - Substance-Related Disorders/ep [Epidemiology] MH - Young Adult AB - In 2010, the American College of Medical Toxicology established its Case Registry, the Toxicology Investigators Consortium (ToxIC). ToxIC is a prospective registry, which exclusively compiles suspected and confirmed toxic exposure cases cared for at the bedside by medical toxicologists at its participating sites. The Registry aims to fulfill two important gaps in the field: a real-time toxicosurveillance system to identify current poisoning trends and a powerful research tool in toxicology. ToxIC allows extraction of information from medical records making it the most robust multicenter database on chemical toxicities in existence. All cases seen by medical toxicologists at participating institutions were entered in a database. Information characterizing patients entered in 2011 was tabulated. 2010 data was also included so that cumulative total numbers could be described as well. The current report is a summary of the data collected in 2011 in comparison to 2010 entries and also includes cumulative data through December 31st, 2011. During 2011, 28 sites with 49 specific institutions contributed a total of 6,456 cases to the Registry. The total number of cases entered into the registry at the end of 2011 was 10,392. Emergency departments remained the most common source of consultations in 2011, accounting for 53 % of cases. The most common reason for consultation was for pharmaceutical overdoses, which occurred in 48 % of patients, including intentional (37 %) and unintentional (11 %) exposures. The most common classes of agents were sedative-hypnotics (1,492 entries in 23 % of cases), non-opioid analgesics (1,368 cases in 21 % of cases), opioids (17 %), antidepressants (16 %), stimulants/sympathomimetics (12 %), and ethanol (8 %). N-acetylcysteine was the most commonly administered antidote during 2011, similar to 2010, followed by the opioid antagonist naloxone, sodium bicarbonate, physostigmine and flumazenil. Anti-crotalid Fab fragments (CroFab) were administered in 106 out of 131 cases in which an envenomation occurred. There were 35 deaths recorded in the Registry during 2011. The most common associated agents, including when reported as sole agent or in combination with other agents, were opioids and analgesics (acetaminophen, aspirin, NSAIDS) with ten and eight deaths, respectively. Oxycodone was reported in six of the ten opioid-related deaths and heroin in three. Acetaminophen was the most common single agent reported overall being identified in all eight of the death cases attributed to analgesics. There were significant trends identified during 2011. Cases involving designer drugs including psychoactive bath salts and synthetic cannabinoids increased substantially from 2010 to 2011. The psychoactive bath salts were responsible for a large increase in stimulant/sympathomimetic-related cases reported to the Registry in 2011 with overall numbers doubling from 6 % of all Registry entries in 2010 to 12 % in 2011. Entries involving psychoactive drugs of abuse also increased twofold from 2010 to 2011 jumping 3 to 6 %, primarily due to increasing frequency of synthetic cannabinoid ("K2") related intoxications as 2011 progressed. The 2011 Registry included over 600 ADR's (10 % of Registry Cases) with 115 agents causing at least 2 ADR's. This is up from only 3 % of cases (116 total cases) in 2010. The ToxIC Case Registry continues to grow. At the end of 2011, over 10,000 cases had been entered into the Registry. As demonstrated by the trends identified in psychoactive bath salt and synthetic cannabinoid reports, the Registry is a valuable toxicosurveillance and research tool. The ToxIC Registry is a unique tool for identifying and characterizing confirmed cases of significant or potential toxicity or complexity to require bedside consultation by a medical toxicologist. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 0 (Antidepressive Agents) RN - 0 (Psychotropic Drugs) RN - 362O9ITL9D (Acetaminophen) RN - CD35PMG570 (Oxycodone) RN - WYQ7N0BPYC (Acetylcysteine) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-012-0264-9 PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't ID - 10.1007/s13181-012-0264-9 [doi] ID - PMC3550266 [pmc] PP - ppublish LG - English DP - 2012 Dec EZ - 2012/10/12 06:00 DA - 2013/05/03 06:00 DT - 2012/10/12 06:00 YR - 2012 ED - 20130502 RD - 20150222 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23055123 <451. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22534003 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schwarz R AU - Zelenev A AU - Bruce RD AU - Altice FL FA - Schwarz, Ryan FA - Zelenev, Alexei FA - Bruce, R Douglas FA - Altice, Frederick L IN - Schwarz, Ryan. Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. TI - Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence. SO - Journal of Substance Abuse Treatment. 43(4):451-7, 2012 Dec AS - J Subst Abuse Treat. 43(4):451-7, 2012 Dec NJ - Journal of substance abuse treatment VO - 43 IP - 4 PG - 451-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - kai, 8500909 IO - J Subst Abuse Treat PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419304 OI - Source: NLM. NIHMS366899 SB - Index Medicus CP - United States MH - Adult MH - *Buprenorphine/ad [Administration & Dosage] MH - Cohort Studies MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Length of Stay MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Opiate Substitution Treatment/mt [Methods] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Prospective Studies MH - Regression Analysis MH - Time Factors MH - Young Adult AB - Drug users are marginalized from typical primary care, often resulting in emergency department (ED) usage and hospitalization due to late-stage disease. Though data suggest methadone decreases such fragmented healthcare utilization (HCU), the impact of buprenorphine maintenance treatment (BMT) on HCU is unknown. Chart review was conducted on opioid dependent patients seeking BMT, comparing individuals (n=59) who left BMT<=7days with those retained on BMT (n=150), for ED use and hospitalization. Using negative binomial regressions, including comparison of time before BMT induction, ED utilization and hospitalization were assessed. Overall, ED utilization was 0.93 events per person year and was significantly reduced by BMT, with increasing time (retention) on BMT. BMT had no significant effect on hospitalizations or average length of stay. Copyright © 2012 Elsevier Inc. All rights reserved. RN - 40D3SCR4GZ (Buprenorphine) ES - 1873-6483 IL - 0740-5472 DI - S0740-5472(12)00054-2 DO - https://dx.doi.org/10.1016/j.jsat.2012.03.008 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - S0740-5472(12)00054-2 [pii] ID - 10.1016/j.jsat.2012.03.008 [doi] ID - PMC3419304 [pmc] ID - NIHMS366899 [mid] PP - ppublish PH - 2011/10/23 [received] PH - 2012/03/15 [revised] PH - 2012/03/19 [accepted] GI - No: K23 DA022143 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K24 DA017072 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K24 DA017072-08 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: H97 TI015767 Organization: (TI) *CSAT SAMHSA HHS* Country: United States LG - English EP - 20120424 DP - 2012 Dec EZ - 2012/04/27 06:00 DA - 2013/05/02 06:00 DT - 2012/04/27 06:00 YR - 2012 ED - 20130501 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22534003 <452. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23347721 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Baumann BM AU - Patterson RA AU - Parone DA AU - Jones MK AU - Glaspey LJ AU - Thompson NM AU - Stauss MP AU - Haroz R FA - Baumann, Brigitte M FA - Patterson, Rachel A FA - Parone, Dominic A FA - Jones, Molly K FA - Glaspey, Lindsey J FA - Thompson, Nicole M FA - Stauss, Mary P FA - Haroz, Rachel IN - Baumann, Brigitte M. Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ 08103, USA. baumann-b@cooperhealth.edu TI - Use and efficacy of nebulized naloxone in patients with suspected opioid intoxication. SO - American Journal of Emergency Medicine. 31(3):585-8, 2013 Mar AS - Am J Emerg Med. 31(3):585-8, 2013 Mar NJ - The American journal of emergency medicine VO - 31 IP - 3 PG - 585-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Administration, Inhalation MH - Adolescent MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose/dt [Drug Therapy] MH - Glasgow Coma Scale MH - Humans MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Pilot Projects MH - Prospective Studies MH - Treatment Outcome MH - Young Adult AB - OBJECTIVE: To describe the use and efficacy of nebulized naloxone in patients with suspected opioid intoxication. AB - METHODS: This was an observational study conducted at an inner city emergency department. Patients were eligible if they had self-reported or suspected opioid intoxication and a spontaneous respiratory rate >=6 breaths/minute. Nebulized naloxone (2 mg in 3 mL normal saline) was administered through a standard face mask at the discretion of the treating physician. Structured data collection included demographics, vital signs pre and post naloxone administration and adverse events. The primary outcome was level of consciousness, which was recorded pre and 15 minutes postnaloxone administration using the Glasgow Coma Scale (GCS) and the Richmond Agitation Sedation Scale (RASS). AB - RESULTS: Of the 73 patients who presented with suspected opioid intoxication and were given naloxone over the study period, 26 were initially treated with nebulized naloxone. After nebulized naloxone administration, median GCS improved from 11 [interquartile range (IQR) 3.5] to 13 (IQR, 2.5), P = .001. Median RASS improved from -3.0 (IQR, -1.0) to -2.0 (IQR, -1.5), P < .0001. Need for supplemental oxygen decreased from 81% to 50%, P = .03. Vital signs did not differ pre/post therapy. There were few adverse effects from nebulized naloxone administration: 12% experienced moderate-severe agitation, 8% were diaphoretic and none vomited. Eleven required subsequent administrations of naloxone, nine of whom self-reported using either heroin, methadone or both. Of these, 5 underwent urine drug screening and all 5 tested positive for either opiates or methadone. AB - CONCLUSIONS: Nebulized naloxone was well-tolerated and led to a reduction in the need for supplemental oxygen as well as improved median GCS and RASS scores in patients with suspected opioid intoxication. Copyright © 2013 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(12)00528-1 DO - https://dx.doi.org/10.1016/j.ajem.2012.10.004 PT - Clinical Trial PT - Journal Article ID - S0735-6757(12)00528-1 [pii] ID - 10.1016/j.ajem.2012.10.004 [doi] PP - ppublish PH - 2012/08/23 [received] PH - 2012/10/03 [revised] PH - 2012/10/03 [accepted] LG - English EP - 20130121 DP - 2013 Mar EZ - 2013/01/26 06:00 DA - 2013/04/30 06:00 DT - 2013/01/26 06:00 YR - 2013 ED - 20130429 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23347721 <453. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23013384 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Soyka M FA - Soyka, Michael IN - Soyka, Michael. University of Munich, Psychiatric Hospital, Nussbaumstr. 7 Munich Munich, Germany. Michael.Soyka@privatklinik-meiringen.ch TI - Buprenorphine and buprenorphine/naloxone soluble-film for treatment of opioid dependence. [Review] SO - Expert Opinion on Drug Delivery. 9(11):1409-17, 2012 Nov AS - Expert Opin Drug Deliv. 9(11):1409-17, 2012 Nov NJ - Expert opinion on drug delivery VO - 9 IP - 11 PG - 1409-17 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101228421 IO - Expert Opin Drug Deliv SB - Index Medicus CP - England MH - Animals MH - *Buprenorphine/ad [Administration & Dosage] MH - Buprenorphine/pk [Pharmacokinetics] MH - Buprenorphine, Naloxone Drug Combination MH - Drug Carriers MH - Drug Combinations MH - Drug Compounding MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/pk [Pharmacokinetics] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/pk [Pharmacokinetics] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Tablets AB - INTRODUCTION: Opioid dependence is a chronic relapsing disorder that shows excess mortality and comorbidity with somatic and psychiatric disorders. Methadone and buprenorphine/naloxone are widely accepted and are used as first-line maintenance treatments for opioid dependence. Fatal intoxications with these agents, risk of diversion, and accidental intoxications, especially in children, are apparent risks and are of increasing public concern. Buprenorphine/naloxone sublingual tablet is an established treatment for opioid dependence. A novel buprenorphine/naloxone film has been developed with improved pharmacokinetics and a hopefully lower risk of diversion and accidental intoxications. AB - AREAS COVERED: This review evaluates the available preclinical and clinical data on the novel buprenorphine/naloxone film for the treatment of opioid dependence. Literature was identified though a comprehensive PubMed search and data sources included official FDA information. AB - EXPERT OPINION: This is an interesting new formulation of a well-established medication in opioid dependence. However, few data have been published on its safety and efficacy. In an experimental study, the new formulation suppressed symptoms of opioid withdrawal as expected. Results of an unpublished study made public by the FDA suggest a spectrum of adverse events similar to that of the conventional sublingual tablet. Some data show patients may prefer the novel film over the sublingual tablet. The estimated lower risk for diversion and especially for accidental poisoning in children cannot be assessed in clinical studies but requires data from emergency room visits. RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - 0 (Drug Carriers) RN - 0 (Drug Combinations) RN - 0 (Narcotic Antagonists) RN - 0 (Tablets) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) ES - 1744-7593 IL - 1742-5247 DO - https://dx.doi.org/10.1517/17425247.2012.729574 PT - Journal Article PT - Review ID - 10.1517/17425247.2012.729574 [doi] PP - ppublish LG - English EP - 20120926 DP - 2012 Nov EZ - 2012/09/28 06:00 DA - 2013/04/27 06:00 DT - 2012/09/28 06:00 YR - 2012 ED - 20130426 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23013384 <454. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23117108 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kobus AM AU - Smith DH AU - Morasco BJ AU - Johnson ES AU - Yang X AU - Petrik AF AU - Deyo RA FA - Kobus, Amy M FA - Smith, David H FA - Morasco, Benjamin J FA - Johnson, Eric S FA - Yang, Xiuhai FA - Petrik, Amanda F FA - Deyo, Richard A IN - Kobus, Amy M. Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. kobusa@ohsu.edu TI - Correlates of higher-dose opioid medication use for low back pain in primary care. SO - Journal of Pain. 13(11):1131-8, 2012 Nov AS - J PAIN. 13(11):1131-8, 2012 Nov NJ - The journal of pain : official journal of the American Pain Society VO - 13 IP - 11 PG - 1131-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - 100898657 IO - J Pain SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Comorbidity MH - Confidence Intervals MH - Demography MH - Drug Overdose MH - Drug Prescriptions MH - Drug Utilization MH - Female MH - Health Behavior MH - Health Services/ut [Utilization] MH - Humans MH - Hypnotics and Sedatives/tu [Therapeutic Use] MH - Low Back Pain/co [Complications] MH - *Low Back Pain/dt [Drug Therapy] MH - Low Back Pain/ep [Epidemiology] MH - Male MH - Medicare/sn [Statistics & Numerical Data] MH - Mental Disorders/co [Complications] MH - Mental Disorders/ep [Epidemiology] MH - Middle Aged MH - Odds Ratio MH - Outpatients MH - Primary Health Care MH - Risk Assessment MH - Sex Factors MH - United States AB - UNLABELLED: Factors associated with high-dose opioid therapy for noncancer pain are poorly understood. We documented the prevalence of high-dose opioid use as well as associated demographic, clinical, and health service utilization correlates among low back pain patients. Patients prescribed higher doses of opioids (>=100 mg/day morphine equivalent at last dispensing; n = 453) and receiving opioids for 90+ consecutive days were compared to 2 groups: lower-dose opioid group (1-99 mg/day; n = 4,815) or no-opioid group (n = 10,184). Higher-dose opioid use occurred in 2.9% of patients who received any opioids and in 8.6% of patients who received opioids long-term. The median dose in the higher-dose group was 180.0 mg/day. Compared to the no-opioid group, higher-dose users reported poorer health. Compared to either comparison group, patients in the higher-dose group had higher rates of mental health and substance use disorders, concurrent sedative-hypnotic use (60.5%; n = 274), and health service utilization. After adjusting for select covariates, male gender (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.37-2.06), higher comorbidity, Medicare coverage (OR = 1.65, 95% CI = 1.22-2.23), any mental health or substance use diagnosis (OR = 1.58, 95% CI = 1.28-1.95), co-prescriptions of sedative-hypnotics (OR = 1.75, 95% CI = 1.42-2.16), and more emergency department and specialty pain clinic visits were associated with higher likelihood of high-dose prescriptions. AB - PERSPECTIVE: Higher-dose opioid therapy is being prescribed to 8.6% of back pain patients who receive long-term opioids. These patients had higher mental health and medical comorbidities and co-prescriptions of sedative-hypnotics, raising potential safety concerns. Copyright © 2012 American Pain Society. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) ES - 1528-8447 IL - 1526-5900 DI - S1526-5900(12)00805-X DO - https://dx.doi.org/10.1016/j.jpain.2012.09.003 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S1526-5900(12)00805-X [pii] ID - 10.1016/j.jpain.2012.09.003 [doi] ID - PMC3641146 [pmc] ID - NIHMS417423 [mid] PP - ppublish PH - 2012/05/24 [received] PH - 2012/08/31 [revised] PH - 2012/09/15 [accepted] GI - No: UL1 RR024140 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: 5T32HS017582 Organization: (HS) *AHRQ HHS* Country: United States LG - English DP - 2012 Nov EZ - 2012/11/03 06:00 DA - 2013/04/16 06:00 DT - 2012/11/03 06:00 YR - 2012 ED - 20130415 RD - 20180319 UP - 20180319 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=23117108 <455. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22944554 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gonzva J AU - Prunet B AU - Deniel C AU - Benner P AU - Toppin F AU - Brun PM FA - Gonzva, J FA - Prunet, B FA - Deniel, C FA - Benner, P FA - Toppin, F FA - Brun, P M IN - Gonzva, J. Prehospital Emergency Medical Services of Marine Fire Battalion, Marseille, France. jonathangonzva@hotmail.fr TI - Early antidote use associated with noninvasive ventilation in prehospital treatment of methadone intoxication. SO - American Journal of Emergency Medicine. 31(2):448.e5-6, 2013 Feb AS - Am J Emerg Med. 31(2):448.e5-6, 2013 Feb NJ - The American journal of emergency medicine VO - 31 IP - 2 PG - 448.e5-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - Combined Modality Therapy MH - Drug Overdose/et [Etiology] MH - *Drug Overdose/th [Therapy] MH - *Emergency Medical Services MH - Humans MH - Male MH - *Methadone/po [Poisoning] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Noninvasive Ventilation MH - Young Adult RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(12)00340-3 DO - https://dx.doi.org/10.1016/j.ajem.2012.06.015 PT - Case Reports PT - Journal Article ID - S0735-6757(12)00340-3 [pii] ID - 10.1016/j.ajem.2012.06.015 [doi] PP - ppublish PH - 2012/05/23 [received] PH - 2012/05/31 [revised] PH - 2012/06/01 [accepted] LG - English EP - 20120831 DP - 2013 Feb EZ - 2012/09/05 06:00 DA - 2013/04/11 06:00 DT - 2012/09/05 06:00 YR - 2013 ED - 20130410 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22944554 <456. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23318919 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gomes T AU - Redelmeier DA AU - Juurlink DN AU - Dhalla IA AU - Camacho X AU - Mamdani MM FA - Gomes, Tara FA - Redelmeier, Donald A FA - Juurlink, David N FA - Dhalla, Irfan A FA - Camacho, Ximena FA - Mamdani, Muhammad M IN - Gomes, Tara. Institute for Clinical Evaluative Sciences, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. gomest@smh.ca TI - Opioid dose and risk of road trauma in Canada: a population-based study. CM - Comment in: JAMA Intern Med. 2013 Feb 11;173(3):178; PMID: 23318461 SO - JAMA Internal Medicine. 173(3):196-201, 2013 Feb 11 AS - JAMA Intern Med. 173(3):196-201, 2013 Feb 11 NJ - JAMA internal medicine VO - 173 IP - 3 PG - 196-201 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101589534 IO - JAMA Intern Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Accidents, Traffic/sn [Statistics & Numerical Data] MH - Adolescent MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Canada MH - Case-Control Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - Risk Assessment MH - Young Adult AB - BACKGROUND: Use of opioids may predispose drivers to road trauma, yet the effect of opioid dose on this association is unknown. AB - METHODS: We conducted a population-based nested case-control study of patients aged 18 to 64 years who received at least 1 publicly funded prescription for an opioid from April 1, 2003, through March 31, 2011. Cases were defined as having an emergency department visit related to road trauma. Patients without road trauma served as a control group matched to cases by age, sex, index year, prior road trauma, and a disease risk index. We compared the risk of road trauma among patients treated with doses of opioids ranging from very low to very high (<20 to >=200 morphine equivalents daily). In a subgroup analysis, we stratified our analysis by driver status. AB - RESULTS: Among 549 878 eligible adults, we identified 5300 cases with road trauma and matched an equal number of controls. Multivariate adjustment yielded no significant association between escalating opioid dose and odds of road trauma (adjusted odds ratio ranged between 1.00 and 1.09). However, a significant association between opioid dose and road trauma was observed among drivers. Compared with very low opioid doses, drivers prescribed low doses had a 21% increased odds of road trauma (adjusted odds ratio, 1.21 [95% CI, 1.02-1.42]); those prescribed moderate doses, 29% increased odds (1.29 [1.06-1.57]); those prescribed high doses, 42% increased odds (1.42 [1.15-1.76]); and those prescribed very high doses, 23% increased odds (1.23 [1.02-1.49]). AB - CONCLUSIONS: Among drivers prescribed opioids, a significant relationship exists between drug dose and risk of road trauma. This association is distinct and does not appear with passengers, pedestrians, and others injured in road trauma. RN - 0 (Analgesics, Opioid) ES - 2168-6114 IL - 2168-6106 DO - https://dx.doi.org/10.1001/2013.jamainternmed.733 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 1556791 [pii] ID - 10.1001/2013.jamainternmed.733 [doi] PP - ppublish LG - English DP - 2013 Feb 11 EZ - 2013/01/16 06:00 DA - 2013/04/09 06:00 DT - 2013/01/16 06:00 YR - 2013 ED - 20130408 RD - 20130212 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23318919 <457. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23034493 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tsze DS AU - Dayan PS FA - Tsze, Daniel S FA - Dayan, Peter S IN - Tsze, Daniel S. Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA. dst2141@columbia.edu TI - Treatment of guanfacine toxicity with naloxone. SO - Pediatric Emergency Care. 28(10):1060-1, 2012 Oct AS - Pediatr Emerg Care. 28(10):1060-1, 2012 Oct NJ - Pediatric emergency care VO - 28 IP - 10 PG - 1060-1 PI - Journal available in: Print PI - Citation processed from: Internet JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Antihypertensive Agents/ae [Adverse Effects] MH - Antihypertensive Agents/tu [Therapeutic Use] MH - Attention Deficit Disorder with Hyperactivity/dt [Drug Therapy] MH - Attention Deficit Disorder with Hyperactivity/pp [Physiopathology] MH - Blood Pressure/de [Drug Effects] MH - Child, Preschool MH - Electrocardiography MH - Follow-Up Studies MH - *Guanfacine/ae [Adverse Effects] MH - Guanfacine/tu [Therapeutic Use] MH - Humans MH - Hypotension/ci [Chemically Induced] MH - *Hypotension/dt [Drug Therapy] MH - Hypotension/pp [Physiopathology] MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] AB - We describe a 4-year-old boy who presents to the emergency department with lethargy, bradycardia, and initial hypertension followed by hypotension due to guanfacine toxicity after ingestion of standard doses of the extended release formulation. This is the first case report to describe the use of naloxone to treat these symptoms and document improvements in level of consciousness, blood pressure, and heart rate associated with this therapy. RN - 0 (Antihypertensive Agents) RN - 0 (Narcotic Antagonists) RN - 30OMY4G3MK (Guanfacine) RN - 36B82AMQ7N (Naloxone) ES - 1535-1815 IL - 0749-5161 DO - https://dx.doi.org/10.1097/PEC.0b013e31826ce9f1 PT - Case Reports PT - Journal Article ID - 10.1097/PEC.0b013e31826ce9f1 [doi] ID - 00006565-201210000-00023 [pii] PP - ppublish LG - English DP - 2012 Oct EZ - 2012/10/05 06:00 DA - 2013/03/27 06:00 DT - 2012/10/05 06:00 YR - 2012 ED - 20130326 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23034493 <458. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22876897 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Iacovidou N AU - Vasileiou PV AU - Papalois A AU - Syggelou A AU - Bassareo PP AU - Xanthos T FA - Iacovidou, N FA - Vasileiou, P V S FA - Papalois, A FA - Syggelou, A FA - Bassareo, P P FA - Xanthos, T IN - Iacovidou, N. 2ndDepartment of Obstetrics and Gynaecology, Aretaieion Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece. niciac@otenet.gr TI - Drugs in newborn resuscitation: the more we learn the least we use. [Review] SO - Current Medicinal Chemistry. 19(27):4606-16, 2012 AS - Curr Med Chem. 19(27):4606-16, 2012 NJ - Current medicinal chemistry VO - 19 IP - 27 PG - 4606-16 PI - Journal available in: Print PI - Citation processed from: Internet JC - c02, 9440157 IO - Curr. Med. Chem. SB - Index Medicus CP - Netherlands MH - Bradycardia/dt [Drug Therapy] MH - Epinephrine/pd [Pharmacology] MH - Epinephrine/tu [Therapeutic Use] MH - Heart Rate/de [Drug Effects] MH - Humans MH - Infant, Newborn MH - Naloxone/pd [Pharmacology] MH - Naloxone/tu [Therapeutic Use] MH - Respiration, Artificial MH - *Resuscitation/st [Standards] MH - Sodium Bicarbonate/pd [Pharmacology] MH - Sodium Bicarbonate/tu [Therapeutic Use] AB - Temperature control, airway management and support of circulation remain the gold-standards for the majority of neonates requiring resuscitation at birth. For the minority of neonates in which the basic steps of resuscitation fail to reverse an adverse situation, drug administration is justifiable. The 2010 International Liaison Committee on Resuscitation (ILCOR) guidelines for newborn resuscitation state: "Drugs are rarely indicated in resuscitation of the newly born infant. Bradycardia in the newborn infant is usually caused by inadequate lung inflation or profound hypoxia, and establishing adequate ventilation is the most important step to correct it. However, if the HR remains less than 60 min-1 despite adequate ventilation and chest compressions, it is reasonable to consider the use of drugs. These are best given via an umbilical venous catheter". Even though drugs have been used in neonatal resuscitation for long, their doses, order and route of administration have been issues of debate among neonatologists, mainly due to the lack of data in human studies. This review will examine existing evidence behind the medications currently used in neonatal resuscitation. RN - 36B82AMQ7N (Naloxone) RN - 8MDF5V39QO (Sodium Bicarbonate) RN - YKH834O4BH (Epinephrine) ES - 1875-533X IL - 0929-8673 PT - Journal Article PT - Review ID - CMC-EPUB-20120809-17 [pii] PP - ppublish PH - 2011/07/08 [received] PH - 2011/09/14 [revised] PH - 2012/01/06 [accepted] LG - English DP - 2012 EZ - 2012/08/11 06:00 DA - 2013/03/22 06:00 DT - 2012/08/11 06:00 YR - 2012 ED - 20130321 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22876897 <459. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23372174 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Walley AY AU - Xuan Z AU - Hackman HH AU - Quinn E AU - Doe-Simkins M AU - Sorensen-Alawad A AU - Ruiz S AU - Ozonoff A FA - Walley, Alexander Y FA - Xuan, Ziming FA - Hackman, H Holly FA - Quinn, Emily FA - Doe-Simkins, Maya FA - Sorensen-Alawad, Amy FA - Ruiz, Sarah FA - Ozonoff, Al IN - Walley, Alexander Y. Clinical Addiction Research Education Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA. awalley@bu.edu TI - Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. SO - BMJ. 346:f174, 2013 Jan 30 AS - BMJ. 346:f174, 2013 Jan 30 NJ - BMJ (Clinical research ed.) VO - 346 PG - f174 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 8900488, bmj, 101090866 IO - BMJ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688551 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adult MH - Allied Health Personnel/ed [Education] MH - *Analgesics, Opioid/po [Poisoning] MH - Curriculum MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/pc [Prevention & Control] MH - Emergency Service, Hospital/ut [Utilization] MH - Female MH - Harm Reduction MH - *Health Education/mt [Methods] MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Massachusetts/ep [Epidemiology] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Prescription Drugs/po [Poisoning] MH - Survival Rate AB - OBJECTIVE: To evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts. AB - DESIGN: Interrupted time series analysis of opioid related overdose death and acute care utilization rates from 2002 to 2009 comparing community-year strata with high and low rates of OEND implementation to those with no implementation. AB - SETTING: 19 Massachusetts communities (geographically distinct cities and towns) with at least five fatal opioid overdoses in each of the years 2004 to 2006. AB - PARTICIPANTS: OEND was implemented among opioid users at risk for overdose, social service agency staff, family, and friends of opioid users. AB - INTERVENTION: OEND programs equipped people at risk for overdose and bystanders with nasal naloxone rescue kits and trained them how to prevent, recognize, and respond to an overdose by engaging emergency medical services, providing rescue breathing, and delivering naloxone. AB - MAIN OUTCOME MEASURES: Adjusted rate ratios for annual deaths related to opioid overdose and utilization of acute care hospitals. AB - RESULTS: Among these communities, OEND programs trained 2912 potential bystanders who reported 327 rescues. Both community-year strata with 1-100 enrollments per 100,000 population (adjusted rate ratio 0.73, 95% confidence interval 0.57 to 0.91) and community-year strata with greater than 100 enrollments per 100,000 population (0.54, 0.39 to 0.76) had significantly reduced adjusted rate ratios compared with communities with no implementation. Differences in rates of acute care hospital utilization were not significant. AB - CONCLUSIONS: Opioid overdose death rates were reduced in communities where OEND was implemented. This study provides observational evidence that by training potential bystanders to prevent, recognize, and respond to opioid overdoses, OEND is an effective intervention. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 0 (Prescription Drugs) RN - 36B82AMQ7N (Naloxone) ES - 1756-1833 IL - 0959-535X DI - bmj.f174 DO - https://dx.doi.org/10.1136/bmj.f174 PT - Comparative Study PT - Evaluation Studies PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural ID - PMC4688551 [pmc] PP - epublish GI - No: 1R21CE001602 Organization: (CE) *NCIPC CDC HHS* Country: United States GI - No: 1R21CE001602-01 Organization: (CE) *NCIPC CDC HHS* Country: United States LG - English EP - 20130130 DP - 2013 Jan 30 EZ - 2013/02/02 06:00 DA - 2013/03/21 06:00 DT - 2013/02/02 06:00 YR - 2013 ED - 20130320 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23372174 <460. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23063265 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Timm NL FA - Timm, Nathan L IN - Timm, Nathan L. Department of Clinical Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Nathan.timm@cchmc.org TI - Maternal use of oxycodone resulting in opioid intoxication in her breastfed neonate. SO - Journal of Pediatrics. 162(2):421-2, 2013 Feb AS - J Pediatr. 162(2):421-2, 2013 Feb NJ - The Journal of pediatrics VO - 162 IP - 2 PG - 421-2 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - jlz, 0375410 IO - J. Pediatr. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Breast Feeding MH - Female MH - Humans MH - Infant, Newborn MH - Male MH - Mothers MH - *Oxycodone/po [Poisoning] AB - A 4-day-old breastfed infant presented with opioid intoxication resulting from the maternal use of oxycodone after cesarean delivery. The infant was hypothermic, lethargic, and had pinpoint pupils. A dose of naloxone reversed the symptoms. This report highlights the importance of recognizing the potential effects of maternal oxycodone on the breastfed neonate in the emergency department setting. Copyright © 2013 Mosby, Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - CD35PMG570 (Oxycodone) ES - 1097-6833 IL - 0022-3476 DI - S0022-3476(12)01005-0 DO - https://dx.doi.org/10.1016/j.jpeds.2012.08.047 PT - Case Reports PT - Journal Article ID - S0022-3476(12)01005-0 [pii] ID - 10.1016/j.jpeds.2012.08.047 [doi] PP - ppublish PH - 2012/05/31 [received] PH - 2012/07/13 [revised] PH - 2012/08/29 [accepted] LG - English EP - 20121010 DP - 2013 Feb EZ - 2012/10/16 06:00 DA - 2013/03/12 06:00 DT - 2012/10/16 06:00 YR - 2013 ED - 20130311 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23063265 <461. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23462783 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Juurlink DN AU - Dhalla IA AU - Nelson LS FA - Juurlink, David N FA - Dhalla, Irfan A FA - Nelson, Lewis S IN - Juurlink, David N. Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. david.juurlink@ices.on.ca TI - Improving opioid prescribing: the New York City recommendations. SO - JAMA. 309(9):879-80, 2013 Mar 06 AS - JAMA. 309(9):879-80, 2013 Mar 06 NJ - JAMA VO - 309 IP - 9 PG - 879-80 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/po [Poisoning] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/st [Standards] MH - Humans MH - Inappropriate Prescribing/pc [Prevention & Control] MH - New York City MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Pain/dt [Drug Therapy] MH - Patient Satisfaction MH - *Practice Guidelines as Topic MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Prescription Drug Misuse RN - 0 (Analgesics, Opioid) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2013.1139 PT - Journal Article ID - 1660392 [pii] ID - 10.1001/jama.2013.1139 [doi] PP - ppublish LG - English DP - 2013 Mar 06 EZ - 2013/03/07 06:00 DA - 2013/03/09 06:00 DT - 2013/03/07 06:00 YR - 2013 ED - 20130308 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23462783 <462. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23344700 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Centers for Disease Control and Prevention (CDC) FA - Centers for Disease Control and Prevention (CDC) TI - Emergency department visits and hospitalizations for buprenorphine ingestion by children--United States, 2010-2011. SO - MMWR - Morbidity & Mortality Weekly Report. 62(3):56, 2013 Jan 25 AS - MMWR Morb Mortal Wkly Rep. 62(3):56, 2013 Jan 25 NJ - MMWR. Morbidity and mortality weekly report VO - 62 IP - 3 PG - 56 PI - Journal available in: Print PI - Citation processed from: Internet JC - ne8, 7802429 IO - MMWR Morb. Mortal. Wkly. Rep. SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/po [Poisoning] MH - Buprenorphine/ad [Administration & Dosage] MH - *Buprenorphine/po [Poisoning] MH - Child, Preschool MH - Eating MH - *Emergency Service, Hospital/ut [Utilization] MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Infant MH - United States/ep [Epidemiology] AB - Buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone) received Food and Drug Administration approval in 2002 for the treatment of opioid dependence. Introduction of these drugs expanded the availability of opioid-dependence treatment options to reduce the morbidity and mortality associated with opioid abuse, and buprenorphine has become an increasingly prescribed component of office-based treatment. However, unsupervised ingestion of buprenorphine-containing products by children is a growing concern. RN - 0 (Analgesics, Opioid) RN - 40D3SCR4GZ (Buprenorphine) ES - 1545-861X IL - 0149-2195 PT - Journal Article ID - mm6203a5 [pii] PP - ppublish LG - English DP - 2013 Jan 25 EZ - 2013/01/25 06:00 DA - 2013/03/08 06:00 DT - 2013/01/25 06:00 YR - 2013 ED - 20130307 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23344700 <463. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23277895 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Coffin PO AU - Sullivan SD FA - Coffin, Phillip O FA - Sullivan, Sean D IN - Coffin, Phillip O. San Francisco Department of Public Health, San Francisco, CA 94102, USA. TI - Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal.[Erratum appears in Ann Intern Med. 2017 May 2;166(9):687; PMID: 28460394], [Summary for patients in Ann Intern Med. 2013 Jan 1;158(1):I-30; PMID: 23277911] CM - Comment in: Ann Intern Med. 2013 Jan 1;158(1):65-6; PMID: 23277902 SO - Annals of Internal Medicine. 158(1):1-9, 2013 Jan 01 AS - Ann Intern Med. 158(1):1-9, 2013 Jan 01 NJ - Annals of internal medicine VO - 158 IP - 1 PG - 1-9 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0372351 IO - Ann. Intern. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Cost-Benefit Analysis MH - Decision Support Techniques MH - Drug Overdose/pc [Prevention & Control] MH - *Heroin/po [Poisoning] MH - Heroin Dependence/dt [Drug Therapy] MH - Heroin Dependence/ec [Economics] MH - Hospital Costs MH - Humans MH - Markov Chains MH - *Naloxone/ec [Economics] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/ec [Economics] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - United States MH - Young Adult AB - BACKGROUND: Opioid overdose is a leading cause of accidental death in the United States. AB - OBJECTIVE: To estimate the cost-effectiveness of distributing naloxone, an opioid antagonist, to heroin users for use at witnessed overdoses. AB - DESIGN: Integrated Markov and decision analytic model using deterministic and probabilistic analyses and incorporating recurrent overdoses and a secondary analysis assuming heroin users are a net cost to society. AB - DATA SOURCES: Published literature calibrated to epidemiologic data. AB - TARGET POPULATION: Hypothetical 21-year-old novice U.S. heroin user and more experienced users with scenario analyses. AB - TIME HORIZON: Lifetime. AB - PERSPECTIVE: Societal. AB - INTERVENTION: Naloxone distribution for lay administration. AB - OUTCOME MEASURES: Overdose deaths prevented and incremental cost-effectiveness ratio (ICER). AB - RESULTS OF BASE-CASE ANALYSIS: In the probabilistic analysis, 6% of overdose deaths were prevented with naloxone distribution; 1 death was prevented for every 227 naloxone kits distributed (95% CI, 71 to 716). Naloxone distribution increased costs by $53 (CI, $3 to $156) and quality-adjusted life-years by 0.119 (CI, 0.017 to 0.378) for an ICER of $438 (CI, $48 to $1706). AB - RESULTS OF SENSITIVITY ANALYSIS: Naloxone distribution was cost-effective in all deterministic and probabilistic sensitivity and scenario analyses, and it was cost-saving if it resulted in fewer overdoses or emergency medical service activations. In a "worst-case scenario" where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the ICER was $14 000. If national drug-related expenditures were applied to heroin users, the ICER was $2429. AB - LIMITATION: Limited sources of controlled data resulted in wide CIs. AB - CONCLUSION: Naloxone distribution to heroin users is likely to reduce overdose deaths and is cost-effective, even under markedly conservative assumptions. AB - PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1539-3704 IL - 0003-4819 DO - https://dx.doi.org/10.7326/0003-4819-158-1-201301010-00003 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 1487798 [pii] ID - 10.7326/0003-4819-158-1-201301010-00003 [doi] PP - ppublish GI - No: 5T32AI007140-33 Organization: (AI) *NIAID NIH HHS* Country: United States LG - English DP - 2013 Jan 01 EZ - 2013/01/02 06:00 DA - 2013/03/05 06:00 DT - 2013/01/02 06:00 YR - 2013 ED - 20130304 RD - 20171207 UP - 20171207 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=23277895 <464. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23222260 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Salimi V AU - Hennus MP AU - Mokhtari-Azad T AU - Shokri F AU - Janssen R AU - Hodemaekers HM AU - Rygiel TP AU - Coenjaerts FE AU - Meyaard L AU - Bont L FA - Salimi, Vahid FA - Hennus, Marije P FA - Mokhtari-Azad, Talat FA - Shokri, Fazel FA - Janssen, Riny FA - Hodemaekers, Hennie M FA - Rygiel, Tomasz P FA - Coenjaerts, Frank E J FA - Meyaard, Linde FA - Bont, Louis IN - Salimi, Vahid. Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. TI - Opioid receptors control viral replication in the airways. CM - Comment in: Crit Care Med. 2013 Jan;41(1):361-2; PMID: 23269153 SO - Critical Care Medicine. 41(1):205-14, 2013 Jan AS - Crit Care Med. 41(1):205-14, 2013 Jan NJ - Critical care medicine VO - 41 IP - 1 PG - 205-14 PI - Journal available in: Print PI - Citation processed from: Internet JC - dtf, 0355501 IO - Crit. Care Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/pd [Pharmacology] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Animals MH - Bronchiolitis/dt [Drug Therapy] MH - Bronchiolitis/ge [Genetics] MH - Bronchiolitis/im [Immunology] MH - *Bronchiolitis/vi [Virology] MH - Case-Control Studies MH - Chemokines/me [Metabolism] MH - Female MH - Genome-Wide Association Study MH - Humans MH - Infant MH - Interleukin-6/me [Metabolism] MH - Mice MH - Mice, Inbred BALB C MH - Naltrexone/aa [Analogs & Derivatives] MH - Naltrexone/pd [Pharmacology] MH - Narcotic Antagonists/pd [Pharmacology] MH - *Polymorphism, Genetic MH - *Receptors, Opioid/ge [Genetics] MH - Receptors, Opioid/me [Metabolism] MH - *Receptors, Opioid, delta/ge [Genetics] MH - *Receptors, Opioid, mu/ge [Genetics] MH - Respiration, Artificial MH - Respiratory Syncytial Virus Infections/dt [Drug Therapy] MH - Respiratory Syncytial Virus Infections/ge [Genetics] MH - Respiratory Syncytial Virus Infections/im [Immunology] MH - *Respiratory Syncytial Virus Infections/vi [Virology] MH - Respiratory System/vi [Virology] MH - Signal Transduction/de [Drug Effects] MH - Viral Load MH - *Virus Replication/de [Drug Effects] AB - OBJECTIVE: Opioids are frequently used during mechanical ventilation for severe viral infection in infancy. Opioid receptors have immunomodulatory properties, but nothing is known about their antiviral effects. We therefore aimed to investigate the role of opioid receptors in virus-induced airway inflammation. AB - PATIENTS AND INTERVENTIONS: Two single nucleotide polymorphisms in OPRM1 and OPRD1 were genotyped in 465 infants with severe respiratory syncytial virus infection and 930 control subjects. Subsequently, the mechanism by which opioid receptors affect clinical outcome in respiratory syncytial virus bronchiolitis was studied in BALB/c mice. Animals were injected daily with nalmefene, a nonselective opioid receptor antagonist, and infected by intranasal inoculation of respiratory syncytial virus 24 hrs after the first dose of nalmefene. The potential therapeutic effect of pharmaceutical opioids was studied using micro (DAMGO), kappa (U50488), and DELTA (DPDPE) opioid receptor agonists 48 hrs after infection. AB - MEASUREMENTS AND MAIN RESULTS: In our human study, the A118G single nucleotide polymorphism rs1799971 was associated with respiratory syncytial virus disease severity (p = 0.015). In mice, nalmefene treatment increased viral titers and was associated with more pronounced weight loss. Increased viral replication was associated with increased levels of cytokines and chemokines in the bronchoalveolar lavage fluid, enhanced bronchoalveolar cellular influx, and exaggerated lung pathology. Pharmaceutical opioids, in particular DPDPE, did not affect viral replication. They did induce a decreased influx of neutrophils, but an increased influx of lymphocytes and monocytes into the bronchoalveolar lumen during respiratory syncytial virus infection. AB - CONCLUSIONS: Using a human study and an experimental model, we show that opioid receptor signaling has a potential beneficial role in the outcome of respiratory viral disease. We show that opioid receptor signaling is required to control respiratory syncytial virus replication and thereby to control disease severity. However, we also show that caution is required before using pharmaceutical opioids as anti-inflammatory or antiviral treatment of patients with viral respiratory infection. RN - 0 (Analgesics, Opioid) RN - 0 (Chemokines) RN - 0 (Interleukin-6) RN - 0 (Narcotic Antagonists) RN - 0 (OPRD1 protein, human) RN - 0 (OPRM1 protein, human) RN - 0 (Receptors, Opioid) RN - 0 (Receptors, Opioid, delta) RN - 0 (Receptors, Opioid, mu) RN - 5S6W795CQM (Naltrexone) RN - TOV02TDP9I (nalmefene) ES - 1530-0293 IL - 0090-3493 DO - https://dx.doi.org/10.1097/CCM.0b013e31826767a8 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1097/CCM.0b013e31826767a8 [doi] PP - ppublish LG - English DP - 2013 Jan EZ - 2012/12/12 06:00 DA - 2013/03/05 06:00 DT - 2012/12/11 06:00 YR - 2013 ED - 20130304 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23222260 <465. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23264318 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - O'Connor AB AU - Rao A FA - O'Connor, Alec B FA - Rao, Ajit IN - O'Connor, Alec B. University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. TI - Why do emergency providers choose one opioid over another? A prospective cohort analysis. SO - Journal of Opioid Management. 8(6):403-13, 2012 Nov-Dec AS - J Opioid Manag. 8(6):403-13, 2012 Nov-Dec NJ - Journal of opioid management VO - 8 IP - 6 PG - 403-13 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Administration, Intravenous MH - Adult MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cohort Studies MH - Dose-Response Relationship, Drug MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Hydromorphone/ad [Administration & Dosage] MH - Hydromorphone/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - Morphine/tu [Therapeutic Use] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Prospective Studies MH - Regression Analysis AB - OBJECTIVE: The reasons providers choose one parenteral opioid over another are not well understood. The authors sought to determine why emergency department (ED) providers choose one parenteral opioid over another. AB - METHODS: In a cohort of ED patients who received intravenous morphine or hydromorphone, the authors prospectively assessed patient and provider factors associated with choice of opioid, which were included in regression analyses to identify independent predictors of hydromorphone prescription. Providers were also asked in real time why they chose one opioid over another for a specific patient. Narrative responses were coded and analyzed. AB - RESULTS: Opioid choice was tightly linked with equianalgesic dose, with the median hydromorphone dosage more than 50 percent higher than the dosage of morphine. Besides dose, choice of hydromorphone was most strongly associated with home opioid use and a diagnosis of kidney stone. Provider preference or habit was the most commonly cited reason for choosing the prescribed opioid, with the majority of those responses given by providers who prescribed morphine. One-fourth of morphine prescribers stated that the patient required a lower dosage or less potent option; one-fourth of hydromorphone prescribers stated that either the patient required a higher dosage or more potent option or hydromorphone is more effective. In total, 46 percent of providers gave a reason that does not seem to have pharmacologic validity. AB - CONCLUSIONS: ED providers seem to prescribe "usual" dosages of morphine and relatively higher usual dosages of hydromorphone. The reasons for choosing one opioid over the other for a specific patient vary from simple preference to common misconceptions about opioid pharmacology. Improved understanding of opioid pharmacology may improve analgesic outcomes for some patients. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) RN - Q812464R06 (Hydromorphone) IS - 1551-7489 IL - 1551-7489 DI - jom.2012.0140 DO - https://dx.doi.org/10.5055/jom.2012.0140 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - jom.2012.0140 [pii] ID - 10.5055/jom.2012.0140 [doi] PP - ppublish PH - 2011/11/23 [received] PH - 2012/06/22 [revised] PH - 2012/08/14 [revised] PH - 2012/08/24 [accepted] LG - English DP - 2012 Nov-Dec EZ - 2012/12/25 06:00 DA - 2013/02/26 06:00 DT - 2012/12/25 06:00 YR - 2012 ED - 20130225 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23264318 <466. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23129079 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kim HK AU - Smiddy M AU - Hoffman RS AU - Nelson LS FA - Kim, Hong K FA - Smiddy, Monica FA - Hoffman, Robert S FA - Nelson, Lewis S IN - Kim, Hong K. New York University Langone Medical Center/Bellevue Hospital Center, New York City Poison Control Center, New York, NY 10016, USA. hongkimmd@gmail.com TI - Buprenorphine may not be as safe as you think: a pediatric fatality from unintentional exposure. SO - Pediatrics. 130(6):e1700-3, 2012 Dec AS - Pediatrics. 130(6):e1700-3, 2012 Dec NJ - Pediatrics VO - 130 IP - 6 PG - e1700-3 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Accidents, Home MH - Buprenorphine/ad [Administration & Dosage] MH - Buprenorphine/aa [Analogs & Derivatives] MH - Buprenorphine/pk [Pharmacokinetics] MH - *Buprenorphine/po [Poisoning] MH - Buprenorphine, Naloxone Drug Combination MH - Dose-Response Relationship, Drug MH - Fatal Outcome MH - Half-Life MH - Humans MH - Infant MH - Infusions, Intravenous MH - Male MH - Metabolic Clearance Rate/ph [Physiology] MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/pk [Pharmacokinetics] MH - *Naloxone/po [Poisoning] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/pk [Pharmacokinetics] MH - *Narcotic Antagonists/po [Poisoning] MH - *Opiate Substitution Treatment MH - *Receptors, Opioid, mu/ag [Agonists] MH - Resuscitation AB - Buprenorphine is a partial mu-opioid receptor agonist that is approved for the treatment of opioid dependency. It is generally believed to be safer than methadone because of its ceiling effect on respiratory depression. As more adults in US households use buprenorphine, an increasing number of children are being exposed. We report a fatal exposure to buprenorphine in a small child that occurred after ingestion of a caretaker's buprenorphine/naloxone. Postmortem toxicology analysis showed free serum concentrations of 52 ng/mL and 39 ng/mL for buprenorphine and norbuprenorphine, respectively. No other drugs were detected. Autopsy did not find signs of injury or trauma. The theoretical safety provided by the ceiling effect in respiratory depression from buprenorphine may not apply to children, and buprenorphine may cause dose-dependent respiratory depression. RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - 0 (Narcotic Antagonists) RN - 0 (Receptors, Opioid, mu) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) RN - 7E53B4O073 (norbuprenorphine) ES - 1098-4275 IL - 0031-4005 DO - https://dx.doi.org/10.1542/peds.2012-1342 PT - Case Reports PT - Journal Article ID - peds.2012-1342 [pii] ID - 10.1542/peds.2012-1342 [doi] PP - ppublish LG - English EP - 20121105 DP - 2012 Dec EZ - 2012/11/07 06:00 DA - 2013/02/05 06:00 DT - 2012/11/07 06:00 YR - 2012 ED - 20130204 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23129079 <467. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23357954 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Chakravarthy B AU - Shah S AU - Lotfipour S FA - Chakravarthy, Bharath FA - Shah, Shyam FA - Lotfipour, Shahram IN - Chakravarthy, Bharath. University of California Irvine, School of Medicine, Department of Emergency Medicine, Irvine, California. TI - Prescription drug monitoring programs and other interventions to combat prescription opioid abuse. SO - The Western Journal of Emergency Medicine. 13(5):422-5, 2012 Nov AS - West J Emerg Med. 13(5):422-5, 2012 Nov NJ - The western journal of emergency medicine VO - 13 IP - 5 PG - 422-5 PI - Journal available in: Print PI - Citation processed from: Print JC - 101476450 IO - West J Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556951 CP - United States AB - The Center for Disease Control and Prevention (CDC) has published significant data and trends related to opioid prescription pain relievers (OPR). In 2008, 20,044 deaths were attributed to prescription drug overdose of which 14,800 (73.8%) were due to OPR, an amount greater than the number of overdose deaths from heroin and cocaine combined. The majority of these deaths were unintentional. Between 1999-2008, overdose deaths from OPR increased almost four-fold. Correspondingly, sales of OPR were four times greater in 2010 than in 1999. Most significant to emergency physicians is the estimate that 39% of all opioids prescribed, administered or continued come from the emergency department (ED). We present findings from the CDC's Morbidity and Mortality Weekly Report (MMWR) with commentary on current recommendations and policies for curtailing the OPR epidemic.1. IS - 1936-900X IL - 1936-900X DO - https://dx.doi.org/10.5811/westjem.2012.7.12936 PT - Journal Article ID - 10.5811/westjem.2012.7.12936 [doi] ID - wjem-13-422 [pii] ID - PMC3556951 [pmc] PP - ppublish PH - 2012/07/11 [received] PH - 2012/07/18 [revised] PH - 2012/07/20 [accepted] LG - English DP - 2012 Nov EZ - 2013/01/30 06:00 DA - 2013/01/30 06:01 DT - 2013/01/30 06:00 YR - 2012 ED - 20130130 RD - 20130418 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=23357954 <468. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22030204 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gilmore T AU - Saccheti A AU - Cortese T FA - Gilmore, Thomas FA - Saccheti, Al FA - Cortese, Teena IN - Gilmore, Thomas. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. thomas_gilmore@hotmail.com TI - Buprenorphine/naloxone inhibition of remifentanil procedural sedation. SO - American Journal of Emergency Medicine. 30(8):1655.e3-4, 2012 Oct AS - Am J Emerg Med. 30(8):1655.e3-4, 2012 Oct NJ - The American journal of emergency medicine VO - 30 IP - 8 PG - 1655.e3-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Buprenorphine/ae [Adverse Effects] MH - *Conscious Sedation MH - Emergency Service, Hospital MH - Humans MH - *Hypnotics and Sedatives/ai [Antagonists & Inhibitors] MH - Male MH - *Naloxone/ae [Adverse Effects] MH - Pain Management/ae [Adverse Effects] MH - Pain Management/mt [Methods] MH - *Piperidines/ai [Antagonists & Inhibitors] MH - Wrist Injuries/su [Surgery] MH - Young Adult AB - Opioid analgesics are the mainstay of treatment of moderate and severe pain. Remifentanil is an ultrashort acting opioid analgesic used in emergency department (ED)procedural sedation, whereas buprenorphine/naloxone (Suboxone) is an opioid agonist-antagonist combination used in the treatment of addiction-prone individuals. We report here a case of buprenorphine/naloxone inhibition of remifentanil analgesia in a patient undergoing ED procedural sedation. Copyright © 2012 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 0 (Piperidines) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) RN - P10582JYYK (remifentanil) ES - 1532-8171 IL - 0735-6757 DI - S0735-6757(11)00341-X DO - https://dx.doi.org/10.1016/j.ajem.2011.07.024 PT - Case Reports PT - Journal Article ID - S0735-6757(11)00341-X [pii] ID - 10.1016/j.ajem.2011.07.024 [doi] PP - ppublish PH - 2011/07/26 [received] PH - 2011/07/28 [accepted] LG - English EP - 20111024 DP - 2012 Oct EZ - 2011/10/28 06:00 DA - 2013/01/30 06:00 DT - 2011/10/28 06:00 YR - 2012 ED - 20130129 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22030204 <469. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23192075 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wedmore IS AU - Kotwal RS AU - McManus JG AU - Pennardt A AU - Talbot TS AU - Fowler M AU - McGhee L FA - Wedmore, Ian S FA - Kotwal, Russ S FA - McManus, John G FA - Pennardt, Andre FA - Talbot, Timothy S FA - Fowler, Marcie FA - McGhee, Laura IN - Wedmore, Ian S. US Army Austere and Wilderness Medicine Fellowship, Madigan Army Medical Center, Fort Bragg, North Carolina, USA. TI - Safety and efficacy of oral transmucosal fentanyl citrate for prehospital pain control on the battlefield. SO - The Journal of Trauma and Acute Care Surgery. 73(6 Suppl 5):S490-5, 2012 Dec AS - J Trauma Acute Care Surg. 73(6 Suppl 5):S490-5, 2012 Dec NJ - The journal of trauma and acute care surgery VO - 73 IP - 6 Suppl 5 PG - S490-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101570622 IO - J Trauma Acute Care Surg SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Administration, Mucosal MH - Administration, Oral MH - Afghanistan MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analysis of Variance MH - Cohort Studies MH - *Emergency Medical Services/mt [Methods] MH - Female MH - *Fentanyl/ad [Administration & Dosage] MH - Fentanyl/ae [Adverse Effects] MH - Humans MH - Iraq MH - Male MH - *Mass Casualty Incidents MH - Mouth Mucosa/de [Drug Effects] MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - Pain/pp [Physiopathology] MH - Pain Management/mt [Methods] MH - *Pain Measurement/de [Drug Effects] MH - Patient Safety MH - Retrospective Studies MH - Risk Assessment MH - Severity of Illness Index MH - Statistics, Nonparametric MH - Treatment Outcome MH - Warfare MH - Wounds and Injuries/co [Complications] MH - Wounds and Injuries/di [Diagnosis] AB - BACKGROUND: Acute pain, resulting from trauma and other causes, is a common condition that imposes a need for prehospital analgesia on and off the battlefield. The narcotic most frequently used for prehospital analgesia on the battlefield during the past century has been morphine. Intramuscular morphine has a delayed onset of pain relief that is suboptimal and difficult to titrate. Although intravenously administered morphine can readily provide rapid and effective prehospital analgesia, oral transmucosal fentanyl citrate (OTFC) is a safe alternative that does not require intravenous access. This study evaluates the safety and efficacy of OTFC in the prehospital battlefield environment. AB - METHODS: Data collected during combat deployments (Afghanistan and Iraq) from March 15, 2003, to March 31, 2010, were analyzed. Patients were US Army Special Operations Command casualties. Patients receiving OTFC for acute pain were evaluated. Pretreatment and posttreatment pain intensities were quantified by the verbal numeric rating scale (NRS) from 0 to 10. OTFC adverse effects and injuries treated were also evaluated. AB - RESULTS: A total of 286 patients were administered OTFC, of whom 197 had NRS pain evaluations conducted before and approximately 15 minutes to 30 minutes following treatment. The difference between NRS pain scores at 0 minutes (NRS, 8.0 [1.4]) and 15 minutes to 30 minutes (NRS, 3.2 [2.1]) was significant (p < 0.001). Only 18.3% (36 of 197) of patients were also administered other types of analgesics. Nausea was the most common adverse effect as reported by 12.7% (25 of 197) of patients. The only major adverse effect occurred in the patient who received the largest opioid dose, 3,200-micro g OTFC and 20-mg morphine. This patient exhibited hypoventilation and saturation of less than 90% requiring low-dose naloxone. AB - CONCLUSION: OTFC is a rapid and noninvasive pain management strategy that provides safe and effective analgesia in the prehospital battlefield setting. OTFC has considerable implications for use in civilian prehospital and austere environments. AB - LEVEL OF EVIDENCE: Therapeutic study, level IV. RN - 0 (Analgesics, Opioid) RN - UF599785JZ (Fentanyl) ES - 2163-0763 IL - 2163-0755 DO - https://dx.doi.org/10.1097/TA.0b013e3182754674 PT - Comparative Study PT - Journal Article ID - 10.1097/TA.0b013e3182754674 [doi] ID - 01586154-201212005-00019 [pii] PP - ppublish LG - English DP - 2012 Dec EZ - 2012/12/05 06:00 DA - 2013/01/25 06:00 DT - 2012/11/30 06:00 YR - 2012 ED - 20130124 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23192075 <470. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22872749 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Al-Qadheeb NS AU - Roberts RJ AU - Griffin R AU - Garpestad E AU - Ruthazer R AU - Devlin JW FA - Al-Qadheeb, Nada S FA - Roberts, Russel J FA - Griffin, Ryan FA - Garpestad, Erik FA - Ruthazer, Robin FA - Devlin, John W IN - Al-Qadheeb, Nada S. School of Pharmacy, Northeastern University, Boston, MA, USA. TI - Impact of enteral methadone on the ability to wean off continuously infused opioids in critically ill, mechanically ventilated adults: a case-control study. SO - Annals of Pharmacotherapy. 46(9):1160-6, 2012 Sep AS - Ann Pharmacother. 46(9):1160-6, 2012 Sep NJ - The Annals of pharmacotherapy VO - 46 IP - 9 PG - 1160-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bbx, 9203131 IO - Ann Pharmacother SB - Index Medicus CP - United States MH - Adult MH - Aged MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Case-Control Studies MH - Critical Illness MH - Enteral Nutrition MH - Female MH - *Fentanyl/ad [Administration & Dosage] MH - Humans MH - Intensive Care Units MH - Male MH - *Methadone/ad [Administration & Dosage] MH - Middle Aged MH - Respiration, Artificial MH - *Substance Withdrawal Syndrome/pc [Prevention & Control] AB - BACKGROUND: Continuously infused opioids are frequently used to optimize patient comfort in the intensive care unit (ICU). However, concerns about rebound pain and opioid withdrawal may delay efforts to discontinue this therapy. AB - OBJECTIVE: To measure the association between use of scheduled enteral methadone according to a protocol in mechanically ventilated, medical critically ill adults receiving prolonged continuously infused fentanyl and the time to discontinue continuously infused fentanyl therapy. AB - METHODS: This case-control study included 20 consecutive mechanically ventilated adults in a medical ICU, without a history of chronic opioid use, who received 72 or more hours of continuously infused fentanyl and were prescribed scheduled enteral methadone as part of a protocol medical ICU strategy to wean off continuously infused fentanyl. Patients were matched in a 1:2 fashion, by duration of mechanical ventilation, to 40 consecutive preprotocol medical ICU patients meeting the same criteria but who were never given methadone. Duration of continuously infused fentanyl was compared between the 2 groups by constructing Kaplan-Meier plots and estimating the likelihood that methadone use was associated with a decrease in continuously infused fentanyl requirements over time, using a Cox proportional hazards model. AB - RESULTS: The groups were well matched except the methadone patients were older (p = 0.04). Time (median [interquartile range]) to continuously infused fentanyl discontinuation was shorter in the methadone group (4.5 [3.9-5.8] vs 7.0 [4.9-11.5] days; p = 0.002). Continuously infused fentanyl was more likely to be discontinued 2 days after methadone was first initiated (hazard ratio 9.1; p = 0.0004). The proportion of patients who experienced 1 or more episodes of either QTc interval prolongation (p = 0.79) or unarousability (p = 0.47) was similar between the groups. AB - CONCLUSIONS: Enterally administered methadone is associated with earlier cessation of continuously infused fentanyl in mechanically ventilated adults without a history of opioid dependence admitted to a medical ICU. Prospective, controlled studies are needed to further evaluate the safety and efficacy of methadone as a strategy to wean off continuously infused fentanyl in different ICU populations. RN - 0 (Analgesics, Opioid) RN - UC6VBE7V1Z (Methadone) RN - UF599785JZ (Fentanyl) ES - 1542-6270 IL - 1060-0280 DO - https://dx.doi.org/10.1345/aph.1R132 PT - Journal Article ID - aph.1R132 [pii] ID - 10.1345/aph.1R132 [doi] PP - ppublish LG - English EP - 20120807 DP - 2012 Sep EZ - 2012/08/09 06:00 DA - 2013/01/23 06:00 DT - 2012/08/09 06:00 YR - 2012 ED - 20130121 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22872749 <471. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20650915 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Reddick AD AU - Hodge K AU - Morrison WG FA - Reddick, Andrew D FA - Hodge, Kirsten FA - Morrison, William G IN - Reddick, Andrew D. Emergency Department, Ninewells Hospital, Dundee DD1 9SY, UK. andrew.reddick@nhs.net TI - Effect of concomitant opiate ingestion on paracetamol levels in acute overdose. SO - Emergency Medicine Journal. 27(10):742-4, 2010 Oct AS - Emerg Med J. 27(10):742-4, 2010 Oct NJ - Emergency medicine journal : EMJ VO - 27 IP - 10 PG - 742-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J SB - Index Medicus CP - England MH - *Acetaminophen/bl [Blood] MH - Acetaminophen/pk [Pharmacokinetics] MH - Acetaminophen/po [Poisoning] MH - Adolescent MH - Adult MH - Aged MH - Analgesics, Opioid/pd [Pharmacology] MH - *Analgesics, Opioid/po [Poisoning] MH - Drug Interactions MH - Female MH - Gastric Emptying/de [Drug Effects] MH - Humans MH - Linear Models MH - Male MH - Middle Aged MH - Observation MH - Prospective Studies MH - Young Adult AB - AIM: To assess whether the co-ingestion of opiates in acute paracetamol overdose has an effect on the paracetamol level 4 h after ingestion. AB - METHODS: A prospective observational study was performed in the emergency department of a teaching hospital. The paracetamol levels at 4 h of consecutive patients who had taken an overdose of either paracetamol alone or in conjunction with an opiate were collected over a 4-month period. The data were then analysed. AB - RESULTS: After exclusions, the results of 21 patients who took paracetamol alone and 20 who took paracetamol and an opiate showed that paracetamol levels were significantly lower at 4 h if there was co-ingestion of an opiate. Analysis shows that opiate ingestion is a predictor for paracetamol levels at 4 h. AB - CONCLUSION: Co-ingestion of opiate decreases the serum paracetamol level at 4 h. If opiate and paracetamol are taken together, there is a case for a repeat measurement of the paracetamol level if the level at 4 h is lower than would be expected in selected patients. RN - 0 (Analgesics, Opioid) RN - 362O9ITL9D (Acetaminophen) ES - 1472-0213 IL - 1472-0205 DO - https://dx.doi.org/10.1136/emj.2009.083469 PT - Comparative Study PT - Journal Article ID - emj.2009.083469 [pii] ID - 10.1136/emj.2009.083469 [doi] PP - ppublish LG - English EP - 20100721 DP - 2010 Oct EZ - 2010/07/24 06:00 DA - 2013/01/09 06:00 DT - 2010/07/24 06:00 YR - 2010 ED - 20130108 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20650915 <472. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22713674 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McNeely J AU - Gourevitch MN AU - Paone D AU - Shah S AU - Wright S AU - Heller D FA - McNeely, Jennifer FA - Gourevitch, Marc N FA - Paone, Denise FA - Shah, Sharmila FA - Wright, Shana FA - Heller, Daliah IN - McNeely, Jennifer. Department of Population Health, NYU School of Medicine, New York, NY 10016, USA. jennifer.mcneely@nyumc.org TI - Estimating the prevalence of illicit opioid use in New York City using multiple data sources. SO - BMC Public Health. 12:443, 2012 Jun 18 AS - BMC Public Health. 12:443, 2012 Jun 18 NJ - BMC public health VO - 12 PG - 443 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100968562 IO - BMC Public Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3416644 SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - *Databases, Factual/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital/ut [Utilization] MH - Female MH - *Heroin Dependence/ep [Epidemiology] MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Middle Aged MH - New York City/ep [Epidemiology] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/th [Therapy] MH - *Prescription Drugs MH - Prevalence MH - *Street Drugs MH - Substance Abuse Treatment Centers/ut [Utilization] MH - Young Adult AB - BACKGROUND: Despite concerns about its health and social consequences, little is known about the prevalence of illicit opioid use in New York City. Individuals who misuse heroin and prescription opioids are known to bear a disproportionate burden of morbidity and mortality. Service providers and public health authorities are challenged to provide appropriate interventions in the absence of basic knowledge about the size and characteristics of this population. While illicit drug users are underrepresented in population-based surveys, they may be identified in multiple administrative data sources. AB - METHODS: We analyzed large datasets tracking hospital inpatient and emergency room admissions as well as drug treatment and detoxification services utilization. These were applied in combination with findings from a large general population survey and administrative records tracking prescriptions, drug overdose deaths, and correctional health services, to estimate the prevalence of heroin and non-medical prescription opioid use among New York City residents in 2006. These data were further applied to a descriptive analysis of opioid users entering drug treatment and hospital-based medical care. AB - RESULTS: These data sources identified 126,681 cases of opioid use among New York City residents in 2006. After applying adjustment scenarios to account for potential overlap between data sources, we estimated over 92,000 individual opioid users. By contrast, just 21,600 opioid users initiated drug treatment in 2006. Opioid users represented 4% of all individuals hospitalized, and over 44,000 hospitalizations during the calendar year. AB - CONCLUSIONS: Our findings suggest that innovative approaches are needed to provide adequate services to this sizeable population of opioid users. Given the observed high rates of hospital services utilization, greater integration of drug services into medical settings could be one component of an effective approach to expanding both the scope and reach of health interventions for this population. RN - 0 (Prescription Drugs) RN - 0 (Street Drugs) ES - 1471-2458 IL - 1471-2458 DO - https://dx.doi.org/10.1186/1471-2458-12-443 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. ID - 1471-2458-12-443 [pii] ID - 10.1186/1471-2458-12-443 [doi] ID - PMC3416644 [pmc] PP - epublish PH - 2012/03/14 [received] PH - 2012/06/18 [accepted] GI - No: L30 DA027429 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: T01 CD000146 Organization: (CD) *ODCDC CDC HHS* Country: United States GI - No: KL2RR029891 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: K23DA030395 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K23 DA030395 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20120618 DP - 2012 Jun 18 EZ - 2012/06/21 06:00 DA - 2012/12/22 06:00 DT - 2012/06/21 06:00 YR - 2012 ED - 20121221 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22713674 <473. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23010181 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cantrill SV AU - Brown MD AU - Carlisle RJ AU - Delaney KA AU - Hays DP AU - Nelson LS AU - O'Connor RE AU - Papa A AU - Sporer KA AU - Todd KH AU - Whitson RR AU - American College of Emergency Physicians Opioid Guideline Writing Panel FA - Cantrill, Stephen V FA - Brown, Michael D FA - Carlisle, Russell J FA - Delaney, Kathleen A FA - Hays, Daniel P FA - Nelson, Lewis S FA - O'Connor, Robert E FA - Papa, Annmarie FA - Sporer, Karl A FA - Todd, Knox H FA - Whitson, Rhonda R FA - American College of Emergency Physicians Opioid Guideline Writing Panel TI - Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department. SO - Annals of Emergency Medicine. 60(4):499-525, 2012 Oct AS - Ann Emerg Med. 60(4):499-525, 2012 Oct NJ - Annals of emergency medicine VO - 60 IP - 4 PG - 499-525 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Acute Pain/dt [Drug Therapy] MH - Adult MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/st [Standards] MH - Humans MH - Low Back Pain/dt [Drug Therapy] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Pain Management/mt [Methods] MH - Pain Management/st [Standards] MH - Risk Factors RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 DI - S0196-0644(12)00637-3 DO - https://dx.doi.org/10.1016/j.annemergmed.2012.06.013 PT - Journal Article PT - Practice Guideline ID - S0196-0644(12)00637-3 [pii] ID - 10.1016/j.annemergmed.2012.06.013 [doi] PP - ppublish LG - English DP - 2012 Oct EZ - 2012/09/27 06:00 DA - 2012/12/15 06:00 DT - 2012/09/27 06:00 YR - 2012 ED - 20121214 RD - 20120926 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23010181 <474. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 23045763 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - The Joint Commission and the FDA take steps to curb adverse events related to the use and misuse of opioid drugs. SO - ED Management. 24(10):112-6, 2012 Oct AS - ED Manag. 24(10):112-6, 2012 Oct NJ - ED management : the monthly update on emergency department management VO - 24 IP - 10 PG - 112-6 PI - Journal available in: Print PI - Citation processed from: Print JC - chx, 9425690 IO - ED Manag SB - Health Administration Journals CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Interactions MH - Emergency Service, Hospital MH - Humans MH - *Joint Commission on Accreditation of Healthcare Organizations MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - United States/ep [Epidemiology] MH - *United States Food and Drug Administration AB - Alarmed by adverse events involving opioid drugs, the Joint Commission has issued a Sentinel Alert urging hospitals to take steps to improve safety in the prescribing of these powerful drugs. In addition, the Food and Drug Administration (FDA) has launched an initiative that will soon require the manufacturers of long-acting and extended-release opioids to offer education and training to physicians and others who prescribe these pharmaceuticals. The Joint Commission reports that of the opioid-related adverse events reported to the agency between 2004 and 2011, 47% involved wrong-dosage medication errors, 29% pertained to improper patient monitoring, and 11% were attributed to other factors such as excessive dosing, drug-drug interactions, and adverse reactions. The FDA reports that nearly 16,000 Americans died from overdoses involving opioids in 2009, and in 2011, there were nearly 23 million prescriptions written for extended-release and long-acting opioids. Some new guidelines on opioid prescribing in the ED urge providers to avoid prescribing extended-release or long-acting opioids altogether, and to consider measures that will limit opportunities for drug diversion. RN - 0 (Analgesics, Opioid) IS - 1044-9167 IL - 1044-9167 PT - Journal Article PP - ppublish LG - English DP - 2012 Oct EZ - 2012/10/11 06:00 DA - 2012/12/10 06:00 DT - 2012/10/11 06:00 YR - 2012 ED - 20121204 RD - 20121010 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=23045763 <475. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22786448 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Manchikanti L AU - Abdi S AU - Atluri S AU - Balog CC AU - Benyamin RM AU - Boswell MV AU - Brown KR AU - Bruel BM AU - Bryce DA AU - Burks PA AU - Burton AW AU - Calodney AK AU - Caraway DL AU - Cash KA AU - Christo PJ AU - Damron KS AU - Datta S AU - Deer TR AU - Diwan S AU - Eriator I AU - Falco FJ AU - Fellows B AU - Geffert S AU - Gharibo CG AU - Glaser SE AU - Grider JS AU - Hameed H AU - Hameed M AU - Hansen H AU - Harned ME AU - Hayek SM AU - Helm S 2nd AU - Hirsch JA AU - Janata JW AU - Kaye AD AU - Kaye AM AU - Kloth DS AU - Koyyalagunta D AU - Lee M AU - Malla Y AU - Manchikanti KN AU - McManus CD AU - Pampati V AU - Parr AT AU - Pasupuleti R AU - Patel VB AU - Sehgal N AU - Silverman SM AU - Singh V AU - Smith HS AU - Snook LT AU - Solanki DR AU - Tracy DH AU - Vallejo R AU - Wargo BW AU - American Society of Interventional Pain Physicians FA - Manchikanti, Laxmaiah FA - Abdi, Salahadin FA - Atluri, Sairam FA - Balog, Carl C FA - Benyamin, Ramsin M FA - Boswell, Mark V FA - Brown, Keith R FA - Bruel, Brian M FA - Bryce, David A FA - Burks, Patricia A FA - Burton, Allen W FA - Calodney, Aaron K FA - Caraway, David L FA - Cash, Kimberly A FA - Christo, Paul J FA - Damron, Kim S FA - Datta, Sukdeb FA - Deer, Timothy R FA - Diwan, Sudhir FA - Eriator, Ike FA - Falco, Frank J E FA - Fellows, Bert FA - Geffert, Stephanie FA - Gharibo, Christopher G FA - Glaser, Scott E FA - Grider, Jay S FA - Hameed, Haroon FA - Hameed, Mariam FA - Hansen, Hans FA - Harned, Michael E FA - Hayek, Salim M FA - Helm, Standiford 2nd FA - Hirsch, Joshua A FA - Janata, Jeffrey W FA - Kaye, Alan D FA - Kaye, Adam M FA - Kloth, David S FA - Koyyalagunta, Dhanalakshmi FA - Lee, Marion FA - Malla, Yogesh FA - Manchikanti, Kavita N FA - McManus, Carla D FA - Pampati, Vidyasagar FA - Parr, Allan T FA - Pasupuleti, Ramarao FA - Patel, Vikram B FA - Sehgal, Nalini FA - Silverman, Sanford M FA - Singh, Vijay FA - Smith, Howard S FA - Snook, Lee T FA - Solanki, Daneshvari R FA - Tracy, Deborah H FA - Vallejo, Ricardo FA - Wargo, Bradley W FA - American Society of Interventional Pain Physicians IN - Manchikanti, Laxmaiah. American Society of Interventional Pain Physicians, USA. TI - American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment. SO - Pain Physician. 15(3 Suppl):S1-65, 2012 Jul AS - Pain physician. 15(3 Suppl):S1-65, 2012 Jul NJ - Pain physician VO - 15 IP - 3 Suppl PG - S1-65 PI - Journal available in: Print PI - Citation processed from: Internet JC - 100954394 IO - Pain Physician SB - Index Medicus CP - United States MH - Adolescent MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - *Chronic Pain/dt [Drug Therapy] MH - Female MH - Humans MH - Infant MH - Male MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Pregnancy AB - BACKGROUND: Opioid abuse has continued to increase at an alarming rate since the 1990 s. As documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration, available evidence suggests a wide variance in chronic opioid therapy of 90 days or longer in chronic non-cancer pain. Part 1 describes evidence assessment. AB - OBJECTIVES: The objectives of opioid guidelines as issued by the American Society of Interventional Pain Physicians (ASIPP) are to provide guidance for the use of opioids for the treatment of chronic non-cancer pain, to produce consistency in the application of an opioid philosophy among the many diverse groups involved, to improve the treatment of chronic non-cancer pain, and to reduce the incidence of abuse and drug diversion. The focus of these guidelines is to curtail the abuse of opioids without jeopardizing non-cancer pain management with opioids. AB - RESULTS: 1) There is good evidence that non-medical use of opioids is extensive; one-third of chronic pain patients may not use prescribed opioids as prescribed or may abuse them, and illicit drug use is significantly higher in these patients. 2) There is good evidence that opioid prescriptions are increasing rapidly, as the majority of prescriptions are from non-pain physicians, many patients are on long-acting opioids, and many patients are provided with combinations of long-acting and short-acting opioids. 3) There is good evidence that the increased supply of opioids, use of high dose opioids, doctor shoppers, and patients with multiple comorbid factors contribute to the majority of the fatalities. 4) There is fair evidence that long-acting opioids and a combination of long-acting and short-acting opioids contribute to increasing fatalities and that even low-doses of 40 mg or 50 mg of daily morphine equivalent doses may be responsible for emergency room admissions with overdoses and deaths. 5) There is good evidence that approximately 60% of fatalities originate from opioids prescribed within the guidelines, with approximately 40% of fatalities occurring in 10% of drug abusers. 6) The short-term effectiveness of opioids is fair, whereas the long-term effectiveness of opioids is limited due to a lack of long-term (> 3 months) high quality studies, with fair evidence with no significant difference between long-acting and short-acting opioids. 7) Among the individual drugs, most opioids have fair evidence for short-term and limited evidence for long-term due to a lack of quality studies. 8) The evidence for the effectiveness and safety of chronic opioid therapy in the elderly for chronic non-cancer pain is fair for short-term and limited for long-term due to lack of high quality studies; limited in children and adolescents and patients with comorbid psychological disorders due to lack of quality studies; and the evidence is poor in pregnant women. 9) There is limited evidence for reliability and accuracy of screening tests for opioid abuse due to lack of high quality studies. 10) There is fair evidence to support the identification of patients who are non-compliant or abusing prescription drugs or illicit drugs through urine drug testing and prescription drug monitoring programs, both of which can reduce prescription drug abuse or doctor shopping. AB - DISCLAIMER: The guidelines are based on the best available evidence and do not constitute inflexible treatment recommendations. Due to the changing body of evidence, this document is not intended to be a "standard of care." RN - 0 (Analgesics, Opioid) ES - 2150-1149 IL - 1533-3159 PT - Journal Article PT - Practice Guideline PP - ppublish LG - English DP - 2012 Jul EZ - 2012/07/20 06:00 DA - 2012/12/10 06:00 DT - 2012/07/13 06:00 YR - 2012 ED - 20121119 RD - 20131106 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22786448 <476. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21908134 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bijur PE AU - Esses D AU - Chang AK AU - Gallagher EJ FA - Bijur, Polly E FA - Esses, David FA - Chang, Andrew K FA - Gallagher, E John IN - Bijur, Polly E. Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA. polly.bijur@einstein.yu.edu TI - Dosing and titration of intravenous opioid analgesics administered to ED patients in acute severe pain. SO - American Journal of Emergency Medicine. 30(7):1241-4, 2012 Sep AS - Am J Emerg Med. 30(7):1241-4, 2012 Sep NJ - The American journal of emergency medicine VO - 30 IP - 7 PG - 1241-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Injections, Intravenous MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - Pain Management/mt [Methods] MH - Pain Measurement MH - Young Adult AB - OBJECTIVES: The objectives were to describe the dose of opioids and incidence of titration for management of acute pain in emergency department patients and, secondarily, to assess the association between change in pain and dose. AB - METHODS: Data from control groups of 2 randomized clinical trials were analyzed. Patients 21 to 64 years with acute pain judged to warrant intravenous (i.v.) opioids were eligible. We calculated the mean weight-based dose of i.v. opioids, distribution of dose, proportion of patients receiving additional i.v. opioids, and 95% confidence intervals. We compared these statistics to 3 recommendations: 0.1 mg/kg morphine, 10 mg morphine, and titration to analgesic effect. We used multiple linear regression to assess the association between change in pain measured on a numerical rating scale and dose. AB - RESULTS: There were 281 patients with an initial median pain score of 10 (interquartile range: 8, 10). Mean weight-based dose of i.v. opioids was 0.08 mg/kg (0.07, 0.08 mg/kg). A total of 268 patients (95.4% [92.2%, 97.5%]) received less than 10 mg i.v. morphine equivalents; 7 patients (2.5% [1.0%, 5.0%]) received additional opioids. There was a weak association between change in pain in the 15, 30, and 60 minutes after the initial bolus and dose: b = 0.22 (0.07, 0.37), b = 0.17 (0.02, 0.32), and b = 0.12 (-0.03, 0.28), respectively, after adjustment for baseline pain. AB - CONCLUSION: Analgesic practice did not conform to recommended doses or regimens. There was only a weak association between change of pain and dose in the range of doses given. These findings suggest that oligoanalgesia continues to be a problem despite improvements over the past 20 years. Copyright © 2012 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1532-8171 IL - 0735-6757 DO - https://dx.doi.org/10.1016/j.ajem.2011.06.015 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0735-6757(11)00290-7 [pii] ID - 10.1016/j.ajem.2011.06.015 [doi] PP - ppublish PH - 2011/04/25 [received] PH - 2011/05/31 [revised] PH - 2011/06/21 [accepted] GI - No: 1R21NR010929 Organization: (NR) *NINR NIH HHS* Country: United States LG - English EP - 20110909 DP - 2012 Sep EZ - 2011/09/13 06:00 DA - 2012/11/03 06:00 DT - 2011/09/13 06:00 YR - 2012 ED - 20121102 RD - 20140408 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21908134 <477. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16266519 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wang WZ AU - Li YQ AU - Zhang JZ AU - Wang L AU - Ma GY AU - Cao SQ FA - Wang, Wei-zhan FA - Li, Ya-qin FA - Zhang, Jian-zhi FA - Wang, Lan FA - Ma, Guo-ying FA - Cao, Shuang-qing IN - Wang, Wei-zhan. Emergency Department, Harrison International Peace Hospital, Hengshui, Hebei Province 053000, China. TI - [Effect of the pre-hospital systematic treatment on prognosis patients of with severe acute organophosphorus pesticide poisoning]. [Chinese] SO - Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi/Zhonghua Laodong Weisheng Zhiyebing Zazhi/Chinese Journal of Industrial Hygiene & Occupational Diseases. 23(5):371-3, 2005 Oct AS - Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 23(5):371-3, 2005 Oct NJ - Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi = Chinese journal of industrial hygiene and occupational diseases VO - 23 IP - 5 PG - 371-3 PI - Journal available in: Print PI - Citation processed from: Print JC - 8410840 IO - Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi SB - Index Medicus CP - China MH - Adult MH - Case-Control Studies MH - *Emergency Medical Services MH - Female MH - Humans MH - Insecticides/po [Poisoning] MH - Male MH - *Organophosphate Poisoning MH - *Pesticides/po [Poisoning] MH - Prognosis AB - OBJECTIVE: To investigate if the duration from poisoning to treatment (no treatment period) is related to the prognosis of patients with severe acute organophosphorus pesticide poisoning (SAOPP). AB - METHODS: One hundred and seventy-four patients with the pre-hospital systematic treatment served as the treatment group while 160 patients going to the hospital by themselves without treatment or rejecting gastrolavage served as the control group. Patients in both groups were treated by gastrolavage, pralidoxime chloride, atropine and other expectant treatment. The duration of no treatment period, death, and severe complication were observed. The time of disappearance of symptoms, the recovery time of acetyl cholinesterase (AChE), atropinization time, atropine dosage, pralidoxime chloride dosage, naloxone dosage, hospitalization days and other targets were also observed. AB - RESULTS: The duration of no treatment period in treatment group [(1.2 +/- 0.3) h] was significantly shorter than that in control group [(2.8 +/- 0.5) h, (P < 0.01)]. The mortality rate in treatment group was 6.32% while that in control group 22.5% (P < 0.01). The incidence of respiratory failure, heart injury, brain injury, atropine poisoning, intermediate syndrome, liver injury in treatment group (12.64%, 5.75%, 8.62%, 1.72%, 4.60%, 5.17% respectively) were lower than those in control group (25.63%, 13.75%, 17.50%, 6.25%, 7.50%, 9.38% respectively, P < 0.05 or P < 0.01). The time of symptoms disappearance, the recovery time of AChE, atropinization time, atropine dosage, pralidoxime chloride dosage, naloxone dosage, hospitalization days in treatment group were significantly superior to those in control group (P < 0.05 or P < 0.01). AB - CONCLUSION: The pre-hospital systematic treatment can improve the prognosis of the patients with SAOPP, which is worth popularizing and using. RN - 0 (Insecticides) RN - 0 (Pesticides) IS - 1001-9391 IL - 1001-9391 PT - English Abstract PT - Journal Article PP - ppublish LG - Chinese DP - 2005 Oct EZ - 2005/11/04 09:00 DA - 2012/10/26 06:00 DT - 2005/11/04 09:00 YR - 2005 ED - 20121025 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16266519 <478. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20020970 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Shadnia S AU - Faiaz-Noori MR AU - Pajoumand A AU - Talaie H AU - Khoshkar A AU - Vosough-Ghanbari S AU - Abdollahi M FA - Shadnia, Shahin FA - Faiaz-Noori, Mohammad-Reza FA - Pajoumand, Abdolkarim FA - Talaie, Haleh FA - Khoshkar, Ali FA - Vosough-Ghanbari, Sanaz FA - Abdollahi, Mohammad IN - Shadnia, Shahin. Loghman-Hakim Hospital Poison Center, Faculty of Medicine, and Toxicological Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. TI - A case report of opium body packer; review of the treatment protocols and mechanisms of poisoning. SO - Toxicology Mechanisms & Methods. 17(4):205-14, 2007 AS - Toxicol. mech. methods. 17(4):205-14, 2007 NJ - Toxicology mechanisms and methods VO - 17 IP - 4 PG - 205-14 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101134521 IO - Toxicol. Mech. Methods CP - England AB - ABSTRACT Body packers are people who illegally carry drugs, mostly cocaine as well as opium and/or heroin, concealed within their bodies. The packets are inserted in the mouth, rectum, or vagina in order to get across borders without being detected. In this presentation we report a case of an opium body packer and review the available scientific literature by focusing on mechanisms of toxicity and treatment approach. The patient was a 35-year-old man who had lethargy, respiratory depression, tachycardia, normal blood pressure, hyperthermia, and pinpoint pupils on presentation. No past medical history was obtained and the only positive history was his travel from Afghanistan 2 days earlier, which he had given to emergency personnel before arriving at our hospital. Complete blood cells and kidney and liver tests were all in normal range. In the emergency department, the patient was treated with oxygen, naloxone, and hypertonic glucose. One dose of activated charcoal (1 g/kg) was administered orally. After intravenous injection of naloxone (4 mg), the lethargy, respiratory depression, and miosis were resolved. The patient was admitted to the intensive care unit and 90 min after admission, the patient redeveloped respiratory distress and lost consciousness. He was intubated and mechanically ventilated due to the suspicious of body packing. Plain abdominal x-ray showed multiple packets throughout the gastrointestinal tract; 81 packets were removed by surgery and three of them were left due to leaking. After removing the packets, the patient was treated conservatively. He suffered a pulmonary infection (aspiration pneumonia) and he regained consciousness after 4 days. Upon recovery the patient was seen by a psychiatrist prior to going to prison. Surgery is recommended for body packers who have significant signs or symptoms. ES - 1537-6524 IL - 1537-6516 DO - https://dx.doi.org/10.1080/15376510600992574 PT - Journal Article ID - 10.1080/15376510600992574 [doi] PP - ppublish LG - English DP - 2007 EZ - 2007/01/01 00:00 DA - 2007/01/01 00:01 DT - 2009/12/22 06:00 YR - 2007 ED - 20121002 RD - 20091221 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=20020970 <479. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17621393 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Etherington J AU - Christenson J AU - Innes G AU - Grafstein E AU - Pennington S AU - Spinelli JJ AU - Gao M AU - Lahiffe B AU - Wanger K AU - Fernandes C FA - Etherington, J FA - Christenson, J FA - Innes, G FA - Grafstein, E FA - Pennington, S FA - Spinelli, J J FA - Gao, M FA - Lahiffe, B FA - Wanger, K FA - Fernandes, C IN - Etherington, J. Department of Emergency Medicine, St. Paul's Hospital, Vancouver British Columbia, Canada. TI - Is early discharge safe after naloxone reversal of presumed opioid overdose?. SO - CJEM Canadian Journal of Emergency Medical Care. 2(3):156-62, 2000 Jul AS - CJEM, Can. j. emerg. med. care. 2(3):156-62, 2000 Jul NJ - CJEM VO - 2 IP - 3 PG - 156-62 PI - Journal available in: Print PI - Citation processed from: Print JC - 100893237 IO - CJEM CP - England AB - INTRODUCTION: Patients with suspected opioid overdose frequently require naloxone treatment. Despite recommendations to observe such patients for 4 to 24 hours after naloxone, earlier discharge is becoming more common. This prospective, observational study of patients with presumed opioid overdose examines the safety of early disposition decisions and the accuracy of outcome prediction by physicians 1 hour after the administration of naloxone. AB - METHODS: The study was carried out at St. Paul's Hospital, an inner city teaching centre that cares for most of the injection drug users in Vancouver, BC. Patients were formally assessed 1 hour after receiving naloxone for presumed opioid overdose. Demographics, medical history and physical examination were documented on specific data forms, and physicians recorded their comfort with early discharge. Patients were followed up, and those who required a critical intervention or suffered a pre-defined adverse event (AE) within 24 hours of their 1-hour assessment were identified. AB - RESULTS: Of 573 patients, 48% were discharged in less than 2 hours, 23% in 2-4 hours and 29% in >4 hours. 94 patients who were held in the emergency department (ED) or admitted required a critical intervention, including supplemental oxygen for hypoxia (74), repeat naloxone (52), antibiotics administered intravenously (IV) (14), assisted ventilations (13), fluid bolus for hypotension (12), charcoal for associated life-threatening overdose (6), IV inotropic agents (2), antiarrhythmics for sustained tachycardia >130 beats/min (1), and administration of bicarbonate for arterial [HCO3] <5 or venous CO2 <5 (1). Physicians predicted adverse events with 94% sensitivity and 59% specificity. No discharged patients suffered a serious AE within 24 hours of ED discharge. AB - CONCLUSIONS: Emergency physicians can clinically identify patients at risk of deterioration after naloxone reversal of suspected opioid overdose. Prolonged observation or hospital admission is not usually required. Selective early discharge of patients with presumed opioid overdose is feasible and appears safe. A clinical prediction rule may be useful in identifying patients eligible for early discharge. IS - 1481-8035 IL - 1481-8035 PT - Journal Article ID - 8972217F485C4B5C84C49A4C617D2AC9 [pii] PP - ppublish LG - English DP - 2000 Jul EZ - 2007/07/11 09:00 DA - 2007/07/11 09:01 DT - 2007/07/11 09:00 YR - 2000 ED - 20121002 RD - 20070710 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=17621393 <480. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22204885 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tanabe P AU - Paice JA AU - Stancati J AU - Fleming M FA - Tanabe, Paula FA - Paice, Judith A FA - Stancati, Jennifer FA - Fleming, Michael IN - Tanabe, Paula. Duke University School of Nursing, Durham, NC, USA. Paula.tanabe@duke.edu TI - How do emergency department patients store and dispose of opioids after discharge? A pilot study. SO - Journal of Emergency Nursing. 38(3):273-9, 2012 May AS - J Emerg Nurs. 38(3):273-9, 2012 May NJ - Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association VO - 38 IP - 3 PG - 273-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 7605913 IO - J Emerg Nurs SB - Nursing Journal CP - United States MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Storage/mt [Methods] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Interviews as Topic MH - Male MH - Middle Aged MH - Patient Discharge MH - Pilot Projects MH - Prospective Studies MH - *Refuse Disposal/mt [Methods] AB - INTRODUCTION: Opioid abuse and overdose have increased drastically in recent years. Diversion of opioids used to treat pain, either through theft or sharing, is increasing and may contribute to this misuse. Based on these trends, we designed a study to investigate opioid storage and disposal practices of patients who were prescribed these agents in the emergency department. AB - METHODS: A prospective cohort pilot study was conducted. All adults (aged >=18 years) with a chief complaint of either minor musculoskeletal trauma, renal colic, or acute back pain who were discharged home with an opioid prescription were eligible for inclusion; persons with chronic pain were excluded. Patients were asked to participate in two home interviews in which the research assistant viewed the storage location of the opioid prescription. Safe storage was defined as being stored in a locked container or cabinet. Safe disposal was defined as returning the drugs to a designated location or mixing unused pills with an undesirable substance, placing in a sealable container, and then in the trash. Patients self-reported disposal methods. Feasibility of study methods evaluated the ability to conduct home interviews after the ED visit. Descriptive statistics were used to analyze the data. AB - RESULTS: Twenty-five subjects consented to participate; 20 patients completed both home interviews. None of the medications were safely stored. Only 1 patient disposed of the medication, yet did so improperly. AB - CONCLUSION: This pilot study revealed widespread improper storage and disposal of opioids. The study has major implications for education for ED physicians, nurses, and residents. Copyright © 2012 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1527-2966 IL - 0099-1767 DO - https://dx.doi.org/10.1016/j.jen.2011.09.023 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0099-1767(11)00492-2 [pii] ID - 10.1016/j.jen.2011.09.023 [doi] PP - ppublish PH - 2011/07/21 [received] PH - 2011/09/12 [revised] PH - 2011/09/28 [accepted] LG - English EP - 20111226 DP - 2012 May EZ - 2011/12/30 06:00 DA - 2012/09/26 06:00 DT - 2011/12/30 06:00 YR - 2012 ED - 20120925 RD - 20120514 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22204885 <481. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22786494 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Nishimori M AU - Low JH AU - Zheng H AU - Ballantyne JC FA - Nishimori, Mina FA - Low, James H S FA - Zheng, Hui FA - Ballantyne, Jane C IN - Nishimori, Mina. Department of Anesthesiology, University of Tokyo, Hongo, Bunkyo, Tokyo, Japan.Minansm@aol.com. TI - Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. [Review][Update in Cochrane Database Syst Rev. 2016;(1):CD005059; PMID: 26731032], [Update of Cochrane Database Syst Rev. 2006;(3):CD005059; PMID: 16856074] SO - Cochrane Database of Systematic Reviews. (7):CD005059, 2012 Jul 11 AS - Cochrane Database Syst Rev. (7):CD005059, 2012 Jul 11 NJ - The Cochrane database of systematic reviews IP - 7 PG - CD005059 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100909747 IO - Cochrane Database Syst Rev SB - Index Medicus CP - England MH - Adult MH - Analgesia, Epidural/ae [Adverse Effects] MH - *Analgesia, Epidural/mt [Methods] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Aorta, Abdominal/su [Surgery] MH - Cause of Death MH - Humans MH - Intubation, Intratracheal/sn [Statistics & Numerical Data] MH - Myocardial Infarction/pc [Prevention & Control] MH - Pain Management/mt [Methods] MH - Pain Measurement MH - *Pain, Postoperative/pc [Prevention & Control] MH - Postoperative Complications/mo [Mortality] MH - Randomized Controlled Trials as Topic MH - Respiration, Artificial/ut [Utilization] MH - Time Factors AB - BACKGROUND: Epidural analgesia offers greater pain relief compared to systemic opioid-based medications, but its effect on morbidity and mortality is unclear. This review was originally published in 2006 and was updated in 2011. AB - OBJECTIVES: To assess the benefits and harms of postoperative epidural analgesia in comparison with postoperative systemic opioid-based pain relief for adult patients who underwent elective abdominal aortic surgery. AB - SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 11) via Ovid; Ovid MEDLINE (from inception to week 1 November 2010); and EMBASE (from inception to week 1, November 2010). The original search was performed in 2004. We assessed non-English language reports and contacted researchers in the field. We did not seek unpublished data. AB - SELECTION CRITERIA: We included all randomized and quasi-randomized controlled trials comparing postoperative epidural analgesia and postoperative systemic opioid-based analgesia for adult patients who underwent elective open abdominal aortic surgery. AB - DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information and data. AB - MAIN RESULTS: We included 15 trials that involved 1297 patients (633 patients received epidural analgesia and 664 received systemic opioid analgesia) in this review. This included one trial we found in our updated search and one trial from our original review that had been awaiting translation. The epidural analgesia group showed significantly lower visual analogue scale scores for pain on movement (up to postoperative day three) regardless of the site of the epidural catheter and epidural formulation. The postoperative duration of tracheal intubation and mechanical ventilation was significantly shorter, by about 48%, in the epidural analgesia group. The overall event rates of myocardial infarction, acute respiratory failure (defined as an extended need for mechanical ventilation), gastrointestinal complications, and renal complications were significantly lower in the epidural analgesia group. AB - AUTHORS' CONCLUSIONS: Epidural analgesia provides better pain relief (especially during movement) in the period up to three postoperative days. It reduces the duration of postoperative tracheal intubation by roughly half. The occurrence of prolonged postoperative mechanical ventilation, myocardial infarction, gastric complications and renal complications was reduced by epidural analgesia. However, current evidence does not confirm the beneficial effect of epidural analgesia on postoperative mortality and other types of complications. RN - 0 (Analgesics, Opioid) ES - 1469-493X IL - 1361-6137 DO - https://dx.doi.org/10.1002/14651858.CD005059.pub3 PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Review ID - 10.1002/14651858.CD005059.pub3 [doi] PP - epublish LG - English EP - 20120711 DP - 2012 Jul 11 EZ - 2012/07/13 06:00 DA - 2012/09/22 06:00 DT - 2012/07/13 06:00 YR - 2012 ED - 20120921 RD - 20160602 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22786494 <482. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22404708 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kelley NE AU - Tepper DE FA - Kelley, Nancy E FA - Tepper, Deborah E IN - Kelley, Nancy E. Center for Headache and Pain, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA. TI - Rescue therapy for acute migraine, part 3: opioids, NSAIDs, steroids, and post-discharge medications. [Review] SO - Headache. 52(3):467-82, 2012 Mar AS - Headache. 52(3):467-82, 2012 Mar NJ - Headache VO - 52 IP - 3 PG - 467-82 PI - Journal available in: Print PI - Citation processed from: Internet JC - 2985091r, g1n IO - Headache SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use] MH - Humans MH - *Migraine Disorders/dt [Drug Therapy] MH - Patient Discharge MH - *Steroids/tu [Therapeutic Use] AB - OBJECTIVE: The final section of this 3-part review analyzes published reports involving the acute treatment of migraine with opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and steroids in the emergency department (ED), urgent care, and headache clinic settings, as well as post-discharge medications. In the Conclusion, there is a general discussion of all the therapies presented in the 3 sections. AB - METHOD: Using the terms ("migraine" AND "emergency") AND ("therapy" OR "treatment"), the author searched MEDLINE for reports from ED and urgent care settings that involved all routes of medication delivery. Reports from headache clinic settings were included only if medications were delivered by a parenteral route. AB - RESULTS: Seventy-five reports were identified that compared the efficacy and safety of multiple acute migraine medications for rescue. Of the medications reviewed in Part 3, opioids, NSAIDs, and steroids all demonstrated some effectiveness. When used alone, nalbuphine and metamizole were superior to placebo. NSAIDs were inferior to the combination of metoclopramide and diphenhydramine. Meperidine was arguably equivalent when compared with ketorolac and dihydroergotamine (DHE) but was inferior to chlorpromazine and equivalent to the other dopamine antagonists. Steroids afford some protection against headache recurrence after the patient leaves the treatment center. AB - CONCLUSIONS: All 3 opioids most frequently studied - meperidine, tramadol, and nalbuphine - were superior to placebo in relieving migraine pain, although meperidine combined with promethazine was not. Opioid side effects included dizziness, sedation, and nausea. With ketorolac being the most frequently studied drug in the class, NSAIDs were generally well tolerated, and they may provide benefit even when given late in the migraine attack. The rate of headache recurrence within 24-72 hours after discharge from the ED can be greater than 50%. Corticosteroids can be useful in reducing headache recurrence after discharge. As discussed in Parts 1, 2, and 3, there are effective medications for provider-administered "rescue" in all the classes discussed. Prochlorperazine and metoclopramide are the most frequently studied of the anti-migraine medications in the emergent setting, and their effectiveness is superior to placebo. Prochlorperazine is superior or equivalent to all other classes of medications in migraine pain relief. Although there are fewer studies involving sumatriptan and DHE, relatively "migraine-specific" medications, they appear to be equivalent to the dopamine antagonists for migraine pain relief. Lack of comparisons with placebo and the frequent use of combinations of medications in treatment arms complicate the comparison of single agents to one another. When used alone, prochlorperazine, promethazine, metoclopramide, nalbuphine, and metamizole were superior to placebo. Droperidol and prochlorperazine were superior or equal in efficacy to all other treatments, although they also are more likely to produce side effects that are difficult for a patient to tolerate (especially akathisia). Metoclopramide was equivalent to prochlorperazine, and, when combined with diphenhydramine, was superior in efficacy to triptans and NSAIDs. Meperidine was arguably equivalent when compared with ketorolac and DHE but was inferior to chlorpromazine and equivalent to the other neuroleptics. Sumatriptan was inferior or equivalent to the neuroleptics and equivalent to DHE when only paired comparisons were considered. The overall percentage of patients with pain relief after taking sumatriptan was equivalent to that observed with droperidol or prochlorperazine. Copyright © 2012 American Headache Society. RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 0 (Steroids) ES - 1526-4610 IL - 0017-8748 DO - https://dx.doi.org/10.1111/j.1526-4610.2012.02097.x PT - Journal Article PT - Review ID - 10.1111/j.1526-4610.2012.02097.x [doi] PP - ppublish LG - English DP - 2012 Mar EZ - 2012/03/13 06:00 DA - 2012/09/18 06:00 DT - 2012/03/13 06:00 YR - 2012 ED - 20120917 RD - 20120312 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22404708 <483. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21478291 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Al-Sohaim SI AU - Awang R AU - Zyoud SH AU - Rashid SM AU - Hashim S FA - Al-Sohaim, Sulaiman I FA - Awang, Rahmat FA - Zyoud, Sa'ed H FA - Rashid, Sazaroni M D FA - Hashim, Sirajuddin IN - Al-Sohaim, Sulaiman I. WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia. TI - Evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia. SO - Human & Experimental Toxicology. 31(3):274-81, 2012 Mar AS - Hum Exp Toxicol. 31(3):274-81, 2012 Mar NJ - Human & experimental toxicology VO - 31 IP - 3 PG - 274-81 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aql, 9004560 IO - Hum Exp Toxicol SB - Index Medicus CP - England MH - *Antidotes/sd [Supply & Distribution] MH - Cross-Sectional Studies MH - *Emergency Service, Hospital/og [Organization & Administration] MH - Emergency Treatment MH - Health Care Surveys/sn [Statistics & Numerical Data] MH - *Health Care Surveys MH - *Health Services Accessibility MH - Humans MH - Malaysia MH - *Poison Control Centers MH - *Poisoning/th [Therapy] AB - INTRODUCTION: The availability of antidotes may be considered essential and lifesaving in the management of certain poisonings. Surveys carried out in a number of countries have demonstrated inadequate availability of a variety of poisoning antidotes. AB - OBJECTIVES: The purpose of this study was to determine the availability of antidote stocking at hospitals, based on published guidelines for antidote stocking, and to evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia. AB - METHODS: A questionnaire on the availability of antidotes was sent to all government accident and emergency departments in Malaysia. The list of commonly required antidotes and essential drugs was compiled from published guidelines. Collected data were analysed in SPSS version 16 using descriptive and comparative analysis. AB - RESULTS: The response rate was 59.06%. None of the responding hospitals stocked all of the antidotes on the lists. In relation to hospital type, there was great variability in the availability of antidotes (there were significant differences between hospitals for 13 antidotes). The availabilities of most antidotes were far better in the General Hospitals and the District Hospitals with specialists compared to District Hospitals without specialists. Calcium gluconate, sodium bicarbonate, atropine sulphate, naloxone, flumazenil, vitamin K, and pyridoxine were available at all general hospitals. Atropine sulphate and naloxone were available at all district hospitals with specialists. AB - CONCLUSION: Most Malaysian government hospitals stocked some important antidotes. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions. Coordination between Malaysian hospitals and the National Poison Centre at Universiti Sains Malaysia is also important. RN - 0 (Antidotes) ES - 1477-0903 IL - 0960-3271 DO - https://dx.doi.org/10.1177/0960327111405861 PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 0960327111405861 [pii] ID - 10.1177/0960327111405861 [doi] PP - ppublish LG - English EP - 20110408 DP - 2012 Mar EZ - 2011/04/12 06:00 DA - 2012/09/05 06:00 DT - 2011/04/12 06:00 YR - 2012 ED - 20120904 RD - 20120511 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21478291 <484. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22086815 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Deyo RA AU - Smith DH AU - Johnson ES AU - Donovan M AU - Tillotson CJ AU - Yang X AU - Petrik AF AU - Dobscha SK FA - Deyo, Richard A FA - Smith, David H M FA - Johnson, Eric S FA - Donovan, Marilee FA - Tillotson, Carrie J FA - Yang, Xiuhai FA - Petrik, Amanda F FA - Dobscha, Steven K IN - Deyo, Richard A. Department of Family Medicine, Oregon Health and Science University, Portland, OR 972329, USA. deyor@ohsu.edu TI - Opioids for back pain patients: primary care prescribing patterns and use of services. SO - Journal of the American Board of Family Medicine: JABFM. 24(6):717-27, 2011 Nov-Dec AS - J Am Board Fam Med. 24(6):717-27, 2011 Nov-Dec NJ - Journal of the American Board of Family Medicine : JABFM VO - 24 IP - 6 PG - 717-27 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101256526 IO - J Am Board Fam Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855548 OI - Source: NLM. NIHMS529091 SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Back Pain/co [Complications] MH - *Back Pain/dt [Drug Therapy] MH - *Drug Utilization/sn [Statistics & Numerical Data] MH - Electronic Health Records MH - Emergency Medical Services/ut [Utilization] MH - Female MH - Health Records, Personal MH - Humans MH - Hypnotics and Sedatives/tu [Therapeutic Use] MH - Life Style MH - Logistic Models MH - Male MH - Managed Care Programs MH - Mental Disorders/co [Complications] MH - Middle Aged MH - Patient Safety MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Primary Health Care/sn [Statistics & Numerical Data] MH - *Primary Health Care/ut [Utilization] MH - Stress, Psychological AB - BACKGROUND: Opioid prescribing for noncancer pain has increased dramatically. We examined whether the prevalence of unhealthy lifestyles, psychologic distress, health care utilization, and co-prescribing of sedative-hypnotics increased with increasing duration of prescription opioid use. AB - METHODS: We analyzed electronic data for 6 months before and after an index visit for back pain in a managed care plan. Use of opioids was characterized as "none," "acute" (<=90 days), "episodic," or "long term." Associations with lifestyle factors, psychologic distress, and utilization were adjusted for demographics and comorbidity. AB - RESULTS: There were 26,014 eligible patients. Of these, 61% received a course of opioids, and 19% were long-term users. Psychologic distress, unhealthy lifestyles, and utilization were associated incrementally with duration of opioid prescription, not just with chronic use. Among long-term opioid users, 59% received only short-acting drugs; 39% received both long- and short-acting drugs; and 44% received a sedative-hypnotic. Of those with any opioid use, 36% had an emergency visit. AB - CONCLUSIONS: Prescription of opioids was common among patients with back pain. The prevalence of psychologic distress, unhealthy lifestyles, and health care utilization increased incrementally with duration of use. Coprescribing sedative-hypnotics was common. These data may help in predicting long-term opioid use and improving the safety of opioid prescribing. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) ES - 1558-7118 IL - 1557-2625 DO - https://dx.doi.org/10.3122/jabfm.2011.06.100232 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 24/6/717 [pii] ID - 10.3122/jabfm.2011.06.100232 [doi] ID - PMC3855548 [pmc] ID - NIHMS529091 [mid] PP - ppublish GI - No: UL1 RR024140 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English DP - 2011 Nov-Dec EZ - 2011/11/17 06:00 DA - 2012/08/21 06:00 DT - 2011/11/17 06:00 YR - 2011 ED - 20120820 RD - 20161025 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22086815 <485. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22506940 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Birnbaum A AU - Schechter C AU - Tufaro V AU - Touger R AU - Gallagher EJ AU - Bijur P FA - Birnbaum, Adrienne FA - Schechter, Clyde FA - Tufaro, Virginia FA - Touger, Rebecca FA - Gallagher, E John FA - Bijur, Polly IN - Birnbaum, Adrienne. Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. adrienne.birnbaum@nbhn.net TI - Efficacy of patient-controlled analgesia for patients with acute abdominal pain in the emergency department: a randomized trial. SO - Academic Emergency Medicine. 19(4):370-7, 2012 Apr AS - Acad Emerg Med. 19(4):370-7, 2012 Apr NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 19 IP - 4 PG - 370-7 PI - Journal available in: Print PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - *Abdominal Pain/dt [Drug Therapy] MH - Adolescent MH - Adult MH - Aged MH - *Analgesia, Patient-Controlled/mt [Methods] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analysis of Variance MH - Area Under Curve MH - Emergency Service, Hospital MH - Female MH - Humans MH - Linear Models MH - Male MH - Middle Aged MH - *Morphine/ad [Administration & Dosage] MH - Pain Management MH - Pain Measurement MH - Patient Satisfaction AB - OBJECTIVES: The objective was to assess the efficacy of patient-controlled analgesia (PCA) in the emergency department (ED) and to compare two PCA dosing regimens. AB - METHODS: A randomized controlled trial with three treatment arms was performed in an urban ED. A convenience sample of ED patients ages 18 to 65 years with abdominal pain of 7 days or less duration requiring intravenous (IV) opioid analgesia was enrolled between April 2009 and June 2010. All patients received an initial dose of 0.1 mg/kg IV morphine followed by physician-managed analgesia as needed. Patients in the PCA arms also received IV morphine with on-demand doses of 1 or 1.5 mg, with a 6-minute lockout between doses. Pain intensity was rated by patients on an 11-point numeric rating scale (NRS). Satisfaction with pain treatment, desire for the same treatment in the future, and need for additional analgesia were assessed at study end. Adverse events (O(2) sat < 92%, respiratory rate [RR] < 10/min, systolic blood pressure [sBP] < 90 mm Hg, and naloxone use) were counted. One-way analysis of variance was used to test the difference among groups in short-term pain relief, as assessed by mean change in NRS pain intensity from baseline to 30 minutes and pain over the entire 2-hour study period measured by area under the curve (AUC) of NRS pain ratings. A post hoc hierarchical linear model was used to test the observed difference in NRS between the groups between 30 and 120 minutes. AB - RESULTS: A total of 211 patients were enrolled. A sharp, nearly identical decline in mean NRS scores occurred from baseline to 30 minutes in the three groups (p = 0.82). Between 30 and 120 minutes, there was little further decline in the non-PCA NRS scores, while both PCA groups continued to decline (p = 0.004). The net treatment effect over the entire 2 hours was smallest in the non-PCA group and largest in the group receiving 1.5 mg of morphine (p = 0.06). The mean decline in pain from baseline to 120 minutes postbaseline in both PCA groups was 1.4 NRS units (95% confidence interval [CI] = 0.3 to 2.4) greater than the decline in patients treated without PCA. More patients in the PCA arms reported satisfaction, wanting the same pain management in the future, and not wanting further analgesics at 120 minutes than patients who did not receive PCA. There were no clinically or statistically significant differences in any outcomes between the two PCA groups. One PCA patient had a transient oxygen saturation of 88% after the initial bolus only, and one non-PCA patient had a brief drop in sBP to 87 mm Hg. AB - CONCLUSIONS: This study provides support for efficacy of PCA when applied to the ED setting. Future studies designed to assess implementation of this modality in the context of conditions of actual ED staffing and competing patient demands are warranted. Copyright © 2012 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/j.1553-2712.2012.01322.x PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural ID - 10.1111/j.1553-2712.2012.01322.x [doi] PP - ppublish SI - ClinicalTrials.gov SA - ClinicalTrials.gov/NCT00910208 SL - https://clinicaltrials.gov/search/term=NCT00910208 GI - No: 1R21NR010929 Organization: (NR) *NINR NIH HHS* Country: United States LG - English DP - 2012 Apr EZ - 2012/04/18 06:00 DA - 2012/08/14 06:00 DT - 2012/04/18 06:00 YR - 2012 ED - 20120813 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22506940 <486. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22445292 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fanciullo GJ FA - Fanciullo, Gilbert J IN - Fanciullo, Gilbert J. Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA. gilbert.j.fanciullo@hitchcock.org TI - Who receives opioids for acute pain in emergency departments? Considering evidence, patient and provider preferences. CM - Comment in: Pain. 2012 Nov;153(11):2300-1; PMID: 22947223 CM - Comment on: Pain. 2012 May;153(5):967-73; PMID: 22386895 SO - Pain. 153(5):941-2, 2012 May AS - Pain. 153(5):941-2, 2012 May NJ - Pain VO - 153 IP - 5 PG - 941-2 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - opf, 7508686 IO - Pain SB - Index Medicus CP - United States MH - *Acute Pain/dt [Drug Therapy] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Utilization MH - Female MH - Humans MH - Male MH - *Practice Patterns, Physicians' RN - 0 (Analgesics, Opioid) ES - 1872-6623 IL - 0304-3959 DO - https://dx.doi.org/10.1016/j.pain.2012.02.038 PT - Comment PT - Journal Article ID - S0304-3959(12)00133-9 [pii] ID - 10.1016/j.pain.2012.02.038 [doi] PP - ppublish PH - 2012/01/25 [received] PH - 2012/02/14 [revised] PH - 2012/02/27 [accepted] LG - English EP - 20120324 DP - 2012 May EZ - 2012/03/27 06:00 DA - 2012/08/14 06:00 DT - 2012/03/27 06:00 YR - 2012 ED - 20120813 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22445292 <487. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22386895 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Platts-Mills TF AU - Hunold KM AU - Bortsov AV AU - Soward AC AU - Peak DA AU - Jones JS AU - Swor RA AU - Lee DC AU - Domeier RM AU - Hendry PL AU - Rathlev NK AU - McLean SA FA - Platts-Mills, Timothy F FA - Hunold, Katie M FA - Bortsov, Andrey V FA - Soward, April C FA - Peak, David A FA - Jones, Jeffrey S FA - Swor, Robert A FA - Lee, David C FA - Domeier, Robert M FA - Hendry, Phyllis L FA - Rathlev, Niels K FA - McLean, Samuel A IN - Platts-Mills, Timothy F. Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599-7010, USA. tplattsm@med.unc.edu TI - More educated emergency department patients are less likely to receive opioids for acute pain. CM - Comment in: Pain. 2012 Nov;153(11):2300-1; PMID: 22947223 CM - Comment in: Pain. 2012 May;153(5):941-2; PMID: 22445292 SO - Pain. 153(5):967-73, 2012 May AS - Pain. 153(5):967-73, 2012 May NJ - Pain VO - 153 IP - 5 PG - 967-73 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - opf, 7508686 IO - Pain PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334443 OI - Source: NLM. NIHMS350350 SB - Index Medicus CP - United States MH - Accidents, Traffic MH - *Acute Pain/dt [Drug Therapy] MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cross-Sectional Studies MH - *Drug Utilization MH - Educational Status MH - Emergency Service, Hospital MH - Female MH - Humans MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Pain Measurement MH - *Practice Patterns, Physicians' MH - Socioeconomic Factors MH - United States AB - Inadequate treatment of pain in United States emergency departments (EDs) is common, in part because of the limited and idiosyncratic use of opioids by emergency providers. This study sought to determine the relationship between patient socioeconomic characteristics and the likelihood that they would receive opioids during a pain-related ED visit. We conducted a cross-sectional analysis of ED data obtained as part of a multicenter study of outcomes after minor motor vehicle collision (MVC). Study patients were non-Hispanic white patients between the ages of 18 and 65 years who were evaluated and discharged home from 1 of 8 EDs in 4 states. Socioeconomic characteristics include educational attainment and income. Of 690 enrolled patients, the majority had moderate or severe pain (80%). Patients with higher education attainment had lower levels of pain, pain catastrophizing, perceived life threat, and distress. More educated patients were also less likely to receive opioids during their ED visit. Opioids were given to 54% of patients who did not complete high school vs 10% of patients with post-college education (chi(2) test P<.001). Differences in the frequency of opioid administration between patients with the lowest educational attainment (39%, 95% confidence interval 22% to 60%) and highest educational attainment (13%, 95% confidence interval 7% to 23%) remained after adjustment for age, sex, income, and pain severity (P=.01). In this sample of post-MVC ED patients, more educated patients were less likely to receive opioids. Further study is needed to assess the generalizability of these findings and to determine the reason for the difference. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1872-6623 IL - 0304-3959 DO - https://dx.doi.org/10.1016/j.pain.2012.01.013 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0304-3959(12)00014-0 [pii] ID - 10.1016/j.pain.2012.01.013 [doi] ID - PMC3334443 [pmc] ID - NIHMS350350 [mid] PP - ppublish PH - 2011/06/22 [received] PH - 2011/11/21 [revised] PH - 2012/01/11 [accepted] GI - No: UL1 TR000064 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: KL2 TR001109 Organization: (TR) *NCATS NIH HHS* Country: United States GI - No: R01 AR056328 Organization: (AR) *NIAMS NIH HHS* Country: United States GI - No: R01 AR056328-03 Organization: (AR) *NIAMS NIH HHS* Country: United States GI - No: UL1RR025747 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: UL1 RR025747 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: KL2 RR025746 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: KL2 RR025746-03 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English EP - 20120303 DP - 2012 May EZ - 2012/03/06 06:00 DA - 2012/08/14 06:00 DT - 2012/03/06 06:00 YR - 2012 ED - 20120813 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22386895 <488. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22191727 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Weber JM AU - Tataris KL AU - Hoffman JD AU - Aks SE AU - Mycyk MB FA - Weber, Joseph M FA - Tataris, Katie L FA - Hoffman, Joyce D FA - Aks, Steven E FA - Mycyk, Mark B IN - Weber, Joseph M. Department of Emergency Medicine, Cook County Hospital, Chicago, IL 60612, USA. josephmweber@yahoo.com TI - Can nebulized naloxone be used safely and effectively by emergency medical services for suspected opioid overdose?. SO - Prehospital Emergency Care. 16(2):289-92, 2012 Apr-Jun AS - Prehosp Emerg Care. 16(2):289-92, 2012 Apr-Jun NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 16 IP - 2 PG - 289-92 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Administration, Inhalation MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/po [Poisoning] MH - Cohort Studies MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/mt [Methods] MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Nebulizers and Vaporizers MH - Opioid-Related Disorders/dt [Drug Therapy] MH - Retrospective Studies MH - Risk Assessment MH - Safety Management MH - Treatment Outcome MH - Young Adult AB - BACKGROUND: Emergency medical services (EMS) traditionally administer naloxone using a needle. Needleless naloxone may be easier when intravenous (IV) access is difficult and may decrease occupational blood-borne exposure in this high-risk population. Several studies have examined intranasal naloxone, but nebulized naloxone as an alternative needleless route has not been examined in the prehospital setting. AB - OBJECTIVE: We sought to determine whether nebulized naloxone can be used safely and effectively by prehospital providers for patients with suspected opioid overdose. AB - METHODS: We performed a retrospective analysis of all consecutive cases administered nebulized naloxone from January 1 to June 30, 2010, by the Chicago Fire Department. All clinical data were entered in real time into a structured EMS database and data abstraction was performed in a systematic manner. Included were cases of suspected opioid overdose, altered mental status, and respiratory depression; excluded were cases where nebulized naloxone was given for opioid-triggered asthma and cases with incomplete outcome data. The primary outcome was patient response to nebulized naloxone. Secondary outcomes included need for rescue naloxone (IV or intramuscular), need for assisted ventilation, and adverse antidote events. Kappa interrater reliability was calculated and study data were analyzed using descriptive statistics. AB - RESULTS: Out of 129 cases, 105 met the inclusion criteria. Of these, 23 (22%) had complete response, 62 (59%) had partial response, and 20 (19%) had no response. Eleven cases (10%) received rescue naloxone, no case required assisted ventilation, and no adverse events occurred. The kappa score was 0.993. AB - CONCLUSION: Nebulized naloxone is a safe and effective needleless alternative for prehospital treatment of suspected opioid overdose in patients with spontaneous respirations. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2011.640763 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.3109/10903127.2011.640763 [doi] PP - ppublish LG - English EP - 20111222 DP - 2012 Apr-Jun EZ - 2011/12/24 06:00 DA - 2012/07/03 06:00 DT - 2011/12/24 06:00 YR - 2012 ED - 20120702 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22191727 <489. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22354400 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lassen CL AU - Zink W AU - Wiese CH AU - Graf BM AU - Wiesenack C FA - Lassen, C L FA - Zink, W FA - Wiese, C H R FA - Graf, B M FA - Wiesenack, C IN - Lassen, C L. Klinik fur Anasthesiologie, Universitatsklinikum Regensburg, Deutschland. christoph.lassen@klinik.uni-regensburg.de TI - [Naloxone-induced pulmonary edema. Case report with review of the literature and critical evaluation]. [German] OT - Naloxoninduziertes Lungenodem. Fallbericht mit Literaturubersicht und kritischer Bewertung. SO - Anaesthesist. 61(2):129-36, 2012 Feb AS - Anaesthesist. 61(2):129-36, 2012 Feb NJ - Der Anaesthesist VO - 61 IP - 2 PG - 129-36 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Adolescent MH - Airway Obstruction/et [Etiology] MH - Airway Obstruction/th [Therapy] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/ai [Antagonists & Inhibitors] MH - Drug Overdose MH - Echocardiography MH - Fluid Therapy MH - Humans MH - Laparoscopy MH - Male MH - *Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - Oxygen/bl [Blood] MH - Platelet Count MH - Positive-Pressure Respiration MH - *Pulmonary Edema/ci [Chemically Induced] MH - Pulmonary Edema/dg [Diagnostic Imaging] MH - Pulmonary Edema/th [Therapy] MH - Purpura, Thrombocytopenic, Idiopathic/su [Surgery] MH - Radiography MH - Respiration, Artificial MH - Respiratory Function Tests MH - Splenectomy AB - A case of pulmonary edema after the administration of naloxone for laparoscopic splenectomy is reported. Previous reports of naloxone-induced pulmonary edema are listed and reviewed. The clinical course is compared to other forms of non-cardiogenic pulmonary edema. Uncertainty remains about the underlying pathophysiological process and the true impact of naloxone on the development of pulmonary edema. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - S88TT14065 (Oxygen) ES - 1432-055X IL - 0003-2417 DO - https://dx.doi.org/10.1007/s00101-012-1982-8 PT - Case Reports PT - Journal Article ID - 10.1007/s00101-012-1982-8 [doi] PP - ppublish PH - 2011/08/31 [received] PH - 2012/01/04 [accepted] PH - 2011/12/30 [revised] LG - German EP - 20120223 DP - 2012 Feb EZ - 2012/02/23 06:00 DA - 2012/06/29 06:00 DT - 2012/02/23 06:00 YR - 2012 ED - 20120628 RD - 20170916 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22354400 <490. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22268775 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Buse DC AU - Pearlman SH AU - Reed ML AU - Serrano D AU - Ng-Mak DS AU - Lipton RB FA - Buse, Dawn C FA - Pearlman, Starr H FA - Reed, Michael L FA - Serrano, Daniel FA - Ng-Mak, Daisy S FA - Lipton, Richard B IN - Buse, Dawn C. Albert Einstein College of Medicine, Bronx, NY, USA. dbuse@montefiore.org TI - Opioid use and dependence among persons with migraine: results of the AMPP study. SO - Headache. 52(1):18-36, 2012 Jan AS - Headache. 52(1):18-36, 2012 Jan NJ - Headache VO - 52 IP - 1 PG - 18-36 PI - Journal available in: Print PI - Citation processed from: Internet JC - 2985091r, g1n IO - Headache SB - Index Medicus CP - United States MH - Adult MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analysis of Variance MH - Anxiety Disorders/ep [Epidemiology] MH - Body Mass Index MH - Comorbidity MH - Cross-Sectional Studies MH - Depressive Disorder/ep [Epidemiology] MH - Disability Evaluation MH - Female MH - Humans MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Migraine Disorders/dt [Drug Therapy] MH - Migraine Disorders/ep [Epidemiology] MH - Migraine Disorders/px [Psychology] MH - *Migraine Disorders MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Pain Measurement MH - Prevalence MH - Psychiatric Status Rating Scales MH - Regression Analysis MH - Retrospective Studies MH - Surveys and Questionnaires AB - OBJECTIVE: To assess the frequency of opioid use for acute migraine treatment and characterize use groups by sociodemographics, health-care resource utilization (HRU), comorbidities and probable dependence within a large, US population-based sample of persons with migraine. AB - BACKGROUND: Opioids are used in the acute treatment of migraine. However, their use is controversial. AB - METHODS: Data from the 2009 American Migraine Prevalence and Prevention (AMPP) study were used to categorize persons with migraine into 4 groups based on reported opioid use: nonusers (between 2005 and 2009), previous users (history of use between 2005 and 2008 but no-use in 2009), and current opioid users (those reporting use of opioids in the 3 months preceding the 2009 American Migraine Prevalence and Prevention survey). Current opioid users were divided into nondependent and probable dependence users according to criteria for dependence adapted for inclusion in the survey from the Diagnostic and Statistical Manual of Mental Disorders-4th edition. All opioid-use groups were contrasted by sociodemographics, headache characteristics, medical and psychiatric comorbidities (depression [measured by the Patient Health Questionnaire-9], anxiety [measured by the Primary Care Evaluation of Mental Health Disorders, PRIME-MD], and cardiovascular events and risk factors), and headache-related HRU. AB - RESULTS: In a sample of 5796 migraineurs, 4076 (70.3%) were opioid nonusers, 798 (13.8%) were previous users, and 922 (15.9%) were current opioid users. Among current opioid users, 153 (16.6%) met criteria for probable dependence and 769 (83.4%) did not. Headache-related disability (Migraine Disability Assessment sum scores) increased across groups as follows: nonusers: 7.8, previous users: 13.3, current nondependent users: 19.1, and current probable dependence users: 44.4, as did monthly headache frequency: nonusers: 3.2 days/month, previous users: 4.3 days/month, current nondependent users: 5.6 days/month, and current probable dependence users: 8.6 days/month. The prevalence of depression and anxiety was highest among current users with probable dependence. Rates of headache-related HRU were higher for all opioid-use groups for emergency department/urgent care, primary care, and specialty care visits compared to nonusers. AB - CONCLUSIONS: Opioid use for migraine is associated with more severe headache-related disability, symptomology, comorbidities (depression, anxiety, and cardiovascular disease and events), and greater HRU for headache. Longitudinal studies are needed to further assess the directionality and causality between opioid use and the outcomes we examined. Copyright © 2011 American Headache Society. RN - 0 (Analgesics, Opioid) ES - 1526-4610 IL - 0017-8748 DO - https://dx.doi.org/10.1111/j.1526-4610.2011.02050.x PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1111/j.1526-4610.2011.02050.x [doi] PP - ppublish LG - English DP - 2012 Jan EZ - 2012/01/25 06:00 DA - 2012/06/07 06:00 DT - 2012/01/25 06:00 YR - 2012 ED - 20120606 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22268775 <491. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21592273 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Harlow W AU - Happell B AU - Browne G FA - Harlow, Warren FA - Happell, Brenda FA - Browne, Graeme IN - Harlow, Warren. Institute for Health and Social Science Research, CQUniversity Australia, Rockhampton, Australia. TI - Opioid replacement therapy: a wait unmanaged. SO - International Journal of Mental Health Nursing. 20(6):418-27, 2011 Dec AS - Int J Ment Health Nurs. 20(6):418-27, 2011 Dec NJ - International journal of mental health nursing VO - 20 IP - 6 PG - 418-27 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101140527 IO - Int J Ment Health Nurs SB - Nursing Journal CP - Australia MH - Adolescent MH - Adult MH - Australia/ep [Epidemiology] MH - Child MH - Emergency Service, Hospital MH - Female MH - Health Services Needs and Demand/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Mental Health Services MH - Middle Aged MH - *Opiate Substitution Treatment/sn [Statistics & Numerical Data] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Practice Guidelines as Topic MH - Triage MH - *Waiting Lists MH - Young Adult AB - There has been a rapid increase in members of the Australian population using opioids in recent years. The flow-on effect has been an increase in demand for treatments, particularly opioid replacement therapy (ORT), but the availability of treatments has not increased. This has frequently resulted in delays before treatment can be commenced. Outcomes could improve if health-care professionals had clearer guidelines on how to prioritize access to ORT. This review investigates the triage of consumers in ORT within Australia. Information on triage in ORT was not available, and an understanding of how consumer needs are managed when they present for ORT triage was not identified. In the absence of research to guide this practice, the body of evidence regarding ORT treatment access is weighted on government policies. Triage, as applied in general health and mental health-care service delivery, was reviewed to consider the components of triage and how these might pertain to triage in ORT. Failure to facilitate the needs of consumers accessing ORT can result in further harm to consumers and increased social and financial costs for society. Research is required to investigate how this issue is currently being managed and to lead the way for needed improvements in service delivery. Copyright © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc. ES - 1447-0349 IL - 1445-8330 DO - https://dx.doi.org/10.1111/j.1447-0349.2011.00748.x PT - Journal Article ID - 10.1111/j.1447-0349.2011.00748.x [doi] PP - ppublish LG - English EP - 20110518 DP - 2011 Dec EZ - 2011/05/20 06:00 DA - 2012/05/19 06:00 DT - 2011/05/20 06:00 YR - 2011 ED - 20120518 RD - 20120112 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21592273 <492. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21889123 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - van Rijn RM AU - Brissett DI AU - Whistler JL FA - van Rijn, Richard M FA - Brissett, Daniela I FA - Whistler, Jennifer L IN - van Rijn, Richard M. Ernest Gallo Clinic and Research Center, Department of Neurology, University of California San Francisco, Emeryville, California 94608, USA. TI - Emergence of functional spinal delta opioid receptors after chronic ethanol exposure. SO - Biological Psychiatry. 71(3):232-8, 2012 Feb 01 AS - Biol Psychiatry. 71(3):232-8, 2012 Feb 01 NJ - Biological psychiatry VO - 71 IP - 3 PG - 232-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - a3s, 0213264 IO - Biol. Psychiatry PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086708 OI - Source: NLM. NIHMS330233 SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/pd [Pharmacology] MH - Animals MH - Drug Administration Schedule MH - Ethanol/ad [Administration & Dosage] MH - *Ethanol/pd [Pharmacology] MH - Injections, Spinal MH - Mice MH - Mice, Knockout MH - Nociception/de [Drug Effects] MH - *Nociception/ph [Physiology] MH - Receptors, Opioid, delta/ag [Agonists] MH - Receptors, Opioid, delta/ai [Antagonists & Inhibitors] MH - Receptors, Opioid, delta/me [Metabolism] MH - *Receptors, Opioid, delta/ph [Physiology] MH - Receptors, Opioid, mu/ag [Agonists] MH - Receptors, Opioid, mu/ai [Antagonists & Inhibitors] MH - Receptors, Opioid, mu/ph [Physiology] MH - Spinal Cord/de [Drug Effects] MH - *Spinal Cord/me [Metabolism] MH - *Up-Regulation/de [Drug Effects] AB - BACKGROUND: The delta opioid receptor (DOR) is a promising target to treat multiple indications, including alcoholism, anxiety, and nonmalignant pain. The potential of the DORs has been underappreciated, in part, due to relatively low functional expression of these receptors in naive states. However, chronic exposure to stress, opioids, and inflammation can induce a redistribution of DORs to the cell surface where they can be activated. Previously, DORs were shown to be selectively/exclusively present in spinal cord circuits mediating mechanical sensitivity but not those mediating thermal nociception under naive conditions. AB - METHODS: We spinally administered DOR and mu opioid receptor (MOR) selective agonists ([D-Pen2,D-Pen5]-Enkephalin, deltorphin II, SNC80, and DAMGO) and antagonists (naltriben and CTAP) and determined thermal antinociception and mechanical sensitivity in wild-type mice or mice with a genetic disruption of DOR or MOR. Thermal antinociception was measured using a radiant heat tail-flick assay; mechanical sensitivity was measured using von Frey filaments. Dose response curves were generated in naive mice and mice exposed to ethanol in a model of voluntary consumption. AB - RESULTS: We show that prolonged exposure to ethanol can promote an upregulation of functional DORs in the spinal cord in thermal pain-mediating circuits but not in those mediating mechanical sensitivity. The upregulated DORs either modulate MOR-mediated analgesia through convergence of circuits or signal transduction pathways and/or interact directly with MORs to form a new functional (heteromeric) unit. AB - CONCLUSIONS: Our findings suggest that DORs could be a novel target in conditions in which DORs are redistributed. Copyright © 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Receptors, Opioid, delta) RN - 0 (Receptors, Opioid, mu) RN - 3K9958V90M (Ethanol) ES - 1873-2402 IL - 0006-3223 DO - https://dx.doi.org/10.1016/j.biopsych.2011.07.015 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. ID - S0006-3223(11)00739-6 [pii] ID - 10.1016/j.biopsych.2011.07.015 [doi] ID - PMC4086708 [pmc] ID - NIHMS330233 [mid] PP - ppublish PH - 2011/03/14 [received] PH - 2011/07/06 [revised] PH - 2011/07/07 [accepted] GI - No: P50 AA017072-03 Organization: (AA) *NIAAA NIH HHS* Country: United States GI - No: DA019958 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA015232 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 AA020401 Organization: (AA) *NIAAA NIH HHS* Country: United States GI - No: R01 DA019958 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA019958-05 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: 5 P50 AA017072-03 Organization: (AA) *NIAAA NIH HHS* Country: United States GI - No: R01 DA015232-07 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: P50 AA017072 Organization: (AA) *NIAAA NIH HHS* Country: United States LG - English EP - 20110901 DP - 2012 Feb 01 EZ - 2011/09/06 06:00 DA - 2012/05/15 06:00 DT - 2011/09/06 06:00 YR - 2012 ED - 20120514 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21889123 <493. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21335578 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Simon LJ AU - Bizamcer AN AU - Lidz CW AU - Stefan S AU - Pletcher MJ FA - Simon, Lorna J FA - Bizamcer, Aurelia N FA - Lidz, Charles W FA - Stefan, Susan FA - Pletcher, Mark J IN - Simon, Lorna J. Center for Mental Health Services Research, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, Massachusetts 01655, USA. lorna.simon@umassmed.edu TI - Disparities in opioid prescribing for patients with psychiatric diagnoses presenting with pain to the emergency department. SO - Emergency Medicine Journal. 29(3):201-4, 2012 Mar AS - Emerg Med J. 29(3):201-4, 2012 Mar NJ - Emergency medicine journal : EMJ VO - 29 IP - 3 PG - 201-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J SB - Index Medicus CP - England MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Healthcare Disparities/sn [Statistics & Numerical Data] MH - Humans MH - *Mental Disorders MH - Multivariate Analysis MH - *Pain/dt [Drug Therapy] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - United States AB - BACKGROUND: The goal of this investigation is to discover whether or not patients with psychiatric diagnoses are less likely to be prescribed opioids for pain in emergency departments compared with other patients. AB - METHODS: Pain-related visits to US emergency departments were identified using reason-for-visit and physician diagnosis codes for 13 years (1993-2005) of the National Hospital Ambulatory Medical Care Survey. The outcome measure was the prescription or administration of an opioid analgesic. AB - RESULTS: Roughly 10 million pain-related visits were made by persons with psychiatric diagnoses in the USA between 1993 and 2005. Across all years, only 18% (95% CI 16 to 20) of pain-related visits by patients with psychiatric diagnoses resulted in an opioid prescription, whereas 33% (95% CI 32 to 34) of visits by other patients did. Lower prescription rates for patients with psychiatric diagnoses were seen for every year of the survey and this difference occurred at every level of pain severity. Controlling for confounding factors did not attenuate this difference. In a multivariate model, patients with psychiatric diagnoses were about half as likely as other patients to be prescribed opiates (adjusted OR 0.49; 95% CI 0.44 to 0.56). Major limitations of the study include the uncertain precision of psychiatric and drug/alcohol diagnoses and the lack of detail about each patient visit. AB - CONCLUSION: Having a psychiatric diagnosis was associated with a lower likelihood of receiving an opioid among persons presenting with pain to the ED. RN - 0 (Analgesics, Opioid) ES - 1472-0213 IL - 1472-0205 DO - https://dx.doi.org/10.1136/emj.2010.097949 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. ID - emj.2010.097949 [pii] ID - 10.1136/emj.2010.097949 [doi] PP - ppublish LG - English EP - 20110218 DP - 2012 Mar EZ - 2011/02/22 06:00 DA - 2012/05/10 06:00 DT - 2011/02/22 06:00 YR - 2012 ED - 20120509 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21335578 <494. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21971434 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Futier E AU - Chanques G AU - Cayot Constantin S AU - Vernis L AU - Barres A AU - Guerin R AU - Chartier C AU - Perbet S AU - Petit A AU - Jabaudon M AU - Bazin JE AU - Constantin JM FA - Futier, E FA - Chanques, G FA - Cayot Constantin, S FA - Vernis, L FA - Barres, A FA - Guerin, R FA - Chartier, C FA - Perbet, S FA - Petit, A FA - Jabaudon, M FA - Bazin, J E FA - Constantin, J M IN - Futier, E. General ICU, Estaing Hospital, University Hospital of Clermont-Ferrand, France. TI - Influence of opioid choice on mechanical ventilation duration and ICU length of stay. CM - Comment in: Minerva Anestesiol. 2012 Jan;78(1):7-9; PMID: 22237788 SO - Minerva Anestesiologica. 78(1):46-53, 2012 Jan AS - Minerva Anestesiol. 78(1):46-53, 2012 Jan NJ - Minerva anestesiologica VO - 78 IP - 1 PG - 46-53 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - n26, 0375272 IO - Minerva Anestesiol SB - Index Medicus CP - Italy MH - Adult MH - Aged MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Conscious Sedation MH - Data Collection MH - Female MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - Hypnotics and Sedatives/tu [Therapeutic Use] MH - *Intensive Care Units MH - Kaplan-Meier Estimate MH - Length of Stay MH - Male MH - Middle Aged MH - Nurses MH - Piperidines/tu [Therapeutic Use] MH - Prospective Studies MH - *Respiration, Artificial MH - Sufentanil/tu [Therapeutic Use] MH - Ventilator Weaning AB - BACKGROUND: The aim of this study was to assess the impact on mechanical ventilation and ICU outcomes of substituting remifentanil for sufentanil, in an analgesia-based sedation protocol. A database of data prospectively collected was retrospectively analyzed. The study was carried out in a 16-bed tertiary-care ICU. AB - METHODS: The study included 1544 mechanically ventilated patients admitted from January 2001 to December 2006. Patients were compared between two consecutive phases. Analgesia-based sedation guidelines were the same, except for the opiate used. The patient-to-nurse ratio (2.5) and ventilator weaning practices remained unchanged. 794 patients were included during the sufentanil phase, and 750 during the remifentanil phase. Remifentanil was associated with significantly less time spent on mechanical ventilation (10 days[3-21] vs. 14 days[3-27], P<0.01) and in the ICU (16 days[3-22] vs. 19 days[4-26], P<0.01). The difference was significant for patients ventilated no longer than four days (P=0.0035) but not for patients ventilated more than four days (P=0.058). Sedation target on the Ramsay scale was reached more often with remifentanil. The use and amount of hypnotic agents in addition to the opiate were significantly lower with remifentanil. The cost of analgesia-based sedation was similar in the sufentanil and the remifentanil group. AB - CONCLUSION: Our study suggests that using a short-acting opiate with short context-sensitive half-life in an analgesia-based sedation protocol may significantly decrease the duration of mechanical ventilation and the ICU length of stay even though not significantly in long term sedation, while improving the achievement of sedation goals despite a lower requirement for adjunctive hypnotic agents, with no additional costs. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 0 (Piperidines) RN - AFE2YW0IIZ (Sufentanil) RN - P10582JYYK (remifentanil) ES - 1827-1596 IL - 0375-9393 PT - Journal Article ID - R02116449 [pii] PP - ppublish LG - English EP - 20111105 DP - 2012 Jan EZ - 2011/10/06 06:00 DA - 2012/05/09 06:00 DT - 2011/10/06 06:00 YR - 2012 ED - 20120508 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21971434 <495. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21524031 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Raghuveer TS AU - Cox AJ FA - Raghuveer, Talkad S FA - Cox, Austin J IN - Raghuveer, Talkad S. Wesley Medical Center, Pediatrix Medical Group of Kansas, Wichita, USA. raghuveer.talkad3@gmail.com TI - Neonatal resuscitation: an update. [Review] SO - American Family Physician. 83(8):911-8, 2011 Apr 15 AS - Am Fam Physician. 83(8):911-8, 2011 Apr 15 NJ - American family physician VO - 83 IP - 8 PG - 911-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - 3bt, 1272646 IO - Am Fam Physician SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adrenergic Agonists/tu [Therapeutic Use] MH - Animals MH - Canada MH - Continuous Positive Airway Pressure MH - Epinephrine/tu [Therapeutic Use] MH - Evidence-Based Medicine MH - Humans MH - Hypothermia, Induced MH - *Hypoxia-Ischemia, Brain/pc [Prevention & Control] MH - Infant, Newborn MH - *Infant, Premature MH - Patient Care Team MH - *Positive-Pressure Respiration MH - Practice Guidelines as Topic MH - Premature Birth MH - Randomized Controlled Trials as Topic MH - Resuscitation/mt [Methods] MH - Resuscitation/st [Standards] MH - *Resuscitation MH - Resuscitation Orders MH - United States AB - Appropriate resuscitation must be available for each of the more than 4 million infants born annually in the United States. Ninety percent of infants transition safely, and it is up to the physician to assess risk factors, identify the nearly 10 percent of infants who need resuscitation, and respond appropriately. A team or persons trained in neonatal resuscitation should be promptly available to provide resuscitation. The Neonatal Resuscitation Program, which was initiated in 1987 to identify infants at risk of needing resuscitation and provide high-quality resuscitation, underwent major updates in 2006 and 2010. Among the most important changes are to not intervene with endotracheal suctioning in vigorous infants born through meconium-stained amniotic fluid (although endotracheal suctioning may be appropriate in nonvigorous infants); to provide positive pressure ventilation with one of three devices when necessary; to begin resuscitation of term infants using room air or blended oxygen; and to have a pulse oximeter readily available in the delivery room. The updated guidelines also provide indications for chest compressions and for the use of intravenous epinephrine, which is the preferred route of administration, and recommend not to use sodium bicarbonate or naloxone during resuscitation. Other recommendations include confirming endotracheal tube placement using an exhaled carbon dioxide detector; using less than 100 percent oxygen and adequate thermal support to resuscitate preterm infants; and using therapeutic hypothermia for infants born at 36 weeks' gestation or later with moderate to severe hypoxic-ischemic encephalopathy. RN - 0 (Adrenergic Agonists) RN - YKH834O4BH (Epinephrine) ES - 1532-0650 IL - 0002-838X PT - Journal Article PT - Review ID - d8463 [pii] PP - ppublish LG - English DP - 2011 Apr 15 EZ - 2011/04/29 06:00 DA - 2012/05/01 06:00 DT - 2011/04/29 06:00 YR - 2011 ED - 20120430 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21524031 <496. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21923882 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pergolizzi JV Jr AU - Labhsetwar SA AU - Amy Puenpatom R AU - Ben-Joseph R AU - Ohsfeldt R AU - Summers KH FA - Pergolizzi, Joseph V Jr FA - Labhsetwar, Sumedha A FA - Amy Puenpatom, R FA - Ben-Joseph, Rami FA - Ohsfeldt, Robert FA - Summers, Kent H IN - Pergolizzi, Joseph V Jr. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jpjmd@msn.com TI - Economic impact of potential CYP450 pharmacokinetic drug-drug interactions among chronic low back pain patients taking opioids. SO - Pain Practice. 12(1):45-56, 2012 Jan AS - Pain pract.. 12(1):45-56, 2012 Jan NJ - Pain practice : the official journal of World Institute of Pain VO - 12 IP - 1 PG - 45-56 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101130835 IO - Pain Pract SB - Index Medicus CP - United States MH - Aged MH - *Analgesics, Opioid/ec [Economics] MH - Analgesics, Opioid/pk [Pharmacokinetics] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Cytochrome P-450 Enzyme System/me [Metabolism] MH - *Drug Interactions MH - Female MH - Health Services/ec [Economics] MH - Hospitalization/ec [Economics] MH - Humans MH - *Low Back Pain/dt [Drug Therapy] MH - *Low Back Pain/ec [Economics] MH - Male MH - Middle Aged MH - Office Visits/ec [Economics] MH - Retinoic Acid 4-Hydroxylase AB - Chronic low back pain (cLBP) patients who take at least 1 CYP450-metabolized opioid analgesic agent concurrent with at least 1 other CYP450-metabolized medication experience a drug-drug exposure (DDE), which puts them at risk for a pharmacokinetic drug-drug interaction (PK DDI). This study compared utilization of healthcare resources and associated payments in cLBP patients with and without incident DDEs with the potential to cause PK DDIs. A retrospective database analysis examined the associated clinical events, healthcare utilization (measured in terms of claims for office visits, outpatient visits, emergency department visits, and hospitalization), and cost to the health plan, as defined as the sum of health plan payments for resources used. Patients were grouped into 2 cohorts by age (those under 65 and those 65 years and over). In the 6 months after exposure, total healthcare payments were significantly higher for DDE patients than those without DDEs (no-DDE), in both in the younger ($7,086, SD = $8,370) and $6,353, SD = $8,352, respectively, P < 0.001) and the older cohorts ($7,806 vs. $7,043, respectively, P = 0.013). Younger and older patients with DDE had significantly higher prescription payments than those without DDE ($2,041, SD = $2,706 vs. $1,565, SD = $2,349, respectively, P < 0.001 for younger and $2,482, SD = $2,481 vs. $2,286, SD = $2,521, respectively, P = 0.044 for older patients). Both older and younger patients with DDE had significantly more claims for office visits and higher associated payments than similar patients without DDE. Patients in the study who experienced DDEs that placed them at risk for PK DDIs had significantly greater utilization rates of healthcare resources and higher associated payments in the 6-month observation period following exposure. Copyright © 2011 The Authors. Pain Practice © 2011 World Institute of Pain. RN - 0 (Analgesics, Opioid) RN - 9035-51-2 (Cytochrome P-450 Enzyme System) RN - EC 1-14-14-1 (Retinoic Acid 4-Hydroxylase) ES - 1533-2500 IL - 1530-7085 DO - https://dx.doi.org/10.1111/j.1533-2500.2011.00503.x PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1111/j.1533-2500.2011.00503.x [doi] PP - ppublish LG - English EP - 20110916 DP - 2012 Jan EZ - 2011/09/20 06:00 DA - 2012/04/28 06:00 DT - 2011/09/20 06:00 YR - 2012 ED - 20120427 RD - 20161125 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21923882 <497. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22149359 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bond GR AU - Ho M AU - Woodward RW FA - Bond, G Randall FA - Ho, Mona FA - Woodward, Randall W IN - Bond, G Randall. Division of Emergency Medicine, Cincinnati Childrens Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA. TI - Trends in hepatic injury associated with unintentional overdose of paracetamol (Acetaminophen) in products with and without opioid: an analysis using the National Poison Data System of the American Association of Poison Control Centers, 2000-7.[Erratum appears in Drug Saf. 2012 Feb 1;35(2):158] SO - Drug Safety. 35(2):149-57, 2012 Feb 01 AS - Drug Saf. 35(2):149-57, 2012 Feb 01 NJ - Drug safety VO - 35 IP - 2 PG - 149-57 PI - Journal available in: Print PI - Citation processed from: Internet JC - ahq, 9002928 IO - Drug Saf SB - Index Medicus CP - New Zealand MH - *Acetaminophen/ae [Adverse Effects] MH - *Analgesics, Non-Narcotic/ae [Adverse Effects] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Chemical and Drug Induced Liver Injury/ep [Epidemiology] MH - Chemical and Drug Induced Liver Injury/et [Etiology] MH - Drug Combinations MH - Drug Overdose MH - Humans MH - *Poison Control Centers/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Statistics as Topic MH - United States AB - BACKGROUND: Unintended hepatic injury associated with the use of paracetamol (acetaminophen)-containing products has been growing. AB - OBJECTIVE: The aim of the study was to seek a better understanding of the causes of this observation in order to evaluate the potential impact of proposed preventive measures. AB - STUDY DESIGN: Retrospective analysis of a large database containing prospectively collected patient exposure data, clinical symptomatology and outcome. AB - SETTING: The National Poison Data System database for 2000-7 involving exposures to paracetamol and an opioid was obtained and analysed. This dataset was limited to non-suicidal cases in patients 13 years of age and older. For comparison, the parallel, mutually exclusive dataset involving exposures to one or more non-opioid containing paracetamol products was analysed. AB - OUTCOME MEASURE: Trends in the numbers of patients exposed, treated, and mildly and severely injured were obtained and compared with each other and with trends calculated from publicly available data on sales and population. The association of injury with the number of paracetamol-containing products and the reason for taking them were also assessed. AB - RESULTS: Comparators: During the study period, the US population of those 15 years of age and over rose 8.5%; all pharmaceutical-related calls to all US poison centres rose 25%. For the 8-year period from 2001 to 2008, sales of over-the-counter paracetamol products rose 5% (single-ingredient products fell 3%; paracetamol-containing combination cough and cold products rose 11%) and prescription paracetamol combination products rose 67%. Opioids with paracetamol: A total of 119731 cases were identified, increasing 70% over the period. The exposure merited acetylcysteine treatment in 8995 cases (252% increase). In total, 2729 patients (2.3%) experienced some hepatic injury (500% increase). Minor injuries rose faster than severe injuries (833% vs 280%) and most injuries (73.0%) were from overuse of a single combination product only, but the injury rate increased with use of more than one paracetamol-containing product. Abuse and misuse accounted for 34% of cases but 58% of the severe injuries. Paracetamol without opioid: A total of 126830 cases were identified, increasing 44%, and 15706 cases merited acetylcysteine (70% increase). A total of 4674 patients (3.7%) experienced some hepatic injury (134% increase). [corrected] Use of more than one non-opioid paracetamol product occurred in 7.3% of patients and was associated with a lower injury rate. AB - CONCLUSIONS: Hepatic injury associated with paracetamol use is increasing significantly faster than population, paracetamol product sales and poison centre use. This suggests a growing portion of consumers is self-dosing paracetamol beyond the toxic threshold. This is true for paracetamol with and without opioids, but the increase in hepatic injury is greater when paracetamol is taken with an opioid. This disproportionate rise is greatest with misuse and abuse of paracetamol products in combination with opioids. Increasing self-dosage of the opioid combination products for the opioid effect is likely to result in more cases of toxic exposure to paracetamol. In contrast, cases of exposure to paracetamol-containing cough and cold products are underrepresented among those injured. In the absence of opioid-containing products, consumption of more than one paracetamol-containing product did not contribute to injury. Efforts to modulate unintentional paracetamol-related hepatic injury should consider these associations. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 0 (Drug Combinations) RN - 362O9ITL9D (Acetaminophen) ES - 1179-1942 IL - 0114-5916 DO - https://dx.doi.org/10.2165/11595890-000000000-00000 PT - Journal Article ID - 10.2165/11595890-000000000-00000 [doi] PP - ppublish LG - English DP - 2012 Feb 01 EZ - 2011/12/14 06:00 DA - 2012/04/25 06:00 DT - 2011/12/14 06:00 YR - 2012 ED - 20120424 RD - 20171113 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22149359 <498. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21999707 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hoyle JD AU - Davis AT AU - Putman KK AU - Trytko JA AU - Fales WD FA - Hoyle, John D FA - Davis, Alan T FA - Putman, Kevin K FA - Trytko, Jeff A FA - Fales, William D IN - Hoyle, John D. Emergency Department, Helen DeVos Children's Hospital/Michigan State University College of Human Medicine, Grand Rapids, Michigan 49503, USA. jdhoyle@hotmail.com TI - Medication dosing errors in pediatric patients treated by emergency medical services. SO - Prehospital Emergency Care. 16(1):59-66, 2012 Jan-Mar AS - Prehosp Emerg Care. 16(1):59-66, 2012 Jan-Mar NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 16 IP - 1 PG - 59-66 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Age Factors MH - Child MH - Child, Preschool MH - Confidence Intervals MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Health Care Surveys MH - Humans MH - Male MH - *Medication Errors/sn [Statistics & Numerical Data] MH - Michigan MH - *Patient-Centered Care/sn [Statistics & Numerical Data] MH - *Pediatrics/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - *Safety/sn [Statistics & Numerical Data] MH - Safety Management AB - BACKGROUND: Medication dosing errors occur in up to 17.8% of hospitalized children. There are limited data to describe pediatric medication errors by emergency medical services (EMS) paramedics. It has been shown that paramedics have infrequent encounters with pediatric patients. AB - OBJECTIVE: To characterize medication dosing errors in children treated by EMS. AB - METHODS: We studied patients aged <=11 years who were treated by paramedics from eight Michigan EMS agencies from January 2004 through March 2006. We defined a medication dosing error as >=20% deviation from the weight-appropriate dose, as determined by the patient's reported weight in the prehospital medical record or by use of the Broselow-Luten tape (BLT). We studied errors in administering six EMS medications commonly given to children: albuterol, atropine, dextrose, diphenhydramine, epinephrine, and naloxone. AB - RESULTS: There were 5,547 children aged <=11 years who were treated during the study period, of whom 230 (4.1%) received drugs and had a documented weight. These patients received a total of 360 medication administrations. Multiple drug administrations occurred in 73 cases. Medication dosing errors occurred in 125 of the 360 drug administrations (34.7%; 95% confidence interval [CI] 30.0, 39.8). Relative drug dosage errors (with 95% CI) were as follows: albuterol 23.3% (18.4, 29.1), atropine 48.8% (34.3, 63.5), diphenhydramine 53.8% (29.1, 76.8), and epinephrine 60.9% (49.9, 73.9). The mean error (+/- standard deviation) for intravenous/intraosseous 1:1000 epinephrine overdoses was 808% +/- 428%. The mean error (+/- standard deviation) for intravenous/intraosseous 1:1000 epinephrine underdoses was 35.5% +/- 27.4%. AB - CONCLUSIONS: Medications delivered in the prehospital care of children were frequently administered outside of the proper dose range when compared with patient weights recorded in the prehospital medical record. EMS systems should develop strategies to reduce pediatric medication dosing errors. ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2011.614043 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.3109/10903127.2011.614043 [doi] PP - ppublish LG - English EP - 20111014 DP - 2012 Jan-Mar EZ - 2011/10/18 06:00 DA - 2012/04/10 06:00 DT - 2011/10/18 06:00 YR - 2012 ED - 20120409 RD - 20130920 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21999707 <499. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21910605 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Feliu MH AU - Wellington C AU - Crawford RD AU - Wood M AU - Edwards L AU - Byrd G AU - Edwards CL FA - Feliu, Miriam H FA - Wellington, Chante FA - Crawford, Regina D FA - Wood, Mary FA - Edwards, Lekisha FA - Byrd, Goldie FA - Edwards, Christopher L IN - Feliu, Miriam H. Department of Psychiatry, Duke University, Durham, North Carolina 27705, USA. feliu001@mc.duke.edu TI - Opioid management and dependency among adult patients with sickle cell disease. SO - Hemoglobin. 35(5-6):485-94, 2011 AS - Hemoglobin. 35(5-6):485-94, 2011 NJ - Hemoglobin VO - 35 IP - 5-6 PG - 485-94 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - g57, 7705865 IO - Hemoglobin SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Anemia, Sickle Cell/co [Complications] MH - *Anemia, Sickle Cell/dt [Drug Therapy] MH - Anemia, Sickle Cell/px [Psychology] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/et [Etiology] MH - Pain Management MH - Pain Measurement MH - Young Adult AB - While pain is one of the most debilitating symptoms of sickle cell disease, narcotics remain an effective although controversial widely practiced intervention. Vaso-occlusive crises are the most common cause for seeking pharmacological treatment. The influence of stigmatization and pseudo addiction in emergency departments and outpatient clinics was reviewed. We analyzed patterns of narcotic utilization in a sample of 63 adult patients with sickle cell disease to determine if their psychological functioning and reports of pain differed as a function of the primary narcotics they were taking for oral pain management. Fifty-one percent of patients reported treatment of Oxycodone, 35% OxyContin, 24% methadone and 11% morphine. Patients who were treated with Oxycodone reported greater sensory reactions to pain (p = 0.001), visual analog scale (VAS) (p = 0.02), and averaged weekly pain intensity ratings than patients who did not use this medication. There were no differences in pain or affective response in patients treated with OxyContin, methadone or morphine. We suggest there are clear differences between the reports of pain in patients with sickle cell disease taking short-acting narcotics for pain management as compared to those who are not, a pattern that does not distinguish patients who are managed with long-acting preparations. We discuss the relevance of addressing narcotic management in the context of the perception of health care providers and patients with sickle cell disease. RN - 0 (Analgesics, Opioid) ES - 1532-432X IL - 0363-0269 DO - https://dx.doi.org/10.3109/03630269.2011.610914 PT - Journal Article ID - 10.3109/03630269.2011.610914 [doi] PP - ppublish LG - English EP - 20110912 DP - 2011 EZ - 2011/09/14 06:00 DA - 2012/03/27 06:00 DT - 2011/09/14 06:00 YR - 2011 ED - 20120325 RD - 20111114 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21910605 <500. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21756968 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Nielsen K AU - Nielsen SL AU - Siersma V AU - Rasmussen LS FA - Nielsen, Karina FA - Nielsen, Soren Louman FA - Siersma, Volkert FA - Rasmussen, Lars S IN - Nielsen, Karina. Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark. karinanielsen_1@msn.com TI - Treatment of opioid overdose in a physician-based prehospital EMS: frequency and long-term prognosis. SO - Resuscitation. 82(11):1410-3, 2011 Nov AS - Resuscitation. 82(11):1410-3, 2011 Nov NJ - Resuscitation VO - 82 IP - 11 PG - 1410-3 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Adult MH - Drug Overdose MH - *Emergency Medical Services MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/th [Therapy] MH - *Opium/po [Poisoning] MH - Prognosis MH - Prospective Studies MH - Time Factors MH - Young Adult AB - BACKGROUND: Prehospital treatment of opioid overdose accounts for a significant proportion of the workload of the emergency system in most major cities. Treatment consists of basic life support and administering naloxone. In our physician-manned mobile emergency care unit (MECU), most patients are released and not admitted to hospital. In this study, we aimed to assess the pattern in the number of episodes with opioid overdose treated by MECU in Copenhagen during a 10-year period and to investigate risk factors for mortality of these patients beyond the initial contact. AB - METHODS: Data were collected prospectively in the MECU database covering all cases of opioid overdose in a 10-year period between 1994 and 2003. The pattern in the number of opioid overdose was analysed in Poisson regression models, and mortality was analysed in Kaplan-Meier plots and in Cox regression models. AB - RESULTS: A total of 4762 episodes of opioid overdose were recorded. Patients were identified in 3245 of these episodes. The annual number of episodes decreased significantly over the data-collection period: from 639 overdoses out of 4520 (14.1%) patients treated in 1994 to 311 out of 7263 patients treated (4.3%) in 2003. A total of 352 patients had cardiac arrest at the scene. The MECU released 2246 patients (69.3%) after treatment, while 675 (20.8%) were admitted to hospital and 322 (9.9%) died. Long-term prognosis was poor with 14% mortality at 1 year. Long-term mortality was significantly related to increasing age, time of the year and if the patient had previous episodes of opioid overdose. AB - CONCLUSIONS: There has been a significant decrease in the number of opioid overdoses during this 10-year-period. Long-term mortality is high in these patients and highest in those with advanced age and numerous episodes of opioid overdose. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved. RN - 8008-60-4 (Opium) ES - 1873-1570 IL - 0300-9572 DO - https://dx.doi.org/10.1016/j.resuscitation.2011.05.027 PT - Journal Article ID - S0300-9572(11)00354-6 [pii] ID - 10.1016/j.resuscitation.2011.05.027 [doi] PP - ppublish PH - 2011/02/01 [received] PH - 2011/05/03 [revised] PH - 2011/05/09 [accepted] LG - English EP - 20110615 DP - 2011 Nov EZ - 2011/07/16 06:00 DA - 2012/03/01 06:00 DT - 2011/07/16 06:00 YR - 2011 ED - 20120227 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21756968 <501. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21745532 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rudolph SS AU - Jehu G AU - Nielsen SL AU - Nielsen K AU - Siersma V AU - Rasmussen LS FA - Rudolph, S S FA - Jehu, G FA - Nielsen, S Louman FA - Nielsen, K FA - Siersma, V FA - Rasmussen, L S IN - Rudolph, S S. The Mobile Emergency Care Unit (MECU), Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark. rudolph@dadlnet.dk TI - Prehospital treatment of opioid overdose in Copenhagen--is it safe to discharge on-scene?. CM - Comment in: Resuscitation. 2013 Jan;84(1):e15; PMID: 23000499 SO - Resuscitation. 82(11):1414-8, 2011 Nov AS - Resuscitation. 82(11):1414-8, 2011 Nov NJ - Resuscitation VO - 82 IP - 11 PG - 1414-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Denmark MH - Drug Overdose MH - *Emergency Medical Services MH - Humans MH - *Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/th [Therapy] MH - *Opium/po [Poisoning] MH - Patient Discharge/st [Standards] MH - *Patient Discharge MH - Prospective Studies MH - Safety MH - Time Factors AB - INTRODUCTION: In the prehospital setting opioid overdose is often treated with naloxone. In our physician-based medical emergency care unit (MECU) we have adopted a discharge-on-scene policy, where patients are released on scene if no residual signs of opioid intoxication are found after treatment. The aim of this study was to describe our experience with the discharge-on-scene policy used during a 10-year-period with focus on the frequency of rebound opioid toxicity. AB - METHODS: Data were prospectively recorded in our MECU database and we reviewed all cases of opioid overdose between 1994 and 2003. The MECU database was cross-referenced with the Central Personal Registry. For patients who died within 48 h of MECU contact we reviewed the forensic autopsy reports to establish whether rebound opioid toxicity was likely. AB - RESULTS: We found 4762 cases of acute opioid overdose. In 3245 cases positive identification was obtained. Over this ten year period fourteen patients who were released on-scene after having been treated with naloxone died within 48 h, but only in 3 of these we found a rebound opioid toxicity to be the likely cause of death, corresponding to 0.13% of those 2241 released on scene who were identified. AB - CONCLUSION: Prehospital discharge-on-scene after naloxone treatment is associated with a low risk of death due to rebound toxicity. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved. RN - 8008-60-4 (Opium) ES - 1873-1570 IL - 0300-9572 DO - https://dx.doi.org/10.1016/j.resuscitation.2011.06.027 PT - Journal Article ID - S0300-9572(11)00403-5 [pii] ID - 10.1016/j.resuscitation.2011.06.027 [doi] PP - ppublish PH - 2011/04/26 [received] PH - 2011/06/06 [revised] PH - 2011/06/22 [accepted] LG - English EP - 20110702 DP - 2011 Nov EZ - 2011/07/13 06:00 DA - 2012/03/01 06:00 DT - 2011/07/13 06:00 YR - 2011 ED - 20120227 RD - 20130206 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21745532 <502. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21145191 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shaw KA AU - Babu KM AU - Hack JB FA - Shaw, Kathryn A FA - Babu, Kavita M FA - Hack, Jason B IN - Shaw, Kathryn A. Department of Emergency Medicine, Brown University Alpert Medical School, Providence, Rhode Island, USA. TI - Methadone, another cause of opioid-associated hearing loss: a case report. SO - Journal of Emergency Medicine. 41(6):635-9, 2011 Dec AS - J Emerg Med. 41(6):635-9, 2011 Dec NJ - The Journal of emergency medicine VO - 41 IP - 6 PG - 635-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Drug Overdose MH - *Hearing Loss, Sensorineural/ci [Chemically Induced] MH - *Hearing Loss, Sudden/ci [Chemically Induced] MH - Humans MH - Male MH - *Methadone/po [Poisoning] MH - *Narcotics/po [Poisoning] MH - Young Adult AB - BACKGROUND: Methadone has been used for many years in the clinical setting and has many well-described side effects. In recent years, the use of methadone and other opioids have been increasing throughout the United States (US), and presentations to US Emergency Departments (EDs) due to opioid use and abuse are increasing as well. AB - OBJECTIVES: As methadone and opioid use increases, ED physicians should be aware of infrequently seen side effects and toxicities associated with the use of these drugs. AB - CASE REPORT: We report the case of a previously healthy 20-year-old man who presented with acute onset of bilateral hearing loss secondary to an unintentional methadone overdose. At follow-up, the patient's hearing had returned to normal, with the only intervention being abstinence from methadone. AB - CONCLUSION: Although bilateral hearing loss is a rare toxic finding of opioid ingestion, given the prevalence of opioid use, this etiology should be considered in any patient presenting with this chief complaint. Copyright © 2011 Elsevier Inc. All rights reserved. RN - 0 (Narcotics) RN - UC6VBE7V1Z (Methadone) IS - 0736-4679 IL - 0736-4679 DO - https://dx.doi.org/10.1016/j.jemermed.2010.11.014 PT - Case Reports PT - Journal Article ID - S0736-4679(10)00896-6 [pii] ID - 10.1016/j.jemermed.2010.11.014 [doi] PP - ppublish PH - 2009/11/10 [received] PH - 2010/03/15 [revised] PH - 2010/11/03 [accepted] LG - English EP - 20101209 DP - 2011 Dec EZ - 2010/12/15 06:00 DA - 2012/02/15 06:00 DT - 2010/12/15 06:00 YR - 2011 ED - 20120214 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21145191 <503. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 22116970 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rady MY AU - Verheijde JL FA - Rady, Mohamed Y FA - Verheijde, Joseph L TI - The confounding effects of pharmacokinetics and pharmacodynamics of sedatives and opioids on time to death after terminal withdrawal of life-support in the intensive care unit. CM - Comment on: Anesth Analg. 2011 Mar;112(3):628-34; PMID: 21304154 SO - Anesthesia & Analgesia. 113(6):1522-3; author reply 1523, 2011 Dec AS - Anesth Analg. 113(6):1522-3; author reply 1523, 2011 Dec NJ - Anesthesia and analgesia VO - 113 IP - 6 PG - 1522-3; author reply 1523 PI - Journal available in: Print PI - Citation processed from: Internet JC - 4r8, 1310650 IO - Anesth. Analg. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Female MH - *Hospital Mortality MH - Humans MH - *Hypnotics and Sedatives/tu [Therapeutic Use] MH - *Intensive Care Units MH - Male MH - *Respiration, Artificial/mo [Mortality] MH - *Withholding Treatment RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) ES - 1526-7598 IL - 0003-2999 DO - https://dx.doi.org/10.1213/ANE.0b013e3182330d8c PT - Comment PT - Letter ID - 113/6/1522-a [pii] ID - 10.1213/ANE.0b013e3182330d8c [doi] PP - ppublish LG - English DP - 2011 Dec EZ - 2011/11/26 06:00 DA - 2012/01/17 06:00 DT - 2011/11/26 06:00 YR - 2011 ED - 20120116 RD - 20111125 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=22116970 <504. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21822085 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Porter R AU - O'Reilly H FA - Porter, Robert FA - O'Reilly, Heather IN - Porter, Robert. Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, Newfoundland and Labrador, Canada. rporter@mun.ca TI - Pulmonary hemorrhage: a rare complication of opioid overdose. SO - Pediatric Emergency Care. 27(8):742-4, 2011 Aug AS - Pediatr Emerg Care. 27(8):742-4, 2011 Aug NJ - Pediatric emergency care VO - 27 IP - 8 PG - 742-4 PI - Journal available in: Print PI - Citation processed from: Internet JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Adolescent MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Bronchi/bs [Blood Supply] MH - Bronchoscopy MH - C-Reactive Protein/an [Analysis] MH - Disease Progression MH - Drug Overdose MH - Emergency Service, Hospital MH - *Hemorrhage/ci [Chemically Induced] MH - Humans MH - *Lung Diseases/ci [Chemically Induced] MH - Male MH - *Morphine/ae [Adverse Effects] MH - Naloxone/ae [Adverse Effects] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ae [Adverse Effects] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Regional Blood Flow MH - Status Asthmaticus/di [Diagnosis] AB - Children and adolescents with pulmonary hemorrhage are infrequently encountered in the emergency department (ED). We describe a case of a 16 year-old boy who presented to a pediatric ED with pulmonary hemorrhage and respiratory distress. The patient's unusual initial presentation resulted in the consideration of a broad differential diagnosis for his symptoms, including traumatic, neurological, respiratory, and toxicological causes. After resuscitation in the ED, a prolonged admission, and extensive testing, no cause could be found other than severe opioid toxicity. This case illustrates a rare, life-threatening presentation of opiod toxicity in a healthy adolescent and underlines the potentially serious nature of such exposures. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 76I7G6D29C (Morphine) RN - 9007-41-4 (C-Reactive Protein) ES - 1535-1815 IL - 0749-5161 DO - https://dx.doi.org/10.1097/PEC.0b013e318226df00 PT - Case Reports PT - Journal Article ID - 10.1097/PEC.0b013e318226df00 [doi] ID - 00006565-201108000-00013 [pii] PP - ppublish LG - English DP - 2011 Aug EZ - 2011/08/09 06:00 DA - 2011/12/23 06:00 DT - 2011/08/09 06:00 YR - 2011 ED - 20111222 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21822085 <505. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21761949 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bryson WC AU - McConnell J AU - Korthuis PT AU - McCarty D FA - Bryson, William C FA - McConnell, John FA - Korthuis, P Todd FA - McCarty, Dennis IN - Bryson, William C. Department of Public Health and Preventive Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. TI - Extended-release naltrexone for alcohol dependence: persistence and healthcare costs and utilization. SO - American Journal of Managed Care. 17 Suppl 8:S222-34, 2011 Jun AS - Am J Manag Care. 17 Suppl 8:S222-34, 2011 Jun NJ - The American journal of managed care VO - 17 Suppl 8 PG - S222-34 PI - Journal available in: Print PI - Citation processed from: Internet JC - cw0, 9613960 IO - Am J Manag Care PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556906 OI - Source: NLM. NIHMS346693 SB - Health Administration Journals CP - United States MH - Female MH - *Health Care Costs/sn [Statistics & Numerical Data] MH - *Health Services/ut [Utilization] MH - Humans MH - Insurance Claim Review MH - Kaplan-Meier Estimate MH - Male MH - Multivariate Analysis MH - Naltrexone/ec [Economics] MH - Naltrexone/pk [Pharmacokinetics] MH - Naltrexone/pd [Pharmacology] MH - *Naltrexone/tu [Therapeutic Use] MH - Narcotic Antagonists/ec [Economics] MH - Narcotic Antagonists/pk [Pharmacokinetics] MH - Narcotic Antagonists/pd [Pharmacology] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Proportional Hazards Models MH - Risk Factors MH - Time Factors MH - United States AB - OBJECTIVE: Evaluate persistence with treatment, healthcare costs, and utilization in stably enrolled Aetna Behavioral Health members receiving extended-release naltrexone (XR-NTX) for alcohol use dependence compared with oral medications and psychosocial therapy only. AB - STUDY DESIGN: Historical cohort study. AB - METHODS: Aetna beneficiaries with stable enrollment (at least 6 months before and after index treatment) who initiated pharmacotherapy with XR-NTX (n = 211), disulfiram (n = 1043), oral naltrexone (n = 1408), acamprosate (n = 2479), or psychosocial therapy only (n = 6374) for alcohol use disorders between January 1, 2007, and December 31, 2008, were extracted and deidentified from Aetna's nationwide claims and utilization database. Survival analysis compared persistence with XR-NTX versus oral pharmacotherapies. Difference-in-differences analysis compared healthcare costs and utilization among patients receiving XR-NTX versus oral pharmacotherapies and psychosocial therapy only. Multivariate analyses controlled for demographics. AB - RESULTS: Patients taking acamprosate and disulfiram were more likely to discontinue treatment than patients taking naltrexone, and patients given oral naltrexone were more likely to discontinue treatment than those given XR-NTX. Outpatient behavioral health treatment visits increased in all study groups. Nonpharmacy healthcare costs and utilization of inpatient and emergency services decreased in the XR-NTX group relative to other study groups. AB - CONCLUSION: Patients receiving XR-NTX persisted with treatment longer than patients receiving oral alcohol use-disorder medications or psychosocial therapy only, and had decreased inpatient and emergency healthcare costs and utilization compared with those receiving other medications. RN - 0 (Narcotic Antagonists) RN - 5S6W795CQM (Naltrexone) ES - 1936-2692 IL - 1088-0224 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 49845 [pii] ID - PMC3556906 [pmc] ID - NIHMS346693 [mid] PP - ppublish GI - No: K23 DA019809 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA029716 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: U10 DA015815 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K23DA019809 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2011 Jun EZ - 2011/07/27 06:00 DA - 2011/12/15 06:00 DT - 2011/07/19 06:00 YR - 2011 ED - 20111214 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21761949 <506. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20832967 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Richards JR AU - Richards IN AU - Ozery G AU - Derlet RW FA - Richards, John R FA - Richards, Irina N FA - Ozery, Gal FA - Derlet, Robert W IN - Richards, John R. Department of Emergency Medicine, UC Davis Medical Center, Sacramento, California 95817, USA. TI - Droperidol analgesia for opioid-tolerant patients. [Review] SO - Journal of Emergency Medicine. 41(4):389-96, 2011 Oct AS - J Emerg Med. 41(4):389-96, 2011 Oct NJ - The Journal of emergency medicine VO - 41 IP - 4 PG - 389-96 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - *Adjuvants, Anesthesia/tu [Therapeutic Use] MH - *Analgesics, Opioid MH - *Droperidol/tu [Therapeutic Use] MH - *Drug Tolerance MH - Humans MH - *Pain/dt [Drug Therapy] AB - BACKGROUND: Patients with acute and chronic pain syndromes such as migraine headache, fibromyalgia, and sickle cell disease represent a significant portion of emergency department (ED) visits. Certain patients may have tolerance to opioid analgesics and often require large doses and prolonged time in the ED to achieve satisfactory pain mitigation. Droperidol is a unique drug that has been successfully used not only as an analgesic adjuvant for the past 30 years, but also for treatment of nausea/vomiting, psychosis, agitation, sedation, and vertigo. AB - OBJECTIVES: In this review, we examine the evidence supporting the use of droperidol for analgesia, adverse side effects, and controversial United States (US) Food and Drug Administration (FDA) black box warning. AB - DISCUSSION: Droperidol has myriad pharmacologic properties that may explain its efficacy as an analgesic, including: dopamine D2 antagonist, dose-dependent GABA agonist/antagonist, alpha2 adrenoreceptor agonist, serotonin antagonist, histamine antagonist, muscarinic and nicotinic cholinergic antagonist, anticholinesterase activity, sodium channel blockade similar to lidocaine, and mu opiate receptor potentiation. AB - CONCLUSION: Droperidol is an important adjuvant for patients who are tolerant to opioid analgesics. The FDA black box warning does not apply to doses below 2.5 mg. Copyright © 2011 Elsevier Inc. All rights reserved. RN - 0 (Adjuvants, Anesthesia) RN - 0 (Analgesics, Opioid) RN - O9U0F09D5X (Droperidol) IS - 0736-4679 IL - 0736-4679 DO - https://dx.doi.org/10.1016/j.jemermed.2010.07.005 PT - Journal Article PT - Review ID - S0736-4679(10)00557-3 [pii] ID - 10.1016/j.jemermed.2010.07.005 [doi] PP - ppublish PH - 2010/01/16 [received] PH - 2010/04/09 [revised] PH - 2010/07/05 [accepted] LG - English EP - 20100915 DP - 2011 Oct EZ - 2010/09/14 06:00 DA - 2011/12/15 06:00 DT - 2010/09/14 06:00 YR - 2011 ED - 20111214 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=20832967 <507. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21658931 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bartlett N AU - Xin D AU - Zhang H AU - Huang B FA - Bartlett, Nicholas FA - Xin, Deming FA - Zhang, Hong FA - Huang, Bamian IN - Bartlett, Nicholas. Department of Anthropology, History and Social Medicine, University of California-San Francisco, San Francisco, CA, USA. Nicholas.bartlett@ucsf.edu TI - A qualitative evaluation of a peer-implemented overdose response pilot project in Gejiu, China. SO - International Journal of Drug Policy. 22(4):301-5, 2011 Jul AS - Int J Drug Policy. 22(4):301-5, 2011 Jul NJ - The International journal on drug policy VO - 22 IP - 4 PG - 301-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9014759 IO - Int. J. Drug Policy SB - Index Medicus CP - Netherlands MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - Attitude of Health Personnel MH - China/ep [Epidemiology] MH - Confidentiality MH - Cost of Illness MH - Drug Overdose MH - Female MH - *Harm Reduction MH - Heroin/po [Poisoning] MH - *Hotlines MH - Humans MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/ec [Economics] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/px [Psychology] MH - *Opioid-Related Disorders/th [Therapy] MH - Organizations/ec [Economics] MH - *Peer Group MH - Pilot Projects MH - Risk Factors MH - *Street Drugs/po [Poisoning] MH - Urban Health Services/ec [Economics] AB - BACKGROUND: A harm reduction NGO in southern Yunnan operating an emergency overdose response hotline service successfully reversed 76 overdoses through the administration of naloxone in one of the first interventions of its kind in China. AB - METHOD: To explore local understandings of risk factors related to overdose, assess ongoing barriers to overdose response, and solicit client input on how to further reduce opiate overdose mortality in Gejiu, the authors conducted qualitative interviews with 30 clients, including 15 individuals who received naloxone injections to reverse an overdose and 15 individuals who called the hotline in response to the overdose of a peer. AB - RESULTS: Participants pointed to a number of local structural shifts in heroin use including the ageing of the opiate using population and drug mixing practises that contribute to the city's overdose toll. Concerns over medical professionals' willingness to treat drug users, protection of confidentiality, and financial costs associated with treatment frequently cause drug users to avoid contact with the city's emergency service providers. Participants suggest directly distributing naloxone to clients as one strategy to further reduce overdose mortality. AB - CONCLUSION: The authors explore possible strategies, including targeted trainings and new partnerships with local hospitals, to further reduce opiate overdose mortality in this resource-poor setting. Copyright © 2011 Elsevier B.V. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 0 (Street Drugs) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1873-4758 IL - 0955-3959 DO - https://dx.doi.org/10.1016/j.drugpo.2011.04.005 PT - Evaluation Studies PT - Journal Article ID - S0955-3959(11)00059-4 [pii] ID - 10.1016/j.drugpo.2011.04.005 [doi] PP - ppublish PH - 2011/01/11 [received] PH - 2011/04/21 [revised] PH - 2011/04/26 [accepted] LG - English EP - 20110611 DP - 2011 Jul EZ - 2011/06/11 06:00 DA - 2011/12/14 06:00 DT - 2011/06/11 06:00 YR - 2011 ED - 20111212 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21658931 <508. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21232910 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mazer MA AU - Alligood CM AU - Wu Q FA - Mazer, Mark A FA - Alligood, Chad M FA - Wu, Qiang IN - Mazer, Mark A. Division of Pulmonary, Critical Care and Sleep Medicine, East Carolina University, Greenville, North Carolina 27834, USA. mazerm@ecu.edu TI - The infusion of opioids during terminal withdrawal of mechanical ventilation in the medical intensive care unit. SO - Journal of Pain & Symptom Management. 42(1):44-51, 2011 Jul AS - J Pain Symptom Manage. 42(1):44-51, 2011 Jul NJ - Journal of pain and symptom management VO - 42 IP - 1 PG - 44-51 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8605836, ijj IO - J Pain Symptom Manage SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Aged, 80 and over MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Euthanasia, Passive MH - Female MH - Humans MH - Intensive Care Units MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - *Morphine/tu [Therapeutic Use] MH - *Pain/dt [Drug Therapy] MH - Prospective Studies MH - *Respiration, Artificial MH - *Withholding Treatment AB - CONTEXT: Most deaths in intensive care units occur after limitation or withdrawal of life-sustaining therapies. Often these patients require opioids to assuage suffering; yet, little has been documented concerning their use in the medical intensive care unit. AB - OBJECTIVES: To determine the dose and factors influencing the use of opioids in patients undergoing terminal withdrawal of mechanical ventilation in this setting. AB - METHODS: Data were prospectively collected from 74 consecutive patients expected to die soon after extubation. The doses of morphine, effect on time to death, and relation of dose to diagnostic categories were analyzed. AB - RESULTS: The mean (+/-standard deviation) dose of morphine given to patients during the last hour of mechanical ventilation was 5.3mg/hour. Patients dying after extubation received 10.6 mg/hour just before death. Immediately before extubation, the dose correlated directly with chronic medical opioid use and sepsis with respiratory failure and inversely with coma after cardiopulmonary resuscitation or a primary neurological event. After terminal extubation, the final morphine dose correlated directly with the presence of sepsis with respiratory failure and chronic pulmonary disease. The mean time to death after terminal extubation was 152.7 +/- 229.5 minutes without correlation with premorbid diagnoses. After extubation, each 1mg/hour increment of morphine infused during the last hour of life was associated with a delay of death by 7.9 minutes (P = 0.011). AB - CONCLUSION: Premorbid conditions may influence the dose of morphine given to patients undergoing terminal withdrawal of mechanical ventilation. Higher doses of morphine are associated with a longer time to death. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1873-6513 IL - 0885-3924 DO - https://dx.doi.org/10.1016/j.jpainsymman.2010.10.256 PT - Journal Article ID - S0885-3924(10)01025-0 [pii] ID - 10.1016/j.jpainsymman.2010.10.256 [doi] PP - ppublish PH - 2010/07/07 [received] PH - 2010/10/08 [revised] PH - 2010/10/17 [accepted] LG - English EP - 20110113 DP - 2011 Jul EZ - 2011/01/15 06:00 DA - 2011/12/14 06:00 DT - 2011/01/15 06:00 YR - 2011 ED - 20111212 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21232910 <509. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21047302 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Martin TC AU - Rocque MA FA - Martin, Thomas C FA - Rocque, Michael A IN - Martin, Thomas C. Department of Pediatrics, Eastern Maine Medical Center, 489 State Street, Bangor, ME 04402, USA. tcmartin@emh.org TI - Accidental and non-accidental ingestion of methadone and buprenorphine in childhood: a single center experience, 1999-2009. SO - Current Drug Safety. 6(1):12-6, 2011 Feb 01 AS - Curr Drug Saf. 6(1):12-6, 2011 Feb 01 NJ - Current drug safety VO - 6 IP - 1 PG - 12-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101270895 IO - Curr Drug Saf SB - Index Medicus CP - United Arab Emirates MH - Adolescent MH - Age Factors MH - *Buprenorphine/po [Poisoning] MH - Child, Preschool MH - Female MH - Humans MH - Infant MH - Male MH - *Methadone/po [Poisoning] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Patient Admission/td [Trends] MH - Retrospective Studies MH - Risk Factors MH - *Suicide, Attempted/td [Trends] AB - OBJECTIVE: To assess the effect of recent availability (due to more home use) of methadone and buprenophine has had on the accidental and non-accidental misuse by children. AB - METHODS: A retrospective review of all pediatric (< 18 years old) admissions for methadone or buprenorphine ingestion at Eastern Maine Medical Center (EMMC) from September 1, 1999 to August 31, 2009 was performed. Data recorded included age, sex, accidental or non-accidental ingestion, source of drug, ward or pediatric intensive care unit (PICU) admission, treatment given and length of hospital stay. Relation to pediatric emergency department (ED) visits, general pediatric ward admissions and patients on opioid maintenance treatment in the area was also assessed. AB - RESULTS: There were 22 children (12 female) admitted for methadone (10, 46%) or buprenorphine (12, 54%) ingestion, with ingestions tripling in the later five year period compared with the earlier five years. The trend was statistically significant, unrelated to pediatric ED visits or ward admissions but statistically related to number of patients on opioid maintenance treatment in the region. Of the 22 children with ingestion, six (27%) were adolescents (mean age 15.2 years) and ingestion was intentional (three suicide, three recreational) and 16 were infants or toddlers (mean age 21.6 months) whose ingestions were accidental. The drug source was family and friend (18, 82%) or unknown (four, 18%). There were six patients admitted to the ward and 16 patients (74%) admitted to the PICU. Two patients had observation only, seven had anticipatory intravenous (IV) line placement, nine patients were given IV line and naloxone (bolus + IV infusion), and four patients required endotracheal intubation, IV placement and naloxone. There were no fatalities and mean hospital stay was one to seven days, mean 2.3 days. All families were referred to family services. AB - CONCLUSIONS: Accidental and non-accidental ingestion of methadone and buprenorphine by children is increasing in proportion to increased clinical use and availability. Health providers should be aware of this increased risk and be able to provide appropriate treatment and family support. RN - 40D3SCR4GZ (Buprenorphine) RN - UC6VBE7V1Z (Methadone) ES - 2212-3911 IL - 1574-8863 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - CDS ABS-57 [pii] PP - ppublish PH - 2009/11/09 [received] PH - 2010/09/09 [accepted] LG - English DP - 2011 Feb 01 EZ - 2010/11/05 06:00 DA - 2011/12/14 06:00 DT - 2010/11/05 06:00 YR - 2011 ED - 20111212 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21047302 <510. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21740578 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wee MY AU - Tuckey JP AU - Thomas P AU - Burnard S FA - Wee, Michael Y K FA - Tuckey, Jenny P FA - Thomas, Peter FA - Burnard, Sara IN - Wee, Michael Y K. Consultant Anaesthetist, Poole Hospital NHS Foundation Trust, Poole, BH15 2JB, England, United Kingdom. m.wee@virgin.net TI - The IDvIP trial: a two-centre randomised double-blind controlled trial comparing intramuscular diamorphine and intramuscular pethidine for labour analgesia. SO - BMC Pregnancy & Childbirth. 11:51, 2011 Jul 08 AS - BMC Pregnancy Childbirth. 11:51, 2011 Jul 08 NJ - BMC pregnancy and childbirth VO - 11 PG - 51 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100967799 IO - BMC Pregnancy Childbirth PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146890 SB - Index Medicus CP - England MH - *Analgesia, Obstetrical MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Apgar Score MH - Cardiotocography MH - Double-Blind Method MH - Feeding Behavior MH - Female MH - Heroin/ad [Administration & Dosage] MH - Heroin/ae [Adverse Effects] MH - *Heroin/tu [Therapeutic Use] MH - Humans MH - Infant, Newborn MH - Injections, Intramuscular MH - Intensive Care, Neonatal MH - *Labor Pain/dt [Drug Therapy] MH - Meperidine/ad [Administration & Dosage] MH - Meperidine/ae [Adverse Effects] MH - *Meperidine/tu [Therapeutic Use] MH - Nausea/ci [Chemically Induced] MH - Oxygen/bl [Blood] MH - Patient Satisfaction MH - Pregnancy MH - Resuscitation MH - Vomiting/ci [Chemically Induced] AB - BACKGROUND: Intramuscular pethidine is routinely used throughout the UK for labour analgesia. Studies have suggested that pethidine provides little pain relief in labour and has a number of side effects affecting mother and neonate. It can cause nausea, vomiting and dysphoria in mothers and can cause reduced fetal heart rate variability and accelerations. Neonatal effects include respiratory depression and impaired feeding. There are few large studies comparing the relative side effects and efficacy of different opioids in labour. A small trial comparing intramuscular pethidine with diamorphine, showed diamorphine to have some benefits over pethidine when used for labour analgesia but the study did not investigate the adverse effects of either opioid. AB - METHODS: The Intramuscular Diamorphine versus Intramuscular Pethidine (IDvIP) trial is a randomised double-blind two centre controlled trial comparing intramuscular diamorphine and pethidine regarding their analgesic efficacy in labour and their side effects in mother, fetus and neonate. Information about the trial will be provided to women in the antenatal period or in early labour. Consent and recruitment to the trial will be obtained when the mother requests opioid analgesia. The sample size requirement is 406 women with data on primary outcomes. The maternal primary outcomes are pain relief during the first 3 hours after trial analgesia and specifically pain relief after 60 minutes. The neonatal primary outcomes are need for resuscitation and Apgar Score <7 at 1 minute. The secondary outcomes are an additional measure of pain relief, maternal sedation, nausea and vomiting, maternal oxygen saturation, satisfaction with analgesia, whether method of analgesia would be used again, use of Entonox, umbilical arterial and venous pH, fetal heart rate, meconium staining, time from delivery to first breath, Apgar scores at 5 mins, naloxone requirement, transfer to neonatal intensive care unit, neonatal haemoglobin oxygen saturation at 30, 60, 90, and 120 mins after delivery, and neonatal sedation and feeding behaviour during first 2 hours. AB - DISCUSSION: If the trial demonstrates that diamorphine provides better analgesia with fewer side effects in mother and neonate this could lead to a change in national practice and result in diamorphine becoming the preferred intramuscular opioid for analgesia in labour. AB - TRIAL REGISTRATION: ISRCTN14898678Eudra No: 2006-003250-18, REC Reference No: 06/Q1702/95, MHRA Authorisation No: 1443/0001/001-0001, NIHR UKCRN reference 6895, RfPB grant PB-PG-0407-13170_IR5. RN - 0 (Analgesics, Opioid) RN - 70D95007SX (Heroin) RN - 9E338QE28F (Meperidine) RN - S88TT14065 (Oxygen) ES - 1471-2393 IL - 1471-2393 DO - https://dx.doi.org/10.1186/1471-2393-11-51 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 1471-2393-11-51 [pii] ID - 10.1186/1471-2393-11-51 [doi] ID - PMC3146890 [pmc] PP - epublish PH - 2011/04/26 [received] PH - 2011/07/08 [accepted] SI - ISRCTN SA - ISRCTN/ISRCTN14898678 SL - https://www.controlled-trials.com/ISRCTN14898678 GI - No: PB-PG-0407-13170 Organization: *Department of Health* Country: United Kingdom LG - English EP - 20110708 DP - 2011 Jul 08 EZ - 2011/07/12 06:00 DA - 2011/12/13 00:00 DT - 2011/07/12 06:00 YR - 2011 ED - 20111129 RD - 20170922 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21740578 <511. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21507527 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chang AK AU - Bijur PE AU - Gallagher EJ FA - Chang, Andrew K FA - Bijur, Polly E FA - Gallagher, E John IN - Chang, Andrew K. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. achang@montefiore.org TI - Randomized clinical trial comparing the safety and efficacy of a hydromorphone titration protocol to usual care in the management of adult emergency department patients with acute severe pain. SO - Annals of Emergency Medicine. 58(4):352-9, 2011 Oct AS - Ann Emerg Med. 58(4):352-9, 2011 Oct NJ - Annals of emergency medicine VO - 58 IP - 4 PG - 352-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Clinical Protocols MH - *Emergency Service, Hospital MH - Female MH - Humans MH - *Hydromorphone/ad [Administration & Dosage] MH - Hydromorphone/ae [Adverse Effects] MH - Hydromorphone/tu [Therapeutic Use] MH - Injections, Intravenous MH - Male MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Treatment Outcome AB - STUDY OBJECTIVE: We test the efficacy and safety of the "1+1" (1 mg plus 1 mg 15 minutes later if needed) hydromorphone protocol against usual care of emergency department (ED) patients with acute severe pain. AB - METHODS: This was a prospective, randomized clinical trial of ED patients with acute severe pain. The 1+1 protocol specifies administration of 1 mg intravenous hydromorphone, followed by a second dose of 1 mg intravenous hydromorphone 15 minutes after the first bolus if the patient answers yes to the question, "Do you want more pain medication?" Usual care is the administration of any intravenous opioid, with type and dose chosen by the ED attending physician. Usual care patients who wanted more medication at 15 minutes were treated at the physician's discretion. At 60 minutes, all patients were asked again whether they wanted more pain medication. The primary outcome was successful treatment defined a priori as not wanting additional analgesia at either 15 or 60 minutes after the initial bolus. The primary endpoint was the difference in the proportion of patients with successful treatment who received the complete 1+1 protocol versus usual care with a per-protocol analysis. An intention-to-treat analysis was also performed. A 10% difference in rate of successful treatment was chosen a priori as a clinically meaningful difference. AB - RESULTS: Of 167 patients in the 1+1 group, 156 received the full 1+1 protocol, whereas 171 received usual care. Of patients who received the 1+1 protocol, 92.3% (144/156) had successful treatment versus 76.6% (131/171) of usual care patients (difference=15.7%; 95% confidence interval 7.9% to 23.3%). In the intention-to-treat analysis, 86.8% (145/167) of patients randomized to the 1+1 group received successful treatment versus 76.6% (131/171) of usual care patients (difference=10.2%; 95% confidence interval 2.0% to 18.3%). No patient required naloxone. One patient in the 1+1 group and 2 patients in the usual care group had transient oxygen saturation less than 95%. The incidence of all adverse effects was similar in both groups. AB - CONCLUSION: When analyzed per protocol or with the more conservative intention-to-treat analysis, the 1+1 hydromorphone protocol is statistically and clinically more efficacious than usual care. Safety profiles were similar in both groups. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - Q812464R06 (Hydromorphone) ES - 1097-6760 IL - 0196-0644 DO - https://dx.doi.org/10.1016/j.annemergmed.2011.03.003 PT - Journal Article PT - Randomized Controlled Trial ID - S0196-0644(11)00205-8 [pii] ID - 10.1016/j.annemergmed.2011.03.003 [doi] PP - ppublish PH - 2010/09/14 [received] PH - 2011/01/29 [revised] PH - 2011/03/02 [accepted] LG - English EP - 20110419 DP - 2011 Oct EZ - 2011/04/22 06:00 DA - 2011/12/13 00:00 DT - 2011/04/22 06:00 YR - 2011 ED - 20111129 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21507527 <512. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20573655 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Solhi H AU - Mostafazadeh B AU - Vishteh HR AU - Ghezavati AR AU - Shooshtarizadeh A FA - Solhi, Hassan FA - Mostafazadeh, Babak FA - Vishteh, Hamid Reza Khoddami FA - Ghezavati, Ali Reza FA - Shooshtarizadeh, Ali IN - Solhi, Hassan. Arak University of Medical Sciences, Arak, Iran. Solhi2@yahoo.com TI - Benefit effect of naloxone in benzodiazepines intoxication: findings of a preliminary study. CM - Comment in: Hum Exp Toxicol. 2011 Apr;30(4):343; PMID: 21056948 CM - Comment in: Hum Exp Toxicol. 2012 Apr;31(4):406-7; PMID: 22549640 SO - Human & Experimental Toxicology. 30(7):535-40, 2011 Jul AS - Hum Exp Toxicol. 30(7):535-40, 2011 Jul NJ - Human & experimental toxicology VO - 30 IP - 7 PG - 535-40 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aql, 9004560 IO - Hum Exp Toxicol SB - Index Medicus CP - England MH - Adult MH - Benzodiazepines/ai [Antagonists & Inhibitors] MH - *Benzodiazepines/to [Toxicity] MH - Female MH - Humans MH - Hypnotics and Sedatives/ai [Antagonists & Inhibitors] MH - *Hypnotics and Sedatives/to [Toxicity] MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Poison Control Centers MH - *Poisoning/dt [Drug Therapy] MH - Poisoning/et [Etiology] MH - Poisoning/pp [Physiopathology] MH - Treatment Outcome MH - Unconsciousness/ci [Chemically Induced] MH - Unconsciousness/dt [Drug Therapy] AB - BACKGROUND: Naloxone, as a low-priced and available drug, may be useful in improvement of signs and symptoms of benzodiazepines intoxication. The aim of this study was assessment of its effect on benzodiazepines poisoning. AB - METHODS: In this clinical-trial study, patients with typical signs and symptoms of benzodiazepines poisoning, who were referred to a poisoning center in Tehran in 2008, were selected. After recording of patients' characteristics, supportive treatment was initiated and patients were randomly assigned to the case group with intravenous (IV) injection of two 0.4 mg naloxone ampules or to the control group. Their signs and symptoms were evaluated again 0.5 hour later. Each of diazepam, clonazepam and alperazolam drug group had 30 patients and lorazepam drug group had 26 patients, half of which patients in each drug group received naloxone. AB - RESULTS: Most of the participants were female and the mean age was 28 years. There were no significant differences between case and control groups in age, sex, time of drug consumption, tablet counts, signs and symptoms and level of consciousness at the admission time in each drug types. After naloxone injection in case groups, all signs and symptoms significantly improved in all drug types in comparison to control groups except nystagmus. In addition, level of consciousness significantly improved in case groups in all drug types except lorazepam. AB - CONCLUSION: Findings of the study showed that naloxone is effective in management of benzodiazepines poisoning. However, future clinical trials with greater sample size are recommended. RN - 0 (Hypnotics and Sedatives) RN - 0 (Narcotic Antagonists) RN - 12794-10-4 (Benzodiazepines) RN - 36B82AMQ7N (Naloxone) ES - 1477-0903 IL - 0960-3271 DO - https://dx.doi.org/10.1177/0960327110374972 PT - Journal Article PT - Randomized Controlled Trial ID - 0960327110374972 [pii] ID - 10.1177/0960327110374972 [doi] PP - ppublish LG - English EP - 20100623 DP - 2011 Jul EZ - 2010/06/25 06:00 DA - 2011/10/12 06:00 DT - 2010/06/25 06:00 YR - 2011 ED - 20111011 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=20573655 <513. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21824060 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tormoehlen LM AU - Mowry JB AU - Bodle JD AU - Rusyniak DE FA - Tormoehlen, Laura M FA - Mowry, James B FA - Bodle, Jeffrey D FA - Rusyniak, Daniel E IN - Tormoehlen, Laura M. Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA. laumjone@iupui.edu TI - Increased adolescent opioid use and complications reported to a poison control center following the 2000 JCAHO pain initiative. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 49(6):492-8, 2011 Jul AS - Clin Toxicol (Phila). 49(6):492-8, 2011 Jul NJ - Clinical toxicology (Philadelphia, Pa.) VO - 49 IP - 6 PG - 492-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adolescent MH - Age Factors MH - Child MH - Data Interpretation, Statistical MH - Databases, Factual MH - Female MH - Humans MH - Indiana/ep [Epidemiology] MH - Joint Commission on Accreditation of Healthcare Organizations MH - Male MH - *Opioid-Related Disorders/co [Complications] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/mo [Mortality] MH - Pain/dt [Drug Therapy] MH - Poison Control Centers MH - Prescription Drugs MH - Sex Factors MH - Treatment Outcome MH - United States AB - CONTEXT: Adolescents are at risk to abuse opioid analgesics for many reasons, including inaccurate perception of risk and increased drug availability. In 2000, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released pain management standards that emphasized pain control as a patient rights issue. This focus on analgesia may have increased both the prescribing and use of opioid analgesics, thereby increasing availability. AB - OBJECTIVE: Using data from a US poison center, this study aims to compare the number of adolescent opioid cases and their outcome severity before and after the 2000 JCAHO pain initiative. AB - METHODS: Retrospective case series of opioid exposures involving persons 12-18 years of age reported to a US poison center from 1994 to 2007. The main outcome measure was the number of adolescent opioid cases reported for 1994-2000 compared to 2001-2007. Secondary outcomes included outcome severity, number of cases involving specific opioids, and correlation between the number of cases and the amount of opioids distributed to the state. AB - RESULTS: There were 1634 adolescent opioid-related cases with 187 cases developing medical complications. Compared with 1994-2000, the rate ratio of cases involving adolescents and opioid analgesics for the years 2001-2007 was 1.69 (95% CI: 1.53, 1.86), and these cases were 2.84 (95% CI: 2.06, 3.91) times more likely to have had medical complications. Medical complications involving methadone (p =0.001) increased after the JCAHO initiative, while complications related to codeine (p =0.001) and propoxyphene (p =0.030) decreased. There were 15 deaths in 2001-2007 and none in 1994-2000 (p =0.012). Lastly, there was a correlation between the rate of adolescent opioid cases and the amount of opioids distributed to the state (r(2) =0.90; p < 0.001). AB - CONCLUSION: In the 7 years following the JCAHO pain standards, there was an increase in the number and severity of adolescent opioid-related poison center cases. The increase correlates with statewide availability of opioids. These data may prove useful in drug education and prevention programs targeting adolescents. RN - 0 (Prescription Drugs) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.3109/15563650.2011.587819 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.3109/15563650.2011.587819 [doi] PP - ppublish LG - English DP - 2011 Jul EZ - 2011/08/10 06:00 DA - 2011/10/01 06:00 DT - 2011/08/10 06:00 YR - 2011 ED - 20110930 RD - 20110809 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21824060 <514. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21612385 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wampler DA AU - Molina DK AU - McManus J AU - Laws P AU - Manifold CA FA - Wampler, David A FA - Molina, D Kimberley FA - McManus, John FA - Laws, Philip FA - Manifold, Craig A IN - Wampler, David A. Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas 78229, USA. wamplerd@uthscsa.edu TI - No deaths associated with patient refusal of transport after naloxone-reversed opioid overdose. SO - Prehospital Emergency Care. 15(3):320-4, 2011 Jul-Sep AS - Prehosp Emerg Care. 15(3):320-4, 2011 Jul-Sep NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 15 IP - 3 PG - 320-4 PI - Journal available in: Print PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/po [Poisoning] MH - Databases, Factual MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - *Heroin/po [Poisoning] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Patient Transfer MH - Retrospective Studies MH - Risk MH - Risk Assessment MH - Texas MH - Treatment Refusal/px [Psychology] MH - *Treatment Refusal/sn [Statistics & Numerical Data] MH - Young Adult AB - INTRODUCTION: Naloxone is widely used in the treatment and reversal of opioid overdose. Most emergency medical services (EMS) systems administer naloxone by standing order, and titrate only to reverse respiratory depression without fully reversing sedation. Some EMS systems routinely administer sufficient naloxone to fully reverse the effects of opioid overdose. Frequently patients refuse further medical evaluation or intervention, including transport. AB - OBJECTIVES: The purpose of this study was to evaluate the safety of this practice and determine whether increased mortality is associated with full reversal of opioids. As a component of a comprehensive quality assurance initiative, we assessed mortality during the 48 hours after patients received naloxone to reverse opioid overdose followed by patient-initiated refusal of transportation. AB - METHODS: The setting was a large urban fire-based EMS system. Investigators provided the Bexar County Medical Examiner's Office (MEO) with a list of patients who were treated by the San Antonio Fire Department with naloxone, and not transported. Inclusion criteria were administration of naloxone and patient-initiated refusal. Patient dispositions also included aid only, referral to the MEO, or referral to law enforcement. The list was then compared with the MEO database. A chart review was completed on all patients treated and subsequently presented to the MEO within two days. A secondary time period of 30 days was also assessed. AB - RESULTS: The list identified 592 patients treated with naloxone and not transported to the emergency department. Five-hundred fifty-two patients received naloxone and refused transport or were not transported. The remaining 40 patients all presented to EMS in cardiac arrest, naloxone was administered during the course of resuscitation, and subsequent efforts were terminated in the field. None of the patients receiving naloxone with a subsequent patient-initiated refusal were examined at the MEO within the two-day end point. The 30-day assessment revealed that nine individuals were treated with naloxone and subsequently died, but the shortest time interval between date of service and date of death was four days. AB - CONCLUSION: The primary outcome was that no patients who were treated with naloxone for opioid overdose and then refused care were examined by the MEO within a 48-hour time frame. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903127.2011.569854 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.3109/10903127.2011.569854 [doi] PP - ppublish LG - English DP - 2011 Jul-Sep EZ - 2011/05/27 06:00 DA - 2011/09/29 06:00 DT - 2011/05/27 06:00 YR - 2011 ED - 20110927 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21612385 <515. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21668753 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Porucznik CA AU - Johnson EM AU - Sauer B AU - Crook J AU - Rolfs RT FA - Porucznik, Christina A FA - Johnson, Erin M FA - Sauer, Brian FA - Crook, Jacob FA - Rolfs, Robert T IN - Porucznik, Christina A. Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah 84108, USA. christy.porucznik@utah.edu TI - Studying adverse events related to prescription opioids: the Utah experience. [Review] SO - Pain Medicine. 12 Suppl 2:S16-25, 2011 Jun AS - PAIN MED. 12 Suppl 2:S16-25, 2011 Jun NJ - Pain medicine (Malden, Mass.) VO - 12 Suppl 2 PG - S16-25 PI - Journal available in: Print PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/po [Poisoning] MH - Cause of Death MH - Coroners and Medical Examiners MH - Databases, Factual MH - Death Certificates MH - Drug Prescriptions MH - Humans MH - *Prescription Drugs/ae [Adverse Effects] MH - Prescription Drugs/po [Poisoning] MH - Registries MH - Utah AB - BACKGROUND: Epidemiologists at the Utah Department of Health (UDOH) began to study prescription drug-related harm in 2004. We have analyzed several types of data including vital statistics, medical examiner records, emergency department diagnoses, and the state prescription registry to estimate the scope and correlates of prescription drug-related harm. AB - OBJECTIVES: To describe data sets analyzed in Utah related to the problem of prescription drug-related harm with the goal of designing interventions to reduce the burden of adverse events and death. AB - RESULTS: Prescription drug-related harm in Utah primarily involved opioids and can be examined with secondary analysis of administrative databases, although each database has limitations. AB - CONCLUSIONS: More analyses, likely from cohort studies, are needed to identify risky prescribing patterns and individual-level risk factors for opioid-related harm. Combining data sets via linkage procedures can generate individual-level drug exposure and outcome histories, which may be useful to simulate a prospective cohort. Copyright Wiley Periodicals, Inc. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/j.1526-4637.2011.01133.x PT - Journal Article PT - Review ID - 10.1111/j.1526-4637.2011.01133.x [doi] PP - ppublish LG - English DP - 2011 Jun EZ - 2011/06/28 06:00 DA - 2011/09/29 06:00 DT - 2011/06/15 06:00 YR - 2011 ED - 20110926 RD - 20110614 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21668753 <516. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20444473 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Zeng X AU - Zhao X AU - Yang Y AU - Kuai J AU - Gao C AU - Yu D AU - Zhao H AU - Chai W AU - Yao L FA - Zeng, Xiaoli FA - Zhao, Xiaoling FA - Yang, Yonghui FA - Kuai, Jianke FA - Gao, Changjun FA - Yu, Daihua FA - Zhao, Hui FA - Chai, Wei FA - Yao, Linong IN - Zeng, Xiaoli. Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China. TI - Opioid delta(1) and delta(2) receptor agonist attenuate myocardial injury via mPTP in rats with acute hemorrhagic shock. SO - Journal of Surgical Research. 169(2):267-76, 2011 Aug AS - J Surg Res. 169(2):267-76, 2011 Aug NJ - The Journal of surgical research VO - 169 IP - 2 PG - 267-76 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - k7b, 0376340 IO - J. Surg. Res. SB - Index Medicus CP - United States MH - Animals MH - Blood Pressure/de [Drug Effects] MH - Heart Injuries/et [Etiology] MH - *Heart Injuries/me [Metabolism] MH - *Heart Injuries/pc [Prevention & Control] MH - Heart Rate/de [Drug Effects] MH - Male MH - *Mitochondrial Membrane Transport Proteins/me [Metabolism] MH - Models, Animal MH - Oligopeptides/pd [Pharmacology] MH - *Oligopeptides/tu [Therapeutic Use] MH - Quinolines/pd [Pharmacology] MH - *Quinolines/tu [Therapeutic Use] MH - Rats MH - Rats, Sprague-Dawley MH - *Receptors, Opioid, delta/ag [Agonists] MH - Resuscitation MH - *Shock, Hemorrhagic/co [Complications] AB - BACKGROUND: Studies have documented the beneficial roles of delta opioid receptor (OR) agonist for hemorrhagic shock. However, the myocardial protection roles and the mechanisms of hemodynamic stability during resuscitation of delta-OR agonist have not been explored. This study was designed to investigate myocardial protective effects and the mechanisms of high selective delta(1) and delta(2)-OR agonists during resuscitation of acute hemorrhagic shock. AB - MATERIALS AND METHODS: Forty-eight adult male SD rats were adopted 60-min hemorrhagic shock through removing 30% (5 mL) of the total blood volume, and followed by 2-h resuscitation with shed blood and L-lactated Ringer's solution. At the end of shock and prior to resuscitation, NS, delta(1)-OR agonist TAN-67 (10 mg/kg) and antagonist BNTX (3 mg/kg), and BNTX+TAN-67, DMSO, delta(2)-OR agonist Deltorphin II (1 mg/kg) and antagonist NTB (2 mg/kg), and NTB+Deltorphin II in 0.5 mL were administrated. Left ventricular function parameters were measured during the whole experimental period. Myocardial mitochondria were isolated to determine opening of mitochondrial permeability transition pore (mPTP). Morphologic changes in myocardium and mitochondria were observed by electron microscope. AB - RESULTS: The hemodynamic indexes in group TAN-67 and group Deltorphin II were higher than control group at each time point during resuscitation, respectively (P<0.05). TAN-67 and Deltorphin II decrease but their antagonists BNTX and NTB increase the opening of mPTP (P<0.05). Myocardial and mitochondrial damage were attenuated in group TAN-67 and group Deltorphin II. AB - CONCLUSIONS: delta(1)-OR agonist TAN-67 and delta(2)-OR agonist Deltorphin II protect the heart by targeting the mPTP in rats with acute hemorrhagic shock. Copyright © 2011 Elsevier Inc. All rights reserved. RN - 0 (Mitochondrial Membrane Transport Proteins) RN - 0 (Oligopeptides) RN - 0 (Quinolines) RN - 0 (Receptors, Opioid, delta) RN - 0 (TAN 67) RN - 0 (mitochondrial permeability transition pore) RN - 122752-16-3 (deltorphin II, Ala(2)-) ES - 1095-8673 IL - 0022-4804 DO - https://dx.doi.org/10.1016/j.jss.2009.12.017 PT - Journal Article ID - S0022-4804(09)01350-X [pii] ID - 10.1016/j.jss.2009.12.017 [doi] PP - ppublish PH - 2009/08/06 [received] PH - 2009/11/27 [revised] PH - 2009/12/17 [accepted] LG - English EP - 20100114 DP - 2011 Aug EZ - 2010/05/07 06:00 DA - 2011/09/13 06:00 DT - 2010/05/07 06:00 YR - 2011 ED - 20110912 RD - 20110712 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=20444473 <517. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21823370 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Macintyre PE AU - Loadsman JA AU - Scott DA FA - Macintyre, P E FA - Loadsman, J A FA - Scott, D A IN - Macintyre, P E. Acute Pain Service, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital and Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia. pamela.macintyre@adelaide.edu.au TI - Opioids, ventilation and acute pain management. [Review] SO - Anaesthesia & Intensive Care. 39(4):545-58, 2011 Jul AS - Anaesth Intensive Care. 39(4):545-58, 2011 Jul NJ - Anaesthesia and intensive care VO - 39 IP - 4 PG - 545-58 PI - Journal available in: Print PI - Citation processed from: Print JC - 4m5, 0342017 IO - Anaesth Intensive Care SB - Index Medicus CP - Australia MH - Acute Disease MH - Analgesia, Patient-Controlled MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Carbon Dioxide/bl [Blood] MH - Humans MH - Obesity/co [Complications] MH - Obesity/pp [Physiopathology] MH - Oxygen/bl [Blood] MH - Oxygen Inhalation Therapy MH - Pain/dt [Drug Therapy] MH - *Pain Management MH - *Respiration, Artificial/mt [Methods] MH - Sleep Apnea Syndromes/co [Complications] MH - Sleep Apnea Syndromes/pp [Physiopathology] MH - Survival AB - Despite the increasing use of a variety of different analgesic strategies, opioids continue as the mainstay for management of moderate to severe acute pain. However concerns remain about their potential adverse effects on ventilation. The most commonly used term, respiratory depression, only describes part of that risk. Opioid-induced ventilatory impairment (OIVI) is a more complete term encompassing opioid-induced central respiratory depression (decreased respiratory drive), decreased level of consciousness (sedation) and upper airway obstruction, all of which, alone or in combination, may result in decreased alveolar ventilation and increased arterial carbon dioxide levels. Concerns about OIVI are warranted, as deaths related to opioid administration in the acute pain setting continue to be reported. Risks are often said to be higher in patients with obstructive sleep apnoea. However, the tendency to use the term 'obstructive sleep apnoea' to encompass the much broader spectrum of sleep- and obesity-related hypoventilation syndromes and the related misuse of terminology in papers relating to obstructive sleep apnoea and sleep-disordered breathing remain significant problems in discussions of opioid-related effects. Opioids given for management of acute pain must be titrated to effect for each patient. However strategies aiming for better pain scores alone, without highlighting the need for appropriate monitoring of OIVI, can and will lead to an increase in adverse events. Therefore, all patients must be monitored appropriately for OIVI (at the very least using sedation scores as a '6th vital sign') so that it can be detected at an early stage and appropriate interventions triggered. RN - 0 (Analgesics, Opioid) RN - 142M471B3J (Carbon Dioxide) RN - S88TT14065 (Oxygen) IS - 0310-057X IL - 0310-057X PT - Journal Article PT - Review ID - 20110161 [pii] PP - ppublish LG - English DP - 2011 Jul EZ - 2011/08/10 06:00 DA - 2011/08/24 06:00 DT - 2011/08/10 06:00 YR - 2011 ED - 20110823 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21823370 <518. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20825821 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bounes V AU - Barniol C AU - Minville V AU - Houze-Cerfon CH AU - Ducasse JL FA - Bounes, Vincent FA - Barniol, Caroline FA - Minville, Vincent FA - Houze-Cerfon, Charles-Henri FA - Ducasse, Jean Louis IN - Bounes, Vincent. SAMU 31, Pole de medecine d'urgences, Hopitaux Universitaires, 31059 Toulouse cedex 9, France. bounes.v@chu-toulouse.fr TI - Predictors of pain relief and adverse events in patients receiving opioids in a prehospital setting. SO - American Journal of Emergency Medicine. 29(5):512-7, 2011 Jun AS - Am J Emerg Med. 29(5):512-7, 2011 Jun NJ - The American journal of emergency medicine VO - 29 IP - 5 PG - 512-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Acetaminophen/tu [Therapeutic Use] MH - Adult MH - Aged MH - Ambulances MH - Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Confidence Intervals MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - *Emergency Medical Services MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Odds Ratio MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Prospective Studies MH - Treatment Failure AB - OBJECTIVE: The aim of the study was to analyze factors predicting pain relief and adverse events in patients receiving opioids for acute pain in a prehospital setting. AB - METHODS: In this prospective, observational clinical study, adult patients with a numerical rating scale (NRS) score of 5 of 10 or higher who required treatment with intravenous opioids for pain control were included. The primary outcome variable was final analgesia defined by an NRS score of 3 of 10 or lower upon arrival to the emergency department. Univariable and multivariable analyses were performed to identify predictive factors of pain relief and adverse effects. AB - RESULTS: In total, 277 patients (age, 49 +/- 22 years), 205 (74%) of whom were male and 154 (56%) with a traumatic pain were included in the analysis. Median (interquartile range) NRS scores at baseline and at discharge were 8 of 10 (7-10) and 3 of 10 (2-5), respectively. The final model had 3 independent variables reaching significance. Physician-staffed ambulance transportation (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.07-5.49) was the only independent predictor of patients' final pain relief. High initial pain scores and acetaminophen use were predictive factors for failure of analgesia (OR, 0.79; 95% CI, 0.68-0.93 for one unit/10; P < .01; and OR, 0.40; 95% CI, 0.21-0.77; P < .01, respectively). In the entire sample, 25 (9.0%) presented one adverse effect, all mild to moderate in severity, with no significant predictive factors. AB - CONCLUSION: Despite advancement in prehospital pain management, pain relief at discharge is still inadequate in some patients. Finally, one important message of our study is that patients in pain have to be transported by well-equipped and staffed ambulances to reevaluate and alleviate pain. Copyright © 2011 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) RN - 362O9ITL9D (Acetaminophen) ES - 1532-8171 IL - 0735-6757 DO - https://dx.doi.org/10.1016/j.ajem.2009.12.005 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0735-6757(09)00627-5 [pii] ID - 10.1016/j.ajem.2009.12.005 [doi] PP - ppublish PH - 2009/11/10 [received] PH - 2009/12/08 [revised] PH - 2009/12/09 [accepted] LG - English EP - 20100326 DP - 2011 Jun EZ - 2010/09/10 06:00 DA - 2011/08/17 06:00 DT - 2010/09/10 06:00 YR - 2011 ED - 20110816 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=20825821 <519. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20627427 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McCarty D AU - Perrin NA AU - Green CA AU - Polen MR AU - Leo MC AU - Lynch F FA - McCarty, Dennis FA - Perrin, Nancy A FA - Green, Carla A FA - Polen, Michael R FA - Leo, Michael C FA - Lynch, Frances IN - McCarty, Dennis. Oregon Health & Science University, Portland, OR 97239, USA. mccartyd@ohsu.edu TI - Methadone maintenance and the cost and utilization of health care among individuals dependent on opioids in a commercial health plan. SO - Drug & Alcohol Dependence. 111(3):235-40, 2010 Oct 01 AS - Drug Alcohol Depend. 111(3):235-40, 2010 Oct 01 NJ - Drug and alcohol dependence VO - 111 IP - 3 PG - 235-40 PI - Journal available in: Print PI - Citation processed from: Internet JC - ebs, 7513587 IO - Drug Alcohol Depend PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950212 OI - Source: NLM. NIHMS206525 SB - Index Medicus CP - Ireland MH - Adult MH - *Delivery of Health Care/ec [Economics] MH - Delivery of Health Care/ut [Utilization] MH - Electronic Health Records/ec [Economics] MH - Female MH - *Health Care Costs MH - Humans MH - Male MH - *Methadone/ad [Administration & Dosage] MH - Middle Aged MH - *Opiate Substitution Treatment/ec [Economics] MH - Opiate Substitution Treatment/ut [Utilization] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Opioid-Related Disorders/ec [Economics] MH - *Prepaid Health Plans/ec [Economics] MH - Prepaid Health Plans/ut [Utilization] AB - BACKGROUND: Few health plans provide maintenance medication for opioid dependence. This study assessed the cost of treating opioid-dependent members in a commercial health plan and the impacts of methadone maintenance on costs of care. AB - METHODS: Individuals with diagnoses of opioid dependence (two or more diagnoses per year) and at least 9 months of health plan eligibility each year were extracted from electronic health records for the years 2000 through 2004 (1,518 individuals and 2,523 observations across the study period-some individuals were in multiple years). Analyses examined the patterns and costs of health care for three groups of patients: (1) one or more methadone visits during the year (n=1,298; 51%); (2) no methadone visits and 0 or 1 visits in the Addiction Medicine Department (n=370; 15%); (3) no methadone visits and 2 or more visits in addiction medicine (n=855; 34%). AB - RESULTS: Primary care (86%), emergency department (48%) and inpatient (24%) visits were common. Mean total annual costs to the health plan were $11,200 (2004 dollars) per member per year. The health plan's costs for members receiving methadone maintenance were 50% lower ($7,163) when compared to those with two or more outpatient addiction treatment visits but no methadone ($14,157) and 62% lower than those with one or zero outpatient addiction treatment visits and no methadone treatment ($18,694). AB - CONCLUSIONS: Use of opioid maintenance services was associated with lower total costs of care for opioid-dependent members in a commercial health plan. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved. RN - UC6VBE7V1Z (Methadone) ES - 1879-0046 IL - 0376-8716 DO - https://dx.doi.org/10.1016/j.drugalcdep.2010.04.018 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0376-8716(10)00174-2 [pii] ID - 10.1016/j.drugalcdep.2010.04.018 [doi] ID - PMC2950212 [pmc] ID - NIHMS206525 [mid] PP - ppublish PH - 2010/02/12 [received] PH - 2010/04/28 [revised] PH - 2010/04/30 [accepted] GI - No: R01 DA016341 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: U10 DA013036 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA 016341 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2010 Oct 01 EZ - 2010/07/16 06:00 DA - 2011/08/13 06:00 DT - 2010/07/15 06:00 YR - 2010 ED - 20110811 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20627427 <520. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21629807 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Faust AC AU - Terpolilli R AU - Hughes DW FA - Faust, Andrew C FA - Terpolilli, Ralph FA - Hughes, Darrel W IN - Faust, Andrew C. Department of Pharmacy Services, University Health System, 4502 Medical Drive, San Antonio, TX 78229, USA. TI - Management of an oral ingestion of transdermal fentanyl patches: a case report and literature review. SO - Case Reports in Medicine. 2011:495938, 2011 AS - Case Report Med. 2011:495938, 2011 NJ - Case reports in medicine VO - 2011 PG - 495938 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 101512910 IO - Case Rep Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099212 CP - United States AB - Purpose. Fentanyl is available as a transdermal system for the treatment of chronic pain in opioid-tolerant patients; however, it carries a black box warning due to both the potency of the product and the potential for abuse. In this report, we describe a case of transbuccal and gastrointestinal ingestion of fentanyl patches and the management of such ingestion. Summary. A 32-year-old man was brought to the emergency department (ED) via emergency medical services for toxic ingestion and suicide attempt. The patient chewed and ingested two illegally purchased transdermal fentanyl patches. In the ED, the patient was obtunded, dizzy and drowsy. Initial vital signs showed the patient to be afebrile and normotensive with a heart rate of 63, respiratory rate of 16, and oxygen saturation of 100% on 2 liters nasal cannula after administration of 2 milligrams of intravenous naloxone. The patient was treated with whole bowel irrigation and continuous intravenous naloxone infusion for approximately 48 hours without complications. Conclusion. Despite numerous case reports describing oral ingestion of fentanyl patches, information on the management of such intoxication is lacking. We report successful management of such a case utilizing whole bowel irrigation along with intravenous push and continuous infusion naloxone. ES - 1687-9635 DO - https://dx.doi.org/10.1155/2011/495938 PT - Journal Article ID - 10.1155/2011/495938 [doi] ID - PMC3099212 [pmc] PP - ppublish PH - 2011/01/11 [received] PH - 2011/03/09 [accepted] LG - English EP - 20110512 DP - 2011 EZ - 2011/06/02 06:00 DA - 2011/06/02 06:01 DT - 2011/06/02 06:00 YR - 2011 ED - 20110714 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=21629807 <521. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21603331 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Deogaonkar A AU - Khin M AU - Samuel S AU - Ebrahim ZY AU - Mascha EJ AU - Schubert A FA - Deogaonkar, Anupa FA - Khin, Mimi FA - Samuel, Samuel FA - Ebrahim, Zeyd Y FA - Mascha, Edward J FA - Schubert, Armin TI - Gender rather than choice of intermediate duration opioids affects emergence after craniotomy for large intracranial tumors. SO - Ochsner Journal. 11(1):22-8, 2011 AS - OCHSNER J. 11(1):22-8, 2011 NJ - The Ochsner journal VO - 11 IP - 1 PG - 22-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101125795 IO - Ochsner J PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096165 CP - United States KW - Alfentanil; anesthetic drug combinations; craniotomy; delayed emergence; fentanyl; intracranial tumor surgery; sufentanil AB - BACKGROUND: Opioid-based anesthetic techniques are commonly used during neurosurgical procedures. In the present randomized prospective study, we studied emergence after 4 anesthetic regimens combining intermediate duration opioids with isoflurane and nitrous oxide (N(2)O), in patients undergoing craniotomy for large (> 30 mm diameter with intracranial mass effect) intracranial tumors. AB - METHODS: One hundred seven patients were randomized into 4 groups: Group A: fentanyl (<= 5 micro g/kg) + isoflurane (<= 1 minimum alveolar concentration [MAC]), Group B: sufentanil (1-2 micro g/kg plus infusion) + isoflurane (<= 0.5 MAC), Group C: sufentanil (2 micro g/kg bolus only) + isoflurane (<= 1 MAC), and Group D: alfentanil (100 micro g/kg plus infusion) + isoflurane (<= 0.5 MAC). Boluses were administered as divided doses during induction, laryngoscopy, head pinning, and incision. Blood pressure was controlled at +/-25% of baseline levels. All infusions were discontinued at the start of dural closure. Emergence was assessed using a mini-neurologic examination consisting of 7 questions. Groups were compared on time to emergence using survival analysis methods. AB - RESULTS: The groups did not differ regarding extubation time, which occurred at a median of 4 to 6 minutes across groups after discontinuing N(2)O. The median emergence time ranged from 15 to 22.5 minutes and did not differ among groups. However, across all groups more women had emerged by 30 minutes compared with men (83% vs 57%, P = .002). The median emergence time in women was found to be significantly shorter (0-15 minutes) than in men (15-30 minutes) (P = .012). AB - CONCLUSIONS: No between-group differences in emergence time were observed; the study was stopped early because of evidence that no differences were likely to be found if the study were continued. However, in a post hoc analysis, female gender was associated with faster emergence. IS - 1524-5012 IL - 1524-5012 PT - Journal Article ID - PMC3096165 [pmc] PP - ppublish LG - English DP - 2011 EZ - 2011/05/24 06:00 DA - 2011/05/24 06:01 DT - 2011/05/24 06:00 YR - 2011 ED - 20110714 RD - 20130529 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=21603331 <522. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21177015 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chung SP AU - Song FQ AU - Yu T AU - Weng Y AU - Sun S AU - Weil MH AU - Tang W FA - Chung, Sung Phil FA - Song, Feng-Qing FA - Yu, Tao FA - Weng, Yinlun FA - Sun, Shijie FA - Weil, Max Harry FA - Tang, Wanchun IN - Chung, Sung Phil. Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States. TI - Effect of therapeutic hypothermia vs delta-opioid receptor agonist on post resuscitation myocardial function in a rat model of CPR. SO - Resuscitation. 82(3):350-4, 2011 Mar AS - Resuscitation. 82(3):350-4, 2011 Mar NJ - Resuscitation VO - 82 IP - 3 PG - 350-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Animals MH - *Cardiopulmonary Resuscitation MH - Disease Models, Animal MH - Echocardiography MH - Enkephalin, Leucine-2-Alanine/ad [Administration & Dosage] MH - *Enkephalin, Leucine-2-Alanine/tu [Therapeutic Use] MH - Heart/de [Drug Effects] MH - *Heart/ph [Physiology] MH - *Hypothermia, Induced MH - Infusions, Intravenous MH - Male MH - Rats MH - Rats, Sprague-Dawley MH - *Receptors, Opioid, delta/ag [Agonists] MH - Stroke Volume/ph [Physiology] AB - AIM: This study is to compare the effect of the delta-opioid receptor agonist, D-Ala(2)-D-Leu(5) enkephalin (DADLE) with normothermic control and therapeutic hypothermia on post resuscitation myocardial function and 72-h survival in a rat model of cardiac arrest and resuscitation. AB - METHODS: Ventricular fibrillation (VF) was induced in 15 male Sprague-Dawley rats. After 8 min of untreated VF, cardiopulmonary resuscitation was performed for 8 min before defibrillation. Animals were randomized to three groups of five: (a) normothermia; (b) hypothermia (32 degreeC); and (c) normothermia with DADLE intravenous infusion (1 mg/kg h(-1)). Hypothermia and drug infusion were started after successful defibrillation. Myocardial functions, including cardiac output (CO), left ventricular ejection fraction (LVEF), and myocardial performance index (MPI) were measured echocardiographically together with duration of survival. AB - RESULTS: The 72-h survival was significantly greater in the hypothermic group than in both DADLE and normothermic group (p = 0.02). However, the survival time of the DADLE treated animals was significantly longer than that of the normothermia group (51.8 +/- 18.9 vs 18.8 +/- 10.1h, p < 0.01). DADLE group showed significantly better CO (PR 60 min, p = 0.049), better LVEF (PR 60 min, p = 0.044; PR 240 min, p < 0.001) and lower MPI (PR 60 min, p = 0.043; PR 240 min, p = 0.045) than normothermic group. Hypothermia group also showed significantly better CO (PR 60m in, p = 0.044; PR 240 min, p = 0.007), better LVEF (PR 60 min, p = 0.001; PR 240 min, p < 0.001) and lower MPI (PR 60 min, p = 0.003; PR 240 min, p = 0.012) than the normothermic group. AB - CONCLUSIONS: DADLE attenuated post resuscitation myocardial dysfunction and increased short term survival time. However, the 72-h survival in the DADLE group was less than that in the hypothermia group. Copyright © 2010. Published by Elsevier Ireland Ltd. RN - 0 (Receptors, Opioid, delta) RN - 63631-40-3 (Enkephalin, Leucine-2-Alanine) ES - 1873-1570 IL - 0300-9572 DO - https://dx.doi.org/10.1016/j.resuscitation.2010.11.010 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0300-9572(10)01102-0 [pii] ID - 10.1016/j.resuscitation.2010.11.010 [doi] PP - ppublish PH - 2010/06/30 [received] PH - 2010/11/08 [revised] PH - 2010/11/18 [accepted] LG - English EP - 20101221 DP - 2011 Mar EZ - 2010/12/24 06:00 DA - 2011/06/28 06:00 DT - 2010/12/24 06:00 YR - 2011 ED - 20110624 RD - 20110214 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21177015 <523. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21348558 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mark TL AU - Montejano LB AU - Kranzler HR AU - Chalk M AU - Gastfriend DR FA - Mark, Tami L FA - Montejano, Leslie B FA - Kranzler, Henry R FA - Chalk, Mady FA - Gastfriend, David R IN - Mark, Tami L. Thomson Reuters Inc, 4301 Connecticut Ave NW, Ste 330, Washington, DC 20008, USA. tami.mark@thomsonreuters.com TI - Comparison of healthcare utilization among patients treated with alcoholism medications. SO - American Journal of Managed Care. 16(12):879-88, 2010 AS - Am J Manag Care. 16(12):879-88, 2010 NJ - The American journal of managed care VO - 16 IP - 12 PG - 879-88 PI - Journal available in: Print PI - Citation processed from: Internet JC - cw0, 9613960 IO - Am J Manag Care PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160801 OI - Source: NLM. NIHMS624972 SB - Health Administration Journals CP - United States MH - Alcohol Deterrents/ad [Administration & Dosage] MH - *Alcohol Deterrents/ec [Economics] MH - Alcohol Deterrents/tu [Therapeutic Use] MH - *Alcoholism/dt [Drug Therapy] MH - *Alcoholism/ec [Economics] MH - Delayed-Action Preparations MH - Disulfiram/ad [Administration & Dosage] MH - Disulfiram/ec [Economics] MH - Disulfiram/tu [Therapeutic Use] MH - Female MH - Health Services/ec [Economics] MH - *Health Services/ut [Utilization] MH - Health Status Indicators MH - Humans MH - Inpatients MH - Insurance Claim Review MH - Male MH - Middle Aged MH - Naltrexone/ad [Administration & Dosage] MH - Naltrexone/ec [Economics] MH - Naltrexone/tu [Therapeutic Use] MH - Narcotics/ad [Administration & Dosage] MH - Narcotics/ec [Economics] MH - Narcotics/tu [Therapeutic Use] MH - Propensity Score MH - Retrospective Studies MH - Taurine/ad [Administration & Dosage] MH - Taurine/aa [Analogs & Derivatives] MH - Taurine/ec [Economics] MH - Taurine/tu [Therapeutic Use] MH - United States AB - OBJECTIVES: To determine in a large claims database the healthcare utilization and costs associated with treatment of alcohol dependence with medications vs no medication and across 4 US Food and Drug Administration (FDA)-approved medications. AB - STUDY DESIGN: Claims database analysis. AB - METHODS: Eligible adults with alcohol dependence claims (n = 27,135) were identified in a commercial database (MarketScan; Thomson Reuters Inc, Chicago, Illinois). Following propensity score-based matching and inverse probability weighting on demographic, clinical, and healthcare utilization variables, patients who had used an FDA-approved medication for alcohol dependence (n = 2977)were compared with patients who had not (n =2977). Patients treated with oral naltrexone hydrochloride(n = 2064), oral disulfiram (n = 2076), oral acamprosate calcium (n = 5068), or extended-release injectable naltrexone (naltrexone XR) (n = 295) were also compared for 6-month utilization rates of alcoholism medication, inpatient detoxification days, alcoholism-related inpatient days, and outpatient services, as well as inpatient charges. AB - RESULTS: Patients who received alcoholism medications had fewer inpatient detoxification days (706 vs 1163 days per 1000 patients, P <.001), alcoholism-related inpatient days (650 vs 1086 days, P <.001), and alcoholism-related emergency department visits (127 vs 171, P = .005). Among 4 medications, the use of naltrexone XR was associated with fewer inpatient detoxification days (224 days per 1000 patients) than the use of oral naltrexone (552 days, P = .001), disulfiram (403 days, P = .049), or acamprosate (525 days, P <.001). The group receiving naltrexone XR also had fewer alcoholism-related inpatient days than the groups receiving disulfiram or acamprosate. More patients in the naltrexone XR group had an outpatient substance abuse visit compared with patients in the oral alcoholism medication groups. AB - CONCLUSION: Patients who received an alcoholism medication had lower healthcare utilization than patients who did not. Naltrexone XR showed an advantage over oral medications in healthcare utilization and costs. RN - 0 (Alcohol Deterrents) RN - 0 (Delayed-Action Preparations) RN - 0 (Narcotics) RN - 1EQV5MLY3D (Taurine) RN - 5S6W795CQM (Naltrexone) RN - N4K14YGM3J (acamprosate) RN - TR3MLJ1UAI (Disulfiram) ES - 1936-2692 IL - 1088-0224 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - 12752 [pii] ID - PMC4160801 [pmc] ID - NIHMS624972 [mid] PP - ppublish GI - No: K24 AA013736 Organization: (AA) *NIAAA NIH HHS* Country: United States LG - English DP - 2010 EZ - 2011/02/26 06:00 DA - 2011/06/03 06:00 DT - 2011/02/26 06:00 YR - 2010 ED - 20110602 RD - 20161025 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=21348558 <524. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21304154 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Epker JL AU - Bakker J AU - Kompanje EJ FA - Epker, Jelle L FA - Bakker, Jan FA - Kompanje, Erwin J O IN - Epker, Jelle L. Department of Intensive Care Medicine, Erasmus MC Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. j.epker@erasmusmc.n TI - The use of opioids and sedatives and time until death after withdrawing mechanical ventilation and vasoactive drugs in a dutch intensive care unit. CM - Comment in: Anesth Analg. 2011 Dec;113(6):1522-3; author reply 1523; PMID: 22116970 SO - Anesthesia & Analgesia. 112(3):628-34, 2011 Mar AS - Anesth Analg. 112(3):628-34, 2011 Mar NJ - Anesthesia and analgesia VO - 112 IP - 3 PG - 628-34 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 4r8, 1310650 IO - Anesth. Analg. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Female MH - Hospital Mortality/td [Trends] MH - *Hospital Mortality MH - Humans MH - *Hypnotics and Sedatives/tu [Therapeutic Use] MH - Intensive Care Units/td [Trends] MH - *Intensive Care Units MH - Male MH - Middle Aged MH - Netherlands/ep [Epidemiology] MH - *Respiration, Artificial/mo [Mortality] MH - Respiration, Artificial/td [Trends] MH - Retrospective Studies MH - Time Factors MH - Withholding Treatment/td [Trends] MH - *Withholding Treatment AB - BACKGROUND: We studied the frequency of withdrawal of mechanical ventilation (MV) and/or vasoactive agents (VAs), the time until death, and dosages of opioids and sedatives in a Dutch academic intensive care unit (ICU), and compared these practices with international observations in this field. AB - METHODS: Retrospective data were collected from the electronic and paper files of all patients who died after withdrawal of treatment in a Dutch ICU between October 2006 and February 2007. AB - RESULTS: In this period, 471 patients were admitted to the ICU, of whom 88 died (18%). In 60 of these patients (68%), MV and/or VAs were withdrawn. This group represented 13% of the total ICU population. Of the 60 patients for whom MV and/or VAs were withdrawn, 54 (90%) died after withdrawal of MV (with or without VAs). Six (10%) died after withdrawal of VAs only, 33 (55%) after withdrawal of MV in combination with VAs, and 21 (35%) after withdrawal of MV only. Death occurred after withdrawal of MV in combination with VAs after a median of 30 minutes (interquartile range [IQR], 10-195 minutes). When only MV was discontinued, the median time until death was 50 minutes (IQR, 15-530 minutes). When only VAs were withdrawn, patients died after a median of 45 minutes (IQR, 20-715 minutes). Ten patients (17%) did not receive opioids or sedatives in their last hours. Fifty patients received opioids in their last hours. Fentanyl, with a median dosage at time of death of 100 mug/h, was the most frequently used opioid. Forty (80%) of the 50 patients mentioned above received some kind of sedative until death. In the MV withdrawal group, 34 of the 54 patients (63%) received sedatives in the last hours of their lives: 16 (27%) received midazolam (median, 10 mg/h), 12 (22%) propofol (median, 160 mg/h), and 6 (11%) lorazepam (2.0 mg/h). Sedatives were administered to all patients in whom only VAs were withdrawn. AB - CONCLUSIONS: Dutch patients who die in the ICU, or die after discharge from the ICU, die after MV and/or VAs are withdrawn. When treatments are withdrawn, death follows within 1 hour in most patients, which is a reflection of the severity of illnesses. At least 80% of patients receive opioids, and 67% receive sedatives until death. Fentanyl is the most used opioid, whereas midazolam is the most used sedative. Dosages of opioids and sedatives did not significantly exceed the ranges described as usual in the international literature. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) ES - 1526-7598 IL - 0003-2999 DO - https://dx.doi.org/10.1213/ANE.0b013e31820ad4d9 PT - Comparative Study PT - Journal Article ID - ANE.0b013e31820ad4d9 [pii] ID - 10.1213/ANE.0b013e31820ad4d9 [doi] PP - ppublish LG - English EP - 20110208 DP - 2011 Mar EZ - 2011/02/10 06:00 DA - 2011/04/22 06:00 DT - 2011/02/10 06:00 YR - 2011 ED - 20110421 RD - 20120104 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21304154 <525. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20532845 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Prosser JM AU - Jones BE AU - Nelson L FA - Prosser, Jane M FA - Jones, Brent E FA - Nelson, Lewis IN - Prosser, Jane M. Division of Emergency Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St. M130, New York, NY 10065, USA. jprosser100@gmail.com TI - Complications of oral exposure to fentanyl transdermal delivery system patches. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 6(4):443-7, 2010 Dec AS - J Med Toxicol. 6(4):443-7, 2010 Dec NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 6 IP - 4 PG - 443-7 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550454 SB - Index Medicus CP - United States MH - Administration, Oral MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/bl [Blood] MH - Databases, Factual MH - Female MH - Fentanyl/ad [Administration & Dosage] MH - *Fentanyl/ae [Adverse Effects] MH - Fentanyl/bl [Blood] MH - Humans MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Poisoning/bl [Blood] MH - *Poisoning/et [Etiology] MH - Poisoning/th [Therapy] MH - Respiration, Artificial MH - Substance-Related Disorders MH - Suicide, Attempted MH - *Transdermal Patch/ae [Adverse Effects] MH - Treatment Outcome AB - PURPOSE: Fentanyl is a synthetic opioid available therapeutically as an intravenous, transbucal, or transdermal preparation. It is also used as a drug of abuse through a variety of different methods, including the oral abuse of transdermal fentanyl patches. This is a series of patients with oral fentanyl patch exposure reported to our center and represents the first series of oral fentanyl patch exposures collected outside of the postmortem setting. AB - METHODS: In this series, we examined the New York Poison Control Center database for all cases of oral abuse of fentanyl reported between January 2000 and April 2008. AB - RESULTS: Twenty cases were reported, nine were asymptomatic or had symptoms of opioid withdrawal; 11 had symptoms of opioid intoxication. Eight patients were administered naloxone and all showed improvement in clinical status. Only one case resulted in a confirmed fatality-this patient had an orally adherent patch discovered at intubation. AB - CONCLUSIONS: Oral exposure may result in life-threatening toxicity. Patients should be closely assessed and monitored for the opioid toxidrome, and if symptomatic, should be managed with opioid antagonists and ventilatory support. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) ES - 1937-6995 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-010-0092-8 PT - Journal Article ID - 10.1007/s13181-010-0092-8 [doi] ID - PMC3550454 [pmc] PP - ppublish LG - English DP - 2010 Dec EZ - 2010/06/10 06:00 DA - 2011/04/13 06:00 DT - 2010/06/10 06:00 YR - 2010 ED - 20110412 RD - 20161114 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20532845 <526. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21164067 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Morriss FH Jr AU - Abramowitz PW AU - Nelson SP AU - Milavetz G AU - Michael SL AU - Gordon SN FA - Morriss, Frank H Jr FA - Abramowitz, Paul W FA - Nelson, Steven P FA - Milavetz, Gary FA - Michael, Stacy L FA - Gordon, Sara N IN - Morriss, Frank H Jr. Department of Pediatrics,Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA. frank-morriss@uiowa.edu TI - Risk of adverse drug events in neonates treated with opioids and the effect of a bar-code-assisted medication administration system. SO - American Journal of Health-System Pharmacy. 68(1):57-62, 2011 Jan 01 AS - Am J Health-Syst Pharm. 68(1):57-62, 2011 Jan 01 NJ - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists VO - 68 IP - 1 PG - 57-62 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9503023, cbh IO - Am J Health Syst Pharm SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Automatic Data Processing MH - Chi-Square Distribution MH - Drug-Related Side Effects and Adverse Reactions/pc [Prevention & Control] MH - Female MH - Humans MH - Infant, Newborn MH - Intensive Care Units, Neonatal/sn [Statistics & Numerical Data] MH - Male MH - Medication Errors/pc [Prevention & Control] MH - Medication Errors/sn [Statistics & Numerical Data] MH - *Medication Systems, Hospital MH - Postoperative Care MH - Proportional Hazards Models MH - Prospective Studies MH - Respiration, Artificial MH - Risk Factors AB - PURPOSE: The risk of adverse drug events (ADEs) in neonates treated with opioids and the effect of a bar-code-assisted medication administration (BCMA) system were studied. AB - METHODS: A prospective cohort study of neonates in a neonatal intensive care unit (NICU) was conducted. A BCMA system was operative for 50% of the study period. Structured medical record audits were conducted to identify medication errors and preventable ADEs. Stratified frequency distribution and Cox proportional hazards analyses were used. AB - RESULTS: Of 618 patients, 78 (12.6%) received postoperative care, 280 (45.3%) required assisted ventilation, and 72 (11.7%) were treated with opioids during their hospitalization. A total of 32 first preventable ADEs occurred. Univariate analyses demonstrated that postoperative status, assisted ventilation, and opioid administration were each significantly associated with ADEs. However, stratified frequency distribution analyses indicated that opioid administration during hospitalization was associated with preventable ADEs, controlling for postoperative status (p = 0.0019) or assisted ventilation (p = 0.0007). The odds ratio for any preventable ADE occurrence in a patient treated with an opioid was 4.74 compared with an infant not treated with an opioid. Patients who were treated with an opioid in the absence of a BCMA system had a 10% probability of an ADE after hospitalization for six days. AB - CONCLUSION: Infants in a NICU who were treated with opioids were at greater risk of a preventable ADE than other patients, adjusted for two medical conditions, assisted ventilation and postoperative status. A BCMA system reduced the risk of harm from an opioid medication error. RN - 0 (Analgesics, Opioid) ES - 1535-2900 IL - 1079-2082 DO - https://dx.doi.org/10.2146/ajhp090561 PT - Journal Article ID - 68/1/57 [pii] ID - 10.2146/ajhp090561 [doi] PP - ppublish LG - English DP - 2011 Jan 01 EZ - 2010/12/18 06:00 DA - 2011/03/26 06:00 DT - 2010/12/18 06:00 YR - 2011 ED - 20110325 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med7&AN=21164067 <527. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 21302646 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Park CL AU - Roberts DE AU - Aldington DJ AU - Moore RA FA - Park, C L FA - Roberts, D E FA - Aldington, D J FA - Moore, R A IN - Park, C L. ST4 in Anaesthetics & Intensive Care Medicine, St Georges Hospital, London, UK. TI - Prehospital analgesia: systematic review of evidence. [Review] SO - Journal of the Royal Army Medical Corps. 156(4 Suppl 1):295-300, 2010 Dec AS - J R Army Med Corps. 156(4 Suppl 1):295-300, 2010 Dec NJ - Journal of the Royal Army Medical Corps VO - 156 IP - 4 Suppl 1 PG - 295-300 PI - Journal available in: Print PI - Citation processed from: Print JC - jv6, 7505627 IO - J R Army Med Corps SB - Index Medicus CP - England MH - Adult MH - *Analgesia/mt [Methods] MH - *Emergency Medical Services/mt [Methods] MH - Evidence-Based Medicine MH - Humans AB - The purpose of this systematic review is to investigate current evidence for analgesic use in the prehospital environment using expert military and civilian opinion to determine the important clinical questions. There was a high degree of agreement that pain should be no worse than mild, that pain relief be rapid (within 10 minutes), that patients should respond to verbal stimuli and not require ventilatory support, and that major adverse events should be avoided. Twenty-one studies provided information about 6212 patients; the majority reported most of the outcomes of interest. With opioids 60-70% of patients still had pain levels above 30/100 mm on a Visual Analogue Scale after 10 minutes, falling to about 30% by 30-40 minutes. Fascia iliaca blocks demonstrated some efficacy for femoral fractures. No patient on opioids required ventilatory support; two required naloxone; sedation was rare. Cardiovascular instability was uncommon. Main adverse events were dizziness or giddiness, and pruritus with opioids. There was little evidence regarding the prehospital use ofketamine. IS - 0035-8665 IL - 0035-8665 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PP - ppublish LG - English DP - 2010 Dec EZ - 2011/02/10 06:00 DA - 2011/03/18 06:00 DT - 2011/02/10 06:00 YR - 2010 ED - 20110317 RD - 20110209 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=21302646 <528. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20511258 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gray A AU - Goodacre S AU - Seah M AU - Tilley S FA - Gray, A FA - Goodacre, S FA - Seah, M FA - Tilley, S IN - Gray, A. Emergency Medicine Research Group, Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK. alasdair.gray@luht.scot.nhs.uk TI - Diuretic, opiate and nitrate use in severe acidotic acute cardiogenic pulmonary oedema: analysis from the 3CPO trial. SO - Qjm. 103(8):573-81, 2010 Aug AS - QJM. 103(8):573-81, 2010 Aug NJ - QJM : monthly journal of the Association of Physicians VO - 103 IP - 8 PG - 573-81 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9438285, B4V IO - QJM SB - Index Medicus CP - England MH - *Acidosis, Respiratory/dt [Drug Therapy] MH - Acidosis, Respiratory/et [Etiology] MH - Acute Disease MH - Aged MH - Aged, 80 and over MH - Algorithms MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Diuretics/tu [Therapeutic Use] MH - Emergency Service, Hospital MH - Female MH - Heart Failure/co [Complications] MH - *Heart Failure/dt [Drug Therapy] MH - Heart Failure/mo [Mortality] MH - Humans MH - Logistic Models MH - Male MH - *Nitrates/tu [Therapeutic Use] MH - Pulmonary Edema/co [Complications] MH - *Pulmonary Edema/dt [Drug Therapy] MH - Pulmonary Edema/mo [Mortality] MH - Treatment Outcome MH - United Kingdom AB - BACKGROUND: Drug treatments for acute cardiogenic pulmonary oedema (ACPO) have not been rigorously evaluated and recent observational data suggests some agents are related to poorer outcome. AB - AIM: We aimed to examine the effect of treatment with diuretics, nitrates and opiates on 7-day mortality, acidosis and respiratory distress in UK Emergency Department (ED) patients with severe acidotic pulmonary oedema. AB - DESIGN: Analysis of data from the 3CPO trial; a multicentre randomized controlled trial. AB - METHODS: Data were analysed from patients recruited with severe acidotic pulmonary oedema to the 3CPO trial in 26 UK EDs between 2003 and 2007. The effects of these treatments on 7-day mortality, improvement in acidosis (pH change between baseline and 1 h) and improvement in respiratory distress (patient measured breathlessness using a Visual Analogue Score between baseline and 1 h) were tested using univariate logistic regression analysis, and a regression model used to adjust for confounding baseline differences. AB - RESULTS: Nitrates were given to 947/1048 (90.4%) patients, diuretics to 934/1049 (89.0%) patients and opiates to 541/1052 patients (51.4%). Adjusted analysis showed that opiate treatment was associated with less improvement in acidosis [difference in improvement in pH -0.022, 95% confidence interval (CI) -0.014 to -0.030, P < 0.001], but no difference in mortality or improvement in respiratory distress. We found no evidence that nitrate or diuretic use were associated with any difference in mortality, improvement in acidosis or respiratory distress. AB - CONCLUSION: Opiate use is associated with less improvement in acidosis during initial treatment and may attenuate effective treatment of severe acidotic ACPO. RN - 0 (Analgesics, Opioid) RN - 0 (Diuretics) RN - 0 (Nitrates) ES - 1460-2393 IL - 1460-2393 DO - https://dx.doi.org/10.1093/qjmed/hcq077 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - hcq077 [pii] ID - 10.1093/qjmed/hcq077 [doi] PP - ppublish LG - English EP - 20100528 DP - 2010 Aug EZ - 2010/06/01 06:00 DA - 2011/02/23 06:00 DT - 2010/06/01 06:00 YR - 2010 ED - 20110222 RD - 20161125 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20511258 <529. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20978218 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Patanwala AE AU - Keim SM AU - Erstad BL FA - Patanwala, Asad E FA - Keim, Samuel M FA - Erstad, Brian L IN - Patanwala, Asad E. University of Arizona, Tucson, USA. Patanwala@pharmacy.arizona TI - Intravenous opioids for severe acute pain in the emergency department. [Review] SO - Annals of Pharmacotherapy. 44(11):1800-9, 2010 Nov AS - Ann Pharmacother. 44(11):1800-9, 2010 Nov NJ - The Annals of pharmacotherapy VO - 44 IP - 11 PG - 1800-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bbx, 9203131 IO - Ann Pharmacother SB - Index Medicus CP - United States MH - Acute Disease MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Clinical Protocols MH - Dose-Response Relationship, Drug MH - *Emergency Service, Hospital MH - Humans MH - Infusions, Intravenous MH - *Pain/dt [Drug Therapy] MH - Randomized Controlled Trials as Topic MH - Severity of Illness Index AB - OBJECTIVE: To review clinical trials of intravenous opioids for severe acute pain in the emergency department (ED) and to provide an approach for optimization of therapy. AB - DATA SOURCES: Articles were identified through a search of Ovid/MEDLINE (1948-August 2010), PubMed (1950-August 2010), Cochrane Central Register of Controlled Trials (1991-August 2010), and Google Scholar (1900-August 2010). The search terms used were pain, opioid, and emergency department. AB - STUDY SELECTION AND DATA EXTRACTION: The search was limited by age group to adults and by publication type to comparative studies. Studies comparing routes of administration other than intravenous or using non-opioid comparators were not included. Bibliographies of all retrieved articles were reviewed to obtain additional articles. The focus of the search was to identify original research that compared intravenous opioids used for treatment of severe acute pain for adults in the ED. AB - DATA SYNTHESIS: At equipotent doses, randomized controlled trials have not shown clinically significant differences in analgesic response or adverse effects between opioids studied. Single opioid doses less than 0.1 mg/kg of intravenous morphine, 0.015 mg/kg of intravenous hydromorphone, or 1 mug/kg of intravenous fentanyl are likely to be inadequate for severe, acute pain and the need for additional doses should be anticipated. In none of the randomized controlled trials did patients develop respiratory depression requiring the use of naloxone. Future trials could investigate the safety and efficacy of higher doses of opioids. Implementation of nurse-initiated and patient-driven pain management protocols for opioids in the ED has shown improvements in timely provision of appropriate analgesics and has resulted in better pain reduction. AB - CONCLUSIONS: Currently, intravenous administration of opioids for severe acute pain in the ED appears to be inadequate. Opioid doses in the ED should be high enough to provide adequate analgesia without additional risk to the patient. EDs could implement institution-specific protocols to standardize the management of pain. RN - 0 (Analgesics, Opioid) ES - 1542-6270 IL - 1060-0280 DO - https://dx.doi.org/10.1345/aph.1P438 PT - Comparative Study PT - Journal Article PT - Review ID - aph.1P438 [pii] ID - 10.1345/aph.1P438 [doi] PP - ppublish LG - English EP - 20101026 DP - 2010 Nov EZ - 2010/10/28 06:00 DA - 2011/02/16 06:00 DT - 2010/10/28 06:00 YR - 2010 ED - 20110215 RD - 20101104 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20978218 <530. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20707888 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Reid BO AU - Skogvoll E FA - Reid, Bjorn Ole FA - Skogvoll, Eirik IN - Reid, Bjorn Ole. Department of Anaesthesiology and Emergency Medicine, St. Olav University Hospital, Trondheim, Norway. bjorn.ole.reid@stolav.no TI - Pitfalls with the "chest compression-only" approach: the challenge of an unusual cause. SO - Scandinavian Journal of Trauma, Resuscitation & Emergency Medicine. 18:45, 2010 Aug 13 AS - Scand J Trauma Resusc Emerg Med. 18:45, 2010 Aug 13 NJ - Scandinavian journal of trauma, resuscitation and emergency medicine VO - 18 PG - 45 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 101477511 IO - Scand J Trauma Resusc Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933597 SB - Index Medicus CP - England MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Cardiopulmonary Resuscitation/mt [Methods] MH - Drug Overdose/co [Complications] MH - Emergency Medical Services MH - *Heart Massage/mt [Methods] MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/pp [Physiopathology] MH - Myocardial Infarction/th [Therapy] MH - Norway AB - Chest compression-only (CC-only) is now incorporated in the Norwegian protocol for dispatch guided CPR (cardiopulmonary resuscitation) in cardiac arrest of presumed cardiac aetiology.We present a case that is unique and instructive as well as unusual. It reminds us of the challenges that face bystanders, dispatch centres and ambulance services when faced with possible cardiac arrest.This case report describes a 50 year old man in a rural community. He had suffered a heart attack 8 months previously, and was found unconscious with respiratory arrest in his garden one morning. Due to the proximity to the ambulance station, the paramedics were on the scene within three minutes. A chain-saw was lying beside him, but no external injuries were seen. The patient had no radial pulse, central cyanosis and respiratory gasps approximately every 30 seconds. Ventilation with bag and mask was given, and soon a femoral pulse could be palpated. Blood sugar was elevated and ECG (electrocardiogram) was normal. GCS (Glasgow Coma Scale) was 3. Upon arrival of the physician staffed air ambulance, further examination revealed bilateral miosis of the pupils and continuing bradypnoea. Naloxone was given with an immediate effect and the patient woke up. The patient denied intake of narcotics, but additional information from the dispatch centre revealed that he was hepatitis C positive. After a few hours, the patient admitted to have obtained a fentanyl transdermal patch from an acquaintance, having chewed it before falling unconscious. This case report shows the importance as well as the challenges of identifying a non-cardiac cause of possible cardiac arrest, and the value of providing causal therapy. RN - 0 (Analgesics, Opioid) ES - 1757-7241 IL - 1757-7241 DO - https://dx.doi.org/10.1186/1757-7241-18-45 PT - Case Reports PT - Journal Article ID - 1757-7241-18-45 [pii] ID - 10.1186/1757-7241-18-45 [doi] ID - PMC2933597 [pmc] PP - epublish PH - 2010/06/18 [received] PH - 2010/08/13 [accepted] LG - English EP - 20100813 DP - 2010 Aug 13 EZ - 2010/08/17 06:00 DA - 2011/01/19 06:00 DT - 2010/08/17 06:00 YR - 2010 ED - 20110118 RD - 20141203 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20707888 <531. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19264439 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wang Y AU - Gao L AU - Meng L FA - Wang, Yong FA - Gao, Linlin FA - Meng, Lingxin IN - Wang, Yong. Department of Anesthesia, Shengjing Hospital, China Medical University, Shenyang, China. TI - Naloxone combined with epinephrine decreases cerebral injury in cardiopulmonary resuscitation. SO - Journal of Emergency Medicine. 39(3):296-300, 2010 Sep AS - J Emerg Med. 39(3):296-300, 2010 Sep NJ - The Journal of emergency medicine VO - 39 IP - 3 PG - 296-300 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Animals MH - Asphyxia/dt [Drug Therapy] MH - Brain Injuries/et [Etiology] MH - *Brain Injuries/pc [Prevention & Control] MH - Cardiopulmonary Resuscitation/ae [Adverse Effects] MH - *Cardiopulmonary Resuscitation MH - Chi-Square Distribution MH - *Epinephrine/pd [Pharmacology] MH - Heart Rate MH - Male MH - *Naloxone/pd [Pharmacology] MH - Random Allocation MH - Rats MH - Rats, Wistar AB - BACKGROUND: Cardiopulmonary arrest is a serious disease that claims many lives every day; 30% of the patients suffer irreversible central nervous system injury after restoration of systemic circulation (ROSC). AB - OBJECTIVES: Naloxone combined with epinephrine was tested in a cardiac arrest rat model in which asphyxia was induced to determine if this drug combination could increase the resuscitation rate (survival) and decrease the cerebral damage. AB - METHODS: Twenty-four male Wistar rats were randomly assigned to one of three groups: the group treated with 1 mL saline (SA group; n = 8), the group treated with only epinephrine 5 microg/100 g (EP group; n = 8), or the group treated with epinephrine 5 microg/100 g combined with naloxone 1 mg/kg (NA group; n = 8). Eight minutes after arrest, cardiopulmonary resuscitation was initiated and the different drugs were administered to the rats in their respective groups at the same time. Mean arterial pressure (MAP), heart rate (HR), and neurodeficit score (NDS) were measured. AB - RESULTS: The HR in the NA group (414 +/- 45 beats/min) was faster than in the EP group (343 +/- 29 beats/min) at the 5-min time point (P < 0.01). The HR in the NA group was 392 +/- 44 beats/min and 416 +/- 19 beats/min at the 60-min and 180-min time points, respectively. There were no statistically significant differences in MAP before or after ROSC. The rates of ROSC were 2 of 8, 6 of 8, and 7 of 8 animals in the SA group, EP group, and NA group, respectively. Three days later, the rates decreased to 1, 3, and 5 in the SA group, EP group, and NA group, respectively. The average resuscitation time in the NA group was significantly shorter than in the other two groups. The NDS in the NA group was 57 +/- 13, higher than in the EP group (45 +/- 13) and SA group (38). AB - CONCLUSION: Naloxone combined with epinephrine significantly increased the resuscitation rate in a rat model. Furthermore, the combination of naloxone and epinephrine increased the NDS after cardiopulmonary resuscitation. Copyright © 2010 Elsevier Inc. All rights reserved. RN - 36B82AMQ7N (Naloxone) RN - YKH834O4BH (Epinephrine) IS - 0736-4679 IL - 0736-4679 DO - https://dx.doi.org/10.1016/j.jemermed.2008.10.014 PT - Journal Article ID - S0736-4679(08)00937-2 [pii] ID - 10.1016/j.jemermed.2008.10.014 [doi] PP - ppublish PH - 2008/07/01 [received] PH - 2008/08/06 [revised] PH - 2008/10/08 [accepted] LG - English EP - 20090305 DP - 2010 Sep EZ - 2009/03/07 09:00 DA - 2011/01/12 06:00 DT - 2009/03/07 09:00 YR - 2010 ED - 20110111 RD - 20140730 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19264439 <532. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20859312 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Manchikanti L AU - Fellows B AU - Ailinani H AU - Pampati V FA - Manchikanti, Laxmaiah FA - Fellows, Bert FA - Ailinani, Hary FA - Pampati, Vidyasagar IN - Manchikanti, Laxmaiah. Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com TI - Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. SO - Pain Physician. 13(5):401-35, 2010 Sep-Oct AS - Pain physician. 13(5):401-35, 2010 Sep-Oct NJ - Pain physician VO - 13 IP - 5 PG - 401-35 PI - Journal available in: Print PI - Citation processed from: Internet JC - 100954394 IO - Pain Physician SB - Index Medicus CP - United States MH - *Analgesics, Opioid MH - Chronic Disease MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Humans MH - *Pain/dt [Drug Therapy] MH - *Substance-Related Disorders/ep [Epidemiology] MH - United States/ep [Epidemiology] AB - The treatment of chronic pain, therapeutic opioid use and abuse, and the nonmedical use of prescription drugs have been topics of intense focus and debate. After the liberalization of laws governing opioid prescribing for the treatment of chronic non-cancer pain by state medical boards in the late 1990s, and with the introduction of new pain management standards implemented by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2000, opioids, in general, and the most potent forms of opioids including Schedule II drugs, in particular, have dramatically increased. Despite the escalating use and abuse of therapeutic opioids, nearly 15 to 20 years later the scientific evidence for the effectiveness of opioids for chronic non-cancer pain remains unclear. Concerns continue regarding efficacy; problematic physiologic effects such as hyperalgesia, hypogonadism and sexual dysfunction; and adverse side effects - especially the potential for misuse and abuse - and the increase in opioid-related deaths. Americans, constituting only 4.6% of the world's population, have been consuming 80% of the global opioid supply, and 99% of the global hydrocodone supply, as well as two-thirds of the world's illegal drugs. Retail sales of commonly used opioid medications (including methadone, oxycodone, fentanyl base, hydromorphone, hydrocodone, morphine, meperidine, and codeine) have increased from a total of 50.7 million grams in 1997 to 126.5 million grams in 2007. This is an overall increase of 149% with increases ranging from 222% for morphine, 280% for hydrocodone, 319% for hydromorphone, 525% for fentanyl base, 866% for oxycodone, to 1,293% for methadone. Average sales of opioids per person have increased from 74 milligrams in 1997 to 369 milligrams in 2007, a 402% increase. Surveys of nonprescription drug abuse, emergency department visits for prescription controlled drugs, unintentional deaths due to prescription controlled substances, therapeutic use of opioids, and opioid abuse have been steadily rising. This manuscript provides an updated 10-year perspective on therapeutic use, abuse, and non-medical use of opioids and their consequences. RN - 0 (Analgesics, Opioid) ES - 2150-1149 IL - 1533-3159 PT - Journal Article PP - ppublish LG - English DP - 2010 Sep-Oct EZ - 2010/09/23 06:00 DA - 2011/01/05 06:00 DT - 2010/09/23 06:00 YR - 2010 ED - 20110103 RD - 20100922 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20859312 <533. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20498036 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ari M AU - Oktar S AU - Duru M FA - Ari, Mustafa FA - Oktar, Suleyman FA - Duru, Mehmet IN - Ari, Mustafa. Department of Psychiatry, Medical Faculty of Mustafa Kemal University, Hatay, Turkey. TI - Amitriptyline and tianeptine poisoning treated by naloxone.[Erratum appears in Hum Exp Toxicol. 2010 Sep;29(9):797] SO - Human & Experimental Toxicology. 29(9):793-5, 2010 Sep AS - Hum Exp Toxicol. 29(9):793-5, 2010 Sep NJ - Human & experimental toxicology VO - 29 IP - 9 PG - 793-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aql, 9004560 IO - Hum Exp Toxicol SB - Index Medicus CP - England MH - Adult MH - *Amitriptyline/po [Poisoning] MH - *Antidepressive Agents, Tricyclic/po [Poisoning] MH - Drug Overdose MH - Female MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Thiazepines/po [Poisoning] MH - Treatment Outcome AB - INTRODUCTION: Severe amitriptyline toxicity may cause cardiac dysrhythmias, severe hypotension, convulsions and CNS depression, including coma. Management with gastric lavage, activated charcoal, alkalinization and supportive care with mechanical ventilation, antiarrhythmics and anticonvulsants, if required, is the general approach. AB - CASE REPORT: A 33-year-old woman who had taken overdose antidepressants (amitriptyline and tianeptine) was admitted to the emergency service. She was intubated because she had pure respiratory arrest. Besides hypotension (80/60 mmHg), she was unresponsive to verbal and painful stimuli and her Glasgow coma score was 6. Hemogram and serum biochemical parameters and electrocardiography were within normal limits. The patient was examined for substance dependence and no trace of the injector was found in the body. Patient underwent a coma cocktail (naloxone 2 mg/body, 50% dextrose 25g/body and thiamin 100 mg/body). [corrected] Activated charcoal and intravenous alkalinization by NaHCO(3) were initiated. Spontaneous respiration started again 20 min after being given the coma cocktail. She became responsive to verbal stimuli first hour after the coma cocktail, and her Glasgow coma score improved to 13. She had spent 2 days in the service and was discharged by the second day of admission, without any complications. AB - DISCUSSION: Herein, we report successful treatment in a case of severe amitriptyline and tianeptine poisoning by naloxone in addition to the above supportive care. Naloxone treatment may have a beneficial role in lethal doses of amitriptyline ingestion because amitriptyline may affect opioid receptors. RN - 0 (Antidepressive Agents, Tricyclic) RN - 0 (Narcotic Antagonists) RN - 0 (Thiazepines) RN - 0T493YFU8O (tianeptine) RN - 1806D8D52K (Amitriptyline) RN - 36B82AMQ7N (Naloxone) ES - 1477-0903 IL - 0960-3271 DO - https://dx.doi.org/10.1177/0960327110372403 PT - Case Reports PT - Journal Article ID - 0960327110372403 [pii] ID - 10.1177/0960327110372403 [doi] PP - ppublish LG - English EP - 20100524 DP - 2010 Sep EZ - 2010/05/26 06:00 DA - 2010/12/22 06:00 DT - 2010/05/26 06:00 YR - 2010 ED - 20101221 RD - 20141120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20498036 <534. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20825766 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - O'Connor AB AU - Zwemer FL AU - Hays DP AU - Feng C FA - O'Connor, Alec B FA - Zwemer, Frank L FA - Hays, Daniel P FA - Feng, Changyong IN - O'Connor, Alec B. Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. alec_oconnor@urmc.rochester.edu TI - Intravenous opioid dosing and outcomes in emergency patients: a prospective cohort analysis. SO - American Journal of Emergency Medicine. 28(9):1041-1050.e6, 2010 Nov AS - Am J Emerg Med. 28(9):1041-1050.e6, 2010 Nov NJ - The American journal of emergency medicine VO - 28 IP - 9 PG - 1041-1050.e6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Dose-Response Relationship, Drug MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Hydromorphone/ad [Administration & Dosage] MH - Hydromorphone/ae [Adverse Effects] MH - Hydromorphone/tu [Therapeutic Use] MH - Infusions, Intravenous MH - Logistic Models MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - Morphine/ae [Adverse Effects] MH - Morphine/tu [Therapeutic Use] MH - Outcome Assessment (Health Care) MH - Pain Measurement MH - Prospective Studies AB - OBJECTIVES: Pain management in emergency department (ED) patients is variable and often inadequate. This study sought to (1) describe the variability in intravenous opioid dosing and (2) compare the outcomes that result from the most commonly prescribed opioid doses. AB - METHODS: This prospective cohort study enrolled emergency patients who were prescribed intravenous morphine or hydromorphone as their initial analgesic. Subjects were interviewed at the time of opioid administration and 1 to 2 hours after opioid administration. Outcomes included the numeric pain score change (using a 0-10 scale), the proportion achieving a 50% pain score reduction, and the proportion developing side effects. Logistic regression was used to assess the effects of demographic, clinical, and treatment variables on outcomes. AB - RESULTS: Six hundred ninety-one patients were analyzed. Initial equianalgesic dosages varied by a factor of 27 (from 1 mg morphine to 4 mg hydromorphone). Opioid dose titration occurred in only 21% of patients. Outcomes were similar across the range of opioid dosages before and after adjusting for potentially confounding variables. Among patients not taking opioids at home who received a total of 4 mg of morphine or less. 48% achieved at least a 50% pain score reduction and 60% did not want additional analgesics. AB - CONCLUSIONS: We found marked opioid dosing variability and infrequent opioid dose titration. A substantial number of ED patients with severe pain responded well to relatively low opioid dosages. Improved ability to predict opioid dose requirements and strategies that increase the use of opioid dose titration in ED patients are needed. Copyright © 2010 Elsevier Inc. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) RN - Q812464R06 (Hydromorphone) ES - 1532-8171 IL - 0735-6757 DO - https://dx.doi.org/10.1016/j.ajem.2009.06.009 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0735-6757(09)00322-2 [pii] ID - 10.1016/j.ajem.2009.06.009 [doi] PP - ppublish PH - 2009/05/28 [received] PH - 2009/06/23 [revised] PH - 2009/06/24 [accepted] LG - English EP - 20100325 DP - 2010 Nov EZ - 2010/09/10 06:00 DA - 2010/11/13 06:00 DT - 2010/09/10 06:00 YR - 2010 ED - 20101112 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20825766 <535. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20376593 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lynch MJ AU - Pizon AF AU - Siam MG AU - Krasowski MD FA - Lynch, Michael J FA - Pizon, Anthony F FA - Siam, Mohamed G FA - Krasowski, Matthew D IN - Lynch, Michael J. Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. lyncmj@upmc.edu TI - Clinical effects and toxicokinetic evaluation following massive topiramate ingestion. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 6(2):135-8, 2010 Jun AS - J Med Toxicol. 6(2):135-8, 2010 Jun NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 6 IP - 2 PG - 135-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916051 OI - Source: NLM. NIHMS198235 SB - Index Medicus CP - United States MH - Acidosis/ci [Chemically Induced] MH - Adult MH - *Anticonvulsants/pk [Pharmacokinetics] MH - *Anticonvulsants/po [Poisoning] MH - Anticonvulsants/tu [Therapeutic Use] MH - Bipolar Disorder/dt [Drug Therapy] MH - Bipolar Disorder/px [Psychology] MH - Blood Gas Analysis MH - Coma/ci [Chemically Induced] MH - Critical Care MH - Drug Overdose MH - Female MH - *Fructose/aa [Analogs & Derivatives] MH - Fructose/pk [Pharmacokinetics] MH - Fructose/po [Poisoning] MH - Fructose/tu [Therapeutic Use] MH - Gas Chromatography-Mass Spectrometry MH - Humans MH - Hypnotics and Sedatives/tu [Therapeutic Use] MH - Lorazepam/tu [Therapeutic Use] MH - Respiration, Artificial AB - Topiramate is used to treat a variety of neurologic and psychiatric diseases due to its benign safety profile. Data regarding the toxicity and toxicokinetics of topiramate in acute overdose are limited. A case of massive, acute ingestion resulting in the highest reported topiramate level is presented, including toxicokinetic evaluation. A 37-year-old woman presented with coma unresponsive to naloxone following topiramate ingestion. She had normal vital signs without respiratory depression. She was intubated for airway protection, given 3.5 mg lorazepam IV for facial and neck muscle twitching, and transferred to our facility. No additional sedation was required for 18 h on the ventilator. Following mental status improvement, the patient was extubated. Confusion, dysarthria, and imbalance resolved over the next 2 days. Nonanion gap metabolic acidosis persisted for 3 days. Peak serum topiramate level was 356.6 microg/ml (reference range, 5-20 microg/ml). Massive topiramate ingestion led to prolonged coma with normal vital signs and nonanion gap metabolic acidosis. Coma of this severity has not been previously reported. Serum half-life, which has not been studied after overdose, was 16 h. Despite the large ingestion and significant presenting symptoms, the patient recovered fully with supportive intensive care alone. Massive acute topiramate ingestion may lead to nonanion gap metabolic acidosis and prolonged coma which resolves with intensive supportive care. Toxicokinetic data following large, suicidal ingestion of topiramate were similar to previously published pharmacokinetic information. RN - 0 (Anticonvulsants) RN - 0 (Hypnotics and Sedatives) RN - 0H73WJJ391 (topiramate) RN - 30237-26-4 (Fructose) RN - O26FZP769L (Lorazepam) IS - 1556-9039 IL - 1556-9039 DO - https://dx.doi.org/10.1007/s13181-010-0065-y PT - Case Reports PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 10.1007/s13181-010-0065-y [doi] ID - PMC2916051 [pmc] ID - NIHMS198235 [mid] PP - ppublish GI - No: K08 GM074238 Organization: (GM) *NIGMS NIH HHS* Country: United States GI - No: K08 GM074238-03 Organization: (GM) *NIGMS NIH HHS* Country: United States GI - No: K08 GM074238-04 Organization: (GM) *NIGMS NIH HHS* Country: United States GI - No: K08-GM074238 Organization: (GM) *NIGMS NIH HHS* Country: United States LG - English DP - 2010 Jun EZ - 2010/04/09 06:00 DA - 2010/10/30 06:00 DT - 2010/04/09 06:00 YR - 2010 ED - 20101029 RD - 20161122 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20376593 <536. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20862910 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ruan X AU - Chen T AU - Gudin J AU - Couch JP AU - Chiravuri S FA - Ruan, Xiulu FA - Chen, Tao FA - Gudin, Jeff FA - Couch, John Patrick FA - Chiravuri, Srinivas IN - Ruan, Xiulu. Physicians' Pain Specialists of Alabama, Mobile, USA. TI - Acute opioid withdrawal precipitated by ingestion of crushed embeda (morphine extended release with sequestered naltrexone): case report and the focused review of the literature. [Review] SO - Journal of Opioid Management. 6(4):300-3, 2010 Jul-Aug AS - J Opioid Manag. 6(4):300-3, 2010 Jul-Aug NJ - Journal of opioid management VO - 6 IP - 4 PG - 300-3 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Acute Disease MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Chronic Disease MH - Delayed-Action Preparations MH - Drug Combinations MH - Humans MH - *Low Back Pain/dt [Drug Therapy] MH - Male MH - Medication Adherence MH - Middle Aged MH - *Morphine/ae [Adverse Effects] MH - *Naltrexone/ae [Adverse Effects] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - *Opioid-Related Disorders/et [Etiology] MH - Severity of Illness Index MH - *Substance Withdrawal Syndrome/et [Etiology] AB - BACKGROUND: The introduction of newly formulated extended release (ER) morphine with sequestered naltrexone (Embeda) has provided another treatment option for moderate to severe persistent pain. Embeda was designed to be an abuse-deterrent opioid formulation. Naltrexone is a centrally acting opioid receptor antagonist that blocks the action of opioid. When taken as directed, insignificant amount of sequestered naltrexone would reach systemic circulation, but upon tampering, the released naltrexone may blunt the euphoria of opioids, and possibly precipitate opioid withdrawal in opioid-dependent patient. AB - OBJECTIVE: To describe a case report ofa 50-year-old opioid-dependent male who developed acute opioid withdrawal after taking crushed Embeda. AB - CASE REPORT: A 50-year-old male with severe, chronic low back pain due to degenerative disc disease was referred to our clinic for pain management. He was taking ER oxycodone 80 mg tid and Roxicodone 30 mg qid prn, with inadequate pain relief A trial of ER oxymorphone was decided, at 40 mg 1-2 doses bid. The patient returned to the clinic 1 week early, out of his ER oxymorphone. At this time, the decision to switch him to Embeda was made, at 80 mg/3.2 mg, 1-2 doses bid. The patient and his family members were counseled about risk involved with tampering with Embeda. A few hours later, our clinic was informed that the patient was brought to emergency room by ambulance, in severe opioid withdrawal. He was treated with IV fluid, antiemetics, clonidine, and IV hydromorphone. His condition improved and he was discharged home the next morning. Later on, the patient admitted that he took two prescribed Embeda within half an hour, the 1st one whole and the 2nd one crushed. He further admitted that he did so against our medical advice. CONCLUSION. Taking tampered Embeda may precipitate opioid withdrawal in opioid-tolerant patient. To the best of our knowledge, this is the first report of induced opioid withdrawal following consumption of crushed Embeda. RN - 0 (Analgesics, Opioid) RN - 0 (Delayed-Action Preparations) RN - 0 (Drug Combinations) RN - 0 (Narcotic Antagonists) RN - 0 (morphine, naltrexone combination) RN - 5S6W795CQM (Naltrexone) RN - 76I7G6D29C (Morphine) IS - 1551-7489 IL - 1551-7489 PT - Case Reports PT - Journal Article PT - Review PP - ppublish LG - English DP - 2010 Jul-Aug EZ - 2010/09/25 06:00 DA - 2010/10/20 06:00 DT - 2010/09/25 06:00 YR - 2010 ED - 20101019 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20862910 <537. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20837827 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Braden JB AU - Russo J AU - Fan MY AU - Edlund MJ AU - Martin BC AU - DeVries A AU - Sullivan MD FA - Braden, Jennifer Brennan FA - Russo, Joan FA - Fan, Ming-Yu FA - Edlund, Mark J FA - Martin, Bradley C FA - DeVries, Andrea FA - Sullivan, Mark D IN - Braden, Jennifer Brennan. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA. TI - Emergency department visits among recipients of chronic opioid therapy. CM - Comment in: Arch Intern Med. 2010 Sep 13;170(16):1422-4; PMID: 20837826 CM - Comment in: Arch Intern Med. 2011 Mar 28;171(6):597; author reply 597-8; PMID: 21444859 SO - Archives of Internal Medicine. 170(16):1425-32, 2010 Sep 13 AS - Arch Intern Med. 170(16):1425-32, 2010 Sep 13 NJ - Archives of internal medicine VO - 170 IP - 16 PG - 1425-32 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0372440, 7fs IO - Arch. Intern. Med. PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715046 OI - Source: NLM. NIHMS485622 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Arkansas MH - Chronic Disease MH - Comorbidity MH - Drug Overdose MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - Hypnotics and Sedatives/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - *Pain/dt [Drug Therapy] MH - Prescription Drugs/ad [Administration & Dosage] MH - *Prescription Drugs/tu [Therapeutic Use] MH - Regression Analysis MH - Risk Factors MH - Substance-Related Disorders/di [Diagnosis] MH - Substance-Related Disorders/et [Etiology] AB - BACKGROUND: There has been an increase in overdose deaths and emergency department visits (EDVs) involving use of prescription opioids, but the association between opioid prescribing and adverse outcomes is unclear. AB - METHODS: Data were obtained from administrative claim records from Arkansas Medicaid and HealthCore commercially insured enrollees, 18 years and older, who used prescription opioids for at least 90 continuous days within a 6-month period between 2000 and 2005 and had no cancer diagnoses. Regression analysis was used to examine risk factors for EDVs and alcohol- or drug-related encounters (ADEs) in the 12 months following 90 days or more of prescribed opioids. AB - RESULTS: Headache, back pain, and preexisting substance use disorders were significantly associated with EDVs and ADEs. Mental health disorders were associated with EDVs in HealthCore enrollees and with ADEs in both samples. Opioid dose per day was not consistently associated with EDVs but doubled the risk of ADEs at morphine-equivalent doses over 120 mg/d. Use of short-acting Drug Enforcement Agency Schedule II opioids was associated with EDVs compared with use of non-Schedule II opioids alone (relative risk range, 1.09-1.74). Use of Schedule II long-acting opioids was strongly associated with ADEs (relative risk range, 1.64-4.00). AB - CONCLUSIONS: Use of Schedule II opioids, headache, back pain, and substance use disorders are associated with EDVs and ADEs among adults prescribed opioids for 90 days or more. It may be possible to increase the safety of chronic opioid therapy by minimizing the prescription of Schedule II opioids in these higher-risk recipients. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 0 (Prescription Drugs) ES - 1538-3679 IL - 0003-9926 DO - https://dx.doi.org/10.1001/archinternmed.2010.273 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 170/16/1425 [pii] ID - 10.1001/archinternmed.2010.273 [doi] ID - PMC3715046 [pmc] ID - NIHMS485622 [mid] PP - ppublish GI - No: R01 DA022560 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: T32 MH020021 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: DA022560 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: T32 MH20021 Organization: (MH) *NIMH NIH HHS* Country: United States LG - English DP - 2010 Sep 13 EZ - 2010/09/15 06:00 DA - 2010/10/15 06:00 DT - 2010/09/15 06:00 YR - 2010 ED - 20101014 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20837827 <538. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20148794 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Salmon AM AU - van Beek I AU - Amin J AU - Kaldor J AU - Maher L FA - Salmon, Allison M FA - van Beek, Ingrid FA - Amin, Janaki FA - Kaldor, John FA - Maher, Lisa IN - Salmon, Allison M. National Centre HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, NSW, Australia. TI - The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia. CM - Comment in: Addiction. 2010 Apr;105(4):684-5; PMID: 20403019 SO - Addiction. 105(4):676-83, 2010 Apr AS - Addiction. 105(4):676-83, 2010 Apr NJ - Addiction (Abingdon, England) VO - 105 IP - 4 PG - 676-83 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Ambulances/ut [Utilization] MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/th [Therapy] MH - *Emergency Medical Services/ut [Utilization] MH - Epidemiologic Methods MH - Harm Reduction MH - *Health Services Needs and Demand/sn [Statistics & Numerical Data] MH - *Heroin/ae [Adverse Effects] MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/ae [Adverse Effects] MH - Needle-Exchange Programs/og [Organization & Administration] MH - *Needle-Exchange Programs/sn [Statistics & Numerical Data] MH - New South Wales/ep [Epidemiology] MH - Program Evaluation MH - Residence Characteristics MH - *Substance Abuse, Intravenous/rh [Rehabilitation] MH - Time Factors AB - AIMS: Supervised injecting facilities (SIFs) are effective in reducing the harms associated with injecting drug use among their clientele, but do SIFs ease the burden on ambulance services of attending to overdoses in the community? This study addresses this question, which is yet to be answered, in the growing body of international evidence supporting SIFs efficacy. AB - DESIGN: Ecological study of patterns in ambulance attendances at opioid-related overdoses, before and after the opening of a SIF in Sydney, Australia. AB - SETTING: A SIF opened as a pilot in Sydney's 'red light' district with the aim of accommodating a high throughput of injecting drug users (IDUs) for supervised injecting episodes, recovery and the management of overdoses. AB - MEASUREMENTS: A total of 20,409 ambulance attendances at opioid-related overdoses before and after the opening of the Sydney SIF. Average monthly ambulance attendances at suspected opioid-related overdoses, before (36 months) and after (60 months) the opening of the Sydney Medically Supervised Injecting Centre (MSIC), in the vicinity of the centre and in the rest of New South Wales (NSW). AB - RESULTS: The burden on ambulance services of attending to opioid-related overdoses declined significantly in the vicinity of the Sydney SIF after it opened, compared to the rest of NSW. This effect was greatest during operating hours and in the immediate MSIC area, suggesting that SIFs may be most effective in reducing the impact of opioid-related overdose in their immediate vicinity. AB - CONCLUSIONS: By providing environments in which IDUs receive supervised injection and overdose management and education SIF can reduce the demand for ambulance services, thereby freeing them to attend other medical emergencies within the community. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1360-0443 IL - 0965-2140 DO - https://dx.doi.org/10.1111/j.1360-0443.2009.02837.x PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - ADD2837 [pii] ID - 10.1111/j.1360-0443.2009.02837.x [doi] PP - ppublish LG - English EP - 20100209 DP - 2010 Apr EZ - 2010/02/13 06:00 DA - 2010/10/05 06:00 DT - 2010/02/13 06:00 YR - 2010 ED - 20101001 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20148794 <539. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20390701 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Spiller H AU - Bailey JE AU - Dart RC AU - Spiller SS FA - Spiller, Henry FA - Bailey, J E FA - Dart, Richard C FA - Spiller, Sarah S IN - Spiller, Henry. Kentucky Regional Poison Center, Louisville, KY 40232-5070, USA. henry.spiller@nortonhealthcare.org TI - Investigation of temporal changes of abuse and misuse of prescription opioids. SO - Journal of Addictive Diseases. 29(1):78-83, 2010 Jan AS - J Addict Dis. 29(1):78-83, 2010 Jan NJ - Journal of addictive diseases VO - 29 IP - 1 PG - 78-83 PI - Journal available in: Print PI - Citation processed from: Internet JC - a0y, 9107051 IO - J Addict Dis SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid MH - Female MH - Follow-Up Studies MH - *Holidays/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Poison Control Centers MH - *Prescription Drugs MH - Prevalence MH - Retrospective Studies MH - *Substance-Related Disorders/ep [Epidemiology] MH - Time Factors MH - United States/ep [Epidemiology] MH - Young Adult AB - We analyzed intentional exposures to prescription opioids (buprenorphine, fentanyl, hydrocodone, hydromorphone, morphine, methadone and Oxycodone) using the Research Abuse, Diversion and Addiction-Related Surveillance System (RADARS) Poison Center data over a 5 year period 2003-2007 to see if there were temporal trends in the abuse and misuse of prescription drugs associated with (1) weekends vs. weekdays and (2) during select holiday periods vs. non-holiday periods. Over the study period 25 of 120 holiday period days showed a decrease of at least 1 SD from the mean and 9 of 120 holiday period days showed an increase of at least 1 SD from the mean. Over the study period there were 144,653 intentional exposures. Mean percent of cases by day of week ranged from 14.03% to 14.39%, with slightly higher use on weekend days. There was no significant difference when evaluating prevalence of intentional exposures by day of week (p = 0.99). There was no significant difference when evaluating weekend versus weekday (p > 0.05). In summary, the prevalence of abuse and misuse of prescription drugs was not impacted by day of the week or difference between weekday and weekend. The impact of 8 traditional holidays appeared to be associated with a minor decrease in abuse and misuse of prescription drugs. No temporally related increase in abuse and misuse of prescription drugs was noted and conversely a trend toward decreased abuse and misuse of prescription drugs was suggested. RN - 0 (Analgesics, Opioid) RN - 0 (Prescription Drugs) ES - 1545-0848 IL - 1055-0887 DO - https://dx.doi.org/10.1080/10550880903436036 PT - Journal Article ID - 918588451 [pii] ID - 10.1080/10550880903436036 [doi] PP - ppublish LG - English DP - 2010 Jan EZ - 2010/04/15 06:00 DA - 2010/09/24 06:00 DT - 2010/04/15 06:00 YR - 2010 ED - 20100922 RD - 20100414 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20390701 <540. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20491551 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ellison NM FA - Ellison, Neil M IN - Ellison, Neil M. Palliative Medicine , Geisinger Medical Center, 100 North Academy Drive, Danville, PA 17822-0140, USA. nellison@geisinger.edu TI - Regulatory issues for prescribing schedule II opioids at the end of life #198. SO - Journal of Palliative Medicine. 13(5):605-6, 2010 May AS - J Palliat Med. 13(5):605-6, 2010 May NJ - Journal of palliative medicine VO - 13 IP - 5 PG - 605-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - d0c, 9808462 IO - J Palliat Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Emergency Medical Services/lj [Legislation & Jurisprudence] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - *Health Services/lj [Legislation & Jurisprudence] MH - Humans MH - Legislation, Drug MH - *Pain/dt [Drug Therapy] MH - *Palliative Care/lj [Legislation & Jurisprudence] MH - United States RN - 0 (Analgesics, Opioid) ES - 1557-7740 IL - 1557-7740 DO - https://dx.doi.org/10.1089/jpm.2010.9835 PT - Journal Article ID - 10.1089/jpm.2010.9835 [doi] PP - ppublish LG - English DP - 2010 May EZ - 2010/05/25 06:00 DA - 2010/09/14 06:00 DT - 2010/05/25 06:00 YR - 2010 ED - 20100913 RD - 20100524 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20491551 <541. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20227155 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shan Y AU - Sun S AU - Yang X AU - Weil MH AU - Tang W FA - Shan, Yi FA - Sun, Shijie FA - Yang, Xingyi FA - Weil, Max Harry FA - Tang, Wanchun IN - Shan, Yi. Weil Institute of Critical Care Medicine, Rancho Mirage, CA 92270, USA. TI - Opioid receptor agonist reduces myocardial ischemic injury when administered during early phase of myocardial ischemia. SO - Resuscitation. 81(6):761-5, 2010 Jun AS - Resuscitation. 81(6):761-5, 2010 Jun NJ - Resuscitation VO - 81 IP - 6 PG - 761-5 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Animals MH - Arrhythmias, Cardiac/et [Etiology] MH - Arrhythmias, Cardiac/pc [Prevention & Control] MH - *Cardiopulmonary Resuscitation/ae [Adverse Effects] MH - *Cardiotonic Agents/ad [Administration & Dosage] MH - Diastole MH - Drug Administration Schedule MH - In Vitro Techniques MH - Male MH - Myocardial Ischemia/dt [Drug Therapy] MH - *Myocardial Ischemia/th [Therapy] MH - Myocardial Reperfusion Injury/et [Etiology] MH - Myocardial Reperfusion Injury/pp [Physiopathology] MH - *Myocardial Reperfusion Injury/pc [Prevention & Control] MH - *Pentazocine/ad [Administration & Dosage] MH - Rats MH - Rats, Sprague-Dawley MH - *Receptors, Opioid/ag [Agonists] MH - Severity of Illness Index MH - Systole MH - Ventricular Function, Left/de [Drug Effects] AB - AIM OF THE STUDY: Postresuscitation myocardial dysfunction is one of the leading causes of early death after initial success of resuscitation, the mechanisms of postresuscitation myocardial dysfunction remain controversial. We hypothesize that ischemia injury, rather than reperfusion injury is the major cause of postresuscitation myocardial dysfunction. We proposed to investigate the separate effects of ischemia and reperfusion injury on postresuscitation myocardial dysfunction. AB - METHODS: Thirty-three Langendorff-perfused isolated rat hearts were subjected to 15 min of global ischemia followed by 120 min of reperfusion. Pentazocine was utilized as a myocardial protective agent, either before ischemia or during reperfusion. All hearts were randomized into 3 groups: (1) "ischemia protection", in which pentazocine was infused 10 min prior to global ischemia, (2) "reperfusion protection", in which pentazocine was infused during 2h of reperfusion and (3) "control", with no pentazocine infusion. Left ventricular (LV) functions were measured by the maximal rate of LV pressure rise (dP/dt(max)) and decline (-dP/dt(max)), the maximal LV diastolic pressure (LVDP). The incidences of postischemic arrhythmias were measured. AB - RESULTS: When pentazocine was administered before onset of ischemia, the LV systolic and diastolic functions were significantly greater, and the postischemic arrhythmias were significantly less in comparison to those with reperfusion protection (p<0.05) and the control group (p<0.05). AB - CONCLUSIONS: In this model, the severity of postischemic myocardial dysfunction was less when the heart was protected during ischemia. Ischemia injury may therefore be the major cause of postresuscitation myocardial dysfunction. Copyright 2010 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Cardiotonic Agents) RN - 0 (Receptors, Opioid) RN - RP4A60D26L (Pentazocine) ES - 1873-1570 IL - 0300-9572 DO - https://dx.doi.org/10.1016/j.resuscitation.2010.02.014 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0300-9572(10)00117-6 [pii] ID - 10.1016/j.resuscitation.2010.02.014 [doi] PP - ppublish PH - 2009/11/04 [received] PH - 2010/02/11 [revised] PH - 2010/02/15 [accepted] LG - English EP - 20100312 DP - 2010 Jun EZ - 2010/03/17 06:00 DA - 2010/09/08 06:00 DT - 2010/03/16 06:00 YR - 2010 ED - 20100907 RD - 20141120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20227155 <542. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19531519 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bellu R AU - de Waal K AU - Zanini R FA - Bellu, R FA - de Waal, Koert FA - Zanini, R IN - Bellu, R. Neonatal Intensive Care Unit, Alessandro Manzoni Hospital, Lecco, Italy. r.bellu@ospedale.lecco.it TI - Opioids for neonates receiving mechanical ventilation: a systematic review and meta-analysis. [Review] [48 refs] CM - Comment in: Arch Dis Child Fetal Neonatal Ed. 2010 Jul;95(4):F232-3; PMID: 20576662 SO - Archives of Disease in Childhood Fetal & Neonatal Edition. 95(4):F241-51, 2010 Jul AS - Arch Dis Child Fetal Neonatal Ed. 95(4):F241-51, 2010 Jul NJ - Archives of disease in childhood. Fetal and neonatal edition VO - 95 IP - 4 PG - F241-51 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - b9p, 9501297 IO - Arch. Dis. Child. Fetal Neonatal Ed. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Humans MH - Infant, Newborn MH - *Intensive Care, Neonatal/mt [Methods] MH - *Pain/pc [Prevention & Control] MH - Pain Measurement/mt [Methods] MH - Randomized Controlled Trials as Topic MH - *Respiration, Artificial MH - Treatment Outcome AB - OBJECTIVE: To evaluate the effect of opioid analgesics, compared to placebo, no drug, or other non-opioid analgesics or sedatives, on pain, duration of mechanical ventilation, mortality, growth and neurodevelopmental outcomes in newborn infants on mechanical ventilation. AB - METHODS: This was a systematic review and meta-analysis of randomised controlled trials (RCTs). Data sources used were Cochrane, MEDLINE, EMBASE and CINAHL databases, and references from review articles. RCTs or quasi-RCTs comparing opioids to a control, or to other analgesics or sedatives in newborn infants on mechanical ventilation were reviewed. AB - RESULTS: A total of 13 studies on 1505 infants were included. Infants given opioids showed reduced Premature Infant Pain Profile (PIPP) scores compared to the control group (weighted mean difference (WMD) -1.71, 95% CI -3.18 to -0.24). Heterogeneity was significantly high in all analyses of pain. Meta-analyses of mortality, duration of mechanical ventilation and long-term and short-term neurodevelopmental outcomes showed no statistically significant differences. Very preterm infants given morphine took significantly longer to reach full enteral feeding than those in control groups (WMD 2.10 days, 95% CI 0.35 to 3.85). One study that compared morphine with midazolam showed similar pain scores, but fewer adverse effects with morphine. AB - CONCLUSIONS: There is insufficient evidence to recommend routine use of opioids in mechanically ventilated newborns. Opioids should be used selectively, when indicated by clinical judgment and evaluation of pain indicators. If sedation is required, morphine is safer than midazolam. [References: 48] RN - 0 (Analgesics, Opioid) ES - 1468-2052 IL - 1359-2998 DO - https://dx.doi.org/10.1136/adc.2008.150318 PT - Journal Article PT - Meta-Analysis PT - Review ID - adc.2008.150318 [pii] ID - 10.1136/adc.2008.150318 [doi] PP - ppublish LG - English EP - 20090615 DP - 2010 Jul EZ - 2009/06/18 09:00 DA - 2010/08/31 06:00 DT - 2009/06/18 09:00 YR - 2010 ED - 20100830 RD - 20100625 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19531519 <543. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19942295 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Stanley B AU - Sher L AU - Wilson S AU - Ekman R AU - Huang YY AU - Mann JJ FA - Stanley, Barbara FA - Sher, Leo FA - Wilson, Scott FA - Ekman, Rolf FA - Huang, Yung-yu FA - Mann, J John IN - Stanley, Barbara. Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York 10032, USA. bhs2@columbia.edu TI - Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters. SO - Journal of Affective Disorders. 124(1-2):134-40, 2010 Jul AS - J Affect Disord. 124(1-2):134-40, 2010 Jul NJ - Journal of affective disorders VO - 124 IP - 1-2 PG - 134-40 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - h3v, 7906073 IO - J Affect Disord PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875354 OI - Source: NLM. NIHMS158252 SB - Index Medicus CP - Netherlands MH - Adolescent MH - Adult MH - Aged MH - Arousal/ph [Physiology] MH - *Dynorphins/cf [Cerebrospinal Fluid] MH - *Enkephalin, Methionine/cf [Cerebrospinal Fluid] MH - Female MH - *Homovanillic Acid/cs [Chemical Synthesis] MH - Humans MH - *Hydroxyindoleacetic Acid/cf [Cerebrospinal Fluid] MH - Male MH - Middle Aged MH - *Personality Disorders/cf [Cerebrospinal Fluid] MH - Personality Disorders/px [Psychology] MH - Reference Values MH - *Self-Injurious Behavior/cf [Cerebrospinal Fluid] MH - Self-Injurious Behavior/px [Psychology] MH - *Suicide, Attempted/px [Psychology] MH - Young Adult MH - *beta-Endorphin/cf [Cerebrospinal Fluid] AB - BACKGROUND: Self-inflicted injury, including cutting or burning, is the most frequent reason for psychiatric visits to medical emergency departments. This behavior, particularly when there is no apparent suicidal intent, is poorly understood from both biological and clinical perspectives. AB - OBJECTIVE: To examine the role of endogenous opioids and monoamine neurotransmitters in non-suicidal self-injury (NSSI). AB - METHODS: We compared cerebrospinal fluid (CSF) levels of endogenous opioids, 5 hydroxyindolacetic acid (5-HIAA) and homovanillic acid (HVA) in individuals with a history of repetitive non-suicidal self-injury with a diagnostically-matched group of individuals who had never engaged in non-suicidal self-injury. History of suicidal behavior, demographic background and psychopathology was assessed. All patients were diagnosed with a Cluster B personality disorder (i.e. borderline, antisocial, narcissistic or histrionic) (N=29) and had a history of at least one suicide attempt. Fourteen participants had a history of repeated non-suicidal self-injurious behavior (NSSI) in adulthood and 15 did not (no NSSI). AB - RESULTS: The NSSI group had significantly lower levels of CSF beta-endorphin and met-enkephalin when compared with the non-NSSI group. CSF dynorphin, HVA and 5-HIAA levels did not differ. Severity of depression, hopelessness and overall psychopathology was greater in the NSSI group. AB - CONCLUSION: beta-endorphin and met-enkephalin, opioids acting upon receptors involved in mediating stress-induced and physical pain analgesia respectively, are implicated in NSSI. Serotonergic and dopaminergic dysfunctions do not appear to be related to NSSI. Based on our findings, we propose a model of non-suicidal self-injury. Our results suggest that drugs acting on the opioid system warrant exploration as pharmacological treatments for NSSI. RN - 54-16-0 (Hydroxyindoleacetic Acid) RN - 58569-55-4 (Enkephalin, Methionine) RN - 60617-12-1 (beta-Endorphin) RN - 74913-18-1 (Dynorphins) RN - X77S6GMS36 (Homovanillic Acid) ES - 1573-2517 IL - 0165-0327 DO - https://dx.doi.org/10.1016/j.jad.2009.10.028 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0165-0327(09)00490-X [pii] ID - 10.1016/j.jad.2009.10.028 [doi] ID - PMC2875354 [pmc] ID - NIHMS158252 [mid] PP - ppublish PH - 2009/06/29 [received] PH - 2009/09/23 [revised] PH - 2009/10/29 [accepted] GI - No: M01 RR000645 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: R01 MH062665-05 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: R01 MH062665 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: P20 AA015630 Organization: (AA) *NIAAA NIH HHS* Country: United States GI - No: MH41847 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: M01 RR000645-280541 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: P30 MH046745 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: P20 AA015630-05 Organization: (AA) *NIAAA NIH HHS* Country: United States LG - English EP - 20091125 DP - 2010 Jul EZ - 2009/11/28 06:00 DA - 2010/08/24 06:00 DT - 2009/11/28 06:00 YR - 2010 ED - 20100823 RD - 20161203 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19942295 <544. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19808992 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Zanin A AU - Masiero S AU - Severino MS AU - Calderone M AU - Da Dalt L AU - Laverda AM FA - Zanin, Anna FA - Masiero, Susanna FA - Severino, Maria Savina FA - Calderone, Milena FA - Da Dalt, Liviana FA - Laverda, Anna Maria IN - Zanin, Anna. Paediatric Emergency Unit, Paediatric Department, University of Padua, 35100 Padua, Italy. anna.zanin@unipd.it TI - A delayed methadone encephalopathy: clinical and neuroradiological findings. SO - Journal of Child Neurology. 25(6):748-51, 2010 Jun AS - J Child Neurol. 25(6):748-51, 2010 Jun NJ - Journal of child neurology VO - 25 IP - 6 PG - 748-51 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ia2, 8606714 IO - J. Child Neurol. SB - Index Medicus CP - United States MH - Brain/de [Drug Effects] MH - *Brain/pa [Pathology] MH - Child, Preschool MH - Encephalitis/ci [Chemically Induced] MH - *Encephalitis/pa [Pathology] MH - Female MH - Humans MH - Magnetic Resonance Imaging MH - *Methadone/po [Poisoning] MH - Neurologic Examination MH - *Neurotoxicity Syndromes/pa [Pathology] MH - Recurrence AB - Several studies on opiates demonstrated that selected brain areas as cerebellum and limbic system have the greatest density of opioid receptors. Recently, few cases of severe cerebellitis following methadone poisoning have been reported in children. We present the case of a 30-month-old girl who developed a delayed encephalopathy after methadone intoxication. She was admitted to our emergency department in coma, and after naloxone infusion, she completely recovered. Five days after intoxication, she developed psychomotor agitation, slurred speech, abnormal movements, and ataxia despite a negative neuroimaging finding. A repeat magnetic resonance imaging (MRI) performed 19 days after the intoxication for persistent symptoms showed signal abnormalities in the temporomesial regions, basal ganglia, and substantia nigra. To our knowledge, this is the first report of these delayed MRI findings associated with synthetic opioid intoxication. RN - UC6VBE7V1Z (Methadone) ES - 1708-8283 IL - 0883-0738 DO - https://dx.doi.org/10.1177/0883073809343318 PT - Case Reports PT - Journal Article ID - 0883073809343318 [pii] ID - 10.1177/0883073809343318 [doi] PP - ppublish LG - English EP - 20091006 DP - 2010 Jun EZ - 2009/10/08 06:00 DA - 2010/08/21 06:00 DT - 2009/10/08 06:00 YR - 2010 ED - 20100820 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19808992 <545. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20598984 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Setoguchi S AU - Glynn RJ AU - Stedman M AU - Flavell CM AU - Levin R AU - Stevenson LW FA - Setoguchi, Soko FA - Glynn, Robert J FA - Stedman, Margaret FA - Flavell, Carol M FA - Levin, Raisa FA - Stevenson, Lynne Warner IN - Setoguchi, Soko. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. ssetoguchi@partners.org TI - Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer. SO - American Heart Journal. 160(1):139-44, 2010 Jul AS - Am Heart J. 160(1):139-44, 2010 Jul NJ - American heart journal VO - 160 IP - 1 PG - 139-44 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0370465 IO - Am. Heart J. PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910447 OI - Source: NLM. NIHMS212786 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Aged, 80 and over MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cause of Death/td [Trends] MH - Female MH - Follow-Up Studies MH - Health Care Costs MH - *Heart Failure/dt [Drug Therapy] MH - Heart Failure/mo [Mortality] MH - *Hospice Care/og [Organization & Administration] MH - Hospital Mortality/td [Trends] MH - Humans MH - *Intensive Care Units MH - Male MH - *Neoplasms/dt [Drug Therapy] MH - Neoplasms/mo [Mortality] MH - Retrospective Studies MH - Survival Rate/td [Trends] MH - United States/ep [Epidemiology] AB - BACKGROUND: Advances in heart failure (HF) treatments have prolonged survival, but more patients die of HF than of any type of cancer. Little is known about the current practice in end-of-life (EOL) care in HF. AB - METHODS: Two EOL cohorts (HF and cancer) were identified using Medicare data linked with pharmacy and cancer registry data. We assessed use of hospice, opiates, and acute care services (hospitalizations, emergency department [ED] visits, intensive care unit [ICU] admissions, and death in acute care). Time trends and predictors of use were assessed using multivariate regression including demographics and cardiovascular and noncardiovasuclar comorbidities. AB - RESULTS: Among 5,836 HF patients with median age of 85, 77% female and 4% black, 20% were referred to hospice compared to 51% of 7,565 cancer patients. A modest rise in hospice use over time was parallel in the 2 groups. Twenty-two percent of HF patients filled opiate prescriptions during 60 days before death compared to 46% of cancer patients. Use of acute care services in the 30 days before death was higher for HF (64% vs 39% for ED visits, 60% vs 45% for hospitalizations, and 19% vs 7% for ICU admission). More HF patients died during acute hospitalizations than cancer patients (39% vs 21%). AB - CONCLUSION: Patients dying of HF were less likely to be supported by hospice and opiates but more likely to die in hospitals than patients with cancer. Our study suggests that opportunities may exist to improve hospice and opiate use in HF patients. Copyright (c) 2010 Mosby, Inc. All rights reserved. RN - 0 (Analgesics, Opioid) ES - 1097-6744 IL - 0002-8703 DO - https://dx.doi.org/10.1016/j.ahj.2010.03.038 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0002-8703(10)00316-9 [pii] ID - 10.1016/j.ahj.2010.03.038 [doi] ID - PMC2910447 [pmc] ID - NIHMS212786 [mid] PP - ppublish PH - 2009/10/06 [received] PH - 2010/03/27 [accepted] GI - No: R01 AG018833 Organization: (AG) *NIA NIH HHS* Country: United States GI - No: R01 AG018833-01A2 Organization: (AG) *NIA NIH HHS* Country: United States GI - No: R56 AG018833 Organization: (AG) *NIA NIH HHS* Country: United States GI - No: AG18833 Organization: (AG) *NIA NIH HHS* Country: United States LG - English DP - 2010 Jul EZ - 2010/07/06 06:00 DA - 2010/08/18 06:00 DT - 2010/07/06 06:00 YR - 2010 ED - 20100817 RD - 20161122 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20598984 <546. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20398048 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Nissen LM AU - Wong KH AU - Jones A AU - Roberts DM FA - Nissen, Lisa M FA - Wong, Kai Hang FA - Jones, Anthea FA - Roberts, Darren M IN - Nissen, Lisa M. University of Queensland, Brisbane, Australia. TI - Availability of antidotes for the treatment of acute poisoning in Queensland public hospitals. SO - Australian Journal of Rural Health. 18(2):78-84, 2010 Apr AS - Aust J Rural Health. 18(2):78-84, 2010 Apr NJ - The Australian journal of rural health VO - 18 IP - 2 PG - 78-84 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9305903, c0i IO - Aust J Rural Health SB - Nursing Journal CP - Australia MH - Adult MH - *Antidotes/sd [Supply & Distribution] MH - Emergency Service, Hospital MH - *Hospitals, Public MH - Humans MH - *Poisoning/th [Therapy] MH - Queensland AB - OBJECTIVE: To determine the sufficiency of stock levels of 13 antidotes in Queensland hospitals. AB - DESIGN: A self-report survey was sent to 128 Queensland hospitals with acute care facilities. The stock level of the following antidotes was determined: acetylcysteine, anti-digoxin Fab antibodies (digibind), atropine, calcium gluconate, cyanokit, desferrioxamine, flumazenil, glucagon, intravenous ethanol, methylene blue, naloxone, pralidoxime and pyridoxine. Other factors sampled were bed capacity, rural, remote and metropolitan areas classification, use of formal stock reviews by pharmacists or nurses, existence of formal borrowing agreements with other facilities for non-stocked antidotes, distance to the nearest referral hospital and time taken to transfer antidotes from another hospital. AB - PARTICIPANTS: Pharmacists or nurses responsible for maintaining antidote stocks in Queensland hospitals. AB - MAIN OUTCOME MEASURES: Proportions of hospitals with sufficient antidote stock to treat a 70-kg adult for four or more hours using previously published guidelines. AB - RESULTS: Survey response rate was 73.4%. No hospital had sufficient stock of all 13 antidotes. The proportion of hospitals with sufficient stocks varied from 0% (pyridoxine) to 68.1% (acetylcysteine). Larger hospitals had a higher frequency of sufficient antidote stocks. Only 16% of hospitals claimed to be able to acquire an antidote from another facility within 30 min. AB - CONCLUSIONS: Most Queensland hospitals stocked some important antidotes, but few had sufficient stock to treat a 70-kg patient or acquire an antidote within the recommended time frame of 30 min. Specific antidote stocking guidelines might be required for Queensland hospitals. A formalised program for stock rotation with rural facilities should be explored. RN - 0 (Antidotes) ES - 1440-1584 IL - 1038-5282 DO - https://dx.doi.org/10.1111/j.1440-1584.2010.01129.x PT - Journal Article ID - AJR1129 [pii] ID - 10.1111/j.1440-1584.2010.01129.x [doi] PP - ppublish LG - English DP - 2010 Apr EZ - 2010/04/20 06:00 DA - 2010/08/10 06:00 DT - 2010/04/20 06:00 YR - 2010 ED - 20100809 RD - 20100419 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20398048 <547. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20569863 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Criss EA FA - Criss, Elizabeth A TI - What Current Studies Mean to EMS. SO - Journal of Emergency Medical Services. 35(6):42, 2010 Jun AS - J Emerg Med Serv JEMS. 35(6):42, 2010 Jun NJ - JEMS : a journal of emergency medical services VO - 35 IP - 6 PG - 42 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - Aged MH - Blast Injuries/th [Therapy] MH - *Emergency Medical Services MH - Humans MH - Hypothermia/th [Therapy] MH - Naloxone/tu [Therapeutic Use] MH - *Research MH - Wounds and Injuries/th [Therapy] RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 DO - https://dx.doi.org/10.1016/S0197-2510(10)70145-5 PT - Journal Article ID - S0197-2510(10)70145-5 [pii] ID - 10.1016/S0197-2510(10)70145-5 [doi] PP - ppublish LG - English DP - 2010 Jun EZ - 2010/06/24 06:00 DA - 2010/07/28 06:00 DT - 2010/06/24 06:00 YR - 2010 ED - 20100727 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20569863 <548. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18749284 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Guss DA AU - Rothstein RJ FA - Guss, D A FA - Rothstein, R J TI - Emergency medicine-important advances in clinical medicine: naloxone-new uses?. SO - Western Journal of Medicine. 138(1):88, 1983 Jan AS - West J Med. 138(1):88, 1983 Jan NJ - The Western journal of medicine VO - 138 IP - 1 PG - 88 PI - Journal available in: Print PI - Citation processed from: Print JC - 0410504, xn5 IO - West. J. Med. CP - United States IS - 0093-0415 IL - 0093-0415 PT - Journal Article ID - PMC1010644 [pmc] PP - ppublish LG - English DP - 1983 Jan EZ - 1983/01/01 00:00 DA - 1983/01/01 00:01 DT - 1983/01/01 00:00 YR - 1983 ED - 20100630 RD - 20100921 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=18749284 <549. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17355670 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Kelly AM AU - Brumby C AU - Barnes C FA - Kelly, Anne-Maree FA - Brumby, Catherine FA - Barnes, Caroline IN - Kelly, Anne-Maree. Joseph Epstein Centre for Emergency Medicine Research, Western Hospital, Melbourne, Victoria, Australia. anne-maree.kelly@wh.org.au TI - Nurse-initiated, titrated intravenous opioid analgesia reduces time to analgesia for selected painful conditions. SO - CJEM Canadian Journal of Emergency Medical Care. 7(3):149-54, 2005 May AS - CJEM, Can. j. emerg. med. care. 7(3):149-54, 2005 May NJ - CJEM VO - 7 IP - 3 PG - 149-54 PI - Journal available in: Print PI - Citation processed from: Print JC - 100893237 IO - CJEM CP - England AB - OBJECTIVES: Traditionally, patients have to wait until assessed by a physician for opioid analgesia to be administered, which contributes to delays to analgesia. Western Hospital developed a protocol enabling nurses to initiate opioid analgesia prior to medical assessment for selected conditions. The aim of this study was to determine the impact of this protocol on time to first opioid dose in patients presenting to the emergency department (ED) with renal or biliary colic. AB - METHODS: This was an explicit medical record review of all adult patients with an ED discharge diagnosis of renal or biliary colic presenting to a metropolitan teaching hospital ED. Patients were identified via the ED data management system. Data collected included demographics, condition, triage category, time of presentation, whether analgesia was nurse-initiated or not, and interval from arrival to first opioid analgesic dose. The narcotic drug register for the relevant period was also searched to cross-check whether opiates were doctor- or nurse-initiated. AB - RESULTS: There were 58 presentations in the nurse-initiated opioid analgesia group and 99 in the non-nurse-initiated analgesia group. Groups were reasonably well matched for gender, triage category and time of presentation, but there was a higher proportion of biliary colic in the non-nurse-initiated analgesia group. Median time to first analgesic dose was 31 minutes in the nurse-initiated group and 57 minutes in the non-nurse-initiated analgesia group (effect size, 26 minutes; 95% confidence interval 16-36 min; p < 0.0001]. There were no major adverse events in either group. AB - CONCLUSION: A nurse-initiated opioid analgesia protocol reduces delays to opioid analgesia for patients with renal and biliary colic. IS - 1481-8035 IL - 1481-8035 PT - Journal Article ID - 104496106E0F41A780F635F605790921 [pii] PP - ppublish LG - English DP - 2005 May EZ - 2007/03/16 09:00 DA - 2007/03/16 09:01 DT - 2007/03/16 09:00 YR - 2005 ED - 20100629 RD - 20111005 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=17355670 <550. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19268564 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wagner KD AU - Valente TW AU - Casanova M AU - Partovi SM AU - Mendenhall BM AU - Hundley JH AU - Gonzalez M AU - Unger JB FA - Wagner, Karla D FA - Valente, Thomas W FA - Casanova, Mark FA - Partovi, Susan M FA - Mendenhall, Brett M FA - Hundley, James H FA - Gonzalez, Mario FA - Unger, Jennifer B IN - Wagner, Karla D. Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Alhambra, CA 91803, USA. kdwagner@usc.edu TI - Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA. SO - International Journal of Drug Policy. 21(3):186-93, 2010 May AS - Int J Drug Policy. 21(3):186-93, 2010 May NJ - The International journal on drug policy VO - 21 IP - 3 PG - 186-93 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9014759 IO - Int. J. Drug Policy PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291458 OI - Source: NLM. NIHMS646627 SB - Index Medicus CP - Netherlands MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - California MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/pc [Prevention & Control] MH - *Education/mt [Methods] MH - Female MH - Health Knowledge, Attitudes, Practice MH - *Homeless Persons/ed [Education] MH - Humans MH - Los Angeles MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - *Patient Education as Topic/mt [Methods] MH - Program Evaluation MH - Substance Abuse, Intravenous/mo [Mortality] AB - BACKGROUND: Fatal opioid overdose is a significant cause of mortality among injection drug users (IDUs). AB - METHODS: We evaluated an overdose prevention and response training programme for IDUs run by a community-based organisation in Los Angeles, CA. During a 1-h training session participants learned skills to prevent, recognise, and respond to opioid overdoses, including: calling for emergency services, performing rescue breathing, and administering an intramuscular injection of naloxone (an opioid antagonist). Between September 2006 and January 2008, 93 IDUs were trained. Of those, 66 (71%) enrolled in the evaluation study and 47 participants (71%) completed an interview at baseline and 3-month follow-up. AB - RESULTS: Twenty-one percent of participants were female, 42% were white, 29% African American, and 18% Latino. Most were homeless or lived in temporary accommodation (73%). We found significant increases in knowledge about overdose, in particular about the use of naloxone. Twenty-two participants responded to 35 overdoses during the follow-up period. Twenty-six overdose victims recovered, four died, and the outcome of five cases was unknown. Response techniques included: staying with the victim (85%), administering naloxone (80%), providing rescue breathing (66%), and calling emergency services (60%). The average number of appropriate response techniques used by participants increased significantly from baseline to follow-up (p<0.05). Half (53%) of programme participants reported decreased drug use at follow-up. AB - CONCLUSION: Overdose prevention and response training programmes may be associated with improved overdose response behaviour, with few adverse consequences and some unforeseen benefits, such as reductions in personal drug use. Copyright 2009 Elsevier B.V. All rights reserved. RN - 0 (Analgesics, Opioid) RN - 36B82AMQ7N (Naloxone) ES - 1873-4758 IL - 0955-3959 DO - https://dx.doi.org/10.1016/j.drugpo.2009.01.003 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0955-3959(09)00041-3 [pii] ID - 10.1016/j.drugpo.2009.01.003 [doi] ID - PMC4291458 [pmc] ID - NIHMS646627 [mid] PP - ppublish PH - 2008/06/27 [received] PH - 2008/09/24 [revised] PH - 2009/01/19 [accepted] GI - No: R01 DA016310 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20090305 DP - 2010 May EZ - 2009/03/10 09:00 DA - 2010/06/23 06:00 DT - 2009/03/10 09:00 YR - 2010 ED - 20100622 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19268564 <551. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20499502 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Poplas-Susic T AU - Klemenc-Ketis Z AU - Komericki-Grzinic M AU - Kersnik J FA - Poplas-Susic, Tonka FA - Klemenc-Ketis, Zalika FA - Komericki-Grzinic, Marija FA - Kersnik, Janko IN - Poplas-Susic, Tonka. Department of Family Medicine, Ljubljana, Slovenia. TI - Glasgow Coma Scale in acute poisonings before and after use of antidote in patients with history of use of psychotropic agents. SO - Srpski Arhiv Za Celokupno Lekarstvo. 138(3-4):210-3, 2010 Mar-Apr AS - Srp Arh Celok Lek. 138(3-4):210-3, 2010 Mar-Apr NJ - Srpski arhiv za celokupno lekarstvo VO - 138 IP - 3-4 PG - 210-3 PI - Journal available in: Print PI - Citation processed from: Print JC - 0027440, uzg IO - Srp Arh Celok Lek SB - Index Medicus CP - Serbia MH - Adolescent MH - Adult MH - Aged MH - *Antidotes/tu [Therapeutic Use] MH - Child MH - *Coma/ci [Chemically Induced] MH - Coma/di [Diagnosis] MH - Female MH - Flumazenil/tu [Therapeutic Use] MH - *Glasgow Coma Scale MH - Humans MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Poisoning/dt [Drug Therapy] MH - Poisoning/pp [Physiopathology] MH - Psychotropic Drugs/po [Poisoning] MH - Psychotropic Drugs/tu [Therapeutic Use] MH - Street Drugs/po [Poisoning] MH - Young Adult AB - INTRODUCTION: Data on emergency interventions in poisonings are scarce. Objective To determine the effectiveness of antidote therapy in acute poisoning-related emergency medical services (EMS) interventions. AB - METHODS: A prospective observational study included all poisoning-related intervention cases over 3 years (1999-2001) in the Celje region, Slovenia, covering 125,000 inhabitants. Data were recorded on an EMS form. AB - RESULTS: Psychoactive agents were present in 56.5% out of 244 poisoning-related EMS interventions. Prescription drugs were a cause of intoxication in 93 (39.2%) cases alone or in combination with alcohol or illegal drugs. More than one fifth of poisonings were due to the use of illegal drugs in 52 (21.9%) cases, 43 (18.1%) out of them heroin related. At the time of EMS arrival, more patients who ingested illegal drugs were in coma or comatose than the rest. 24 (45.3%) vs. 32 (17.3%) of poisoned patients were in coma (p < 0.001). Glasgow Coma Scale (GCS) at the first contact was lower in patients who ingested illegal drugs than in the remaining patients (9.0 vs. 11.6, p = 0.001). In 23.2% of the cases, an antidote was administered. In 29 (12.2%) naloxone and in 16 (6.7%) flumazenil was administered. Mean GCS after intervention was higher in all cases but significantly higher in illegal drug cases, 13.4 vs. 12.2 (p = 0.001), with a mean positive change in GCS of 4.5 vs. 0.6 (p < 0.001). In illegal drug users, mean change after antidote administration was 8.2 vs. 0.5 without antidote administration (p < 0.001). AB - CONCLUSION: High rate of successful antidote use during the intervention indicated the importance of good EMS protocols and the presence of a skilled doctor in the EMS team. RN - 0 (Antidotes) RN - 0 (Narcotic Antagonists) RN - 0 (Psychotropic Drugs) RN - 0 (Street Drugs) RN - 36B82AMQ7N (Naloxone) RN - 40P7XK9392 (Flumazenil) IS - 0370-8179 IL - 0370-8179 PT - Journal Article PP - ppublish LG - English DP - 2010 Mar-Apr EZ - 2010/05/27 06:00 DA - 2010/06/16 06:00 DT - 2010/05/27 06:00 YR - 2010 ED - 20100615 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20499502 <552. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20197473 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kwong WJ AU - Diels J AU - Kavanagh S FA - Kwong, Winghan Jacqueline FA - Diels, Joris FA - Kavanagh, Shane IN - Kwong, Winghan Jacqueline. Johnson and Johnson Pharmaceutical Services, LLC, Raritan, NJ, USA. TI - Costs of gastrointestinal events after outpatient opioid treatment for non-cancer pain. SO - Annals of Pharmacotherapy. 44(4):630-40, 2010 Apr AS - Ann Pharmacother. 44(4):630-40, 2010 Apr NJ - The Annals of pharmacotherapy VO - 44 IP - 4 PG - 630-40 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bbx, 9203131 IO - Ann Pharmacother SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Ambulatory Care/ec [Economics] MH - Ambulatory Care/sn [Statistics & Numerical Data] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Cohort Studies MH - Constipation/ci [Chemically Induced] MH - Constipation/ec [Economics] MH - Databases, Factual MH - Drug Prescriptions MH - Drug Utilization MH - Emergency Medical Services/ec [Economics] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - *Gastrointestinal Diseases/ci [Chemically Induced] MH - *Gastrointestinal Diseases/ec [Economics] MH - Gastrointestinal Diseases/ep [Epidemiology] MH - Humans MH - Hydrocodone/ae [Adverse Effects] MH - Insurance, Health, Reimbursement MH - Intestinal Obstruction/ci [Chemically Induced] MH - Intestinal Obstruction/ec [Economics] MH - Male MH - Middle Aged MH - Nausea/ci [Chemically Induced] MH - Nausea/ec [Economics] MH - Oxycodone/ae [Adverse Effects] MH - Pain/dt [Drug Therapy] MH - *Pain/ec [Economics] MH - Retrospective Studies MH - Socioeconomic Factors MH - United States/ep [Epidemiology] MH - Vomiting/ci [Chemically Induced] MH - Vomiting/ec [Economics] AB - BACKGROUND: Gastrointestinal (GI) adverse effects are common with oral opioid treatment. AB - OBJECTIVE: To estimate the costs associated with GI events after oral short-acting opioid treatment, from the payer perspective. AB - METHODS: Medical and pharmacy claims from the PharMetrics' Patient-Centric Database were used to identify opioid-naive patients who received a new prescription for oxycodone- or hydrocodone-containing immediate-release oral products between 2002 and 2006. Health-care resource use and costs were determined for patients with claims associated with ICD-9 CM (International Classification of Diseases-9th Clinical Modification) codes for nausea/vomiting (787.0x), constipation (564.0x), bowel obstruction (560, 560.1, 560.3, 560.39, 564.81), or antiemetic and laxative prescriptions during the 3 months after opioid index prescription and compared with patients without these GI event medical or prescription claims. Resource use data were compared using negative binomial regression and cost data were compared using ordinary least squares confirmed by generalized gamma regression analysis while controlling for demographics, treatment duration, and comorbidities. AB - RESULTS: Data from 237,447 patients were analyzed. Patients with GI event claims had significantly more hospitalizations (adjusted mean 0.20 to 0.97 vs 0.17, respectively, p < 0.001), days in the hospital (1.12 to 12.05 vs 1.00 days, p < 0.001), emergency department visits (0.36 to 1.44 vs 0.25 visits, p < 0.001), outpatient office visits (5.68 to 11.81 vs 4.11 visits, p < 0.001), and prescription claims (7.46 to 8.21 vs 6.06 claims, p < 0.001) than did patients without any GI event claims in the 3 months after index opioid prescription. Compared with patients without any GI event claims, incremental adjusted mean total health-care costs for patients with any of the GI event claims ranged from $4,880 to $36,152 and were significant (p < 0.001). AB - CONCLUSIONS: The economic burden of GI events coincident with opioid treatment is significant for patients with a GI event recorded in claims. Reducing GI adverse effects has potential cost savings for the health-care system. RN - 0 (Analgesics, Opioid) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - CD35PMG570 (Oxycodone) ES - 1542-6270 IL - 1060-0280 DO - https://dx.doi.org/10.1345/aph.1M520 PT - Journal Article ID - aph.1M520 [pii] ID - 10.1345/aph.1M520 [doi] PP - ppublish LG - English EP - 20100302 DP - 2010 Apr EZ - 2010/03/04 06:00 DA - 2010/06/16 06:00 DT - 2010/03/04 06:00 YR - 2010 ED - 20100615 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20197473 <553. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20199230 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fleischman RJ AU - Frazer DG AU - Daya M AU - Jui J AU - Newgard CD FA - Fleischman, Ross J FA - Frazer, David G FA - Daya, Mohamud FA - Jui, Jonathan FA - Newgard, Craig D IN - Fleischman, Ross J. Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA. fleischr@ohsu.edu TI - Effectiveness and safety of fentanyl compared with morphine for out-of-hospital analgesia. SO - Prehospital Emergency Care. 14(2):167-75, 2010 Apr-Jun AS - Prehosp Emerg Care. 14(2):167-75, 2010 Apr-Jun NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 14 IP - 2 PG - 167-75 PI - Journal available in: Print PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924527 OI - Source: NLM. NIHMS211327 SB - Index Medicus CP - England MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Medical Services MH - Female MH - Fentanyl/ae [Adverse Effects] MH - *Fentanyl/tu [Therapeutic Use] MH - Humans MH - Male MH - Medical Audit MH - Middle Aged MH - Morphine/ae [Adverse Effects] MH - *Morphine/tu [Therapeutic Use] MH - Retrospective Studies MH - Treatment Outcome AB - BACKGROUND: Fentanyl has several potential advantages for out-of-hospital analgesia, including rapid onset, short duration, and less histamine release. Objective. To compare the effectiveness and safety of fentanyl with that of morphine. AB - METHODS: This was a retrospective before-and-after study of a protocol change from morphine to fentanyl in an advanced life support emergency medical services system in January 2007. Charts from nine months prior to the change and for nine months afterward were abstracted by two reviewers using a standardized instrument. The first three months after the change were excluded. Effectiveness was measured by change in pain scores on a 0-10 scale. A priori-defined adverse events included out-of-hospital events: respiratory rate <12 breaths/min, pulse oximetry <92%, systolic blood pressure <90 mmHg, any fall in Glasgow Coma Scale score, nausea or vomiting, intubation, and use of antiemetic agents or naloxone. Emergency department charts were reviewed for initial pain scores and the same adverse events during the first two hours. Events clearly not attributable to the opioid were discounted. The changes in pain scores were also compared adjusting for confounders by multivariable linear regression. AB - RESULTS: Three hundred fifty-five patients aged 13 to 99 years received morphine during the nine months before the protocol change and 363 received fentanyl following the washout period. Initial pain scores for morphine (8.1) and fentanyl (8.3) were comparable (95% confidence interval [CI] for difference -1.1 to 0.3). Fentanyl patients received a higher equivalent dose of opioid (7.7 mg morphine equivalents for morphine, 9.2 mg for fentanyl, CI for the difference 0.9 to 2.3). The mean decreases in pain score were similar between the drugs (2.9 for morphine, 3.1 for fentanyl, CI for the difference -0.3 to 0.7). With regard to adverse events, 9.9% of the morphine patients and 6.6% of the fentanyl patients experienced an adverse event in the field (CI for the difference -0.8 to 7.3%). The most common event was nausea, with a rate of 7.0% for morphine vs. 3.8% for fentanyl (CI for the difference -0.1% to 6.5%). AB - CONCLUSION: Morphine and fentanyl provide similar degrees of out-of-hospital analgesia, although this was achieved with a higher dose of fentanyl. Both medications had low rates of adverse events, which were easily controlled. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) RN - UF599785JZ (Fentanyl) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.3109/10903120903572301 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - 10.3109/10903120903572301 [doi] ID - PMC2924527 [pmc] ID - NIHMS211327 [mid] PP - ppublish GI - No: UL1 RR024140 Organization: (RR) *NCRR NIH HHS* Country: United States GI - No: UL1 RR024140-05 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English DP - 2010 Apr-Jun EZ - 2010/03/05 06:00 DA - 2010/06/03 06:00 DT - 2010/03/05 06:00 YR - 2010 ED - 20100602 RD - 20161025 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20199230 <554. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20418299 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Neligan PJ AU - Malhotra G AU - Fraser M AU - Williams N AU - Greenblatt EP AU - Cereda M AU - Ochroch EA FA - Neligan, Patrick J FA - Malhotra, Guarav FA - Fraser, Michael FA - Williams, Noel FA - Greenblatt, Eric P FA - Cereda, Maurizio FA - Ochroch, E Andrew IN - Neligan, Patrick J. Department of Anaesthesia and Critical Care, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA. patrick.neligan@hse.ie TI - Noninvasive ventilation immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery.[Retraction in Neligan PJ, Malhotra G, Fraser M, Williams N, Greenblatt EP, Cereda M, Ochroch EA. Anesth Analg. 2010 Aug;111(2):519; PMID: 20664094] CM - Comment in: Anesth Analg. 2010 Aug;111(2):576; PMID: 20664097 SO - Anesthesia & Analgesia. 110(5):1360-5, 2010 May 01 AS - Anesth Analg. 110(5):1360-5, 2010 May 01 NJ - Anesthesia and analgesia VO - 110 IP - 5 PG - 1360-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - 4r8, 1310650 IO - Anesth. Analg. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Anesthesia, Inhalation MH - Bariatric Surgery/mo [Mortality] MH - *Bariatric Surgery MH - Critical Care MH - Female MH - Heart Arrest/et [Etiology] MH - Humans MH - *Intubation, Intratracheal MH - Laparoscopy/mo [Mortality] MH - *Laparoscopy MH - *Lung/pp [Physiopathology] MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Obesity, Morbid/co [Complications] MH - Obesity, Morbid/mo [Mortality] MH - *Obesity, Morbid/pp [Physiopathology] MH - Oximetry MH - Oxygen/bl [Blood] MH - Peak Expiratory Flow Rate/ph [Physiology] MH - Positive-Pressure Respiration MH - *Respiration, Artificial MH - Respiratory Insufficiency/et [Etiology] MH - Sleep Apnea, Obstructive/co [Complications] MH - Sleep Apnea, Obstructive/mo [Mortality] MH - *Sleep Apnea, Obstructive/pp [Physiopathology] MH - Spirometry MH - Treatment Outcome MH - Vital Capacity/ph [Physiology] AB - BACKGROUND: Noninvasive positive pressure ventilation (NIPPV) may improve postoperative lung function and reduce postoperative complications in patients undergoing abdominal surgery. The purpose of our study was to determine whether the timing of postoperative NIPPV affects lung function 1 day postoperatively. AB - METHODS: Forty morbidly obese patients with known obstructive sleep apnea undergoing laparoscopic bariatric surgery with standardized anesthesia care were randomly assigned to receive NIPPV immediately after tracheal extubation (immediate group) or supplemental oxygen (standard group). All patients had continuous positive airway pressure initiated 30 minutes after extubation in the postanesthesia care unit (PACU) via identical noninvasive ventilators. Spirometry was performed by a blinded observer in the perioperative holding area 1 hour after admission to the PACU and 1 day postoperatively. The primary outcome was the change in forced vital capacity (FVC) from baseline to 24 hours (FVC baseline-FVC 24 hours). AB - RESULTS: Forty patients, 20 in each group, were enrolled in the study. Forced expiratory volume in 1 second, FVC, and peak expiratory flow rate were significantly reduced in both groups from perioperative values throughout the study. At 24 hours, the intervention group had lost only 0.7 L FVC, versus 1.3 L for the intervention group (P = 0.0005). An analysis of covariance confirmed this and indicated that the immediate postoperative NIPPV better preserved spirometric function at 1 and 24 hours postoperatively. Specifically, the differences in the primary outcome were statistically significant. AB - CONCLUSIONS: NIPPV given immediately after extubation significantly improves spirometric lung function at 1 hour and 1 day postoperatively, compared with continuous positive airway pressure started in the PACU, in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - S88TT14065 (Oxygen) ES - 1526-7598 IL - 0003-2999 DO - https://dx.doi.org/10.1213/ANE.0b013e3181d5e3ef PT - Journal Article PT - Randomized Controlled Trial PT - Retracted Publication ID - 110/5/1360 [pii] ID - 10.1213/ANE.0b013e3181d5e3ef [doi] PP - ppublish LG - English DP - 2010 May 01 EZ - 2010/04/27 06:00 DA - 2010/05/14 06:00 DT - 2010/04/27 06:00 YR - 2010 ED - 20100513 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20418299 <555. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20223386 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Merlin MA AU - Saybolt M AU - Kapitanyan R AU - Alter SM AU - Jeges J AU - Liu J AU - Calabrese S AU - Rynn KO AU - Perritt R AU - Pryor PW 2nd FA - Merlin, Mark A FA - Saybolt, Matthew FA - Kapitanyan, Raffi FA - Alter, Scott M FA - Jeges, Janos FA - Liu, Junfeng FA - Calabrese, Susan FA - Rynn, Kevin O FA - Perritt, Rachael FA - Pryor, Peter W 2nd IN - Merlin, Mark A. Department of Emergency Medicine and Pediatrics, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA. merlinma@umdnj.edu TI - Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses. SO - American Journal of Emergency Medicine. 28(3):296-303, 2010 Mar AS - Am J Emerg Med. 28(3):296-303, 2010 Mar NJ - The American journal of emergency medicine VO - 28 IP - 3 PG - 296-303 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Administration, Intranasal MH - Adult MH - Aged MH - Chi-Square Distribution MH - *Drug Overdose/dt [Drug Therapy] MH - Female MH - Humans MH - Injections, Intravenous MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Retrospective Studies MH - Statistics, Nonparametric MH - Treatment Outcome AB - INTRODUCTION: This study proposes that intranasal (IN) naloxone administration is preferable to intravenous (IV) naloxone by emergency medical services for opioid overdoses. Our study attempts to establish that IN naloxone is as effective as IV naloxone but without the risk of needle exposure. We also attempt to validate the use of the Glasgow Coma Scale (GCS) in opioid intoxication. AB - METHODS: A retrospective chart review of prehospital advanced life support patients was performed on confirmed opioid overdose patients. Initial and final unassisted respiratory rates (RR) and GCS, recorded by paramedics, were used as indicators of naloxone effectiveness. The median changes in RR and GCS were determined. AB - RESULTS: Three hundred forty-four patients who received naloxone by paramedics from January 1, 2005, until December 31, 2007, were evaluated. Of confirmed opioid overdoses, change in RR was 6 for the IV group and 4 for the IN group (P = .08). Change in GCS was 4 for the IV group and 3 for the IN group (P = .19). Correlations between RR and GCS for initial, final, and change were significant at the 0.01 level (rho = 0.577, 0.462, 0.568, respectively). AB - CONCLUSION: Intranasal naloxone is statistically as effective as IV naloxone at reversing the effects of opioid overdose. The IV and IN groups had similar average increases in RR and GCS. Based on our results, IN naloxone is a viable alternative to IV naloxone while posing less risk of needle stick injury. Additionally, we demonstrated that GCS is correlated with RR in opioid intoxication. Copyright 2010 Elsevier Inc. All rights reserved. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1532-8171 IL - 0735-6757 DO - https://dx.doi.org/10.1016/j.ajem.2008.12.009 PT - Journal Article ID - S0735-6757(08)00826-7 [pii] ID - 10.1016/j.ajem.2008.12.009 [doi] PP - ppublish PH - 2008/08/17 [received] PH - 2008/10/25 [revised] PH - 2008/12/04 [accepted] LG - English EP - 20100128 DP - 2010 Mar EZ - 2010/03/13 06:00 DA - 2010/05/07 06:00 DT - 2010/03/13 06:00 YR - 2010 ED - 20100506 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20223386 <556. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20410114 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bie B AU - Zhang Z AU - Cai YQ AU - Zhu W AU - Zhang Y AU - Dai J AU - Lowenstein CJ AU - Weinman EJ AU - Pan ZZ FA - Bie, Bihua FA - Zhang, Zhi FA - Cai, You-Qing FA - Zhu, Wei FA - Zhang, Yong FA - Dai, Jaile FA - Lowenstein, Charles J FA - Weinman, Edward J FA - Pan, Zhizhong Z IN - Bie, Bihua. Department of Anesthesiology, The University of Texas-MD Anderson Cancer Center, Houston, Texas 77030, USA. TI - Nerve growth factor-regulated emergence of functional delta-opioid receptors. SO - Journal of Neuroscience. 30(16):5617-28, 2010 Apr 21 AS - J Neurosci. 30(16):5617-28, 2010 Apr 21 NJ - The Journal of neuroscience : the official journal of the Society for Neuroscience VO - 30 IP - 16 PG - 5617-28 PI - Journal available in: Print PI - Citation processed from: Internet JC - jdf, 8102140 IO - J. Neurosci. PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865237 OI - Source: NLM. NIHMS197622 SB - Index Medicus CP - United States MH - Animals MH - Excitatory Postsynaptic Potentials/de [Drug Effects] MH - Excitatory Postsynaptic Potentials/ph [Physiology] MH - Male MH - Mice MH - Mice, Knockout MH - Morphine/pd [Pharmacology] MH - *Nerve Growth Factor/pd [Pharmacology] MH - *Nerve Growth Factor/ph [Physiology] MH - Rats MH - Rats, Wistar MH - Receptors, Opioid, delta/ag [Agonists] MH - *Receptors, Opioid, delta/ph [Physiology] AB - Sorting of intracellular G-protein-coupled receptors (GPCRs) either to lysosomes for degradation or to plasma membrane for surface insertion and functional expression is a key process regulating signaling strength of GPCRs across the plasma membrane in adult mammalian cells. However, little is known about the molecular mechanisms governing the dynamic process of receptor sorting to the plasma membrane for functional expression under normal and pathological conditions. In this study, we demonstrate that delta-opioid receptor (DOPr), a GPCR constitutively targeted to intracellular compartments, is driven to the surface membrane of central synaptic terminals and becomes functional by the neurotrophin nerve growth factor (NGF) in native brainstem neurons. The NGF-triggered DOPr translocation is predominantly mediated by the signaling pathway involving the tyrosine receptor kinase A, Ca(2+)-mobilizing phospholipase C, and Ca(2+)/calmodulin-dependent protein kinase II. Importantly, it requires interactions with the cytoplasmic sorting protein NHERF-1 (Na(+)/H(+) exchange regulatory factor-1) and N-ethyl-maleimide-sensitive factor-regulated exocytosis. In addition, this NGF-mediated mechanism is likely responsible for the emergence of functional DOPr induced by chronic opioids. Thus, NGF may function as a key molecular switch that redirects the sorting of intracellularly targeted DOPr to plasma membrane, resulting in new functional DOPr on central synapses under chronic opioid conditions. RN - 0 (Receptors, Opioid, delta) RN - 76I7G6D29C (Morphine) RN - 9061-61-4 (Nerve Growth Factor) ES - 1529-2401 IL - 0270-6474 DO - https://dx.doi.org/10.1523/JNEUROSCI.5296-09.2010 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural ID - 30/16/5617 [pii] ID - 10.1523/JNEUROSCI.5296-09.2010 [doi] ID - PMC2865237 [pmc] ID - NIHMS197622 [mid] PP - ppublish GI - No: R21 DA025826 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: DA023069 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R21 DA025826-02 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA027541 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: DA025826 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA023069-02 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA027541-01 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA023069 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2010 Apr 21 EZ - 2010/04/23 06:00 DA - 2010/05/05 06:00 DT - 2010/04/23 06:00 YR - 2010 ED - 20100504 RD - 20161122 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20410114 <557. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20361548 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Iyer S AU - Davis KL AU - Candrilli S FA - Iyer, Shrividya FA - Davis, Keith L FA - Candrilli, Sean IN - Iyer, Shrividya. Global Health Outcomes Assessment, Pfizer Inc, 500 Arcola Road, E4269, Collegeville, PA,19426, USA. Shrividya.lyer@pfizer.com TI - Opioid use patterns and health care resource utilization in patients prescribed opioid therapy with and without constipation. SO - Managed Care. 19(3):44-51, 2010 Mar AS - Manag Care. 19(3):44-51, 2010 Mar NJ - Managed care (Langhorne, Pa.) VO - 19 IP - 3 PG - 44-51 PI - Journal available in: Print PI - Citation processed from: Print JC - b7n, 9303583 IO - Manag Care SB - Health Administration Journals CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cohort Studies MH - *Constipation/ci [Chemically Induced] MH - Databases as Topic MH - Female MH - Health Expenditures MH - *Health Services/ut [Utilization] MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Young Adult AB - PURPOSE: The main objective of this study was to compare the opioid use patterns, resource utilization, and costs of patients on opioid therapy who have constipation with those who do not. AB - DESIGN: Retrospective, observational matched cohort design AB - METHODOLOGY: Patients initiating opioid therapy between Jan. 1, 1999 and Dec. 31, 2005 were identified from a longitudinal insurance claims database. Patients had > or = 30 days of opioid use and continuous plan coverage for > or = 6 months before and > or = 12 months after their index date, defined as the date of the first pharmacy claim for an opioid. Constipation was defined as having one or more ICD-9 codes of 564.0 during the follow-up period. Patterns of opioid use and resource utilization were compared between patients with constipation and a demographically matched (1:1) cohort of opioid initiators without consti- pation using t-tests and Chi-square (chi2) tests. AB - PRINCIPAL FINDINGS: We identified 39,485 patients, of whom 2,519 (6.4%) had constipation. Most patients with constipation were female (66%) and > or = 45 years old (68%). Compared to controls, the constipation group had significantly higher rates of concurrent use of > or = 2 opioids (p < 0.0001), discontinuation, and switching between opioids. Patients with constipation had statistically significant higher hospital admissions, emergency room visits, home health services, nursing home care, physician office visits, other outpatient/ ancillary care, and laboratory tests. Patients with constipation had significantly higher mean all-cause costs for emergency, physician visits, nursing facility, home health, and prescription drug services compared to patients without constipation. AB - CONCLUSION: Opioid-treated patients with constipation were found to have significant differences in opioid use patterns and significantly higher health care utilization and associated costs. RN - 0 (Analgesics, Opioid) IS - 1062-3388 IL - 1062-3388 PT - Comparative Study PT - Journal Article PP - ppublish LG - English DP - 2010 Mar EZ - 2010/04/07 06:00 DA - 2010/05/05 06:00 DT - 2010/04/06 06:00 YR - 2010 ED - 20100504 RD - 20100405 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20361548 <558. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19913979 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Saybolt MD AU - Alter SM AU - Dos Santos F AU - Calello DP AU - Rynn KO AU - Nelson DA AU - Merlin MA FA - Saybolt, Matthew D FA - Alter, Scott M FA - Dos Santos, Frank FA - Calello, Diane P FA - Rynn, Kevin O FA - Nelson, Daniel A FA - Merlin, Mark A IN - Saybolt, Matthew D. UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ, USA. TI - Naloxone in cardiac arrest with suspected opioid overdoses. SO - Resuscitation. 81(1):42-6, 2010 Jan AS - Resuscitation. 81(1):42-6, 2010 Jan NJ - Resuscitation VO - 81 IP - 1 PG - 42-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Adult MH - Aged MH - Confidence Intervals MH - Drug Overdose MH - Electrocardiography MH - Emergency Medical Services/og [Organization & Administration] MH - Female MH - *Heart Arrest/ci [Chemically Induced] MH - *Heart Arrest/dt [Drug Therapy] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Retrospective Studies MH - Treatment Outcome AB - INTRODUCTION: Naloxone's use in cardiac arrest has been of recent interest, stimulated by conflicting results in both human case reports and animal studies demonstrating antiarrhythmic and positive ionotropic effects. We hypothesized that naloxone administration during cardiac arrest, in suspected opioid overdosed patients, is associated with a change in cardiac rhythm. AB - METHODS: From a database of 32,544 advanced life support (ALS) emergency medical dispatches between January 2003 and December 2007, a retrospective chart review was completed of patients receiving naloxone in cardiac arrest. Forty-two patients in non-traumatic cardiac arrest were identified. Each patient received naloxone because of suspicion by a paramedic of acute opioid use. AB - RESULTS: Fifteen of the 36 (42%) (95% confidence interval [CI]: 26-58) patients in cardiac arrest who received naloxone in the pre-hospital setting had an improvement in electrocardiogram (EKG) rhythm. Of the participants who responded to naloxone, 47% (95% CI: 21-72) (19% [95% CI: 7-32] of all study subjects) demonstrated EKG rhythm changes immediately following the administration of naloxone. AB - DISCUSSION: Although we cannot support the routine use of naloxone during cardiac arrest, we recommend its administration with any suspicion of opioid use. Due to low rates of return of spontaneous circulation and survival during cardiac arrest, any potential intervention leading to rhythm improvement is a reasonable treatment modality. Copyright 2009 Elsevier Ireland Ltd. All rights reserved. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) ES - 1873-1570 IL - 0300-9572 DO - https://dx.doi.org/10.1016/j.resuscitation.2009.09.016 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0300-9572(09)00492-4 [pii] ID - 10.1016/j.resuscitation.2009.09.016 [doi] PP - ppublish PH - 2009/03/02 [received] PH - 2009/09/08 [revised] PH - 2009/09/18 [accepted] LG - English EP - 20091113 DP - 2010 Jan EZ - 2009/11/17 06:00 DA - 2010/05/05 06:00 DT - 2009/11/17 06:00 YR - 2010 ED - 20100504 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19913979 <559. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 20219502 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dymes M FA - Dymes, Mike TI - Wake-up call. SO - Journal of Emergency Medical Services. 35(2):16, 2010 Feb AS - J Emerg Med Serv JEMS. 35(2):16, 2010 Feb NJ - JEMS : a journal of emergency medical services VO - 35 IP - 2 PG - 16 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Emergency Medical Services MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 DO - https://dx.doi.org/10.1016/S0197-2510(10)70031-0 PT - Letter ID - S0197-2510(10)70031-0 [pii] ID - 10.1016/S0197-2510(10)70031-0 [doi] PP - ppublish LG - English DP - 2010 Feb EZ - 2010/03/12 06:00 DA - 2010/04/23 06:00 DT - 2010/03/12 06:00 YR - 2010 ED - 20100422 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=20219502 <560. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19922572 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kerr D AU - Kelly AM AU - Dietze P AU - Jolley D AU - Barger B FA - Kerr, Debra FA - Kelly, Anne-Maree FA - Dietze, Paul FA - Jolley, Damien FA - Barger, Bill IN - Kerr, Debra. Victoria University, School of Nursing and Midwifery, St Albans, Victoria, Australia. deb.kerr@vu.edu.au TI - Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. SO - Addiction. 104(12):2067-74, 2009 Dec AS - Addiction. 104(12):2067-74, 2009 Dec NJ - Addiction (Abingdon, England) VO - 104 IP - 12 PG - 2067-74 PI - Journal available in: Print PI - Citation processed from: Internet JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Administration, Intranasal MH - Adolescent MH - Adult MH - Allied Health Personnel MH - *Analgesics, Opioid/po [Poisoning] MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services MH - Female MH - *Heroin/po [Poisoning] MH - Humans MH - Injections, Intramuscular MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/ae [Adverse Effects] MH - Prospective Studies MH - Treatment Outcome MH - Victoria MH - Young Adult AB - AIMS: Traditionally, the opiate antagonist naloxone has been administered parenterally; however, intranasal (i.n.) administration has the potential to reduce the risk of needlestick injury. This is important when working with populations known to have a high prevalence of blood-borne viruses. Preliminary research suggests that i.n. administration might be effective, but suboptimal naloxone solutions were used. This study compared the effectiveness of concentrated (2 mg/ml) i.n. naloxone to intramuscular (i.m.) naloxone for suspected opiate overdose. AB - METHODS: This randomized controlled trial included patients treated for suspected opiate overdose in the pre-hospital setting. Patients received 2 mg of either i.n. or i.m. naloxone. The primary outcome was the proportion of patients who responded within 10 minutes of naloxone treatment. Secondary outcomes included time to adequate response and requirement for supplementary naloxone. Data were analysed using multivariate statistical techniques. AB - RESULTS: A total of 172 patients were enrolled into the study. Median age was 29 years and 74% were male. Rates of response within 10 minutes were similar: i.n. naloxone (60/83, 72.3%) compared with i.m. naloxone (69/89, 77.5%) [difference: -5.2%, 95% confidence interval (CI) -18.2 to 7.7]. No difference was observed in mean response time (i.n.: 8.0, i.m.: 7.9 minutes; difference 0.1, 95% CI -1.3 to 1.5). Supplementary naloxone was administered to fewer patients who received i.m. naloxone (i.n.: 18.1%; i.m.: 4.5%) (difference: 13.6%, 95% CI 4.2-22.9). AB - CONCLUSIONS: Concentrated intranasal naloxone reversed heroin overdose successfully in 82% of patients. Time to adequate response was the same for both routes, suggesting that the i.n. route of administration is of similar effectiveness to the i.m. route as a first-line treatment for heroin overdose. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1360-0443 IL - 0965-2140 DO - https://dx.doi.org/10.1111/j.1360-0443.2009.02724.x PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - ADD2724 [pii] ID - 10.1111/j.1360-0443.2009.02724.x [doi] PP - ppublish LG - English DP - 2009 Dec EZ - 2009/11/20 06:00 DA - 2010/03/18 06:00 DT - 2009/11/20 06:00 YR - 2009 ED - 20100317 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19922572 <561. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19853350 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mumma BE AU - Shellenbarger D AU - Callaway CW AU - Katz KD AU - Guyette FX AU - Rittenberger JC FA - Mumma, Bryn E FA - Shellenbarger, David FA - Callaway, Clifton W FA - Katz, Kenneth D FA - Guyette, Francis X FA - Rittenberger, Jon C TI - Neurologic recovery following cardiac arrest due to benzodiazepine and opiate toxicity. SO - Resuscitation. 80(12):1446-7, 2009 Dec AS - Resuscitation. 80(12):1446-7, 2009 Dec NJ - Resuscitation VO - 80 IP - 12 PG - 1446-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Adult MH - *Benzodiazepines/ae [Adverse Effects] MH - Cardiopulmonary Resuscitation MH - Glasgow Coma Scale MH - *Heart Arrest/ci [Chemically Induced] MH - Heart Arrest/th [Therapy] MH - *Heroin Dependence/co [Complications] MH - Heroin Dependence/th [Therapy] MH - Humans MH - Hypothermia, Induced MH - Intubation, Intratracheal MH - Magnetic Resonance Imaging MH - Male RN - 12794-10-4 (Benzodiazepines) ES - 1873-1570 IL - 0300-9572 DO - https://dx.doi.org/10.1016/j.resuscitation.2009.08.027 PT - Case Reports PT - Letter ID - S0300-9572(09)00477-8 [pii] ID - 10.1016/j.resuscitation.2009.08.027 [doi] PP - ppublish PH - 2009/08/14 [received] PH - 2009/08/15 [accepted] LG - English EP - 20091022 DP - 2009 Dec EZ - 2009/10/27 06:00 DA - 2010/02/26 06:00 DT - 2009/10/27 06:00 YR - 2009 ED - 20100225 RD - 20091127 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19853350 <562. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19731165 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Robertson TM AU - Hendey GW AU - Stroh G AU - Shalit M FA - Robertson, Tania Mieke FA - Hendey, Gregory W FA - Stroh, Geoff FA - Shalit, Marc IN - Robertson, Tania Mieke. Department of Emergency Medicine, UCSF-Fresno, Medical Education Program, Fresno, California 93701, USA. TI - Intranasal naloxone is a viable alternative to intravenous naloxone for prehospital narcotic overdose. SO - Prehospital Emergency Care. 13(4):512-5, 2009 Oct-Dec AS - Prehosp Emerg Care. 13(4):512-5, 2009 Oct-Dec NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 13 IP - 4 PG - 512-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - *Administration, Intranasal MH - Adolescent MH - Adult MH - Aged MH - California MH - *Drug Overdose/th [Therapy] MH - *Emergency Medical Services MH - Female MH - Humans MH - *Infusions, Intravenous MH - Male MH - Medical Records MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Retrospective Studies MH - Young Adult AB - OBJECTIVE: To compare the prehospital time intervals from patient contact and medication administration to clinical response for intranasal (IN) versus intravenous (IV) naloxone in patients with suspected narcotic overdose. AB - METHODS: This was a retrospective review of emergency medical services (EMS) and hospital records, before and after implementation of a protocol for administration of intranasal naloxone by the Central California EMS Agency. We included patients with suspected narcotic overdose treated in the prehospital setting over 17 months, between March 2003 and July 2004. Paramedics documented dose, route of administration, and positive response times using an electronic record. Clinical response was defined as an increase in respiratory rate (breaths/min) or Glasgow Coma Scale score of at least 6. Main outcome variables included time from medication to clinical response and time from patient contact to clinical response. Secondary variables included numbers of doses administered and rescue doses given by an alternate route. Between-group comparisons were accomplished using t-tests and chi-square tests as appropriate. AB - RESULTS: One hundred fifty-four patients met the inclusion criteria, including 104 treated with IV and 50 treated with IN naloxone. Clinical response was noted in 33 (66%) and 58 (56%) of the IN and IV groups, respectively (p = 0.3). The mean time between naloxone administration and clinical response was longer for the IN group (12.9 vs. 8.1 min, p = 0.02). However, the mean times from patient contact to clinical response were not significantly different between the IN and IV groups (20.3 vs. 20.7 min, p = 0.9). More patients in the IN group received two doses of naloxone (34% vs. 18%, p = 0.05), and three patients in the IN group received a subsequent dose of IV or IM naloxone. AB - CONCLUSIONS: The time from dose administration to clinical response for naloxone was longer for the IN route, but the overall time from patient contact to response was the same for the IV and IN routes. Given the difficulty and potential hazards in obtaining IV access in many patients with narcotic overdose, IN naloxone appears to be a useful and potentially safer alternative. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1545-0066 IL - 1090-3127 DO - https://dx.doi.org/10.1080/10903120903144866 PT - Journal Article ID - 914290348 [pii] ID - 10.1080/10903120903144866 [doi] PP - ppublish LG - English DP - 2009 Oct-Dec EZ - 2009/09/05 06:00 DA - 2010/01/07 06:00 DT - 2009/09/05 06:00 YR - 2009 ED - 20100106 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19731165 <563. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19356347 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Naseem A AU - Abbas S FA - Naseem, Arshad FA - Abbas, Shahid IN - Naseem, Arshad. Department of Pulmonology, Military Hospital, Rawalpindi. an91104@yahoo.co.in TI - Diacetylmorphine (heroin) body packer presenting with respiratory arrest. SO - Jcpsp, Journal of the College of Physicians & Surgeons - Pakistan. 19(4):262-3, 2009 Apr AS - J Coll Physicians Surg Pak. 19(4):262-3, 2009 Apr NJ - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP VO - 19 IP - 4 PG - 262-3 PI - Journal available in: Print PI - Citation processed from: Print JC - 9606447 IO - J Coll Physicians Surg Pak SB - Index Medicus CP - Pakistan MH - Adult MH - *Crime MH - Heroin/ad [Administration & Dosage] MH - *Heroin/ae [Adverse Effects] MH - Heroin/ur [Urine] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Narcotics/ad [Administration & Dosage] MH - *Narcotics/ae [Adverse Effects] MH - Narcotics/ur [Urine] MH - Respiration, Artificial MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Respiratory Insufficiency/dt [Drug Therapy] MH - Respiratory Insufficiency/th [Therapy] MH - *Street Drugs/ae [Adverse Effects] MH - Street Drugs/ur [Urine] AB - Intracorporeal concealment of illicit drugs known as 'body packing' is uncommonly reported. A body packer with swallowed capsules containing Diacetylmorphine (heroin) for smuggling purposes presented with respiratory arrest and recovered after ventilatory support and nalaxone infusion. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 0 (Street Drugs) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 1022-386X IL - 1022-386X DO - https://dx.doi.org/04.2009/JCPSP.262263 PT - Case Reports PT - Journal Article ID - 040579197 [pii] ID - 04.2009/JCPSP.262263 [doi] PP - ppublish PH - 2008/02/04 [received] PH - 2009/01/22 [accepted] LG - English DP - 2009 Apr EZ - 2009/04/10 09:00 DA - 2010/01/06 06:00 DT - 2009/04/10 09:00 YR - 2009 ED - 20100105 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19356347 <564. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19799535 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cavaliere F AU - Masieri S FA - Cavaliere, F FA - Masieri, S IN - Cavaliere, F. Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy. f.cavaliere@rm.unicatt.it TI - Opioids and mechanical ventilation. [Review] [80 refs] SO - Current Drug Targets. 10(9):816-25, 2009 Sep AS - Curr Drug Targets. 10(9):816-25, 2009 Sep NJ - Current drug targets VO - 10 IP - 9 PG - 816-25 PI - Journal available in: Print PI - Citation processed from: Internet JC - d3u, 100960531 IO - Curr Drug Targets SB - Index Medicus CP - Netherlands MH - Analgesics, Opioid/pd [Pharmacology] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Humans MH - Respiration/de [Drug Effects] MH - *Respiration, Artificial AB - In last years opioids have been increasingly utilized to sedate patients during mechanical ventilation. First, in Hypnotic Based Sedation (HBS), they were added to hypnotics because of their analgesic properties. Successively, in Analgesic Based Sedation (ABS), both sedative and analgesic properties were utilized and opioids were given alone; hypnotics were added only if adequate sedation was not achieved at maximum dosage. Apart from their analgesic and sedative properties, opioid effects on respiratory function are of particular value in many mechanically-ventilated patients. Dose-dependent inhibition of respiratory drive may usefully prevent spontaneous breathing during controlled ventilation, particularly when permissive hypercapnia is applied, or decrease excessive respiratory rate during assisted or noninvasive ventilation. Even cough inhibition can be valuable in some conditions, for instance, during respiratory weaning and endotracheal tube removal in patients that should not cough because of a recent tracheal resection. On the other hand, excessive respiratory depression may cause hypoventilation and apnea during assisted or spontaneous ventilation and lengthens the weaning process. In order to take advantage from positive effects and to avoid negative ones, opioid dosage should be thoroughly titrated. On this basis remifentanil has become increasingly popular as the opioid agent most suitable for ABS because of its unique, favorable pharmacokinetics. [References: 80] RN - 0 (Analgesics, Opioid) ES - 1873-5592 IL - 1389-4501 PT - Journal Article PT - Review PP - ppublish LG - English DP - 2009 Sep EZ - 2009/10/06 06:00 DA - 2009/12/16 06:00 DT - 2009/10/06 06:00 YR - 2009 ED - 20091130 RD - 20091005 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19799535 <565. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19576523 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Devlin JW AU - Roberts RJ FA - Devlin, John W FA - Roberts, Russel J IN - Devlin, John W. Northeastern University School of Pharmacy, MU206, 360 Huntington Avenue, Boston, MA 02115, USA. j.devlin@neu.edu TI - Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. [Review] [99 refs][Reprint in Anesthesiol Clin. 2011 Dec;29(4):567-85; PMID: 22078910] SO - Critical Care Clinics. 25(3):431-49, vii, 2009 Jul AS - Crit Care Clin. 25(3):431-49, vii, 2009 Jul NJ - Critical care clinics VO - 25 IP - 3 PG - 431-49, vii PI - Journal available in: Print PI - Citation processed from: Internet JC - ccc, 8507720 IO - Crit Care Clin SB - Index Medicus CP - United States MH - Analgesics/ad [Administration & Dosage] MH - Analgesics/ae [Adverse Effects] MH - *Analgesics/pd [Pharmacology] MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/pd [Pharmacology] MH - Benzodiazepines/ad [Administration & Dosage] MH - Benzodiazepines/ae [Adverse Effects] MH - *Benzodiazepines/pd [Pharmacology] MH - *Critical Care/mt [Methods] MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - Hypnotics and Sedatives/ae [Adverse Effects] MH - *Hypnotics and Sedatives/pd [Pharmacology] MH - Intensive Care Units MH - Pain/dt [Drug Therapy] MH - Pain/pc [Prevention & Control] MH - Propofol/ad [Administration & Dosage] MH - Propofol/ae [Adverse Effects] MH - *Propofol/pd [Pharmacology] MH - *Respiration, Artificial/mt [Methods] AB - Opioids, benzodiazepines, and propofol remain the mainstay by which to optimize patient comfort and facilitate mechanical ventilation in patients who are critically ill. Unfortunately none of these agents share all of the characteristics of the ideal sedative or analgesic agent: rapid onset, rapid recovery, a predictable dose response, a lack of drug accumulation, and no toxicity. To optimize care, critical care clinicians should be familiar with the many pharmacokinetic, pharmacodynamic, and pharmacogenetic variables that can affect the safety and efficacy of these sedatives and analgesics. [References: 99] RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 12794-10-4 (Benzodiazepines) RN - YI7VU623SF (Propofol) ES - 1557-8232 IL - 0749-0704 DO - https://dx.doi.org/10.1016/j.ccc.2009.03.003 PT - Journal Article PT - Review ID - S0749-0704(09)00033-5 [pii] ID - 10.1016/j.ccc.2009.03.003 [doi] PP - ppublish LG - English DP - 2009 Jul EZ - 2009/07/07 09:00 DA - 2009/10/20 06:00 DT - 2009/07/07 09:00 YR - 2009 ED - 20091019 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19576523 <566. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18945240 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Miner JR AU - Moore J AU - Gray RO AU - Skinner L AU - Biros MH FA - Miner, James R FA - Moore, Johanna FA - Gray, Richard O FA - Skinner, Lisa FA - Biros, Michelle H IN - Miner, James R. Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA. jimminer@hotmail.com TI - Oral versus intravenous opioid dosing for the initial treatment of acute musculoskeletal pain in the emergency department. SO - Academic Emergency Medicine. 15(12):1234-40, 2008 Dec AS - Acad Emerg Med. 15(12):1234-40, 2008 Dec NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 15 IP - 12 PG - 1234-40 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Acute Disease MH - Administration, Oral MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Child MH - Drug Administration Schedule MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Infusions, Intravenous MH - Male MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - *Musculoskeletal Diseases/co [Complications] MH - Oxycodone/ad [Administration & Dosage] MH - Pain/di [Diagnosis] MH - *Pain/dt [Drug Therapy] MH - *Pain/et [Etiology] MH - Pain Measurement MH - Prospective Studies MH - Treatment Outcome MH - Young Adult AB - OBJECTIVES: The objective was to compare the time to medication administration, the side effects, and the analgesic effect at sequential time points after medication administration of an oral treatment strategy using oxycodone solution with an intravenous (IV) treatment strategy using morphine sulfate for the initial treatment of musculoskeletal pain in emergency department (ED) patients. AB - METHODS: This was a prospective randomized clinical trial of patients >6 years old who were going to receive IV morphine sulfate for the treatment of musculoskeletal pain but did not yet have an IV. Consenting patients were randomized to have the treating physician order either 0.1 mg/kg morphine sulfate IV or 0.125 mg/kg oxycodone orally in a 5 mg/5 mL suspension as their initial treatment for pain. The time from the placement of the order to the administration of the medication was recorded. Pain was measured using a 100-mm visual analog scale (VAS) and recorded at 0, 10, 20, 30 and 40 minutes after drug administration. AB - RESULTS: A total of 405 eligible patients were identified during the study period; 328 (81.0%) patients consented to be in the study. A total of 158 patients were randomized to the IV morphine sulfate treatment group, and 162 were randomized to the oral oxycodone treatment group. Of the patients who were randomized to IV therapy, 34 were withdrawn from the study prior to drug administration; leaving 125 patients in the IV group for analysis. Of the patients who randomized to oral therapy, 22 were withdrawn from the study prior to drug administration, leaving 140 patients for analysis. No serious adverse events were detected. There was a 12-minute difference between the median time of the order and the administration of oral oxycodone (8.5 minutes) and IV morphine (20.5 minutes). The mean percent change in VAS score was larger for patients in the IV therapy group than those in the oral therapy group at 10 and 20 minutes. At 30 and 40 minutes, the authors could no longer detect a difference. The satisfaction scale score was higher after treatment for the morphine group (median = 4; interquartile range [IQR] = 4 to 5) than for the oxycodone group (median = 4; IQR = 2 to 5; p = 0.008). AB - CONCLUSIONS: The oral loading strategy was associated with delayed onset of analgesia and decreased patient satisfaction, but a shorter time to administration. The oral loading strategy using an oxycodone solution provided similar pain relief to the IV strategy using morphine 30 minutes after administration of the drug. Oral 0.125 mg/kg oxycodone represents a feasible alternative to 0.1 mg/kg IV morphine in the treatment of severe acute musculoskeletal pain when difficult or delayed IV placement greater than 30 minutes presents a barrier to treatment. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) RN - CD35PMG570 (Oxycodone) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/j.1553-2712.2008.00266.x PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - ACEM266 [pii] ID - 10.1111/j.1553-2712.2008.00266.x [doi] PP - ppublish LG - English EP - 20081017 DP - 2008 Dec EZ - 2008/10/24 09:00 DA - 2009/10/14 06:00 DT - 2008/10/24 09:00 YR - 2008 ED - 20091013 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18945240 <567. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19560838 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chang AK AU - Bijur PE AU - Davitt M AU - Gallagher EJ FA - Chang, Andrew K FA - Bijur, Polly E FA - Davitt, Michelle FA - Gallagher, E John IN - Chang, Andrew K. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. achang@montefiore.org TI - Randomized clinical trial comparing a patient-driven titration protocol of intravenous hydromorphone with traditional physician-driven management of emergency department patients with acute severe pain. SO - Annals of Emergency Medicine. 54(4):561-567.e2, 2009 Oct AS - Ann Emerg Med. 54(4):561-567.e2, 2009 Oct NJ - Annals of emergency medicine VO - 54 IP - 4 PG - 561-567.e2 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Analgesia, Patient-Controlled MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Critical Pathways MH - Drug Administration Schedule MH - *Emergency Service, Hospital MH - Female MH - Humans MH - *Hydromorphone/ad [Administration & Dosage] MH - Infusions, Intravenous MH - Male MH - Middle Aged MH - New York MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Patient Satisfaction AB - STUDY OBJECTIVE: We test the null hypothesis that the "1+1" hydromorphone patient-driven protocol is clinically and statistically equivalent in safety and efficacy to that of traditional physician-driven administration of opioids for emergency department (ED) treatment of acute severe pain. AB - METHODS: This was a prospective randomized clinical trial of nonelderly adults presenting to an urban academic ED with acute pain of sufficient severity to warrant intravenous (IV) opioids in the judgment of the attending physician. Patients randomized to the 1+1 hydromorphone patient-driven protocol received 1 mg IV hydromorphone followed by a second 1-mg dose 15 minutes later if the patient responded affirmatively to the question, "Do you want more pain medication?" Patients in the physician-driven group received any IV opioid in the dose chosen by the ED attending physician, with any additional analgesia provided at the discretion of that physician. The primary outcome was the difference in improvement in pain between the 2 groups at 60 minutes, as measured by a validated and reproducible numeric rating scale. Secondary outcomes included incidence of oxygen desaturation, hypoventilation, hypotension, bradycardia, nausea, vomiting, pruritus, and use of naloxone. AB - RESULTS: The mean decrease in numeric rating scale pain scores for the 1+1 hydromorphone patient-driven group was 5.6 versus 4.5 in the physician-driven group. The difference of 1.1 numeric rating scale units (95% confidence interval 0.3 to 1.9) was statistically significant but fell 0.2 numeric rating scale units short of the 1.3 numeric rating scale unit threshold required to attain clinically significant efficacy. Safety profiles were similarly satisfactory in both groups. Ninety-four percent of the 1+1 hydromorphone patient-driven group achieved adequate analgesia (as defined by the patient) within 60 minutes of protocol initiation. AB - CONCLUSION: The 1+1 hydromorphone patient-driven protocol is statistically superior and at least as clinically efficacious and safe as traditional physician-driven treatment of ED patients with acute severe pain. More than 9 of 10 patients randomized to the study protocol achieved satisfactory pain control, as defined by the patient, within an hour or less. RN - 0 (Analgesics, Opioid) RN - Q812464R06 (Hydromorphone) ES - 1097-6760 IL - 0196-0644 DO - https://dx.doi.org/10.1016/j.annemergmed.2009.05.003 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - S0196-0644(09)00487-9 [pii] ID - 10.1016/j.annemergmed.2009.05.003 [doi] PP - ppublish PH - 2008/12/15 [received] PH - 2009/04/27 [revised] PH - 2009/05/04 [accepted] LG - English EP - 20090628 DP - 2009 Oct EZ - 2009/06/30 09:00 DA - 2009/10/09 06:00 DT - 2009/06/30 09:00 YR - 2009 ED - 20091008 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19560838 <568. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18280084 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tornabene SV AU - Deutsch R AU - Davis DP AU - Chan TC AU - Vilke GM FA - Tornabene, Stephen V FA - Deutsch, Reena FA - Davis, Daniel P FA - Chan, Theodore C FA - Vilke, Gary M IN - Tornabene, Stephen V. Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Oakland, Oakland, California, USA. TI - Evaluating the use and timing of opioids for the treatment of migraine headaches in the emergency department. SO - Journal of Emergency Medicine. 36(4):333-7, 2009 May AS - J Emerg Med. 36(4):333-7, 2009 May NJ - The Journal of emergency medicine VO - 36 IP - 4 PG - 333-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Analgesics, Non-Narcotic/ad [Administration & Dosage] MH - *Analgesics, Non-Narcotic/tu [Therapeutic Use] MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Administration Schedule MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Medical Records MH - Middle Aged MH - *Migraine Disorders/dt [Drug Therapy] MH - *Migraine Disorders/ep [Epidemiology] MH - Patient Readmission/sn [Statistics & Numerical Data] MH - Polypharmacy MH - Recurrence MH - Retrospective Studies MH - Self Administration MH - United States/ep [Epidemiology] AB - The objective of this study was to evaluate the throughput times of patients administered opioids for the treatment of migraine headaches in the frequent emergency department (ED) visitor. A retrospective review of ED patient records was conducted. Repeat patients were significantly more likely to receive opioids as a treatment, receive multiple doses of opioids, and receive opioids as the initial pharmacological treatment compared to non-repeaters. Patients administered opioids, regardless of repeater status, had significantly longer ED stays; 142 min (95% confidence interval [CI] 124-160) vs. 111 min (95% CI 93-129), respectively, p = 0.015. Patients given multiple doses of opioids had significantly longer ED stays than patients given a single dose of an opioid; 191 min (95% CI 156-225) vs. 125 min (95% CI 101-149), respectively, p = 0.003. Delayed administration of opioids did not result in longer ED stays in those patients eventually treated with opioids. Administration of opioids for migraine headache may result in longer ED stays when compared with non-opioid migraine treatments. Judicious use of opioids as a treatment for migraine headaches is recommended. RN - 0 (Analgesics, Non-Narcotic) RN - 0 (Analgesics, Opioid) IS - 0736-4679 IL - 0736-4679 DO - https://dx.doi.org/10.1016/j.jemermed.2007.07.068 PT - Evaluation Studies PT - Journal Article ID - S0736-4679(07)00768-8 [pii] ID - 10.1016/j.jemermed.2007.07.068 [doi] PP - ppublish PH - 2006/08/26 [received] PH - 2007/07/09 [revised] PH - 2007/07/13 [accepted] LG - English EP - 20080214 DP - 2009 May EZ - 2008/02/19 09:00 DA - 2009/08/29 09:00 DT - 2008/02/19 09:00 YR - 2009 ED - 20090828 RD - 20090427 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18280084 <569. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19662923 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bell T AU - Annunziata K AU - Leslie JB FA - Bell, Timothy FA - Annunziata, Kathy FA - Leslie, John B IN - Bell, Timothy. GlaxoSmithKline, Research Triangle Park, NC, USA. TI - Opioid-induced constipation negatively impacts pain management, productivity, and health-related quality of life: findings from the National Health and Wellness Survey. SO - Journal of Opioid Management. 5(3):137-44, 2009 May-Jun AS - J Opioid Manag. 5(3):137-44, 2009 May-Jun NJ - Journal of opioid management VO - 5 IP - 3 PG - 137-44 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Constipation/ci [Chemically Induced] MH - Cross-Sectional Studies MH - Efficiency MH - Female MH - Health Services/ut [Utilization] MH - Health Surveys MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Middle Aged MH - *Pain/dt [Drug Therapy] MH - *Quality of Life MH - Young Adult AB - OBJECTIVE: To characterize the impact of opioid-induced constipation (OIC) on healthcare resource use, work productivity, and health-related quality of life (HRQOL) in patients receiving chronic opioid therapy. AB - DESIGN: Data were collected via Internet questionnaires during the international National Health and Wellness Survey (NHWS) 2004 from individuals aged > or = 18 years who reported taking opioids for > or = 6 months. Healthcare resource utilization, Work Productivity, and Activity Impairment, and Short-Form 8 (SF-8) questionnaire responses were compared between those who did or did not report OIC. AB - RESULTS: Data were available from 2,430 individuals receiving opioids, of whom 359 reported OIC. Participants with OIC reported significantly more physician visits (mean difference 3.84 visits; p < 0.05) and alternative care provider visits (mean difference 1.73 visits; p < 0.05) over the previous 6 months than those without OIC; however, no significant differences in emergency room visits or number of days of hospitalization were observed. Respondents with OIC also reported significantly greater time missed from work, impairment while working, overall work impairment, and activity impairment (p < 0.05 for all comparisons). HRQOL scores were significantly lower in the OIC group than those without OIC on both the physical and mental components of the SF-8 questionnaire (p < 0.05 for both comparisons). AB - CONCLUSIONS: The survey results reflect a negative impact of OIC on individuals' HRQOL and on society in terms of healthcare resource use and work productivity beyond that imposed by patients' pain conditions. These findings indicate a need for effective treatment for opioid-induced constipation in patients receiving chronic opioid therapy. RN - 0 (Analgesics, Opioid) IS - 1551-7489 IL - 1551-7489 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2009 May-Jun EZ - 2009/08/11 09:00 DA - 2009/08/27 09:00 DT - 2009/08/11 09:00 YR - 2009 ED - 20090826 RD - 20120713 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19662923 <570. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19097733 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rosen P FA - Rosen, Peter IN - Rosen, Peter. Department of Emergency Medicine, Harvard University, Boston, Massachusetts, USA. TI - No opiates for headache. CM - Comment in: J Emerg Med. 2009 Apr;36(3):305-6; PMID: 19097739 CM - Comment in: J Emerg Med. 2010 Jan;38(1):62; author reply 62-3; PMID: 19744813 SO - Journal of Emergency Medicine. 36(3):302-4, 2009 Apr AS - J Emerg Med. 36(3):302-4, 2009 Apr NJ - The Journal of emergency medicine VO - 36 IP - 3 PG - 302-4 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Drug Prescriptions MH - Emergency Medical Services/mt [Methods] MH - *Ethics, Clinical MH - Headache/di [Diagnosis] MH - *Headache/dt [Drug Therapy] MH - Humans MH - *Narcotics/ae [Adverse Effects] MH - Physician-Patient Relations RN - 0 (Narcotics) IS - 0736-4679 IL - 0736-4679 DO - https://dx.doi.org/10.1016/j.jemermed.2008.07.025 PT - Journal Article ID - S0736-4679(08)00697-5 [pii] ID - 10.1016/j.jemermed.2008.07.025 [doi] PP - ppublish PH - 2008/07/10 [received] PH - 2008/07/30 [accepted] LG - English EP - 20081220 DP - 2009 Apr EZ - 2008/12/23 09:00 DA - 2009/08/18 09:00 DT - 2008/12/23 09:00 YR - 2009 ED - 20090817 RD - 20100204 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19097733 <571. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19426295 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - O'Connor AB AU - Zwemer FL AU - Hays DP AU - Feng C FA - O'Connor, Alec B FA - Zwemer, Frank L FA - Hays, Daniel P FA - Feng, Changyong IN - O'Connor, Alec B. Department of Internal Medicine , University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. alec_oconnor@urmc.rochester.edu TI - Outcomes after intravenous opioids in emergency patients: a prospective cohort analysis. SO - Academic Emergency Medicine. 16(6):477-87, 2009 Jun AS - Acad Emerg Med. 16(6):477-87, 2009 Jun NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 16 IP - 6 PG - 477-87 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Cohort Studies MH - *Emergency Service, Hospital MH - Female MH - Humans MH - *Hydromorphone/ad [Administration & Dosage] MH - Hydromorphone/ae [Adverse Effects] MH - Hydromorphone/tu [Therapeutic Use] MH - Infusions, Intravenous MH - Interviews as Topic MH - Logistic Models MH - Male MH - Middle Aged MH - *Morphine/ad [Administration & Dosage] MH - Morphine/ae [Adverse Effects] MH - Morphine/tu [Therapeutic Use] MH - Outcome Assessment (Health Care) MH - Pain Measurement MH - Patient Satisfaction/sn [Statistics & Numerical Data] MH - Prospective Studies AB - OBJECTIVES: Pain management continues to be suboptimal in emergency departments (EDs). Several studies have documented failures in the processes of care, such as whether opioid analgesics were given. The objectives of this study were to measure the outcomes following administration of intravenous (IV) opioids and to identify clinical factors that may predict poor analgesic outcomes in these patients. AB - METHODS: In this prospective cohort study, emergency patients were enrolled if they were prescribed IV morphine or hydromorphone (the most commonly used IV opioids in the study hospital) as their initial analgesic. Patients were surveyed at the time of opioid administration and 1 to 2 hours after the initial opioid dosage. They scored their pain using a verbal 0-10 pain scale. The following binary analgesic variables were primarily used to identify patients with poor analgesic outcomes: 1) a pain score reduction of less than 50%, 2) a postanalgesic pain score of 7 or greater (using the 0-10 numeric rating scale), and 3) the development of opioid-related side effects. Logistic regression analyses were used to study the effects of demographic, clinical, and treatment covariates on the outcome variables. AB - RESULTS: A total of 2,414 were approached for enrollment, of whom 1,312 were ineligible (658 were identified more than 2 hours after IV opioid was administered and 341 received another analgesic before or with the IV opioid) and 369 declined to consent. A total of 691 patients with a median baseline pain score of 9 were included in the final analyses. Following treatment, 57% of the cohort failed to achieve a 50% pain score reduction, 36% had a pain score of 7 or greater, 48% wanted additional analgesics, and 23% developed opioid-related side effects. In the logistic regression analyses, the factors associated with poor analgesia (both <50% pain score reduction and postanalgesic pain score of >or=7) were the use of long-acting opioids at home, administration of additional analgesics, provider concern for drug-seeking behavior, and older age. An initial pain score of 10 was also strongly associated with a postanalgesic pain score of >or=7. African American patients who were not taking opioids at home were less likely to achieve a 50% pain score reduction than other patients, despite receiving similar initial and total equianalgesic dosages. None of the variables we assessed were significantly associated with the development of opioid-related side effects. AB - CONCLUSIONS: Poor analgesic outcomes were common in this cohort of ED patients prescribed IV opioids. Patients taking long-acting opioids, those thought to be drug-seeking, older patients, those with an initial pain score of 10, and possibly African American patients are at especially high risk of poor analgesia following IV opioid administration. Copyright (c) 2009 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) RN - Q812464R06 (Hydromorphone) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/j.1553-2712.2009.00405.x PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - ACEM405 [pii] ID - 10.1111/j.1553-2712.2009.00405.x [doi] PP - ppublish LG - English EP - 20090507 DP - 2009 Jun EZ - 2009/05/12 09:00 DA - 2009/08/07 09:00 DT - 2009/05/12 09:00 YR - 2009 ED - 20090806 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19426295 <572. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19388914 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McGerald G AU - Dvorkin R AU - Levy D AU - Lovell-Rose S AU - Sharma A FA - McGerald, Genevieve FA - Dvorkin, Ronald FA - Levy, David FA - Lovell-Rose, Stephanie FA - Sharma, Adhi IN - McGerald, Genevieve. Department of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY, USA. genmcger2000@yahoo.com TI - Prescriptions for schedule II opioids and benzodiazepines increase after the introduction of computer-generated prescriptions. SO - Academic Emergency Medicine. 16(6):508-12, 2009 Jun AS - Acad Emerg Med. 16(6):508-12, 2009 Jun NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 16 IP - 6 PG - 508-12 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Analgesics, Opioid/cl [Classification] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Benzodiazepines/tu [Therapeutic Use] MH - Cohort Studies MH - Confidence Intervals MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Drug and Narcotic Control MH - *Electronic Prescribing/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Hydrocodone/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - New York MH - Oxycodone/tu [Therapeutic Use] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Retrospective Studies AB - BACKGROUND: Prescriptions for controlled substances decrease when regulatory barriers are put in place. The converse has not been studied. AB - OBJECTIVES: The objective was to determine whether a less complicated prescription writing process is associated with a change in the prescribing patterns of controlled substances in the emergency department (ED). AB - METHODS: The authors conducted a retrospective nonconcurrent cohort study of all patients seen in an adult ED between April 19, 2005, and April 18, 2007, who were discharged with a prescription. Prior to April 19, 2006, a specialized prescription form stored in a locked cabinet was obtained from the nursing staff to write a prescription for benzodiazepines or Schedule II opioids. After April 19, 2006, New York State mandated that all prescriptions, regardless of schedule classification, be generated on a specialized bar-coded prescription form. The main outcome of the study was to compare the proportion of Schedule III-V opioids to Schedule II opioids and benzodiazepines prescribed in the ED before and after the introduction of a less cumbersome prescription writing process. AB - RESULTS: Of the 26,638 charts reviewed, 2.1% of the total number of prescriptions generated were for a Schedule II controlled opioid before the new system was implemented compared to 13.6% after (odds ratio [OR] = 7.3, 95% confidence interval [CI] = 6.4 to 8.4). The corresponding percentages for Schedule III-V opioids were 29.9% to 18.1% (OR = 0.52, 95% CI = 0.49 to 0.55) and for benzodiazepines 1.4% to 3.9% (OR = 2.8, 95% CI = 2.4 to 3.4). AB - CONCLUSIONS: Patients were more likely to receive a prescription for a Schedule II opioid or a benzodiazepine after a more streamlined computer-generated prescription writing process was introduced in this ED. Copyright (c) 2009 by the Society for Academic Emergency Medicine. RN - 0 (Analgesics, Opioid) RN - 12794-10-4 (Benzodiazepines) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - CD35PMG570 (Oxycodone) ES - 1553-2712 IL - 1069-6563 DO - https://dx.doi.org/10.1111/j.1553-2712.2009.00398.x PT - Journal Article ID - ACEM398 [pii] ID - 10.1111/j.1553-2712.2009.00398.x [doi] PP - ppublish LG - English EP - 20090421 DP - 2009 Jun EZ - 2009/04/25 09:00 DA - 2009/08/07 09:00 DT - 2009/04/25 09:00 YR - 2009 ED - 20090806 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19388914 <573. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19453578 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sharwood LN AU - Babl FE FA - Sharwood, Lisa N FA - Babl, Franz E IN - Sharwood, Lisa N. Emergency Department, Royal Children's Hospital, Murdoch Children's Research Institute, Parkville, Vic. 3055, Australia. lisa.sharwoodl@gmail.com TI - The efficacy and effect of opioid analgesia in undifferentiated abdominal pain in children: a review of four studies. [Review] [20 refs] SO - Paediatric Anaesthesia. 19(5):445-51, 2009 May AS - Paediatr Anaesth. 19(5):445-51, 2009 May NJ - Paediatric anaesthesia VO - 19 IP - 5 PG - 445-51 PI - Journal available in: Print PI - Citation processed from: Internet JC - cg8, 9206575 IO - Paediatr Anaesth SB - Index Medicus CP - France MH - Abdomen, Acute/di [Diagnosis] MH - Abdomen, Acute/dt [Drug Therapy] MH - Abdominal Pain/di [Diagnosis] MH - *Abdominal Pain/dt [Drug Therapy] MH - Adolescent MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Appendicitis/di [Diagnosis] MH - Child MH - Child, Preschool MH - Emergency Medical Services/mt [Methods] MH - Humans MH - Randomized Controlled Trials as Topic MH - Treatment Outcome AB - INTRODUCTION: The question of whether opioid analgesia should be given in patients with undifferentiated acute abdominal pain has been characterized by concerns about its efficacy and that signs used to determine accurate diagnosis may be masked by the drug. The objective of this review is to critically analyze pertinent pediatric randomized controlled studies considering this issue. AB - METHODS: A comprehensive literature search was conducted via Medline in October 2007, using the terms 'abdominal pain', 'physical examination', 'analgesics', 'opioid' and 'appendicitis'. Other articles were identified using the bibliographies of papers found through Medline; alternate databases were searched but did not reveal additional studies. AB - RESULTS: A total of four trials were identified, and their validity and applicability were reviewed. In all studies, randomization to the analgesia group was associated with significant reduction in pain; one study showing no greater effect with opioid than placebo. All studies used a 10 cm Visual Analogue Scale to assess pain. All studies were only sufficiently powered to consider the primary outcome of opioid efficacy in abdominal pain vs placebo rather than diagnostic accuracy, although they all reported on diagnostic accuracy. Meta-analysis of results for efficacy and accuracy was not possible due to the heterogeneity of study populations. AB - CONCLUSIONS: A large, probably multi-centred trial is needed to answer with sufficient power the question of whether opioid analgesia impairs diagnostic accuracy in children with undifferentiated acute abdominal pain. [References: 20] RN - 0 (Analgesics, Opioid) ES - 1460-9592 IL - 1155-5645 DO - https://dx.doi.org/10.1111/j.1460-9592.2008.02807.x PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review ID - PAN2807 [pii] ID - 10.1111/j.1460-9592.2008.02807.x [doi] PP - ppublish LG - English DP - 2009 May EZ - 2009/05/21 09:00 DA - 2009/07/28 09:00 DT - 2009/05/21 09:00 YR - 2009 ED - 20090727 RD - 20090520 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19453578 <574. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19340681 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Siavash M AU - Janghorbani M AU - Gheshlaghi F AU - Adeli SH AU - Saljoughi M AU - Moradi F AU - Majidinezhad M FA - Siavash, Mansour FA - Janghorbani, Mohsen FA - Gheshlaghi, Farzad FA - Adeli, Seyed Hasan FA - Saljoughi, Mohsen FA - Moradi, Farhad FA - Majidinezhad, Maede IN - Siavash, Mansour. Isfahan Endocrine & Metabolism Research Center, Isfahan, Iran. TI - A case series of abuse of a new opioid combination, Norjizak. SO - Journal of Addictive Diseases. 28(2):180-5, 2009 AS - J Addict Dis. 28(2):180-5, 2009 NJ - Journal of addictive diseases VO - 28 IP - 2 PG - 180-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - a0y, 9107051 IO - J Addict Dis SB - Index Medicus CP - England MH - Adult MH - *Benzodiazepines/ae [Adverse Effects] MH - Chromatography, High Pressure Liquid MH - Comorbidity MH - *Cushing Syndrome/ci [Chemically Induced] MH - *Dexamethasone/ae [Adverse Effects] MH - Drug Combinations MH - Female MH - *Glucocorticoids/ae [Adverse Effects] MH - Glucocorticoids/an [Analysis] MH - Humans MH - Interviews as Topic MH - Iran MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/co [Complications] MH - *Opium/ae [Adverse Effects] MH - Substance Abuse, Intravenous/co [Complications] MH - Young Adult AB - Cushing's syndrome results from lengthy and inappropriate exposure to excessive concentrations of either endogenous or exogenous glucocorticoids. This study described 30 patients with a novel type of severe exogenous Cushing's syndrome in a group of intravenous drug users due to illicit use and dependence on a new opioid combination, Norjizak. Thirty consecutive patients (2 women and 28 men) who presented with a novel type of severe exogenous Cushing's syndrome and other complications were admitted to the emergency departments of Qom and Isfahan University of Medical Sciences, Isfahan, Iran, between September 2005 and September 2007 were enrolled. All participating patients were intravenous drug users who used a narcotic drug called Norjizak, a combination of different opioids with dexamethason or benzodiazepines. Patients were first evaluated and managed based on the current illness, and then entered into a detoxification program by a medical team. Clinical data were collected by an open interview and the patient's files using a standard form. High-performance liquid chromatography was used to determined glucocorticoid existence in the brand. The major complaints and clinical findings were withdrawal symptoms, severe edema, osteoporotic fracture, impairment in glucose tolerance, decreased libido, and sepsis (including necrotizing pneumonia, cutaneous infection, multivalvular endocarditis, osteomyelitis, and urogenital infection). Most patients had started with 2 or 3 vials per day and then increased the dose compulsively to maximum of approximately 15 to 20 vials per day. The concentration of Dexamethhasone disodium phosphate in each 2 mL vial was 0.4 to 1 mg/mL. Heroin was also found in them. We are witnessing a special exogenous Cushing syndrome due to the mixing of opiates and dexamethasone. Norjizak syndrome is the clinical condition of poisoning with a second material when it is combined with opiates due to compulsive dose increment and long duration. RN - 0 (Drug Combinations) RN - 0 (Glucocorticoids) RN - 12794-10-4 (Benzodiazepines) RN - 7S5I7G3JQL (Dexamethasone) RN - 8008-60-4 (Opium) ES - 1545-0848 IL - 1055-0887 DO - https://dx.doi.org/10.1080/10550880902772928 PT - Journal Article ID - 910142574 [pii] ID - 10.1080/10550880902772928 [doi] PP - ppublish LG - English DP - 2009 EZ - 2009/04/03 09:00 DA - 2009/07/25 09:00 DT - 2009/04/03 09:00 YR - 2009 ED - 20090723 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19340681 <575. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19340675 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Spiller H AU - Lorenz DJ AU - Bailey EJ AU - Dart RC FA - Spiller, Henry FA - Lorenz, Douglas J FA - Bailey, Elise J FA - Dart, Richard C IN - Spiller, Henry. Kentucky Regional Poison Center, Louisville, KY 40232-5070, USA. henry.spiller@nortonhealthcare.org TI - Epidemiological trends in abuse and misuse of prescription opioids. SO - Journal of Addictive Diseases. 28(2):130-6, 2009 AS - J Addict Dis. 28(2):130-6, 2009 NJ - Journal of addictive diseases VO - 28 IP - 2 PG - 130-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - a0y, 9107051 IO - J Addict Dis SB - Index Medicus CP - England MH - Censuses MH - Drug Utilization MH - Humans MH - Methadone/tu [Therapeutic Use] MH - Narcotics/tu [Therapeutic Use] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Poison Control Centers MH - *Prescription Drugs/tu [Therapeutic Use] MH - Socioeconomic Factors MH - United States/ep [Epidemiology] AB - The authors evaluated trends between social, geographic, and demographic factors and cases of select scheduled drugs (buprenorphine, fentanyl, hydrocodone, hydromorphone, morphine, methadone, and oxycodone) using the Researched Abuse, Diversion and Addiction-Related Surveillance System poison center data and census data. Spontaneous calls from the public and healthcare professionals are recorded by poison centers using a standardized, electronic data collection system. We compared the annual incidence of total prescription opioid drug cases to annual data from the U.S. Department of Labor and U.S. Census Bureau by year and by state for unemployment rate, poverty rate, population density, high school graduation rate, and bachelor's degree proportion using the best least square fit in an evaluation for trends for 2003 to 2006. Two strong positive trends were found between poverty rate, unemployment rate, and prescription opioid drug rates, with prescription opioid drug rates increasing as poverty rate and unemployment rate increased. This trend was consistent over the 4 years of study and strongly influenced by the hydrocodone and methadone rates, with less influence from oxycodone rates. The high school graduation rate trend was consistent over the 4 years and was strongly influenced by the hydrocodone and methadone rate. No consistent trend was identified with population density and prescription opioid drug rates. Understanding trends may help guide distribution of scarce resources and prevention efforts to where they may have their greatest impact. RN - 0 (Narcotics) RN - 0 (Prescription Drugs) RN - UC6VBE7V1Z (Methadone) ES - 1545-0848 IL - 1055-0887 DO - https://dx.doi.org/10.1080/10550880902772431 PT - Journal Article ID - 910142660 [pii] ID - 10.1080/10550880902772431 [doi] PP - ppublish LG - English DP - 2009 EZ - 2009/04/03 09:00 DA - 2009/07/25 09:00 DT - 2009/04/03 09:00 YR - 2009 ED - 20090723 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19340675 <576. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19340674 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wakeman SE AU - Bowman SE AU - McKenzie M AU - Jeronimo A AU - Rich JD FA - Wakeman, Sarah E FA - Bowman, Sarah E FA - McKenzie, Michelle FA - Jeronimo, Alexandra FA - Rich, Josiah D IN - Wakeman, Sarah E. Warren Alpert Medical School of Brown University, Providence, RI, USA. TI - Preventing death among the recently incarcerated: an argument for naloxone prescription before release. SO - Journal of Addictive Diseases. 28(2):124-9, 2009 AS - J Addict Dis. 28(2):124-9, 2009 NJ - Journal of addictive diseases VO - 28 IP - 2 PG - 124-9 PI - Journal available in: Print PI - Citation processed from: Internet JC - a0y, 9107051 IO - J Addict Dis PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851239 OI - Source: NLM. NIHMS110775 SB - Index Medicus CP - England MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Cocaine/po [Poisoning] MH - Drug Overdose/ep [Epidemiology] MH - *Drug Overdose/pc [Prevention & Control] MH - Emergency Medical Services/mt [Methods] MH - Female MH - Humans MH - Male MH - Methadone/tu [Therapeutic Use] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/px [Psychology] MH - Patient Education as Topic MH - *Prisoners/px [Psychology] MH - Rhode Island/ep [Epidemiology] MH - Surveys and Questionnaires AB - Death from opiate overdose is a tremendous source of mortality, with a heightened risk in the weeks following incarceration. The goal of this study is to assess overdose experience and response among long-term opiate users involved in the criminal justice system. One hundred thirty-seven subjects from a project linking opiate-dependent individuals being released from prison with methadone maintenance programs were asked 73 questions regarding overdose. Most had experienced and witnessed multiple overdoses; 911 was often not called. The majority of personal overdoses occurred within 1 month of having been institutionalized. Nearly all participants expressed an interest in being trained in overdose prevention with Naloxone. The risk of death from overdose is greatly increased in the weeks following release from prison. A pre-release program of overdose prevention education, including Naloxone prescription, for inmates with a history of opiate addiction would likely prevent many overdose deaths. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - I5Y540LHVR (Cocaine) RN - UC6VBE7V1Z (Methadone) ES - 1545-0848 IL - 1055-0887 DO - https://dx.doi.org/10.1080/10550880902772423 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. ID - 910145894 [pii] ID - 10.1080/10550880902772423 [doi] ID - PMC2851239 [pmc] ID - NIHMS110775 [mid] PP - ppublish GI - No: 6H79TI14562 Organization: (TI) *CSAT SAMHSA HHS* Country: United States GI - No: R01 DA018641 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01 DA018641-01A1 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: P30-AI-42853 Organization: (AI) *NIAID NIH HHS* Country: United States GI - No: P30 AI042853 Organization: (AI) *NIAID NIH HHS* Country: United States GI - No: 1 R01 DA 018641-01 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2009 EZ - 2009/04/03 09:00 DA - 2009/07/25 09:00 DT - 2009/04/03 09:00 YR - 2009 ED - 20090723 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19340674 <577. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18929432 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Vadera R AU - Sherbino J FA - Vadera, Rajiv FA - Sherbino, Jonathan IN - Vadera, Rajiv. Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada. TI - Evidence-based emergency medicine/rational clinical examination abstract. Do opioids affect the clinical evaluation of patients with acute abdominal pain?. CM - Comment on: JAMA. 2006 Oct 11;296(14):1764-74; PMID: 17032990 SO - Annals of Emergency Medicine. 54(1):126-7, 2009 Jul AS - Ann Emerg Med. 54(1):126-7, 2009 Jul NJ - Annals of emergency medicine VO - 54 IP - 1 PG - 126-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med CP - United States ES - 1097-6760 IL - 0196-0644 DO - https://dx.doi.org/10.1016/j.annemergmed.2008.08.028 PT - Comment PT - Journal Article ID - S0196-0644(08)01715-0 [pii] ID - 10.1016/j.annemergmed.2008.08.028 [doi] PP - ppublish PH - 2008/08/19 [received] PH - 2008/08/22 [revised] PH - 2008/08/22 [accepted] LG - English EP - 20081016 DP - 2009 Jul EZ - 2008/10/22 09:00 DA - 2008/10/22 09:01 DT - 2008/10/22 09:00 YR - 2009 ED - 20090716 RD - 20090622 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=18929432 <578. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19369840 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fasano CJ AU - O'Malley GF AU - Lares C AU - Rowden AK FA - Fasano, Charles J FA - O'Malley, Gerald F FA - Lares, Claudia FA - Rowden, Adam K IN - Fasano, Charles J. Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA. pasanoc@einstein.edu TI - Pediatric ziprasidone overdose. SO - Pediatric Emergency Care. 25(4):258-9, 2009 Apr AS - Pediatr Emerg Care. 25(4):258-9, 2009 Apr NJ - Pediatric emergency care VO - 25 IP - 4 PG - 258-9 PI - Journal available in: Print PI - Citation processed from: Internet JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Adrenergic alpha-1 Receptor Antagonists MH - Antidotes/tu [Therapeutic Use] MH - Antipsychotic Agents/ad [Administration & Dosage] MH - Antipsychotic Agents/pk [Pharmacokinetics] MH - *Antipsychotic Agents/po [Poisoning] MH - Charcoal/tu [Therapeutic Use] MH - Child, Preschool MH - *Coma/ci [Chemically Induced] MH - Drug Resistance MH - Emergencies MH - Female MH - Humans MH - Hypotension, Orthostatic/ci [Chemically Induced] MH - Intubation, Intratracheal MH - Miosis/ci [Chemically Induced] MH - Miosis/pp [Physiopathology] MH - Naloxone/tu [Therapeutic Use] MH - Piperazines/ad [Administration & Dosage] MH - Piperazines/pk [Pharmacokinetics] MH - *Piperazines/po [Poisoning] MH - Tachycardia/ci [Chemically Induced] MH - Thiazoles/ad [Administration & Dosage] MH - Thiazoles/pk [Pharmacokinetics] MH - *Thiazoles/po [Poisoning] AB - We describe the first ziprasidone overdose with quantitative serum levels of a pediatric patient in coma and with pinpoint pupils. This case is an important contribution to the pediatric ziprasidone literature because it illustrates that ingestion of just 1 pill may result to profound mental status and respiratory depression in a child. H.C., a 30-month-old girl, presented to the emergency department approximately 30 minutes after an accidental ingestion of an adult family member's medication. The child was found on the floor surrounded by numerous pills and was witnessed to have ingested at least 1 tablet by a caregiver. After finding the child with the pills, the family observed the child for a brief period but transported her to the hospital after she became lethargic and unresponsive. The child received 2 doses of 0.4 mg of intravenous naloxone without change in her neurologic status. The child then underwent a rapid sequence intubation for airway protection and subsequently received gastrointestinal decontamination with 15 g of activated charcoal via the orogastric tube. Ziprasidone is an atypical antipsychotic drug that was approved by the Food and Drug Administration in February 2001 for the general treatment of schizophrenia in adults. Previously reported pediatric ziprasidone overdoses describe a syndrome of sedation, tachycardia, hypotonia, and coma consistent with that of the patient described in this paper. In pediatric ziprasidone overdose, QTc prolongation and hypotension have also been illustrated, but seizures have not been reported. An interesting aspect of this case is the development of pinpoint pupils unresponsive to naloxone. This phenomenon has been reported before with overdose of olanzapine, a similar atypical antipsychotic. The mechanism of miosis associated with overdose of atypical antipsychotics is unclear but is likely related to interference with central innervation of the pupil. Pupil size is maintained by a balance between sympathetic and parasympathetic neurohumeral tones. We propose that an overdose of an alpha-1 receptor blocking agent, such as ziprasidone, results in unopposed parasympathetic stimulation resulting in miosis. RN - 0 (Adrenergic alpha-1 Receptor Antagonists) RN - 0 (Antidotes) RN - 0 (Antipsychotic Agents) RN - 0 (Piperazines) RN - 0 (Thiazoles) RN - 16291-96-6 (Charcoal) RN - 36B82AMQ7N (Naloxone) RN - 6UKA5VEJ6X (ziprasidone) ES - 1535-1815 IL - 0749-5161 DO - https://dx.doi.org/10.1097/PEC.0b013e31819e3775 PT - Case Reports PT - Journal Article ID - 10.1097/PEC.0b013e31819e3775 [doi] ID - 00006565-200904000-00010 [pii] PP - ppublish LG - English DP - 2009 Apr EZ - 2009/04/17 09:00 DA - 2009/07/16 09:00 DT - 2009/04/17 09:00 YR - 2009 ED - 20090715 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19369840 <579. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19507808 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wiese CH AU - Barrels UE AU - Graf BM AU - Hanekop GG FA - Wiese, Christoph H R FA - Barrels, Utz E FA - Graf, Bernhard M FA - Hanekop, Gerd G IN - Wiese, Christoph H R. Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre, Goettingen, Germany. TI - Out-of-hospital opioid therapy of palliative care patients with "acute dyspnoea": a retrospective multicenter investigation. SO - Journal of Opioid Management. 5(2):115-22, 2009 Mar-Apr AS - J Opioid Manag. 5(2):115-22, 2009 Mar-Apr NJ - Journal of opioid management VO - 5 IP - 2 PG - 115-22 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Acute Disease MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Attitude of Health Personnel MH - Bronchodilator Agents/tu [Therapeutic Use] MH - Dyspnea/di [Diagnosis] MH - *Dyspnea/dt [Drug Therapy] MH - Dyspnea/et [Etiology] MH - *Emergency Medical Services MH - Female MH - Germany MH - Health Knowledge, Attitudes, Practice MH - Hospitalization MH - Humans MH - Male MH - Middle Aged MH - *Morphine/tu [Therapeutic Use] MH - Neoplasms/co [Complications] MH - *Neoplasms/th [Therapy] MH - Oxygen Inhalation Therapy MH - *Palliative Care MH - Retrospective Studies MH - Treatment Outcome AB - BACKGROUND: Prehospital emergency physicians (EP) are often confronted with the acute care of palliative care patients. Dyspnoea is a frequent acute symptom and its causes often differ from the generally known emergency medical causes. Till now, there have been no relevant concepts for emergency care of palliative care patients for their specific symptoms. AB - METHODS: Over a 24-month period, the authors retrospectively investigated all out-of-hospital emergency medical services for palliative care patients with acute dyspnoea at four emergency physician support points. The evaluation of these services was followed retrospectively on the basis of the therapy carried out by the EP (Group 1: therapy with morphine and oxygen; Group 2: therapy with morphine, bronchodilator effective drugs and oxygen; Group 3: therapy with bronchodilator effective drugs and oxygen; Group 4: therapy with oxygen; Group 5: no medical treatment). Moreover, EPs were interviewed about their actions and their uncertainties in the treatment of palliative care patients. AB - RESULTS: The diagnosis of acute dyspnoea in palliative care patients occurred 121 times (116 patients were integrated in the present investigation) within the defined period. In total, 116 patients were included (Group 1: 21, Group 2: 29, Group 3: 31, Group 4: 28, and Group 5: 7). Dyspnoea was satisfactorily treated in 41 percent of the patients (Group 1: 67 percent, Group 2: 52 percent, Group 3: 22 percent, Group 4: 18 percent, and Group 5: 71 percent). Most EPs (70 percent) revealed uncertainties in emergency medical therapy for patients at the end of life. AB - CONCLUSIONS: The current investigation showed a significant relief of acute dyspnoea when using opioids, in contrast with the established out-of-hospital emergency medical therapy for acute dyspnoea. Therefore, opioids should be recommended for emergency medical therapy of dyspnoea in palliative care patients. Clinical studies that recommend the use of effective opioids for the treatment of dyspnoea in palliative care patients are supported by the current retrospective study. Most EPs felt uncertain in the treatment of palliative care patients. Therefore, advanced training in palliative care medicine and end-of-life care should be integrated into emergency medical training. RN - 0 (Analgesics, Opioid) RN - 0 (Bronchodilator Agents) RN - 76I7G6D29C (Morphine) IS - 1551-7489 IL - 1551-7489 PT - Comparative Study PT - Journal Article PT - Multicenter Study PP - ppublish LG - English DP - 2009 Mar-Apr EZ - 2009/06/11 09:00 DA - 2009/07/03 09:00 DT - 2009/06/11 09:00 YR - 2009 ED - 20090702 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19507808 <580. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19507803 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chang AK AU - Bijur PE AU - Napolitano A AU - Lupow J AU - Gallagher EJ FA - Chang, Andrew K FA - Bijur, Polly E FA - Napolitano, Antonio FA - Lupow, Jason FA - Gallagher, E John IN - Chang, Andrew K. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA. TI - Two milligrams i.v. hydromorphone is efficacious for treating pain but is associated with oxygen desaturation. SO - Journal of Opioid Management. 5(2):75-80, 2009 Mar-Apr AS - J Opioid Manag. 5(2):75-80, 2009 Mar-Apr NJ - Journal of opioid management VO - 5 IP - 2 PG - 75-80 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Acute Disease MH - Adult MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Antiemetics/tu [Therapeutic Use] MH - Emergency Service, Hospital MH - Female MH - Humans MH - *Hydromorphone/ad [Administration & Dosage] MH - Hydromorphone/ae [Adverse Effects] MH - Infusions, Intravenous MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - New York City MH - *Oxygen/bl [Blood] MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Pilot Projects MH - Prospective Studies MH - Severity of Illness Index MH - Treatment Outcome AB - OBJECTIVE: To evaluate the safety and efficacy of a single dose of 2 mg i.v. hydromorphone administered to emergency department patients in acute severe pain. AB - DESIGN: Prospective interventional. AB - SETTING: Urban academic emergency department. PATIENT, PARTICIPANTS: Nonelderly adults (21- 64-years-old) with acute severe pain and baseline oxygen saturation (SO2) > or = 95 percent. AB - INTERVENTIONS: Two milligrams i.v. hydromorphone administered over 2-3 minutes. AB - MAIN OUTCOME MEASURES: The primary outcome was use of naloxone as a reversal agent. Secondary outcomes included degree of pain relief as measured on a numerical rating scale, frequency of oxygen desaturation (SO2 < 95 percent), and side effects. AB - RESULTS: Of the 269 patients, none received i.v. naloxone. Median pain scores fell from 10 (worst pain possible) at baseline to 1 within 5 minutes and to 0 (no pain) at 30 minutes. SO2 was > or = 95 percent at all time points in 68 percent of patients (95 percent CI 62-73 percent), while 26 percent (95 percent CI 21-32 percent) had one or more SO2 levels between 90-94 percent, and 6 percent (95 percent CI 4-10 percent) had SO2 values below 90 percent at one or more time points. The lowest SO2 was 82 percent. The incidence of nausea and vomiting were 16 percent and 7 percent, respectively. AB - CONCLUSIONS: Two milligrams i.v. hydromorphone provides efficacious and rapid pain relief in nonelderly adults presenting to the ED with acute severe pain. However, oxygen desaturation below 95 percent occurred in about one third of patients. Although no noticeable clinical signs of hypoxemia occurred, a conservative interpretation of this finding suggests that 2 mg i.v. hydromorphone is too much opioid to be given routinely to patients in pain as a single initial dose. RN - 0 (Analgesics, Opioid) RN - 0 (Antiemetics) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - Q812464R06 (Hydromorphone) RN - S88TT14065 (Oxygen) IS - 1551-7489 IL - 1551-7489 PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2009 Mar-Apr EZ - 2009/06/11 09:00 DA - 2009/07/03 09:00 DT - 2009/06/11 09:00 YR - 2009 ED - 20090702 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19507803 <581. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19270623 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Singh SM AU - Sharma B FA - Singh, Shubh M FA - Sharma, Balkishan IN - Singh, Shubh M. Department of Psychiatry, Gian Sagar Medical College and Hospital, Banur, Punjab, India. shubhmohan@gmail.com TI - Unintentional rapid opioid detoxification: case report. [Review] [9 refs] SO - Psychiatria Danubina. 21(1):65-7, 2009 Mar AS - PSYCHIATR. DANUB.. 21(1):65-7, 2009 Mar NJ - Psychiatria Danubina VO - 21 IP - 1 PG - 65-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 9424753 IO - Psychiatr Danub SB - Index Medicus CP - Croatia MH - Adult MH - Consciousness Disorders/ci [Chemically Induced] MH - Consciousness Disorders/di [Diagnosis] MH - Consciousness Disorders/th [Therapy] MH - Critical Care MH - Diazepam/ad [Administration & Dosage] MH - Drug Interactions MH - Emergency Service, Hospital MH - Epilepsy, Generalized/ci [Chemically Induced] MH - Epilepsy, Generalized/th [Therapy] MH - Humans MH - Infusions, Intravenous MH - Male MH - *Naltrexone/ae [Adverse Effects] MH - Naltrexone/tu [Therapeutic Use] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/ae [Adverse Effects] MH - Neurologic Examination/de [Drug Effects] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Private Practice MH - *Street Drugs/ae [Adverse Effects] MH - Substance Abuse Detection MH - Substance Withdrawal Syndrome/di [Diagnosis] MH - *Substance Withdrawal Syndrome/et [Etiology] MH - Substance Withdrawal Syndrome/th [Therapy] AB - BACKGROUND: Naltrexone is a competitive opioid antagonist and is often used to maintain abstinence in detoxified opioid dependent patients. However, it can precipitate an accelerated withdrawal when ingested by an individual with concurrent opioid use. AB - METHODS: We report the case of a 28 year old male with opioid dependence syndrome presenting with chaotic symptoms following ingestion of naltrexone. Symptomatology, management is described and literature in this area is reviewed. AB - RESULTS: Accidental or surreptitious ingestion of naltrexone in a patient with concurrent opioid use can precipitate symptoms typical of opioid withdrawal in addition to other varying symptomatology. Most cases would require sedation and management of concurrent vomiting and diarrhoea. AB - CONCLUSIONS: Clinicians, especially those providing substance abuse and emergency care, need to be aware of the possibility of an accelerated and possibly life threatening withdrawal associated with naltrexone ingestion in an incompletely detoxified patient with opioid dependence. [References: 9] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 0 (Street Drugs) RN - 5S6W795CQM (Naltrexone) RN - Q3JTX2Q7TU (Diazepam) IS - 0353-5053 IL - 0353-5053 PT - Case Reports PT - Journal Article PT - Review PP - ppublish LG - English DP - 2009 Mar EZ - 2009/03/10 09:00 DA - 2009/05/19 09:00 DT - 2009/03/10 09:00 YR - 2009 ED - 20090518 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19270623 <582. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19363214 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Doe-Simkins M AU - Walley AY AU - Epstein A AU - Moyer P FA - Doe-Simkins, Maya FA - Walley, Alexander Y FA - Epstein, Andy FA - Moyer, Peter IN - Doe-Simkins, Maya. Boston Public Health Commission AHOPE Needle Exchange program, Boston, MA, USA. TI - Saved by the nose: bystander-administered intranasal naloxone hydrochloride for opioid overdose. SO - American Journal of Public Health. 99(5):788-91, 2009 May AS - Am J Public Health. 99(5):788-91, 2009 May NJ - American journal of public health VO - 99 IP - 5 PG - 788-91 PI - Journal available in: Print PI - Citation processed from: Internet JC - 1254074, 3xw IO - Am J Public Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667836 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Administration, Intranasal MH - Adult MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services MH - Female MH - Humans MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Needle-Exchange Programs MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Program Evaluation MH - Risk Factors AB - Administering naloxone hydrochloride (naloxone) during an opioid overdose reverses the overdose and can prevent death. Although typically delivered via intramuscular or intravenous injection, naloxone may be delivered via intranasal spray device. In August 2006, the Boston Public Health Commission passed a public health regulation that authorized an opioid overdose prevention program that included intranasal naloxone education and distribution of the spray to potential bystanders. Participants were taught by trained nonmedical needle exchange staff. After 15 months, the program provided training and intranasal naloxone to 385 participants who reported 74 successful overdose reversals. Problems with intranasal naloxone were uncommon. Overdose prevention education with distribution of intranasal naloxone is a feasible public health intervention to address opioid overdose. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1541-0048 IL - 0090-0036 DO - https://dx.doi.org/10.2105/AJPH.2008.146647 PT - Journal Article ID - 99/5/788 [pii] ID - 10.2105/AJPH.2008.146647 [doi] ID - PMC2667836 [pmc] PP - ppublish LG - English DP - 2009 May EZ - 2009/04/14 09:00 DA - 2009/05/07 09:00 DT - 2009/04/14 09:00 YR - 2009 ED - 20090506 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19363214 <583. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18926349 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mendoza-Davila N AU - Varon J FA - Mendoza-Davila, Natalia FA - Varon, Joseph TI - Naloxone in advanced cardiac life support: myth or reality?. CM - Comment on: Am J Emerg Med. 2008 Oct;26(8):898-901; PMID: 18926348 SO - American Journal of Emergency Medicine. 26(8):902-3, 2008 Oct AS - Am J Emerg Med. 26(8):902-3, 2008 Oct NJ - The American journal of emergency medicine VO - 26 IP - 8 PG - 902-3 PI - Journal available in: Print PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adrenergic Agonists/tu [Therapeutic Use] MH - *Advanced Cardiac Life Support MH - Animals MH - Clinical Trials as Topic MH - Drug Therapy, Combination MH - Epinephrine/tu [Therapeutic Use] MH - *Heart Arrest/dt [Drug Therapy] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Shock/dt [Drug Therapy] RN - 0 (Adrenergic Agonists) RN - 36B82AMQ7N (Naloxone) RN - YKH834O4BH (Epinephrine) ES - 1532-8171 IL - 0735-6757 DO - https://dx.doi.org/10.1016/j.ajem.2008.05.016 PT - Comment PT - Editorial ID - S0735-6757(08)00426-9 [pii] ID - 10.1016/j.ajem.2008.05.016 [doi] PP - ppublish PH - 2008/04/17 [received] PH - 2008/05/23 [revised] PH - 2008/05/26 [accepted] LG - English DP - 2008 Oct EZ - 2008/10/18 09:00 DA - 2009/04/17 09:00 DT - 2008/10/18 09:00 YR - 2008 ED - 20090416 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18926349 <584. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18926348 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wang Y AU - Gao L AU - Meng L FA - Wang, Yong FA - Gao, Linlin FA - Meng, Lingxin IN - Wang, Yong. Department of Anesthesia, Shengjing Hospital, China Medical University, Shenyang 110004, China. wangy54321@hotmail.com TI - Small-dose naloxone combined with epinephrine improves the resuscitation of cardiopulmonary arrest. CM - Comment in: Am J Emerg Med. 2008 Oct;26(8):902-3; PMID: 18926349 SO - American Journal of Emergency Medicine. 26(8):898-901, 2008 Oct AS - Am J Emerg Med. 26(8):898-901, 2008 Oct NJ - The American journal of emergency medicine VO - 26 IP - 8 PG - 898-901 PI - Journal available in: Print PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Animals MH - *Cardiopulmonary Resuscitation/mt [Methods] MH - *Epinephrine/ad [Administration & Dosage] MH - Epinephrine/pd [Pharmacology] MH - *Heart Arrest/th [Therapy] MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/pd [Pharmacology] MH - Random Allocation MH - Rats MH - Rats, Sprague-Dawley AB - OBJECTIVES: To investigate if naloxone combined with epinephrine can increase the resuscitation rate in cardiac arrest rat models induced by asphyxia. AB - METHODS: Twenty-four rats were allocated into SA group (treated with 1 mL of saline, n = 8), EP group (treated with epinephrine 5 microg/100g, n = 8), and NA group (treated with epinephrine 5 microg/100g in combination with naloxone100 microg/100g, n = 8). Eight minutes after asphyxia, cardiopulmonary resuscitation was initiated, and different drugs were used in different groups at the same time. AB - RESULTS: Rates of restoration of spontaneous circulation (ROSC) were 25%, 75%, and 87.5% in SA, EP, and NA groups, respectively. The rate of ROSC in the NA group was significantly higher than that in the other 2 experimental groups (P < .05). The average resuscitation time in the NA group was much lower than that in the other 2 cohorts. AB - CONCLUSION: The administration of epinephrine alone may increase early resuscitation rate in a cardiac arrest model compared with placebo group. Moreover, the combination of naloxone and epinephrine may significantly increase resuscitation rate. The duration of ROSC in combination group is much shorter than that in the other 2 groups. RN - 36B82AMQ7N (Naloxone) RN - YKH834O4BH (Epinephrine) ES - 1532-8171 IL - 0735-6757 DO - https://dx.doi.org/10.1016/j.ajem.2008.04.017 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0735-6757(08)00327-6 [pii] ID - 10.1016/j.ajem.2008.04.017 [doi] PP - ppublish PH - 2008/01/23 [received] PH - 2008/04/14 [revised] PH - 2008/04/14 [accepted] LG - English DP - 2008 Oct EZ - 2008/10/18 09:00 DA - 2009/04/17 09:00 DT - 2008/10/18 09:00 YR - 2008 ED - 20090416 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18926348 <585. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18774283 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Green TC AU - Grau LE AU - Blinnikova KN AU - Torban M AU - Krupitsky E AU - Ilyuk R AU - Kozlov A AU - Heimer R FA - Green, Traci C FA - Grau, Lauretta E FA - Blinnikova, Ksenia N FA - Torban, Mikhail FA - Krupitsky, Evgeny FA - Ilyuk, Ruslan FA - Kozlov, Andrei FA - Heimer, Robert IN - Green, Traci C. Department of Epidemiology and Public Health, Yale School of Medicine, PO Box 208034, 60 College Street, New Haven, CT 06520-8034, USA. traci.c.green@yale.edu TI - Social and structural aspects of the overdose risk environment in St. Petersburg, Russia. SO - International Journal of Drug Policy. 20(3):270-6, 2009 May AS - Int J Drug Policy. 20(3):270-6, 2009 May NJ - The International journal on drug policy VO - 20 IP - 3 PG - 270-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9014759 IO - Int. J. Drug Policy PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696401 OI - Source: NLM. NIHMS98920 SB - Index Medicus CP - Netherlands MH - Adult MH - Attitude to Health MH - Cardiopulmonary Resuscitation/ed [Education] MH - Cardiopulmonary Resuscitation/st [Standards] MH - Data Collection MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/pc [Prevention & Control] MH - *Emergency Medical Services/st [Standards] MH - Female MH - Harm Reduction MH - Humans MH - Male MH - Naloxone/sd [Supply & Distribution] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/sd [Supply & Distribution] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/mo [Mortality] MH - Risk Factors MH - *Risk-Taking MH - Russia/ep [Epidemiology] MH - *Social Environment MH - Substance Abuse, Intravenous/ep [Epidemiology] MH - Substance Abuse, Intravenous/mo [Mortality] AB - BACKGROUND: While overdose is a common cause of mortality among opioid injectors worldwide, little information exists on opioid overdoses or how context may influence overdose risk in Russia. This study sought to uncover social and structural aspects contributing to fatal overdose risk in St. Petersburg and assess prevention intervention feasibility. AB - METHODS: Twenty-one key informant interviews were conducted with drug users, treatment providers, toxicologists, police, and ambulance staff. Thematic coding of interview content was conducted to elucidate elements of the overdose risk environment. AB - RESULTS: Several factors within St. Petersburg's environment were identified as shaping illicit drug users' risk behaviours and contributing to conditions of suboptimal response to overdose in the community. Most drug users live and experience overdoses at home, where family and home environment may mediate or moderate risk behaviours. The overdose risk environment is also worsened by inefficient emergency response infrastructure, insufficient cardiopulmonary or naloxone training resources, and the preponderance of abstinence-based treatment approaches to the exclusion of other treatment modalities. However, attitudes of drug users and law enforcement officials generally support overdose prevention intervention feasibility. Modifiable aspects of the risk environment suggest community-based and structural interventions, including overdose response training for drug users and professionals that encompasses naloxone distribution to the users and equipping more ambulances with naloxone. AB - CONCLUSION: Local social and structural elements influence risk environments for overdose. Interventions at the community and structural levels to prevent and respond to opioid overdoses are needed for and integral to reducing overdose mortality in St. Petersburg. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1873-4758 IL - 0955-3959 DO - https://dx.doi.org/10.1016/j.drugpo.2008.07.002 PT - Journal Article PT - Research Support, N.I.H., Extramural ID - S0955-3959(08)00166-7 [pii] ID - 10.1016/j.drugpo.2008.07.002 [doi] ID - PMC2696401 [pmc] ID - NIHMS98920 [mid] PP - ppublish PH - 2008/04/07 [received] PH - 2008/07/08 [revised] PH - 2008/07/10 [accepted] GI - No: T32 MH020031-07 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: T32 MH020031 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: 5U2RTW006893 Organization: *PHS HHS* Country: United States GI - No: U2R TW006893 Organization: (TW) *FIC NIH HHS* Country: United States GI - No: 5T32MH020031 Organization: (MH) *NIMH NIH HHS* Country: United States LG - English EP - 20080905 DP - 2009 May EZ - 2008/09/09 09:00 DA - 2009/04/16 09:00 DT - 2008/09/09 09:00 YR - 2009 ED - 20090415 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18774283 <586. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19133894 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bjorn AM AU - Jepsen P AU - Larsson HJ AU - Thomsen HF AU - Kieler H AU - Ehrenstein V AU - Christensen S FA - Bjorn, Anne-Mette Bay FA - Jepsen, Peter FA - Larsson, Heidi Jeanet FA - Thomsen, Henrik Frederik FA - Kieler, Helle FA - Ehrenstein, Vera FA - Christensen, Steffen IN - Bjorn, Anne-Mette Bay. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark. abb@dce.au.dk TI - Hospitalizations for opioid poisoning: a nation-wide population-based study in Denmark, 1998-2004. SO - Addiction. 104(1):104-8, 2009 Jan AS - Addiction. 104(1):104-8, 2009 Jan NJ - Addiction (Abingdon, England) VO - 104 IP - 1 PG - 104-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Adult MH - Aged MH - *Analgesics, Opioid/po [Poisoning] MH - Denmark/ep [Epidemiology] MH - Female MH - *Heroin/po [Poisoning] MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - *Methadone/po [Poisoning] MH - Middle Aged MH - *Narcotics/po [Poisoning] MH - *Prescription Drugs/po [Poisoning] MH - Registries MH - Young Adult AB - AIMS: To assess hospitalization rates (HR) for poisoning with heroin, methadone or strong analgesics and relate them to quantities of prescribed methadone and strong analgesics in Denmark between 1998 and 2004. AB - DESIGN: Population-based ecological study. AB - SETTINGS: We extracted data on all emergency department visits and hospital admissions registered in the Danish National Patient Registry with a diagnosis of poisoning with heroin (n = 1688), methadone (n = 173) or strong analgesics (n = 384). To ascertain sale of prescribed medications we used data from the Danish Medicines Agency. AB - MEASUREMENTS: Age- and gender-standardized HR and defined daily doses (DDD) per 1000 people per day. AB - FINDINGS: HR for heroin poisoning was 4.4 [95% confidence interval (CI): 3.8-4.9] per 100,000 person-years (p-y) in 1998 and 4.6 (CI: 4.0-5.2) per 100,000 p-y in 2004. HR for methadone poisoning increased from 0.1 (CI: 0.0-0.2) per 100,000 p-y in 1998 to 1.1 (CI: 0.8-1.4) per 100,000 p-y in 2004. HR for poisoning with strong analgesics increased from 0.6 (CI: 0.4-0.9) per 100,000 p-y in 1998 to 2.1 (CI: 1.8-2.6) per 100,000 p-y in 2004. The sale of prescribed strong analgesics (5.0 DDD per 1000 people per day in 1998 to 5.9 DDD in 2004) and methadone (3.0 DDD per 1000 people per day in 1998 to 3.4 DDD in 2004) increased slightly between 1998 and 2004. AB - CONCLUSION: Increasing sale of prescribed methadone and strong analgesics coincided with increasing HRs of poisoning with these drugs, whereas HR of heroin poisoning varied. Further longitudinal studies are important for the guidance of future policy making. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotics) RN - 0 (Prescription Drugs) RN - 70D95007SX (Heroin) RN - UC6VBE7V1Z (Methadone) ES - 1360-0443 IL - 0965-2140 DO - https://dx.doi.org/10.1111/j.1360-0443.2008.02420.x PT - Journal Article PT - Multicenter Study ID - ADD2420 [pii] ID - 10.1111/j.1360-0443.2008.02420.x [doi] PP - ppublish LG - English DP - 2009 Jan EZ - 2009/01/13 09:00 DA - 2009/04/15 09:00 DT - 2009/01/13 09:00 YR - 2009 ED - 20090414 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19133894 <587. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19245950 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tabano C FA - Tabano, Charlie TI - 'Nother one for Narcan. CM - Comment on: JEMS. 2008 Aug;33(8):72-6; PMID: 18692733 SO - Journal of Emergency Medical Services. 34(1):20, 2009 Jan AS - J Emerg Med Serv JEMS. 34(1):20, 2009 Jan NJ - JEMS : a journal of emergency medical services VO - 34 IP - 1 PG - 20 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - Emergency Medical Services MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Suicide, Attempted MH - Valproic Acid RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 614OI1Z5WI (Valproic Acid) IS - 0197-2510 IL - 0197-2510 DO - https://dx.doi.org/10.1016/S0197-2510(09)70007-5 PT - Comment PT - Letter ID - S0197-2510(09)70007-5 [pii] ID - 10.1016/S0197-2510(09)70007-5 [doi] PP - ppublish LG - English DP - 2009 Jan EZ - 2009/02/28 09:00 DA - 2009/04/02 09:00 DT - 2009/02/28 09:00 YR - 2009 ED - 20090401 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19245950 <588. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18434126 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tobin KE AU - Sherman SG AU - Beilenson P AU - Welsh C AU - Latkin CA FA - Tobin, Karin E FA - Sherman, Susan G FA - Beilenson, Peter FA - Welsh, Christopher FA - Latkin, Carl A IN - Tobin, Karin E. Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry Street, Second Floor, Baltimore, MD 21205, USA. ktobin@jhsph.edu TI - Evaluation of the Staying Alive programme: training injection drug users to properly administer naloxone and save lives. SO - International Journal of Drug Policy. 20(2):131-6, 2009 Mar AS - Int J Drug Policy. 20(2):131-6, 2009 Mar NJ - The International journal on drug policy VO - 20 IP - 2 PG - 131-6 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 9014759 IO - Int. J. Drug Policy SB - Index Medicus CP - Netherlands MH - Adult MH - Baltimore MH - *Cardiopulmonary Resuscitation/ed [Education] MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/th [Therapy] MH - Female MH - Follow-Up Studies MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/ae [Adverse Effects] MH - Naloxone/sd [Supply & Distribution] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/ae [Adverse Effects] MH - Narcotic Antagonists/sd [Supply & Distribution] MH - Needle-Exchange Programs/og [Organization & Administration] MH - Preventive Health Services/mt [Methods] MH - Substance Abuse, Intravenous/mo [Mortality] MH - *Substance Abuse, Intravenous/th [Therapy] AB - BACKGROUND: In response to the high rates of opiate-related overdoses and deaths in the United States, a number of overdose prevention programmes have been implemented that include training drug users to administer naloxone, an opiate antagonist. The purpose of this study was to evaluate the Staying Alive (SA) programme in Baltimore, Maryland, which trained drug users to prevent and respond to opiate overdose using techniques including mouth-to-mouth resuscitation and administration of naloxone. AB - METHODS: Participants for the SA programme were recruited from multiple locations by Baltimore City Health Department Needle Exchange programme staff. A 1-h training was conducted by two facilitators. Participants who successfully completed the programme were provided with a kit that contained naloxone. Participants in the evaluation study were enrolled prior to the training session. The present analysis includes 85 participants who completed a pre- and post-test evaluation survey. AB - RESULTS: At both time points, 43 participants reported having witnessed an overdose. Post-training, naloxone was administered by 19 with no reported adverse effects. Post-training, a greater proportion of participants reported using resuscitation skills taught in the SA programme along with increased knowledge specifically about naloxone. AB - CONCLUSIONS: Results from this study provide additional evidence to support the effectiveness of overdose prevention training programmes that include skills building for drug users to administer naloxone. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1873-4758 IL - 0955-3959 DO - https://dx.doi.org/10.1016/j.drugpo.2008.03.002 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - S0955-3959(08)00087-X [pii] ID - 10.1016/j.drugpo.2008.03.002 [doi] PP - ppublish PH - 2007/10/18 [received] PH - 2008/02/28 [revised] PH - 2008/03/05 [accepted] GI - No: R01DA13142 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20080422 DP - 2009 Mar EZ - 2008/04/25 09:00 DA - 2009/03/10 09:00 DT - 2008/04/25 09:00 YR - 2009 ED - 20090309 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18434126 <589. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19150908 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kim D AU - Irwin KS AU - Khoshnood K FA - Kim, Daniel FA - Irwin, Kevin S FA - Khoshnood, Kaveh IN - Kim, Daniel. American Medical Association, Chicago, IL, USA. TI - Expanded access to naloxone: options for critical response to the epidemic of opioid overdose mortality. SO - American Journal of Public Health. 99(3):402-7, 2009 Mar AS - Am J Public Health. 99(3):402-7, 2009 Mar NJ - American journal of public health VO - 99 IP - 3 PG - 402-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 1254074, 3xw IO - Am J Public Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661437 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - Disease Outbreaks MH - Drug Overdose/mo [Mortality] MH - Drug-Related Side Effects and Adverse Reactions MH - *Emergency Treatment/mt [Methods] MH - Family MH - *Health Services Accessibility MH - Humans MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Peer Group MH - *Prescription Drugs MH - United States/ep [Epidemiology] AB - The United States is in the midst of a prolonged and growing epidemic of accidental and preventable deaths associated with overdoses of licit and illicit opioids. For more than 3 decades, naloxone has been used by emergency medical personnel to pharmacologically reverse overdoses. The peers or family members of overdose victims, however, are most often the actual first responders and are best positioned to intervene within an hour of the onset of overdose symptoms. Data from recent pilot programs demonstrate that lay persons are consistently successful in safely administering naloxone and reversing opioid overdose. Current evidence supports the extensive scaleup of access to naloxone. We present advantages and limitations associated with a range of possible policy and program responses. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 0 (Prescription Drugs) RN - 36B82AMQ7N (Naloxone) ES - 1541-0048 IL - 0090-0036 DO - https://dx.doi.org/10.2105/AJPH.2008.136937 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - AJPH.2008.136937 [pii] ID - 10.2105/AJPH.2008.136937 [doi] ID - PMC2661437 [pmc] PP - ppublish LG - English EP - 20090115 DP - 2009 Mar EZ - 2009/01/20 09:00 DA - 2009/03/07 09:00 DT - 2009/01/20 09:00 YR - 2009 ED - 20090306 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19150908 <590. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19033500 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lidder S AU - Ovaska H AU - Archer JR AU - Greene SL AU - Jones AL AU - Dargan PI AU - Wood DM FA - Lidder, S FA - Ovaska, H FA - Archer, J R H FA - Greene, S L FA - Jones, A L FA - Dargan, P I FA - Wood, D M IN - Lidder, S. Guy's and St Thomas Poisons Unit, Guy's and St Thomas' NHS Foundation Trust, London SE14 5ER, UK. TI - Doctors' knowledge of the appropriate use and route of administration of antidotes in the management of recreational drug toxicity. CM - Comment in: Emerg Med J. 2009 Oct;26(10):760; PMID: 19773516 SO - Emergency Medicine Journal. 25(12):820-3, 2008 Dec AS - Emerg Med J. 25(12):820-3, 2008 Dec NJ - Emergency medicine journal : EMJ VO - 25 IP - 12 PG - 820-3 PI - Journal available in: Print PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - *Antidotes/ad [Administration & Dosage] MH - *Clinical Competence/st [Standards] MH - Drug Administration Routes MH - Emergency Service, Hospital MH - Female MH - Health Care Surveys MH - Humans MH - Male MH - *Medical Staff, Hospital/st [Standards] MH - Middle Aged MH - *Street Drugs/ae [Adverse Effects] MH - *Substance-Related Disorders/dt [Drug Therapy] MH - Surveys and Questionnaires MH - Young Adult AB - BACKGROUND: Specific antidotes (eg, naloxone, flumazenil, cyproheptadine and benzodiazepines) are available for the management of certain recreational drug-induced toxicities. Some controversies surround the use of some of these antidotes, especially flumazenil in benzodiazepine toxicity. There are no previously published data on doctors' knowledge of the use of these specific antidotes. AB - METHODS: A questionnaire survey was designed to determine internal/emergency medicine doctors' knowledge of the appropriate use of antidotes in the management of clinical scenarios of acutely poisoned patients. For nine simulated clinical scenarios of acute toxicity from recreational drugs (benzodiazepines, cocaine, N-methyl-L-(3,4-methylene-dioxyphenyl)-2-aminopropane (MDMA)-induced serotonin toxicity and opioids), they were asked to indicate whether the suggested antidote and route of administration were correct. AB - RESULTS: 42 physicians of all grades completed the questionnaire. The mean correct score was 5.4 (SD 1.1) (median 6, interquartile range 5-7). The percentages correct for the various clinical scenarios were 68.3% for opioid toxicity, 81% for benzodiazepine toxicity, 28.6% for MDMA-induced serotonin toxicity and 70.2% for cocaine toxicity. Doctors were more likely to record an answer of "unsure" for the use of cyproheptadine in ST serotonin toxicity (28.6%) compared with the use of the other antidotes (1.4%; p<0.001). AB - CONCLUSION: Knowledge of the appropriate use of antidotes in recreational drug toxicity is not consistent, with poorer knowledge on the use of newer antidotes such as cyproheptadine in serotonin toxicity. Education is required both to increase overall knowledge on the use of specific antidotes in the management of recreational drug-induced toxicity, as well as focusing on newer antidotes such as cyproheptadine. RN - 0 (Antidotes) RN - 0 (Street Drugs) ES - 1472-0213 IL - 1472-0205 DO - https://dx.doi.org/10.1136/emj.2007.054890 PT - Journal Article ID - 25/12/820 [pii] ID - 10.1136/emj.2007.054890 [doi] PP - ppublish LG - English DP - 2008 Dec EZ - 2008/11/27 09:00 DA - 2009/02/28 09:00 DT - 2008/11/27 09:00 YR - 2008 ED - 20090227 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19033500 <591. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18266809 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wilsey BL AU - Fishman SM AU - Tsodikov A AU - Ogden C AU - Symreng I AU - Ernst A FA - Wilsey, Barth L FA - Fishman, Scott M FA - Tsodikov, Alexander FA - Ogden, Christine FA - Symreng, Ingela FA - Ernst, Amy IN - Wilsey, Barth L. Department of Anesthesiology and Pain Medicine, and VA Northern California Health Care System, University of California, Davis, CA, USA. TI - Psychological comorbidities predicting prescription opioid abuse among patients in chronic pain presenting to the emergency department. SO - Pain Medicine. 9(8):1107-17, 2008 Nov AS - PAIN MED. 9(8):1107-17, 2008 Nov NJ - Pain medicine (Malden, Mass.) VO - 9 IP - 8 PG - 1107-17 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Comorbidity MH - *Emergency Service, Hospital/ut [Utilization] MH - Humans MH - Male MH - Mental Disorders/pp [Physiopathology] MH - Mental Disorders/px [Psychology] MH - *Mental Disorders MH - Middle Aged MH - Opioid-Related Disorders/pp [Physiopathology] MH - *Opioid-Related Disorders/px [Psychology] MH - Pain/dt [Drug Therapy] MH - Pain/px [Psychology] MH - *Pain MH - Psychiatric Status Rating Scales MH - Regression Analysis MH - Young Adult AB - OBJECTIVE: We attempted to identify psychological comorbidities that are associated with the propensity for prescription opioid abuse. AB - INTERVENTIONS: Patients presenting to an emergency department seeking opioid refills for chronic pain were evaluated with five validated self-report instruments and structured clinical interviews. The potential for prescription opioid abuse was modeled with multiple regression analysis using depression, anxiety disorders, personality disorder, and addiction as independent variables. AB - RESULTS: Of the 113 patients studied, 91 (81%) showed a propensity for prescription opioid abuse as determined by scores on the Screener and Opioid Assessment for Patients with Pain instrument. Depression, anxiety, and a history of substance were common and panic attacks, posttraumatic stress disorder, and personality disorders were also found, albeit less frequently. Panic attacks, trait anxiety, and the presence of a personality disorder accounted for 38% of the variance in the potential for prescription opioid abuse. AB - CONCLUSIONS: Patients in chronic pain should be assessed for psychological and addiction disorders because they are at increased risk for abusing opioids. They should also be referred for psychosocial treatment as part of their care, where appropriate. RN - 0 (Analgesics, Opioid) ES - 1526-4637 IL - 1526-2375 DO - https://dx.doi.org/10.1111/j.1526-4637.2007.00401.x PT - Journal Article PT - Research Support, N.I.H., Extramural ID - PME401 [pii] ID - 10.1111/j.1526-4637.2007.00401.x [doi] PP - ppublish GI - No: UL1 RR024146 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English EP - 20080205 DP - 2008 Nov EZ - 2008/02/13 09:00 DA - 2009/02/13 09:00 DT - 2008/02/13 09:00 YR - 2008 ED - 20090212 RD - 20081210 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18266809 <592. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19032530 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kranzler HR AU - Stephenson JJ AU - Montejano L AU - Wang S AU - Gastfriend DR FA - Kranzler, Henry R FA - Stephenson, Judith J FA - Montejano, Leslie FA - Wang, Shaohung FA - Gastfriend, David R IN - Kranzler, Henry R. Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030-2103, USA. kranzler@psychiatry.uchc.edu TI - Persistence with oral naltrexone for alcohol treatment: implications for health-care utilization. SO - Addiction. 103(11):1801-8, 2008 Nov AS - Addiction. 103(11):1801-8, 2008 Nov NJ - Addiction (Abingdon, England) VO - 103 IP - 11 PG - 1801-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - bm3, 9304118 IO - Addiction PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652482 OI - Source: NLM. NIHMS68051 SB - Index Medicus CP - England MH - Adult MH - Aged MH - *Alcohol Drinking/dt [Drug Therapy] MH - Alcohol Drinking/ec [Economics] MH - *Alcoholism/dt [Drug Therapy] MH - Alcoholism/ec [Economics] MH - Drug Prescriptions/sn [Statistics & Numerical Data] MH - England MH - Female MH - Health Services/ec [Economics] MH - *Health Services/ut [Utilization] MH - Humans MH - Male MH - *Medication Adherence MH - Middle Aged MH - Naltrexone/ec [Economics] MH - *Naltrexone/tu [Therapeutic Use] MH - Narcotic Antagonists/ec [Economics] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Retrospective Studies MH - Young Adult AB - AIMS: Concerns have been raised about patients' failure to persist in alcohol treatment. We examined prescriptions for oral naltrexone in a large, nationally distributed treatment population to identify characteristics and health-care utilization patterns associated with persistence. AB - DESIGN: Data from the 2000-2004 MarketScan Commercial Claims and Encounters Database were used to identify patients with alcohol-related claims who were prescribed naltrexone. AB - MEASUREMENTS: Analysis identified patient characteristics that predicted persistence with naltrexone (defined as having filled prescriptions for >or=80% of the 6-month treatment period) and its association to health-care utilization. AB - FINDINGS: Of 1138 patients, 162 (14.2%) were persistent in obtaining naltrexone. Non-persistent patients were significantly younger, more likely to be hourly employees and to live in an area with a lower median income, and less likely to be newly diagnosed with an alcohol-related disorder. Non-persistence in obtaining naltrexone was associated with significantly more intensive treatments, including inpatient detoxification, emergency room visits and hospitalizations. AB - CONCLUSIONS: Over a 6-month period, 85.8% of patients who filled an initial prescription for naltrexone did not persist in obtaining the medication. Non-persistence was associated with significantly greater use of costly health-care services. Because the study was correlational, it is not possible to conclude that persistence reduced health-care costs, as patients with a better prognosis may have been more persistent. Research is needed to determine whether interventions that enhance persistence with naltrexone therapy improve treatment outcomes and reduce health-care costs. RN - 0 (Narcotic Antagonists) RN - 5S6W795CQM (Naltrexone) ES - 1360-0443 IL - 0965-2140 DO - https://dx.doi.org/10.1111/j.1360-0443.2008.02345.x PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - ADD2345 [pii] ID - 10.1111/j.1360-0443.2008.02345.x [doi] ID - PMC2652482 [pmc] ID - NIHMS68051 [mid] PP - ppublish GI - No: K24 AA013736 Organization: (AA) *NIAAA NIH HHS* Country: United States GI - No: K24 AA013736-06 Organization: (AA) *NIAAA NIH HHS* Country: United States GI - No: K24 AA13736 Organization: (AA) *NIAAA NIH HHS* Country: United States LG - English DP - 2008 Nov EZ - 2008/11/27 09:00 DA - 2009/02/10 09:00 DT - 2008/11/27 09:00 YR - 2008 ED - 20090209 RD - 20161122 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19032530 <593. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16320011 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gille J AU - Gille M AU - Gahr R AU - Wiedemann B FA - Gille, J FA - Gille, M FA - Gahr, R FA - Wiedemann, B IN - Gille, J. Klinik fur Anasthesiologie, Intensiv- und Schmerztherapie, Stadt Klinikum St Georg, Leipzig, Germany. Jochen.Gille@sankt georg.de TI - [Acute pain management in proximal femoral fractures: femoral nerve block (catheter technique) vs. systemic pain therapy using a clinic internal organisation model]. [German] OT - Akutschmerztherapie bei Patienten mit huftgelenknahen Frakturen : N.-femoralis-Katheter-Analgesie vs. systemische Schmerztherapie unter Anwendung eines klinikinternen Organisationsmodells. SO - Anaesthesist. 55(4):414-22, 2006 Apr AS - Anaesthesist. 55(4):414-22, 2006 Apr NJ - Der Anaesthesist VO - 55 IP - 4 PG - 414-22 PI - Journal available in: Print PI - Citation processed from: Internet JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Acute Disease MH - Aged MH - Aged, 80 and over MH - Amides MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Anesthetics, Local MH - Catheterization MH - Female MH - *Femoral Neck Fractures/co [Complications] MH - Femoral Neck Fractures/su [Surgery] MH - *Femoral Nerve MH - Humans MH - Male MH - Methimazole/tu [Therapeutic Use] MH - Middle Aged MH - Models, Organizational MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Nerve Block/ae [Adverse Effects] MH - *Nerve Block MH - *Pain/dt [Drug Therapy] MH - *Pain/et [Etiology] MH - Pain Measurement/de [Drug Effects] MH - Pain, Postoperative/dt [Drug Therapy] MH - Prilocaine MH - Prospective Studies MH - Tilidine/tu [Therapeutic Use] AB - BACKGROUND: The aim of this study was to compare safety and efficacy of catheter-mediated femoral nerve block analgesia with systemic pain therapy in patients with proximal femoral fractures in the pre-operative and post-operative setting using a protocol for coordinating pain management. AB - METHODS: In a prospective randomised trial of patients attending the emergency department, 100 individuals were selected with a clinically diagnosed proximal femoral fracture. Patients were divided into two equal groups A and B. Group A (n=50) received a catheter-mediated femoral nerve block with 1% prilocaine (40 ml) and post-operatively 0.2% ropivacaine (30 ml) 6 hourly. Group B (n=50) initially received intravenous metamizol (1 g) and a fixed combination of oral tilidine (100 mg) + naloxone (8 mg). Patients aged 90 years or more received a reduced dose (tilidine 75 mg + naloxone 6 mg). In the post-operative period regular oral ibuprofen (400 mg, 8 hourly) in addition to oral tilidine (50 mg) + naloxone (4 mg) was given as required for break through pain. Pain intensity was measured using a verbal rating scale (VRS) from 1 to 5: pain free (=1), mild pain (=2), moderate pain (=3), severe pain (=4), excruciating pain (=5). Pain scores were recorded at rest (R), during passive anteflection (30 degrees) of the hip (PA) on arrival and at 15 and 30 min after initial administration of analgesia. Thereafter, recordings were made 4 times a day up to the third post-operative day. AB - RESULTS: Pain scores were comparable for both groups on admission (VRS in R 2.50 vs. 2.46; VRS during PA 4.30 vs. 4.34). Significant pain relief was achieved in both groups following initial administration of analgesia, but the total pain scores in group A were significantly lower than in group B (VRS in R 1.22 vs. 1.58, p<0.01 and VRS during PA 2.66 vs. 3.26; p<0.001). No difference was noted between the two groups during the first 3 post-operative days. No severe complications occurred as a result of analgesia, however, the catheter was dislodged in 20% of patients in group A resulting in the need for systemically administered analgesia. AB - CONCLUSION: All patients presenting with proximal femoral fractures should receive adequate analgesia within the emergency department even prior to radiographic imaging. Femoral nerve block should be considered as the method of choice. The insertion of a femoral nerve block catheter has the dual advantage of early analgesia permitting repeated clinical examination in addition to continued post-operative pain management. The cumbersome logistics inherent in this technique within the clinical setting limits its practical application. An initial single-shot regional nerve block followed by a systemic post-operative analgesia protocol was considered an appropriate alternative. The execution of safe, consistent and appropriate regional nerve block anaesthesia is reliant on formal guidelines and protocols as agreed by the multidisciplinary teams involved with patient-directed pain management and good clinical practice. RN - 0 (Amides) RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Local) RN - 0 (Narcotic Antagonists) RN - 046O35D44R (Prilocaine) RN - 36B82AMQ7N (Naloxone) RN - 554Z48XN5E (Methimazole) RN - 7IO5LYA57N (ropivacaine) RN - GY33N31E9Y (Tilidine) ES - 1432-055X IL - 0003-2417 PT - Comparative Study PT - English Abstract PT - Journal Article PT - Randomized Controlled Trial ID - 10.1007/s00101-005-0949-4 [doi] PP - ppublish LG - German DP - 2006 Apr EZ - 2005/12/02 09:00 DA - 2009/02/10 09:00 DT - 2005/12/02 09:00 YR - 2006 ED - 20090209 RD - 20170916 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16320011 <594. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18843073 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barrie J FA - Barrie, Jenifer IN - Barrie, Jenifer. Manchester Royal Infirmary, Manchester, UK. TI - Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3. Training and prescription of naloxone for personal use in overdose for opiate addicts. [Review] [3 refs] SO - Emergency Medicine Journal. 25(10):688-9, 2008 Oct AS - Emerg Med J. 25(10):688-9, 2008 Oct NJ - Emergency medicine journal : EMJ VO - 25 IP - 10 PG - 688-9 PI - Journal available in: Print PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J SB - Index Medicus CP - England MH - Drug Overdose/dt [Drug Therapy] MH - Evidence-Based Emergency Medicine MH - *Heroin/po [Poisoning] MH - *Heroin Dependence/dt [Drug Therapy] MH - Humans MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] MH - Self Administration RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1472-0213 IL - 1472-0205 DO - https://dx.doi.org/10.1136/emj.2008.065698 PT - Journal Article PT - Review ID - 25/10/688 [pii] ID - 10.1136/emj.2008.065698 [doi] PP - ppublish LG - English DP - 2008 Oct EZ - 2008/10/10 09:00 DA - 2009/02/04 09:00 DT - 2008/10/10 09:00 YR - 2008 ED - 20090203 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18843073 <595. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18834372 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Davies EC AU - Green CF AU - Mottram DR AU - Pirmohamed M FA - Davies, E C FA - Green, C F FA - Mottram, D R FA - Pirmohamed, M IN - Davies, E C. Department of Pharmacy, Royal Liverpool Hospital, Prescot Street, Liverpool L15 4JT, UK. e.c.davies@2005.ljmu.ac.uk TI - The use of opioids and laxatives, and incidence of constipation, in patients requiring neck-of-femur (NOF) surgery: a pilot study. SO - Journal of Clinical Pharmacy & Therapeutics. 33(5):561-6, 2008 Oct AS - J Clin Pharm Ther. 33(5):561-6, 2008 Oct NJ - Journal of clinical pharmacy and therapeutics VO - 33 IP - 5 PG - 561-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - hpi, 8704308 IO - J Clin Pharm Ther SB - Index Medicus CP - England MH - Age Factors MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Constipation/ci [Chemically Induced] MH - Constipation/ep [Epidemiology] MH - Constipation/pc [Prevention & Control] MH - Emergency Medical Services MH - Evidence-Based Medicine MH - Female MH - *Femoral Neck Fractures/su [Surgery] MH - Humans MH - *Laxatives/tu [Therapeutic Use] MH - London MH - Male MH - Nutritional Status MH - Pilot Projects MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] AB - BACKGROUND AND OBJECTIVE: Constipation is one of the most frequent adverse drug reactions occurring in hospital inpatients. There is no evidence base for the use of laxatives in orthopaedic patients on opioids. The aim of the study was to determine the current nature of opioid and laxative prescribing, and the incidence of constipation in patients who require emergency neck-of-femur (NOF) surgery. AB - METHODS: Patients admitted to the Royal Liverpool Hospital for emergency surgery for fractured NOF over an 8-week period in 2007 were included in the study. All opioid and laxative prescribing was recorded, alongside the incidence of constipation, nutritional status and mobility. AB - RESULTS: During the study period, 46 patients were eligible for inclusion. All patients received opioid analgesics. Constipation occurred in 33 patients (71.7%). Prophylactic laxatives were prescribed in 20 (43%) patients, 12 of whom developed constipation. Of the 26 (57%) patients not prescribed prophylaxis, 21 developed constipation (chi(2) = 2.3, P < 0.1 NS). Constipated patients were older (86 years vs. 76 years) (U = 112.5, P < 0.05), and had poorer nutritional status (2/13 vs. 16/33) (chi(2) = 4.28, P < 0.05), than patients without constipation. AB - CONCLUSIONS: This study demonstrates that age and nutritional status are significant factors influencing the occurrence of constipation, though the prophylactic use of laxatives did not alleviate the incidence of constipation. There is a clinical need to develop a robust evidence base surrounding the best management of constipation in this vulnerable group of orthopaedic patients. RN - 0 (Analgesics, Opioid) RN - 0 (Laxatives) ES - 1365-2710 IL - 0269-4727 DO - https://dx.doi.org/10.1111/j.1365-2710.2008.00949.x PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - JCP949 [pii] ID - 10.1111/j.1365-2710.2008.00949.x [doi] PP - ppublish LG - English DP - 2008 Oct EZ - 2008/10/07 09:00 DA - 2009/01/31 09:00 DT - 2008/10/07 09:00 YR - 2008 ED - 20090130 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18834372 <596. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 19025643 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Heyerdahl F AU - Hovda KE AU - Bjornaas MA AU - Nore AK AU - Figueiredo JC AU - Ekeberg O AU - Jacobsen D FA - Heyerdahl, Fridtjof FA - Hovda, Knut E FA - Bjornaas, Mari A FA - Nore, Anne K FA - Figueiredo, Jose C P FA - Ekeberg, Oivind FA - Jacobsen, Dag IN - Heyerdahl, Fridtjof. Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway. fridtjof.heyerdahl@medisin.uio.no TI - Pre-hospital treatment of acute poisonings in Oslo. SO - BMC Emergency Medicine. 8:15, 2008 Nov 24 AS - BMC emerg. med.. 8:15, 2008 Nov 24 NJ - BMC emergency medicine VO - 8 PG - 15 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100968543 IO - BMC Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605443 SB - Index Medicus CP - England MH - Acute Disease MH - *Emergency Medical Services/og [Organization & Administration] MH - Female MH - Humans MH - Incidence MH - Logistic Models MH - Male MH - Norway/ep [Epidemiology] MH - Poisoning/mo [Mortality] MH - *Poisoning/th [Therapy] MH - Prospective Studies MH - Registries MH - Statistics, Nonparametric MH - Treatment Outcome AB - BACKGROUND: Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. AB - AIMS: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. AB - METHODS: A one-year multi-centre study with prospective inclusion of all acutely poisoned patients > or = 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. AB - RESULTS: A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40%) were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84%) were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%), were frequently comatose (35%), had respiratory depression (37%), and many received naloxone (49%). The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%), fewer were comatose (10%), and they rarely had respiratory depression (4%). Among the hospitalized, pharmaceutical poisonings were most common (58%), 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. AB - CONCLUSION: More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often caused by drug and alcohol abuse than in those who were hospitalized, and more than two-thirds were males. Almost half of those discharged from ambulances received an antidote. The pre-hospital treatment of these poisonings appears safe regarding short-term mortality. ES - 1471-227X IL - 1471-227X DO - https://dx.doi.org/10.1186/1471-227X-8-15 PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't ID - 1471-227X-8-15 [pii] ID - 10.1186/1471-227X-8-15 [doi] ID - PMC2605443 [pmc] PP - epublish PH - 2008/04/04 [received] PH - 2008/11/24 [accepted] LG - English EP - 20081124 DP - 2008 Nov 24 EZ - 2008/11/26 09:00 DA - 2009/01/27 09:00 DT - 2008/11/26 09:00 YR - 2008 ED - 20090126 RD - 20140902 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=19025643 <597. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18695599 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Engrav LH FA - Engrav, Loren H TI - Creeping fluid, technology and opioids. CM - Comment on: J Burn Care Res. 2008 Jan-Feb;29(1):180-6; PMID: 18182919 SO - Journal of Burn Care & Research. 29(5):857-8, 2008 Sep-Oct AS - J Burn Care Res. 29(5):857-8, 2008 Sep-Oct NJ - Journal of burn care & research : official publication of the American Burn Association VO - 29 IP - 5 PG - 857-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 101262774 IO - J Burn Care Res SB - Index Medicus CP - England MH - Acute Disease MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Burns/co [Complications] MH - Burns/pp [Physiopathology] MH - *Burns/th [Therapy] MH - *Fluid Therapy MH - Humans MH - Injury Severity Score MH - *Resuscitation MH - Texas MH - *Urination RN - 0 (Analgesics, Opioid) IS - 1559-047X IL - 1559-047X DO - https://dx.doi.org/10.1097/BCR.0b013e3181848c5f PT - Comment PT - Letter ID - 10.1097/BCR.0b013e3181848c5f [doi] PP - ppublish LG - English DP - 2008 Sep-Oct EZ - 2008/08/13 09:00 DA - 2009/01/15 09:00 DT - 2008/08/13 09:00 YR - 2008 ED - 20090114 RD - 20180302 UP - 20180305 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=18695599 <598. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17934758 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Huenseler C AU - Borucki D AU - Mueller C AU - Hering F AU - Kremer W AU - Theisohn M AU - Roth B FA - Huenseler, Christoph FA - Borucki, Diana FA - Mueller, Carsten FA - Hering, Fritz FA - Kremer, Wolf FA - Theisohn, Martin FA - Roth, Bernhard IN - Huenseler, Christoph. Department of Neonatology and Pediatric Intensive Care, Children's Hospital of the University of Cologne, Josef-Stelzmann-Strasse 9, 50924, Koln, Germany. christoph.huenseler@uni-koeln.de TI - Prospective evaluation of the pharmacodynamics of piritramide in neonates and infants. SO - European Journal of Pediatrics. 167(8):867-72, 2008 Aug AS - Eur J Pediatr. 167(8):867-72, 2008 Aug NJ - European journal of pediatrics VO - 167 IP - 8 PG - 867-72 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - end, 7603873 IO - Eur. J. Pediatr. SB - Index Medicus CP - Germany MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/pk [Pharmacokinetics] MH - *Analgesics, Opioid/pd [Pharmacology] MH - Child, Preschool MH - Humans MH - Infant MH - Infant, Newborn MH - Pain Measurement MH - Pirinitramide/ad [Administration & Dosage] MH - Pirinitramide/ae [Adverse Effects] MH - Pirinitramide/pk [Pharmacokinetics] MH - *Pirinitramide/pd [Pharmacology] MH - Postoperative Period MH - Respiration, Artificial AB - Piritramide is a synthetic opioid commonly used in Germany and Austria for the analgesia of pediatric patients. Little pharmacokinetic and pharmacodynamic data for the pediatric population is available. The aim of this investigation was to gain pharmacodynamic data on postsurgical analgesia and the side effects of piritramide. The study was approved by the Ethics Committee of the Medical Faculty. Data were collected in an open, prospective clinical trial. After obtaining the parents' informed written consent, patients received a bolus of piritramide 50 mug/kg for postsurgical analgesia or to prevent pain resulting from invasive procedures. Titration doses of 15 microg/kg were allowed. Vital signs and pain intensity were closely monitored. Data from 39 patients could be included in the analysis. Of the patients, 95% were in the immediate postsurgical course, 5% had piritramide for invasive procedures, and 46% of the patients were ventilated. The mean piritramide dosage was 64 +/- 24 microg/kg. Pharmacodynamic analysis showed adequate analgesia for at least 50% of the spontaneously breathing patients for 120 min after piritramide bolus. More than 50% of the ventilated patients showed inadequate analgesia at any point in time after piritramide bolus. Fifty-nine percent (59%) of the ventilated patients received additive analgesia versus 31% of spontaneously breathing patients. No relevant changes of vital signs could be observed. One patient received naloxone for apnea. We conclude that dosages of more than 50-70 microg/kg are needed for sufficient analgesia in ventilated postsurgical infants. In spontaneously breathing patients, 50-70 microg/kg provides a 120-min period of analgesia for more than 50% of patients. Cardiovascular stability of the patients was good and, with one exception, there was no respiratory depression. RN - 0 (Analgesics, Opioid) RN - 4RP92LYZ2F (Pirinitramide) IS - 0340-6199 IL - 0340-6199 PT - Journal Article ID - 10.1007/s00431-007-0601-1 [doi] PP - ppublish PH - 2007/04/25 [received] PH - 2007/08/24 [accepted] PH - 2007/08/23 [revised] LG - English EP - 20071013 DP - 2008 Aug EZ - 2007/10/16 09:00 DA - 2009/01/07 09:00 DT - 2007/10/16 09:00 YR - 2008 ED - 20090106 RD - 20171006 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=17934758 <599. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18821875 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Strang J AU - Manning V AU - Mayet S AU - Best D AU - Titherington E AU - Santana L AU - Offor E AU - Semmler C FA - Strang, John FA - Manning, Victoria FA - Mayet, Soraya FA - Best, David FA - Titherington, Emily FA - Santana, Laura FA - Offor, Elizabeth FA - Semmler, Claudia IN - Strang, John. National Addiction Centre (Institute of Psychiatry/The Maudsley), Addiction Sciences Building, Denmark Hill, London, UK. j.strang@iop.kcl.ac.uk TI - Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses. CM - Comment in: Addiction. 2008 Oct;103(10):1658-9; PMID: 18821876 SO - Addiction. 103(10):1648-57, 2008 Oct AS - Addiction. 103(10):1648-57, 2008 Oct NJ - Addiction (Abingdon, England) VO - 103 IP - 10 PG - 1648-57 PI - Journal available in: Print PI - Citation processed from: Internet JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Adult MH - Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/mo [Mortality] MH - *Emergency Treatment/mt [Methods] MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Preventive Health Services/st [Standards] MH - Program Evaluation MH - Prospective Studies AB - AIM: To examine the impact of training in overdose management and naloxone provision on the knowledge and confidence of current opiate users; and to record subsequent management of overdoses that occur during a 3-month follow-up period. AB - DESIGN: Repeated-measures design to examine changes in knowledge and confidence immediately after overdose management training; retention of knowledge and confidence at 3 months; and prospective cohort study design to document actual interventions applied at post-training overdose situations. AB - METHOD: A total of 239 opiate users in treatment completed a pre-training questionnaire on overdose management and naloxone administration and were re-assessed immediately post-training, at which point they were provided with the take-home emergency supply of naloxone. Three months later they were re-interviewed. AB - RESULTS: Significant improvements were seen in knowledge of risks of overdose, characteristics of overdose and appropriate actions to be taken; and in confidence in the administration of naloxone. A 78% follow-up rate was achieved (186 of 239) among whom knowledge of both the risks and physical/behavioural characteristics of overdose and also of recommended management actions was well retained. Eighteen overdoses (either experienced or witnessed) had occurred during the 3 months between the training and the follow-up. Naloxone was used on 12 occasions (a trained client's own supply on 10 occasions). One death occurred in one of the six overdoses where naloxone was not used. Where naloxone was used, all 12 resulted in successful reversal. AB - CONCLUSIONS: With overdose management training, opiate users can be trained to execute appropriate actions to assist the successful reversal of potentially fatal overdose. Wider provision may reduce drug-related deaths further. Future studies should examine whether public policy of wider overdose management training and naloxone provision could reduce the extent of opiate overdose fatalities, particularly at times of recognized increased risk. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) ES - 1360-0443 IL - 0965-2140 DO - https://dx.doi.org/10.1111/j.1360-0443.2008.02314.x PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - ADD2314 [pii] ID - 10.1111/j.1360-0443.2008.02314.x [doi] PP - ppublish LG - English DP - 2008 Oct EZ - 2008/09/30 09:00 DA - 2008/12/20 09:00 DT - 2008/09/30 09:00 YR - 2008 ED - 20081219 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18821875 <600. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18803336 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Smith MY AU - Irish W AU - Wang J AU - Haddox JD AU - Dart RC FA - Smith, Meredith Y FA - Irish, William FA - Wang, Jianmin FA - Haddox, J David FA - Dart, Richard C IN - Smith, Meredith Y. Purdue Pharma LP, Stamford, CT, USA. meredith.smith@pharma.com TI - Detecting signals of opioid analgesic abuse: application of a spatial mixed effect poisson regression model using data from a network of poison control centers. SO - Pharmacoepidemiology & Drug Safety. 17(11):1050-9, 2008 Nov AS - Pharmacoepidemiol Drug Saf. 17(11):1050-9, 2008 Nov NJ - Pharmacoepidemiology and drug safety VO - 17 IP - 11 PG - 1050-9 PI - Journal available in: Print PI - Citation processed from: Internet JC - d0r, 9208369 IO - Pharmacoepidemiol Drug Saf SB - Index Medicus CP - England MH - *Analgesics, Opioid/po [Poisoning] MH - Bayes Theorem MH - Humans MH - Models, Statistical MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - *Poison Control Centers/sn [Statistics & Numerical Data] MH - Poisson Distribution MH - Population Surveillance MH - *Product Surveillance, Postmarketing/sn [Statistics & Numerical Data] MH - Residence Characteristics MH - Time Factors MH - United States/ep [Epidemiology] AB - PURPOSE: The recent rise in the non-medical use of opioid analgesics in the US has underscored the importance of comprehensive post-marketing surveillance of these products. To assist pharmacovigilance efforts, we developed a methodology for detecting geo-specific "signals" of potential outbreaks of prescription drug abuse by 3-digit ZIP (3DZ) code. AB - METHODS: The number of intentional exposure calls involving nine specific opioid analgesics were obtained from eight regional poison control centers between first quarter 2003 and fourth quarter 2004. The unit of analysis was a combination of drug-quarter/year-3DZ. We fitted an empirical Bayes mixed effects Poisson-Gamma regression model that adjusted for differences across 3DZs in opioid analgesic exposure. A relative report rate (RR) >or=3 at a probability of >0.95 was the signal threshold criterion. AB - RESULTS: A total of 15,769 valid drug-time-3DZ combinations were identified. Of these, 1.9% (n = 294) met the signal threshold criterion. The number of signals generated per drug-quarter/year-3DZ combination ranged from 0 to 13. The largest number of signals were those involving methadone (n = 71), hydrocodone (n = 57), and branded oxycodone extended-release (n = 45). Signals for methadone and branded oxycodone extended-release were predominantly clustered in Appalachia. Hydrocodone-related signals showed less geographic clustering with approximately 26% reported from California, and the remainder from other regions in the US. AB - CONCLUSIONS: Our results show marked regional differences in reported abuse of specific opioid analgesics. Additional research is needed to determine the sensitivity and specificity of signals obtained using this spatial mixed effect Poisson regression model. Copyright (c) 2008 John Wiley & Sons, Ltd. RN - 0 (Analgesics, Opioid) ES - 1099-1557 IL - 1053-8569 DO - https://dx.doi.org/10.1002/pds.1658 PT - Journal Article PT - Multicenter Study ID - 10.1002/pds.1658 [doi] PP - ppublish LG - English DP - 2008 Nov EZ - 2008/09/23 09:00 DA - 2008/12/17 09:00 DT - 2008/09/23 09:00 YR - 2008 ED - 20081211 RD - 20081029 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18803336 <601. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18821494 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Courtney J AU - Boyer E FA - Courtney, James FA - Boyer, Edward IN - Courtney, James. Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, Worcester, MA 01655, USA. jcourtn@gmail.com TI - Case files of the University of Massachusetts fellowship in medical toxicology: lethal dose of opioids contained in an elastomeric capsule labeled as vancomycin. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 4(3):192-6, 2008 Sep AS - J Med Toxicol. 4(3):192-6, 2008 Sep NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 4 IP - 3 PG - 192-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550037 SB - Index Medicus CP - United States MH - Aged MH - *Analgesics, Opioid/po [Poisoning] MH - *Anti-Bacterial Agents MH - Capsules MH - Drug Contamination MH - *Drug Labeling MH - Drug Packaging MH - Heroin/ch [Chemistry] MH - Heroin/pk [Pharmacokinetics] MH - Heroin/po [Poisoning] MH - Home Infusion Therapy MH - Humans MH - Male MH - *Medication Errors MH - Respiratory Insufficiency/ci [Chemically Induced] MH - Respiratory Insufficiency/th [Therapy] MH - *Vancomycin AB - UNLABELLED: A 67 year-old male presented to the emergency department with alteration in mental status. On arrival he had vital signs: pulse 110, BP 173/83, respiratory rate 4, oxygen saturation 57% and temperature 36.1 degrees Celsius. His past medical history included hypertension, vitamin B12 deficiency, hyperlipidemia, and recurrent cellulitis treated with vancomycin. The patient had no response to noxious stimuli, pinpoint pupils, and agonal respirations. Secondary to his wife's vehement denial that he had access to or history of using any narcotics, he was intubated after 2.2mg IV naloxone failed to reverse respiratory depression. Thirty minutes before presentation, however, he had received an intravenous infusion of vancomycin administered by his wife at home. The vancomycin, obtained from a home infusion medication supply company, was contained in one of five sealed elastomeric capsules delivered earlier that day. A qualitative comprehensive toxicology screen of urine for 1043 substances identified morphine, codeine, naloxone, lidocaine and caffeine. The original elastomeric container was not available for testing, but another container from the same delivery was submitted for testing to the state forensic laboratory. This intact container was labeled as Vancomycin 1g in 240mL of normal saline. The forensic laboratory confirmed that the alkaloidal contents of the elastomeric capsule were 10% codeine, 4.4% 6-monoacetyl morphine, and 84% morphine. No vancomycin was identified in the infusion bottles. The case was referred to the local police department and the state department of health drug control board. The home infusion company was also immediately notified to prevent similar occurrence. AB - CONCLUSION: We are reporting the first known case of opioid overdose from an adulterated elastomeric capsule that was labeled as containing an antimicrobial agent. RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Bacterial Agents) RN - 0 (Capsules) RN - 6Q205EH1VU (Vancomycin) RN - 70D95007SX (Heroin) IS - 1556-9039 IL - 1556-9039 PT - Case Reports PT - Journal Article ID - PMC3550037 [pmc] PP - ppublish LG - English DP - 2008 Sep EZ - 2008/09/30 09:00 DA - 2008/11/05 09:00 DT - 2008/09/30 09:00 YR - 2008 ED - 20081104 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18821494 <602. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18692733 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barker K AU - Hunjadi D FA - Barker, Karen FA - Hunjadi, Don IN - Barker, Karen. Gateway Technical College, Burlington, WI, USA. barkerk@gtc.edu TI - Meet Narcan. The amazing drug that helps save overdose patients. CM - Comment in: JEMS. 2009 Jan;34(1):20; PMID: 19245950 SO - Journal of Emergency Medical Services. 33(8):72-6, 2008 Aug AS - J Emerg Med Serv JEMS. 33(8):72-6, 2008 Aug NJ - JEMS : a journal of emergency medical services VO - 33 IP - 8 PG - 72-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services MH - Humans MH - Naloxone/ae [Adverse Effects] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ae [Adverse Effects] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Narcotics/ae [Adverse Effects] AB - They wake the unconscious, cure the very ill and even rescue patients from death's door. They're miracle drugs, and thousands of ambulance services across the country carry them. For those onlookers and new EMS providers who see a patient wake up from a deep, unconscious state, it's a captivating experience. The most common of these drugs is dextrose. But there's another--meet Narcan. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 DO - https://dx.doi.org/10.1016/S0197-2510(08)70292-4 PT - Journal Article ID - S0197-2510(08)70292-4 [pii] ID - 10.1016/S0197-2510(08)70292-4 [doi] PP - ppublish LG - English DP - 2008 Aug EZ - 2008/08/12 09:00 DA - 2008/10/22 09:00 DT - 2008/08/12 09:00 YR - 2008 ED - 20081021 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18692733 <603. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18608263 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Manoguerra AS AU - Erdman AR AU - Woolf AD AU - Chyka PA AU - Caravati EM AU - Scharman EJ AU - Booze LL AU - Christianson G AU - Nelson LS AU - Cobaugh DJ AU - Troutman WG AU - American Association of Poison Control Centers FA - Manoguerra, Anthony S FA - Erdman, Andrew R FA - Woolf, Alan D FA - Chyka, Peter A FA - Caravati, E Martin FA - Scharman, Elizabeth J FA - Booze, Lisa L FA - Christianson, Gwenn FA - Nelson, Lewis S FA - Cobaugh, Daniel J FA - Troutman, William G FA - American Association of Poison Control Centers IN - Manoguerra, Anthony S. American Association of Poison Control Centers, Washington, District of Columbia 20016, USA. IR - Booze LL IR - Caravati EM IR - Christianson G IR - Chyka PA IR - Cobaugh DJ IR - Keyes DC IR - Manoguerra AS IR - Nelson LS IR - Scharman EJ IR - Wax PM IR - Woolf AD TI - Valproic acid poisoning: an evidence-based consensus guideline for out-of-hospital management. [Review] [85 refs] SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 46(7):661-76, 2008 Aug AS - Clin Toxicol (Phila). 46(7):661-76, 2008 Aug NJ - Clinical toxicology (Philadelphia, Pa.) VO - 46 IP - 7 PG - 661-76 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Ambulatory Care/mt [Methods] MH - Antidotes/ad [Administration & Dosage] MH - Charcoal/ad [Administration & Dosage] MH - Drug Overdose MH - Humans MH - Poison Control Centers/st [Standards] MH - Poisoning/th [Therapy] MH - Practice Guidelines as Topic MH - *Valproic Acid/po [Poisoning] AB - A review of US poison center data for 2004 showed over 9000 ingestions of valproic acid. A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected ingestion of valproic acid by 1) describing the process by which an ingestion of valproic acid might be managed, 2) identifying the key decision elements in managing cases of valproic acid ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to the acute ingestion and acute-on-chronic ingestion of immediate-release and extended-release dosage forms of valproic acid, divalproex, and valproate sodium alone. Co-ingestion of additional substances could require different referral and management recommendations depending on the combined toxicities of the substances. This review focuses on the ingestion of more than a single therapeutic dose and the effects of an overdose. Although therapeutic doses of valproic acid can cause adverse effects in adults and children, some idiosyncratic and some dose-dependent, these cases are not considered. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions might be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) All patients with suicidal intent, intentional abuse, or in whom a malicious intent is suspected (e.g., child abuse or neglect) should be referred to an emergency department (Grade D). 2) Patients who are symptomatic (more than somnolence or exhibiting coma or seizures) after a valproic acid ingestion should be referred to an emergency department (Grade C). 3) Asymptomatic patients with an unintentional acute ingestion of 50 mg/kg or more or asymptomatic patients who are taking the drug therapeutically and who take an additional single acute ingestion of 50 mg/kg or more of any valproic acid formulation should be referred to an emergency department for evaluation (Grade C). 4) Patients with unintentional ingestions of immediate-release valproic acid formulations, who are asymptomatic, and more than 6 hours has elapsed since the time of ingestion, can be observed at home (Grade C). 5) Patients with unintentional ingestions of delayed-release or extended-release formulations of valproic acid who are asymptomatic, and more than 12 hours has elapsed since the time of ingestion, can be observed at home (Grade C). 6) Pregnant women who ingest below the dose for emergency department referral and do not have other referral conditions should be directed to their primary care obstetrical provider for evaluation of potential maternal and fetal risk. Routine referral to an emergency department for immediate care is not required (Grade D). 7) Do not induce emesis (Grade C). 8) Activated charcoal can be administered to asymptomatic patients who have ingested valproic acid within the preceding hour (Grade C). Prehospital activated charcoal administration, if available, should only be carried out by health professionals and only if no contraindications are present. Poison centers should follow local protocols and experience with its use. Do not delay transportation in order to administer activated charcoal (Grades D). 9) In patients who have ingested valproic acid and who are comatose, naloxone can be considered for prehospital administration in the doses used for treatment of opioid overdose, particularly if the patient has respiratory depression (Grade C). 10) A benzodiazepine can be administered by EMS personnel if convulsions are present and if authorized by EMS medical direction, expressed by written treatment protocol or policy, or if there is direct medical oversight (Grade C). [References: 85] RN - 0 (Antidotes) RN - 16291-96-6 (Charcoal) RN - 614OI1Z5WI (Valproic Acid) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.1080/15563650802178136 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PT - Review ID - 794092047 [pii] ID - 10.1080/15563650802178136 [doi] PP - ppublish GI - No: 8 U4BHS00084 Organization: *PHS HHS* Country: United States LG - English DP - 2008 Aug EZ - 2008/07/09 09:00 DA - 2008/10/22 09:00 DT - 2008/07/09 09:00 YR - 2008 ED - 20081021 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18608263 <604. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18774063 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Isenberg D AU - Wong SC AU - Curtis JA FA - Isenberg, Derek FA - Wong, Stella C FA - Curtis, John A IN - Isenberg, Derek. Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, USA. disenber@drexelmed.edu TI - Serotonin syndrome triggered by a single dose of suboxone. SO - American Journal of Emergency Medicine. 26(7):840.e3-5, 2008 Sep AS - Am J Emerg Med. 26(7):840.e3-5, 2008 Sep NJ - The American journal of emergency medicine VO - 26 IP - 7 PG - 840.e3-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Buprenorphine/ae [Adverse Effects] MH - Buprenorphine, Naloxone Drug Combination MH - Cyproheptadine/tu [Therapeutic Use] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - Serotonin Antagonists/tu [Therapeutic Use] MH - *Serotonin Syndrome/ci [Chemically Induced] MH - Serotonin Syndrome/dt [Drug Therapy] MH - *Serotonin Syndrome/pp [Physiopathology] AB - Suboxone (buprenorphine/naloxone) is an oral medication used for the treatment of opiate dependence. Because of its mixed properties at the opiate receptors, buprenorphine has a ceiling on its euphoric effects. We report the first case of serotonin syndrome caused by buprenorphine and review other medications implicated in serotonin syndrome. A 54-year-old man on tricyclic antidepressants took an unprescribed dose of buprenorphine/naloxone. He presented to the emergency department with signs and symptoms of severe serotonin syndrome including clonus, agitation, and altered mental status. His agitation was not controlled with benzodiazepines and was electively intubated. At the recommendation of the toxicology service, cyproheptadine, a serotonin receptor antagonist, was administered with improvement in the patient's symptoms. Emergency physicians should be aware of the potential of buprenorphine/naloxone to trigger serotonin syndrome. RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - 0 (Narcotic Antagonists) RN - 0 (Serotonin Antagonists) RN - 2YHB6175DO (Cyproheptadine) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) ES - 1532-8171 IL - 0735-6757 DO - https://dx.doi.org/10.1016/j.ajem.2008.01.039 PT - Case Reports PT - Journal Article ID - S0735-6757(08)00118-6 [pii] ID - 10.1016/j.ajem.2008.01.039 [doi] PP - ppublish PH - 2007/12/27 [received] PH - 2008/01/27 [accepted] LG - English DP - 2008 Sep EZ - 2008/09/09 09:00 DA - 2008/09/25 09:00 DT - 2008/09/09 09:00 YR - 2008 ED - 20080924 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18774063 <605. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18717147 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hon KL AU - Ho JK AU - Hung EC AU - Cheung KL AU - Ng PC FA - Hon, Kam-Lun Ellis FA - Ho, Jasperine Ka-Yee FA - Hung, Emily Chi-Wan FA - Cheung, Kam-Lau FA - Ng, Pak-Cheung IN - Hon, Kam-Lun Ellis. Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, People's Republic of China. ehon@cuhk.edu.hk TI - Poisoning necessitating pediatric ICU admissions: size of pupils does matter. SO - Journal of the National Medical Association. 100(8):952-6, 2008 Aug AS - J Natl Med Assoc. 100(8):952-6, 2008 Aug NJ - Journal of the National Medical Association VO - 100 IP - 8 PG - 952-6 PI - Journal available in: Print PI - Citation processed from: Print JC - j9z, 7503090 IO - J Natl Med Assoc SB - Index Medicus CP - United States MH - *Central Nervous System Depressants/po [Poisoning] MH - Child MH - Child, Preschool MH - Drug Overdose/di [Diagnosis] MH - Female MH - Humans MH - Infant MH - Infant, Newborn MH - Intensive Care Units, Pediatric MH - Male MH - *Methadone/po [Poisoning] MH - *Neuromuscular Depolarizing Agents/po [Poisoning] MH - Patient Admission MH - *Phenobarbital/po [Poisoning] MH - *Pupil/de [Drug Effects] AB - INTRODUCTION: Childhood poisonings are common, but usually trivial, and infrequently necessitate intensive care unit (ICU) admissions. AB - METHODS: A retrospective record review was conducted to analyze the pattern of severe poisoning-associated ICU admissions at a teaching hospital between May 2002 and December 2007. AB - RESULTS: Six cases (4 boys and 2 girls, aged 2 months to 11 years) of drug poisoning-associated ICU admissions were identified. Methadone was the culprit in 3 boys and 1 girl, resulting in respiratory failure, depressed conscious state and pinpoint pupils. As relevant exposure history was not immediately apparent, diagnosis at the emergency department was only made correctly in 2 patients. Phenobarbitone overdose occurred in 1 girl with past history of phenobarbitone overdose as a clue. She was also considered to have pinpoint pupils that were unresponsive to naloxone. Features consistent with cholinergic toxidrome, including small pupils, and increased secretion occurred in an infant fed with milk prepared with an herbal broth suspected to have been adulterated with a pesticide. Atropine as an antidote was used when the child was in the pediatric ICU. All children made an uneventful recovery following their short ICU stay. AB - CONCLUSIONS: Life-threatening poisonings requiring ICU support can pose diagnostic difficulties and challenges to frontline medical officers at the emergency department. Children from all age groups can be affected. Prompt diagnosis is based on relevant history, careful clinical examination and a high index of suspicion in patients known to be at risk. The pupillary size and its reaction following treatment serves as an important diagnostic clue. RN - 0 (Central Nervous System Depressants) RN - 0 (Neuromuscular Depolarizing Agents) RN - UC6VBE7V1Z (Methadone) RN - YQE403BP4D (Phenobarbital) IS - 0027-9684 IL - 0027-9684 PT - Case Reports PT - Journal Article ID - S0027-9684(15)31411-5 [pii] PP - ppublish LG - English DP - 2008 Aug EZ - 2008/08/23 09:00 DA - 2008/09/20 09:00 DT - 2008/08/23 09:00 YR - 2008 ED - 20080919 RD - 20151225 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18717147 <606. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18638337 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Menahem S FA - Menahem, Samuel TI - Re: Naloxone use in neonatal resuscitation. CM - Comment on: J Paediatr Child Health. 2007 Dec;43(12):795-8; PMID: 17803674 SO - Journal of Paediatrics & Child Health. 44(7-8):467; author reply 467, 2008 Jul-Aug AS - J Paediatr Child Health. 44(7-8):467; author reply 467, 2008 Jul-Aug NJ - Journal of paediatrics and child health VO - 44 IP - 7-8 PG - 467; author reply 467 PI - Journal available in: Print PI - Citation processed from: Internet JC - arp, 9005421 IO - J Paediatr Child Health SB - Index Medicus CP - Australia MH - Female MH - Humans MH - Infant, Newborn MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Pregnancy MH - Respiration/de [Drug Effects] MH - *Resuscitation RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) ES - 1440-1754 IL - 1034-4810 DO - https://dx.doi.org/10.1111/j.1440-1754.2008.01342.x PT - Comment PT - Letter ID - JPC1342 [pii] ID - 10.1111/j.1440-1754.2008.01342.x [doi] PP - ppublish LG - English DP - 2008 Jul-Aug EZ - 2008/07/22 09:00 DA - 2008/08/30 09:00 DT - 2008/07/22 09:00 YR - 2008 ED - 20080828 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18638337 <607. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18207625 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Drabek T AU - Han F AU - Garman RH AU - Stezoski J AU - Tisherman SA AU - Stezoski SW AU - Morhard RC AU - Kochanek PM FA - Drabek, Tomas FA - Han, Fei FA - Garman, Robert H FA - Stezoski, Jason FA - Tisherman, Samuel A FA - Stezoski, S William FA - Morhard, Ryan C FA - Kochanek, Patrick M IN - Drabek, Tomas. Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States. drabekt@anes.upmc.edu TI - Assessment of the delta opioid agonist DADLE in a rat model of lethal hemorrhage treated by emergency preservation and resuscitation. CM - Comment in: Resuscitation. 2009 Nov;80(11):1330-1; author reply 1331-2; PMID: 19740586 SO - Resuscitation. 77(2):220-8, 2008 May AS - Resuscitation. 77(2):220-8, 2008 May NJ - Resuscitation VO - 77 IP - 2 PG - 220-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Animals MH - *Cardiopulmonary Bypass MH - Disease Models, Animal MH - *Enkephalin, Leucine-2-Alanine/pd [Pharmacology] MH - *Hypothermia, Induced MH - Male MH - Random Allocation MH - Rats MH - Rats, Sprague-Dawley MH - *Resuscitation/mt [Methods] MH - *Shock, Hemorrhagic/th [Therapy] MH - Statistics, Nonparametric MH - Survival Rate AB - Emergency preservation and resuscitation (EPR) is a new approach for resuscitation of exsanguination cardiac arrest (CA) victims. EPR uses a cold aortic flush to induce deep hypothermic preservation during no-flow to buy time for transport and damage control surgery, followed by resuscitation with cardiopulmonary bypass (CPB). We reported previously that 20-60 min EPR in rats was associated with intact outcome, while 75 min EPR resulted in high mortality and neurological impairment in survivors. The delta opioid agonist DADLE ([D-Ala(2),D-Leu(5)]-enkephalin) was shown previously to be protective against ischemia-reperfusion injury in multiple organs, including brain. We hypothesized that DADLE could augment neurological outcome after EPR in rats. After rapid lethal hemorrhage, EPR was initiated by perfusion with ice-cold crystalloid to induce hypothermia (15 degrees C). After 75 min EPR, resuscitation was attempted with CPB. After randomization, three groups were studied (n=10 per group): DADLE 0mg/kg (D0), 4 mg/kg (D4) or 10mg/kg (D10) added to the flush and during reperfusion. Survival, overall performance category (OPC; 1=normal, 5=death), neurological deficit score (NDS; 0-10% normal, 100%=max deficit), and histological damage score (HDS) were assessed in survivors on day 3. In D0 group, 2/10 rats survived, while in D4 and D10 groups, 4/10 and 5/10 rats survived, respectively (p=NS). Survival time (h) was 26.7+/-28.2 in D0, 36.3+/-31.9 in D4 and 47.1+/-30.3 in D10 groups, respectively (p=0.3). OPC, NDS and HDS were not significantly different between groups. In conclusion, DADLE failed to confer benefit on functional or histological outcome in our model of prolonged rat EPR. RN - 63631-40-3 (Enkephalin, Leucine-2-Alanine) IS - 0300-9572 IL - 0300-9572 DO - https://dx.doi.org/10.1016/j.resuscitation.2007.11.020 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0300-9572(07)00634-X [pii] ID - 10.1016/j.resuscitation.2007.11.020 [doi] PP - ppublish PH - 2007/08/20 [received] PH - 2007/11/03 [revised] PH - 2007/11/12 [accepted] LG - English EP - 20080118 DP - 2008 May EZ - 2008/01/22 09:00 DA - 2008/08/30 09:00 DT - 2008/01/22 09:00 YR - 2008 ED - 20080826 RD - 20091027 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18207625 <608. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18422830 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Green TC AU - Heimer R AU - Grau LE FA - Green, Traci C FA - Heimer, Robert FA - Grau, Lauretta E IN - Green, Traci C. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA. traci.c.green@yale.edu TI - Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. SO - Addiction. 103(6):979-89, 2008 Jun AS - Addiction. 103(6):979-89, 2008 Jun NJ - Addiction (Abingdon, England) VO - 103 IP - 6 PG - 979-89 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - bm3, 9304118 IO - Addiction PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163671 OI - Source: NLM. NIHMS293269 SB - Index Medicus CP - England MH - Clinical Competence MH - Diagnosis, Differential MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Treatment/mt [Methods] MH - Emergency Treatment/st [Standards] MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Male MH - Multivariate Analysis MH - Naloxone/sd [Supply & Distribution] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/sd [Supply & Distribution] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Program Evaluation AB - AIMS: This study assessed overdose and naloxone administration knowledge among current or former opioid abusers trained and untrained in overdose-response in the United States. AB - DESIGN AND PARTICIPANTS: Ten individuals, divided equally between those trained or not trained in overdose recognition and response, were recruited from each of six sites (n = 62). AB - SETTING: US-based overdose training and naloxone distribution programs in Baltimore, San Francisco, Chicago, New York and New Mexico. AB - MEASUREMENTS: Participants completed a brief questionnaire on overdose knowledge that included the task of rating 16 putative overdose scenarios for: (i) whether an overdose was occurring and (ii) if naloxone was indicated. Bivariate and multivariable analyses compared results for those trained to untrained. Responses were also compared to those of 11 medical experts using weighted and unweighted kappa statistics. AB - FINDINGS: Respondents were primarily male (72.6%); 45.8% had experienced an overdose and 72% had ever witnessed an overdose. Trained participants recognized more opioid overdose scenarios accurately (t(60) = 3.76, P < 0.001) and instances where naloxone was indicated (t(59) = 2.2, P < 0.05) than did untrained participants. Receipt of training and higher perceived competency in recognizing signs of an opioid overdose were associated independently with higher overdose recognition scores. Trained respondents were as skilled as medical experts in recognizing opioid overdose situations (weighted kappa = 0.85) and when naloxone was indicated (kappa = 1.0). AB - CONCLUSIONS: Results suggest that naloxone training programs in the United States improve participants' ability to recognize and respond to opioid overdoses in the community. Drug users with overdose training and confidence in their abilities to respond may effectively prevent overdose mortality. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0965-2140 IL - 0965-2140 DO - https://dx.doi.org/10.1111/j.1360-0443.2008.02182.x PT - Comparative Study PT - Evaluation Studies PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural ID - ADD2182 [pii] ID - 10.1111/j.1360-0443.2008.02182.x [doi] ID - PMC3163671 [pmc] ID - NIHMS293269 [mid] PP - ppublish GI - No: T32 MH020031 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: T32 MH020031-07 Organization: (MH) *NIMH NIH HHS* Country: United States GI - No: 5T32MH020031 Organization: (MH) *NIMH NIH HHS* Country: United States LG - English EP - 20080416 DP - 2008 Jun EZ - 2008/04/22 09:00 DA - 2008/08/15 09:00 DT - 2008/04/22 09:00 YR - 2008 ED - 20080814 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18422830 <609. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18355425 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Galicia M AU - Nogue S AU - To-Figueras J AU - Echarte JL AU - Iglesias ML AU - Miro O FA - Galicia, Miguel FA - Nogue, Santiago FA - To-Figueras, Jordi FA - Echarte, Jose-Luis FA - Iglesias, M Luisa FA - Miro, Oscar IN - Galicia, Miguel. Servicio de Urgencias, Hospital Clinic, Barcelona, Espana. miguelgaliciap@hotmail.com TI - [Poisoning by liquid ecstasy (GHB) in hospital emergency departments of Barcelona: a 2-years study]. [Spanish] OT - Intoxicaciones por extasis liquido atendidas en servicios de urgencias hospitalarios de la ciudad de Barcelona durante 2 anos. SO - Medicina Clinica. 130(7):254-8, 2008 Mar 01 AS - Med Clin (Barc). 130(7):254-8, 2008 Mar 01 NJ - Medicina clinica VO - 130 IP - 7 PG - 254-8 PI - Journal available in: Print PI - Citation processed from: Print JC - ltq, 0376377 IO - Med Clin (Barc) SB - Index Medicus CP - Spain MH - Adolescent MH - Adult MH - Emergencies MH - Emergency Service, Hospital MH - Female MH - *Hallucinogens/po [Poisoning] MH - Humans MH - Male MH - Middle Aged MH - *N-Methyl-3,4-methylenedioxyamphetamine/po [Poisoning] MH - Poisoning/di [Diagnosis] MH - Poisoning/ep [Epidemiology] MH - Spain MH - Time Factors AB - BACKGROUND AND OBJECTIVE: Liquid ecstasy (GHB) is a new cause of drug overdose in our country. To describe the epidemiological profile and clinical manifestations, we analyzed cases of poisoning by GHB attended by the Emergency Departments (ED) of 2 hospitals of the city of Barcelona. AB - PATIENTS AND METHOD: During two years (2003-2004) all cases of poisoning or overdose due to GHB attended in the ED of the Hospital del Mar and the Hospital Clinic of Barcelona were collected. The diagnosis was clinical and/or by means of toxicological analysis. Epidemiological, clinical, laboratory and therapeutic variables as well as the evolution were collected. AB - RESULTS: A total of 339 patients (mean age 23.5 years, 62% male) were identified. Most patients (89%) were admitted during the early morning and during weekends (89%). Symptoms began in a public place in 97%. Reduced consciousness was the most important clinical manifestation, since 72% of patients had a Glasgow Coma Score of 12 or less. Seventy per cent stated having consumed GHB with other drugs, mainly ethyl alcohol (53%) and cocaine (16%). Some form of treatment was required in 32% of cases and 20 cases were administered an antidote: naloxone (12 cases), flumazenil (8 cases) and physostigmine (6 cases). Five patients needed orotracheal intubation and ventilatory support. One patient needed advanced vital support. There were no deaths. AB - CONCLUSIONS: GHB intoxication leading to reduced consciousness is a frequent motive for admission to the ED, mostly in young people and in the early morning during the weekend. GHB intoxication should be discarded in all cases of coma of unknown origin. RN - 0 (Hallucinogens) RN - KE1SEN21RM (N-Methyl-3,4-methylenedioxyamphetamine) IS - 0025-7753 IL - 0025-7753 PT - English Abstract PT - Journal Article ID - S0025-7753(08)71415-5 [pii] PP - ppublish LG - Spanish DP - 2008 Mar 01 EZ - 2008/03/22 09:00 DA - 2008/08/12 09:00 DT - 2008/03/22 09:00 YR - 2008 ED - 20080811 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18355425 <610. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18443641 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Manchikanti L AU - Singh A FA - Manchikanti, Laxmaiah FA - Singh, Angelie IN - Manchikanti, Laxmaiah. Pain Management Center of Paducah, KY 42003, USA. drlm@thepainmd.com TI - Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. [Review] [94 refs] SO - Pain Physician. 11(2 Suppl):S63-88, 2008 Mar AS - Pain physician. 11(2 Suppl):S63-88, 2008 Mar NJ - Pain physician VO - 11 IP - 2 Suppl PG - S63-88 PI - Journal available in: Print PI - Citation processed from: Print JC - 100954394 IO - Pain Physician SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Drug Prescriptions MH - Forensic Medicine MH - Humans MH - Hydrocodone MH - Methadone MH - Oxycodone MH - Risk Assessment MH - Substance Abuse Detection/mt [Methods] MH - Substance Abuse Detection/sn [Statistics & Numerical Data] MH - *Substance-Related Disorders/ep [Epidemiology] MH - United States/ep [Epidemiology] AB - Therapeutic opioid use and abuse coupled with the nonmedical use of other psychotherapeutic drugs has shown an explosive growth in recent years and has been a topic of great concern and controversy. Americans, constituting only 4.6% of the world's population, have been consuming 80% of the global opioid supply, and 99% of the global hydrocodone supply, as well as two-thirds of the world's illegal drugs. With the increasing therapeutic use of opioids, the supply and retail sales of opioids are mirrored by increasing abuse in patients receiving opioids, nonmedical use of other psychotherapeutic drugs (in this article the category of psychotherapeutics includes pain relievers, tranquilizers, stimulants, and sedatives, but does not include over-the-counter drugs), emergency department visits for prescription controlled drugs, exploding costs, increasing incidence of side effects, and unintentional deaths. However, all these ills of illicit drug use and opioid use, abuse, and non-medical use do not stop with adults. It has been shown that 80% of America's high school students, or 11 million teens, and 44% of middle school students, or 5 million teens, have personally witnessed, on the grounds of their schools, illegal drug use, illegal drug dealing, illegal drug possession, and other activities related to drug abuse. The results of the 2006 National Survey on Drug Use and Health showed that 7.0 million or 2.8% of all persons aged 12 or older had used prescription type psychotherapeutic drugs nonmedically in the past month, 16.387 million, or 6.6% of the population, had used in the past year, and 20.3%, or almost 49.8 million, had used prescription psychotherapeutic drugs nonmedically during their lifetime. Sadly, the initiates of psychotherapeutic drugs used for nonmedical purposes were highest for opioids. Therapeutic opioid use has increased substantially, specifically of Schedule II drugs. Apart from lack of effectiveness (except for short-term, acute pain) there are multiple adverse consequences including hormonal and immune system effects, abuse and addiction, tolerance, and hyperalgesia. Patients on long-term opioid use have been shown to increase the overall cost of healthcare, disability, rates of surgery, and late opioid use. [References: 94] RN - 0 (Analgesics, Opioid) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - CD35PMG570 (Oxycodone) RN - UC6VBE7V1Z (Methadone) IS - 1533-3159 IL - 1533-3159 PT - Journal Article PT - Review PP - ppublish LG - English DP - 2008 Mar EZ - 2008/06/17 09:00 DA - 2008/08/06 09:00 DT - 2008/06/17 09:00 YR - 2008 ED - 20080805 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18443641 <611. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18584361 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schumann H AU - Erickson T AU - Thompson TM AU - Zautcke JL AU - Denton JS FA - Schumann, Heather FA - Erickson, Tim FA - Thompson, Trevonne M FA - Zautcke, John L FA - Denton, J Scott IN - Schumann, Heather. Department of Pharmacy Practice, University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois 60612, USA. heather.eyrich@gmail.com TI - Fentanyl epidemic in Chicago, Illinois and surrounding Cook County. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 46(6):501-6, 2008 Jul AS - Clin Toxicol (Phila). 46(6):501-6, 2008 Jul NJ - Clinical toxicology (Philadelphia, Pa.) VO - 46 IP - 6 PG - 501-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adult MH - Cause of Death/td [Trends] MH - Coroners and Medical Examiners MH - Databases, Factual MH - Drug Overdose MH - Emergency Service, Hospital MH - Female MH - *Fentanyl/po [Poisoning] MH - Forensic Toxicology MH - Humans MH - Illinois/ep [Epidemiology] MH - Male MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Retrospective Studies MH - *Street Drugs/po [Poisoning] MH - Transportation of Patients AB - INTRODUCTION: Epidemics related to illicit fentanyl abuse have been reported and the potential exists for a national epidemic associated with high mortality. This report describes emergency department visits for opioid toxicity and a recent outbreak of illicit fentanyl fatalities in Chicago, Illinois and surrounding Cook County. AB - METHODS: Retrospective chart review of opioid-related overdoses seen in our emergency department and a retrospective review of data from the Cook County Medical Examiner's Office Fentanyl Fatality Database from April 2005 through December 2006. AB - RESULTS: Our emergency department treated 43 patients with a total of 55 emergency department visits during this time. Paramedic transport was utilized for 83.6% of the emergency department visits and naloxone was administered during 80.4% of transports. Naloxone was administered during 47.3% of emergency department visits with total doses ranging from 0.4 mg to 12 mg. Eighty percent of cases were treated and discharged from the emergency department. During this same time frame, the Medical Examiner's office identified 342 fentanyl-related fatalities. In 2006, illicit fentanyl fatalities represented 6.9% of all Medical Examiner cases for that year. Approximately 80% of deaths occurred in Chicago. A peak in fentanyl-related deaths occurred in the spring of 2006 and again in the fall of 2006 while the number of emergency department visits peaked during May of 2006. AB - CONCLUSION: Chicago and surrounding Cook County experienced an outbreak of 342 fentanyl-related deaths between April 2005 and December 2006. The experience demonstrated a clear need for an interdisciplinary approach to identifying, communicating, and managing an outbreak. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 0 (Street Drugs) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) ES - 1556-9519 IL - 1556-3650 DO - https://dx.doi.org/10.1080/15563650701877374 PT - Journal Article ID - 793381995 [pii] ID - 10.1080/15563650701877374 [doi] PP - ppublish LG - English DP - 2008 Jul EZ - 2008/06/28 09:00 DA - 2008/07/17 09:00 DT - 2008/06/28 09:00 YR - 2008 ED - 20080715 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18584361 <612. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18551883 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wisniewski AM AU - Purdy CH AU - Blondell RD FA - Wisniewski, Angela M FA - Purdy, Christopher H FA - Blondell, Richard D IN - Wisniewski, Angela M. University at Buffalo, School of Medicine and Biomedical Sciences. Department of Family Medicine, Family Medicine Research Institute, 462 Grider Street, Room CC-191, Buffalo, NY 14215, USA. amw25@buffalo.edu TI - The epidemiologic association between opioid prescribing, non-medical use, and emergency department visits. SO - Journal of Addictive Diseases. 27(1):1-11, 2008 AS - J Addict Dis. 27(1):1-11, 2008 NJ - Journal of addictive diseases VO - 27 IP - 1 PG - 1-11 PI - Journal available in: Print PI - Citation processed from: Print JC - a0y, 9107051 IO - J Addict Dis SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - *Analgesics, Opioid/po [Poisoning] MH - *Analgesics, Opioid/sd [Supply & Distribution] MH - *Drug Overdose/ep [Epidemiology] MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Health Surveys MH - Humans MH - Hydrocodone/po [Poisoning] MH - Hydrocodone/sd [Supply & Distribution] MH - Male MH - Middle Aged MH - Morphine/po [Poisoning] MH - Morphine/sd [Supply & Distribution] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Oxycodone/po [Poisoning] MH - Oxycodone/sd [Supply & Distribution] MH - Statistics as Topic MH - United States MH - Utilization Review/sn [Statistics & Numerical Data] AB - INTRODUCTION: Since the 1990s prescriptions for and the non-medical use of opioids have increased. This study examines associations between opioid prescribing, non-medical use, and emergency department (ED) visits. AB - METHODS: Data were abstracted from four federally sponsored, nationally representative, annual surveys (National Hospital Ambulatory Medical Care Survey, National Ambulatory Medical Care Survey, National Survey on Drug Use and Health, and Drug Abuse Warning Network). AB - RESULTS: For hydrocodone and oxycodone, associations between prescribing and non-medical use, and prescribing and ED visits were statistically significant (p-values < 0.04) and strongly associated (correlation coefficient range 0.73 to 0.87). Male gender, White race, and age > or = 35 were all statistically significant (p-values < 0.0001) predictors of receiving a hydrocodone or oxycodone-containing prescription. AB - CONCLUSION: The increased number of prescriptions written for hydrocodone and oxycodone between 1995 and 2004 was associated with similar increases in non-medical use and the number of ED visits during this time period. RN - 0 (Analgesics, Opioid) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - 76I7G6D29C (Morphine) RN - CD35PMG570 (Oxycodone) IS - 1055-0887 IL - 1055-0887 DO - https://dx.doi.org/10.1300/J069v27n01_01 PT - Journal Article ID - 10.1300/J069v27n01_01 [doi] PP - ppublish LG - English DP - 2008 EZ - 2008/06/17 09:00 DA - 2008/07/09 09:00 DT - 2008/06/17 09:00 YR - 2008 ED - 20080708 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18551883 <613. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18534286 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gammon DL AU - Su S AU - Jordan J AU - Patterson R AU - Finley PJ AU - Lowe C AU - Huckfeldt R FA - Gammon, Dustin L FA - Su, Shujun FA - Jordan, Janet FA - Patterson, Robert FA - Finley, Phillip J FA - Lowe, Cindy FA - Huckfeldt, Roger IN - Gammon, Dustin L. St. John's Emergency Medical Services, Springfield, MO 65804, USA. dustin.gammon@mercy.net TI - Alteration in prehospital drug concentration after thermal exposure. SO - American Journal of Emergency Medicine. 26(5):566-73, 2008 Jun AS - Am J Emerg Med. 26(5):566-73, 2008 Jun NJ - The American journal of emergency medicine VO - 26 IP - 5 PG - 566-73 PI - Journal available in: Print PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Chromatography, High Pressure Liquid MH - *Drug Stability MH - Drug Storage MH - *Emergency Medical Services MH - *Hot Temperature/ae [Adverse Effects] MH - Humans MH - *Pharmaceutical Preparations MH - Spectrum Analysis AB - OBJECTIVE: The aim of the study was to determine the remaining concentration of 23 commonly carried emergency medical services medications used in the United States after they have experienced thermal extremes that have been documented in the prehospital environment for a period of 1 month. AB - METHODS: Pharmaceuticals were thermally cycled (-6 degrees C and 54 degrees C) every 12 hours and then assayed by high-performance liquid chromatography. AB - RESULTS: Eight (35%) of 23 prehospital pharmaceuticals revealed ending concentrations of less than 90% with strong correlation to thermal exposure time. These included lidocaine, diltiazem, dopamine, nitroglycerin, ipratropium, succinylcholine, haloperidol, and naloxone. AB - CONCLUSION: A decrease in concentration was found to be statistically significant in 8 (35%) of 23 commonly carried emergency medical services pharmaceuticals. These results provide new information and perspective regarding stability of emergency drugs in the prehospital environment by evaluating a broad range of pharmaceuticals as well as by using thermal exposure points that have been documented in the United States. RN - 0 (Pharmaceutical Preparations) ES - 1532-8171 IL - 0735-6757 DO - https://dx.doi.org/10.1016/j.ajem.2007.09.004 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0735-6757(07)00596-7 [pii] ID - 10.1016/j.ajem.2007.09.004 [doi] PP - ppublish PH - 2007/08/14 [received] PH - 2007/09/08 [revised] PH - 2007/09/09 [accepted] LG - English DP - 2008 Jun EZ - 2008/06/07 09:00 DA - 2008/07/02 09:00 DT - 2008/06/07 09:00 YR - 2008 ED - 20080701 RD - 20081121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18534286 <614. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18482649 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Maggiore WA FA - Maggiore, W Ann IN - Maggiore, W Ann. University of New Mexico, USA. desertrose1@wildblue.net TI - In a Delirium: patient in a post-excited state takes EMS by surprise. SO - Journal of Emergency Medical Services. 33(5):44, 2008 May AS - J Emerg Med Serv JEMS. 33(5):44, 2008 May NJ - JEMS : a journal of emergency medical services VO - 33 IP - 5 PG - 44 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - Adult MH - Delirium/di [Diagnosis] MH - *Delirium/pp [Physiopathology] MH - *Emergency Medical Services MH - Humans MH - Male MH - Naloxone/ad [Administration & Dosage] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Periodicity RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 DO - https://dx.doi.org/10.1016/S0197-2510(08)70188-8 PT - Case Reports PT - Journal Article ID - S0197-2510(08)70188-8 [pii] ID - 10.1016/S0197-2510(08)70188-8 [doi] PP - ppublish LG - English DP - 2008 May EZ - 2008/05/17 09:00 DA - 2008/07/02 09:00 DT - 2008/05/17 09:00 YR - 2008 ED - 20080701 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18482649 <615. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18468342 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Saugo M AU - Pellizzari M AU - Marcon L AU - Benetollo P AU - Toffanin R AU - Gallina P AU - Cecchetto G AU - Miccinesi G AU - Rigon S AU - Cancian M AU - Sichetti D FA - Saugo, Mario FA - Pellizzari, Michele FA - Marcon, Laura FA - Benetollo, Pierpaolo FA - Toffanin, Roberto FA - Gallina, Pietro FA - Cecchetto, Giovanna FA - Miccinesi, Guido FA - Rigon, Stefano FA - Cancian, Maurizio FA - Sichetti, Daniela IN - Saugo, Mario. Servizio Epidemiologico, ULSS 4, Italy. mario.saugo@ulss4.veneto.it TI - Impact of home care on place of death, access to emergency departments and opioid therapy in 350 terminal cancer patients. SO - Tumori. 94(1):87-95, 2008 Jan-Feb AS - Tumori. 94(1):87-95, 2008 Jan-Feb NJ - Tumori VO - 94 IP - 1 PG - 87-95 PI - Journal available in: Print PI - Citation processed from: Print JC - wjs, 0111356 IO - Tumori SB - Index Medicus CP - United States MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cause of Death MH - Cohort Studies MH - *Death MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - *Health Services Accessibility/sn [Statistics & Numerical Data] MH - *Home Care Services/ut [Utilization] MH - Humans MH - Male MH - Middle Aged MH - *Neoplasms/mo [Mortality] MH - Retrospective Studies MH - *Terminal Care/sn [Statistics & Numerical Data] RN - 0 (Analgesics, Opioid) IS - 0300-8916 IL - 0300-8916 PT - Journal Article PP - ppublish LG - English DP - 2008 Jan-Feb EZ - 2008/05/13 09:00 DA - 2008/06/11 09:00 DT - 2008/05/13 09:00 YR - 2008 ED - 20080610 RD - 20171213 UP - 20171214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=18468342 <616. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18411237 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Darnell CM AU - Thompson J AU - Stromberg D AU - Roy L AU - Sheeran P FA - Darnell, Cindy Maria FA - Thompson, Jennifer FA - Stromberg, Daniel FA - Roy, Lonnie FA - Sheeran, Paul IN - Darnell, Cindy Maria. Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA. cindy.darnell@childrens.com TI - Effect of low-dose naloxone infusion on fentanyl requirements in critically ill children. SO - Pediatrics. 121(5):e1363-71, 2008 May AS - Pediatrics. 121(5):e1363-71, 2008 May NJ - Pediatrics VO - 121 IP - 5 PG - e1363-71 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Child MH - Child, Preschool MH - *Conscious Sedation MH - *Critical Illness MH - Double-Blind Method MH - Female MH - *Fentanyl/ad [Administration & Dosage] MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - Infant MH - Infant, Newborn MH - Infusions, Intravenous MH - Intensive Care Units, Pediatric MH - Male MH - Midazolam/ad [Administration & Dosage] MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Respiration, Artificial MH - Substance Withdrawal Syndrome AB - OBJECTIVE: Sedating critically ill patients often involves prolonged opioid infusions causing opioid tolerance. Naloxone has been hypothesized to limit opioid tolerance by decreasing adenylate cyclase/cyclic adenosine monophosphate activation. The study purpose was to investigate the effect of low-dose naloxone on the maximum cumulative daily fentanyl dose in critically ill children. AB - METHODS: We conducted a double-blinded, randomized, placebo-control trial from December 2002 through July 2004 in a university PICU. We enrolled 82 children age 1 day to 18 years requiring mechanical ventilation and fentanyl infusions anticipated to last for >4 days were eligible for enrollment. Those receiving additional oral analgesia or sedation, having a history of drug dependence or withdrawal, or having significant neurologic, renal, or hepatic disease were excluded. In addition to fentanyl infusions, patients received low-dose naloxone or placebo infusions. Medications were adjusted using the Modified Motor Activity Assessment Scale. Withdrawal was monitored using the Modified Narcotic Withdrawal Scale. Intervention was a low-dose naloxone infusion (0.25 microg/kg per hour) and the main outcome variable was the maximum cumulative daily fentanyl dose (micrograms per kilogram per day). AB - RESULTS: There was no difference in the maximum cumulative daily fentanyl dose between patients treated with naloxone (N = 37) or those receiving placebo (N = 35). Adjustment for the starting fentanyl dose also failed to reveal group differences. Total fentanyl dose received throughout the study in the naloxone group (360 microg/kg) versus placebo (223 microg/kg) was not statistically different. Placebo patients trended toward fewer rescue midazolam boluses (10.7 vs 17.8), lower total midazolam dose (11.6 mg/kg vs 23.9 mg/kg), and fewer rescue fentanyl boluses (18.5 vs 23.9). AB - CONCLUSIONS: We conclude that administration of low-dose naloxone (0.25 microg/kg per hour) does not decrease fentanyl requirements in critically ill, mechanically ventilated children. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - R60L0SM5BC (Midazolam) RN - UF599785JZ (Fentanyl) ES - 1098-4275 IL - 0031-4005 DO - https://dx.doi.org/10.1542/peds.2007-1468 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - peds.2007-1468 [pii] ID - 10.1542/peds.2007-1468 [doi] PP - ppublish SI - ClinicalTrials.gov SA - ClinicalTrials.gov/NCT00286052 SL - https://clinicaltrials.gov/search/term=NCT00286052 LG - English EP - 20080414 DP - 2008 May EZ - 2008/04/16 09:00 DA - 2008/06/05 09:00 DT - 2008/04/16 09:00 YR - 2008 ED - 20080604 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18411237 <617. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18383970 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Palacio FJ AU - Ortiz-Gomez JR AU - Fornet I AU - Lopez MA AU - Morillas P FA - Palacio, F J FA - Ortiz-Gomez, J R FA - Fornet, I FA - Lopez, M A FA - Morillas, P IN - Palacio, F J. Servicio de Anestesiologia y Reanimacion, Hospital Maternal La Paz. Madrid. TI - [Remifentanil bolus for cesarean section in high-risk patients: study of 12 cases]. [Spanish] OT - Uso del remifentanilo en bolus en la cesarea de la paciente de alto riesgo: estudio sobre 12 casos. SO - Revista Espanola de Anestesiologia y Reanimacion. 55(2):86-9, 2008 Feb AS - Rev Esp Anestesiol Reanim. 55(2):86-9, 2008 Feb NJ - Revista espanola de anestesiologia y reanimacion VO - 55 IP - 2 PG - 86-9 PI - Journal available in: Print PI - Citation processed from: Print JC - rsx, 0134516 IO - Rev Esp Anestesiol Reanim SB - Index Medicus CP - Spain MH - Adult MH - *Anesthetics, Intravenous/ad [Administration & Dosage] MH - Anesthetics, Intravenous/ae [Adverse Effects] MH - Atracurium/ad [Administration & Dosage] MH - Atracurium/aa [Analogs & Derivatives] MH - *Cesarean Section MH - Female MH - Fentanyl/ad [Administration & Dosage] MH - Fetus/de [Drug Effects] MH - Fetus/pp [Physiopathology] MH - Hemodynamics/de [Drug Effects] MH - Humans MH - Infant, Newborn MH - Methyl Ethers/ad [Administration & Dosage] MH - Muscle Rigidity/ci [Chemically Induced] MH - Naloxone/tu [Therapeutic Use] MH - Nitrous Oxide/ad [Administration & Dosage] MH - *Piperidines/ad [Administration & Dosage] MH - Piperidines/ae [Adverse Effects] MH - Pregnancy MH - Pregnancy Complications MH - *Pregnancy, High-Risk MH - Propofol/ad [Administration & Dosage] MH - Resuscitation MH - Retrospective Studies MH - Succinylcholine/ad [Administration & Dosage] AB - OBJECTIVES: To evaluate the utility and safety of remifentanil for hemodynamic control during cesarean section in high-risk patients ineligible for spinal anesthesia. AB - METHODS: One minute before induction we injected a bolus of 1 microg x kg(-1) of remifentanil, followed by propofol (2.5 mg x kg(-1)), succinylcholine (1 mg x kg(-1)), cisatracurium, sevoflurane in oxygen and nitrous oxide, and fentanyl (5 microg x kg(-1)) after clamping the umbilical cord. We recorded maternal hemodynamic variables, pulse oximetry, capnography, bispectral index, and presence of muscular rigidity. In the neonate we assessed fetal wellbeing, weight, and requirement for naloxone. Hemodynamic stability was defined as no more than 15% variation in arterial pressure with respect to baseline. AB - RESULTS: Twelve patients undergoing surgery because of placenta abruptio, subarachnoid hemorrhage, HELLP syndrome, or preeclampsia were enrolled. Hemodynamic variables were consistently stable during surgery in all patients. No cases of neonatal rigidity were noted and there was no need for naloxone. The mean Apgar score was 6.42 (1.5) at 1 minute and 8.42 (0.9) at 5 minutes. AB - CONCLUSION: Bolus injection of 1 microg x kg(-1) of remifentanil may be useful for maintaining maternal hemodynamic stability in high-risk obstetric cases. Given the risk of neonatal depression, this resource should be used selectively and the means for neonatal resuscitation should be available. RN - 0 (Anesthetics, Intravenous) RN - 0 (Methyl Ethers) RN - 0 (Piperidines) RN - 2GQ1IRY63P (Atracurium) RN - 36B82AMQ7N (Naloxone) RN - 38LVP0K73A (sevoflurane) RN - J2R869A8YF (Succinylcholine) RN - K50XQU1029 (Nitrous Oxide) RN - P10582JYYK (remifentanil) RN - QX62KLI41N (cisatracurium) RN - UF599785JZ (Fentanyl) RN - YI7VU623SF (Propofol) IS - 0034-9356 IL - 0034-9356 PT - Journal Article ID - S0034-9356(08)70515-2 [pii] PP - ppublish LG - Spanish DP - 2008 Feb EZ - 2008/04/04 09:00 DA - 2008/05/24 09:00 DT - 2008/04/04 09:00 YR - 2008 ED - 20080523 RD - 20171116 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18383970 <618. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18381506 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hayes BD AU - Klein-Schwartz W AU - Doyon S FA - Hayes, Bryan D FA - Klein-Schwartz, Wendy FA - Doyon, Suzanne IN - Hayes, Bryan D. PharmD, Maryland Poison Center, University of Maryland School of Pharmacy, 220 Arch St, Office Level 1, Baltimore, MD 21201, USA. bryan_d_hayes@yahoo.com TI - Toxicity of buprenorphine overdoses in children. SO - Pediatrics. 121(4):e782-6, 2008 Apr AS - Pediatrics. 121(4):e782-6, 2008 Apr NJ - Pediatrics VO - 121 IP - 4 PG - e782-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/po [Poisoning] MH - Buprenorphine/ad [Administration & Dosage] MH - *Buprenorphine/po [Poisoning] MH - Child MH - Child, Preschool MH - Cohort Studies MH - Dose-Response Relationship, Drug MH - Drug Overdose MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Infant MH - Male MH - Poisoning/ep [Epidemiology] MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Retrospective Studies MH - Risk Assessment AB - OBJECTIVE: There are few reports in children of overdoses of buprenorphine, a partial opioid agonist used in the treatment of opioid dependence and pain. The purpose of this study was to analyze buprenorphine overdoses in young children reported by US poison centers to the Researched Abuse, Diversion, and Addiction-Related Surveillance System. AB - METHODS: A retrospective review of buprenorphine overdoses in children < 6 years of age reported to the Researched Abuse, Diversion, and Addiction-Related Surveillance System from November 2002 through December 2005 was performed. Patients lost to follow-up and those ingesting multiple substances were excluded. AB - RESULTS: Eighty-six cases met inclusion criteria. In the 54 children who developed toxicity, the clinical effects included drowsiness or lethargy (55%), vomiting (21%), miosis (21%), respiratory depression (7%), agitation or irritability (5%), pallor (3%), and coma (2%). There were no fatalities. The mean time to onset of effects was 64.2 minutes, with a range of 20 minutes to 3 hours. Duration of clinical effects was under 2 hours in 11%, 2 to 8 hours in 59%, 8 to 24 hours in 26%, and > 24 hours in 4%. Children who ingested > or = 2 mg of buprenorphine were more likely to experience clinical effects, and all of the children who ingested > 4 mg experienced some effect. No child ingesting < 4 mg experienced a severe effect. Of the 22 children administered naloxone, 67% had at least a partial response. AB - CONCLUSIONS: Buprenorphine overdoses are generally well tolerated in children, with significant central nervous system and respiratory depression occurring in only 7%. Any child ingesting > 2 mg and children < 2 years of age ingesting more than a lick or taste should be referred to the emergency department for a minimum of 6 hours of observation. Naloxone can be used to reverse respiratory depression. RN - 0 (Analgesics, Opioid) RN - 40D3SCR4GZ (Buprenorphine) ES - 1098-4275 IL - 0031-4005 DO - https://dx.doi.org/10.1542/peds.2007-1774 PT - Journal Article ID - 121/4/e782 [pii] ID - 10.1542/peds.2007-1774 [doi] PP - ppublish LG - English DP - 2008 Apr EZ - 2008/04/03 09:00 DA - 2008/05/01 09:00 DT - 2008/04/03 09:00 YR - 2008 ED - 20080430 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18381506 <619. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18413872 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Maserejian NN AU - McKinlay JB FA - Maserejian, Nancy N FA - McKinlay, John B TI - Demographic characteristics and opioid prescribing. CM - Comment on: JAMA. 2008 Jan 2;299(1):70-8; PMID: 18167408 SO - JAMA. 299(15):1773; author reply 1774, 2008 Apr 16 AS - JAMA. 299(15):1773; author reply 1774, 2008 Apr 16 NJ - JAMA VO - 299 IP - 15 PG - 1773; author reply 1774 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Utilization/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Ethnic Groups MH - Female MH - *Healthcare Disparities/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - *Pain/dt [Drug Therapy] MH - Pain/eh [Ethnology] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Socioeconomic Factors MH - United States RN - 0 (Analgesics, Opioid) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.299.15.1773-a PT - Comment PT - Letter ID - 299/15/1773 [pii] ID - 10.1001/jama.299.15.1773-a [doi] PP - ppublish LG - English DP - 2008 Apr 16 EZ - 2008/04/17 09:00 DA - 2008/04/22 09:00 DT - 2008/04/17 09:00 YR - 2008 ED - 20080421 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18413872 <620. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18413871 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Berger JT FA - Berger, Jeffrey T TI - Demographic characteristics and opioid prescribing. CM - Comment on: JAMA. 2008 Jan 2;299(1):70-8; PMID: 18167408 SO - JAMA. 299(15):1773-4; author reply 1774, 2008 Apr 16 AS - JAMA. 299(15):1773-4; author reply 1774, 2008 Apr 16 NJ - JAMA VO - 299 IP - 15 PG - 1773-4; author reply 1774 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Utilization/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Ethnic Groups MH - Female MH - *Healthcare Disparities/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - *Pain/dt [Drug Therapy] MH - Pain/eh [Ethnology] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] RN - 0 (Analgesics, Opioid) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.299.15.1773-b PT - Comment PT - Letter ID - 299/15/1773-a [pii] ID - 10.1001/jama.299.15.1773-b [doi] PP - ppublish LG - English DP - 2008 Apr 16 EZ - 2008/04/17 09:00 DA - 2008/04/22 09:00 DT - 2008/04/17 09:00 YR - 2008 ED - 20080421 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18413871 <621. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18254040 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bellu R AU - de Waal KA AU - Zanini R FA - Bellu, R FA - de Waal, K A FA - Zanini, R IN - Bellu, R. Ospedale "Manzoni" -Lecco, Neonatal Intensive Care Unit, Via Eremo 9, Lecco, Italy, 23900. r.bellu@ospedale.lecco.it TI - Opioids for neonates receiving mechanical ventilation. [Review] [57 refs][Update of Cochrane Database Syst Rev. 2005;(1):CD004212; PMID: 15674933] SO - Cochrane Database of Systematic Reviews. (1):CD004212, 2008 Jan 23 AS - Cochrane Database Syst Rev. (1):CD004212, 2008 Jan 23 NJ - The Cochrane database of systematic reviews IP - 1 PG - CD004212 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100909747 IO - Cochrane Database Syst Rev SB - Index Medicus CP - England MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Humans MH - Infant, Newborn MH - Infant, Premature MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - Pain Measurement MH - Randomized Controlled Trials as Topic MH - *Respiration, Artificial/ae [Adverse Effects] AB - BACKGROUND: Mechanical ventilation is a potentially painful and discomforting intervention widely used in neonatal intensive care units. Newborn babies (neonates) demonstrate increased sensitivity to pain, which may affect clinical and neurodevelopmental outcomes. The use of drugs that reduce pain might be important in improving survival and neurodevelopmental outcomes. AB - OBJECTIVES: To determine the effect of opioid analgesics (pain-killing drugs derived from opium e.g. morphine), compared to placebo, no drug, or other non-opioid analgesics or sedatives, on pain, duration of mechanical ventilation, mortality, growth and neurodevelopmental outcomes in newborn infants on mechanical ventilation. AB - SEARCH STRATEGY: Electronic searches included: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007); MEDLINE (1966 to June 2007); EMBASE (1974 to June 2007); and CINAHL (1982 to 2007). Previous reviews and lists of relevant articles were cross-referenced. AB - SELECTION CRITERIA: Randomised controlled trials or quasi-randomised controlled trials comparing opioids to a control, or to other analgesics or sedatives in newborn infants on mechanical ventilation. AB - DATA COLLECTION AND ANALYSIS: Data were extracted independently by two review authors. Categorical outcomes were analysed using relative risk and risk difference; and continuous outcomes with weighted mean difference or standardised mean difference. A fixed effect model was used for meta-analysis except where heterogeneity existed, in which case a random effects model was used. AB - MAIN RESULTS: Thirteen studies on 1505 infants were included. Infants given opioids showed reduced premature infant pain profile (PIPP) scores compared to the control group (weighted mean difference -1.71; 95% confidence interval -3.18 to -0.24). Differences in execution and reporting of trials mean that this meta-analysis should be interpreted with caution. Heterogeneity was significantly high in all analyses of pain, even when lower quality studies were excluded and analysis limited to very preterm newborns. Meta-analyses of mortality, duration of mechanical ventilation, and long and short-term neurodevelopmental outcomes showed no statistically significant differences. Very preterm infants given morphine took significantly longer to reach full enteral feeding than those in control groups (weighted mean difference 2.10 days; 95% confidence interval 0.35 to 3.85). One study compared morphine with a sedative: the treatments showed similar pain scores, but morphine had fewer adverse effects. AB - AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend routine use of opioids in mechanically ventilated newborns. Opioids should be used selectively, when indicated by clinical judgment and evaluation of pain indicators. If sedation is required, morphine is safer than midazolam. Further research is needed. [References: 57] RN - 0 (Analgesics, Opioid) ES - 1469-493X IL - 1361-6137 DO - https://dx.doi.org/10.1002/14651858.CD004212.pub3 PT - Journal Article PT - Meta-Analysis PT - Review ID - 10.1002/14651858.CD004212.pub3 [doi] PP - epublish LG - English EP - 20080123 DP - 2008 Jan 23 EZ - 2008/02/07 09:00 DA - 2008/04/15 09:00 DT - 2008/02/07 09:00 YR - 2008 ED - 20080414 RD - 20130628 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18254040 <622. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17629900 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wolthuis EK AU - Veelo DP AU - Choi G AU - Determann RM AU - Korevaar JC AU - Spronk PE AU - Kuiper MA AU - Schultz MJ FA - Wolthuis, Esther K FA - Veelo, Denise P FA - Choi, Goda FA - Determann, Rogier M FA - Korevaar, Johanna C FA - Spronk, Peter E FA - Kuiper, Michael A FA - Schultz, Marcus J IN - Wolthuis, Esther K. Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. e.k.wolthuis@amc.uva.nl TI - Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives. SO - Critical Care (London, England). 11(4):R77, 2007 AS - Crit Care. 11(4):R77, 2007 NJ - Critical care (London, England) VO - 11 IP - 4 PG - R77 PI - Journal available in: Print PI - Citation processed from: Internet JC - 9801902 IO - Crit Care PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206517 SB - Index Medicus CP - England MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Dose-Response Relationship, Drug MH - Female MH - Humans MH - *Hypnotics and Sedatives/tu [Therapeutic Use] MH - Male MH - Outcome and Process Assessment (Health Care) MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Respiration, Artificial/sn [Statistics & Numerical Data] MH - Respiratory Distress Syndrome, Adult/pp [Physiopathology] MH - *Respiratory Distress Syndrome, Adult/th [Therapy] MH - Tidal Volume AB - INTRODUCTION: We compared the effects of mechanical ventilation with a lower tidal volume (V(T)) strategy versus those of greater V(T) in patients with or without acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) on the use of opioids and sedatives. AB - METHODS: This is a secondary analysis of a previously conducted before/after intervention study, which consisting of feedback and education on lung protective mechanical ventilation using lower V(T). We evaluated the effects of this intervention on medication prescriptions from days 0 to 28 after admission to our multidisciplinary intensive care unit. AB - RESULTS: Medication prescriptions in 23 patients before and 38 patients after intervention were studied. Of these patients, 10 (44%) and 15 (40%) suffered from ALI/ARDS. The V(T) of ALI/ARDS patients declined from 9.7 ml/kg predicted body weight (PBW) before to 7.8 ml/kg PBW after the intervention (P = 0.007). For patients who did not have ALI/ARDS there was a trend toward a decline from 10.2 ml/kg PBW to 8.6 ml/kg PBW (P = 0.073). Arterial carbon dioxide tension was significantly greater after the intervention in ALI/ARDS patients. Neither the proportion of patients receiving opioids or sedatives, or prescriptions at individual time points differed between pre-intervention and post-intervention. Also, there were no statistically significant differences in doses of sedatives and opioids. Findings were no different between non-ALI/ARDS patients and ALI/ARDS patients. AB - CONCLUSION: Concerns regarding sedation requirements with use of lower V(T) are unfounded and should not preclude its use in patients with ALI/ARDS. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) ES - 1466-609X IL - 1364-8535 PT - Comparative Study PT - Journal Article ID - cc5969 [pii] ID - 10.1186/cc5969 [doi] ID - PMC2206517 [pmc] PP - ppublish PH - 2007/05/01 [received] PH - 2007/06/21 [revised] PH - 2007/07/13 [accepted] LG - English DP - 2007 EZ - 2007/07/17 09:00 DA - 2008/03/28 09:00 DT - 2007/07/17 09:00 YR - 2007 ED - 20080326 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17629900 <623. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17846727 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tank S AU - Stork K AU - Skibba W AU - Zittel S AU - Andresen H AU - Goetz AE AU - Beck H FA - Tank, S FA - Stork, K FA - Skibba, W FA - Zittel, S FA - Andresen, H FA - Goetz, A E FA - Beck, H IN - Tank, S. Klinik fur Anasthesiologie, Universitatsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg. sascha.tank@gmx.de TI - [Accidental intoxication with unlabeled, generic transdermal fentanyl patches caused by insufficient instruction]. [German] OT - Akzidentelle Intoxikation durch unbeschriftete, generische transdermale Fentanylpflaster nach unzureichender Aufklarung. SO - Anaesthesist. 56(11):1137-41, 2007 Nov AS - Anaesthesist. 56(11):1137-41, 2007 Nov NJ - Der Anaesthesist VO - 56 IP - 11 PG - 1137-41 PI - Journal available in: Print PI - Citation processed from: Print JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Administration, Cutaneous MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/po [Poisoning] MH - Drugs, Generic MH - Electrocardiography MH - Emergency Medical Services MH - Fentanyl/ad [Administration & Dosage] MH - *Fentanyl/po [Poisoning] MH - Humans MH - Infusions, Intravenous MH - Male MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Stroke/di [Diagnosis] AB - A somnolent 78-year-old male patient was brought to our emergency room by an ambulance with the presumptive diagnosis of stroke. Cranial computed tomography provided no evidence. On the intensive care unit of the neurosurgical department the patient was completely undressed. Covered by a sock and underwear the ICU staff found five unlabeled, transparent patches. Under the presumptive diagnosis of an opioid intoxication by a transdermal therapeutic system naloxone was infused over 3 days. The patient reported after rapidly awaking that fentanyl patches had been prescribed by his family practitioner the day before. The patient recovered without any sequelae. RN - 0 (Analgesics, Opioid) RN - 0 (Drugs, Generic) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0003-2417 IL - 0003-2417 PT - Case Reports PT - English Abstract PT - Journal Article ID - 10.1007/s00101-007-1240-7 [doi] PP - ppublish LG - German DP - 2007 Nov EZ - 2007/09/12 09:00 DA - 2008/03/12 09:00 DT - 2007/09/12 09:00 YR - 2007 ED - 20080311 RD - 20170916 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17846727 <624. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18220551 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shelley K AU - Paech MJ FA - Shelley, Katherine FA - Paech, Michael James IN - Shelley, Katherine. Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia. TI - The clinical applications of intranasal opioids. [Review] [45 refs] SO - Current Drug Delivery. 5(1):55-8, 2008 Jan AS - Curr Drug Deliv. 5(1):55-8, 2008 Jan NJ - Current drug delivery VO - 5 IP - 1 PG - 55-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 101208455 IO - Curr Drug Deliv SB - Index Medicus CP - United Arab Emirates MH - Acute Disease MH - Administration, Intranasal MH - Analgesia, Patient-Controlled MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/pd [Pharmacology] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Chronic Disease MH - Humans MH - *Pain/dt [Drug Therapy] MH - Palliative Care AB - Opioids are widely used in all fields of pain management and may be delivered by a number of routes of administration. The intranasal administration of opioid is a convenient route of transmucosal drug delivery that has received limited attention. Potential advantages compared with parenteral or oral administration include avoidance of painful injection, avoidance of risks associated with intravenous access, rapid onset and titration to effect, good bioavailability, and high levels of acceptability and familiarity to patients. These features also lend themselves to the benefits of patient-controlled delivery systems and commercially available devices are described. In this paper we briefly consider the relevant pharmacology of intranasal drug delivery; opioid drugs and formulations; and delivery devices used clinically for intranasal administration. We review the clinical applications of intranasal opioid analgesia. These have included use for in-hospital pain management in adult and paediatric populations, in the emergency department, perioperatively and in burns units. Out-of-hospital use has included palliative care and paramedic use during retrieval and transfer to hospital. Many small trials suggest that intranasal opioids play a useful role in pain management, but large clinical trials are needed to better define advantages, safety and acceptability. [References: 45] RN - 0 (Analgesics, Opioid) IS - 1567-2018 IL - 1567-2018 PT - Journal Article PT - Review PP - ppublish LG - English DP - 2008 Jan EZ - 2008/01/29 09:00 DA - 2008/03/01 09:00 DT - 2008/01/29 09:00 YR - 2008 ED - 20080229 RD - 20080128 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18220551 <625. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18237421 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Skeie I AU - Brekke M AU - Lindbaek M AU - Waal H FA - Skeie, Ivar FA - Brekke, Mette FA - Lindbaek, Morten FA - Waal, Helge IN - Skeie, Ivar. Aker University Hospital, Oslo, Norway. ivskeie@online.no TI - Somatic health among heroin addicts before and during opioid maintenance treatment: a retrospective cohort study. SO - BMC Public Health. 8:43, 2008 Jan 31 AS - BMC Public Health. 8:43, 2008 Jan 31 NJ - BMC public health VO - 8 PG - 43 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100968562 IO - BMC Public Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253538 SB - Index Medicus CP - England MH - *Acute Disease/ep [Epidemiology] MH - Adult MH - Ambulatory Care/ut [Utilization] MH - *Chronic Disease/ep [Epidemiology] MH - Cohort Studies MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/pc [Prevention & Control] MH - Female MH - *Health Services/ut [Utilization] MH - Heroin Dependence/co [Complications] MH - Heroin Dependence/dt [Drug Therapy] MH - *Heroin Dependence/rh [Rehabilitation] MH - Hospitals/ut [Utilization] MH - Humans MH - Incidence MH - Male MH - *Methadone/tu [Therapeutic Use] MH - Middle Aged MH - *Narcotics/tu [Therapeutic Use] MH - Norway/ep [Epidemiology] MH - Substance Abuse, Intravenous/co [Complications] MH - Substance Abuse, Intravenous/dt [Drug Therapy] MH - *Substance Abuse, Intravenous/rh [Rehabilitation] AB - BACKGROUND: The long-term impact of opioid maintenance treatment (OMT) on morbidity and health care utilization among heroin addicts has been insufficiently studied. The objective of this study was to investigate whether health care utilization due to somatic disease decreased during OMT, and if so, whether the reduction included all kinds of diseases and whether a reduction was related to abstinence from drug use. AB - METHODS: Cohort study with retrospective registration of somatic disease incidents (health problems, acute or sub-acute, or acute problems related to chronic disease, resulting in a health care contact). Medical record data were collected from hospitals, Outpatients' Departments, emergency wards and from general practitioners (GPs) and prospective data on substance use during OMT were available from 2001 onwards. The observation period was five years before and up to five years during OMT. The cohort consisted of 35 out of 40 patients who received OMT between April 1999 and January 2005 in a Norwegian district town. Statistical significance concerning changes in number of incidents and inpatient and outpatient days during OMT compared with the pre OMT period was calculated according to Wilcoxon signed rank test. Significance concerning pre/during OMT changes in disease incidents by relation to the type of health service contacts, as well as the impact of ongoing substance use during OMT on the volume of contacts, was calculated according to Pearson chi-square and Fisher's exact tests. AB - RESULTS: 278 disease incidents were registered. There was a reduction in all incidents by 35% (p = 0.004), in substance-related incidents by 62% (p < 0.001) and in injection-related incidents by 70% (p < 0.001). There was an insignificant reduction in non-fatal overdose incidents by 44% (p = 0.127) and an insignificant increase in non-substance-related incidents by 13% (p = 0.741). Inpatient and outpatient days were reduced by 76% (p = 0.003) and 46% (p = 0.060), respectively. The disease incidents were less often drug-related during OMT (p < 0.001). Patients experienced a reduction in substance-related disease incidents regardless of ongoing substance use, however there was a trend towards greater reductions in those without ongoing abuse. AB - CONCLUSION: Although as few as 35 patients were included, this study demonstrates a significant reduction in health care utilization due to somatic disease incidents during OMT. The reduction was most pronounced for incidents related to substance use and injection. Inpatient and outpatient days were reduced. Most probably these findings reflect somatic health improvement among heroin addicts during OMT. RN - 0 (Narcotics) RN - UC6VBE7V1Z (Methadone) ES - 1471-2458 IL - 1471-2458 DO - https://dx.doi.org/10.1186/1471-2458-8-43 PT - Journal Article ID - 1471-2458-8-43 [pii] ID - 10.1186/1471-2458-8-43 [doi] ID - PMC2253538 [pmc] PP - epublish PH - 2007/04/27 [received] PH - 2008/01/31 [accepted] LG - English EP - 20080131 DP - 2008 Jan 31 EZ - 2008/02/02 09:00 DA - 2008/02/29 09:00 DT - 2008/02/02 09:00 YR - 2008 ED - 20080228 RD - 20170220 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18237421 <626. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18191089 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Maloney GE Jr AU - Pakiela JA FA - Maloney, Gerald E Jr FA - Pakiela, John A IN - Maloney, Gerald E Jr. Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109, USA. gmaloney@metrohealth.org TI - Characteristics of patients transported by an aeromedical service for acute toxicologic emergencies: a 5-year experience. SO - Air Medical Journal. 27(1):48-50, 2008 Jan-Feb AS - Air Med J. 27(1):48-50, 2008 Jan-Feb NJ - Air medical journal VO - 27 IP - 1 PG - 48-50 PI - Journal available in: Print PI - Citation processed from: Print JC - bs3, 9312325 IO - Air Med. J. SB - Health Administration Journals CP - United States MH - Acute Disease MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Air Ambulances MH - Child MH - Child, Preschool MH - Female MH - *Hazardous Substances/po [Poisoning] MH - Humans MH - Infant MH - Male MH - Medical Audit MH - Middle Aged MH - Ohio MH - Retrospective Studies MH - *Transportation of Patients AB - INTRODUCTION: Aeromedical services are used routinely in the prehospital and interhospital transfer of patients with trauma, neurosurgical, cardiac, and other conditions requiring specialized care. The use of aeromedical transport in patients with acute toxicologic emergencies is not well described. We sought to investigate and describe the characteristics of patients transported by our aeromedical service. AB - SETTING: The study was performed at an urban critical care transport service operating both ground and aeromedical units and transporting an average of 3,362 patients per year during the study period. AB - METHODS: Charts from the 5-year period of 2000 to 2004 for which a toxicologic emergency was coded as the primary diagnosis were identified and reviewed by the authors. Data abstracted included age, sex, toxin(s) involved, treatment rendered at the scene/bedside and en route by the transport team, and additional data (electrocardiogram [ECG] findings, serum levels) when appropriate. AB - RESULTS: One hundred thirty-three patients were transported (for a total of 135 transports). Most (82%) were transported by air. Carbon monoxide was the most common toxic exposure, accounting for 16% of all transports. Fifty-seven percent of the patients were intubated, with 11% intubated by the flight crew. Antidotes were administered in 40 patients, with naloxone and bicarbonate being the most common. AB - CONCLUSION: Acute toxicologic emergencies accounted for a small percentage of total transports. The most common additional intervention by flight crews was endotracheal intubation. Identification of common poisonings encountered by flight crews may assist services in developing education and quality assurance programs. RN - 0 (Hazardous Substances) IS - 1067-991X IL - 1067-991X DO - https://dx.doi.org/10.1016/j.amj.2007.07.002 PT - Journal Article ID - S1067-991X(07)00168-X [pii] ID - 10.1016/j.amj.2007.07.002 [doi] PP - ppublish PH - 2007/03/23 [received] PH - 2007/06/30 [revised] PH - 2007/07/11 [accepted] LG - English DP - 2008 Jan-Feb EZ - 2008/01/15 09:00 DA - 2008/02/28 09:00 DT - 2008/01/15 09:00 YR - 2008 ED - 20080227 RD - 20080114 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18191089 <627. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18180630 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Goldman RD AU - Narula N AU - Klein-Kremer A AU - Finkelstein Y AU - Rogovik AL FA - Goldman, Ran D FA - Narula, Neeraj FA - Klein-Kremer, Adi FA - Finkelstein, Yaron FA - Rogovik, Alex L IN - Goldman, Ran D. Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada. rgoldman@cw.bc.ca TI - Predictors for opioid analgesia administration in children with abdominal pain presenting to the emergency department. SO - Clinical Journal of Pain. 24(1):11-5, 2008 Jan AS - Clin J Pain. 24(1):11-5, 2008 Jan NJ - The Clinical journal of pain VO - 24 IP - 1 PG - 11-5 PI - Journal available in: Print PI - Citation processed from: Print JC - beg, 8507389 IO - Clin J Pain SB - Index Medicus CP - United States MH - *Abdominal Pain/dt [Drug Therapy] MH - Adolescent MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Analysis of Variance MH - Child MH - Child, Preschool MH - Emergency Medical Services MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Prognosis MH - Retrospective Studies MH - Triage AB - OBJECTIVES: Abdominal pain is one of the most common symptoms in children. The aim of this study was to determine the rate of opioid analgesia in children with abdominal pain presenting to the pediatric Emergency Department (ED) and to identify factors associated with administration of opioids. AB - METHODS: We retrospectively reviewed all charts of patients with abdominal pain < 7 days presenting to the ED of a tertiary pediatric hospital over a 3-month period. Demographic and illness-related variables were recorded, and the primary outcome variable was whether opioid analgesia was used to relieve abdominal pain. We analyzed the data with a univariate analysis and a multivariate stepwise regression analysis to determine independent influences on the rate of opioid prescribing. AB - RESULTS: Of 582 children included in the analysis, 53 (9%) received opioid analgesia. Pain in the right lower quadrant on examination, documentation of a pain score in triage, and the level of acuity as determined by the triage nurse were predictors of administration of opioids by the physician. Thirty-four (77%) of the opioids given were below the recommended dose for the child. AB - CONCLUSIONS: Few pediatric patients with abdominal pain are treated with pain medications. The decision to use opioid analgesia for acute abdominal pain in the pediatric ED is influenced by acuity level, pain score documentation in triage, and location of abdominal pain. Efforts should be made to educate physicians on the appropriate administration and dose of opioids in children with abdominal pain in the ED. RN - 0 (Analgesics, Opioid) IS - 0749-8047 IL - 0749-8047 DO - https://dx.doi.org/10.1097/AJP.0b013e318156d921 PT - Journal Article ID - 10.1097/AJP.0b013e318156d921 [doi] ID - 00002508-200801000-00003 [pii] PP - ppublish LG - English DP - 2008 Jan EZ - 2008/01/09 09:00 DA - 2008/02/21 09:00 DT - 2008/01/09 09:00 YR - 2008 ED - 20080220 RD - 20080108 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18180630 <628. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18029522 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Parris R FA - Parris, Richard IN - Parris, Richard. Royal Bolton Hospital, UK. TI - Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Epidural analgesia/anaesthesia versus systemic intravenous opioid analgesia in the management of blunt thoracic trauma. [Review] [4 refs] SO - Emergency Medicine Journal. 24(12):848-9, 2007 Dec AS - Emerg Med J. 24(12):848-9, 2007 Dec NJ - Emergency medicine journal : EMJ VO - 24 IP - 12 PG - 848-9 PI - Journal available in: Print PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658360 SB - Index Medicus CP - England MH - Aged MH - *Analgesia, Epidural MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Evidence-Based Medicine MH - Humans MH - Male MH - Rib Fractures/co [Complications] MH - *Thoracic Injuries/co [Complications] MH - *Wounds, Nonpenetrating/co [Complications] AB - A short cut review was carried out to establish whether an epidural infusion provided any advantage over intravenous analgesia in the management of blunt thoracic trauma. Only four papers presented evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are presented in table 2. The clinical bottom line is that epidural analgesia may provide better pain relief, but may not alter clinical outcomes. [References: 4] RN - 0 (Analgesics, Opioid) ES - 1472-0213 IL - 1472-0205 PT - Journal Article PT - Review ID - 24/12/848 [pii] ID - 10.1136/emj.2007.054999 [doi] ID - PMC2658360 [pmc] PP - ppublish LG - English DP - 2007 Dec EZ - 2007/11/22 09:00 DA - 2008/02/19 09:00 DT - 2007/11/22 09:00 YR - 2007 ED - 20080215 RD - 20140904 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=18029522 <629. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17803674 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gill AW AU - Colvin J FA - Gill, Andrew W FA - Colvin, Joanne IN - Gill, Andrew W. School of Medicine, University of Western Australia. andy.gill@health.wa.gov.au TI - Use of naloxone during neonatal resuscitation in Australia: compliance with published guidelines. CM - Comment in: J Paediatr Child Health. 2008 Jul-Aug;44(7-8):467; author reply 467; PMID: 18638337 SO - Journal of Paediatrics & Child Health. 43(12):795-8, 2007 Dec AS - J Paediatr Child Health. 43(12):795-8, 2007 Dec NJ - Journal of paediatrics and child health VO - 43 IP - 12 PG - 795-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - arp, 9005421 IO - J Paediatr Child Health SB - Index Medicus CP - Australia MH - Australia MH - *Guideline Adherence MH - *Guidelines as Topic MH - Humans MH - Infant, Newborn MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Resuscitation MH - Western Australia AB - AIMS: The aims of this study were to describe the use of naloxone during neonatal resuscitation in Australia, and to assess this against the published guidelines for use. AB - METHODS: The states of Queensland, South Australia and the Australian Capital Territory record the administration of naloxone in their statutory state perinatal database collections, covering all deliveries within each state. Relevant information was extracted from these databases. In addition, we interrogated the perinatal database from a single tertiary perinatal centre in Western Australia and conducted a chart review of the 100 most recent infants identified as receiving naloxone. AB - RESULTS: A total of 531 058 liveborn infants from 1994 through 2004 were assessed. The administration of naloxone fell from 4% to 1% of liveborn infants during this period. There was inconsistent compliance with published guidelines. Forty-two per cent of infants received naloxone without documentation of prior ventilatory support, 14% of infants received naloxone without prior administration of maternal narcotics and 80% of infants were not monitored following naloxone administration. The prevalent route of administration was intramuscular. AB - CONCLUSIONS: Despite a steady decrease in the use of naloxone for neonatal resuscitation, there is a considerable lack of compliance with published guidelines for use. Given the scant evidence supporting naloxone use during neonatal resuscitation and increasing documentation of potential deleterious effects, perhaps it is time to remove naloxone from our resuscitaires. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1034-4810 IL - 1034-4810 PT - Journal Article ID - JPC1194 [pii] ID - 10.1111/j.1440-1754.2007.01194.x [doi] PP - ppublish LG - English EP - 20070904 DP - 2007 Dec EZ - 2007/09/07 09:00 DA - 2008/02/15 09:00 DT - 2007/09/07 09:00 YR - 2007 ED - 20080214 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17803674 <630. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18034166 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hughes SM AU - Blake BL AU - Woods SL AU - Lehmann CU FA - Hughes, S M FA - Blake, B L FA - Woods, S L FA - Lehmann, C U IN - Hughes, S M. Eudowood Neonatal Pulmonary Division, Department of Pediatrics, The Johns Hopkins University, Baltimore, MD, USA. TI - False-positive results on colorimetric carbon dioxide analysis in neonatal resuscitation: potential for serious patient harm. SO - Journal of Perinatology. 27(12):800-1, 2007 Dec AS - J Perinatol. 27(12):800-1, 2007 Dec NJ - Journal of perinatology : official journal of the California Perinatal Association VO - 27 IP - 12 PG - 800-1 PI - Journal available in: Print PI - Citation processed from: Print JC - jfp, 8501884 IO - J Perinatol SB - Index Medicus CP - United States MH - Administration, Inhalation MH - Bradycardia/dt [Drug Therapy] MH - *Carbon Dioxide/an [Analysis] MH - Colorimetry MH - *Epinephrine/ad [Administration & Dosage] MH - *False Positive Reactions MH - Humans MH - Infant, Newborn MH - Intubation, Intratracheal MH - *Resuscitation MH - *Sympathomimetics/ad [Administration & Dosage] AB - A term infant requiring resuscitation was found to have a false-positive color change on a colorimetric carbon dioxide device as a result of administration of epinephrine via an endotracheal tube. Using models of direct application and vapor exposure with a test lung, we discovered that epinephrine, atropine, infasurf and naloxone may result in false-positive color change. This false-positive response may lead to delayed recognition of esophageal intubation. RN - 0 (Sympathomimetics) RN - 142M471B3J (Carbon Dioxide) RN - YKH834O4BH (Epinephrine) IS - 0743-8346 IL - 0743-8346 PT - Case Reports PT - Journal Article ID - 7211831 [pii] ID - 10.1038/sj.jp.7211831 [doi] PP - ppublish LG - English DP - 2007 Dec EZ - 2007/11/24 09:00 DA - 2008/02/09 09:00 DT - 2007/11/24 09:00 YR - 2007 ED - 20080208 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=18034166 <631. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18072176 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wong SC AU - Roberts JR FA - Wong, Stella C FA - Roberts, James R IN - Wong, Stella C. Department of Emergency Medicine, Division of Medical Toxicology, Drexel University College of Medicine, Philadelphia, PA, USA. scw101@gmail.com TI - Case files of the Drexel University Medical Toxicology Fellowship: methadone-induced QTc prolongation. SO - Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. 3(4):190-4, 2007 Dec AS - J Med Toxicol. 3(4):190-4, 2007 Dec NJ - Journal of medical toxicology : official journal of the American College of Medical Toxicology VO - 3 IP - 4 PG - 190-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 101284598 IO - J Med Toxicol PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550015 SB - Index Medicus CP - United States MH - Adult MH - Drug Overdose/dt [Drug Therapy] MH - Electrocardiography MH - Emergency Medical Services MH - Humans MH - *Long QT Syndrome/ci [Chemically Induced] MH - Long QT Syndrome/pp [Physiopathology] MH - Male MH - *Methadone/ae [Adverse Effects] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/ae [Adverse Effects] MH - *Torsades de Pointes/ci [Chemically Induced] MH - Torsades de Pointes/pp [Physiopathology] MH - Treatment Outcome RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) IS - 1556-9039 IL - 1556-9039 PT - Case Reports PT - Journal Article ID - PMC3550015 [pmc] PP - ppublish LG - English DP - 2007 Dec EZ - 2007/12/12 09:00 DA - 2008/02/02 09:00 DT - 2007/12/12 09:00 YR - 2007 ED - 20080201 RD - 20140904 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=18072176 <632. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18181378 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chan L AU - Winegard B FA - Chan, Lisa FA - Winegard, Billie IN - Chan, Lisa. Department of Emergency Medicine, University of Arizona, Tucson, USA. TI - Attributes and behaviors associated with opioid seeking in the emergency department. SO - Journal of Opioid Management. 3(5):244-8, 2007 Sep-Oct AS - J Opioid Manag. 3(5):244-8, 2007 Sep-Oct NJ - Journal of opioid management VO - 3 IP - 5 PG - 244-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Adult MH - Behavior MH - Data Interpretation, Statistical MH - *Emergency Service, Hospital MH - Female MH - Flank Pain/di [Diagnosis] MH - Flank Pain/dt [Drug Therapy] MH - Flank Pain/px [Psychology] MH - Humans MH - Male MH - Malingering/di [Diagnosis] MH - Malingering/px [Psychology] MH - Middle Aged MH - *Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/px [Psychology] MH - Physician-Patient Relations MH - Retrospective Studies MH - Tomography, X-Ray Computed AB - OBJECTIVE: Determine if the attributes and behaviors anecdotally thought to be indicative of drug seeking have statistical association with opioid seeking. AB - METHODS: Data on variables thought to be indicative of drug seeking were retrospectively extracted and compared between two patient groups seen in the Emergency Department between July 1, 2006 and December 31, 2006. Group 1 was considered to have true physical pain, and Group 2 was thought to be seeking opioids. AB - RESULTS: Seven variables were found to have statistical associations with opioid seeking. There was no chart documentation on absence or presence of six variables. AB - CONCLUSIONS: Significant associations were found between several variables and opioid seeking. A prospective study should be performed so that all variables of interest can be thoroughly studied and a predictive model can be developed to differentiate patients with real pain from drug seekers. IS - 1551-7489 IL - 1551-7489 PT - Journal Article PP - ppublish LG - English DP - 2007 Sep-Oct EZ - 2008/01/10 09:00 DA - 2008/01/24 09:00 DT - 2008/01/10 09:00 YR - 2007 ED - 20080123 RD - 20120713 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=18181378 <633. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18167408 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pletcher MJ AU - Kertesz SG AU - Kohn MA AU - Gonzales R FA - Pletcher, Mark J FA - Kertesz, Stefan G FA - Kohn, Michael A FA - Gonzales, Ralph IN - Pletcher, Mark J. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94107, USA. mpletcher@epi.ucsf.edu TI - Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. CM - Comment in: JAMA. 2008 Apr 16;299(15):1773-4; author reply 1774; PMID: 18413871 CM - Comment in: JAMA. 2008 Apr 16;299(15):1773; author reply 1774; PMID: 18413872 SO - JAMA. 299(1):70-8, 2008 Jan 02 AS - JAMA. 299(1):70-8, 2008 Jan 02 NJ - JAMA VO - 299 IP - 1 PG - 70-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Utilization/sn [Statistics & Numerical Data] MH - *Drug Utilization/td [Trends] MH - Emergency Service, Hospital/td [Trends] MH - *Emergency Service, Hospital/ut [Utilization] MH - Ethnic Groups/cl [Classification] MH - Ethnic Groups/sn [Statistics & Numerical Data] MH - Female MH - Health Care Surveys MH - Healthcare Disparities/sn [Statistics & Numerical Data] MH - *Healthcare Disparities/td [Trends] MH - Humans MH - Male MH - *Pain/dt [Drug Therapy] MH - *Pain/eh [Ethnology] MH - Pain/et [Etiology] MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians'/td [Trends] MH - Quality Indicators, Health Care MH - United States/ep [Epidemiology] AB - CONTEXT: National quality improvement initiatives implemented in the late 1990s were followed by substantial increases in opioid prescribing in the United States, but it is unknown whether opioid prescribing for treatment of pain in the emergency department has increased and whether differences in opioid prescribing by race/ethnicity have decreased. AB - OBJECTIVES: To determine whether opioid prescribing in emergency departments has increased, whether non-Hispanic white patients are more likely to receive an opioid than other racial/ethnic groups, and whether differential prescribing by race/ethnicity has diminished since 2000. AB - DESIGN AND SETTING: Pain-related visits to US emergency departments were identified using reason-for-visit and physician diagnosis codes from 13 years (1993-2005) of the National Hospital Ambulatory Medical Care Survey. AB - MAIN OUTCOME MEASURE: Prescription of an opioid analgesic. AB - RESULTS: Pain-related visits accounted for 156 729 of 374 891 (42%) emergency department visits. Opioid prescribing for pain-related visits increased from 23% (95% confidence interval [CI], 21%-24%) in 1993 to 37% (95% CI, 34%-39%) in 2005 (P < .001 for trend), and this trend was more pronounced in 2001-2005 (P = .02). Over all years, white patients with pain were more likely to receive an opioid (31%) than black (23%), Hispanic (24%), or Asian/other patients (28%) (P < .001 for trend), and differences did not diminish over time (P = .44), with opioid prescribing rates of 40% for white patients and 32% for all other patients in 2005. Differential prescribing by race/ethnicity was evident for all types of pain visits, was more pronounced with increasing pain severity, and was detectable for long-bone fracture and nephrolithiasis as well as among children. Statistical adjustment for pain severity and other factors did not substantially attenuate these differences, with white patients remaining significantly more likely to receive an opioid prescription than black patients (adjusted odds ratio, 0.66; 95% CI, 0.62-0.70), Hispanic patients (0.67; 95% CI, 0.63-0.72), and Asian/other patients (0.79; 95% CI, 0.67-0.93). AB - CONCLUSION: Opioid prescribing for patients making a pain-related visit to the emergency department increased after national quality improvement initiatives in the late 1990s, but differences in opioid prescribing by race/ethnicity have not diminished. RN - 0 (Analgesics, Opioid) ES - 1538-3598 IL - 0098-7484 DO - https://dx.doi.org/10.1001/jama.2007.64 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. ID - 299/1/70 [pii] ID - 10.1001/jama.2007.64 [doi] PP - ppublish GI - No: K23DA015487 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R03 HS016238 Organization: (HS) *AHRQ HHS* Country: United States LG - English DP - 2008 Jan 02 EZ - 2008/01/03 09:00 DA - 2008/01/11 09:00 DT - 2008/01/03 09:00 YR - 2008 ED - 20080110 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18167408 <634. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 18082805 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Martins HS AU - Silva RV AU - Bugano D AU - Santana AN AU - Brandao-Neto RA AU - Giannini FP AU - Scalabrini-Neto A AU - Velasco IT FA - Martins, Herlon Saraiva FA - Silva, Roberta Vasconcelos FA - Bugano, Diogo FA - Santana, Alfredo Nicodemos Cruz FA - Brandao-Neto, Rodrigo Antonio FA - Giannini, Fabio Poianas FA - Scalabrini-Neto, Augusto FA - Velasco, Irineu Tadeu IN - Martins, Herlon Saraiva. Department of Emergency Medicine, School of Medicine of the University of Sao Paulo, Hospital das Clinicas, 05.403-900 Sao Paulo, Brazil. TI - Should naloxone be prescribed in the ED management of patients with cardiac arrest? A case report and review of literature. [Review] [43 refs] SO - American Journal of Emergency Medicine. 26(1):113.e5-8, 2008 Jan AS - Am J Emerg Med. 26(1):113.e5-8, 2008 Jan NJ - The American journal of emergency medicine VO - 26 IP - 1 PG - 113.e5-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - Emergency Service, Hospital MH - Female MH - *Heart Arrest/ci [Chemically Induced] MH - Humans MH - *Methadone/po [Poisoning] MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) ES - 1532-8171 IL - 0735-6757 PT - Case Reports PT - Journal Article PT - Review ID - S0735-6757(07)00458-5 [pii] ID - 10.1016/j.ajem.2007.06.029 [doi] PP - ppublish PH - 2007/06/08 [received] PH - 2007/06/22 [accepted] LG - English DP - 2008 Jan EZ - 2007/12/18 09:00 DA - 2008/01/09 09:00 DT - 2007/12/18 09:00 YR - 2008 ED - 20080108 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med6&AN=18082805 <635. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17229529 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Karbakhsh M AU - Salehian Zandi N FA - Karbakhsh, Mojgan FA - Salehian Zandi, Negar IN - Karbakhsh, Mojgan. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. mkarbakh@sina.tums.ac.ir TI - Acute opiate overdose in Tehran: the forgotten role of opium. SO - Addictive Behaviors. 32(9):1835-42, 2007 Sep AS - Addict Behav. 32(9):1835-42, 2007 Sep NJ - Addictive behaviors VO - 32 IP - 9 PG - 1835-42 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - 2gw, 7603486 IO - Addict Behav SB - Index Medicus CP - England MH - Acute Disease MH - Adult MH - Catchment Area (Health) MH - Cross-Sectional Studies MH - Drug Overdose MH - Heroin Dependence/ep [Epidemiology] MH - Heroin Dependence/rh [Rehabilitation] MH - Hospitalization MH - Humans MH - Iran/ep [Epidemiology] MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - *Opium/ae [Adverse Effects] MH - Poison Control Centers MH - Prevalence MH - Surveys and Questionnaires AB - INTRODUCTION: The global epidemic of opiate use continues to spread and is an increasing burden especially in developing countries. Acute opiate overdose (AOO) is one of the most dramatic complications of drug abuse. The purpose of this study is to examine the epidemiology of acute opiate overdose in a poisoning center in Tehran. AB - METHODS: In this cross-sectional survey, patients who attended the emergency room of Loghman-Hakim hospital - the only poisoning center in Tehran - and diagnosed with acute opiate overdose over a six month period were included. AB - RESULTS: Overdose was more common among men (91.2%). The mean and standard deviation of age was 36.9+/-15. The most frequent opiate agent was opium (56.5%) followed by heroin. Opium was most commonly used by regular users, as a single agent and through ingestion. Benzodiazepines, antidepressants and alcohol were the most common agents consumed accompanied with opiates. The mortality rate was 8.8% which was not significantly different between cases of heroin and opium overdose. AB - CONCLUSION: Opium was the major cause of overdose in our study. This result suggests that opium is not a harmless form of addiction although it is regarded as a thing of the past in many countries. RN - 8008-60-4 (Opium) IS - 0306-4603 IL - 0306-4603 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0306-4603(06)00394-7 [pii] ID - 10.1016/j.addbeh.2006.12.014 [doi] PP - ppublish PH - 2006/07/23 [received] PH - 2006/11/26 [revised] PH - 2006/12/13 [accepted] LG - English EP - 20061219 DP - 2007 Sep EZ - 2007/01/19 09:00 DA - 2007/12/18 09:00 DT - 2007/01/19 09:00 YR - 2007 ED - 20071217 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17229529 <636. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17991279 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Benhamou D FA - Benhamou, D TI - Local anaesthetic-opioid mixture for emergency Caesarean section. CM - Comment on: Anaesthesia. 2007 Jul;62(7):667-71; PMID: 17567341 SO - Anaesthesia. 62(12):1298; author reply 1298, 2007 Dec AS - Anaesthesia. 62(12):1298; author reply 1298, 2007 Dec NJ - Anaesthesia VO - 62 IP - 12 PG - 1298; author reply 1298 PI - Journal available in: Print PI - Citation processed from: Internet JC - 4mc, 0370524 IO - Anaesthesia SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Analgesia, Epidural/mt [Methods] MH - *Analgesia, Obstetrical/mt [Methods] MH - Analgesics, Opioid MH - Anesthetics, Local MH - *Cesarean Section MH - Female MH - Fentanyl MH - Humans MH - Pregnancy MH - Sufentanil RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Local) RN - AFE2YW0IIZ (Sufentanil) RN - UF599785JZ (Fentanyl) ES - 1365-2044 IL - 0003-2409 PT - Comment PT - Letter ID - ANA5362_1 [pii] ID - 10.1111/j.1365-2044.2007.05362_1.x [doi] PP - ppublish LG - English DP - 2007 Dec EZ - 2007/11/10 09:00 DA - 2007/12/07 09:00 DT - 2007/11/10 09:00 YR - 2007 ED - 20071206 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17991279 <637. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17849242 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chyka PA AU - Erdman AR AU - Manoguerra AS AU - Christianson G AU - Booze LL AU - Nelson LS AU - Woolf AD AU - Cobaugh DJ AU - Caravati EM AU - Scharman EJ AU - Troutman WG AU - American Assiciation of Poison Control Centers FA - Chyka, Peter A FA - Erdman, Andrew R FA - Manoguerra, Anthony S FA - Christianson, Gwenn FA - Booze, Lisa L FA - Nelson, Lewis S FA - Woolf, Alan D FA - Cobaugh, Daniel J FA - Caravati, E Martin FA - Scharman, Elizabeth J FA - Troutman, William G FA - American Assiciation of Poison Control Centers IN - Chyka, Peter A. American Association of Poison Control Centers, Washington, District of Columbia, USA. TI - Dextromethorphan poisoning: an evidence-based consensus guideline for out-of-hospital management. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 45(6):662-77, 2007 Sep AS - Clin Toxicol (Phila). 45(6):662-77, 2007 Sep NJ - Clinical toxicology (Philadelphia, Pa.) VO - 45 IP - 6 PG - 662-77 PI - Journal available in: Print PI - Citation processed from: Print JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Algorithms MH - *Ambulatory Care/mt [Methods] MH - Child MH - Child, Preschool MH - *Dextromethorphan/po [Poisoning] MH - Evidence-Based Medicine MH - Humans MH - Infant MH - *Poison Control Centers/st [Standards] MH - Poisoning/di [Diagnosis] MH - Poisoning/th [Therapy] MH - Triage AB - The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected ingestion of dextromethorphan by 1) describing the process by which an ingestion of dextromethorphan might be managed, 2) identifying the key decision elements in managing cases of dextromethorphan ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to the ingestion of dextromethorphan alone. Co-ingestion of additional substances could require different referral and management recommendations depending on the combined toxicities of the substances. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions might be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. The grade of recommendation is in parentheses. 1) All patients with suicidal intent, intentional abuse, or in cases in which a malicious intent is suspected (e.g., child abuse or neglect) should be referred to an emergency department (Grade D). 2) Patients who exhibit more than mild effects (e.g., infrequent vomiting or somnolence [lightly sedated and arousable with speaking voice or light touch]) after an acute dextromethorphan ingestion should be referred to an emergency department (Grade C). 3) Patients who have ingested 5-7.5 mg/kg should receive poison center-initiated follow-up approximately every 2 hours for up to 4 hours after ingestion. Refer to an emergency department if more than mild symptoms develop (Grade D). 4) Patients who have ingested more than 7.5 mg/kg should be referred to an emergency department for evaluation (Grade C). 5) If the patient is taking other medications likely to interact with dextromethorphan and cause serotonin syndrome, such as monoamine oxidase inhibitors or selective serotonin reuptake inhibitors, poison center-initiated follow-up every 2 hours for 8 hours is recommended (Grade D). 6) Patients who are asymptomatic and more than 4 hours have elapsed since the time of ingestion can be observed at home (Grade C). 7) Do not induce emesis (Grade D). 8) Do not use activated charcoal at home. Activated charcoal can be administered to asymptomatic patients who have ingested overdoses of dextromethorphan within the preceding hour. Its administration, if available, should only be carried out by health professionals and only if no contraindications are present. Do not delay transportation in order to administer activated charcoal (Grade D). 9) For patients who have ingested dextromethorphan and are sedated or comatose, naloxone, in the usual doses for treatment of opioid overdose, can be considered for prehospital administration, particularly if the patient has respiratory depression (Grade C). 10) Use intravenous benzodiazepines for seizures and benzodiazepines and external cooling measures for hyperthermia (>104 degrees F, >40 degrees C) for serotonin syndrome. This should be done in consultation with and authorized by EMS medical direction, by a written treatment protocol or policy, or with direct medical oversight (Grade C). 11) Carefully ascertain by history whether other drugs, such as acetaminophen, were involved in the incident and assess the risk for toxicity or for a drug interaction. RN - 7355X3ROTS (Dextromethorphan) IS - 1556-3650 IL - 1556-3650 PT - Journal Article PT - Practice Guideline PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. ID - 781914405 [pii] ID - 10.1080/15563650701606443 [doi] PP - ppublish LG - English DP - 2007 Sep EZ - 2007/09/13 09:00 DA - 2007/11/06 09:00 DT - 2007/09/13 09:00 YR - 2007 ED - 20071105 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17849242 <638. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17910238 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Augustine JJ FA - Augustine, James J IN - Augustine, James J. Department of Emergency Medicine, Emory University, Atlanta, GA, USA. jaugustine@emp.com TI - Why won't he wake up? Altered LOC, decreased respirations & pinpoint pupils provide clues to a medication mishap. SO - EMS magazine. 36(9):25, 27, 2007 Sep AS - EMS Mag. 36(9):25, 27, 2007 Sep NJ - EMS magazine VO - 36 IP - 9 PG - 25, 27 PI - Journal available in: Print PI - Citation processed from: Print JC - 101466002 IO - EMS Mag SB - Health Administration Journals CP - United States MH - Adult MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/pp [Physiopathology] MH - Emergency Medical Services MH - Humans MH - Male MH - *Medication Errors/ae [Adverse Effects] MH - Naloxone/ai [Antagonists & Inhibitors] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Unconsciousness/di [Diagnosis] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1946-4967 IL - 1946-4967 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 2007 Sep EZ - 2007/10/04 09:00 DA - 2007/11/01 09:00 DT - 2007/10/04 09:00 YR - 2007 ED - 20071031 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17910238 <639. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17876257 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schwarz KA AU - Cantrell FL AU - Vohra RB AU - Clark RF FA - Schwarz, Kerry A FA - Cantrell, F Lee FA - Vohra, Rais B FA - Clark, Richard F IN - Schwarz, Kerry A. California Poison Control System, San Diego Division, University of California, San Diego Medical Center, San Diego, CA 92103, USA. kschwarz@calpoison.org TI - Suboxone (buprenorphine/naloxone) toxicity in pediatric patients: a case report. SO - Pediatric Emergency Care. 23(9):651-2, 2007 Sep AS - Pediatr Emerg Care. 23(9):651-2, 2007 Sep NJ - Pediatric emergency care VO - 23 IP - 9 PG - 651-2 PI - Journal available in: Print PI - Citation processed from: Internet JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - *Buprenorphine/po [Poisoning] MH - Buprenorphine, Naloxone Drug Combination MH - Child, Preschool MH - Humans MH - Male MH - *Naloxone/po [Poisoning] MH - *Narcotic Antagonists/po [Poisoning] MH - Vomiting AB - BACKGROUND: Suboxone, a combination of buprenorphine and naloxone in sublingual tablet form, was recently approved in the United States for management of opioid dependence. Little information exists regarding the potential for opioid toxicity after Suboxone exposure in the pediatric population. We report a case of opioid toxicity after exposure to Suboxone in a pediatric patient and a review of other cases of pediatric Suboxone ingestion in the literature. AB - CASE: A previously healthy 2-year-old boy was found with 1 tablet of Suboxone (8 mg buprenorphine/2 mg naloxone) in his mouth. Remnants of the partly dissolved tablet were immediately removed from the child's oropharynx. The child experienced 1 episode of spontaneous emesis and became drowsy en route to the emergency department 30 minutes after the exposure. The patient was observed in the emergency department; no interventions were necessary, and the child was discharged asymptomatic and stable 6 hours post ingestion. AB - CONCLUSION: Suboxone, a combination of buprenorphine and naloxone, may produce opioid toxicity via sublingual absorption or ingestion by children. We present the case of a child with mild central nervous system depression after exposure to Suboxone. Pediatric case reports that demonstrate more significant central nervous system and respiratory depressant effects from Suboxone ingestion are emerging. RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) ES - 1535-1815 IL - 0749-5161 PT - Case Reports PT - Journal Article ID - 10.1097/PEC.0b013e31814a6aac [doi] ID - 00006565-200709000-00010 [pii] PP - ppublish LG - English DP - 2007 Sep EZ - 2007/09/19 09:00 DA - 2007/10/19 09:00 DT - 2007/09/19 09:00 YR - 2007 ED - 20071018 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17876257 <640. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17114982 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fang X AU - Tang W AU - Sun S AU - Weil MH FA - Fang, Xiangshao FA - Tang, Wanchun FA - Sun, Shijie FA - Weil, Max Harry IN - Fang, Xiangshao. Weil Institute of Critical Care Medicine, Rancho Mirage, California, USA. TI - delta-Opioid-induced pharmacologic myocardial hibernation during cardiopulmonary resuscitation. [Review] [41 refs] SO - Critical Care Medicine. 34(12 Suppl):S486-9, 2006 Dec AS - Crit Care Med. 34(12 Suppl):S486-9, 2006 Dec NJ - Critical care medicine VO - 34 IP - 12 Suppl PG - S486-9 PI - Journal available in: Print PI - Citation processed from: Print JC - dtf, 0355501 IO - Crit. Care Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Animals MH - *Cardiopulmonary Resuscitation MH - Heart Arrest/me [Metabolism] MH - Heart Arrest/pp [Physiopathology] MH - *Heart Arrest/th [Therapy] MH - Hibernation MH - Myocardial Reperfusion Injury/me [Metabolism] MH - Myocardial Reperfusion Injury/pp [Physiopathology] MH - *Myocardial Reperfusion Injury/pc [Prevention & Control] MH - Myocardial Stunning/me [Metabolism] MH - *Myocardium/me [Metabolism] MH - Rats MH - *Receptors, Opioid, delta/ag [Agonists] MH - Swine MH - Ventricular Fibrillation/me [Metabolism] MH - Ventricular Fibrillation/pp [Physiopathology] MH - Ventricular Fibrillation/th [Therapy] AB - OBJECTIVES: Cardiac arrest and cardiopulmonary resuscitation is an event of global myocardial ischemia and reperfusion, which is associated with severe postresuscitation myocardial dysfunction and fatal outcome. Evidence has demonstrated that mammalian hibernation is triggered by cyclic variation of a delta-opiate-like compound in endogenous serum, during which the myocardial metabolism is dramatically reduced and the myocardium tolerates the stress of ischemia and reperfusion without overt ischemic and reperfusion injury. Previous investigations also proved that the delta-opioid agonist elicited the cardioprotection in a model of regional ischemic intact heart or myocyte. Accordingly, we were prompted to search for an alternative intervention of pharmacologically induced myocardial hibernation that would result in rapid reductions of myocardial metabolism and therefore minimize the myocardial ischemic and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation. AB - DESIGN: Prospective, controlled laboratory study. AB - SETTING: University-affiliated research laboratory. AB - INTERVENTIONS: In the series of studies performed in the established rat and pig model of cardiac arrest and cardiopulmonary resuscitation, the delta-opioid receptor agonist, pentazocine, was administered during ventricular fibrillation. AB - MEASUREMENTS AND MAIN RESULTS: : The myocardial metabolism reflected by the concentration of lactate, or myocardial tissue PCO2 and PO2, is dramatically reduced during cardiac arrest and cardiopulmonary resuscitation. These are associated with less severe postresuscitation myocardial dysfunction and longer duration of postresuscitation survival. AB - CONCLUSIONS: delta-Opioid-induced pharmacologic myocardial hibernation is an option to minimize the myocardial ischemia and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation. [References: 41] RN - 0 (Receptors, Opioid, delta) IS - 0090-3493 IL - 0090-3493 PT - Journal Article PT - Review ID - 10.1097/01.CCM.0000246015.05214.5A [doi] ID - 00003246-200612001-00013 [pii] PP - ppublish LG - English DP - 2006 Dec EZ - 2006/11/23 09:00 DA - 2007/09/07 09:00 DT - 2006/11/23 09:00 YR - 2006 ED - 20070906 RD - 20061120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17114982 <641. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17517283 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Behrman A AU - Goertemoeller S FA - Behrman, Alysha FA - Goertemoeller, Sheila IN - Behrman, Alysha. Cincinnati Drug and Poison Information Center, Cincinnati, Ohio 45219, USA. Alysha.Behrman@cchmc.org TI - A sticky situation: toxicity of clonidine and fentanyl transdermal patches in pediatrics. SO - Journal of Emergency Nursing. 33(3):290-3, 2007 Jun AS - J Emerg Nurs. 33(3):290-3, 2007 Jun NJ - Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association VO - 33 IP - 3 PG - 290-3 PI - Journal available in: Print PI - Citation processed from: Print JC - 7605913 IO - J Emerg Nurs SB - Nursing Journal CP - United States MH - Accidents MH - Administration, Cutaneous MH - *Analgesics, Opioid/po [Poisoning] MH - Analgesics, Opioid/sd [Supply & Distribution] MH - *Antihypertensive Agents/po [Poisoning] MH - Antihypertensive Agents/sd [Supply & Distribution] MH - *Clonidine/po [Poisoning] MH - Clonidine/sd [Supply & Distribution] MH - Coma/ci [Chemically Induced] MH - Coma/th [Therapy] MH - Drug Overdose MH - Emergency Treatment/mt [Methods] MH - *Fentanyl/po [Poisoning] MH - Fentanyl/sd [Supply & Distribution] MH - Humans MH - Infant MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Patient Education as Topic MH - Seizures/ci [Chemically Induced] MH - Seizures/th [Therapy] MH - Self Administration/ae [Adverse Effects] RN - 0 (Analgesics, Opioid) RN - 0 (Antihypertensive Agents) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - MN3L5RMN02 (Clonidine) RN - UF599785JZ (Fentanyl) IS - 0099-1767 IL - 0099-1767 PT - Case Reports PT - Journal Article ID - S0099-1767(07)00072-4 [pii] ID - 10.1016/j.jen.2007.02.004 [doi] PP - ppublish LG - English DP - 2007 Jun EZ - 2007/05/23 09:00 DA - 2007/08/19 09:00 DT - 2007/05/23 09:00 YR - 2007 ED - 20070817 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17517283 <642. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17542332 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dixon P FA - Dixon, Pamela IN - Dixon, Pamela. Jersey General Hospital. TI - Managing acute heroin overdose. [Review] [28 refs] SO - Emergency Nurse. 15(2):30-5, 2007 May AS - Emerg Nurse. 15(2):30-5, 2007 May NJ - Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association VO - 15 IP - 2 PG - 30-5 PI - Journal available in: Print PI - Citation processed from: Print JC - bia, 9208913 IO - Emerg Nurse SB - Nursing Journal CP - England MH - *Drug Overdose/nu [Nursing] MH - Emergency Service, Hospital MH - Heroin/pd [Pharmacology] MH - *Heroin/po [Poisoning] MH - Humans MH - Naloxone/ae [Adverse Effects] MH - Naloxone/pd [Pharmacology] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/pd [Pharmacology] MH - United Kingdom RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 1354-5752 IL - 1354-5752 PT - Journal Article PT - Review ID - 10.7748/en2007.05.15.2.30.c4243 [doi] PP - ppublish LG - English DP - 2007 May EZ - 2007/06/05 09:00 DA - 2007/07/20 09:00 DT - 2007/06/05 09:00 YR - 2007 ED - 20070719 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17542332 <643. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16930865 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Berg ML AU - Idrees U AU - Ding R AU - Nesbit SA AU - Liang HK AU - McCarthy ML FA - Berg, M L FA - Idrees, U FA - Ding, R FA - Nesbit, S A FA - Liang, H K FA - McCarthy, M L IN - Berg, M L. University of Illinois-Chicago, Edward Hospital, Department of Pharmacy, 801 S. Washington Street, Naperville, IL 60540, United States. TI - Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department. SO - Drug & Alcohol Dependence. 86(2-3):239-44, 2007 Jan 12 AS - Drug Alcohol Depend. 86(2-3):239-44, 2007 Jan 12 NJ - Drug and alcohol dependence VO - 86 IP - 2-3 PG - 239-44 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Academic Medical Centers MH - Baltimore MH - *Buprenorphine/tu [Therapeutic Use] MH - *Emergency Service, Hospital MH - Humans MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - *Substance Withdrawal Syndrome/dt [Drug Therapy] MH - Urban Population AB - OBJECTIVES: To examine the use of buprenorphine for the treatment of opioid withdrawal (OW) in an emergency department (ED) setting. AB - METHODS: The medical records of all adult patients who presented to the study ED during a 10 week period for OW were abstracted. Subjects were categorized as receiving buprenorphine, symptomatic treatment or no pharmacologic treatment for their OW. The three groups were compared by patient and service characteristics, withdrawal symptoms and outcomes. AB - RESULTS: Of the 11,019 patients who presented to the ED during the 10 week study period, 158 (1.4%) were eligible. Subjects were more likely to receive buprenorphine (56%) compared to symptomatic treatment only (26%) or no pharmacologic treatment (18%). Subjects who received buprenorphine were more likely to have a history of suicide ideation (34% versus 12% p<0.05) compared to subjects who received symptomatic treatment(s) and were less likely to present with a gastrointestinal complaint (9% versus 25% p<0.05). Subjects who received buprenorphine were less likely to return to the same ED within 30 days for a drug-related visit (8%) compared to those who received symptomatic treatment (17%) (p<0.05). AB - CONCLUSIONS: Buprenorphine was a common treatment for OW in this ED without any documented adverse outcomes. Given that it did not result in an increase in drug-related return ED visits and its proven efficacy in other settings, a prospective evaluation of its potential value to ED patients who present with OW is warranted. RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) IS - 0376-8716 IL - 0376-8716 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0376-8716(06)00237-7 [pii] ID - 10.1016/j.drugalcdep.2006.06.014 [doi] PP - ppublish PH - 2006/05/05 [received] PH - 2006/06/27 [revised] PH - 2006/06/28 [accepted] LG - English EP - 20060822 DP - 2007 Jan 12 EZ - 2006/08/26 09:00 DA - 2007/06/22 09:00 DT - 2006/08/26 09:00 YR - 2007 ED - 20070621 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16930865 <644. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17518311 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Heller DI AU - Stancliff S FA - Heller, Daliah I FA - Stancliff, Sharon IN - Heller, Daliah I. New York City Department of Health and Mental Hygiene, New York, NY 10013, USA. dheller1@health.nyc.gov TI - Providing naloxone to substance users for secondary administration to reduce overdose mortality in New York City. SO - Public Health Reports. 122(3):393-7, 2007 May-Jun AS - Public Health Rep. 122(3):393-7, 2007 May-Jun NJ - Public health reports (Washington, D.C. : 1974) VO - 122 IP - 3 PG - 393-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 9716844, qja IO - Public Health Rep PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847483 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Drug Overdose MH - Emergency Treatment/mt [Methods] MH - Health Education MH - Humans MH - Legislation, Drug/og [Organization & Administration] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - New York City/ep [Epidemiology] MH - Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/pc [Prevention & Control] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0033-3549 IL - 0033-3549 PT - Journal Article ID - PMC1847483 [pmc] ID - 10.1177/003335490712200313 [doi] PP - ppublish LG - English DP - 2007 May-Jun EZ - 2007/05/24 09:00 DA - 2007/06/15 09:00 DT - 2007/05/24 09:00 YR - 2007 ED - 20070614 RD - 20170219 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17518311 <645. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17373592 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hansmann G AU - Humpl T AU - Zimmermann A AU - Buhrer C AU - Wauer R AU - Stannigel H AU - Hoehn T AU - ILCOR FA - Hansmann, G FA - Humpl, T FA - Zimmermann, A FA - Buhrer, C FA - Wauer, R FA - Stannigel, H FA - Hoehn, T FA - ILCOR IN - Hansmann, G. Institutsangaben sind am Ende des Beitrags gelistet. TI - [ILCOR's new resuscitation guidelines in preterm and term infants: critical discussion and suggestions for implementation]. [53 refs] [German] OT - Neue Reanimationsrichtlinien der ILCOR bei Fruh- und Reifgeborenen: Kritische Diskussion und Vorschlage zur praktischen Umsetzung. CM - Comment in: Klin Padiatr. 2007 Mar-Apr;219(2):49; PMID: 17405069 SO - Klinische Padiatrie. 219(2):50-7, 2007 Mar-Apr AS - Klin Padiatr. 219(2):50-7, 2007 Mar-Apr NJ - Klinische Padiatrie VO - 219 IP - 2 PG - 50-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - kwe, 0326144 IO - Klin Padiatr SB - Index Medicus CP - Germany MH - Asphyxia Neonatorum/th [Therapy] MH - *Cardiopulmonary Resuscitation/mt [Methods] MH - Delivery Rooms MH - Epinephrine/ad [Administration & Dosage] MH - Evidence-Based Medicine MH - Fluid Therapy/mt [Methods] MH - Humans MH - Hypothermia, Induced MH - Infant, Newborn MH - *Infant, Premature, Diseases/th [Therapy] MH - Meconium Aspiration Syndrome/th [Therapy] MH - Naloxone/ad [Administration & Dosage] MH - Oxygen Inhalation Therapy/mt [Methods] MH - Respiration, Artificial/mt [Methods] MH - Respiratory Distress Syndrome, Newborn/th [Therapy] AB - Recommendations of the International Liaison Committee on Resuscitation (ILCOR) become updated every five years with changing evidence resulting in revised recommendations for clinical practice. New data exist concerning the adequate oxygen concentration to be used in the delivery room, the management of imminent meconium aspiration, ventilation strategies and the role of body temperature during and after resuscitation of preterm and term newborn infants. Only in some cases new evidence has led to clear-cut recommendations for or against specific interventions. Therefore the present publication cites the original ILCOR-recommendations and discusses these with regard to their practical implementation. The authors of the present work suggest to commence resuscitation independendly of gestational age with room air and adjust the inspiratory oxygen concentration thereafter on clinical grounds. The authors also advocate the retention of the presently performed intranatal suction procedure in cases of meconium-stained amniotic fluid and the use of therapeutic hypothermia following perinatal asphyxia in term newborns according to the protocol of one of the published randomized, controlled trials. Standard equipment for neonatal resuscitation should include pressure gauge for monitoring of inspiratory pressures, oxygen blender, and pulse oxymeter. The predominant majority of ILCOR-recommendations have only been cited and have been commented with respect to their practical implementation within the clinical context. [References: 53] RN - 36B82AMQ7N (Naloxone) RN - YKH834O4BH (Epinephrine) IS - 0300-8630 IL - 0300-8630 PT - Consensus Development Conference PT - English Abstract PT - Journal Article PT - Practice Guideline ID - 10.1055/s-2007-970072 [doi] PP - ppublish LG - German EP - 20070320 DP - 2007 Mar-Apr EZ - 2007/03/22 09:00 DA - 2007/06/15 09:00 DT - 2007/03/22 09:00 YR - 2007 ED - 20070614 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17373592 <646. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17504834 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hartung DM AU - Middleton L AU - Haxby DG AU - Koder M AU - Ketchum KL AU - Chou R FA - Hartung, Daniel M FA - Middleton, Luke FA - Haxby, Dean G FA - Koder, Michele FA - Ketchum, Kathy L FA - Chou, Roger IN - Hartung, Daniel M. College of Pharmacy, Oregon State University, Oregon Health & Science University Campus, Portland, OR 97239, USA. hartungd@ohsu.edu TI - Rates of adverse events of long-acting opioids in a state Medicaid program.[Erratum appears in Ann Pharmacother. 2007 Sep;41(9):1552] SO - Annals of Pharmacotherapy. 41(6):921-8, 2007 Jun AS - Ann Pharmacother. 41(6):921-8, 2007 Jun NJ - The Annals of pharmacotherapy VO - 41 IP - 6 PG - 921-8 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - bbx, 9203131 IO - Ann Pharmacother SB - Index Medicus CP - United States MH - Adult MH - Aged MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Chronic Disease/dt [Drug Therapy] MH - Cohort Studies MH - Female MH - Humans MH - Male MH - Medicaid MH - Middle Aged MH - Oregon MH - Pain/dt [Drug Therapy] MH - Proportional Hazards Models MH - Retrospective Studies MH - Risk Factors AB - BACKGROUND: Despite widespread use and emerging safety concerns, data on the comparative safety and effectiveness of long-acting opioid (LAO) analgesics are weak. AB - OBJECTIVE: To compare rates of adverse events among patients newly prescribed an LAO. AB - METHODS: A retrospective observational cohort study using Medicaid administrative claims data was conducted examining time until first adverse outcome among patients with new prescriptions for methadone, extended-release (ER) oxycodone, ER morphine, or transdermal fentanyl. Adverse outcomes included emergency department (ED) encounters or hospitalizations for opioid-related adverse events, all-cause ED encounters or hospitalizations, death, and diagnoses for opioid-related adverse effects. Cox proportional hazards models were used to adjust for a variety of measured covariates overall and within subgroups of patients with and without cancer. AB - RESULTS: This study included 5684 subjects. Patients prescribed ER oxycodone were 55[corrected]% less likely (adjusted hazard ratio [HR] 0.45; 95% CI 0.26 to 0.77) to experience an ED or hospitalization involving an opioid-related adverse event, 23% lower risk of hospitalization (adjusted HR 0.77; 95% CI 0.66 to 0.91), 41% lower risk of constipation (adjusted HR 0.59; 95% CI 0.35 to 1.00), and a 29% lower risk of death (adjusted HR 0.71; 95% CI 0.54 to 0.94) compared with those prescribed ER morphine. Among subjects with noncancer pain, fentanyl was associated with a higher risk of ED encounters (adjusted HR 1.27; 95% CI 1.02 to 1.59) and methadone was associated with a greater risk of overdose symptoms (adjusted HR 1.57; 95% CI 1.03 to 2.40) compared with ER morphine. AB - CONCLUSIONS: Our results support a modest safety advantage with ER oxycodone compared with ER morphine. Among subjects with noncancer pain, fentanyl and methadone were associated with an increased risk of an adverse event compared with ER morphine. Additional studies are needed to confirm our findings and further clarify risks associated with different LAOs. RN - 0 (Analgesics, Opioid) ES - 1542-6270 IL - 1060-0280 PT - Comparative Study PT - Journal Article ID - aph.1K066 [pii] ID - 10.1345/aph.1K066 [doi] PP - ppublish LG - English EP - 20070515 DP - 2007 Jun EZ - 2007/05/17 09:00 DA - 2007/06/15 09:00 DT - 2007/05/17 09:00 YR - 2007 ED - 20070613 RD - 20071009 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17504834 <647. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17499673 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Osterhoudt KC AU - Calello DP FA - Osterhoudt, Kevin C FA - Calello, Diane P TI - Obtundation in a toddler: naloxone is fundamental. SO - American Journal of Emergency Medicine. 25(4):481, 2007 May AS - Am J Emerg Med. 25(4):481, 2007 May NJ - The American journal of emergency medicine VO - 25 IP - 4 PG - 481 PI - Journal available in: Print PI - Citation processed from: Internet JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Child, Preschool MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Medicine/mt [Methods] MH - Female MH - Humans MH - *Methadone/po [Poisoning] MH - Methadone/ur [Urine] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Narcotics/ur [Urine] MH - Resuscitation/mt [Methods] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) ES - 1532-8171 IL - 0735-6757 PT - Case Reports PT - Letter ID - S0735-6757(05)00350-5 [pii] ID - 10.1016/j.ajem.2005.09.011 [doi] PP - ppublish PH - 2005/09/19 [received] PH - 2005/09/20 [accepted] LG - English DP - 2007 May EZ - 2007/05/15 09:00 DA - 2007/06/09 09:00 DT - 2007/05/15 09:00 YR - 2007 ED - 20070608 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17499673 <648. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17407734 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Donoghue J FA - Donoghue, John TI - Thanks for the high. SO - Journal of Emergency Medical Services. 32(4):16, 2007 Apr AS - J Emerg Med Serv JEMS. 32(4):16, 2007 Apr NJ - JEMS : a journal of emergency medical services VO - 32 IP - 4 PG - 16 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - Emergency Medical Services MH - *Fentanyl/tu [Therapeutic Use] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Substance-Related Disorders/dt [Drug Therapy] MH - United States RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0197-2510 IL - 0197-2510 PT - Letter ID - S0197-2510(07)72149-6 [pii] ID - 10.1016/S0197-2510(07)72149-6 [doi] PP - ppublish LG - English DP - 2007 Apr EZ - 2007/04/05 09:00 DA - 2007/05/30 09:00 DT - 2007/04/05 09:00 YR - 2007 ED - 20070529 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17407734 <649. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17305687 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cicero TJ AU - Dart RC AU - Inciardi JA AU - Woody GE AU - Schnoll S AU - Munoz A FA - Cicero, Theodore J FA - Dart, Richard C FA - Inciardi, James A FA - Woody, George E FA - Schnoll, Sidney FA - Munoz, Alvaro IN - Cicero, Theodore J. Washington University School of Medicine, St. Louis, Missouri 63110, USA. cicerot@wustl.edu TI - The development of a comprehensive risk-management program for prescription opioid analgesics: researched abuse, diversion and addiction-related surveillance (RADARS). SO - Pain Medicine. 8(2):157-70, 2007 Mar AS - PAIN MED. 8(2):157-70, 2007 Mar NJ - Pain medicine (Malden, Mass.) VO - 8 IP - 2 PG - 157-70 PI - Journal available in: Print PI - Citation processed from: Print JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - *Analgesics, Opioid MH - Data Collection MH - Delayed-Action Preparations MH - Drug Prescriptions MH - Humans MH - Hydrocodone MH - Indiana/ep [Epidemiology] MH - National Institutes of Health (U.S.) MH - *Opioid-Related Disorders/ep [Epidemiology] MH - *Opioid-Related Disorders/pc [Prevention & Control] MH - Oxycodone MH - Poison Control Centers/sn [Statistics & Numerical Data] MH - Police MH - Risk Assessment MH - *Risk Management/og [Organization & Administration] MH - Risk Reduction Behavior MH - Substance Abuse Treatment Centers/sn [Statistics & Numerical Data] MH - *Substance-Related Disorders/ep [Epidemiology] MH - *Substance-Related Disorders/pc [Prevention & Control] MH - United States AB - UNLABELLED: OBJECTIVE. Beginning in the late 1990's a marked increase in abuse of OxyContin emerged, which led to the development and establishment of a proactive surveillance program to monitor and characterize abuse, named the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS) System. The main goal of RADARS was to develop proactive, timely and geographically sensitive methods to assess the abuse and diversion of OxyContin, along with a number of other Schedule II and III opioids with the aim of using this information to guide risk reduction interventions. Thus, its major focus was the detection of abuse of OxyContin and other commonly prescribed opioid analgesics at the three-digit ZIP code level across the country utilizing a number of different detection systems. AB - METHODS: The detection systems selected were: (1) Quarterly-surveys of drug abuse experts who are knowledgeable about cases of prescription drug abuse; (2) Surveys of law enforcement agencies that detect diversion of prescription drugs; and (3) Poison Control Center reports of intentional misuse or abuse of prescription opioids. Collectively, the three systems provide overlapping coverage of over 80% of the nation's 973 three-digit ZIP codes. AB - RESULTS: Preliminary results indicate that prescription drug abuse is prevalent nationwide, but it seems to be heavily localized in rural, suburban and small urban areas. Our results also indicate that hydrocodone and extended and immediate release oxycodone products are by far the most widely abused drugs in the country, but the abuse of all prescription opioids seems to have grown over the 14 quarters since the inception of RADARS. AB - CONCLUSION: The next step in these studies is to develop regionally specific, risk-minimization-strategies, which is the goal of all risk-management programs. If successful, RADARS will serve as a prototype of such programs for any new drug approved that has measurable abuse potential. RN - 0 (Analgesics, Opioid) RN - 0 (Delayed-Action Preparations) RN - 6YKS4Y3WQ7 (Hydrocodone) RN - CD35PMG570 (Oxycodone) IS - 1526-2375 IL - 1526-2375 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - PME259 [pii] ID - 10.1111/j.1526-4637.2006.00259.x [doi] PP - ppublish LG - English DP - 2007 Mar EZ - 2007/02/20 09:00 DA - 2007/05/03 09:00 DT - 2007/02/20 09:00 YR - 2007 ED - 20070502 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17305687 <650. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17286343 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bray JW AU - Zarkin GA AU - Miller WR AU - Mitra D AU - Kivlahan DR AU - Martin DJ AU - Couper DJ AU - Cisler RA FA - Bray, Jeremy W FA - Zarkin, Gary A FA - Miller, William R FA - Mitra, Debanjali FA - Kivlahan, Daniel R FA - Martin, Daniel J FA - Couper, David J FA - Cisler, Ron A IN - Bray, Jeremy W. RTI International, 3040 Cornwallis Road, Research Triangle Park, North Carolina 27709, USA. bray@rti.org TI - Measuring economic outcomes of alcohol treatment using the Economic Form 90. SO - Journal of Studies on Alcohol & Drugs. 68(2):248-55, 2007 Mar AS - J Stud Alcohol. 68(2):248-55, 2007 Mar NJ - Journal of studies on alcohol and drugs VO - 68 IP - 2 PG - 248-55 PI - Journal available in: Print PI - Citation processed from: Print JC - k76, 101295847 IO - J Stud Alcohol Drugs SB - Index Medicus CP - United States MH - Absenteeism MH - Accidents, Traffic/ec [Economics] MH - Adult MH - *Alcohol Deterrents/ec [Economics] MH - *Alcohol Deterrents/tu [Therapeutic Use] MH - Alcoholism/cl [Classification] MH - *Alcoholism/ec [Economics] MH - *Alcoholism/rh [Rehabilitation] MH - *Behavior Therapy/ec [Economics] MH - Combined Modality Therapy/ec [Economics] MH - Cost-Benefit Analysis MH - Criminal Law/ec [Economics] MH - Employment/ec [Economics] MH - Female MH - Follow-Up Studies MH - *Health Care Costs/sn [Statistics & Numerical Data] MH - Health Resources/ec [Economics] MH - Health Resources/ut [Utilization] MH - Humans MH - Male MH - Middle Aged MH - *Models, Economic MH - *Naltrexone/ec [Economics] MH - *Naltrexone/tu [Therapeutic Use] MH - Prisons/ec [Economics] MH - *Taurine/aa [Analogs & Derivatives] MH - Taurine/ec [Economics] MH - Taurine/tu [Therapeutic Use] MH - Treatment Outcome MH - United States AB - OBJECTIVE: This article assesses the ability of the economic outcome measures in the Economic Form 90 to detect differences across levels of alcohol dependence as measured by the Alcohol Dependence Scale. AB - METHOD: We used baseline data from the Combining Medications and Behavioral Interventions (COMBINE) Study, a large, multisite clinical trial, to assess the extent to which the economic items on the Economic Form 90 instrument can detect differences across levels of alcohol dependence. AB - RESULTS: After adjusting for differences in demographic characteristics, the Economic Form 90 can detect significant differences across a range of dependence severity levels for the economic outcomes of inpatient medical care, emergency-department medical care, behavioral health care, being on parole or probation, and missed workdays, conditional on being employed. We did not detect significant differences across dependence severity for employment status, outpatient medical care, other criminal justice involvement, or motor vehicle accidents. AB - CONCLUSIONS: The Economic Form 90 can identify differences in many economic outcomes associated with differing levels of alcohol dependence. This suggests that the Economic Form 90 may be useful in assessing changes in economic outcomes that result from changes in alcohol dependence. RN - 0 (Alcohol Deterrents) RN - 1EQV5MLY3D (Taurine) RN - 5S6W795CQM (Naltrexone) RN - N4K14YGM3J (acamprosate) IS - 1937-1888 IL - 1937-1888 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PP - ppublish GI - No: 1-R01-AA12788 Organization: (AA) *NIAAA NIH HHS* Country: United States LG - English DP - 2007 Mar EZ - 2007/02/09 09:00 DA - 2007/05/03 09:00 DT - 2007/02/09 09:00 YR - 2007 ED - 20070502 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17286343 <651. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17146712 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Beletsky L AU - Ruthazer R AU - Macalino GE AU - Rich JD AU - Tan L AU - Burris S FA - Beletsky, Leo FA - Ruthazer, Robin FA - Macalino, Grace E FA - Rich, Josiah D FA - Tan, Litjen FA - Burris, Scott IN - Beletsky, Leo. Temple University Beasley School of Law, Philadelphia, PA 19122, USA. leob@temple.edu TI - Physicians' knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose: challenges and opportunities. SO - Journal of Urban Health. 84(1):126-36, 2007 Jan AS - J Urban Health. 84(1):126-36, 2007 Jan NJ - Journal of urban health : bulletin of the New York Academy of Medicine VO - 84 IP - 1 PG - 126-36 PI - Journal available in: Print PI - Citation processed from: Print JC - c5l, 9809909 IO - J Urban Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078257 SB - Index Medicus CP - United States MH - *Attitude of Health Personnel MH - Demography MH - Drug Overdose/dt [Drug Therapy] MH - Evidence-Based Medicine MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - *Opiate Alkaloids/po [Poisoning] MH - Opioid-Related Disorders/co [Complications] MH - *Physicians/px [Psychology] AB - Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a "take-home" dose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 0 (Opiate Alkaloids) RN - 36B82AMQ7N (Naloxone) IS - 1099-3460 IL - 1099-3460 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1007/s11524-006-9120-z [doi] ID - PMC2078257 [pmc] PP - ppublish LG - English DP - 2007 Jan EZ - 2006/12/06 09:00 DA - 2007/04/11 09:00 DT - 2006/12/06 09:00 YR - 2007 ED - 20070410 RD - 20140907 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17146712 <652. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17156179 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barnett PG AU - Masson CL AU - Sorensen JL AU - Wong W AU - Hall S FA - Barnett, Paul G FA - Masson, Carmen L FA - Sorensen, James L FA - Wong, Wynnie FA - Hall, Sharon IN - Barnett, Paul G. Department of Psychiatry, University of California, San Francisco, CA, USA. paul.barnett@va.gov TI - Linking opioid-dependent hospital patients to drug treatment: Health care use and costs 6 months after randomization. SO - Addiction. 101(12):1797-804, 2006 Dec AS - Addiction. 101(12):1797-804, 2006 Dec NJ - Addiction (Abingdon, England) VO - 101 IP - 12 PG - 1797-804 PI - Journal available in: Print PI - Citation processed from: Print JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - Case Management/ec [Economics] MH - *Case Management MH - Emergency Medical Services/ec [Economics] MH - Emergency Medical Services/ut [Utilization] MH - Female MH - *Health Care Costs/sn [Statistics & Numerical Data] MH - Hospitalization/ec [Economics] MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Methadone/ec [Economics] MH - *Methadone/tu [Therapeutic Use] MH - Middle Aged MH - Narcotics/ec [Economics] MH - *Narcotics/tu [Therapeutic Use] MH - Opioid-Related Disorders/ec [Economics] MH - *Opioid-Related Disorders/rh [Rehabilitation] AB - AIMS: To conduct an economic evaluation of the first 6 months' trial of treatment vouchers and case management for opioid-dependent hospital patients. AB - DESIGN: Randomized clinical trial and evaluation of administrative data. AB - SETTING: Emergency department, wound clinic, in-patient units and methadone clinic in a large urban public hospital. AB - PARTICIPANTS: The study randomized 126 opioid-dependent drug users seeking medical care. AB - INTERVENTIONS: Participants were randomized among four groups. These received vouchers for 6 months of methadone treatment, 6 months of case management, both these interventions, or usual care. AB - FINDINGS: During the first 6 months of this study, 90% of those randomized to vouchers alone enrolled in methadone maintenance, significantly more than the 44% enrollment in those randomized to case management without vouchers (P < 0.001). The direct costs of substance abuse treatment, including case management, was 4040 dollars for those who received vouchers, 4177 dollars for those assigned to case management and 5277 dollars for those who received the combination of both interventions. After 3 months, the vouchers alone group used less heroin than the case management alone group. The difference was not significant at 6 months. There were no significant differences in other health care costs in the 6 months following randomization. AB - CONCLUSION: Vouchers were slightly more effective but no more costly than case management during the initial 6 months of the study. Vouchers were as effective and less costly than the combination of case management and vouchers. The finding that vouchers dominate is tempered by the possibility that case management may lower medical care costs. RN - 0 (Narcotics) RN - UC6VBE7V1Z (Methadone) IS - 0965-2140 IL - 0965-2140 PT - Evaluation Studies PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural ID - ADD1636 [pii] ID - 10.1111/j.1360-0443.2006.01636.x [doi] PP - ppublish GI - No: K01DA00408 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K05DA16752 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: P50DA14922 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01DA14922 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: U10DA15815 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2006 Dec EZ - 2006/12/13 09:00 DA - 2007/04/11 09:00 DT - 2006/12/13 09:00 YR - 2006 ED - 20070410 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17156179 <653. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17367089 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Klein-Kremer A AU - Goldman RD FA - Klein-Kremer, Adi FA - Goldman, Ran D IN - Klein-Kremer, Adi. Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. TI - Opioid administration for acute abdominal pain in the pediatric emergency department. [Review] [19 refs] SO - Journal of Opioid Management. 3(1):11-4, 2007 Jan-Feb AS - J Opioid Manag. 3(1):11-4, 2007 Jan-Feb NJ - Journal of opioid management VO - 3 IP - 1 PG - 11-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Abdomen, Acute/di [Diagnosis] MH - *Abdomen, Acute/dt [Drug Therapy] MH - Adolescent MH - Adult MH - *Analgesia/mt [Methods] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Appendicitis/di [Diagnosis] MH - Child MH - Child, Preschool MH - Contraindications MH - Emergency Service, Hospital MH - Humans MH - Infant MH - Morphine/tu [Therapeutic Use] MH - Pain Measurement MH - Pediatrics AB - The use of opioid analgesia for acute abdominal pain of unclear etiology has traditionally been thought to mask symptoms, alter physical exam findings, delay diagnosis, and increase morbidity and mortality. However, studies in children and adults have demonstrated that administering intravenous opioids to patients with acute abdominal pain induces analgesia but does not delay diagnosis or adversely affect diagnostic accuracy. This review discusses the effects of opioid administration on pain relief and diagnostic accuracy in children with moderate to severe acute abdominal pain who have been evaluated in the emergency department. We hold that current evidence supports the administration of opioids to children with acute abdominal pain, and future trials will help determine safe and effective timing and dosing related to opioid administration. [References: 19] RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) IS - 1551-7489 IL - 1551-7489 PT - Journal Article PT - Review PP - ppublish LG - English DP - 2007 Jan-Feb EZ - 2007/03/21 09:00 DA - 2007/04/05 09:00 DT - 2007/03/21 09:00 YR - 2007 ED - 20070404 RD - 20171116 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17367089 <654. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17364631 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hughes AA AU - Bogdan GM AU - Dart RC FA - Hughes, Alice A FA - Bogdan, Gregory M FA - Dart, Richard C IN - Hughes, Alice A. Rocky Mountain Poison and Drug Center - Denver Health and Hospital Authority, Denver, Colorado 80204, USA. Alice.Hughes@RMPDC.org TI - Active surveillance of abused and misused prescription opioids using poison center data: a pilot study and descriptive comparison. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 45(2):144-51, 2007 AS - Clin Toxicol (Phila). 45(2):144-51, 2007 NJ - Clinical toxicology (Philadelphia, Pa.) VO - 45 IP - 2 PG - 144-51 PI - Journal available in: Print PI - Citation processed from: Print JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Prescriptions MH - Female MH - Humans MH - Male MH - Middle Aged MH - Pilot Projects MH - *Poison Control Centers MH - *Population Surveillance MH - Substance-Related Disorders/ep [Epidemiology] MH - *Substance-Related Disorders MH - United States AB - BACKGROUND: Prescription opioids are abused throughout the United States. Several monitoring programs are in existence, however, none of these systems provide up-to-date information on prescription opioid abuse. This article describes the use of poison centers as a real-time, geographically specific, surveillance system for prescription opioid abuse and compares our system with an existing prescription drug abuse monitoring program, the Drug Abuse Warning Network (DAWN). AB - METHODS: Data were collected from eight geographically dispersed poison centers for a period of twelve months. Any call involving buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone was considered a case. Any case coded as intentional exposure (abuse, intentional misuse, suicide, or intentional unknown) was regarded as misuse and abuse. Comparative data were obtained from DAWN. AB - RESULTS: Poison center rates of abuse and misuse were highest for hydrocodone at 3.75 per 100,000 population, followed by oxycodone at 1.81 per 100,000 population. DAWN emergency department (ED) data illustrate a similar pattern of abuse with most mentions involving hydrocodone and oxycodone. Poison center data indicate that people aged 18 to 25 had the highest rates of abuse. DAWN reported the majority of ED mentions among 35 to 44-year-olds. Geographically, Kentucky had the uppermost rates of abuse and misuse for all opioids combined at 20.69 per 100,000 population. CONCLUSIONS. Comparing poison center data to DAWN yielded mostly comparable results, including hydrocodone as the most commonly mentioned drug. Our results suggest poison center data can be used as an indicator for prescription opioid abuse and misuse and can provide timely, geographically specific information on prescription drug abuse. RN - 0 (Analgesics, Opioid) IS - 1556-3650 IL - 1556-3650 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 770465095 [pii] ID - 10.1080/15563650600981137 [doi] PP - ppublish LG - English DP - 2007 EZ - 2007/03/17 09:00 DA - 2007/03/30 09:00 DT - 2007/03/17 09:00 YR - 2007 ED - 20070329 RD - 20091117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17364631 <655. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17357378 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Smith MY AU - Schneider MF AU - Wentz A AU - Hughes A AU - Haddox JD AU - Dart R FA - Smith, Meredith Y FA - Schneider, Michael F FA - Wentz, Alicia FA - Hughes, Alice FA - Haddox, J David FA - Dart, Richard IN - Smith, Meredith Y. Purdue Pharma L.P., One Stamford Forum, Stamford, Connecticut 06901-3431, USA. meredith.smith@pharma.com TI - Quantifying morbidity associated with the abuse and misuse of opioid analgesics: a comparison of two approaches. SO - Clinical Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European Association of Poisons Centres & Clinical Toxicologists. 45(1):23-30, 2007 AS - Clin Toxicol (Phila). 45(1):23-30, 2007 NJ - Clinical toxicology (Philadelphia, Pa.) VO - 45 IP - 1 PG - 23-30 PI - Journal available in: Print PI - Citation processed from: Print JC - 101241654 IO - Clin Toxicol (Phila) SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Analgesics, Opioid/po [Poisoning] MH - Humans MH - *Opioid-Related Disorders/mo [Mortality] MH - Poison Control Centers MH - *Street Drugs/po [Poisoning] MH - Substance Abuse Detection MH - Survival Rate/td [Trends] MH - United States/ep [Epidemiology] AB - BACKGROUND: Due to the rising nonmedical use of opioid analgesics, methods are needed to quantify the associated health-related consequences. AB - METHODS: Using opioid analgesic intentional exposure reports from poison control centers from January 2003-June 2004, we calculated quarterly rates for 7 opioids at the 3-digit ZIP code level using population- and patient-based denominators. AB - RESULTS: Hydrocodone was the most widely prescribed opioid (maximum: 5,321,390 patients per quarter), with the largest intentional exposure caseload (range: 498-1,290), and the highest aggregate population-based rate (maximum of 13.61 cases per 1,000,000 individuals). Methadone had the highest aggregate patient-based rate (maximum 2.03 cases per 1,000 patients). AB - CONCLUSION: Population- and patient-based rates are complementary tools that address different public health questions. Population-based rates describe the health-related burden of nonmedical opioid analgesic use on the community as a whole, while patient-based rates show this burden ("risk") in relation to the level of corresponding medicinal use ("benefit") within a given area. RN - 0 (Analgesics, Opioid) RN - 0 (Street Drugs) IS - 1556-3650 IL - 1556-3650 PT - Comparative Study PT - Journal Article PT - Multicenter Study PP - ppublish LG - English DP - 2007 EZ - 2007/03/16 09:00 DA - 2007/03/30 09:00 DT - 2007/03/16 09:00 YR - 2007 ED - 20070329 RD - 20091117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17357378 <656. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17326595 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Heins A AU - Grammas M AU - Heins JK AU - Costello MW AU - Huang K AU - Mishra S FA - Heins, Alan FA - Grammas, Marianthe FA - Heins, Janet Kaye FA - Costello, Melissa W FA - Huang, Kun FA - Mishra, Satya IN - Heins, Alan. University of South Alabama Department of Emergency Medicine, Mobile, USA. TI - Determinants of variation in analgesic and opioid prescribing practice in an emergency department. SO - Journal of Opioid Management. 2(6):335-40, 2006 Nov-Dec AS - J Opioid Manag. 2(6):335-40, 2006 Nov-Dec NJ - Journal of opioid management VO - 2 IP - 6 PG - 335-40 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - African Continental Ancestry Group MH - Aged MH - Alabama MH - Analgesics/ad [Administration & Dosage] MH - *Analgesics/tu [Therapeutic Use] MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Chronic Disease MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Drug Utilization MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - European Continental Ancestry Group MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - *Musculoskeletal Diseases/dt [Drug Therapy] MH - *Pain/dt [Drug Therapy] MH - Pain Measurement/de [Drug Effects] MH - Treatment Outcome AB - OBJECTIVE: Adequate treatment of patients' pain is a top priority for the World Health Organization (WHO), American Medical Association (AMA), and American College of Emergency Physicians (ACEP), but "adequate" is not clearly defined. Most previous studies of emergency department (ED) pain treatments have centered on musculoskeletal pain in terms of rates of analgesia and disparities in treatment based on race and age. This study will examine complaints of pain other than musculoskeletal and will focus on treatment disparities that may result from differences inpatient and physician characteristics. AB - METHODS: This retrospective study is of ED patients 18 years and older with nonmusculoskeletal pain who were seen by ED faculty over a period of eight weeks. Logistic regression and CHI2 tests were performed to quantify effects of doctor, patient, and clinical characteristics on rates of ED analgesia, ED opioids, and analgesic prescriptions at discharge. AB - RESULTS: A total of 1360 patients were included. There was wide variation in the type and frequency of ED analgesia depending on the attending doctor. For example, patients seen by one specific ED doctor were less than half as likely to receive any analgesia and seven times less likely to receive an opioid than those seen by another doctor. Age, race, doctor's training and experience, and whether the patient had chronic pain were important predictors of ED analgesia. There were similar findings for ED opioids and discharge analgesics. AB - CONCLUSION: Pain practices in EDs are highly variable and seem inadequate when measured against the goals of WHO, AMA, and ACEP. Patient age, race, and type of pain and the physician's identity, training, and experience all contribute to practice variation. Further research is needed to identify the causes of these variations, and there is a need to develop interventions to standardize and improve pain assessment and treatment. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) IS - 1551-7489 IL - 1551-7489 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2006 Nov-Dec EZ - 2007/03/01 09:00 DA - 2007/03/16 09:00 DT - 2007/03/01 09:00 YR - 2006 ED - 20070314 RD - 20120713 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17326595 <657. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17319484 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Puntillo K AU - Neighbor M AU - Chan GK AU - Garbez R FA - Puntillo, Kathleen FA - Neighbor, Martha FA - Chan, Garrett K FA - Garbez, Roxanne IN - Puntillo, Kathleen. University of California, San Francisco School of Nursing, USA. TI - The influence of chief complaint on opioid use in the emergency department. SO - Journal of Opioid Management. 2(4):228-35, 2006 Jul-Aug AS - J Opioid Manag. 2(4):228-35, 2006 Jul-Aug NJ - Journal of opioid management VO - 2 IP - 4 PG - 228-35 PI - Journal available in: Print PI - Citation processed from: Print JC - 101234523 IO - J Opioid Manag SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Utilization MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - Middle Aged MH - Nurses MH - Pain/di [Diagnosis] MH - *Pain/dt [Drug Therapy] MH - Pain Measurement/mt [Methods] MH - Physicians AB - The aim of this study was to explore factors influencing emergency department (ED) clinicians' use of opioids in treating selected patients. Patients who either received or did not receive opioids in the ED, as well as their nurses and physicians, were interviewed before patient discharge. We found that the decrease in patients' mean (SD) pain intensity from the time of admission to the ED (7.3 +/- 2.4 on a 0 to 10 numeric rating scale) to discharge (5.0 +/- 2.9) was statistically significant (t93 = 8.4, p < 0.001, 95 percent CI = 1.7, 2.8) for all groups except those with trauma-related pain. The factor that most frequently led physicians of patients with abdominal pain and nurses in general to administer no opioids was that the patient was "not in that much pain." However, the patients in question had self-reported pain scores that indicated moderate pain. Our findings lead us to conclude that clinicians inaccurately infer severity of patient pain. This in turn can influence the prescription of opioids and the patient's decrease in pain. RN - 0 (Analgesics, Opioid) IS - 1551-7489 IL - 1551-7489 PT - Journal Article PT - Research Support, N.I.H., Extramural PP - ppublish GI - No: 1 R55 NR04451-01A2 Organization: (NR) *NINR NIH HHS* Country: United States LG - English DP - 2006 Jul-Aug EZ - 2007/02/27 09:00 DA - 2007/03/16 09:00 DT - 2007/02/27 09:00 YR - 2006 ED - 20070314 RD - 20120713 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17319484 <658. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16872781 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Saito T AU - Mase H AU - Takeichi S AU - Inokuchi S FA - Saito, Takeshi FA - Mase, Hiroyasu FA - Takeichi, Sanae FA - Inokuchi, Sadaki IN - Saito, Takeshi. Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan. saito@is.icc.u-tokai.ac.jp TI - Rapid simultaneous determination of ephedrines, amphetamines, cocaine, cocaine metabolites, and opiates in human urine by GC-MS. SO - Journal of Pharmaceutical & Biomedical Analysis. 43(1):358-63, 2007 Jan 04 AS - J Pharm Biomed Anal. 43(1):358-63, 2007 Jan 04 NJ - Journal of pharmaceutical and biomedical analysis VO - 43 IP - 1 PG - 358-63 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - a2c, 8309336 IO - J Pharm Biomed Anal SB - Index Medicus CP - England MH - Adult MH - *Amphetamines/ur [Urine] MH - *Analgesics, Opioid/ur [Urine] MH - Autopsy MH - Calibration MH - *Cocaine/ur [Urine] MH - Drug Overdose MH - Emergency Medical Services MH - *Ephedrine/ur [Urine] MH - Gas Chromatography-Mass Spectrometry MH - Heroin Dependence/ur [Urine] MH - Humans MH - Hydrolysis MH - Male MH - Reproducibility of Results AB - This paper presents a simple and sensitive chromatographic procedure for the simultaneous determination and quantification of ephedrines, amphetamines, cocaine, cocaine metabolites, and opiates in human urine by gas chromatography-mass spectrometry. This method involves enzyme hydrolysis in the presence of a deuterated internal standard, liquid-liquid extraction, and derivatization with pentafluoropropionic anhydride and pentafluoropropanol. The recovery of each compound averaged at 65.8% or more. The limits of detection determined for each compound by using a 2-mL sample volume ranged from 5 to 50 ng/mL. The calibration curves were linear to 100 ng/mL for all compounds when determined using methamphetamine-d4 and MDMA-d5 as internal standards. This method was successfully applied for the analysis of urine samples suspected to contain intoxicants such as methamphetamine and heroin. RN - 0 (Amphetamines) RN - 0 (Analgesics, Opioid) RN - GN83C131XS (Ephedrine) RN - I5Y540LHVR (Cocaine) IS - 0731-7085 IL - 0731-7085 PT - Case Reports PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0731-7085(06)00433-X [pii] ID - 10.1016/j.jpba.2006.06.031 [doi] PP - ppublish PH - 2006/04/27 [received] PH - 2006/06/15 [revised] PH - 2006/06/19 [accepted] LG - English EP - 20060726 DP - 2007 Jan 04 EZ - 2006/07/29 09:00 DA - 2007/03/14 09:00 DT - 2006/07/29 09:00 YR - 2007 ED - 20070313 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16872781 <659. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17157781 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McErlean M AU - Triner W AU - Young A FA - McErlean, Mara FA - Triner, Wayne FA - Young, Amy IN - McErlean, Mara. Department of Emergency Medicine, Albany Medical College, Albany, New York 12208, USA. TI - Impact of outside regulatory investigation on opiate administration in the emergency department. SO - Journal of Pain. 7(12):947-50, 2006 Dec AS - J PAIN. 7(12):947-50, 2006 Dec NJ - The journal of pain : official journal of the American Pain Society VO - 7 IP - 12 PG - 947-50 PI - Journal available in: Print PI - Citation processed from: Print JC - 100898657 IO - J Pain SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - Drug Utilization/sn [Statistics & Numerical Data] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Emergency Treatment MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Outcome and Process Assessment (Health Care) MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Patient Discharge MH - Retrospective Studies AB - UNLABELLED: This study was conducted to determine whether outside regulatory investigation related to opiate prescription diversion changes the prescribing frequency of opiates in an emergency department (ED). The presence of ED administration of opiates and prescriptions for opiates on discharge were compared across a baseline period 90 days before arrest of a physician for opiate diversion, a period immediately surrounding the arrest, and a follow-up period 90 days later. At no time was there investigation of excessive opiate prescribing for patients in the ED. The likelihood of receiving opiate analgesia either in the ED or on discharge was not significantly different for patients reporting mild pain or severe pain across all three periods. Patients with moderate pain (self-reported pain scores of 4 to 6 out of 10) were less likely to receive opiates in the ED immediately after the arrest compared with the baseline period (likelihood ratio, 0.4; confidence interval, 0.2 to 0.7). Patients with moderate pain were also less likely to receive prescriptions for opiates on discharge from the ED immediately after the arrest (likelihood ratio, 0.5; confidence interval, 0.3 to 0.9). These effects had diminished by 90 days. AB - PERSPECTIVE: This study indicates that factors outside of the provider-patient relationship influence the likelihood of receiving opiates during an ED visit. Awareness of this phenomenon might serve to reduce oligoanalgesia. RN - 0 (Analgesics, Opioid) IS - 1526-5900 IL - 1526-5900 PT - Clinical Trial PT - Comparative Study PT - Journal Article ID - S1526-5900(06)00836-4 [pii] ID - 10.1016/j.jpain.2006.05.012 [doi] PP - ppublish PH - 2006/03/15 [received] PH - 2006/05/17 [revised] PH - 2006/05/24 [accepted] LG - English DP - 2006 Dec EZ - 2006/12/13 09:00 DA - 2007/02/23 09:00 DT - 2006/12/13 09:00 YR - 2006 ED - 20070222 RD - 20130520 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17157781 <660. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16542798 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dietze P AU - Jolley D AU - Fry CL AU - Bammer G AU - Moore D FA - Dietze, Paul FA - Jolley, Damien FA - Fry, Craig L FA - Bammer, Gabriele FA - Moore, David IN - Dietze, Paul. Turning Point Alcohol and Drug Centre, 54-62 Gertrude St Fitzroy, Vic. 3065, Australia. pauld@turningpoint.org.au TI - When is a little knowledge dangerous? Circumstances of recent heroin overdose and links to knowledge of overdose risk factors. SO - Drug & Alcohol Dependence. 84(3):223-30, 2006 Oct 01 AS - Drug Alcohol Depend. 84(3):223-30, 2006 Oct 01 NJ - Drug and alcohol dependence VO - 84 IP - 3 PG - 223-30 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Adolescent MH - Adult MH - *Attitude to Health MH - Australia/ep [Epidemiology] MH - Catchment Area (Health) MH - *Cognition MH - Cross-Sectional Studies MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/pc [Prevention & Control] MH - Female MH - Harm Reduction MH - *Heroin/ae [Adverse Effects] MH - *Heroin Dependence/ep [Epidemiology] MH - Heroin Dependence/rh [Rehabilitation] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Resuscitation MH - *Risk-Taking MH - Surveys and Questionnaires AB - OBJECTIVES: To describe the circumstances surrounding recent heroin overdose among a sample of heroin overdose survivors and the links to their knowledge of overdose risk. AB - METHODS: A cross-sectional survey of 257 recent non-fatal heroin overdose survivors was undertaken to examine self-reported knowledge of overdose risk reduction strategies, behaviour in the 12 h prior to overdose and attributions of overdose causation. AB - RESULTS: Most of the overdoses occurred in public spaces as a result of heroin use within 5 min of purchasing the drug. A substantial number of overdoses occurred with no one else present and/or involved the concomitant use of other drugs. While knowledge of at least one overdose prevention strategy was reported by 90% of the sample, less then half of the sample knew any single strategy. Furthermore knowledge of the dangers of mixing benzodiazepines and/or alcohol with heroin was associated with an increased likelihood of such mixing being reported prior to overdose. AB - CONCLUSIONS: While heroin users can articulate knowledge of key overdose risk reduction strategies, this knowledge was not generally associated with a reduction in risk behaviours but was in some cases associated with increased reports of overdose risk behaviours. Further research is required in order to better understand this paradoxical effect, focussing on risk reduction education amenable to the social contexts in which heroin use takes place. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 0376-8716 IL - 0376-8716 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0376-8716(06)00063-9 [pii] ID - 10.1016/j.drugalcdep.2006.02.005 [doi] PP - ppublish PH - 2005/09/01 [received] PH - 2006/02/06 [revised] PH - 2006/02/06 [accepted] LG - English EP - 20060320 DP - 2006 Oct 01 EZ - 2006/03/18 09:00 DA - 2007/02/16 09:00 DT - 2006/03/18 09:00 YR - 2006 ED - 20070215 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16542798 <661. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17157684 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - LoVecchio F AU - Pizon A AU - Riley B AU - Sami A AU - D'Incognito C FA - LoVecchio, Frank FA - Pizon, Anthony FA - Riley, Brad FA - Sami, Azadeh FA - D'Incognito, Carmella IN - LoVecchio, Frank. BannerGood Samaritan Regional Poison Center, Phoenix, AZ 85006, USA. frank.lovecchio@bannerhealth.com TI - Onset of symptoms after methadone overdose. CM - Comment in: Am J Emerg Med. 2007 Sep;25(7):855-6; PMID: 17870501 CM - Comment in: Am J Emerg Med. 2008 Feb;26(2):242; PMID: 18272114 SO - American Journal of Emergency Medicine. 25(1):57-9, 2007 Jan AS - Am J Emerg Med. 25(1):57-9, 2007 Jan NJ - The American journal of emergency medicine VO - 25 IP - 1 PG - 57-9 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/pp [Physiopathology] MH - Humans MH - Medical Records MH - *Methadone/po [Poisoning] MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Poison Control Centers MH - Retrospective Studies MH - Time Factors AB - BACKGROUND: Methadone ingestion may cause delayed coma and require naloxone infusion. Few studies exist regarding the time development of symptoms following methadone overdose in adults. AB - METHODS: After a brief training period, reviewers who were blinded to the purpose of the study completed a standardized data collection sheet. Two consecutive years of poison center patient encounters were reviewed. Age, outcomes, coingestions, vital signs, clinical manifestations, hospital admissions, and mortality were abstracted. Data were analyzed using descriptive statistics. The first reviewer was designated to extract the data. The second reviewer conducted a review of 20% of all the charts for a kappa value to be calculated. AB - RESULTS: In total, 44 cases of isolated methadone overdose in patients older than 18 years were identified. A mean age of 32.5 (18-58) years and a mean presumed ingestion of 106 mg of methadone was calculated. Of the 44 patients, 32 received naloxone for symptoms consistent with opiate toxicity. All symptoms occurred within 9 hours of methadone ingestion, with a mean symptom onset of 3.2 hours. All patients had resolution of symptoms within 24 hours. No deaths were recorded. The kappa score for interreviewer reliability was 0.69, with a 95% confidence interval of 0.58 to 0.73. AB - LIMITATIONS: This was a retrospective study that was limited by patient history. AB - CONCLUSION: Acute methadone toxicity typically results in symptoms within 9 hours of ingestion. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) IS - 0735-6757 IL - 0735-6757 PT - Journal Article ID - S0735-6757(06)00261-0 [pii] ID - 10.1016/j.ajem.2006.07.006 [doi] PP - ppublish PH - 2006/01/26 [received] PH - 2006/07/02 [accepted] LG - English DP - 2007 Jan EZ - 2006/12/13 09:00 DA - 2007/02/09 09:00 DT - 2006/12/13 09:00 YR - 2007 ED - 20070208 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17157684 <662. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16791673 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Del Nogal Saez F FA - Del Nogal Saez, F TI - Opiates at the end of life in an emergency department in Spain: euthanasia or good clinical practice?. SO - Intensive Care Medicine. 32(7):1086-7, 2006 Jul AS - Intensive Care Med. 32(7):1086-7, 2006 Jul NJ - Intensive care medicine VO - 32 IP - 7 PG - 1086-7 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - h2j, 7704851 IO - Intensive Care Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Attitude of Health Personnel MH - Decision Making MH - Euthanasia, Active/lj [Legislation & Jurisprudence] MH - *Euthanasia, Active MH - Humans MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Religion and Medicine MH - Spain MH - Terminal Care/lj [Legislation & Jurisprudence] MH - *Terminal Care/mt [Methods] RN - 0 (Analgesics, Opioid) IS - 0342-4642 IL - 0342-4642 PT - News ID - 10.1007/s00134-006-0140-7 [doi] PP - ppublish PH - 2006/03/01 [received] PH - 2006/03/01 [accepted] LG - English EP - 20060516 DP - 2006 Jul EZ - 2006/06/23 09:00 DA - 2007/02/09 09:00 DT - 2006/06/23 09:00 YR - 2006 ED - 20070208 RD - 20170919 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16791673 <663. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17067327 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Boyd JJ AU - Kuisma MJ AU - Alaspaa AO AU - Vuori E AU - Repo JV AU - Randell TT FA - Boyd, J J FA - Kuisma, M J FA - Alaspaa, A O FA - Vuori, E FA - Repo, J V FA - Randell, T T IN - Boyd, J J. Helsinki Emergency Medical Service, Helsinki University Central Hospital, Helsinki, Finland. james.boyd@hus.fi TI - Recurrent opioid toxicity after pre-hospital care of presumed heroin overdose patients. SO - Acta Anaesthesiologica Scandinavica. 50(10):1266-70, 2006 Nov AS - Acta Anaesthesiol Scand. 50(10):1266-70, 2006 Nov NJ - Acta anaesthesiologica Scandinavica VO - 50 IP - 10 PG - 1266-70 PI - Journal available in: Print PI - Citation processed from: Print JC - 0370270 IO - Acta Anaesthesiol Scand SB - Index Medicus CP - England MH - Administration, Inhalation MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Drug Overdose MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Finland MH - Heroin/ad [Administration & Dosage] MH - *Heroin/po [Poisoning] MH - Humans MH - Injections MH - Male MH - Medical Records MH - Recurrence MH - Reproducibility of Results MH - Respiration Disorders/ci [Chemically Induced] MH - Retrospective Studies AB - BACKGROUND: In patients with presumed heroin overdose, the recommended time of observation after reversing heroin toxicity with naloxone varies widely. The aims of this study were to examine the incidence of recurrent opioid toxicity and the time interval in which it occurs after pre-hospital treatment in presumed heroin overdose patients. AB - METHODS: We undertook a retrospective study in Helsinki (population, 560,000). Records were reviewed from 1 January 1995 to 31 December 2000. Patients included were treated by the emergency medical service (EMS) for a presumed heroin overdose. Patients with known polydrug/alcohol use or the use of opioids other than heroin were excluded. The EMS records were compared with the cardiac arrest database and the medical examiners' records. AB - RESULTS: One hundred and forty-five patients were included. The median dose of pre-hospital administered naloxone was 0.4 mg. After pre-hospital care, 84 patients refused further care and were not transported to an emergency department (ED). Seventy-one received pre-hospital naloxone, and no life-threatening events were recorded during a 12-h follow-up period in these patients. After pre-hospital care, 61 patients were transported to an ED. Twelve patients received naloxone in the ED for respiratory depression. All had signs of heroin use-related adverse events within 1 h after receiving pre-hospital naloxone. AB - CONCLUSIONS: Allowing presumed heroin overdose patients to sign out after pre-hospital care with naloxone is safe. If transported to an ED, a 1-h observation period after naloxone administration seems to be adequate for recurrent heroin toxicity. RN - 0 (Analgesics, Opioid) RN - 70D95007SX (Heroin) IS - 0001-5172 IL - 0001-5172 PT - Journal Article ID - AAS1172 [pii] ID - 10.1111/j.1399-6576.2006.01172.x [doi] PP - ppublish LG - English DP - 2006 Nov EZ - 2006/10/28 09:00 DA - 2007/01/31 09:00 DT - 2006/10/28 09:00 YR - 2006 ED - 20070130 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17067327 <664. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16997776 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Belz D AU - Lieb J AU - Rea T AU - Eisenberg MS FA - Belz, Daniel FA - Lieb, Jacob FA - Rea, Tom FA - Eisenberg, Mickey S IN - Belz, Daniel. Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA. TI - Naloxone use in a tiered-response emergency medical services system. SO - Prehospital Emergency Care. 10(4):468-71, 2006 Oct-Dec AS - Prehosp Emerg Care. 10(4):468-71, 2006 Oct-Dec NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 10 IP - 4 PG - 468-71 PI - Journal available in: Print PI - Citation processed from: Print JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Drug Overdose MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/mo [Mortality] MH - Severity of Illness Index MH - Time Factors MH - Washington AB - OBJECTIVE: To examine the delivery and effect of naloxone for opioid overdose in a tiered-response emergency medical services (EMS) system and to ascertain how much time could be saved if the first arriving emergency medical technicians (EMTs) could have administered intranasal naloxone. AB - METHODS: This was case series of all EMS-treated overdose patients who received naloxone by paramedics in a two-tiered EMS system during 2004. The system dispatches basic life support-trained fire fighter-EMTs and/or advanced life support-trained paramedics depending on the severity of cases. Main outcomes were geographic distribution of naloxone-treated overdose, severity of cases, response to naloxone, and time interval between arrival of EMTs and arrival of paramedics at the scene. AB - RESULTS: There were 164 patients who received naloxone for suspected overdose. There were 75 patients (46%) initially unresponsive to painful stimulus. Respiratory rate was <10 breaths/min in 79 (48%). Death occurred in 36 (22%) at the scene or during transport. A full or partial response to naloxone occurred in 119 (73%). Recognized adverse reactions were limited to agitation/combativeness in 25 (15%) and emesis in six (4%). Average EMT arrival time was 5.9 minutes. Average paramedic arrival time was 11.6 minutes in most cases and 16.1 minutes in 46 cases (28%) in which paramedics were requested by EMTs at the scene. AB - CONCLUSIONS: There is potential for significantly earlier delivery of naloxone to patients in opioid overdose if EMTs could deliver intranasal naloxone. A pilot study training and authorizing EMTs to administer intranasal naloxone in suspected opioid overdose is warranted. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1090-3127 IL - 1090-3127 PT - Journal Article ID - K7JH9283027521J5 [pii] ID - 10.1080/10903120600885134 [doi] PP - ppublish LG - English DP - 2006 Oct-Dec EZ - 2006/09/26 09:00 DA - 2007/01/24 09:00 DT - 2006/09/26 09:00 YR - 2006 ED - 20070123 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16997776 <665. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16987343 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chen MH AU - Xie L AU - Liu TW AU - Song FQ AU - He T FA - Chen, M-H FA - Xie, L FA - Liu, T-W FA - Song, F-Q FA - He, T IN - Chen, M-H. Institute of Cardiovascular Diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, China. TI - Naloxone and epinephrine are equally effective for cardiopulmonary resuscitation in a rat asphyxia model. SO - Acta Anaesthesiologica Scandinavica. 50(9):1125-30, 2006 Oct AS - Acta Anaesthesiol Scand. 50(9):1125-30, 2006 Oct NJ - Acta anaesthesiologica Scandinavica VO - 50 IP - 9 PG - 1125-30 PI - Journal available in: Print PI - Citation processed from: Print JC - 0370270 IO - Acta Anaesthesiol Scand SB - Index Medicus CP - England MH - Animals MH - Asphyxia/dt [Drug Therapy] MH - *Asphyxia/th [Therapy] MH - Blood Pressure/ph [Physiology] MH - *Cardiopulmonary Resuscitation MH - Electrocardiography MH - *Epinephrine/tu [Therapeutic Use] MH - Female MH - Heart Arrest/dt [Drug Therapy] MH - Heart Rate/ph [Physiology] MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Rats MH - Rats, Sprague-Dawley MH - Survival MH - *Vasoconstrictor Agents/tu [Therapeutic Use] AB - BACKGROUND: It is not known whether naloxone is as efficacious as epinephrine during cardiopulmonary resuscitation (CPR). The aim of the study was to compare the effects of naloxone and epinephrine on the outcomes of CPR following asphyxial cardiac arrest in rats. AB - METHODS: Cardiac arrest was induced with asphyxia by clamping the tracheal tubes. Twenty-four Sprague-Dawley rats were randomized prospectively into a saline group (treated with normal saline, 1 ml intravenously, n = 8), an epinephrine group (treated with epinephrine, 0.04 mg/kg intravenously, n = 8) or a naloxone group (treated with naloxone, 1 mg/kg intravenously, n = 8) in a blind fashion during resuscitation after asphyxial cardiac arrest. After 5 min of untreated cardiac arrest, conventional manual CPR was started and each drug was administered at the same time. AB - RESULTS: The rates of restoration of spontaneous circulation (ROSC) were one of eight (12.5%), seven of eight (87.5%) and seven of eight (87.5%) in the saline, epinephrine and naloxone groups, respectively. The rates of ROSC in the epinephrine and naloxone groups were equal and significantly greater than that in the saline group (P = 0.01 and P = 0.01, respectively). AB - CONCLUSION: The administration of naloxone or epinephrine alone may increase the resuscitation rate, and both drugs are equally effective for CPR in a rat asphyxia model. However, the mechanism by which naloxone produces its efficacy during CPR remains unclear and further experimentation will be necessary. RN - 0 (Narcotic Antagonists) RN - 0 (Vasoconstrictor Agents) RN - 36B82AMQ7N (Naloxone) RN - YKH834O4BH (Epinephrine) IS - 0001-5172 IL - 0001-5172 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - AAS1141 [pii] ID - 10.1111/j.1399-6576.2006.01141.x [doi] PP - ppublish LG - English DP - 2006 Oct EZ - 2006/09/22 09:00 DA - 2007/01/05 09:00 DT - 2006/09/22 09:00 YR - 2006 ED - 20070104 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16987343 <666. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16861173 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Merchant RC AU - Schwartzapfel BL AU - Wolf FA AU - Li W AU - Carlson L AU - Rich JD FA - Merchant, Roland C FA - Schwartzapfel, Beth L FA - Wolf, Francis A FA - Li, Wenjun FA - Carlson, Lynn FA - Rich, Josiah D IN - Merchant, Roland C. Division of Infectious Diseases, Brown University School of Medicine, Providence, RI 02903, USA. rmerchant@lifespan.org TI - Demographic, geographic, and temporal patterns of ambulance runs for suspected opiate overdose in Rhode Island, 1997-20021. SO - Substance Use & Misuse. 41(9):1209-26, 2006 AS - Subst Use Misuse. 41(9):1209-26, 2006 NJ - Substance use & misuse VO - 41 IP - 9 PG - 1209-26 PI - Journal available in: Print PI - Citation processed from: Print JC - cgg, 9602153 IO - Subst Use Misuse SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Ambulances/sn [Statistics & Numerical Data] MH - Child MH - Child, Preschool MH - Continental Population Groups MH - Databases, Factual MH - Demography MH - *Drug Overdose/ep [Epidemiology] MH - Female MH - Geography MH - Humans MH - Infant MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Rhode Island/ep [Epidemiology] AB - We examine ambulance runs for suspected opiate overdose from 1997 to 2002 using a Rhode Island Department of Health database. Of the 8,763 ambulance runs for overdoses, 18.6% were for suspected opiate overdoses. Most cases were males under age 54. Suspected opiate overdoses were more likely to occur in a private residence, were more frequent on Fridays and Saturdays, and peaked in incidence around 9:00 p.m. The incidence rate of suspected opiate overdose by year was similar. The study results may help identify areas for preventive intervention and demonstrate the limitation of using naloxone as a marker of opiate overdose events. RN - 36B82AMQ7N (Naloxone) IS - 1082-6084 IL - 1082-6084 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - X28VQN5V42635560 [pii] ID - 10.1080/10826080600751898 [doi] PP - ppublish GI - No: P30 AI042853 Organization: (AI) *NIAID NIH HHS* Country: United States GI - No: T32 DA013911 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: 5 T32 DA13911-02 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: P30 AI42853-01 Organization: (AI) *NIAID NIH HHS* Country: United States LG - English DP - 2006 EZ - 2006/07/25 09:00 DA - 2007/01/04 09:00 DT - 2006/07/25 09:00 YR - 2006 ED - 20070103 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16861173 <667. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16905092 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cohen S AU - Hunter CW AU - Yanni B AU - Striker P AU - Hijazi RH FA - Cohen, Shaul FA - Hunter, Christine W FA - Yanni, Baher FA - Striker, Paul FA - Hijazi, Raza H TI - Central anticholinergic syndrome strikes again. SO - Journal of Clinical Anesthesia. 18(5):399-400, 2006 Aug AS - J Clin Anesth. 18(5):399-400, 2006 Aug NJ - Journal of clinical anesthesia VO - 18 IP - 5 PG - 399-400 PI - Journal available in: Print PI - Citation processed from: Print JC - an9, 8812166 IO - J Clin Anesth SB - Index Medicus CP - United States MH - Adjuvants, Anesthesia/ad [Administration & Dosage] MH - Adult MH - *Anesthesia, General/ae [Adverse Effects] MH - Anesthetics, Intravenous/ae [Adverse Effects] MH - *Central Nervous System Diseases/ci [Chemically Induced] MH - Central Nervous System Diseases/dt [Drug Therapy] MH - Central Nervous System Diseases/th [Therapy] MH - Cholinesterase Inhibitors/tu [Therapeutic Use] MH - Electrocardiography MH - Female MH - Glucose/ad [Administration & Dosage] MH - Glycopyrrolate/ad [Administration & Dosage] MH - Heart Block/ci [Chemically Induced] MH - Heart Block/dt [Drug Therapy] MH - Heart Rate/de [Drug Effects] MH - Humans MH - Midazolam/ae [Adverse Effects] MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Physostigmine/tu [Therapeutic Use] MH - Propofol/ae [Adverse Effects] MH - Respiration, Artificial/mt [Methods] MH - Syndrome RN - 0 (Adjuvants, Anesthesia) RN - 0 (Anesthetics, Intravenous) RN - 0 (Cholinesterase Inhibitors) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 9U1VM840SP (Physostigmine) RN - IY9XDZ35W2 (Glucose) RN - R60L0SM5BC (Midazolam) RN - V92SO9WP2I (Glycopyrrolate) RN - YI7VU623SF (Propofol) IS - 0952-8180 IL - 0952-8180 PT - Case Reports PT - Letter ID - S0952-8180(06)00110-3 [pii] ID - 10.1016/j.jclinane.2005.11.007 [doi] PP - ppublish PH - 2005/09/06 [received] PH - 2005/10/20 [revised] PH - 2005/11/11 [accepted] LG - English DP - 2006 Aug EZ - 2006/08/15 09:00 DA - 2006/12/27 09:00 DT - 2006/08/15 09:00 YR - 2006 ED - 20061226 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16905092 <668. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17057146 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barrie J AU - May G FA - Barrie, Jenifer FA - May, Gabby IN - Barrie, Jenifer. Manchester Medical School, Manchester, UK. TI - Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. Diagnosis of drug overdose by rapid reversal with naloxone. [Review] [3 refs] SO - Emergency Medicine Journal. 23(11):874-5, 2006 Nov AS - Emerg Med J. 23(11):874-5, 2006 Nov NJ - Emergency medicine journal : EMJ VO - 23 IP - 11 PG - 874-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464401 SB - Index Medicus CP - England MH - Adult MH - Diagnosis, Differential MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - Emergencies MH - *Emergency Service, Hospital/st [Standards] MH - *Evidence-Based Medicine MH - Glasgow Coma Scale MH - Humans MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] AB - A short-cut review was carried out to establish whether naloxone may have an awakening effect in patients who have not taken opiates, thereby clouding its use as a diagnostic manoeuvre. The clinical bottom line is that opioid antagonists are able to reverse symptoms such as altered consciousness in patients who have not taken an overdose of opiates. It is unclear in which conditions or circumstances this occurs. [References: 3] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) ES - 1472-0213 IL - 1472-0205 PT - Journal Article PT - Review ID - 23/11/874 [pii] ID - 10.1136/emj.2006.042176 [doi] ID - PMC2464401 [pmc] PP - ppublish LG - English DP - 2006 Nov EZ - 2006/10/24 09:00 DA - 2006/12/14 09:00 DT - 2006/10/24 09:00 YR - 2006 ED - 20061213 RD - 20140907 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17057146 <669. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16942954 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Arendts G AU - Fry M FA - Arendts, Glenn FA - Fry, Margaret IN - Arendts, Glenn. Department of Emergency Medicine, St. George Hospital, Kogarah, Australia. glenn.arendts@sesiahs.health.nsw.gov.au TI - Factors associated with delay to opiate analgesia in emergency departments. SO - Journal of Pain. 7(9):682-6, 2006 Sep AS - J PAIN. 7(9):682-6, 2006 Sep NJ - The journal of pain : official journal of the American Pain Society VO - 7 IP - 9 PG - 682-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 100898657 IO - J Pain SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Age Factors MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - Cohort Studies MH - Early Diagnosis MH - *Emergency Service, Hospital/st [Standards] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Emergency Treatment/st [Standards] MH - Emergency Treatment/ut [Utilization] MH - Female MH - *Health Services Accessibility/st [Standards] MH - Health Services Accessibility/sn [Statistics & Numerical Data] MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Middle Aged MH - *Pain/dt [Drug Therapy] MH - *Quality Assurance, Health Care MH - Retrospective Studies MH - Time Factors MH - Treatment Outcome MH - Triage/st [Standards] MH - Triage/sn [Statistics & Numerical Data] AB - UNLABELLED: Patients presenting to an emergency department (ED) with painful conditions continue to experience significant delay to analgesia. It remains unclear whether demographic and clinical factors are associated with this outcome. The objectives of this study were to determine 1) the proportion of patients that require parenteral opiate analgesia for pain in an ED and who receive the opiate in less than 60 minutes; and 2) whether any factors are predictive for the first dose of analgesia being delayed beyond 60 minutes. A retrospective cohort study with descriptive and comparative data analysis was conducted. Over a 3-month period, the medical record of every patient receiving parenteral opiates in a tertiary emergency department was reviewed and analyzed. Of 857 patients, 451 (52.6%) received analgesia in less then 60 minutes. Multiple demographic and clinical factors are associated with statistically significant delay to analgesia, including age, triage code, seniority of treating doctor, diagnosis, and disposition from the ED. AB - PERSPECTIVE: A considerable proportion of patients suffer delay to analgesia. Identifiable factors associated with a delay to analgesia exist. There is potential for clinicians to develop strategies to address the population in emergency departments at risk for delay to analgesia. RN - 0 (Analgesics, Opioid) IS - 1526-5900 IL - 1526-5900 PT - Journal Article ID - S1526-5900(06)00627-4 [pii] ID - 10.1016/j.jpain.2006.03.003 [doi] PP - ppublish PH - 2005/09/15 [received] PH - 2006/01/23 [revised] PH - 2006/03/07 [accepted] LG - English DP - 2006 Sep EZ - 2006/09/01 09:00 DA - 2006/11/04 09:00 DT - 2006/09/01 09:00 YR - 2006 ED - 20061103 RD - 20130520 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16942954 <670. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16160675 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Selbst SM FA - Selbst, Steven M IN - Selbst, Steven M. Division of Emergency Medicine, A.I. duPont Hospital for Children, Wilmington, DE and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA. sselbst@nemours.org TI - Pediatric emergency medicine: legal briefs. SO - Pediatric Emergency Care. 21(9):633-6, 2005 Sep AS - Pediatr Emerg Care. 21(9):633-6, 2005 Sep NJ - Pediatric emergency care VO - 21 IP - 9 PG - 633-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Adult MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Medicine/lj [Legislation & Jurisprudence] MH - Emergency Medicine/mt [Methods] MH - Foreign Bodies/dg [Diagnostic Imaging] MH - *Foreign Bodies/su [Surgery] MH - *Gastrointestinal Tract MH - *Heroin/po [Poisoning] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Radiography MH - *Street Drugs/lj [Legislation & Jurisprudence] MH - *Street Drugs/po [Poisoning] MH - Treatment Outcome MH - United States RN - 0 (Street Drugs) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1535-1815 IL - 0749-5161 PT - Journal Article PT - Legal Cases ID - 00006565-200509000-00019 [pii] PP - ppublish LG - English DP - 2005 Sep EZ - 2005/09/15 09:00 DA - 2006/10/28 09:00 DT - 2005/09/15 09:00 YR - 2005 ED - 20061027 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16160675 <671. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16775573 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fang X AU - Tang W AU - Sun S AU - Huang L AU - Huang Z AU - Weil MH FA - Fang, Xiangshao FA - Tang, Wanchun FA - Sun, Shijie FA - Huang, Lei FA - Huang, Zitong FA - Weil, Max Harry IN - Fang, Xiangshao. Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA. TI - Mechanism by which activation of delta-opioid receptor reduces the severity of postresuscitation myocardial dysfunction. SO - Critical Care Medicine. 34(10):2607-12, 2006 Oct AS - Crit Care Med. 34(10):2607-12, 2006 Oct NJ - Critical care medicine VO - 34 IP - 10 PG - 2607-12 PI - Journal available in: Print PI - Citation processed from: Print JC - dtf, 0355501 IO - Crit. Care Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adenosine Triphosphate MH - Analysis of Variance MH - Animals MH - Cardiomyopathies/et [Etiology] MH - *Cardiomyopathies/pc [Prevention & Control] MH - *Cardiopulmonary Resuscitation MH - *Cardiotonic Agents/pd [Pharmacology] MH - *Heart Arrest/th [Therapy] MH - Male MH - Potassium Channels/de [Drug Effects] MH - Random Allocation MH - Rats MH - Rats, Sprague-Dawley MH - *Receptors, Opioid, delta/ag [Agonists] MH - Survival Analysis AB - OBJECTIVE: Postresuscitation myocardial dysfunction has been recognized as a leading cause of early death after initially successful cardiopulmonary resuscitation. We have previously demonstrated that opening adenosine triphosphate (ATP)-sensitive K (KATP) channels or activation of delta-opioid receptors minimized the severity of postresuscitation myocardial dysfunction and increased the duration of postresuscitation survival. In the present study, we investigated the potential mechanism of myocardial protection following delta-opioid receptor activation in a rat model of cardiac arrest and cardiopulmonary resuscitation. AB - DESIGN: Randomized prospective animal study. AB - SETTING: Animal research laboratory. AB - SUBJECTS: Male Sprague-Dawley rats. AB - INTERVENTIONS: Ventricular fibrillation was induced in 24 Sprague-Dawley rats. Mechanical ventilation and precordial compression were initiated after 8 mins of untreated ventricular fibrillation. Defibrillation was attempted after 6 mins of cardiopulmonary resuscitation. The animals were randomized to four groups: a) pentazocine (0.3 mg/kg), a delta-opioid receptor agonist; b) pentazocine pretreated with KATP channel blocker, glibenclamide (0.3 mg/kg), administered 45 mins before induction of ventricular fibrillation; c) glibenclamide pretreated alone 45 mins before induction of ventricular fibrillation; and d) placebo. Pentazocine or saline placebo was injected into the right atrium after 5 mins of untreated ventricular fibrillation. AB - MEASUREMENTS AND MAIN RESULTS: Postresuscitation myocardial function, as measured by the rate of left ventricular pressure increase at 40 mm Hg, left ventricular end-diastolic pressure, and cardiac index, was significantly improved in pentazocine-treated animals. This was associated with significantly prolonged duration of survival. Except for ease of defibrillation, the beneficial effects of pentazocine were abolished by pretreatment with the KATP channel blocker glibenclamide. AB - CONCLUSIONS: The postresuscitation myocardial protective effects provided by activation of delta-opioid receptor may be mediated via opening KATP channels. RN - 0 (Cardiotonic Agents) RN - 0 (Potassium Channels) RN - 0 (Receptors, Opioid, delta) RN - 8L70Q75FXE (Adenosine Triphosphate) IS - 0090-3493 IL - 0090-3493 PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1097/01.CCM.0000228916.81470.E1 [doi] PP - ppublish LG - English DP - 2006 Oct EZ - 2006/06/16 09:00 DA - 2006/10/14 09:00 DT - 2006/06/16 09:00 YR - 2006 ED - 20061013 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16775573 <672. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17023479 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Byrne A FA - Byrne, Andrew TI - Emergency naloxone for heroin overdose: over the counter availability needs careful consideration. CM - Comment on: BMJ. 2006 Sep 23;333(7569):614-5; PMID: 16990298 CM - Comment on: BMJ. 1996 Jun 8;312(7044):1435-6; PMID: 8664611 SO - BMJ. 333(7571):754, 2006 Oct 07 AS - BMJ. 333(7571):754, 2006 Oct 07 NJ - BMJ (Clinical research ed.) VO - 333 IP - 7571 PG - 754 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8900488, bmj, 101090866 IO - BMJ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592400 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Drug Overdose/dt [Drug Therapy] MH - *Heroin/po [Poisoning] MH - Humans MH - *Naloxone/sd [Supply & Distribution] MH - *Narcotic Antagonists/sd [Supply & Distribution] MH - *Narcotics/po [Poisoning] MH - *Nonprescription Drugs/sd [Supply & Distribution] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 0 (Nonprescription Drugs) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1756-1833 IL - 0959-535X PT - Comment PT - Letter ID - 333/7571/754 [pii] ID - 10.1136/bmj.333.7571.754 [doi] ID - PMC1592400 [pmc] PP - ppublish LG - English DP - 2006 Oct 07 EZ - 2006/10/07 09:00 DA - 2006/10/13 09:00 DT - 2006/10/07 09:00 YR - 2006 ED - 20061012 RD - 20140908 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17023479 <673. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17023478 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ashworth AJ FA - Ashworth, Andrew J TI - Emergency naloxone for heroin overdose: beware of naloxone's other characteristics. CM - Comment on: BMJ. 2006 Sep 23;333(7569):614-5; PMID: 16990298 CM - Comment on: BMJ. 2006 Sep 23;333(7569):618; PMID: 16990303 SO - BMJ. 333(7571):754, 2006 Oct 07 AS - BMJ. 333(7571):754, 2006 Oct 07 NJ - BMJ (Clinical research ed.) VO - 333 IP - 7571 PG - 754 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8900488, bmj, 101090866 IO - BMJ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592433 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Drug Overdose/dt [Drug Therapy] MH - Emergencies MH - Emergency Treatment MH - *Heroin/po [Poisoning] MH - Humans MH - *Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - *Narcotics/po [Poisoning] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1756-1833 IL - 0959-535X PT - Comment PT - Letter ID - 333/7571/754-a [pii] ID - 10.1136/bmj.333.7571.754-a [doi] ID - PMC1592433 [pmc] PP - ppublish LG - English DP - 2006 Oct 07 EZ - 2006/10/07 09:00 DA - 2006/10/13 09:00 DT - 2006/10/07 09:00 YR - 2006 ED - 20061012 RD - 20140908 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17023478 <674. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17023477 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Brewer C FA - Brewer, Colin TI - Emergency naloxone for heroin overdose: naloxone is not the only opioid antagonist. CM - Comment on: BMJ. 2006 Sep 23;333(7569):614-5; PMID: 16990298 SO - BMJ. 333(7571):754-5, 2006 Oct 07 AS - BMJ. 333(7571):754-5, 2006 Oct 07 NJ - BMJ (Clinical research ed.) VO - 333 IP - 7571 PG - 754-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8900488, bmj, 101090866 IO - BMJ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592434 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Drug Overdose/dt [Drug Therapy] MH - Emergencies MH - Emergency Treatment MH - *Heroin/po [Poisoning] MH - Humans MH - Methadone/tu [Therapeutic Use] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) RN - UC6VBE7V1Z (Methadone) ES - 1756-1833 IL - 0959-535X PT - Comment PT - Letter ID - 333/7571/754-b [pii] ID - 10.1136/bmj.333.7571.754-b [doi] ID - PMC1592434 [pmc] PP - ppublish LG - English DP - 2006 Oct 07 EZ - 2006/10/07 09:00 DA - 2006/10/13 09:00 DT - 2006/10/07 09:00 YR - 2006 ED - 20061012 RD - 20140908 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17023477 <675. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16990298 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Strang J AU - Kelleher M AU - Best D AU - Mayet S AU - Manning V FA - Strang, John FA - Kelleher, Michael FA - Best, David FA - Mayet, Soraya FA - Manning, Victoria TI - Emergency naloxone for heroin overdose. CM - Comment in: BMJ. 2006 Oct 7;333(7571):754; PMID: 17023479 CM - Comment in: BMJ. 2006 Oct 7;333(7571):754-5; PMID: 17023477 CM - Comment in: BMJ. 2006 Oct 7;333(7571):754; PMID: 17023478 SO - BMJ. 333(7569):614-5, 2006 Sep 23 AS - BMJ. 333(7569):614-5, 2006 Sep 23 NJ - BMJ (Clinical research ed.) VO - 333 IP - 7569 PG - 614-5 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8900488, bmj, 101090866 IO - BMJ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570807 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Drug Overdose/dt [Drug Therapy] MH - Emergencies MH - Emergency Treatment MH - *Heroin/po [Poisoning] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) ES - 1756-1833 IL - 0959-535X PT - Editorial ID - 333/7569/614 [pii] ID - 10.1136/bmj.333.7569.614 [doi] ID - PMC1570807 [pmc] PP - ppublish LG - English DP - 2006 Sep 23 EZ - 2006/09/23 09:00 DA - 2006/10/13 09:00 DT - 2006/09/23 09:00 YR - 2006 ED - 20061012 RD - 20170219 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16990298 <676. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 17015570 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Geib AJ AU - Babu K AU - Ewald MB AU - Boyer EW FA - Geib, Ann-Jeannette FA - Babu, Kavita FA - Ewald, Michele Burns FA - Boyer, Edward W IN - Geib, Ann-Jeannette. Program in Medical Toxicology, Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA. ajgeib@hotmail.com TI - Adverse effects in children after unintentional buprenorphine exposure. SO - Pediatrics. 118(4):1746-51, 2006 Oct AS - Pediatrics. 118(4):1746-51, 2006 Oct NJ - Pediatrics VO - 118 IP - 4 PG - 1746-51 PI - Journal available in: Print PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Buprenorphine/po [Poisoning] MH - Consciousness Disorders/ci [Chemically Induced] MH - Female MH - Humans MH - Infant MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Poisoning/di [Diagnosis] MH - Poisoning/dt [Drug Therapy] MH - Respiration, Artificial MH - *Respiratory Insufficiency/ci [Chemically Induced] AB - Buprenorphine in sublingual formulation was recently introduced to the American market for treatment of opioid dependence. We report a series of 5 toddlers with respiratory and mental-status depression after unintentional buprenorphine exposure. Despite buprenorphine's partial agonist activity and ceiling effect on respiratory depression, all children required hospital admission and either opioid-antagonist therapy or mechanical ventilation. Results of routine urine toxicology screening for opioids were negative in all cases. Confirmatory testing was sent for 1 child and returned with a positive result. The increasing use of buprenorphine as a home-based therapy for opioid addiction in the United States raises public health concerns for the pediatric population. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) ES - 1098-4275 IL - 0031-4005 PT - Case Reports PT - Journal Article ID - 118/4/1746 [pii] ID - 10.1542/peds.2006-0948 [doi] PP - ppublish LG - English DP - 2006 Oct EZ - 2006/10/04 09:00 DA - 2006/10/13 09:00 DT - 2006/10/04 09:00 YR - 2006 ED - 20061011 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=17015570 <677. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16938595 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chen MH AU - Liu TW AU - Xie L AU - Song FQ AU - He T FA - Chen, Meng-Hua FA - Liu, Tang-Wei FA - Xie, Lu FA - Song, Feng-Qing FA - He, Tao IN - Chen, Meng-Hua. Institute of Cardiovascular Diseases, first affiliated hospital of Guangxi Medical University, Nanning 530027, PR China. TI - Does naloxone alone increase resuscitation rate during cardiopulmonary resuscitation in a rat asphyxia model?. SO - American Journal of Emergency Medicine. 24(5):567-72, 2006 Sep AS - Am J Emerg Med. 24(5):567-72, 2006 Sep NJ - The American journal of emergency medicine VO - 24 IP - 5 PG - 567-72 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Animals MH - Asphyxia/co [Complications] MH - Blood Pressure/de [Drug Effects] MH - *Cardiopulmonary Resuscitation/mt [Methods] MH - Disease Models, Animal MH - Dose-Response Relationship, Drug MH - Female MH - *Heart Arrest/dt [Drug Therapy] MH - Heart Arrest/et [Etiology] MH - Heart Rate/de [Drug Effects] MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Prospective Studies MH - Random Allocation MH - Rats MH - Rats, Sprague-Dawley MH - Reference Values MH - Respiration/de [Drug Effects] MH - Time Factors MH - Treatment Outcome AB - Cardiac arrest was induced with asphyxia to identify if naloxone alone increases resuscitation rate during cardiopulmonary resuscitation in a rat asphyxia model. The animals were randomized into either a saline group (Sal-gro, treated with normal saline 1 ml iv, n = 8), a low-dose naloxone group (treated with naloxone 0.5 mg/kg iv, n = 8), or a high-dose naloxone group (HN-gro, treated with naloxone 1 mg/kg iv, n = 8) in a blinded fashion during resuscitation. At the end of 10 minutes of asphyxia, cardiopulmonary resuscitation was started, and each drug was administered at the same time. The rate of restoration of spontaneous circulation was seen in 1 of 8, 3 of 8, and 7 of 8 animals in the Sal-gro, LN-gro, and HN-gro, respectively. The rate of restoration of spontaneous circulation in HN-gro was significantly higher than that in Sal-gro (P < .05). Naloxone (1 mg/kg) alone can increase resuscitation rate following asphyxial cardiac arrest in rats. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0735-6757 IL - 0735-6757 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0735-6757(06)00034-9 [pii] ID - 10.1016/j.ajem.2006.01.017 [doi] PP - ppublish PH - 2005/12/04 [received] PH - 2006/01/18 [revised] PH - 2006/01/18 [accepted] LG - English DP - 2006 Sep EZ - 2006/08/30 09:00 DA - 2006/10/13 09:00 DT - 2006/08/30 09:00 YR - 2006 ED - 20061010 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16938595 <678. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16953529 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gallagher EJ AU - Esses D AU - Lee C AU - Lahn M AU - Bijur PE FA - Gallagher, E John FA - Esses, David FA - Lee, Conroy FA - Lahn, Michael FA - Bijur, Polly E IN - Gallagher, E John. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10463, USA. jgallagh@montefiore.org TI - Randomized clinical trial of morphine in acute abdominal pain. CM - Comment in: CJEM. 2007 Mar;9(2):114-7; PMID: 17391583 CM - Comment in: Ann Emerg Med. 2006 Aug;48(2):161-3; PMID: 16857466 SO - Annals of Emergency Medicine. 48(2):150-60, 160.e1-4, 2006 Aug AS - Ann Emerg Med. 48(2):150-60, 160.e1-4, 2006 Aug NJ - Annals of emergency medicine VO - 48 IP - 2 PG - 150-60, 160.e1-4 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Abdomen, Acute/di [Diagnosis] MH - Abdomen, Acute/et [Etiology] MH - Abdomen, Acute/pc [Prevention & Control] MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Double-Blind Method MH - Emergency Service, Hospital MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - *Morphine/tu [Therapeutic Use] MH - Pain Measurement MH - Prospective Studies AB - STUDY OBJECTIVE: Administration of analgesia to patients with acute abdominal pain is controversial. We test the hypothesis that morphine given to emergency department (ED) patients with acute abdominal pain will reduce discomfort and improve clinically important diagnostic accuracy. AB - METHODS: Pain was measured with a standard 0- to 100-mm visual analog scale. ED patients with acute abdominal pain were randomized in a double-blind fashion to 0.1 mg/kg intravenous morphine or placebo. The primary endpoint was the difference between the 2 study arms in clinically important diagnostic accuracy. Clinically important diagnostic accuracy was defined a priori by its complement, clinically important diagnostic error, using 2 independent, blinded investigators to identify any discordance between the provisional and final diagnoses that might adversely affect the patient's health status. The provisional diagnosis was provided by an ED attending physician, who examined the patient only once, 15 minutes after administration of the study agent. The final diagnosis was obtained through follow-up at least 6 weeks after the index ED visit. AB - RESULTS: We randomized 160 patients, of whom 153 patients were available for analysis, 78 patients in the morphine group and 75 patients in the placebo group. Baseline features were similar in both groups, including initial median visual analog scale scores of 98 mm and 99 mm. The median decrease in visual analog scale score at 15 minutes was 33 mm in the morphine group and 2 mm in the placebo group. There were 11 instances of diagnostic discordance in each group, for a clinically important diagnostic accuracy of 86% (67/78) in the morphine group and 85% (64/75) in the placebo group. The difference in clinically important diagnostic accuracy between the 2 groups was 1% (95% confidence interval [CI] -11% to 12%). Analysis by efficacy and intention to treat yielded similar results. Kappa for interobserver concordance in classification of clinically important diagnostic accuracy was 0.94 (95% CI 0.79 to 1.00). No patients required naloxone. AB - CONCLUSION: Although administration of intravenous morphine to adult ED patients with acute abdominal pain could lead to as much as a 12% difference in diagnostic accuracy, equally favoring opioid or placebo, our data are most consistent with the inference that morphine safely provides analgesia without impairing clinically important diagnostic accuracy. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) ES - 1097-6760 IL - 0196-0644 PT - Journal Article PT - Randomized Controlled Trial PP - ppublish LG - English DP - 2006 Aug EZ - 2006/09/06 09:00 DA - 2006/10/07 09:00 DT - 2006/09/06 09:00 YR - 2006 ED - 20061006 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16953529 <679. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16857467 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chang AK AU - Bijur PE AU - Meyer RH AU - Kenny MK AU - Solorzano C AU - Gallagher EJ FA - Chang, Andrew K FA - Bijur, Polly E FA - Meyer, Robert H FA - Kenny, Mark K FA - Solorzano, Clemencia FA - Gallagher, E John IN - Chang, Andrew K. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. achang@montefiore.org TI - Safety and efficacy of hydromorphone as an analgesic alternative to morphine in acute pain: a randomized clinical trial. SO - Annals of Emergency Medicine. 48(2):164-72, 2006 Aug AS - Ann Emerg Med. 48(2):164-72, 2006 Aug NJ - Annals of emergency medicine VO - 48 IP - 2 PG - 164-72 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Antiemetics/tu [Therapeutic Use] MH - Double-Blind Method MH - Emergency Service, Hospital MH - Female MH - Humans MH - Hydromorphone/ad [Administration & Dosage] MH - *Hydromorphone/tu [Therapeutic Use] MH - Male MH - Middle Aged MH - Morphine/tu [Therapeutic Use] MH - *Pain/pc [Prevention & Control] MH - Pain Measurement MH - Prospective Studies MH - Treatment Outcome AB - STUDY OBJECTIVE: We compare a standard weight-based dose of intravenous hydromorphone (Dilaudid) to a standard weight-based dose of intravenous morphine in adults presenting to the ED with acute severe pain. AB - METHODS: This was a prospective, randomized, double-blind, clinical trial conducted in an academic medical center. Of the 198 adult patients presenting to the ED with acute severe pain who were randomized to receive either intravenous hydromorphone at 0.015 mg/kg or intravenous morphine at 0.1 mg/kg, 191 patients had sufficient data for analysis. The main outcome measure was the difference between the 2 groups in pain reduction at 30 minutes as measured on a validated numeric rating scale. Adverse effects, pain reduction at 5 minutes and 2 hours postbaseline, and additional analgesics and antiemetics were tracked as secondary outcome measures. AB - RESULTS: The mean change of pain from baseline to 30 minutes postbaseline in patients allocated to intravenous hydromorphone was -5.5 numeric rating scale units versus -4.1 in patients allocated to intravenous morphine (difference -1.3; 95% confidence interval -2.2 to -0.5). Adverse effects were similar in both groups, with the exception of pruritus, which did not occur in patients receiving hydromorphone (0% versus 6% [difference -6%; 95% confidence interval -11% to -1%]). No patient required naloxone. AB - CONCLUSION: For the treatment of acute, severe pain in the emergency department, intravenous hydromorphone at 0.015 mg/kg represents a feasible alternative to intravenous morphine at 0.1 mg/kg. RN - 0 (Analgesics, Opioid) RN - 0 (Antiemetics) RN - 76I7G6D29C (Morphine) RN - Q812464R06 (Hydromorphone) ES - 1097-6760 IL - 0196-0644 PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial ID - S0196-0644(06)00398-2 [pii] ID - 10.1016/j.annemergmed.2006.03.005 [doi] PP - ppublish PH - 2005/09/20 [received] PH - 2006/02/27 [revised] PH - 2006/03/03 [accepted] LG - English EP - 20060427 DP - 2006 Aug EZ - 2006/07/22 09:00 DA - 2006/10/07 09:00 DT - 2006/07/22 09:00 YR - 2006 ED - 20061006 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16857467 <680. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16898939 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - O'Connor AB AU - Lang VJ AU - Quill TE FA - O'Connor, Alec B FA - Lang, Valerie J FA - Quill, Timothy E IN - O'Connor, Alec B. Hospital Medicine Division, and Department of Medicine, Palliative Care Program, University of Rochester, School of Medicine and Dentistry, Rochester, New York 14642, USA. alec_oconnor@urmc.rochester.edu TI - Underdosing of morphine in comparison with other parenteral opioids in an acute hospital: a quality of care challenge. SO - Pain Medicine. 7(4):299-307, 2006 Jul-Aug AS - PAIN MED. 7(4):299-307, 2006 Jul-Aug NJ - Pain medicine (Malden, Mass.) VO - 7 IP - 4 PG - 299-307 PI - Journal available in: Print PI - Citation processed from: Print JC - 100894201 IO - Pain Med SB - Index Medicus CP - England MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Critical Care/sn [Statistics & Numerical Data] MH - Drug Administration Schedule MH - Drug Utilization/sn [Statistics & Numerical Data] MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - *Infusions, Parenteral/sn [Statistics & Numerical Data] MH - *Morphine/ad [Administration & Dosage] MH - *Narcotics/ad [Administration & Dosage] MH - New York/ep [Epidemiology] MH - *Pain/dt [Drug Therapy] MH - *Pain/ep [Epidemiology] MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Quality Assurance, Health Care MH - Retrospective Studies MH - Therapeutic Equivalency MH - Treatment Outcome AB - OBJECTIVE: We observed that parenteral morphine is routinely prescribed in doses that are quite low in relation to doses of alternative parenteral opioids and in comparison with published effective doses and guidelines. The present study was undertaken to determine: 1) whether different parenteral opioids are dosed equivalently; 2) which patient factors affect equianalgesic dose; and 3) which patient factors affect opioid choice. AB - DESIGN: At a 750-bed tertiary care, teaching hospital in Rochester, NY, patients on the medical and surgical floors and in the emergency department who received one or more doses of parenteral morphine, hydromorphone, or meperidine were identified using computerized pharmacy records. A detailed chart review was performed for each patient, recording a variety of patient variables, which were then correlated separately with opioid dose and choice. AB - RESULTS: Of the 293 patients treated with boluses of a parenteral opioid, 75% received morphine at a median dose of only 2 mg. Patients prescribed hydromorphone or meperidine received median equianalgesic doses that were 6.7 and 3.4 times higher, respectively. A prescriber's choice of opioid affected the equianalgesic dose more significantly than any of the patient variables studied, including active home opioid use. AB - CONCLUSIONS: At our institution, parenteral morphine boluses are routinely given at relatively low doses compared with: 1) other opioids; 2) patient-controlled analgesic dosing; 3) usual doses required for analgesia from previous studies; and 4) a historical control in the same hospital. The reasons for this pattern are largely unexplained by patient variables. Inadequate bolus dosing of morphine may be a barrier to appropriate patient analgesia. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotics) RN - 76I7G6D29C (Morphine) IS - 1526-2375 IL - 1526-2375 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - PME183 [pii] ID - 10.1111/j.1526-4637.2006.00183.x [doi] PP - ppublish LG - English DP - 2006 Jul-Aug EZ - 2006/08/11 09:00 DA - 2006/10/06 09:00 DT - 2006/08/11 09:00 YR - 2006 ED - 20061005 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16898939 <681. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16864474 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Smith MY AU - Dart R AU - Hughes A AU - Geller A AU - Senay E AU - Woody G AU - Colucci S FA - Smith, Meredith Y FA - Dart, Richard FA - Hughes, Alice FA - Geller, Anne FA - Senay, Edward FA - Woody, George FA - Colucci, Salvatore IN - Smith, Meredith Y. Purdue Pharma L.P., Stamford, Connecticut 06901-3431, USA. meredith.smith@pharma.com TI - Clinician validation of Poison Control Center (PCC) intentional exposure cases involving prescription opioids. SO - American Journal of Drug & Alcohol Abuse. 32(3):465-78, 2006 AS - Am J Drug Alcohol Abuse. 32(3):465-78, 2006 NJ - The American journal of drug and alcohol abuse VO - 32 IP - 3 PG - 465-78 PI - Journal available in: Print PI - Citation processed from: Print JC - 3gw, 7502510 IO - Am J Drug Alcohol Abuse SB - Index Medicus CP - England MH - Drug Evaluation, Preclinical MH - *Drug Prescriptions/sn [Statistics & Numerical Data] MH - Humans MH - *Intention MH - Narcotics/ae [Adverse Effects] MH - *Narcotics MH - Observer Variation MH - *Poison Control Centers/sn [Statistics & Numerical Data] MH - Substance Withdrawal Syndrome/ep [Epidemiology] MH - Substance Withdrawal Syndrome/et [Etiology] MH - *Substance-Related Disorders/ep [Epidemiology] MH - Suicide/sn [Statistics & Numerical Data] MH - *Surveys and Questionnaires AB - Poison Control Center (PCC) cases involving intentional ingestion, injection or inhalation of prescription opioids are a potentially valuable source of information on the abuse and misuse of these products. This study sought to validate PCC classifications of prescription opioid intentional exposure cases against clinical diagnostic criteria. 4,321 cases were reviewed. PCC-clinician concordance was good to excellent for Withdrawal, Abuse, and Suicide (kappa statistics: 0.73, 0.53, 0.48, respectively), but poor for Misuse and Intentional Unknown (Specific motive not known). Interrater reliability among clinicians was good (weighted kappa range: 0.56-0.68). Results demonstrate the degree of compatibility between PCC and standard nosologic classifications. RN - 0 (Narcotics) IS - 0095-2990 IL - 0095-2990 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Validation Studies ID - L20001147KU711M0 [pii] ID - 10.1080/00952990600753982 [doi] PP - ppublish LG - English DP - 2006 EZ - 2006/07/26 09:00 DA - 2006/09/02 09:00 DT - 2006/07/26 09:00 YR - 2006 ED - 20060901 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16864474 <682. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16752109 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Deck DD AU - Wiitala WL AU - Laws KE FA - Deck, Dennis D FA - Wiitala, Wyndy L FA - Laws, Katherine E IN - Deck, Dennis D. RMC Research Corporation, 111 S.W. Columbia, Suite 1200, Portland, OR 97201-5843, USA. ddeck@rmccorp.com TI - Medicaid coverage and access to publicly funded opiate treatment. SO - Journal of Behavioral Health Services & Research. 33(3):324-34, 2006 Jul AS - J Behav Health Serv Res. 33(3):324-34, 2006 Jul NJ - The journal of behavioral health services & research VO - 33 IP - 3 PG - 324-34 PI - Journal available in: Print PI - Citation processed from: Print JC - 9803531, cwv IO - J Behav Health Serv Res SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Cohort Studies MH - Female MH - *Financing, Government MH - *Health Services Accessibility MH - Humans MH - Male MH - *Medicaid MH - Middle Aged MH - *Narcotics MH - Oregon MH - *Substance-Related Disorders/th [Therapy] AB - This observational study examines changes in access to methadone maintenance treatment following Oregon's decision to remove substance abuse treatment from the Medicaid benefit for an expansion population. Access was compared before and after the benefit change for two cohorts of adults addicted to opiates presenting for publicly funded treatment. Propensity score analysis helped model some selective disenrollment from Medicaid that occurred after the benefit change. Logistic regression was used to compare access to methadone by cohort controlling for client characteristics. Opiate users presenting for publicly funded treatment after the change were less than half as likely (OR = 0.40) to be placed in an opiate treatment program compared to the prior year. Further analysis revealed that those with no recent treatment history were less likely to present for treatment after the benefit change. These results have implications for states considering Medicaid cuts, especially if the anticipated increases in illegal activity, emergency room utilization, unemployment, and mortality can be demonstrated. RN - 0 (Narcotics) IS - 1094-3412 IL - 1094-3412 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - 10.1007/s11414-006-9018-2 [doi] PP - ppublish GI - No: R01 DA015060 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2006 Jul EZ - 2006/06/06 09:00 DA - 2006/09/01 09:00 DT - 2006/06/06 09:00 YR - 2006 ED - 20060831 RD - 20171104 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16752109 <683. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16325987 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Singh J AU - Santosh S AU - Wyllie JP AU - Mellon A FA - Singh, Jaideep FA - Santosh, Sanuja FA - Wyllie, J P FA - Mellon, A IN - Singh, Jaideep. Neonatal Directorate, The James Cook University Hospital, Middlesbrough TS4 3BW, UK. jaideep.singh@ncl.ac.uk TI - Effects of a course in neonatal resuscitation--evaluation of an educational intervention on the standard of neonatal resuscitation. SO - Resuscitation. 68(3):385-9, 2006 Mar AS - Resuscitation. 68(3):385-9, 2006 Mar NJ - Resuscitation VO - 68 IP - 3 PG - 385-9 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Drug Utilization/td [Trends] MH - England/ep [Epidemiology] MH - Humans MH - Hypothermia/ep [Epidemiology] MH - Incidence MH - Infant, Newborn MH - *Inservice Training MH - Intensive Care Units, Neonatal MH - Intubation, Intratracheal/ut [Utilization] MH - Masks MH - *Midwifery/ed [Education] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Patient Admission MH - Positive-Pressure Respiration/is [Instrumentation] MH - Positive-Pressure Respiration/ut [Utilization] MH - *Resuscitation/ed [Education] MH - Retrospective Studies AB - BACKGROUND: Appropriate assessment and resuscitation is an important part of neonatal care provided during the first minutes of life. Midwifery and junior medical staff are often in the frontline of neonatal resuscitation. Appropriate education and training of midwifery staff is therefore essential if the standard of care delivered to babies in the delivery suite is to be improved and maintained. Evaluation of any such educational interventions is necessary to assess their effectiveness. AB - AIM: To assess the effect of a course in neonatal resuscitation introduced in 1995 aimed at midwifery staff, on the standard of care provided to babies immediately after birth. Prior to this, training in neonatal resuscitation was largely theoretical. AB - METHODS: Naturalistic design observational study conducted in a maternity unit with a tertiary neonatal intensive care unit in the North of England. We compared two groups of babies born before and after the course was introduced. Use of naloxone in the delivery suite and appropriateness of its use, and temperature on admission to neonatal intensive care unit were used as proxy markers for standard of care and compared in the two groups. We also looked at the use of mask intermittent positive pressure ventilation (IPPV) and tracheal intubation in the delivery suite. AB - RESULTS: Use of naloxone fell dramatically from 13.2% of all babies born in 1994 to 0.5% in 2003. Inappropriate use of naloxone before other resuscitation measures were initiated declined from 75% of babies given naloxone in 1994 to 10% in 2003. The incidence of hypothermia (<35 degrees C) on admission to neonatal unit declined from 9% of all admissions to 2.3% in 2003. There was a trend towards increased use of mask ventilation in the delivery suite with a corresponding trend towards less tracheal intubation. AB - CONCLUSION: We have shown that the intervention has been related temporally to an improvement in the quality of care delivered by midwifery staff to newborn babies. Practical courses in neonatal resuscitation can contribute to improvements in the quality of care provided to babies immediately after birth. These courses are more effective than theoretical teaching alone. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0300-9572 IL - 0300-9572 PT - Journal Article ID - S0300-9572(05)00301-1 [pii] ID - 10.1016/j.resuscitation.2005.07.012 [doi] PP - ppublish PH - 2004/12/03 [received] PH - 2005/07/06 [revised] PH - 2005/07/15 [accepted] LG - English EP - 20051201 DP - 2006 Mar EZ - 2005/12/06 09:00 DA - 2006/08/03 09:00 DT - 2005/12/06 09:00 YR - 2006 ED - 20060802 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16325987 <684. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16750800 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bijur PE AU - Berard A AU - Esses D AU - Nestor J AU - Schechter C AU - Gallagher EJ FA - Bijur, Polly E FA - Berard, Anick FA - Esses, David FA - Nestor, Jordan FA - Schechter, Clyde FA - Gallagher, E John IN - Bijur, Polly E. Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA. bijur@aecom.yu.edu TI - Lack of influence of patient self-report of pain intensity on administration of opioids for suspected long-bone fractures. SO - Journal of Pain. 7(6):438-44, 2006 Jun AS - J PAIN. 7(6):438-44, 2006 Jun NJ - The journal of pain : official journal of the American Pain Society VO - 7 IP - 6 PG - 438-44 PI - Journal available in: Print PI - Citation processed from: Print JC - 100898657 IO - J Pain SB - Index Medicus CP - United States MH - Analgesia/px [Psychology] MH - Analgesia/sn [Statistics & Numerical Data] MH - Analgesia/td [Trends] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Decision Making MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital/td [Trends] MH - *Fractures, Bone/co [Complications] MH - Humans MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - *Pain/px [Psychology] MH - Pain Measurement/mt [Methods] MH - *Pain Measurement/px [Psychology] MH - Pain Measurement/td [Trends] MH - Physician-Patient Relations MH - Prospective Studies MH - *Self-Assessment AB - UNLABELLED: The purpose of the present study was to prospectively investigate the extent to which emergency providers base their decisions about pain management of suspected long-bone fracture on patient's self-reported pain intensity. Of 100 long-bone fracture patients presenting to 2 inner-city emergency departments, 69% received opioids as compared to 30% of 110 patients without long-bone fracture (RR = 2.3; 95% CI 1.6 to 3.1). After stratification by pain ratings on a validated self-reported numerical rating scale, fracture patients remained twice as likely to receive opioids as those without fracture (RR = 2.0; 95% CI 1.5 to 2.7). Similarly, multivariate adjustment for self-reported pain intensity had little effect on the observed association (RR = 2.1; 95% CI 1.6 to 2.8). We conclude that emergency providers do not primarily base their decisions about pain management of suspected long-bone fractures on patient self-reporting of pain intensity. AB - PERSPECTIVE: This article addresses the question of the role of self-reported pain intensity rating on the treatment of suspected fractures. The findings indicate that self-reported pain is not used as the most important measure of pain as recommended by expert panels. We speculate this may contribute to oligoanalgesia in the Emergency Department. RN - 0 (Analgesics, Opioid) IS - 1526-5900 IL - 1526-5900 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. ID - S1526-5900(06)00531-1 [pii] ID - 10.1016/j.jpain.2006.01.451 [doi] PP - ppublish PH - 2005/11/17 [received] PH - 2006/01/13 [revised] PH - 2006/01/26 [accepted] GI - No: 1 R01 HS13924 Organization: (HS) *AHRQ HHS* Country: United States LG - English DP - 2006 Jun EZ - 2006/06/06 09:00 DA - 2006/07/28 09:00 DT - 2006/06/06 09:00 YR - 2006 ED - 20060727 RD - 20130520 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16750800 <685. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16730276 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Heins JK AU - Heins A AU - Grammas M AU - Costello M AU - Huang K AU - Mishra S FA - Heins, Janet Kaye FA - Heins, Alan FA - Grammas, Marianthe FA - Costello, Melissa FA - Huang, Kun FA - Mishra, Satya IN - Heins, Janet Kaye. University of Mobile School of Nursing, Alabama, USA. knkansas@hotmail.com TI - Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department. SO - Journal of Emergency Nursing. 32(3):219-24, 2006 Jun AS - J Emerg Nurs. 32(3):219-24, 2006 Jun NJ - Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association VO - 32 IP - 3 PG - 219-24 PI - Journal available in: Print PI - Citation processed from: Print JC - 7605913 IO - J Emerg Nurs SB - Nursing Journal CP - United States MH - African Americans MH - Age Factors MH - *Analgesics MH - *Analgesics, Opioid MH - Drug Utilization MH - *Emergency Service, Hospital MH - European Continental Ancestry Group MH - Female MH - Health Services Accessibility MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - *Musculoskeletal Diseases/dt [Drug Therapy] MH - *Pain/dt [Drug Therapy] MH - *Practice Patterns, Physicians' MH - Retrospective Studies MH - United States AB - INTRODUCTION: Healthy People 2010 seeks to eliminate racial and ethnic disparities in health care; however, disparities due to age and race have been described in emergency department pain treatment. Although pain is a common patient complaint in emergency departments, many people receive no analgesia. This study examined the influence of patient and provider characteristics on ED and discharge analgesia and opioid prescribing practices. AB - METHODS: This descriptive study used chart review of selected variables from ED patients 18 years and older who presented with musculoskeletal pain and were treated by core ED faculty. Logistic regression analyses were performed to determine whether analgesia- and opioid-prescribing disparities existed and were influenced by patient and provider characteristics. AB - RESULTS: A total of 868 patient records were examined. Physician characteristics and wide variation in practice were the only sources of disparities in the prescription of analgesics in the emergency department, but patient characteristics including race, age, chronic pain, and trauma influenced prescription of ED opioids and discharge analgesics. No gender or financial status disparities were found. Fewer opioids and discharge analgesics were prescribed for black patients than for white patients. Younger patients, those with trauma, and those with chronic pain received more opioids and discharge analgesics compared with older patients and those without trauma or chronic pain. Providers who completed emergency medicine residencies and had fewer than 3 years' experience prescribed more analgesics in the emergency department. AB - DISCUSSION: Pain management in our emergency department is widely variable, with some disparities based on patient and physician characteristics. Multicenter prospective studies are needed to validate these findings and examine knowledge and attitude development about pain and its management. Protocols for nurse-initiated analgesia may help improve and standardize ED pain care. RN - 0 (Analgesics) RN - 0 (Analgesics, Opioid) IS - 0099-1767 IL - 0099-1767 PT - Comparative Study PT - Journal Article ID - S0099-1767(06)00062-6 [pii] ID - 10.1016/j.jen.2006.01.010 [doi] PP - ppublish LG - English DP - 2006 Jun EZ - 2006/05/30 09:00 DA - 2006/07/22 09:00 DT - 2006/05/30 09:00 YR - 2006 ED - 20060721 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16730276 <686. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16399848 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ma J AU - Zhang Y AU - Kalyuzhny AE AU - Pan ZZ FA - Ma, Junyi FA - Zhang, Yong FA - Kalyuzhny, Alex E FA - Pan, Zhizhong Z IN - Ma, Junyi. Department of Anesthesiology and Pain Medicine, Unit 110, University of Texas-MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. TI - Emergence of functional delta-opioid receptors induced by long-term treatment with morphine. SO - Molecular Pharmacology. 69(4):1137-45, 2006 Apr AS - Mol Pharmacol. 69(4):1137-45, 2006 Apr NJ - Molecular pharmacology VO - 69 IP - 4 PG - 1137-45 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - ngr, 0035623 IO - Mol. Pharmacol. SB - Index Medicus CP - United States MH - Animals MH - Base Sequence MH - DNA Primers MH - Immunohistochemistry MH - In Vitro Techniques MH - Microinjections MH - *Morphine/pd [Pharmacology] MH - Rats MH - *Receptors, Opioid, delta/de [Drug Effects] MH - Reverse Transcriptase Polymerase Chain Reaction AB - Opioid analgesics remain the choice for the treatment of moderate to severe pain. Recent research has established that the mu-opioid receptor is predominantly responsible for mediating many opioid actions, including analgesia and opioid tolerance. However, the function of delta-opioid receptors is rather puzzling at present, with inconsistent reports of system effects by agonists of delta-opioid receptors. The functional interaction between mu-opioid receptors and delta-opioid receptors is also poorly understood. In this study, we demonstrated that in a brainstem site critically involved in opioid analgesia, agonists of delta-opioid receptors, ineffective in opioid naive rats, significantly inhibit presynaptic GABA release in the brainstem neurons from morphine-tolerant rats. In membrane preparation from control brainstem tissues, Western blot detected no proteins of delta-opioid receptors, but consistent delta-opioid receptor proteins were expressed in membrane preparation from morphine-tolerant rats. Immunohistochemical studies revealed that long-term morphine treatment significantly increases the number of delta-opioid receptor-immunoreactive varicosities that appose the postsynaptic membrane of these neurons. The colocalization of delta-opioid receptor-immunoreactive varicosities with the labeling of the GABA-synthesizing enzyme glutamic acid decarboxylase is also significantly increased. From a behavioral perspective, activation of delta-opioid receptors in the brainstem nucleus, lacking an effect in opioid naive rats, became analgesic in morphine-tolerant rats and significantly reduced morphine tolerance. These findings indicate that long-term morphine treatment induces the emergence of functional delta-opioid receptors and delta-opioid receptor-mediated analgesia, probably through receptor translocation to surface membrane in GABAergic terminals. They also suggest that opioid drugs with preference for delta-opioid receptors may have better therapeutic effect in a mu-opioid-tolerant state. RN - 0 (DNA Primers) RN - 0 (Receptors, Opioid, delta) RN - 76I7G6D29C (Morphine) IS - 0026-895X IL - 0026-895X PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't ID - mol.105.019109 [pii] ID - 10.1124/mol.105.019109 [doi] PP - ppublish GI - No: 5K01DA00381 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: DA14524 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20060106 DP - 2006 Apr EZ - 2006/01/10 09:00 DA - 2006/06/20 09:00 DT - 2006/01/10 09:00 YR - 2006 ED - 20060619 RD - 20141120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16399848 <687. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16686246 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wilsey BL AU - Fishman SM AU - Ogden C FA - Wilsey, Barth L FA - Fishman, Scott M FA - Ogden, Christine IN - Wilsey, Barth L. University of California, Davis, VANCHCS/UCD Analgesic Research Center, USA. TI - Prescription opioid abuse in the emergency department. SO - Journal of Law, Medicine & Ethics. 33(4):770-82, 2005 AS - J Law Med Ethics. 33(4):770-82, 2005 NJ - The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics VO - 33 IP - 4 PG - 770-82 PI - Journal available in: Print PI - Citation processed from: Print JC - bv9, 9315583 IO - J Law Med Ethics SB - Health Technology Assessment Journals CP - United States MH - Chronic Disease MH - Comorbidity MH - Diagnosis, Differential MH - Documentation MH - Drug and Narcotic Control/lj [Legislation & Jurisprudence] MH - *Emergency Service, Hospital MH - Humans MH - *Opioid-Related Disorders/di [Diagnosis] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/ep [Epidemiology] MH - *Pain/di [Diagnosis] MH - Pain/dt [Drug Therapy] MH - Pain/ep [Epidemiology] MH - Patient Compliance MH - United States/ep [Epidemiology] IS - 1073-1105 IL - 1073-1105 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2005 EZ - 2006/05/12 09:00 DA - 2006/06/13 09:00 DT - 2006/05/12 09:00 YR - 2005 ED - 20060612 RD - 20170516 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16686246 <688. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16002027 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tracy M AU - Piper TM AU - Ompad D AU - Bucciarelli A AU - Coffin PO AU - Vlahov D AU - Galea S FA - Tracy, Melissa FA - Piper, Tinka Markham FA - Ompad, Danielle FA - Bucciarelli, Angela FA - Coffin, Phillip O FA - Vlahov, David FA - Galea, Sandro IN - Tracy, Melissa. Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, USA. TI - Circumstances of witnessed drug overdose in New York City: implications for intervention. SO - Drug & Alcohol Dependence. 79(2):181-90, 2005 Aug 01 AS - Drug Alcohol Depend. 79(2):181-90, 2005 Aug 01 NJ - Drug and alcohol dependence VO - 79 IP - 2 PG - 181-90 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Adolescent MH - Adult MH - Crisis Intervention MH - *Drug Overdose/th [Therapy] MH - *Emergency Medical Services MH - *Emergency Treatment MH - Female MH - *Heroin/ae [Adverse Effects] MH - *Heroin Dependence/mo [Mortality] MH - *Heroin Dependence/th [Therapy] MH - Humans MH - Male MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/ae [Adverse Effects] MH - New York City/ep [Epidemiology] MH - Peer Group MH - Prevalence AB - Drug users frequently witness the nonfatal and fatal drug overdoses of their peers, but often fail to intervene effectively to reduce morbidity and mortality. We assessed the circumstances of witnessed heroin-related overdoses in New York City (NYC) among a predominantly minority population of drug users. Among 1184 heroin, crack, and cocaine users interviewed between November 2001 and February 2004, 672 (56.8%) had witnessed at least one nonfatal or fatal heroin-related overdose. Of those, 444 (67.7%) reported that they or someone else present called for medical help for the overdose victim at the last witnessed overdose. In multivariable models, the respondent never having had an overdose her/himself and the witnessed overdose occurring in a public place were associated with the likelihood of calling for medical help. Fear of police response was the most commonly cited reason for not calling or delaying before calling for help (52.2%). Attempts to revive the overdose victim through physical stimulation (e.g., applying ice, causing pain) were reported by 59.7% of respondents, while first aid measures were attempted in only 11.9% of events. Efforts to equip drug users to manage overdoses effectively, including training in first aid and the provision of naloxone, and the reduction of police involvement at overdose events may have a substantial impact on overdose-related morbidity and mortality. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 0376-8716 IL - 0376-8716 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. ID - S0376-8716(05)00050-5 [pii] ID - 10.1016/j.drugalcdep.2005.01.010 [doi] PP - ppublish PH - 2004/08/31 [received] PH - 2005/01/07 [revised] PH - 2005/01/26 [accepted] GI - No: DA-06534 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: DA-12801-S1 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: R01-DA-017642-01 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20050219 DP - 2005 Aug 01 EZ - 2005/07/09 09:00 DA - 2006/06/10 09:00 DT - 2005/07/09 09:00 YR - 2005 ED - 20060609 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16002027 <689. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16546020 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cappell MS FA - Cappell, Mitchell S IN - Cappell, Mitchell S. Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, Klein Professional Building, Philadelphia, PA 19141, USA. mscappell@yahoo.com TI - Sedation and analgesia for gastrointestinal endoscopy during pregnancy. [Review] [205 refs] SO - Gastrointestinal Endoscopy Clinics of North America. 16(1):1-31, 2006 Jan AS - Gastrointest Endosc Clin N Am. 16(1):1-31, 2006 Jan NJ - Gastrointestinal endoscopy clinics of North America VO - 16 IP - 1 PG - 1-31 PI - Journal available in: Print PI - Citation processed from: Print JC - b07, 9202792 IO - Gastrointest. Endosc. Clin. N. Am. SB - Index Medicus CP - United States MH - *Analgesia MH - Analgesics, Opioid/pd [Pharmacology] MH - Cholangiopancreatography, Endoscopic Retrograde MH - *Conscious Sedation MH - Diazepam/pd [Pharmacology] MH - *Endoscopy, Gastrointestinal MH - Female MH - Fentanyl/pd [Pharmacology] MH - Fetus/de [Drug Effects] MH - Flumazenil/pd [Pharmacology] MH - Humans MH - *Hypnotics and Sedatives/pd [Pharmacology] MH - Ketamine/pd [Pharmacology] MH - Lidocaine/pd [Pharmacology] MH - Meperidine/pd [Pharmacology] MH - Naloxone/pd [Pharmacology] MH - Pregnancy MH - Propofol/pd [Pharmacology] MH - Risk Assessment MH - Triage AB - Endoscopy during pregnancy raises the unique issue of fetal safety. Endoscopic medications comprise a significant component of fetal risks from endoscopy. Before endoscopy, the gastroenterologist or anesthesiologist should evaluate the potential fetal risks of sedation and analgesia, identify any contraindications to endoscopy, stabilize the maternal medical status as necessary, and correct maternal hypoxia or hypotension. The mother should be informed about the potential teratogenic risks of endoscopic medications during pregnancy. Patients who receive sedation and analgesia should be monitored during endoscopy by continuous electrocardiography, continuous pulse oximetry, and intermittent sphygmomanometry, as well as by the pulse and respiratory rate. General principles of sedation and analgesia during pregnancy include use of the minimal effective dose, avoidance of unnecessary medications, and preferable use of Food and Drug Administration category B medications. [References: 205] RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 36B82AMQ7N (Naloxone) RN - 40P7XK9392 (Flumazenil) RN - 690G0D6V8H (Ketamine) RN - 98PI200987 (Lidocaine) RN - 9E338QE28F (Meperidine) RN - Q3JTX2Q7TU (Diazepam) RN - UF599785JZ (Fentanyl) RN - YI7VU623SF (Propofol) IS - 1052-5157 IL - 1052-5157 PT - Journal Article PT - Review ID - S1052-5157(06)00009-2 [pii] ID - 10.1016/j.giec.2006.01.007 [doi] PP - ppublish LG - English DP - 2006 Jan EZ - 2006/03/21 09:00 DA - 2006/05/24 09:00 DT - 2006/03/21 09:00 YR - 2006 ED - 20060523 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16546020 <690. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16459272 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bijur PE AU - Schechter C AU - Esses D AU - Chang AK AU - Gallagher EJ FA - Bijur, Polly E FA - Schechter, Clyde FA - Esses, David FA - Chang, Andrew K FA - Gallagher, E John IN - Bijur, Polly E. Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA. bijur@aecom.yu.edu TI - Intravenous bolus of ultra-low-dose naloxone added to morphine does not enhance analgesia in emergency department patients. SO - Journal of Pain. 7(2):75-81, 2006 Feb AS - J PAIN. 7(2):75-81, 2006 Feb NJ - The journal of pain : official journal of the American Pain Society VO - 7 IP - 2 PG - 75-81 PI - Journal available in: Print PI - Citation processed from: Print JC - 100898657 IO - J Pain SB - Index Medicus CP - United States MH - Acute Disease MH - Adult MH - Aged MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Dose-Response Relationship, Drug MH - Double-Blind Method MH - Drug Therapy, Combination MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Infusions, Intravenous MH - Male MH - Middle Aged MH - *Morphine/ad [Administration & Dosage] MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Treatment Failure AB - UNLABELLED: There is some evidence from in vitro, animal, and postoperative clinical studies that low doses of opioid antagonists combined with morphine increase analgesia. The theoretical model of this effect posits that ultra-low doses of opioid antagonists selectively antagonize excitatory, but not inhibitory, opioid receptor-mediated signaling. To determine whether this effect occurs in emergency department patients presenting with severe acute pain, we conducted a randomized, double-blind placebo-controlled trial to assess the relative analgesic effect of morphine administered with 3 different doses of naloxone versus morphine alone. Patients received 0.1 mg/kg morphine intravenously (IV) over 2 min plus one of 3 different doses of naloxone (0.1 ng/kg, 0.01 ng/kg, or 0.001 ng/kg) or normal saline. A 0 to 10 numerical rating scale (NRS) was used to measure pain intensity at baseline and every 30 min up to 4 hours. One hundred fifty-six patients with a median NRS of 10 (IQR: 8-10) were studied. There were no clinically or statistically significant differences in the mean pain intensity of patients in the 4 treatment groups over the 4-hour study period, nor were there differences in the administration of additional analgesics or incidence of side effects. AB - PERSPECTIVE: Ultra-low doses of naloxone in the 0.001 ng/kg to 0.1 ng/kg range do not enhance the analgesia provided by morphine alone among emergency department patients with acute, severe pain. This suggests that naloxone in these doses is not an effective adjunct to morphine for control of acute pain. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 76I7G6D29C (Morphine) IS - 1526-5900 IL - 1526-5900 PT - Journal Article PT - Randomized Controlled Trial ID - S1526-5900(05)00849-7 [pii] ID - 10.1016/j.jpain.2005.08.008 [doi] PP - ppublish PH - 2005/06/13 [received] PH - 2005/08/09 [revised] PH - 2005/08/22 [accepted] LG - English DP - 2006 Feb EZ - 2006/02/07 09:00 DA - 2006/05/19 09:00 DT - 2006/02/07 09:00 YR - 2006 ED - 20060518 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16459272 <691. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16540957 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Richman PS AU - Baram D AU - Varela M AU - Glass PS FA - Richman, Paul S FA - Baram, Daniel FA - Varela, Marie FA - Glass, Peter S IN - Richman, Paul S. Departments of Medicine, Stony Brook University, Stony Brook, NY, USA. TI - Sedation during mechanical ventilation: a trial of benzodiazepine and opiate in combination. CM - Comment in: Crit Care Med. 2006 May;34(5):1558-9; PMID: 16633258 SO - Critical Care Medicine. 34(5):1395-401, 2006 May AS - Crit Care Med. 34(5):1395-401, 2006 May NJ - Critical care medicine VO - 34 IP - 5 PG - 1395-401 PI - Journal available in: Print PI - Citation processed from: Print JC - dtf, 0355501 IO - Crit. Care Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/ec [Economics] MH - Cost-Benefit Analysis MH - Drug Costs MH - Drug Therapy, Combination MH - Female MH - *Fentanyl/ad [Administration & Dosage] MH - Fentanyl/ae [Adverse Effects] MH - Fentanyl/ec [Economics] MH - Humans MH - *Hypnotics and Sedatives/ad [Administration & Dosage] MH - Hypnotics and Sedatives/ae [Adverse Effects] MH - Hypnotics and Sedatives/ec [Economics] MH - Infusions, Intravenous MH - Linear Models MH - Male MH - *Midazolam/ad [Administration & Dosage] MH - Midazolam/ae [Adverse Effects] MH - Midazolam/ec [Economics] MH - Middle Aged MH - Prospective Studies MH - *Respiration, Artificial MH - Statistics, Nonparametric AB - OBJECTIVE: To compare the efficacy of continuous intravenous sedation with midazolam alone vs. midazolam plus fentanyl ("co-sedation") during mechanical ventilation. AB - DESIGN: A randomized, prospective, controlled trial. AB - SETTING: A ten-bed medical intensive care unit at a university hospital. AB - PATIENTS: Thirty patients with respiratory failure who were expected to require >48 hrs of mechanical ventilation and who were receiving a sedative regimen that did not include opiate pain control. AB - INTERVENTIONS: An intravenous infusion of either midazolam alone or co-sedation was administered by a nurse-implemented protocol to achieve a target Ramsay Sedation Score set by the patient's physician. Study duration was 3 days, with a brief daily "wake-up." AB - MEASUREMENTS AND MAIN RESULTS: We recorded the number of hours/day that patients were "off-target" with their Ramsay Sedation Scores, the number of dose titrations per day, the incidence of patient-ventilator asynchrony, and the time required to achieve adequate sedation as measures of sedative efficacy. We also recorded sedative cost in U.S. dollars and adverse events including hypotension, hypoventilation, ileus, and coma. Compared with the midazolam-only group, the co-sedation group had fewer hours per day with an "off-target" Ramsay Score (4.2 +/- 2.4 and 9.1 +/- 4.9, respectively, p < .002). Fewer episodes per day of patient-ventilator asynchrony were noted in the co-sedation group compared with midazolam-only (0.4 +/- 0.1 and 1.0 +/- 0.2, respectively, p < .05). Co-sedation also showed nonsignificant trends toward a shorter time to achieve sedation, a need for fewer dose titrations per day, and a lower total sedative drug cost. There was a trend toward more episodes of ileus with co-sedation compared with midazolam-only (2 vs. 0). AB - CONCLUSIONS: In mechanically ventilated patients, co-sedation with midazolam and fentanyl by constant infusion provides more reliable sedation and is easier to titrate than midazolam alone, without significant difference in the rate of adverse events. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - R60L0SM5BC (Midazolam) RN - UF599785JZ (Fentanyl) IS - 0090-3493 IL - 0090-3493 PT - Journal Article PT - Randomized Controlled Trial ID - 10.1097/01.CCM.0000215454.50964.F8 [doi] PP - ppublish LG - English DP - 2006 May EZ - 2006/03/17 09:00 DA - 2006/05/18 09:00 DT - 2006/03/17 09:00 YR - 2006 ED - 20060517 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16540957 <692. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16620534 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Huang MK AU - Dai YS AU - Lee CH AU - Liu C AU - Tsay WI AU - Li JH FA - Huang, Min-Kun FA - Dai, Yu-Shan FA - Lee, Choung-Huei FA - Liu, Chiareiy FA - Tsay, Wen-Ing FA - Li, Jih-Heng IN - Huang, Min-Kun. National Bureau of Controlled Drugs, Department of Health-Taiwan, 6 Linsen South Road, Taipei 10050, Taiwan, ROC. TI - Performance characteristics of DRI, CEDIA, and REMEDi systems for preliminary tests of amphetamines and opiates in human urine. SO - Journal of Analytical Toxicology. 30(1):61-4, 2006 Jan-Feb AS - J Anal Toxicol. 30(1):61-4, 2006 Jan-Feb NJ - Journal of analytical toxicology VO - 30 IP - 1 PG - 61-4 PI - Journal available in: Print PI - Citation processed from: Print JC - k4r, 7705085 IO - J Anal Toxicol SB - Index Medicus CP - England MH - *Amphetamines/ur [Urine] MH - Humans MH - *Immunoassay MH - *Narcotics/ur [Urine] MH - Reproducibility of Results MH - Sensitivity and Specificity MH - *Street Drugs/ur [Urine] MH - *Substance Abuse Detection/mt [Methods] AB - Arrestee urine specimens (930) were tested with DRI, CEDIA, and REMEDi; those that tested positive for amphetamines and opiates (616 and 414, respectively) were then confirmed by gas chromatography-mass spectrometry. The performance characteristics of these three preliminary systems were evaluated using the following commonly used parameters: true positive, true negative, false positive, and false negative. The sensitivity, specificity, and efficiency of these methods were also calculated. Data derived from this study indicated DRI and CEDIA adapted by this study generated acceptable preliminary test results for amphetamine/methamphetamine and morphine/codeine, but not for MDA/MDMA and REMEDi has lower sensitivity than DRI and CEDIA, but with better specificity and efficiency, supporting its use under emergency room settings where drug concentrations in overdose cases are expectedly at high levels. RN - 0 (Amphetamines) RN - 0 (Narcotics) RN - 0 (Street Drugs) IS - 0146-4760 IL - 0146-4760 PT - Comparative Study PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2006 Jan-Feb EZ - 2006/04/20 09:00 DA - 2006/05/05 09:00 DT - 2006/04/20 09:00 YR - 2006 ED - 20060504 RD - 20061115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16620534 <693. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16533641 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wyckoff MH AU - Wyllie J FA - Wyckoff, Myra H FA - Wyllie, Jonathan IN - Wyckoff, Myra H. Department of Pediatrics, Division of Neonatal/Perinatal Medicine, University of Texas, Southwestern Medical Center, Dallas, TX 75290-9063, USA. myra.wyckoff@utsouthwestern.edu TI - Endotracheal delivery of medications during neonatal resuscitation. [Review] [35 refs] SO - Clinics in Perinatology. 33(1):153-60, ix, 2006 Mar AS - Clin Perinatol. 33(1):153-60, ix, 2006 Mar NJ - Clinics in perinatology VO - 33 IP - 1 PG - 153-60, ix PI - Journal available in: Print PI - Citation processed from: Print JC - dhh, 7501306 IO - Clin Perinatol SB - Index Medicus CP - United States MH - *Adrenergic Agonists/ad [Administration & Dosage] MH - Animals MH - Asphyxia Neonatorum/th [Therapy] MH - *Cardiopulmonary Resuscitation/mt [Methods] MH - *Epinephrine/ad [Administration & Dosage] MH - *Heart Arrest/th [Therapy] MH - Humans MH - Infant, Newborn MH - Intubation, Intratracheal AB - If the endotracheal route is to be used for administration of epinephrine, the limited available evidence suggests that the currently recommended dose of 0.01 mg/kg is likely to be too low to be effective. Given the paucity of high-quality clinical data regarding endotracheal epinephrine, the intravenous route should be used as soon as venous access is established. Given the complete lack of clinical data in newborns, endotracheal administration of naloxone is not recommended. [References: 35] RN - 0 (Adrenergic Agonists) RN - YKH834O4BH (Epinephrine) IS - 0095-5108 IL - 0095-5108 PT - Journal Article PT - Review ID - S0095-5108(05)00126-0 [pii] ID - 10.1016/j.clp.2005.11.013 [doi] PP - ppublish LG - English DP - 2006 Mar EZ - 2006/03/15 09:00 DA - 2006/05/05 09:00 DT - 2006/03/15 09:00 YR - 2006 ED - 20060504 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16533641 <694. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16533638 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Guinsburg R AU - Wyckoff MH FA - Guinsburg, Ruth FA - Wyckoff, Myra H IN - Guinsburg, Ruth. Department of Pediatrics, Division of Neonatal Medicine, Federal University of Sao Paulo, Rua Vicente Felix 77/09, Sao Paulo, SP 01410-020, Brazil. ruthgbr@netpoint.com.br TI - Naloxone during neonatal resuscitation: acknowledging the unknown. [Review] [40 refs] SO - Clinics in Perinatology. 33(1):121-32, viii, 2006 Mar AS - Clin Perinatol. 33(1):121-32, viii, 2006 Mar NJ - Clinics in perinatology VO - 33 IP - 1 PG - 121-32, viii PI - Journal available in: Print PI - Citation processed from: Print JC - dhh, 7501306 IO - Clin Perinatol SB - Index Medicus CP - United States MH - Analgesia, Obstetrical/ae [Adverse Effects] MH - Animals MH - Female MH - Humans MH - Infant, Newborn MH - Maternal-Fetal Exchange MH - Naloxone/pk [Pharmacokinetics] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/pk [Pharmacokinetics] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Pregnancy MH - Respiratory Insufficiency/ci [Chemically Induced] MH - *Respiratory Insufficiency/dt [Drug Therapy] MH - *Resuscitation/mt [Methods] AB - There are no studies to support or to refute the current recommendations regarding naloxone concentration, routes for administration, and doses in neonatal resuscitation in the delivery room. Given the lack of supporting evidence, naloxone should not be given routinely in the delivery room to depressed neonates whether or not they are exposed to opioids before delivery because no important improvement has been documented and the drug may have potential short- and long-term harmful effects. [References: 40] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0095-5108 IL - 0095-5108 PT - Journal Article PT - Review ID - S0095-5108(05)00130-2 [pii] ID - 10.1016/j.clp.2005.11.017 [doi] PP - ppublish LG - English DP - 2006 Mar EZ - 2006/03/15 09:00 DA - 2006/05/05 09:00 DT - 2006/03/15 09:00 YR - 2006 ED - 20060504 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16533638 <695. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15917504 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tobin KE AU - Gaasch WR AU - Clarke C AU - MacKenzie E AU - Latkin CA FA - Tobin, Karin E FA - Gaasch, Wade R FA - Clarke, Carla FA - MacKenzie, Ellen FA - Latkin, Carl A IN - Tobin, Karin E. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA. ktobin@jhsph.edu TI - Attitudes of Emergency Medical Service providers towards naloxone distribution programs. SO - Journal of Urban Health. 82(2):296-302, 2005 Jun AS - J Urban Health. 82(2):296-302, 2005 Jun NJ - Journal of urban health : bulletin of the New York Academy of Medicine VO - 82 IP - 2 PG - 296-302 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - c5l, 9809909 IO - J Urban Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456561 SB - Index Medicus CP - United States MH - Adult MH - *Attitude of Health Personnel MH - Baltimore MH - *Drug Overdose/pc [Prevention & Control] MH - Education, Continuing/mt [Methods] MH - Emergency Medical Services MH - Emergency Medical Technicians/ed [Education] MH - *Emergency Medical Technicians/px [Psychology] MH - Female MH - Health Care Surveys MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Patient Education as Topic/mt [Methods] MH - Pilot Projects MH - Preventive Health Services MH - Substance Abuse, Intravenous/dt [Drug Therapy] MH - *Substance Abuse, Intravenous/mo [Mortality] AB - Training and distributing naloxone to drug users is a promising method for reducing deaths associated with heroin overdose. Emergency Medical Service (EMS) providers have experience responding to overdose, administering naloxone, and performing clinical management of the patient. Little is known about the attitudes of EMS providers toward training drug users to use naloxone. We conducted an anonymous survey of 327 EMS providers to assess their attitudes toward a pilot naloxone program. Of 176 who completed the survey, the majority were male (79%) and Caucasian (75%). The average number of years working as an EMS provider was 7 (SD=6). Overall attitudes toward training drug users to administer naloxone were negative with 56% responding that this training would not be effective in reducing overdose deaths. Differences in attitudes did not vary by gender, level of training, or age. Providers with greater number of years working in EMS were more likely to view naloxone trainings as effective in reducing overdose death. Provider concerns included drug users' inability to properly administer the drug, program condoning and promoting drug use, and unsafe disposal of used needles. Incorporating information about substance abuse and harm reduction approaches in continuing education classes may improve the attitudes of provider toward naloxone training programs. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1099-3460 IL - 1099-3460 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - jti052 [pii] ID - 10.1093/jurban/jti052 [doi] ID - PMC3456561 [pmc] PP - ppublish GI - No: R01 DA13142 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20050525 DP - 2005 Jun EZ - 2005/05/27 09:00 DA - 2006/04/21 09:00 DT - 2005/05/27 09:00 YR - 2005 ED - 20060420 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15917504 <696. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15872192 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Seal KH AU - Thawley R AU - Gee L AU - Bamberger J AU - Kral AH AU - Ciccarone D AU - Downing M AU - Edlin BR FA - Seal, Karen H FA - Thawley, Robert FA - Gee, Lauren FA - Bamberger, Joshua FA - Kral, Alex H FA - Ciccarone, Dan FA - Downing, Moher FA - Edlin, Brian R IN - Seal, Karen H. Department of Medicine, San Francisco VA Medical Center, University of California, San Francisco, CA 94121, USA. karens@itsa.ucsf.edu TI - Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: a pilot intervention study. SO - Journal of Urban Health. 82(2):303-11, 2005 Jun AS - J Urban Health. 82(2):303-11, 2005 Jun NJ - Journal of urban health : bulletin of the New York Academy of Medicine VO - 82 IP - 2 PG - 303-11 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - c5l, 9809909 IO - J Urban Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2570543 OI - Source: NLM. NIHMS67318 SB - Index Medicus CP - United States MH - Adult MH - *Cardiopulmonary Resuscitation/ed [Education] MH - Drug Overdose/ep [Epidemiology] MH - *Drug Overdose/pc [Prevention & Control] MH - Drug Overdose/th [Therapy] MH - *Emergency Treatment MH - Female MH - Follow-Up Studies MH - Health Knowledge, Attitudes, Practice MH - *Heroin Dependence/mo [Mortality] MH - Humans MH - Interviews as Topic MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/sd [Supply & Distribution] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/sd [Supply & Distribution] MH - *Patient Education as Topic/mt [Methods] MH - Pilot Projects MH - Politics MH - San Francisco/ep [Epidemiology] MH - *Substance Abuse, Intravenous/mo [Mortality] MH - Urban Health Services AB - Fatal heroin overdose has become a leading cause of death among injection drug users (IDUs). Several recent feasibility studies have concluded that naloxone distribution programs for heroin injectors should be implemented to decrease heroin over-dose deaths, but there have been no prospective trials of such programs in North America. This pilot study was undertaken to investigate the safety and feasibility of training injection drug using partners to perform cardiopulmonary resuscitation (CPR) and administer naloxone in the event of heroin overdose. During May and June 2001, 24 IDUs (12 pairs of injection partners) were recruited from street settings in San Francisco. Participants took part in 8-hour training in heroin overdose prevention, CPR, and the use of naloxone. Following the intervention, participants were prospectively followed for 6 months to determine the number and outcomes of witnessed heroin overdoses, outcomes of participant interventions, and changes in participants' knowledge of overdose and drug use behavior. Study participants witnessed 20 heroin overdose events during 6 months follow-up. They performed CPR in 16 (80%) events, administered naloxone in 15 (75%) and did one or the other in 19 (95%). All overdose victims survived. Knowledge about heroin overdose management increased, whereas heroin use decreased. IDUs can be trained to respond to heroin overdose emergencies by performing CPR and administering naloxone. Future research is needed to evaluate the effectiveness of this peer intervention to prevent fatal heroin overdose. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1099-3460 IL - 1099-3460 PT - Journal Article ID - jti053 [pii] ID - 10.1093/jurban/jti053 [doi] ID - PMC2570543 [pmc] ID - NIHMS67318 [mid] PP - ppublish GI - No: K23 DA016165 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: K23 DA016165-02 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English EP - 20050504 DP - 2005 Jun EZ - 2005/05/06 09:00 DA - 2006/04/21 09:00 DT - 2005/05/06 09:00 YR - 2005 ED - 20060420 RD - 20170219 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15872192 <697. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16293897 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Neighbor ML AU - Baird CH AU - Kohn MA FA - Neighbor, Martha L FA - Baird, Carina H FA - Kohn, Michael A IN - Neighbor, Martha L. University of California, San Francisco, Lafayette, CA, USA. mneighbor@sfghed.ucsf.edu TI - Changing opioid use for right lower quadrant abdominal pain in the emergency department. SO - Academic Emergency Medicine. 12(12):1216-20, 2005 Dec AS - Acad Emerg Med. 12(12):1216-20, 2005 Dec NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 12 IP - 12 PG - 1216-20 PI - Journal available in: Print-Electronic PI - Citation processed from: Internet JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Abdominal Pain/dg [Diagnostic Imaging] MH - *Abdominal Pain/dt [Drug Therapy] MH - Adolescent MH - Adult MH - Aged MH - Cohort Studies MH - Drug Utilization MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Length of Stay/sn [Statistics & Numerical Data] MH - Male MH - Middle Aged MH - *Narcotics/tu [Therapeutic Use] MH - Patient Admission/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - Proportional Hazards Models MH - Radiography MH - Retrospective Studies MH - San Francisco AB - OBJECTIVES: To compare the use of opioid analgesia in the treatment of emergency department patients with acute right lower quadrant (RLQ) abdominal pain between 1998 and 2003 and to explore the relationship between opioid use and abdominal computed tomography (CT) scanning. AB - METHODS: This was a retrospective cohort study of patients presenting in 1998 and 2003 to an urban emergency department with a triage complaint of RLQ pain. The authors abstracted use and timing of abdominal CT scanning and opioid analgesia. Other predictor variables were patient demographics. Risk ratio for receiving opioids with CT scan versus without CT scan, stratifying by year, were calculated. Proportional-hazards analysis was used to control for time in the emergency department. AB - RESULTS: Of the 187 patients seen in 1998, 38 (20%) underwent CT scanning and 43 (23%) received opioids. Of the 137 patients seen in 2003, 77 (56%) underwent CT scanning and 72 (53%) received opioids. In 1998, the risk ratio for receiving opioids in patients who underwent CT scanning (vs. without) was 3.7 (95% confidence interval [CI] = 2.3 to 6.1); in 2003, it was 1.5 (95% CI = 1.0 to 2.1). Opioids were overwhelmingly given before CT scanning in those patients who received both (81% in 1998 and 98% in 2003). The mean time to administration of the first opioid dose in 1998 was 155 minutes and in 2003 was 94 minutes. The proportional-hazards analysis confirmed a strong association between CT scanning and opioid administration in 1998 (relative hazard, 2.7; 95% CI = 1.5 to 5.1) and substantial attenuation of the association in 2003 (relative hazard, 1.3; 95% CI = 0.8 to 2.1). The hospitalization rate was not significantly different in 2003 (33%) versus 1998 (27%) (p = 0.28). The risk ratio of receiving opioids in admitted patients was 2.8 (95% CI = 1.7 to 4.6) in 1998 and 2.0 (95% CI = 1.5 to 2.7) in 2003. AB - CONCLUSIONS: Opioid administration to patients with RLQ pain has dramatically increased between 1998 and 2003. During these five years, the number of patients receiving opioids more than doubled and the time to first administration of opioids decreased by one hour. The authors show that this cannot be attributed to an increased use of CT scanning. RN - 0 (Narcotics) ES - 1553-2712 IL - 1069-6563 PT - Comparative Study PT - Journal Article ID - j.aem.2005.07.024 [pii] ID - 10.1197/j.aem.2005.07.024 [doi] PP - ppublish LG - English EP - 20051117 DP - 2005 Dec EZ - 2005/11/19 09:00 DA - 2006/04/06 09:00 DT - 2005/11/19 09:00 YR - 2005 ED - 20060405 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16293897 <698. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15870139 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Marquardt KA AU - Alsop JA AU - Albertson TE FA - Marquardt, Kathy A FA - Alsop, Judith A FA - Albertson, Timothy E IN - Marquardt, Kathy A. California Poison Control System, Sacramento Division, University of California Davis Medical Center, Sacramento, CA 95817-2201, USA. kmarquardt@calpoison.org TI - Tramadol exposures reported to statewide poison control system. SO - Annals of Pharmacotherapy. 39(6):1039-44, 2005 Jun AS - Ann Pharmacother. 39(6):1039-44, 2005 Jun NJ - The Annals of pharmacotherapy VO - 39 IP - 6 PG - 1039-44 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - bbx, 9203131 IO - Ann Pharmacother SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics, Opioid/po [Poisoning] MH - California/ep [Epidemiology] MH - Central Nervous System/de [Drug Effects] MH - Central Nervous System/pp [Physiopathology] MH - Child MH - Child, Preschool MH - Depression/ci [Chemically Induced] MH - Depression/ep [Epidemiology] MH - Drug Overdose MH - Female MH - Humans MH - Infant MH - Logistic Models MH - Male MH - Medication Errors/sn [Statistics & Numerical Data] MH - Middle Aged MH - Nausea/ci [Chemically Induced] MH - Nausea/ep [Epidemiology] MH - *Poison Control Centers/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Seizures/ci [Chemically Induced] MH - Seizures/ep [Epidemiology] MH - Self Administration/sn [Statistics & Numerical Data] MH - Self Medication/sn [Statistics & Numerical Data] MH - Suicide, Attempted/sn [Statistics & Numerical Data] MH - Tachycardia/ci [Chemically Induced] MH - Tachycardia/ep [Epidemiology] MH - Time Factors MH - *Tramadol/po [Poisoning] MH - Vomiting/ci [Chemically Induced] MH - Vomiting/ep [Epidemiology] AB - BACKGROUND: Tramadol is a unique analgesic that has been associated with seizures on overdose. AB - OBJECTIVE: To determine the toxic effects associated with tramadol exposure. AB - METHODS: A retrospective chart review of tramadol exposures reported to a multisite, state-wide poison control system over a 2.5-year period was performed. AB - RESULTS: A total of 602 cases were retrieved; 190 had sufficient data for study evaluation. Cases with coingestants or unknown outcomes were eliminated. Of the 190 remaining cases, 55% were females. Acute ingestions represented 90.0%, chronic ingestions 7.9%, and acute on chronic 2.1% of the overdoses. Ages of the patients ranged from 9 months to 80 years. Suicide attempts represented the largest group of exposures. Main symptoms included central nervous system (CNS) depression (27.4%), nausea and vomiting (21.1%), tachycardia (17.4%), and seizures (13.7%). Dosage ranged from a taste amount to 5000 mg. The smallest amount of tramadol associated with seizure was 200 mg, and 84.6% of seizures occurred within 6 hours of time of ingestion. Logistic regression analysis showed an association between seizures and tramadol use in males, chronic use, suicide attempts, intentional abuse or misuse, and tachycardia (HR >100 beats/min). No effect was seen in 36.3% of patients, minor effects in 43.7%, moderate effects in 19.5%, and major effects in 0.5%. Symptoms resolved within 24 hours in 96.7% of the 121 patients who had symptoms. Naloxone improved CNS depression in 7 of 8 patients in whom a response was documented. AB - CONCLUSIONS: Tramadol overdoses frequently cause CNS depression, nausea/vomiting, tachycardia, and seizures. Symptoms generally resolve within 24 hours. Accidental ingestions in children were well tolerated, primarily causing sedation. RN - 0 (Analgesics, Opioid) RN - 39J1LGJ30J (Tramadol) IS - 1060-0280 IL - 1060-0280 PT - Journal Article ID - aph.1E577 [pii] ID - 10.1345/aph.1E577 [doi] PP - ppublish LG - English EP - 20050503 DP - 2005 Jun EZ - 2005/05/05 09:00 DA - 2006/03/03 09:00 DT - 2005/05/05 09:00 YR - 2005 ED - 20060302 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15870139 <699. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16009076 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ishoy T AU - Haastrup L AU - Hay G FA - Ishoy, Torben FA - Haastrup, Lene FA - Hay, Gordon IN - Ishoy, Torben. Department of Social Medicine, DK-2600 Glostrup. ti@dgma.dk TI - Estimating the prevalence of problem opioid use in Copenhagen 1997-1998. SO - Danish Medical Bulletin. 51(1):114-6, 2004 Feb AS - Dan Med Bull. 51(1):114-6, 2004 Feb NJ - Danish medical bulletin VO - 51 IP - 1 PG - 114-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - dyn, 0066040 IO - Dan Med Bull SB - Index Medicus CP - Denmark MH - Adolescent MH - Adult MH - Data Collection/mt [Methods] MH - Denmark/ep [Epidemiology] MH - Humans MH - Middle Aged MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/rh [Rehabilitation] MH - Prevalence AB - INTRODUCTION: Estimates of the prevalence of drug use in Denmark were, until 1999, based on the mortality multiplier method. This paper presents a study estimating the prevalence of problem opioid use in the Greater Copenhagen region using the capture-recapture method. AB - METHODS AND MATERIAL: Records from the prehospital mobile emergency care unit, The Copenhagen Prehospital Research Database, were searched with a particular focus on treatment of opioid overdose. In addition, data from The National Register of Drug Users in Treatment in Greater Copenhagen were analysed for the years 1997 and 1998. Four samples were used within the capture-recapture analysis, ie the Prehospital Research Database for 1997/1998 and the Register of Drug Users in Treatment for the same period. AB - RESULTS: The estimates from the stratified capture-recapture analyses, when summed up, suggest that there is a hidden population of 4116 and thus a total population of 6992 opioid users in Greater Copenhagen (population approx 700,000). This corresponds to a rate of 10 per 1000 inhabitants aged 15-54 years. The 95% confidence attached to this estimate is 5787 to 10,885. AB - DISCUSSION: The prevalence rate of 10 per 1000 inhabitants aged 15-54 years is comparable to figures found in similar cities in Europe. A previous study of Central Copenhagen calculated the rate to be 12.4 per 1000 inhabitants between 15 and 59 years. It seems reasonable that the estimate of prevalence of problem drug use in Greater Copenhagen is lower than the prevalence in Central Copenhagen, as the city area is more urbanised and has a slightly different demographic and socio-economic profile. About 75% of all opioid overdose incidents are assumed to occur in the central district of the city during the observed period. ES - 1603-9629 IL - 0907-8916 PT - Journal Article ID - DMB3483 [pii] PP - ppublish LG - English DP - 2004 Feb EZ - 2005/07/13 09:00 DA - 2006/02/24 09:00 DT - 2005/07/13 09:00 YR - 2004 ED - 20060221 RD - 20091111 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16009076 <700. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16304459 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Molina DK AU - Dimaio VJ FA - Molina, D Kimberley FA - Dimaio, Vincent J IN - Molina, D Kimberley. Bexar County Forensic Science Center, San Antonio, TX 78229, USA. kmolina@co.bexar.tx.us TI - The reliability of immunoassay for determining the presence of opiates in the forensic setting. SO - American Journal of Forensic Medicine & Pathology. 26(4):303-4, 2005 Dec AS - Am J Forensic Med Pathol. 26(4):303-4, 2005 Dec NJ - The American journal of forensic medicine and pathology VO - 26 IP - 4 PG - 303-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 3hc, 8108948 IO - Am J Forensic Med Pathol SB - Index Medicus CP - United States MH - Drug Overdose MH - False Negative Reactions MH - *Fluorescence Polarization Immunoassay MH - *Forensic Medicine MH - *Gas Chromatography-Mass Spectrometry MH - Humans MH - Morphine/bl [Blood] MH - Morphine/ur [Urine] MH - Morphine Derivatives/bl [Blood] MH - Morphine Derivatives/ur [Urine] MH - *Narcotics/bl [Blood] MH - Narcotics/po [Poisoning] MH - *Narcotics/ur [Urine] MH - Reproducibility of Results MH - Retrospective Studies AB - Urine immunoassays are commonly used as a rapid screen for drugs of abuse in emergency room, hospital, clinic, and forensic settings. The authors were concerned whether or not a negative screen of the urine for opiates was of significance and indicative that analysis of blood for opiates was not necessary. Specifically, we wished to determine whether a negative test for opiates by immunoassay absolutely rules out an acute overdose, and if not, what percentage of cases with negative results have opiates in the blood. A retrospective analysis was performed using the toxicology results for cases ruled an acute narcotic overdose at the Bexar County Medical Examiner's Office between 1998 and 2003. One hundred eighty-three cases met the criteria for the study. A false-negative rate of approximately 15% was found using an immunoassay as compared with blood analysis for narcotics. The authors feel that while this rate may be acceptable in a clinical setting, it is unacceptable in a forensic setting. RN - 0 (6-monobutanoylmorphine) RN - 0 (Morphine Derivatives) RN - 0 (Narcotics) RN - 76I7G6D29C (Morphine) IS - 0195-7910 IL - 0195-7910 PT - Journal Article ID - 00000433-200512000-00001 [pii] PP - ppublish LG - English DP - 2005 Dec EZ - 2005/11/24 09:00 DA - 2006/02/08 09:00 DT - 2005/11/24 09:00 YR - 2005 ED - 20060207 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16304459 <701. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16183444 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barton ED AU - Colwell CB AU - Wolfe T AU - Fosnocht D AU - Gravitz C AU - Bryan T AU - Dunn W AU - Benson J AU - Bailey J FA - Barton, Erik D FA - Colwell, Christopher B FA - Wolfe, Timothy FA - Fosnocht, Dave FA - Gravitz, Craig FA - Bryan, Tamara FA - Dunn, Will FA - Benson, Jeff FA - Bailey, Jeff IN - Barton, Erik D. Division of Emergency Medicine, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA. TI - Efficacy of intranasal naloxone as a needleless alternative for treatment of opioid overdose in the prehospital setting. SO - Journal of Emergency Medicine. 29(3):265-71, 2005 Oct AS - J Emerg Med. 29(3):265-71, 2005 Oct NJ - The Journal of emergency medicine VO - 29 IP - 3 PG - 265-71 PI - Journal available in: Print PI - Citation processed from: Print JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Administration, Intranasal MH - Adolescent MH - Adult MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/mt [Methods] MH - Emergency Medical Technicians MH - Humans MH - Injections, Intravenous MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/pk [Pharmacokinetics] MH - Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/pk [Pharmacokinetics] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Narcotics/ae [Adverse Effects] MH - Needlestick Injuries/pc [Prevention & Control] MH - Prospective Studies MH - Treatment Outcome AB - Prehospital providers are at increased risk for blood-borne exposure and disease due to the nature of their environment. The use if intranasal (i.n.) medications in high-risk populations may limit this risk of exposure. To determine the efficacy of i.n. naloxone in the treatment of suspected opiate overdose patients in the prehospital setting, a prospective, nonrandomized trial of administering i.n. naloxone by paramedics to patients with suspected opiate overdoses over a 6-month period was performed. All adult patients encountered in the prehospital setting as suspected opiate overdose (OD), found down (FD), or with altered mental status (AMS) who met the criteria for naloxone administration were included in the study. i.n. naloxone (2 mg) was administered immediately upon patient contact and before i.v. insertion and administration of i.v. naloxone (2 mg). Patients were then treated by EMS protocol. The main outcome measures were: time of i.n. naloxone administration, time of i.v. naloxone administration, time of appropriate patient response as reported by paramedics. Ninety-five patients received i.n. naloxone and were included in the study. A total of 52 patients responded to naloxone by either i.n. or i.v., with 43 (83%) responding to i.n. naloxone alone. Seven patients (16%) in this group required further doses of i.v. naloxone. In conclusion, i.n. naloxone is a novel alternative method for drug administration in high-risk patients in the prehospital setting with good overall effectiveness. The use of this route is further discussed in relation to efficacy of treatment and minimizing the risk of blood-borne exposures to EMS personnel. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0736-4679 IL - 0736-4679 PT - Clinical Trial PT - Comparative Study PT - Journal Article ID - S0736-4679(05)00153-8 [pii] ID - 10.1016/j.jemermed.2005.03.007 [doi] PP - ppublish PH - 2004/07/07 [received] PH - 2005/01/19 [revised] PH - 2005/03/21 [accepted] LG - English DP - 2005 Oct EZ - 2005/09/27 09:00 DA - 2006/01/04 09:00 DT - 2005/09/27 09:00 YR - 2005 ED - 20060103 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16183444 <702. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15899557 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hulse GK AU - Tait RJ AU - Comer SD AU - Sullivan MA AU - Jacobs IG AU - Arnold-Reed D FA - Hulse, Gary K FA - Tait, Robert J FA - Comer, Sandra D FA - Sullivan, Maria A FA - Jacobs, Ian G FA - Arnold-Reed, Diane IN - Hulse, Gary K. School of Psychiatry & Clinical Neurosciences, University of Western Australia, QE II Medical Centre, Nedlands, WA 6009, Australia. TI - Reducing hospital presentations for opioid overdose in patients treated with sustained release naltrexone implants. SO - Drug & Alcohol Dependence. 79(3):351-7, 2005 Sep 01 AS - Drug Alcohol Depend. 79(3):351-7, 2005 Sep 01 NJ - Drug and alcohol dependence VO - 79 IP - 3 PG - 351-7 PI - Journal available in: Print PI - Citation processed from: Print JC - ebs, 7513587 IO - Drug Alcohol Depend PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646626 OI - Source: NLM. NIHMS8158 SB - Index Medicus CP - Ireland MH - Adult MH - Cohort Studies MH - Drug Implants MH - Drug Overdose/pc [Prevention & Control] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Heroin Dependence/dt [Drug Therapy] MH - Heroin Dependence/rh [Rehabilitation] MH - *Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Medical Record Linkage MH - Naltrexone/ad [Administration & Dosage] MH - *Naltrexone/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Patient Admission MH - Prospective Studies AB - BACKGROUND: Non-fatal overdoses represent a significant morbidity for regular heroin users. Naltrexone is an opioid antagonist capable of blocking the effects of heroin, thereby preventing accidental overdose. However, treatment with oral naltrexone is often associated with non-compliance. An alternative is the use of a sustained release preparation of naltrexone. The aim of this study was to assess the change in number of opioid and other drug overdoses in a large cohort of heroin dependent persons (n=361; 218 males) before and after treatment with a sustained release naltrexone implant. A sub-group of this cohort (n=146; 83 males) had previously received treatment with oral naltrexone, which also allowed a comparison of overdoses pre- and post-oral and also post-implant treatments. AB - METHOD: We used a pre-post design, with data prospectively collected via the West Australian Health Services Research Linked Database, and the Emergency Department Information System. Participants were treated under the Australian Therapeutic Goods Administration's special access guidelines. AB - RESULTS: Most (336, 93%) of the cohort was in one or both databases. We identified 21 opioid overdoses involving 20 persons in the 6 months pre-treatment that required emergency department presentation or hospital admission: none were observed in the 6 months post-treatment. This is consistent with the existing pharmacokinetic data on this implant, which indicates maintenance of blood naltrexone levels at or above 2 ng/ml for approximately 6 months. A reduced number of opioid overdoses were also observed 7-12 months post-implant. The study found a significant increase in sedative "overdoses", some of which occurred in the 10 days following implant treatment and were likely associated with opioid withdrawal and/or implant treatment. For those previously treated with oral naltrexone, more opioid overdoses occurred in both the 6-months prior to and after oral compared to the 6-months post-implant treatment. AB - CONCLUSIONS: The findings support the clinical efficacy of this sustained release naltrexone implant in preventing opioid overdose. However, given the high prevalence of poly-substance use among dependent heroin users, programs offering this type of treatment should also focus on preventing, detecting and managing poly-substance use. RN - 0 (Drug Implants) RN - 0 (Narcotics) RN - 5S6W795CQM (Naltrexone) IS - 0376-8716 IL - 0376-8716 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - S0376-8716(05)00096-7 [pii] ID - 10.1016/j.drugalcdep.2005.02.009 [doi] ID - PMC1646626 [pmc] ID - NIHMS8158 [mid] PP - ppublish PH - 2004/11/09 [received] PH - 2005/02/21 [revised] PH - 2005/02/26 [accepted] GI - No: P50 DA009236 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: 3P50 DA 009236-10S2 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 2005 Sep 01 EZ - 2005/05/19 09:00 DA - 2005/12/13 09:00 DT - 2005/05/19 09:00 YR - 2005 ED - 20051205 RD - 20170219 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15899557 <703. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15502660 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Perez A AU - Scribano PV AU - Perry H FA - Perez, Alberto FA - Scribano, Philip V FA - Perry, Holly IN - Perez, Alberto. Division of Medical Toxicology, Department of Emergency Medicine and Traumatology, University of Connecticut Health Center, Farmington, CT, USA. aaperez@harthosp.org TI - An intentional opiate intoxication of an infant: when medical toxicology and child maltreatment services merge. SO - Pediatric Emergency Care. 20(11):769-72, 2004 Nov AS - Pediatr Emerg Care. 20(11):769-72, 2004 Nov NJ - Pediatric emergency care VO - 20 IP - 11 PG - 769-72 PI - Journal available in: Print PI - Citation processed from: Internet JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - *Child Abuse MH - *Codeine/po [Poisoning] MH - Humans MH - Infant MH - Male MH - *Morphine/po [Poisoning] MH - Toxicology AB - We present an instructive case of a 5-week-old infant seen in the emergency department with acute inspiratory stridor and depressed level of consciousness. His emergency department course identified an acute opiate intoxication. The child also developed chest wall rigidity, a rare complication of narcotic use. We discuss the emergency department management, as well as the toxicologic and child protection investigations. RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) RN - Q830PW7520 (Codeine) ES - 1535-1815 IL - 0749-5161 PT - Case Reports PT - Journal Article ID - 00006565-200411000-00009 [pii] PP - ppublish LG - English DP - 2004 Nov EZ - 2004/10/27 09:00 DA - 2005/11/09 09:00 DT - 2004/10/27 09:00 YR - 2004 ED - 20051108 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15502660 <704. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15961014 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sachdeva DK AU - Stadnyk JM FA - Sachdeva, Deepak K FA - Stadnyk, John M IN - Sachdeva, Deepak K. Department of Emergency Medicine, Georgetown University, Washington, DC, USA. TI - Are one or two dangerous? Opioid exposure in toddlers. [Review] [50 refs] SO - Journal of Emergency Medicine. 29(1):77-84, 2005 Jul AS - J Emerg Med. 29(1):77-84, 2005 Jul NJ - The Journal of emergency medicine VO - 29 IP - 1 PG - 77-84 PI - Journal available in: Print PI - Citation processed from: Print JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/po [Poisoning] MH - Child, Preschool MH - Codeine/po [Poisoning] MH - Dose-Response Relationship, Drug MH - Drug Overdose MH - Emergency Medicine/mt [Methods] MH - Fentanyl/po [Poisoning] MH - Humans MH - Infant MH - Methadone/po [Poisoning] MH - Pediatrics/mt [Methods] MH - Poisoning/di [Diagnosis] MH - Poisoning/pp [Physiopathology] MH - Poisoning/th [Therapy] MH - Tramadol/po [Poisoning] AB - Ingestions of opioid analgesics by children may lead to significant toxicity as a result of depression of the respiratory and central nervous systems. A review of the medical literature was performed to determine whether low doses of opioids are dangerous in the pediatric population under 6 years old. Methadone was found to be the most toxic of the opioids; doses as low as a single tablet can lead to death. All children who have ingested any amount of methadone need to be observed in an Emergency Department (ED) for at least 6 h and considered for hospital admission. Most other opioids are better tolerated in ingestions as small as one or two tablets. Based on the limited data available for these opioids, we conclude that equianalgesic doses of 5 mg/kg of codeine or greater require 4 to 6 h of observation in the ED. Data for propoxyphene and all extended-release preparations are limited; their prolonged half-lives would suggest the need for longer observation periods. All opioid ingestions leading to respiratory depression or significant central nervous system depression require admission to an intensive care unit. [References: 50] RN - 0 (Analgesics, Opioid) RN - 39J1LGJ30J (Tramadol) RN - Q830PW7520 (Codeine) RN - UC6VBE7V1Z (Methadone) RN - UF599785JZ (Fentanyl) IS - 0736-4679 IL - 0736-4679 PT - Journal Article PT - Review ID - S0736-4679(05)00078-8 [pii] ID - 10.1016/j.jemermed.2004.12.015 [doi] PP - ppublish PH - 2004/06/30 [received] PH - 2004/10/28 [revised] PH - 2004/12/03 [accepted] LG - English DP - 2005 Jul EZ - 2005/06/18 09:00 DA - 2005/11/08 09:00 DT - 2005/06/18 09:00 YR - 2005 ED - 20051107 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15961014 <705. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15998164 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - White AG AU - Birnbaum HG AU - Mareva MN AU - Daher M AU - Vallow S AU - Schein J AU - Katz N FA - White, Alan G FA - Birnbaum, Howard G FA - Mareva, Milena N FA - Daher, Maham FA - Vallow, Susan FA - Schein, Jeff FA - Katz, Nathaniel IN - White, Alan G. Analysis Group, Inc., 111 Huntington Ave., 10th Fl., Boston, MA 02199, USA. awhite@analysisgroup.com TI - Direct costs of opioid abuse in an insured population in the United States. SO - Journal of Managed Care Pharmacy. 11(6):469-79, 2005 Jul-Aug AS - J Manage Care Pharm. 11(6):469-79, 2005 Jul-Aug NJ - Journal of managed care pharmacy : JMCP VO - 11 IP - 6 PG - 469-79 PI - Journal available in: Print PI - Citation processed from: Print JC - 9605854 IO - J Manag Care Pharm SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Child MH - *Cost of Illness MH - Demography MH - Female MH - Humans MH - Insurance Claim Review MH - *Insurance Coverage MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/ec [Economics] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/rh [Rehabilitation] MH - Prevalence MH - United States/ep [Epidemiology] AB - OBJECTIVE: To (a) describe the demographics of opioid abusers; (b) compare the prevalence rates of selected comorbidities and the medical and drug utilization patterns of opioid abusers with patients from a control group, for the period from 1998 to 2002; and (c) calculate the mean annual per-patient total health care costs (e.g., inpatient, outpatient, emergency room, drug, other) from the perspective of a private payer. AB - METHODS: An administrative database of medical and pharmacy claims from 1998 to 2002 of 16 self-insured employer health plans with approximately 2 million lives was used to identify "opioid abusers"--patients with claims associated with ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes for opioid abuse (304.0, 304.7, 305.5, and 965.0 [excluding 965.01]). A control group of nonabusers was selected using a matched sample (by age, gender, employment status, and census region) in a 3:1 ratio. Per-patient annual health care costs (mean total medical and drug costs) were measured in 2003 U.S. dollars. Multivariate regression techniques were also used to control for comorbidities and to compare costs with a benchmark of depressed patients. AB - RESULTS: 740 patients were identified as opioid abusers, a prevalence of 8 in 10,000 persons aged 12 to 64 years continuously enrolled in health care plans for whom 12 months of data were available for calculating costs. Opioid abusers, compared with nonabusers, had significantly higher prevalence rates for a number of specific comorbidities, including nonopioid poisoning, hepatitis (A, B, or C), psychiatric illnesses, and pancreatitis, which were approximately 78, 36, 9, and 21 (P<0.01) times higher, respectively, compared with nonabusers. Opioid abusers also had higher levels of medical and prescription drug utilization. Almost 60% of opioid abusers had prescription drug claims for opioids compared with approximately 20% for nonabusers. Prevalence rates for hospital inpatient visits for opioid abusers were more than 12 times higher compared with nonabusers (P<0.01). Mean annual direct health care costs for opioid abusers were more than 8 times higher than for nonabusers ($15,884 versus $1,830, respectively, P < 0.01). Hospital inpatient and physician-outpatient costs accounted for 46% ($7,239) and 31% ($5,000) of opioid abusers. health care costs, compared with 17% ($310) and 50% ($906), respectively, for nonabusers. Mean drug costs for opioid abusers were more than 5 times higher than costs for nonabusers ($2,034 vs. $386, respectively, P<0.01), driven by higher drug utilization (including opioids) for opioid abusers. Even when controlling for comorbidities using a multivariate regression model of a matched control of depressed patients, the average health care costs of opioid abusers were 1.8 times higher than the average health care costs of depressed patients. AB - CONCLUSION: The high costs of opioid abuse were driven primarily by high prevalence rates of costly comorbidites and high utilization rates of medical services and prescription drugs. IS - 1083-4087 IL - 1083-4087 PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 2005(11)6: 469-479 [pii] ID - 10.18553/jmcp.2005.11.6.469 [doi] PP - ppublish LG - English DP - 2005 Jul-Aug EZ - 2005/07/07 09:00 DA - 2005/10/21 09:00 DT - 2005/07/07 09:00 YR - 2005 ED - 20051020 RD - 20141117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15998164 <706. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15919568 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cantwell K AU - Dietze P AU - Flander L FA - Cantwell, Kate FA - Dietze, Paul FA - Flander, Louisa IN - Cantwell, Kate. Metropolitan Ambulance Service, Melbourne, Australia. TI - The relationship between naloxone dose and key patient variables in the treatment of non-fatal heroin overdose in the prehospital setting. SO - Resuscitation. 65(3):315-9, 2005 Jun AS - Resuscitation. 65(3):315-9, 2005 Jun NJ - Resuscitation VO - 65 IP - 3 PG - 315-9 PI - Journal available in: Print PI - Citation processed from: Print JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Adolescent MH - Adult MH - Aged MH - Alcohol-Related Disorders/co [Complications] MH - Alcohol-Related Disorders/dt [Drug Therapy] MH - Dose-Response Relationship, Drug MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services MH - Female MH - *Heroin/ae [Adverse Effects] MH - Heroin Dependence/co [Complications] MH - *Heroin Dependence/dt [Drug Therapy] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Retrospective Studies AB - OBJECTIVES: To examine the relationship between key patient variables and variation in naloxone dose (from the standard dose of 1.6 mg IMI) administered by ambulance paramedics in the prehospital management of heroin overdose. AB - METHODS: A retrospective analysis of 7985 ambulance patient care records of non-fatal heroin overdose cases collected in greater metropolitan Melbourne. The main outcome measure was the dose of intramuscular naloxone required to increase the level of consciousness and the respiratory rate in patients presenting with suspected heroin overdose. Key patient variables influencing the dose that were recorded included: age, sex, initial patient presentation and reported concurrent alcohol use. AB - RESULTS: Multinomial logistic regression revealed that patients with higher levels of consciousness and respiratory rates on arrival of the paramedic crew were more likely to receive a less than standard dose of naloxone. Conversely, patients with lower levels of consciousness and low respiratory rates received greater than standard doses of naloxone for resuscitation. Patients who received greater than the standard dose of naloxone were 2.25 (95% CI, 1.83-2.77) times more likely to have been under the influence of alcohol when consuming the heroin that resulted in overdose. AB - CONCLUSIONS: The concurrent use of alcohol with heroin resulted in the use of greater than standard doses of naloxone by paramedics in resuscitating overdose patients. It is possible that the higher dose of naloxone is required to reverse the combined effects of alcohol and heroin. There was also a link between initial patient presentation and the dose of naloxone required for resuscitation. In light of these findings, it would appear that initial patient presentation and evidence of alcohol use might be useful guides as to providing the most effective dose of naloxone in the prehospital setting. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 0300-9572 IL - 0300-9572 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0300-9572(05)00023-7 [pii] ID - 10.1016/j.resuscitation.2004.12.012 [doi] PP - ppublish PH - 2004/09/01 [received] PH - 2004/11/25 [revised] PH - 2004/12/15 [accepted] LG - English DP - 2005 Jun EZ - 2005/05/28 09:00 DA - 2005/09/30 09:00 DT - 2005/05/28 09:00 YR - 2005 ED - 20050929 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15919568 <707. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 16113176 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Clarke SF AU - Dargan PI AU - Jones AL FA - Clarke, S F J FA - Dargan, P I FA - Jones, A L IN - Clarke, S F J. South Manchester University Hospital Trust, Manchester, UK. sfjclarke@doctors.org.uk TI - Naloxone in opioid poisoning: walking the tightrope. [Review] [82 refs] SO - Emergency Medicine Journal. 22(9):612-6, 2005 Sep AS - Emerg Med J. 22(9):612-6, 2005 Sep NJ - Emergency medicine journal : EMJ VO - 22 IP - 9 PG - 612-6 PI - Journal available in: Print PI - Citation processed from: Internet JC - b0u, 100963089 IO - Emerg Med J PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726910 SB - Index Medicus CP - England MH - Algorithms MH - Dose-Response Relationship, Drug MH - Drug Overdose/dt [Drug Therapy] MH - Humans MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] AB - Acute opioid intoxication and overdose are common causes of presentation to emergency departments. Although naloxone, a pure opioid antagonist, has been available for many years, there is still confusion over the appropriate dose and route of administration. This article looks at the reasons for this uncertainty and undertakes a literature review from which a treatment algorithm is presented. [References: 82] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) ES - 1472-0213 IL - 1472-0205 PT - Journal Article PT - Review ID - 22/9/612 [pii] ID - 10.1136/emj.2003.009613 [doi] ID - PMC1726910 [pmc] PP - ppublish LG - English DP - 2005 Sep EZ - 2005/08/23 09:00 DA - 2005/09/16 09:00 DT - 2005/08/23 09:00 YR - 2005 ED - 20050915 RD - 20140606 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16113176 <708. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15917742 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gordon DB AU - Pellino TA FA - Gordon, Debra B FA - Pellino, Teresa A IN - Gordon, Debra B. University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA. db.gordon@hosp.wisc.edu TI - Incidence and characteristics of naloxone use in postoperative pain management: a critical examination of naloxone use as a potential quality measure. SO - Pain Management Nursing. 6(1):30-6, 2005 Mar AS - Pain Manag Nurs. 6(1):30-6, 2005 Mar NJ - Pain management nursing : official journal of the American Society of Pain Management Nurses VO - 6 IP - 1 PG - 30-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 100890606 IO - Pain Manag Nurs SB - Index Medicus SB - Nursing Journal CP - United States MH - Adult MH - Analgesics, Opioid/po [Poisoning] MH - Case-Control Studies MH - Central Nervous System Depressants/po [Poisoning] MH - Drug Utilization Review MH - Female MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Midwestern United States MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Nurse's Role MH - Nursing Assessment MH - Nursing Audit MH - Nursing Evaluation Research MH - Outcome and Process Assessment (Health Care) MH - *Pain, Postoperative/dt [Drug Therapy] MH - Pain, Postoperative/nu [Nursing] MH - Patient Selection MH - Postoperative Care/mt [Methods] MH - Postoperative Care/nu [Nursing] MH - Postoperative Care/st [Standards] MH - Quality Indicators, Health Care MH - Time Factors MH - Trauma Centers AB - The administration of naloxone may be an important monitor of the quality and safety of postoperative pain management. However, studies that support the use of naloxone as a quality measure are absent. The purposes of this study are to determine the incidence and factors associated with naloxone administration in the postoperative setting and to critically examine naloxone as a potential quality measure. Participants included all postoperative adult inpatients at an academic hospital who received naloxone and an equal number of matched control patients who did not receive naloxone during the calendar year 2003. Medical record audits were performed to examine patient demographics, relevant medical history, postoperatively administered analgesics and central nervous system depressants, documented sedation and respiratory assessments, reason provided for naloxone administration, and patient outcome. Naloxone was administered to .53% (56/10,511) of all adult inpatient postoperative patients. Patients who received naloxone were significantly older and received more central nervous system depressants than cohorts. No significant differences were found in comorbidities, route of opioid administration, or amount of opioids taken by the two groups. Reversal of excessive opioid-induced sedation was the primary reason provided for naloxone administration. However, 25% of the patients were later determined to have a new diagnosis that contributed to sedation. Examination of naloxone administration proved useful in uncovering deficits in structures and processes of care. However, caution is warranted when using naloxone as a quality measure to avoid the implication that higher use indicates opioid analgesic over-treatment or error. RN - 0 (Analgesics, Opioid) RN - 0 (Central Nervous System Depressants) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1524-9042 IL - 1524-9042 PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S1524904204001614 [pii] ID - 10.1016/j.pmn.2004.12.003 [doi] PP - ppublish LG - English DP - 2005 Mar EZ - 2005/05/27 09:00 DA - 2005/07/23 09:00 DT - 2005/05/27 09:00 YR - 2005 ED - 20050722 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15917742 <709. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15837021 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Nelson BP AU - Senecal EL AU - Hong C AU - Ptak T AU - Thomas SH FA - Nelson, Bret P FA - Senecal, Emily L FA - Hong, Christine FA - Ptak, Thomas FA - Thomas, Stephen H IN - Nelson, Bret P. Division of Emergency Medicine & Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, Massachusetts, USA. TI - Opioid analgesia and assessment of the sonographic Murphy sign. SO - Journal of Emergency Medicine. 28(4):409-13, 2005 May AS - J Emerg Med. 28(4):409-13, 2005 May NJ - The Journal of emergency medicine VO - 28 IP - 4 PG - 409-13 PI - Journal available in: Print PI - Citation processed from: Print JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - *Abdominal Pain/dt [Drug Therapy] MH - Abdominal Pain/et [Etiology] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Cohort Studies MH - Female MH - Gallbladder Diseases/co [Complications] MH - *Gallbladder Diseases/dg [Diagnostic Imaging] MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Sensitivity and Specificity MH - Ultrasonography AB - Administration of intravenous opioid analgesia to patients with undifferentiated abdominal pain remains a controversial topic in many emergency departments. To determine whether opioid analgesia impacts assessment of the sonographic Murphy sign (SM) in evaluating acute gallbladder disease (GBD), a retrospective chart review was undertaken. The chart review encompassed 119 patients, 21% of whom, having received opioid analgesia before ultrasound, constituted the opioid group. Between the opioid and control (i.e., no opioid analgesia) groups, there were no significant differences in SM sensitivity (48.2%; CI 28.7-68.1% vs. 68.8%; CI 41.3-89%, respectively) or specificity (92.5%; CI 83.4-97.5% vs. 88.9%; CI 51.8-99.7%, respectively) for GBD. There was no association between opioid analgesia and false-positive SM (OR 0.74, CI 0.08-6.65), or false-negative SM (OR 1.42, CI 0.46-4.43). We conclude that the test characteristics of SM are unaffected by opioid analgesia. RN - 0 (Analgesics, Opioid) IS - 0736-4679 IL - 0736-4679 PT - Journal Article ID - S0736-4679(05)00026-0 [pii] ID - 10.1016/j.jemermed.2004.12.009 [doi] PP - ppublish PH - 2003/12/10 [received] PH - 2004/10/20 [revised] PH - 2004/12/03 [accepted] LG - English DP - 2005 May EZ - 2005/04/20 09:00 DA - 2005/07/13 09:00 DT - 2005/04/20 09:00 YR - 2005 ED - 20050712 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15837021 <710. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15850442 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Glaser A AU - Arakaki D AU - Chan GM AU - Hoffman RS FA - Glaser, Ariella FA - Arakaki, Dwight FA - Chan, Gar Ming FA - Hoffman, Robert S TI - Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose. CM - Comment on: Med J Aust. 2005 Jan 3;182(1):24-7; PMID: 15651944 SO - Medical Journal of Australia. 182(8):427; author reply 427, 429, 2005 Apr 18 AS - Med J Aust. 182(8):427; author reply 427, 429, 2005 Apr 18 NJ - The Medical journal of Australia VO - 182 IP - 8 PG - 427; author reply 427, 429 PI - Journal available in: Print PI - Citation processed from: Print JC - 0400714, m26 IO - Med. J. Aust. SB - Index Medicus CP - Australia MH - Administration, Intranasal MH - Bias MH - *Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services MH - Glasgow Coma Scale MH - Humans MH - Injections, Intramuscular MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0025-729X IL - 0025-729X PT - Clinical Trial PT - Comparative Study PT - Letter PT - Randomized Controlled Trial PT - Comment ID - letters_180405-2 [pii] PP - ppublish PH - 2005/02/25 [received] PH - 2005/03/10 [accepted] LG - English DP - 2005 Apr 18 EZ - 2005/04/27 09:00 DA - 2005/06/24 09:00 DT - 2005/04/27 09:00 YR - 2005 ED - 20050623 RD - 20171116 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15850442 <711. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15674933 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bellu R AU - de Waal KA AU - Zanini R FA - Bellu, R FA - de Waal, K A FA - Zanini, R IN - Bellu, R. Neonatal Intensive Care Unit, Ospedale "Manzoni" -Lecco, Via Eremo 9, Lecco, Italy, 23900. r.bellu@ospedale.lecco.it TI - Opioids for neonates receiving mechanical ventilation. [Review] [56 refs][Update in Cochrane Database Syst Rev. 2008;(1):CD004212; PMID: 18254040] SO - Cochrane Database of Systematic Reviews. (1):CD004212, 2005 Jan 25 AS - Cochrane Database Syst Rev. (1):CD004212, 2005 Jan 25 NJ - The Cochrane database of systematic reviews IP - 1 PG - CD004212 PI - Journal available in: Electronic PI - Citation processed from: Internet JC - 100909747 IO - Cochrane Database Syst Rev SB - Index Medicus CP - England MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Humans MH - Infant, Newborn MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - Pain Measurement MH - Randomized Controlled Trials as Topic MH - *Respiration, Artificial/ae [Adverse Effects] AB - BACKGROUND: Mechanical ventilation is a potentially painful intervention widely used in neonatal intensive care units. Since newborn babies (neonates) demonstrate increased sensitivity to pain, which may affect clinical and neurodevelopmental outcomes, the use of drugs which reduce pain might be very important. AB - OBJECTIVES: To determine the effect of opioid analgesics (pain-killing drugs derived from opium e.g. morphine), compared to placebo, no drug, or other non-opioid analgesics or sedatives, on pain, duration of mechanical ventilation, mortality, growth and neurodevelopmental outcomes in newborn infants on mechanical ventilation. AB - SEARCH STRATEGY: Electronic searches included: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2004); MEDLINE (1966 to June 2004); EMBASE (1974 to June 2004); and CINAHL (1982 to 2003). Previous reviews and lists of relevant articles were cross-referenced. AB - SELECTION CRITERIA: Randomised controlled trials or quasi-randomised controlled trials comparing opioids to a control, or to other analgesics or sedatives in newborn infants on mechanical ventilation. AB - DATA COLLECTION AND ANALYSIS: Data were extracted by two reviewers independently. Categorical outcomes were analysed using relative risk and risk difference; and continuous outcomes with weighted mean difference or standardised mean difference. A fixed effect model was used for meta-analysis except where heterogeneity existed, when a random effects model was used. AB - MAIN RESULTS: Thirteen studies on 1505 infants were included. Infants given opioids showed reduced premature infant pain profile (PIPP) scores compared to the control group (weighted mean difference -1.71; 95% confidence interval -3.18 to -0.24). Differences in execution and reporting of trials mean that this meta-analysis should be interpreted with caution. Heterogeneity was significantly high in all analyses of pain, even when lower quality studies were excluded and analysis limited to very preterm newborns. Meta-analyses of mortality, duration of mechanical ventilation, and long and short term neurodevelopmental outcomes showed no statistically significant differences. Very preterm infants given morphine took significantly longer to reach full enteral feeding than those in control groups (weighted mean difference 2.10 days; 95% confidence interval 0.35 to 3.85). One study compared morphine with a sedative: the treatments showed similar pain scores, but morphine had fewer adverse effects. AB - AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend routine use of opioids in mechanically ventilated newborns. Opioids should be used selectively, when indicated by clinical judgment and evaluation of pain indicators. If sedation is required, morphine is safer than midazolam. Further research is needed. [References: 56] RN - 0 (Analgesics, Opioid) ES - 1469-493X IL - 1361-6137 PT - Journal Article PT - Meta-Analysis PT - Review ID - 10.1002/14651858.CD004212.pub2 [doi] PP - epublish LG - English EP - 20050125 DP - 2005 Jan 25 EZ - 2005/01/28 09:00 DA - 2005/05/28 09:00 DT - 2005/01/28 09:00 YR - 2005 ED - 20050527 RD - 20130628 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15674933 <712. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12537700 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hargreaves K AU - Lenton S AU - Phillips M AU - Swensen G FA - Hargreaves, Kim FA - Lenton, Simon FA - Phillips, Mike FA - Swensen, Greg IN - Hargreaves, Kim. National Drug Research Institute, Curtin University of Technology, Perth, Western Australia. TI - Potential impacts on the incidence of fatal heroin-related overdose in Western Australia: a time-series analysis. SO - Drug & Alcohol Review. 21(4):321-7, 2002 Dec AS - Drug Alcohol Rev. 21(4):321-7, 2002 Dec NJ - Drug and alcohol review VO - 21 IP - 4 PG - 321-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 9015440 IO - Drug Alcohol Rev SB - Index Medicus CP - Australia MH - Adolescent MH - Adult MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/mo [Mortality] MH - *Heroin/to [Toxicity] MH - Heroin Dependence/ep [Epidemiology] MH - *Heroin Dependence/mo [Mortality] MH - Humans MH - Time Factors MH - Western Australia/ep [Epidemiology] AB - In response to the rising concerns about the rate of heroin-related fatalities, overdose prevention campaigns, run by both users' organizations and government agencies, have been implemented in a number of states across Australia. In Western Australia (WA) in mid-1997, various overdose prevention initiatives were implemented. These included the implementation of a protocol limiting police presence at overdose events; the commencement of naloxone administration by ambulance staff; and the establishment of the Opiate Overdose Prevention Strategy (OOPS) which provided follow-up for individuals treated for overdose in emergency departments. This paper reports the results of a multiple linear regression analysis of 60 months of time-series data, both prior to and following the implementation of these interventions, to determine their impact on the number of fatal heroin overdoses inWA. The model employed in the analysis controlled for changes over time in proxy indicators of use and community concerns about heroin, as well as market indicators. The results suggest that, although the interventions implemented have managed to reduce the expected number of fatalities, they have become less successful in doing so as time passes. This has implications for both existing and potential interventions to reduce fatal heroin-related overdose. RN - 70D95007SX (Heroin) IS - 0959-5236 IL - 0959-5236 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1080/0959523021000023162 [doi] PP - ppublish LG - English DP - 2002 Dec EZ - 2003/01/23 04:00 DA - 2005/05/26 09:00 DT - 2003/01/23 04:00 YR - 2002 ED - 20050525 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12537700 <713. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15707208 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dietze P AU - Jolley D AU - Cvetkovski S AU - Cantwell K AU - Jacobs I AU - Indig D FA - Dietze, Paul FA - Jolley, Damien FA - Cvetkovski, Stefan FA - Cantwell, Kate FA - Jacobs, Ian FA - Indig, Devon IN - Dietze, Paul. Turning Point Alcohol and Drug Centre Inc, Victoria. pauld@turningpoint.org.au TI - Characteristics of non-fatal opioid overdoses attended by ambulance services in Australia. SO - Australian & New Zealand Journal of Public Health. 28(6):569-75, 2004 Dec AS - Aust N Z J Public Health. 28(6):569-75, 2004 Dec NJ - Australian and New Zealand journal of public health VO - 28 IP - 6 PG - 569-75 PI - Journal available in: Print PI - Citation processed from: Print JC - ck2, 9611095 IO - Aust N Z J Public Health SB - Index Medicus CP - Australia MH - Adult MH - *Ambulances/ut [Utilization] MH - *Analgesics, Opioid/po [Poisoning] MH - Australia/ep [Epidemiology] MH - Databases, Factual MH - *Drug Overdose/ep [Epidemiology] MH - Emergency Treatment/mt [Methods] MH - *Emergency Treatment/ut [Utilization] MH - Feasibility Studies MH - Female MH - Geography MH - *Heroin/po [Poisoning] MH - Humans MH - Linear Models MH - Male MH - Naloxone/ad [Administration & Dosage] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Periodicity MH - Public Health Informatics AB - OBJECTIVE: To examine the feasibility of establishing a database on non-fatal opioid overdose in order to examine patterns and characteristics of these overdoses across Australia. AB - METHODS: Unit record data on opioid overdose attended by ambulances were obtained from ambulance services in the five mainland States of Australia for available periods, along with information on case definition and opioid overdose management within these jurisdictions. Variables common across States were examined including the age and sex of cases attended, the time of day and day of week of the attendance, and the transportation outcome (whether the victim was left at the scene or transported to hospital). AB - RESULTS: The monthly rate of non-fatal opioid overdose attended by ambulance was generally highest in Victoria (Melbourne) followed by NSW, with the rates substantially lower in the remaining States over the period January 1999 to February 2001. Non-fatal opioid overdose victims were most likely to be male in all States, with the proportion of males highest in Victoria (77%), and were aged around 28 years with ages lowest in Western Australia (m=26) and highest in NSW (m=30). Most of the attendances occurred in the afternoon/early evening and towards the later days of the working week in all States. The rates of transportation varied according to ambulance service practice across the States with around 94% of cases transported in Western Australia and around 18% and 29% of cases transported in Melbourne and NSW respectively. AB - CONCLUSIONS: It is feasible to establish a database of comparable data on non-fatal opioid overdoses attended by ambulances in Australia. This compilation represents a useful adjunct to existing surveillance systems on heroin (and other opioid) use and related harms. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 1326-0200 IL - 1326-0200 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2004 Dec EZ - 2005/02/15 09:00 DA - 2005/04/22 09:00 DT - 2005/02/15 09:00 YR - 2004 ED - 20050421 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15707208 <714. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15672335 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Greenwald PW AU - Provataris J AU - Coffey J AU - Bijur P AU - Gallagher EJ FA - Greenwald, Peter W FA - Provataris, Jennifer FA - Coffey, John FA - Bijur, Polly FA - Gallagher, E John IN - Greenwald, Peter W. New York-Presbyterian Emergency Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. pg2014@columbia.edu TI - Low-dose naloxone does not improve morphine-induced nausea, vomiting, or pruritus. SO - American Journal of Emergency Medicine. 23(1):35-9, 2005 Jan AS - Am J Emerg Med. 23(1):35-9, 2005 Jan NJ - The American journal of emergency medicine VO - 23 IP - 1 PG - 35-9 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Analgesia/ae [Adverse Effects] MH - Analgesia/mt [Methods] MH - Double-Blind Method MH - Female MH - Humans MH - Infusions, Intravenous MH - Male MH - Morphine/ad [Administration & Dosage] MH - *Morphine/ae [Adverse Effects] MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Nausea/ci [Chemically Induced] MH - *Nausea/dt [Drug Therapy] MH - Pain Measurement MH - Prospective Studies MH - Pruritus/ci [Chemically Induced] MH - *Pruritus/dt [Drug Therapy] MH - Treatment Outcome MH - Vomiting/ci [Chemically Induced] MH - *Vomiting/dt [Drug Therapy] AB - OBJECTIVE: We tested the hypothesis that low-dose naloxone delivered with intravenous (IV) bolus morphine to emergency department patients in pain would reduce nausea. AB - METHODS: Randomized, double-blind, placebo-controlled trial. Patients receiving 0.10 mg/kg morphine IV bolus rated pain, nausea, and pruritus on 100-mm visual analog scales at enrollment and 20 minutes. Patients were randomized to 0.25 microg/kg naloxone or equal volume placebo administered with IV morphine. AB - RESULTS: One hundred thirty-one enrolled, 99 (76%) treated according to protocol with sufficient data for analysis. At 20 minutes the difference between groups (naloxone-placebo) was 1 mm (95% CI [confidence interval], -9 to 11) for nausea, 1 mm (95% CI, -3 to 3) for pruritus, 4% (95% CI, -1 to 9) for vomiting, and 0% (95% CI, -5 to 5) for rescue antiemetics. Pain was significantly reduced in both groups. AB - CONCLUSION: Addition of 0.25 microg/kg naloxone to bolus morphine does not improve nausea, pruritus, vomiting, or reduce use of rescue antiemetics when administered to emergency department patients in pain. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 76I7G6D29C (Morphine) IS - 0735-6757 IL - 0735-6757 PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial ID - S0735675704002694 [pii] PP - ppublish LG - English DP - 2005 Jan EZ - 2005/01/27 09:00 DA - 2005/04/01 09:00 DT - 2005/01/27 09:00 YR - 2005 ED - 20050331 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15672335 <715. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15651944 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kelly AM AU - Kerr D AU - Dietze P AU - Patrick I AU - Walker T AU - Koutsogiannis Z FA - Kelly, Anne-Maree FA - Kerr, Debra FA - Dietze, Paul FA - Patrick, Ian FA - Walker, Tony FA - Koutsogiannis, Zeff IN - Kelly, Anne-Maree. Western Hospital, Footscray, Melbourne, VIC. Anne-Maree.Kelly@wh.org.au TI - Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose. CM - Comment in: Med J Aust. 2005 Apr 18;182(8):427; author reply 427, 429; PMID: 15850442 SO - Medical Journal of Australia. 182(1):24-7, 2005 Jan 03 AS - Med J Aust. 182(1):24-7, 2005 Jan 03 NJ - The Medical journal of Australia VO - 182 IP - 1 PG - 24-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 0400714, m26 IO - Med. J. Aust. SB - Index Medicus CP - Australia MH - Administration, Intranasal MH - Adolescent MH - Adult MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Medical Services/mt [Methods] MH - Female MH - Humans MH - Injections, Intramuscular MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] MH - Prospective Studies MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - *Respiratory Insufficiency/dt [Drug Therapy] MH - Treatment Outcome AB - OBJECTIVE: To determine the effectiveness of intranasal (IN) naloxone compared with intramuscular (IM) naloxone for treatment of respiratory depression due to suspected opiate overdose in the prehospital setting. AB - DESIGN: Prospective, randomised, unblinded trial of either 2 mg naloxone injected intramuscularly or 2 mg naloxone delivered intranasally with a mucosal atomiser. AB - PARTICIPANTS AND SETTING: 155 patients (71 IM and 84 IN) requiring treatment for suspected opiate overdose and attended by paramedics of the Metropolitan Ambulance Service (MAS) and Rural Ambulance Victoria (RAV) in Victoria. AB - MAIN OUTCOME MEASURES: Response time to regain a respiratory rate greater than 10 per minute. Secondary outcome measures were proportion of patients with respiratory rate greater than 10 per minute at 8 minutes and/or a GCS score over 11 at 8 minutes; proportion requiring rescue naloxone; rate of adverse events; proportion of the IN group for whom IN naloxone alone was sufficient treatment. AB - RESULTS: The IM group had more rapid response than the IN group, and were more likely to have more than 10 spontaneous respirations per minute within 8 minutes (82% v 63%; P = 0.0173). There was no statistically significant difference between the IM and IN groups for needing rescue naloxone (13% [IM group] v 26% [IN group]; P = 0.0558). There were no major adverse events. For patients treated with IN naloxone, this was sufficient to reverse opiate toxicity in 74%. AB - CONCLUSION: IN naloxone is effective in treating opiate-induced respiratory depression, but is not as effective as IM naloxone. IN delivery of naxolone could reduce the risk of needlestick injury to ambulance officers and, being relatively safe to make more widely available, could increase access to life-saving treatment in the community. RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0025-729X IL - 0025-729X PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - kel10472_fm [pii] PP - ppublish PH - 2004/07/02 [received] PH - 2004/10/21 [accepted] LG - English DP - 2005 Jan 03 EZ - 2005/01/18 09:00 DA - 2005/04/01 09:00 DT - 2005/01/18 09:00 YR - 2005 ED - 20050331 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15651944 <716. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15167681 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Molina PE AU - Zambell KL AU - Zhang P AU - Vande Stouwe C AU - Carnal J FA - Molina, Patricia E FA - Zambell, Kirsten L FA - Zhang, Ping FA - Vande Stouwe, Curtis FA - Carnal, Jean IN - Molina, Patricia E. Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA. pmolin@lsuhsc.edu TI - Hemodynamic and immune consequences of opiate analgesia after trauma/hemorrhage. SO - Shock. 21(6):526-34, 2004 Jun AS - Shock. 21(6):526-34, 2004 Jun NJ - Shock (Augusta, Ga.) VO - 21 IP - 6 PG - 526-34 PI - Journal available in: Print PI - Citation processed from: Print JC - cae, 9421564 IO - Shock SB - Index Medicus CP - United States MH - *Analgesics, Opioid/pd [Pharmacology] MH - Animals MH - Blood Pressure/de [Drug Effects] MH - Corticosterone/bl [Blood] MH - Epinephrine/bl [Blood] MH - Follow-Up Studies MH - Hemodynamics MH - *Hemorrhage/im [Immunology] MH - Hemorrhage/mo [Mortality] MH - *Hemorrhage/pp [Physiopathology] MH - Ketamine/pd [Pharmacology] MH - Lipopolysaccharides MH - Male MH - Morphine/pd [Pharmacology] MH - Neurosecretory Systems/de [Drug Effects] MH - Neurosecretory Systems/me [Metabolism] MH - Norepinephrine/bl [Blood] MH - Rats MH - Rats, Sprague-Dawley MH - Resuscitation/mt [Methods] MH - Time Factors MH - Tumor Necrosis Factor-alpha/me [Metabolism] MH - *Wounds and Injuries/im [Immunology] MH - Wounds and Injuries/mo [Mortality] MH - *Wounds and Injuries/pp [Physiopathology] AB - The regulation of compensatory hemodynamic, inflammatory, and metabolic counter-regulatory responses to traumatic injury (trauma/hemorrhage [tx/hem]) and subsequent inflammatory challenges during the post-tx/hem period relies on balanced activation of neuroendocrine and opioid pathways. Pharmacological interventions during the rescue period as well as during the early post-tx/hem period that target these regulatory pathways can potentially affect the activation or efficacy of compensatory mechanisms. Their impact on mechanisms involved in these responses has not been well defined. We examined the impact of morphine and ketamine on immediate hemodynamic responses to tx/hem as well as on the integrity of host defense mechanisms at day 5 post-tx/hem. Morphine (10 mg/kg), ketamine (18 mg/kg), or saline (0.3 ml) were injected intraperitoneally at 15 min post-tx/hem (soft tissue injury and fixed pressure hemorrhage, 40 mmHg, 60 min) and 15 min before lactated Ringer's fluid resuscitation (LRFR, 2.4x total blood volume removed). Morphine, but not ketamine, produced effective and sustained analgesia. Morphine and ketamine impaired the rise in mean arterial blood pressure (MABP) during LRFR and increased 48-h mortality (2- to 3-fold). Morphine and ketamine markedly (40%-80%) attenuated the systemic LPS- (100 microg/100 g body weight) induced TNF response at day 5 post-tx/hem. Morphine attenuated LPS-induced lung and spleen TNF expression, whereas ketamine enhanced spleen TNF expression but did not alter lung responses. Subsequent studies demonstrated that the morphine-induced impairment of the response was not due to altered cytokine responses during the early post-tx/hem period but that they could be restored and 24 h mortality could be reduced by increasing the volume of LRFR (2-fold). These results indicate that morphine and ketamine analgesia compromise the hemodynamic and host defense responses after tx/hem, directly affecting mortality and morbidity during the recovery period. RN - 0 (Analgesics, Opioid) RN - 0 (Lipopolysaccharides) RN - 0 (Tumor Necrosis Factor-alpha) RN - 690G0D6V8H (Ketamine) RN - 76I7G6D29C (Morphine) RN - W980KJ009P (Corticosterone) RN - X4W3ENH1CV (Norepinephrine) RN - YKH834O4BH (Epinephrine) IS - 1073-2322 IL - 1073-2322 PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. ID - 00024382-200406000-00006 [pii] PP - ppublish LG - English DP - 2004 Jun EZ - 2004/05/29 05:00 DA - 2005/02/16 09:00 DT - 2004/05/29 05:00 YR - 2004 ED - 20050215 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15167681 <717. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15626007 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Alexander JL AU - Burton JH AU - Bradshaw JR AU - Colin F FA - Alexander, John L FA - Burton, John H FA - Bradshaw, Jay R FA - Colin, Faith IN - Alexander, John L. Department of Emergency Medicine, Maine Medical Center, Portland, Maine 04102, USA. alexajo@mmc.org TI - Suspected opioid-related emergency medical services encounters in a rural state, 1997-2002. SO - Prehospital Emergency Care. 8(4):427-30, 2004 Oct-Dec AS - Prehosp Emerg Care. 8(4):427-30, 2004 Oct-Dec NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 8 IP - 4 PG - 427-30 PI - Journal available in: Print PI - Citation processed from: Print JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adult MH - Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services/ut [Utilization] MH - Female MH - Humans MH - Maine/ep [Epidemiology] MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Retrospective Studies MH - Rural Population AB - INTRODUCTION: News organizations and governmental agencies have reported substantial increases in the number of opioid-related overdose cases in recent years. AB - OBJECTIVE: To describe the utilization of emergency medical services (EMS) for suspected opioid-related overdose cases in a rural state during the period 1997 through 2002. AB - METHODS: Statewide EMS records were reviewed for 1997 through 2002. Data reviewed included prehospital diagnosis and medications given to all patients by prehospital providers. For cases with a prehospital diagnosis of poisoning or overdose, data reviewed included medications given to patients by prehospital providers, pupil size, and respiratory rate. All records were reviewed in a defined sequence. AB - RESULTS: The study period encompassed 1,175,781 patient encounters. Poisoning or overdose patients accounted for 19,808 (1.7%) encounters. Naloxone was administered by the EMS provider to 2,668 (0.2%) patients. For all poisoning or overdose patients, 1,308 (6.6%) had miotic pupils, 450 (2.2%) had a respiratory rate of <12 breaths/min, and 1,569 (7.9%) received naloxone. During the investigation period, total EMS patient encounters increased 25%, while patients with a complaint of poisoning or overdose increased 47%. The incidences of EMS overdose patients with miotic pupils, respiratory rate <10 breaths/min, and naloxone administration increased 167%, 295%, and 154%, respectively. AB - CONCLUSION: In this rural state, prehospital patients with findings suspicious for opioid overdose disproportionately outpaced the growth of all EMS encounters as well as general overdose encounters during the defined investigation period. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 1090-3127 IL - 1090-3127 PT - Journal Article PP - ppublish LG - English DP - 2004 Oct-Dec EZ - 2005/01/01 09:00 DA - 2005/02/03 09:00 DT - 2005/01/01 09:00 YR - 2004 ED - 20050201 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15626007 <718. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15576519 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Neighbor ML AU - Honner S AU - Kohn MA FA - Neighbor, Martha L FA - Honner, Samantha FA - Kohn, Michael A IN - Neighbor, Martha L. Department of Medicine, University of San Francisco, CA, USA. neighbo@itsa.ucsf.edu TI - Factors affecting emergency department opioid administration to severely injured patients. SO - Academic Emergency Medicine. 11(12):1290-6, 2004 Dec AS - Acad Emerg Med. 11(12):1290-6, 2004 Dec NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 11 IP - 12 PG - 1290-6 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Analgesia/mt [Methods] MH - *Analgesia/sn [Statistics & Numerical Data] MH - California MH - Child MH - Cohort Studies MH - Comorbidity MH - Critical Care/mt [Methods] MH - *Critical Care/sn [Statistics & Numerical Data] MH - Drug Utilization Review MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - *Narcotics/tu [Therapeutic Use] MH - *Pain/dt [Drug Therapy] MH - Pain/ep [Epidemiology] MH - Retrospective Studies MH - Survival Analysis MH - *Wounds and Injuries/ep [Epidemiology] AB - OBJECTIVES: Studies of emergency department (ED) pain management in patients with trauma have been mostly restricted to patients with fractures, yet the potential for undertreatment of more severely injured patients is great. The authors sought to identify factors associated with failure to receive ED opioid administration in patients with acute trauma who subsequently required hospitalization. AB - METHODS: At an urban Level 1 trauma center and teaching hospital, a retrospective cohort study of trauma team activation patients requiring hospitalization between January 1 and December 31, 1999, was conducted. The authors excluded patients receiving opioids only within ten minutes of chest tube insertion or fracture manipulation. The main outcome measure was ED opioid administration. AB - RESULTS: A total of 540 charts of hospitalized first-tier trauma team activation patients were reviewed. A total of 258 (47.8%) received intravenous opioid analgesia within three hours of ED arrival. The median time to receiving the first dose of opioids was 95 minutes. Patients were independently less likely to receive opioids if they were younger or older, were intubated, had a lower Revised Trauma Score, or did not require fracture manipulation. Patients with these factors were less likely to receive opioids independent of the amount of time they spent in the ED. AB - CONCLUSIONS: Many trauma activation patients requiring hospitalization do not receive opioid analgesia in the ED. Patients at particular risk for oligoanalgesia include those who are younger or older and those who are more seriously injured, as defined by a lower Revised Trauma Score, lower Glasgow Coma Scale score, and intubation. RN - 0 (Narcotics) IS - 1069-6563 IL - 1069-6563 PT - Journal Article ID - 11/12/1290 [pii] ID - 10.1197/j.aem.2004.07.014 [doi] PP - ppublish LG - English DP - 2004 Dec EZ - 2004/12/04 09:00 DA - 2005/01/26 09:00 DT - 2004/12/04 09:00 YR - 2004 ED - 20050125 RD - 20041203 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15576519 <719. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15294411 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Perkin MR AU - Wey EQ FA - Perkin, Michael R FA - Wey, Emmanuel Q IN - Perkin, Michael R. Department of Child Health, St. George's Hospital Medical School, London SW17 0RE, UK. mperkin@sghms.ac.uk TI - Emergency drug availability on general paediatric units. SO - Resuscitation. 62(2):243-7, 2004 Aug AS - Resuscitation. 62(2):243-7, 2004 Aug NJ - Resuscitation VO - 62 IP - 2 PG - 243-7 PI - Journal available in: Print PI - Citation processed from: Print JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - *Cardiopulmonary Resuscitation MH - Child MH - Emergency Medical Services MH - *Emergency Treatment MH - *Hospital Departments MH - Humans MH - *Pediatrics MH - Pharmaceutical Preparations/sd [Supply & Distribution] MH - *Pharmaceutical Preparations MH - United Kingdom AB - Following an incident where intravenous lorazepam was not available on a general paediatric ward we undertook a national survey of emergency drug availability on general paediatric units in the United Kingdom. Drugs chosen were those recommended in the Advanced Paediatric Life Support manual and the British National Formulary for the management of the most common paediatric emergencies. Twelve drugs were chosen covering emergencies in the following systems: cardiovascular (adrenaline (epinephrine), atropine and adenosine); neurological (flumazenil, lorazepam, paraldehyde, phenytoin and mannitol); metabolic (Hypostop Gel and glucagon); analgesia related (naloxone); and respiratory (aminophylline). A thirteenth drug, intravenous salbutamol was included in a reminder letter sent to non-responding units. Questionnaires were sent to 274 units. Replies were received from 242 (88.3%), of whom 20 did not have a general paediatric ward, leaving 222 units (81.0%). Drug availability varied for the different drugs: adrenaline (available on 100% of units), atropine (98.2%), naloxone (96.4%), phenytoin (95.9%), aminophylline (93.2%), paraldehyde (92.3%), mannitol (87.8%), lorazepam (86.9%), glucagon (86.5%), Hypostop Gel (80.6%), adenosine (72.1%) and flumazenil (66.7%). Six of the drugs were classified as first line agents (adrenaline, atropine, adenosine, lorazepam, paraldehyde and aminophylline). Over one in 10 units did not stock two or more of these first line drugs. Consideration needs to be given to the compiling of a consensus based list of drugs that ought to be stocked on all general paediatric units. RN - 0 (Pharmaceutical Preparations) IS - 0300-9572 IL - 0300-9572 PT - Journal Article ID - 10.1016/j.resuscitation.2004.03.004 [doi] ID - S0300957204001224 [pii] PP - ppublish PH - 2003/11/17 [received] PH - 2004/02/23 [revised] PH - 2004/03/02 [accepted] LG - English DP - 2004 Aug EZ - 2004/08/06 05:00 DA - 2004/12/23 09:00 DT - 2004/08/06 05:00 YR - 2004 ED - 20041222 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15294411 <720. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15278196 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hainer C AU - Bernhard M AU - Gries A FA - Hainer, C FA - Bernhard, M FA - Gries, A IN - Hainer, C. Klinik fur Anaesthesiologie, Bereich Notfallmedizin, Ruprecht-Karls-Universitat Heidelberg. christian_hainer@med.uni-heidelberg.de TI - [Preclinical management of accidental methadone intoxication of a 4-year-old girl. Antagonist or intubation?]. [German] OT - Praklinisches Management der akzidentellen Methadonintoxikation bei einem 4-jahrigen Madchen. Antagonisierung oder Intubation? SO - Anaesthesist. 53(10):955-8, 2004 Oct AS - Anaesthesist. 53(10):955-8, 2004 Oct NJ - Der Anaesthesist VO - 53 IP - 10 PG - 955-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Analgesics, Opioid/ai [Antagonists & Inhibitors] MH - *Analgesics, Opioid/po [Poisoning] MH - Child, Preschool MH - *Coma/ci [Chemically Induced] MH - Emergency Medical Services MH - Female MH - Humans MH - Intubation, Intratracheal MH - Methadone/ai [Antagonists & Inhibitors] MH - *Methadone/po [Poisoning] MH - Naloxone/ae [Adverse Effects] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ae [Adverse Effects] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Oxygen Inhalation Therapy MH - Respiratory Insufficiency/ci [Chemically Induced] AB - We report on the preclinical management of a 4-year-old child who was found in a comatose condition with respiratory failure after accidental ingestion of methadone. Emergency airway management was carried out with endotracheal intubation instead of administering the antagonist naloxone. The child could be extubated 12 h later and was released from hospital after 3 days with no neurological symptoms. The authors attempt to formulate an algorithm for the preclinical management of opioid intoxication with reference to the literature and own experience. Endotracheal intubation seems to be superior to the use of the antagonist naloxone, especially in a critical situation. This is the only way to ensure a rapid oxygenation with adequate airway protection and with the simultaneous avoidance of the side-effects of naloxone. A restrictive and critical administration of the opioid antagonist naloxone is recommended when there is suspicion of opioid ingestion but no signs of intoxication. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) IS - 0003-2417 IL - 0003-2417 PT - Case Reports PT - English Abstract PT - Journal Article ID - 10.1007/s00101-004-0730-0 [doi] PP - ppublish LG - German DP - 2004 Oct EZ - 2004/07/28 05:00 DA - 2004/12/16 09:00 DT - 2004/07/28 05:00 YR - 2004 ED - 20041207 RD - 20170916 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15278196 <721. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15505438 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Maze M AU - Angst MS FA - Maze, Mervyn FA - Angst, Martin S TI - Dexmedetomidine and opioid interactions: defining the role of dexmedetomidine for intensive care unit sedation. CM - Comment on: Anesthesiology. 2004 Nov;101(5):1077-83; PMID: 15505442 CM - Comment on: Anesthesiology. 2004 Nov;101(5):1066-76; PMID: 15505441 SO - Anesthesiology. 101(5):1059-61, 2004 Nov AS - Anesthesiology. 101(5):1059-61, 2004 Nov NJ - Anesthesiology VO - 101 IP - 5 PG - 1059-61 PI - Journal available in: Print PI - Citation processed from: Print JC - 4sg, 1300217 IO - Anesthesiology SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/pk [Pharmacokinetics] MH - Analgesics, Opioid/pd [Pharmacology] MH - *Critical Care MH - *Dexmedetomidine/pk [Pharmacokinetics] MH - Dexmedetomidine/pd [Pharmacology] MH - Drug Interactions MH - Humans MH - *Hypnotics and Sedatives/pk [Pharmacokinetics] MH - Hypnotics and Sedatives/pd [Pharmacology] MH - Respiration, Artificial MH - Respiratory Mechanics/de [Drug Effects] RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 67VB76HONO (Dexmedetomidine) IS - 0003-3022 IL - 0003-3022 PT - Comment PT - Editorial ID - 00000542-200411000-00002 [pii] PP - ppublish LG - English DP - 2004 Nov EZ - 2004/10/27 09:00 DA - 2004/12/16 09:00 DT - 2004/10/27 09:00 YR - 2004 ED - 20041206 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15505438 <722. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15334330 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Meissner W AU - Hartmann M AU - Kahler G AU - Brauer M FA - Meissner, W FA - Hartmann, M FA - Kahler, G FA - Brauer, M IN - Meissner, W. Klinik fur Anasthesiologie und Intensivtherapie, Friedrich-Schiller-Universitat Jena. Winfried.Meissner@med.uni-jena.de TI - [Effect of enteral naloxone on the incidence of gastritis and esophagitis in mechanically ventilated patients]. [German] OT - Der Einfluss von enteralem Naloxon auf die Inzidenz von Gastritis und Osophagitis bei opioidbehandelten Intensivpatienten: Doppelblinde plazebokontrollierte Studie. SO - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie. 39(9):538-41, 2004 Sep AS - Anasthesiol Intensivmed Notfallmed Schmerzther. 39(9):538-41, 2004 Sep NJ - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS VO - 39 IP - 9 PG - 538-41 PI - Journal available in: Print PI - Citation processed from: Print JC - 9109478, a4c IO - Anasthesiol Intensivmed Notfallmed Schmerzther SB - Index Medicus CP - Germany MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Double-Blind Method MH - *Esophagitis/dt [Drug Therapy] MH - Esophagitis/ep [Epidemiology] MH - Esophagitis/et [Etiology] MH - Female MH - Fentanyl/ae [Adverse Effects] MH - Gastric Mucosa/pa [Pathology] MH - *Gastritis/dt [Drug Therapy] MH - Gastritis/ep [Epidemiology] MH - Gastritis/et [Etiology] MH - Gastrointestinal Motility/de [Drug Effects] MH - Humans MH - Intubation, Gastrointestinal MH - Male MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Respiration, Artificial/ae [Adverse Effects] AB - BACKGROUND: Gastrtis and esophagitis are frequent and severe complications in intensive care patients, mainly caused by increased duodenogastral reflux. Opioids, commonly used in intensive care, are known to impair gastrointestinal (GI) motility which increases retrograd flow of gastric content. In a previous study, we showed that enteral administered naloxone reduces gastric reflux by selectively blocking GI opioid receptors. Therefore, in a subpopulation of these patients we studied the effect of enteral naloxone on the incidence of mucosal injury in opioid-treated, mechanically ventilated patients. AB - METHODS: After IRB approval, mechanically ventilated, fentanyl-treated patients without gastrointestinal surgery or diseases were assigned to receive 8 mg naloxone or placebo four times daily via a gastric tube. Additional inclusion criteria were opioid treatment for at least three days and endoscopy of the upper GI tract. Frequency of gastritis and esophagitis was quantified according to the Savary-Miller Score, and further parameter of GI motility (frequency of propulsive medication, amount of enteral feeding) were measured. AB - RESULTS: In four of seventeen patients of the naloxone group (24 %) and 14 of 22 patients of the placebo group (64 %; p = 0.02), esophageal or gastral mucosal injuries were detected. In the naloxone group, gastral reflux as well as need for propulsive medication were significantly lower. Volume of enteral feeding showed an increasing trend in the second half of the study. AB - CONCLUSION: Reduction of esophagogastral mucosal injury and reduced need for procinetic medication suggests an improvement of GI motility by enteral naloxone in fentanyl-treated, mechanically ventilated patients. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0939-2661 IL - 0939-2661 PT - Clinical Trial PT - English Abstract PT - Journal Article PT - Randomized Controlled Trial ID - 10.1055/s-2004-825738 [doi] PP - ppublish LG - German DP - 2004 Sep EZ - 2004/08/31 05:00 DA - 2004/10/27 09:00 DT - 2004/08/31 05:00 YR - 2004 ED - 20041026 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15334330 <723. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15159457 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lipton RB AU - Bigal ME FA - Lipton, Richard B FA - Bigal, Marcelo E TI - Opioid therapy and headache: a cause and a cure. CM - Comment on: Neurology. 2004 May 25;62(10):1695-700; PMID: 15159464 CM - Comment on: Neurology. 2004 May 25;62(10):1687-94; PMID: 15159463 SO - Neurology. 62(10):1662-3, 2004 May 25 AS - Neurology. 62(10):1662-3, 2004 May 25 NJ - Neurology VO - 62 IP - 10 PG - 1662-3 PI - Journal available in: Print PI - Citation processed from: Internet JC - 0401060, nz0 IO - Neurology SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Cohort Studies MH - Drug Utilization MH - Emergencies MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - *Headache/dt [Drug Therapy] MH - *Headache Disorders/et [Etiology] MH - Headache Disorders/pc [Prevention & Control] MH - Humans MH - Migraine Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/co [Complications] MH - Salvage Therapy RN - 0 (Analgesics, Opioid) ES - 1526-632X IL - 0028-3878 PT - Comment PT - Editorial PP - ppublish LG - English DP - 2004 May 25 EZ - 2004/05/26 05:00 DA - 2004/10/27 09:00 DT - 2004/05/26 05:00 YR - 2004 ED - 20041026 RD - 20051117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15159457 <724. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15462150 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Spiller HA AU - Bosse GM AU - Adamson LA FA - Spiller, Henry A FA - Bosse, George M FA - Adamson, Larry A IN - Spiller, Henry A. Kentucky Regional Poison Center, PO Box 35070, Louisville, KY 40232-5070, USA. Henry.Spiller@nortonhealthcare.org TI - Retrospective review of Tizanidine (Zanaflex) overdose. SO - Journal of Toxicology - Clinical Toxicology. 42(5):593-6, 2004 AS - J Toxicol Clin Toxicol. 42(5):593-6, 2004 NJ - Journal of toxicology. Clinical toxicology VO - 42 IP - 5 PG - 593-6 PI - Journal available in: Print PI - Citation processed from: Print JC - kan, 8213460 IO - J. Toxicol. Clin. Toxicol. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Antidotes/tu [Therapeutic Use] MH - Charcoal/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - *Clonidine/aa [Analogs & Derivatives] MH - *Clonidine/po [Poisoning] MH - Drug Overdose MH - Female MH - Humans MH - Infant MH - Kentucky MH - Male MH - Middle Aged MH - *Muscle Relaxants, Central/po [Poisoning] MH - Poison Control Centers MH - Respiration, Artificial MH - Retrospective Studies AB - BACKGROUND: Tizanidine is a centrally acting muscle relaxant with a novel mechanism of action and structurally related to clonidine. There are no large case series of tizanidine exposure. AB - METHODS: Retrospective review of all ingestions involving tizanidine reported to a poison control center from January 2000 through February 2003. Exclusion criteria were polydrug ingestion, no follow-up or lost to follow-up. AB - RESULTS: There were 121 cases of which 45 patients met entrance criteria. Mean age was 32 years (range 1 to 80). Thirty-seven patients were evaluated in a health care facility of which 27 were admitted for medical care. Clinical effects included lethargy (n = 38), bradycardia (n = 14), hypotension (n = 8), agitation (n = 7), confusion (n = 5), vomiting (n = 3), and coma (n = 2). Mean dose ingested by history was 72 mg (S.D. + 86). The lowest dose associated with hypotension was 28mg, which occurred in a 63-year-old female with a BP of 88/52 and a HR of 54. The lowest dose associated with coma was between 60 mg and 120 mg, which occurred in a 30-year-old female with a HR of 30 and BP of 81/48. There were 6 patients < 6 yrs. The lowest dose with bradycardia and drowsiness in a small child was 16 mg in a 2 YO (weight unknown). All other cases in children < 6 yrs involved ingestion of a single tablet (2 or 4 mg) with only mild drowsiness reported. Therapy in this series was primarily supportive and included pressors in 3 cases and intubation in 3 cases. Naloxone was administered to 7 patients. There was no response to naloxone in 5 patients, poor documentation of response in one, and arousal in one patient. All patients recovered without residual complications. AB - CONCLUSION: Clinical manifestations of tizanidine overdose include alterations of mental status, bradycardia, and hypotension. In this series, outcome was good with supportive therapy. RN - 0 (Antidotes) RN - 0 (Muscle Relaxants, Central) RN - 16291-96-6 (Charcoal) RN - 6AI06C00GW (tizanidine) RN - MN3L5RMN02 (Clonidine) IS - 0731-3810 IL - 0731-3810 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 2004 EZ - 2004/10/07 09:00 DA - 2004/10/19 09:00 DT - 2004/10/07 09:00 YR - 2004 ED - 20041018 RD - 20141120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15462150 <725. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15111917 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sporer KA FA - Sporer, Karl A IN - Sporer, Karl A. Department of Emergency Services, San Francisco General Hospital, University of California-San Francisco, San Francisco, CA 94110, USA. ksporer@itsa.ucsf.edu TI - Buprenorphine: a primer for emergency physicians. [Review] [46 refs] CM - Comment in: Ann Emerg Med. 2006 Jul;48(1):109; PMID: 16781931 SO - Annals of Emergency Medicine. 43(5):580-4, 2004 May AS - Ann Emerg Med. 43(5):580-4, 2004 May NJ - Annals of emergency medicine VO - 43 IP - 5 PG - 580-4 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Buprenorphine/pd [Pharmacology] MH - *Buprenorphine/tu [Therapeutic Use] MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/pc [Prevention & Control] MH - Drug Overdose/th [Therapy] MH - Drug and Narcotic Control MH - Emergency Medicine MH - Humans MH - Narcotic Antagonists/pd [Pharmacology] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Pain/dt [Drug Therapy] MH - United States AB - The recent approval of office-based treatment for opioid addiction and US Food and Drug Administration approval of buprenorphine will expand treatment options for opioid addiction. Buprenorphine is classified as a partial micro opioid agonist and a weak kappa antagonist. It has a high affinity for the micro receptor, with slow dissociation resulting in a long duration of action and an analgesic potency 25 to 40 times more potent than morphine. At higher doses, its agonist effects plateau and it begins to behave more like an antagonist, limiting the maximal analgesic effect and respiratory depression. This "ceiling effect" confers a high safety profile clinically, a low level of physical dependence, and only mild withdrawal symptoms on cessation after prolonged administration. Suboxone contains a mixture of buprenorphine and naloxone. The naloxone is poorly absorbed sublingually and is designed to discourage intravenous use. Subutex, buprenorphine only, will also be available primarily as an initial test dose. Clinicians will be using this drug for detoxification or for maintenance of opioid addiction. Patients with recent illicit opioid use may develop a mild precipitated withdrawal syndrome with the induction of buprenorphine. Acute buprenorphine intoxication may present with some diffuse mild mental status changes, mild to minimal respiratory depression, small but not pinpoint pupils, and relatively normal vital signs. Naloxone may improve respiratory depression but will have limited effect on other symptoms. Patients with significant symptoms related to buprenorphine should be admitted to the hospital for observation because symptoms will persist for 12 to 24 hours. [References: 46] RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) ES - 1097-6760 IL - 0196-0644 PT - Journal Article PT - Review ID - 10.1016/S0196064403012058 [doi] ID - S0196064403012058 [pii] PP - ppublish LG - English DP - 2004 May EZ - 2004/04/28 05:00 DA - 2004/10/09 09:00 DT - 2004/04/28 05:00 YR - 2004 ED - 20041008 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15111917 <726. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15039692 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tamayo-Sarver JH AU - Dawson NV AU - Cydulka RK AU - Wigton RS AU - Baker DW FA - Tamayo-Sarver, Joshua H FA - Dawson, Neal V FA - Cydulka, Rita K FA - Wigton, Robert S FA - Baker, David W IN - Tamayo-Sarver, Joshua H. Case Western Reserve University School of Medicine, Cleveland, OH, USA. TI - Variability in emergency physician decision making about prescribing opioid analgesics. SO - Annals of Emergency Medicine. 43(4):483-93, 2004 Apr AS - Ann Emerg Med. 43(4):483-93, 2004 Apr NJ - Annals of emergency medicine VO - 43 IP - 4 PG - 483-93 PI - Journal available in: Print PI - Citation processed from: Internet JC - 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Ankle Injuries/dt [Drug Therapy] MH - Attitude of Health Personnel MH - *Back Pain/dt [Drug Therapy] MH - Data Collection MH - Decision Making MH - Decision Support Techniques MH - Emergency Medicine/ed [Education] MH - *Emergency Medicine MH - Emergency Service, Hospital MH - Female MH - Fractures, Bone/dt [Drug Therapy] MH - Humans MH - Male MH - *Migraine Disorders/dt [Drug Therapy] MH - Practice Patterns, Physicians'/sn [Statistics & Numerical Data] MH - *Practice Patterns, Physicians' MH - Substance-Related Disorders AB - STUDY OBJECTIVE: The purpose of this study is to determine what factors influence emergency physicians' decisions to prescribe an opioid analgesic for 3 common, painful conditions. AB - METHODS: We developed items thought to influence the decision to prescribe an opioid analgesic through a review of the literature, expert consultation, and interviews with practicing emergency physicians. We developed a baseline vignette and items expected to influence the decision for each of the 3 conditions: migraine, back pain, and ankle fracture. We surveyed 650 physicians randomly selected from the American College of Emergency Physicians. The influence of individual items was explored through a univariate analysis of the response distribution. Patterns were assessed by analytically creating scales. AB - RESULTS: We received responses from 398 (63%) of the 634 eligible physicians. Physicians' likelihoods of prescribing an opioid showed marked variability, with at least 10% of physicians saying they were unlikely and 10% of physicians saying they were likely to prescribe for each condition. Physician responses to individual pieces of clinical information, such as the patient requesting "something strong" for the pain, were also highly variable, with at least 10% of physicians saying they would be negatively influenced by this request and at least 10% saying they would be positively influenced by it. AB - CONCLUSION: Even when faced with identical case scenarios, physicians' decisions to prescribe opioid analgesics are highly variable. Moreover, the same clinical information, such as a patient requesting a strong analgesic, changes the likelihood of prescribing opioids in opposite directions for different physicians. RN - 0 (Analgesics, Opioid) ES - 1097-6760 IL - 0196-0644 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - 10.1016/S0196064403011284 [doi] ID - S0196064403011284 [pii] PP - ppublish GI - No: HS-00059-06 Organization: (HS) *AHRQ HHS* Country: United States GI - No: R03 HS11948-01 Organization: (HS) *AHRQ HHS* Country: United States LG - English DP - 2004 Apr EZ - 2004/03/25 05:00 DA - 2004/09/24 05:00 DT - 2004/03/25 05:00 YR - 2004 ED - 20040922 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15039692 <727. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14748762 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Nava-Ocampo AA AU - Alarcon-Almanza JM AU - Moyao-Garcia D AU - Ramirez-Mora JC AU - Salmeron J FA - Nava-Ocampo, Alejandro A FA - Alarcon-Almanza, Juan M FA - Moyao-Garcia, Diana FA - Ramirez-Mora, Juan Carlos FA - Salmeron, Jorge IN - Nava-Ocampo, Alejandro A. Department of Anesthesia and Respiratory Therapy, Hospital Infantil de Mexico Federico Gomez, Mexico DF, Mexico. navaocampo_aa@yahoo.com TI - Undocumented drug utilization and drug waste increase costs of pediatric anesthesia care. CM - Comment in: Acta Anaesthesiol Scand. 2016 Aug;60(7):917-24; PMID: 26935817 SO - Fundamental & Clinical Pharmacology. 18(1):107-12, 2004 Feb AS - Fundam Clin Pharmacol. 18(1):107-12, 2004 Feb NJ - Fundamental & clinical pharmacology VO - 18 IP - 1 PG - 107-12 PI - Journal available in: Print PI - Citation processed from: Print JC - f8s, 8710411 IO - Fundam Clin Pharmacol SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - *Anesthesia/ec [Economics] MH - Anesthesia Department, Hospital/og [Organization & Administration] MH - *Anesthetics/ec [Economics] MH - Child MH - Child, Preschool MH - Documentation MH - Double-Blind Method MH - Drug Costs MH - Drug Utilization MH - Elective Surgical Procedures MH - Emergency Medical Services MH - Female MH - Humans MH - Infant MH - Male MH - Medication Systems, Hospital MH - Prospective Studies AB - The present study was performed in order to identify the cost of drugs used without documenting them in the patients' file and the wastage of drugs in a pediatric anesthesiology ward. In a prospective, blinded, observational design, drug utilization of 610 consecutive patients, undergoing an elective or emergency surgical procedure was evaluated. The number of undocumented drugs per 100 requested units and the number of wasted drugs per 100 requested units were computed and multiplied by its corresponding unitary cost. The median undocumented cost was 92.4 US dollars (95% CI 17.2-216.6 dollars) per 100 requested units. Succinylcholine (40 mg/2 mL) was the main undocumented drug; its use was not documented in approximately 50% cases in which this neuromuscular blocking agent was requested. However, rocuronium and nalbuphine had the highest unjustified cost, 770.6 dollars and 847.0 dollars per 100 requested units, respectively. Ketorolac, diclofenac, metamizol, furosemide, methylprednisolone, sodium bicarbonate, and cisatracurium were requested and documented. The median cost of wasted drug was 141.8 dollars (95% CI 55.8-448.2 dollars) per 100 requested drugs. More than 80% of adrenaline, naloxone, flunitrazepam, ephedrine, and cisatracurium were wasted. However, the highest cost of wasted drugs was for ondansetron, cisatracurium, methylprednisolone, and rocuronium. The uncontrolled availability and use of drugs may represent an important amount of resources wasted without any awareness of the staff in a department of pediatric anesthesia. RN - 0 (Anesthetics) IS - 0767-3981 IL - 0767-3981 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 214 [pii] PP - ppublish LG - English DP - 2004 Feb EZ - 2004/01/30 05:00 DA - 2004/09/21 05:00 DT - 2004/01/30 05:00 YR - 2004 ED - 20040920 RD - 20161130 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=14748762 <728. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15303398 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Forrester MB AU - Stanley SK FA - Forrester, Mathias B FA - Stanley, Sharilyn K IN - Forrester, Mathias B. Texas Department of Health, 11 W 49th Street, Austin, Texas 78756, USA. TI - Exposures and treatments among women of childbearing age and pregnant women reported to Texas poison centers. SO - Veterinary & Human Toxicology. 46(4):210-2, 2004 Aug AS - Vet Hum Toxicol. 46(4):210-2, 2004 Aug NJ - Veterinary and human toxicology VO - 46 IP - 4 PG - 210-2 PI - Journal available in: Print PI - Citation processed from: Print JC - xbv, 7704194 IO - Vet Hum Toxicol SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Emergency Treatment/sn [Statistics & Numerical Data] MH - Female MH - Gestational Age MH - Humans MH - Medical Records MH - Poison Control Centers/sn [Statistics & Numerical Data] MH - Poisoning/ep [Epidemiology] MH - Poisoning/et [Etiology] MH - Poisoning/th [Therapy] MH - Pregnancy MH - *Pregnancy Complications/ep [Epidemiology] MH - Pregnancy Complications/et [Etiology] MH - Pregnancy Complications/th [Therapy] MH - Retrospective Studies MH - *Teratogens/to [Toxicity] MH - Texas/ep [Epidemiology] AB - Both exposures reported to poison centers and the treatments used involved potential teratogens. This investigation describes the patterns of exposures and treatments among women of childbearing age and pregnant women reported to Texas poison centers during 2000-2002. Of 476,365 total reported human exposures, 65,074 (13.7%) involved women of childbearing age and 1,406 (0.3%) involved pregnant women. The most frequently reported exposures among women of childbearing age were analgesics (sedatives, hypnotics, antipsychotics) and antidepressants. The teratogens alcohol and anticonvulsants were the 5th and 13th most frequently reported exposures, respectively. The substances used most often to treat women of childbearing age were oral N-acetylcysteine, antihistamines and naloxone; anticonvulsants were the 7th most frequently reported substance used in treatment, and ethanol the 28th most commonly reported substance. Although only a small fraction of pregnant women of childbearing age reported to Texas poison centers, a portion of women reported to be not pregnant may have been pregnant and unaware of the fact, and thus may have been exposed to a teratogen at a time when susceptibility to teratogens is greatest. Poison centers need to be aware of this when providing information to patients and recommending treatment. RN - 0 (Teratogens) IS - 0145-6296 IL - 0145-6296 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2004 Aug EZ - 2004/08/12 05:00 DA - 2004/09/11 05:00 DT - 2004/08/12 05:00 YR - 2004 ED - 20040910 RD - 20061115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15303398 <729. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15044199 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sun S AU - Weil MH AU - Tang W AU - Kamohara T AU - Klouche K FA - Sun, Shijie FA - Weil, Max Harry FA - Tang, Wanchun FA - Kamohara, Takashi FA - Klouche, Kada IN - Sun, Shijie. Institute of Critical Care Medicine, Palm Springs, CA 92262, USA. shijiesun@aol.com TI - Delta-opioid receptor agonist reduces severity of postresuscitation myocardial dysfunction. SO - American Journal of Physiology - Heart & Circulatory Physiology. 287(2):H969-74, 2004 Aug AS - Am J Physiol Heart Circ Physiol. 287(2):H969-74, 2004 Aug NJ - American journal of physiology. Heart and circulatory physiology VO - 287 IP - 2 PG - H969-74 PI - Journal available in: Print-Electronic PI - Citation processed from: Print JC - dkm, 100901228 IO - Am. J. Physiol. Heart Circ. Physiol. SB - Index Medicus CP - United States MH - Animals MH - *Cardiomyopathies/et [Etiology] MH - *Cardiomyopathies/pp [Physiopathology] MH - Naloxone/pd [Pharmacology] MH - Narcotic Antagonists/pd [Pharmacology] MH - *Pentazocine/pd [Pharmacology] MH - Rats MH - Rats, Sprague-Dawley MH - *Receptors, Opioid, delta/ag [Agonists] MH - *Resuscitation/ae [Adverse Effects] MH - Severity of Illness Index AB - Postresuscitation myocardial dysfunction is recognized as a leading cause of early death after initially successful cardiopulmonary resuscitation (CPR). In the present study, we hypothesized that a delta-opioid receptor agonist would decrease the severity of postresuscitation myocardial dysfunction and improve survival. Fifteen Sprague-Dawley rats, fasted overnight with access to water, were anesthetized by an injection of 45 mg/kg ip pentobarbital sodium. Additional doses of 10 mg/kg were administered at hourly intervals but not within 30 min before induced ventricular fibrillation (VF). Either the delta-opioid receptor agonist pentazocine (300 microg/kg), pentazocine pretreated with the opioid receptor-blocking agent naloxone (1 mg/kg), or saline placebo was injected into the right atrium after 5 min of untreated VF and 3 min before initiation of CPR. After an additional 8 min of CPR administration, defibrillation was attempted. All animals were successfully resuscitated. Left ventricular rate of pressure increase at 40 mmHg and cardiac index values were significantly improved in pentazocine-treated animals, which also had significantly longer survival times (60 +/- 11 vs. 16 +/- 7 h; P < 0.01). Except for ease of defibrillation, the beneficial effects of pentazocine were completely abolished by pretreatment with naloxone. The concept of pharmacological hibernation employing a delta-opioid receptor agonist is a novel and promising intervention for minimizing global ischemic injury during CPR and postresuscitation myocardial dysfunction. RN - 0 (Narcotic Antagonists) RN - 0 (Receptors, Opioid, delta) RN - 36B82AMQ7N (Naloxone) RN - RP4A60D26L (Pentazocine) IS - 0363-6135 IL - 0363-6135 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - 10.1152/ajpheart.01171.2003 [doi] ID - 01171.2003 [pii] PP - ppublish GI - No: HL-54322 Organization: (HL) *NHLBI NIH HHS* Country: United States LG - English EP - 20040325 DP - 2004 Aug EZ - 2004/03/27 05:00 DA - 2004/09/04 05:00 DT - 2004/03/27 05:00 YR - 2004 ED - 20040903 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15044199 <730. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15112137 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hansmann G AU - Humpl T AU - Zimmermann A FA - Hansmann, G FA - Humpl, T FA - Zimmermann, A IN - Hansmann, G. Charite Campus Virchow-Klinikum, Klinik fur Neonatologie, Neugeborenen-Intensivstation, Berlin. georg.hansmann@charite.de TI - [Neonatal-emergencies: basics in cardiopulmonary resuscitation]. [Review] [53 refs] [German] OT - Neugeborenen-Notfalle: Basale kardiopulmonale Reanimation. SO - Zeitschrift fur Geburtshilfe und Neonatologie. 208(2):43-56, 2004 Apr AS - Z Geburtshilfe Neonatol. 208(2):43-56, 2004 Apr NJ - Zeitschrift fur Geburtshilfe und Neonatologie VO - 208 IP - 2 PG - 43-56 PI - Journal available in: Print PI - Citation processed from: Print JC - ced, 9508901 IO - Z Geburtshilfe Neonatol SB - Index Medicus CP - Germany MH - Cardiopulmonary Resuscitation/is [Instrumentation] MH - *Cardiopulmonary Resuscitation/mt [Methods] MH - *Cardiopulmonary Resuscitation/st [Standards] MH - Emergency Treatment/is [Instrumentation] MH - Emergency Treatment/mt [Methods] MH - Emergency Treatment/st [Standards] MH - *Heart Arrest/th [Therapy] MH - Humans MH - Infant, Newborn MH - *Infant, Newborn, Diseases/th [Therapy] MH - Intubation, Intratracheal/is [Instrumentation] MH - Intubation, Intratracheal/mt [Methods] MH - Intubation, Intratracheal/st [Standards] MH - *Patient Care Management/mt [Methods] MH - *Patient Care Management/st [Standards] MH - Practice Guidelines as Topic MH - Respiration, Artificial/is [Instrumentation] MH - Respiration, Artificial/mt [Methods] MH - Respiration, Artificial/st [Standards] AB - The international guidelines for neonatal resuscitation were recently updated by the American Academy of Pediatrics (AAP), the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR). The most important steps in resuscitation of the newly born infant are oxygenation and ventilation, including endotracheal intubation. These fundamental techniques will be emphasized and discussed in a problem-oriented approach. The clinical assessment of the newly born infant is based on a triad of respiration, heart rate and color. If indicated, resuscitation has to be initiated approximately 30 s after birth, i. e. prior to determination of the 1 min. Apgar score and umbilical artery pH. The key to successful neonatal resuscitation is establishment of adequate ventilation; it should commence - after oropharyngeal suctioning and ineffective tactile stimulation - when the heart rate drops < 100 bpm. Clinical evidence supporting the hypothesis that ventilation with room air versus 50 or 100 % oxygen is preferable in terms of neurological outcome is still preliminary and requires further investigation. Chest compressions should be administered if the heart rate remains < 60 bpm (or heart rate 60 to 80 bpm and not rising) despite adequate assisted ventilation. There should be a 3 : 1 ratio of compressions to ventilations to achieve approximately 120 events per minute. Moreover, the international guidelines recommend crystalloid volume expanders (normal saline or Ringer's lactate), red blood cells, sodium bicarbonate and naloxone for cardiopulmonary resuscitation of the newly born infant. [References: 53] IS - 0948-2393 IL - 0948-2393 PT - English Abstract PT - Guideline PT - Journal Article PT - Review ID - 10.1055/s-2004-818958 [doi] PP - ppublish LG - German DP - 2004 Apr EZ - 2004/04/28 05:00 DA - 2004/08/12 05:00 DT - 2004/04/28 05:00 YR - 2004 ED - 20040811 RD - 20071115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15112137 <731. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15253332 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shaiova L AU - Wallenstein D FA - Shaiova, Lauren FA - Wallenstein, David IN - Shaiova, Lauren. Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003, USA. lshaiova@bethisraelny.org TI - Outpatient management of sickle cell pain with chronic opioid pharmacotherapy. SO - Journal of the National Medical Association. 96(7):984-6, 2004 Jul AS - J Natl Med Assoc. 96(7):984-6, 2004 Jul NJ - Journal of the National Medical Association VO - 96 IP - 7 PG - 984-6 PI - Journal available in: Print PI - Citation processed from: Print JC - j9z, 7503090 IO - J Natl Med Assoc PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568430 SB - Index Medicus CP - United States MH - Adult MH - Ambulatory Care MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Anemia, Sickle Cell/dt [Drug Therapy] MH - Female MH - Fentanyl/ad [Administration & Dosage] MH - Humans MH - Male MH - Methadone/ad [Administration & Dosage] MH - Oxycodone/ad [Administration & Dosage] AB - We report our experience of providing chronic opioid pharmacotherapy on an outpatient basis to selected patients with frequent episodes of moderate-to-severe pain from sickle cell disease (SCD). Three cases illustrate our clinical experience in approximately 40 patients with sickle cell pain. Patients were seen at our sickle cell pain clinic at Beth Israel Hospital once each month for a three-hour visit. Visits included group music therapy and individual medical care, including comprehensive blood work and scheduling of medical tests when appropriate. Between visits, the pain and palliative care physicians followed patients on an as-needed basis. The SCD pain opioid pharmacotherapy protocol was modeled on a regimen used to treat malignant pain-typically a long-acting opioid in combination with a short-acting opioid, such as oral transmucosal fentanyl citrate (OTFC; Actiq) for breakthrough pain (BTP). Emergency department (ED) visits and hospital admissions were dramatically reduced in the three patients whose pain was managed by adapting the cancer pain model. During the year before their first visit to our pain clinic, the patients each had between six and 18 ED visits, which resulted in six- to 13 hospital admissions amounting to 32-182 inpatient days per patient. Each of the patients was prescribed a long-acting opioid (methadone, control-release oxycodone, or transdermal fentanyl) with a short-acting opioid for BTP from crises (oral transmucosal fentanyl citrate for two patients; short-acting oxycodone for one patient). Pain was well controlled. For each patient, hospital admissions were reduced to < or = 1 visit per year. These reduced levels of ED visits and hospital admissions have remained constant for more than three years. RN - 0 (Analgesics, Opioid) RN - CD35PMG570 (Oxycodone) RN - UC6VBE7V1Z (Methadone) RN - UF599785JZ (Fentanyl) IS - 0027-9684 IL - 0027-9684 PT - Case Reports PT - Journal Article ID - PMC2568430 [pmc] PP - ppublish LG - English DP - 2004 Jul EZ - 2004/07/16 05:00 DA - 2004/08/11 05:00 DT - 2004/07/16 05:00 YR - 2004 ED - 20040810 RD - 20151225 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15253332 <732. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15167188 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Buajordet I AU - Naess AC AU - Jacobsen D AU - Brors O FA - Buajordet, Ingebjorg FA - Naess, Anne-Cathrine FA - Jacobsen, Dag FA - Brors, Odd IN - Buajordet, Ingebjorg. Clinical Pharmacology and Toxicology Unit, Clinical Chemistry Department, Ullevaal University Hospital, Oslo, Norway. ingebjorg.buajordet@legemiddelverket.no TI - Adverse events after naloxone treatment of episodes of suspected acute opioid overdose. SO - European Journal of Emergency Medicine. 11(1):19-23, 2004 Feb AS - Eur J Emerg Med. 11(1):19-23, 2004 Feb NJ - European journal of emergency medicine : official journal of the European Society for Emergency Medicine VO - 11 IP - 1 PG - 19-23 PI - Journal available in: Print PI - Citation processed from: Print JC - cl2, 9442482 IO - Eur J Emerg Med SB - Index Medicus CP - England MH - Acute Disease MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Confusion/ci [Chemically Induced] MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services/mt [Methods] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Headache/ci [Chemically Induced] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - *Narcotics/po [Poisoning] MH - Nausea/ci [Chemically Induced] MH - Norway/ep [Epidemiology] MH - Prospective Studies MH - Seizures/ci [Chemically Induced] MH - Substance-Related Disorders/ep [Epidemiology] MH - *Substance-Related Disorders/th [Therapy] MH - Tachycardia/ci [Chemically Induced] MH - Tremor/ci [Chemically Induced] MH - Vomiting/ci [Chemically Induced] AB - OBJECTIVE: An increasing and serious heroin overdose problem in Oslo has mandated the increasing out-of-hospital use of naloxone administered by paramedics. The aim of this study was to determine the frequencies and characteristics of adverse events related to this out-of-hospital administration by paramedics. AB - METHODS: A one-year prospective observational study from February 1998 to January 1999 was performed in patients suspected to be acutely overdosed by an opioid. A total of 1192 episodes treated with naloxone administered by the Emergency Medical Service system in Oslo, were included. The main outcome variable was adverse events observed immediately after the administration of naloxone. AB - RESULTS: The mean age of patients included was 32.6 years, and 77% were men. Adverse events suspected to be related to naloxone treatment were reported in 45% of episodes. The most common adverse events were related to opioid withdrawal (33%) such as gastrointestinal disorders, aggressiveness, tachycardia, shivering, sweating and tremor. Cases of confusion/restlessness (32%) might be related either to opioid withdrawal or to the effect of the heroin in combination with other drugs. Headache and seizures (25%) were probably related to hypoxia. Most events were non-serious. In three episodes (0.3%) the patients were hospitalized because of adverse events. AB - CONCLUSION: Although adverse events were common among patients treated for opioid overdose in an out-of-hospital setting, serious complications were rare. Out-of-hospital naloxone treatment by paramedics seems to save several lives a year without a high risk of serious complications. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0969-9546 IL - 0969-9546 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 00063110-200402000-00004 [pii] PP - ppublish LG - English DP - 2004 Feb EZ - 2004/05/29 05:00 DA - 2004/08/06 05:00 DT - 2004/05/29 05:00 YR - 2004 ED - 20040805 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15167188 <733. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 15039670 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wolfe TR AU - Bernstone T FA - Wolfe, Timothy R FA - Bernstone, Tony IN - Wolfe, Timothy R. Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, USA. wolfeman@csolutions.net TI - Intranasal drug delivery: an alternative to intravenous administration in selected emergency cases. [Review] [23 refs] SO - Journal of Emergency Nursing. 30(2):141-7, 2004 Apr AS - J Emerg Nurs. 30(2):141-7, 2004 Apr NJ - Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association VO - 30 IP - 2 PG - 141-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 7605913 IO - J Emerg Nurs SB - Nursing Journal CP - United States MH - Absorption MH - *Administration, Intranasal MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Anesthetics, Local/ad [Administration & Dosage] MH - Benzodiazepines/ad [Administration & Dosage] MH - Biological Availability MH - Conscious Sedation/mt [Methods] MH - Conscious Sedation/nu [Nursing] MH - *Emergency Nursing/is [Instrumentation] MH - *Emergency Nursing/mt [Methods] MH - Epistaxis/dt [Drug Therapy] MH - Epistaxis/nu [Nursing] MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - Intubation, Gastrointestinal/nu [Nursing] MH - Lidocaine/ad [Administration & Dosage] MH - Naloxone/ad [Administration & Dosage] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Nasal Decongestants/ad [Administration & Dosage] MH - Nasal Mucosa/me [Metabolism] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/nu [Nursing] MH - Oxymetazoline/ad [Administration & Dosage] MH - Seizures/dt [Drug Therapy] MH - Seizures/nu [Nursing] RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Local) RN - 0 (Hypnotics and Sedatives) RN - 0 (Narcotic Antagonists) RN - 0 (Nasal Decongestants) RN - 12794-10-4 (Benzodiazepines) RN - 36B82AMQ7N (Naloxone) RN - 8VLN5B44ZY (Oxymetazoline) RN - 98PI200987 (Lidocaine) IS - 0099-1767 IL - 0099-1767 PT - Journal Article PT - Review ID - 10.1016/j.jen.2004.01.006 [doi] ID - S0099176704000078 [pii] PP - ppublish LG - English DP - 2004 Apr EZ - 2004/03/25 05:00 DA - 2004/05/27 05:00 DT - 2004/03/25 05:00 YR - 2004 ED - 20040525 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=15039670 <734. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14991468 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Takahashi M AU - Sugiyama K AU - Hori M AU - Chiba S AU - Kusaka K FA - Takahashi, Masahiko FA - Sugiyama, Kimitoshi FA - Hori, Masaki FA - Chiba, Satoko FA - Kusaka, Kiyoshi IN - Takahashi, Masahiko. Division of Pain Control, Department of Anesthesiology and Emergency Medicine, Tohoku University Postgraduate Medical School, 1-1 Seiryo, Aoba-ku, 980-8574, Sendai, Japan. TI - Naloxone reversal of opioid anesthesia revisited: clinical evaluation and plasma concentration analysis of continuous naloxone infusion after anesthesia with high-dose fentanyl. SO - Journal of Anesthesia. 18(1):1-8, 2004 AS - J. ANESTH.. 18(1):1-8, 2004 NJ - Journal of anesthesia VO - 18 IP - 1 PG - 1-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 8905667 IO - J Anesth SB - Index Medicus CP - Japan MH - Abdomen/su [Surgery] MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/pk [Pharmacokinetics] MH - *Anesthetics, Intravenous/ad [Administration & Dosage] MH - Anesthetics, Intravenous/ae [Adverse Effects] MH - Anesthetics, Intravenous/pk [Pharmacokinetics] MH - Depression, Chemical MH - Female MH - *Fentanyl/ad [Administration & Dosage] MH - Fentanyl/ae [Adverse Effects] MH - Fentanyl/pk [Pharmacokinetics] MH - Humans MH - Infusion Pumps MH - Infusions, Intravenous MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/pk [Pharmacokinetics] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/pk [Pharmacokinetics] MH - Pain Measurement MH - Respiration/de [Drug Effects] MH - Respiration, Artificial AB - PURPOSE: In spite of several advantages, the need for postoperative ventilatory support limits the use of high-dose opioid anesthesia. We prospectively evaluated the effectiveness of naloxone infusion for the reversal of high-dose fentanyl anesthesia. AB - METHODS: Anesthesia was maintained with fentanyl in patients undergoing major abdominal surgery. After anesthesia, the trachea was extubated when intravenous naloxone, which was titrated in separate 50- micro g doses, established an acceptable level of consciousness and arterial blood gas (ABG) status under spontaneous respiration; this was followed by continuous infusion started at the rate of the sum of the bolus doses per hour. The naloxone infusion was terminated based on evaluation of the level of consciousness, ABG, and acute abstinence symptoms. Postoperative pain was evaluated using self-reported four-step categorical terms (none, mild, moderate, and severe). Plasma concentrations of fentanyl and naloxone were analyzed in 12 patients, using high-performance liquid chromatography. AB - RESULTS: Fifty-seven out of 59 eligible patients were successfully extubated at 34 +/- 14 min after termination of fentanyl (total dose, 127 +/- 64 micro g.kg(-1); mean +/- SD) with naloxone (total bolus, 3.4 +/- 2.6 micro g.kg(-1)). All these patients recovered fully without ventilatory support under the naloxone infusion, which was terminated at 11 +/- 7 h. The reduction of the naloxone infusion rate effectively relieved the increased pain, and no supplemental analgesic was used in any patients during the naloxone infusion. Pharmacokinetic analysis did not indicate any correlations between plasma fentanyl and naloxone concentrations. AB - CONCLUSION: The results suggest that naloxone infusion with individual dose titration facilitates the use of high-dose opioid anesthesia, maintaining the advantager of this anesthesia. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Intravenous) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0913-8668 IL - 0913-8668 PT - Journal Article ID - 10.1007/s00540-003-0214-4 [doi] PP - ppublish PH - 2003/08/11 [received] PH - 2003/11/13 [accepted] LG - English DP - 2004 EZ - 2004/03/03 05:00 DA - 2004/04/30 05:00 DT - 2004/03/03 05:00 YR - 2004 ED - 20040429 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=14991468 <735. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14767800 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kleinschmidt S AU - Wilhelm W AU - Risch B AU - Hammer B FA - Kleinschmidt, S FA - Wilhelm, W FA - Risch, B FA - Hammer, B IN - Kleinschmidt, S. Klinik fur Anaesthesiologie und Intensivmedizin, Universitatskliniken des Saarlandes, Homburg/Saar. aiskle@uniklinik-saarland.de TI - [Intoxication with methadone and benzodiazepines in a morbidly obese patient in the social environment of a heroin addict receiving methadone maintenance therapy]. [German] OT - Intoxikation durch Methadon und Benzodiazepine bei einem Patienten mit Adipositas permagna im Umfeld einer substituierten Drogenabhangigen. SO - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie. 39(2):101-5, 2004 Feb AS - Anasthesiol Intensivmed Notfallmed Schmerzther. 39(2):101-5, 2004 Feb NJ - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS VO - 39 IP - 2 PG - 101-5 PI - Journal available in: Print PI - Citation processed from: Print JC - 9109478, a4c IO - Anasthesiol Intensivmed Notfallmed Schmerzther SB - Index Medicus CP - Germany MH - *Analgesics, Opioid/po [Poisoning] MH - *Anti-Anxiety Agents/po [Poisoning] MH - *Benzodiazepines/po [Poisoning] MH - Blood Gas Analysis MH - Diazepam/po [Poisoning] MH - Emergency Medical Services MH - *Heroin Dependence/px [Psychology] MH - *Heroin Dependence/rh [Rehabilitation] MH - Humans MH - Male MH - *Methadone/po [Poisoning] MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Obesity, Morbid/co [Complications] MH - Social Environment AB - Methadone is a well-established maintenance drug for the therapy of opioid addicts. Reduction of mortality, social stabilization and reintegration are basic goals of this therapeutic concept. In the ideal case, total opioid abstinence can be achieved. In Germany, detailed guidelines exist for methadone maintenance treatment (e. g. choice of the maintenance drug, "take home" doses) and are regularly published and updated by the National Medical Council. In the social environment of opioid addicts, misuse or accidental intoxication in non-addict family members or co-addicts may occur. We report an intoxication with methadone of the husband of a heroin-addict patient. In this morbidly obese patient, a simultaneous ingestion of benzodiazepines was suspected. This case report describes the diagnostic and therapeutical options of an opioid intoxication in a patient with severe obesity with special emphasis on the airway management strategy in an out-of-hospital situation. RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Anxiety Agents) RN - 0 (Narcotic Antagonists) RN - 12794-10-4 (Benzodiazepines) RN - 36B82AMQ7N (Naloxone) RN - Q3JTX2Q7TU (Diazepam) RN - UC6VBE7V1Z (Methadone) IS - 0939-2661 IL - 0939-2661 PT - Case Reports PT - English Abstract PT - Journal Article ID - 10.1055/s-2004-817679 [doi] PP - ppublish LG - German DP - 2004 Feb EZ - 2004/02/10 05:00 DA - 2004/04/07 05:00 DT - 2004/02/10 05:00 YR - 2004 ED - 20040406 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=14767800 <736. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14660133 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lubman D AU - Koutsogiannis Z AU - Kronborg I FA - Lubman, Dan FA - Koutsogiannis, Zeff FA - Kronborg, Ian IN - Lubman, Dan. Substance Use Research and Recovery Focussed (SURRF) Program, ORYGEN Research Centre, University of Melbourne, Victoria, Australia. dan.lubman@mh.org.au TI - Emergency management of inadvertent accelerated opiate withdrawal in dependent opiate users. SO - Drug & Alcohol Review. 22(4):433-6, 2003 Dec AS - Drug Alcohol Rev. 22(4):433-6, 2003 Dec NJ - Drug and alcohol review VO - 22 IP - 4 PG - 433-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 9015440 IO - Drug Alcohol Rev SB - Index Medicus CP - Australia MH - Adult MH - *Buprenorphine/tu [Therapeutic Use] MH - *Emergency Medical Services MH - Female MH - Humans MH - Inactivation, Metabolic MH - Male MH - *Naltrexone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/ae [Adverse Effects] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Severity of Illness Index MH - *Substance Abuse, Intravenous/rh [Rehabilitation] MH - *Substance Withdrawal Syndrome/dt [Drug Therapy] MH - *Substance Withdrawal Syndrome/et [Etiology] AB - Six opiate-dependent drug users presented to the local emergency department within a 10-day period with symptoms of severe opioid withdrawal immediately following intravenous use of recently acquired street 'heroin'. The withdrawal picture was similar to that described in patients undergoing rapid opioid detoxification, suggesting that the substance injected was contaminated with an opiate antagonist. A number of potential compounds are discussed, including naltrexone and buprenorphine, and recommendations for the medical management of severe opiate withdrawal within an emergency setting are outlined. [Lubman DI, Koutsogiannis Z, Kronborg I. Emergency management of inadvertent accelerated opiate withdrawal in dependent opiate users. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 40D3SCR4GZ (Buprenorphine) RN - 5S6W795CQM (Naltrexone) IS - 0959-5236 IL - 0959-5236 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1080/09595230310001613958 [doi] ID - E3YUKU69Q74P29NX [pii] PP - ppublish LG - English DP - 2003 Dec EZ - 2003/12/09 05:00 DA - 2004/03/16 05:00 DT - 2003/12/09 05:00 YR - 2003 ED - 20040312 RD - 20141120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=14660133 <737. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14565809 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hasan RA AU - Benko AS AU - Nolan BM AU - Campe J AU - Duff J AU - Zureikat GY FA - Hasan, Rashed A FA - Benko, Amy S FA - Nolan, Brian M FA - Campe, Julie FA - Duff, Jenny FA - Zureikat, George Y IN - Hasan, Rashed A. Michigan State University, Hurley Medical Center, Flint, MI, USA. Rhasan1@hurleymc.com TI - Cardiorespiratory effects of naloxone in children. SO - Annals of Pharmacotherapy. 37(11):1587-92, 2003 Nov AS - Ann Pharmacother. 37(11):1587-92, 2003 Nov NJ - The Annals of pharmacotherapy VO - 37 IP - 11 PG - 1587-92 PI - Journal available in: Print PI - Citation processed from: Print JC - bbx, 9203131 IO - Ann Pharmacother SB - Index Medicus CP - United States MH - *Blood Pressure/de [Drug Effects] MH - Child MH - Female MH - *Heart Rate/de [Drug Effects] MH - Humans MH - Injections, Intravenous MH - Male MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/ae [Adverse Effects] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - *Respiration/de [Drug Effects] MH - Retrospective Studies AB - BACKGROUND: Data on the cardiorespiratory changes and complications following administration of naloxone in children are limited. AB - OBJECTIVE: To evaluate the cardiorespiratory changes and complications following naloxone treatment in children. AB - METHODS: The maximal changes in respiratory rate (RR), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and any complications within 1 and 2 hours following naloxone were tabulated. AB - RESULTS: One hundred ninety-five children received naloxone over 3 years. The mean +/- SD age was 9.7 +/- 6 years. The total doses of naloxone ranged from 0.01 to 7 mg (0.001-0.5 mg/kg body weight), with a median dose of 0.1 mg. Group 1 patients consisted of 116 (60%) children who were postoperative and had been given naloxone by an anesthesiologist; group 2 patients consisted of 79 (40%) children who received naloxone in the emergency department or pediatric intensive care unit. Patients in group 1 were older: 10.6 +/- 5.3 versus 8.2 +/- 6.7 years (p < 0.006), but received significantly lower doses of naloxone (0.09 +/- 0.2 vs. 1.1 +/- 0.76 mg; p < 0.001). When the entire cohort was evaluated, a significant increase in RR (15 +/- 7 vs. 21 +/- 8 breaths/min; p < 0.001), HR (102 +/- 29 vs.107 +/- 29 beats/min; p < 0.001), SBP (109 +/- 17 vs. 115 +/- 15 mm Hg; p < 0.001), and DBP (56 +/- 10 vs. 60 +/- 13 mm Hg; p < 0.001) within 1 hour following naloxone was noted. When the 2 groups were compared, only the changes in RR were greater in group 2 patients (6.8 +/- 7.9 vs. 4.7 +/- 5 breaths/min; p < 0.001) following naloxone. Systolic hypertension occurred in 33 of 195 (16.9%) of all patients, while diastolic hypertension occurred in 13 (6.6%) of all patients after naloxone. Only the incidence of diastolic hypertension was higher in group 2 compared with group 1 patients following naloxone (16% vs. 2%; p < 0.001). Hypertension resolved spontaneously. One child developed pulmonary edema and required positive pressure ventilation for 22 hours. AB - CONCLUSIONS: Moderate increases in RR, HR, and BP occur after naloxone administration to children, but development of more serious complications is rare. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1060-0280 IL - 1060-0280 PT - Clinical Trial PT - Journal Article ID - 10.1345/aph.1C521 [doi] PP - ppublish LG - English DP - 2003 Nov EZ - 2003/10/21 05:00 DA - 2004/03/06 05:00 DT - 2003/10/21 05:00 YR - 2003 ED - 20040305 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=14565809 <738. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14597500 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tamayo-Sarver JH AU - Dawson NV AU - Hinze SW AU - Cydulka RK AU - Wigton RS AU - Albert JM AU - Ibrahim SA AU - Baker DW FA - Tamayo-Sarver, Joshua H FA - Dawson, Neal V FA - Hinze, Susan W FA - Cydulka, Rita K FA - Wigton, Robert S FA - Albert, Jeffrey M FA - Ibrahim, Said A FA - Baker, David W IN - Tamayo-Sarver, Joshua H. Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH, USA. sarver@po.cwru.edu TI - The effect of race/ethnicity and desirable social characteristics on physicians' decisions to prescribe opioid analgesics. SO - Academic Emergency Medicine. 10(11):1239-48, 2003 Nov AS - Acad Emerg Med. 10(11):1239-48, 2003 Nov NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 10 IP - 11 PG - 1239-48 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Attitude of Health Personnel MH - Continental Population Groups MH - *Emergency Service, Hospital MH - Ethnic Groups MH - Female MH - Humans MH - Logistic Models MH - Male MH - *Pain/dt [Drug Therapy] MH - *Practice Patterns, Physicians' MH - Social Desirability AB - OBJECTIVE: Racial/ethnic disparities in physician treatment have been documented in multiple areas, including emergency department (ED) analgesia. The purpose of this study was to determine if physicians were predisposed to different treatment decisions based on patient race/ethnicity and if physicians' treatment predispositions changed when socially desirable information about the patient (occupation, socioeconomic status, and relationship with a primary care physician) was made explicit. AB - METHODS: The authors developed three clinical vignettes designed to engage physicians' decision-making processes. The patient's race/ethnicity was included. Each vignette randomly included or omitted explicit socially desirable information. The authors mailed 5,750 practicing emergency physicians three clinical vignettes and a one-page questionnaire about demographic and practice characteristics. Chi-square tests of significance for bivariate analyses and multiple logistic regression were used for multivariate analyses. AB - RESULTS: A total of 2,872 (53%) of the 5,398 potential physician subjects participated. Patient race/ethnicity had no effect on physician prescription of opioids at discharge for African Americans, Hispanics, and whites: absolute differences in rates of prescribing opioids at discharge were less than 2% for all three conditions presented. Making socially desirable information explicit increased the prescribing rates by 4% (95% CI = 0.1% to 8%) for the migraine vignette and 6% (95% CI = 3% to 8%) for the back pain vignette. AB - CONCLUSIONS: Patient race/ethnicity did not influence physicians' predispositions to treatment plans in clinical vignettes. Even knowing that the patient had a high-prestige occupation and a primary care provider only minimally increased prescribing of opioid analgesics for conditions with few objective findings. RN - 0 (Analgesics, Opioid) IS - 1069-6563 IL - 1069-6563 PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish LG - English DP - 2003 Nov EZ - 2003/11/05 05:00 DA - 2004/02/28 05:00 DT - 2003/11/05 05:00 YR - 2003 ED - 20040227 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=14597500 <739. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14748415 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barrueto F Jr AU - Howland MA AU - Hoffman RS AU - Nelson LS FA - Barrueto, Fermin Jr FA - Howland, Mary Ann FA - Hoffman, Robert S FA - Nelson, Lewis S IN - Barrueto, Fermin Jr. Division of Emergency Medicine, Department of Surgery, University of Maryland School of Medicine, 419 West Redwood Street, Suite 280, Baltimore, Maryland 21201, USA. TI - The fentanyl tea bag. SO - Veterinary & Human Toxicology. 46(1):30-1, 2004 Feb AS - Vet Hum Toxicol. 46(1):30-1, 2004 Feb NJ - Veterinary and human toxicology VO - 46 IP - 1 PG - 30-1 PI - Journal available in: Print PI - Citation processed from: Print JC - xbv, 7704194 IO - Vet Hum Toxicol SB - Index Medicus CP - United States MH - Adult MH - Beverages MH - Diagnosis, Differential MH - *Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/et [Etiology] MH - Emergency Treatment MH - Female MH - Fentanyl/ad [Administration & Dosage] MH - *Fentanyl/to [Toxicity] MH - Humans MH - Infusions, Intravenous MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Narcotics/ad [Administration & Dosage] MH - *Narcotics/to [Toxicity] AB - Fentanyl patches create unique opportunities for use and abuse. Each patch contains 100-fold more drug than is stated on the label in order to create the gradient required to deliver the stated amount (ie 25-100 microg/h). Several methods of abuse of this analgesic have been reported, ranging from ingestion to inhalation to application of multiple patches to the skin. We report the unique case of a 21-y-old woman who steeped a fentanyl patch in a cup of hot water and then drank the mixture. Coma and hypoventilation resulted. The woman was resuscitated with naloxone i.v. and recovered without sequelae. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0145-6296 IL - 0145-6296 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 2004 Feb EZ - 2004/01/30 05:00 DA - 2004/02/26 05:00 DT - 2004/01/30 05:00 YR - 2004 ED - 20040224 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=14748415 <740. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14746420 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Miller PL AU - Ernst AA FA - Miller, Penny L FA - Ernst, Amy A IN - Miller, Penny L. Patient Care Services, Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA. TI - Sex differences in analgesia: a randomized trial of mu versus kappa opioid agonists. SO - Southern Medical Journal. 97(1):35-41, 2004 Jan AS - South Med J. 97(1):35-41, 2004 Jan NJ - Southern medical journal VO - 97 IP - 1 PG - 35-41 PI - Journal available in: Print PI - Citation processed from: Print JC - uvh, 0404522 IO - South. Med. J. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Analysis of Variance MH - *Butorphanol/tu [Therapeutic Use] MH - Diastole/de [Drug Effects] MH - Double-Blind Method MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Morphine/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - Pain Measurement MH - *Sex Characteristics MH - Time Factors MH - Treatment Outcome MH - Wounds and Injuries/co [Complications] AB - OBJECTIVES: We sought to evaluate whether there is a sex difference in the analgesic response to mu versus kappa opioids in the management of acute moderate to severe pain of injury in the emergency department. AB - METHODS: The study was a randomized, double-blind, clinical trial comparing the prototypical mu-receptor agonist, morphine sulfate, to the prototypical kappa agonist, butorphanol. The primary endpoints were degree of relief by visual analog scores at 30 and 60 minutes. Statistical analysis was performed using Mann-Whitney Utest for nonparametric analysis and repeated-measures analysis of variance. AB - RESULTS: Ninety-four patients were entered in the study, with 49 (52%) males and 45 (48%) females. Forty-six received morphine sulfate and 48 received butorphanol. There was no difference in demographics in the two groups. At 60 minutes, females had significantly lower visual analog scores with butorphanol compared with morphine (P = 0.046). At 60 minutes, there was a trend for a difference in response of males versus females to morphine, with males responding better than females (P = 0.06). AB - CONCLUSION: Females had better pain scores with butorphanol than morphine at 60 minutes. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 76I7G6D29C (Morphine) RN - QV897JC36D (Butorphanol) IS - 0038-4348 IL - 0038-4348 PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2004 Jan EZ - 2004/01/30 05:00 DA - 2004/02/14 05:00 DT - 2004/01/30 05:00 YR - 2004 ED - 20040213 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=14746420 <741. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14705840 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mirakbari SM AU - Innes GD AU - Christenson J AU - Tilley J AU - Wong H FA - Mirakbari, Seyed Mostafa FA - Innes, Grant D FA - Christenson, Jim FA - Tilley, Jessica FA - Wong, Hubert IN - Mirakbari, Seyed Mostafa. Department of Emergency Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. smm@fastmail.ca TI - Do co-intoxicants increase adverse event rates in the first 24 hours in patients resuscitated from acute opioid overdose?. SO - Journal of Toxicology - Clinical Toxicology. 41(7):947-53, 2003 AS - J Toxicol Clin Toxicol. 41(7):947-53, 2003 NJ - Journal of toxicology. Clinical toxicology VO - 41 IP - 7 PG - 947-53 PI - Journal available in: Print PI - Citation processed from: Print JC - kan, 8213460 IO - J. Toxicol. Clin. Toxicol. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Acute Disease MH - Adult MH - Central Nervous System Depressants/po [Poisoning] MH - Cocaine/po [Poisoning] MH - Databases, Factual MH - Drug Overdose MH - Drug Synergism MH - Ethanol/po [Poisoning] MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - *Opioid-Related Disorders/co [Complications] MH - Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/mo [Mortality] MH - Prospective Studies MH - *Resuscitation MH - Time Factors MH - Treatment Outcome AB - BACKGROUND: Patients frequently arrive in emergency departments (EDs) after being resuscitated from opioid overdose. Autopsy studies suggest that multidrug intoxication is a major risk factor for adverse outcomes after acute heroin overdose in patients. If this is true, there may be high-risk drug combinations that identify patients who require more intensive monitoring and prolonged observation. Our objective was to determine the impact of co-intoxication with alcohol, cocaine, or CNS depressant drugs on short-term adverse event rates in patients resuscitated from acute opioid overdose. AB - METHODS: Data were extracted from the database of a prospective opioid overdose cohort study conducted between May 1997 and 1999. Patients were prospectively enrolled if they received naloxone for presumed opioid overdose. Investigators gathered clinical, demographic, and other predictor variables, including co-intoxicants used. Patients were followed to identify prespecified adverse outcome events occurring within 24 h, and multiple logistic regression was used to determine the association of concomitant drug use on short-term adverse event rates. AB - RESULTS: Of 1155 patients studied, 58 (5%) had pure opioid overdose and 922 (80%) reported co-intoxicants, including alcohol, cocaine, and CNS depressants. Overall, out of 1056 patients with known outcome status there were 123 major adverse events (11.6%) and 194 minor adverse events (18.4%). After adjustment for age, gender, HIV status, cardiovascular disease, pulmonary disease and diabetes, we found that coadministration of alcohol, cocaine, or CNS depressants, alone or in combination, was not associated with increased risk of death or adverse events during the 24 h follow-up period. AB - CONCLUSION: In patients resuscitated from acute opioid overdose, short-term outcomes are similar for patients with pure opioid overdose and multidrug intoxications. A history of cointoxication cannot be used to identify high-risk patients who require more intensive ED monitoring or prolonged observation. RN - 0 (Central Nervous System Depressants) RN - 3K9958V90M (Ethanol) RN - I5Y540LHVR (Cocaine) IS - 0731-3810 IL - 0731-3810 PT - Journal Article PP - ppublish LG - English DP - 2003 EZ - 2004/01/07 05:00 DA - 2004/01/24 05:00 DT - 2004/01/07 05:00 YR - 2003 ED - 20040123 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=14705840 <742. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12904197 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Boyd J AU - Randell T AU - Luurila H AU - Kuisma M FA - Boyd, J FA - Randell, T FA - Luurila, H FA - Kuisma, M IN - Boyd, J. Helsinki Emergency Medical Service, Helsinki University Central Hospital, Helsinki, Finland. james.boyd@hel.fi TI - Serious overdoses involving buprenorphine in Helsinki. SO - Acta Anaesthesiologica Scandinavica. 47(8):1031-3, 2003 Sep AS - Acta Anaesthesiol Scand. 47(8):1031-3, 2003 Sep NJ - Acta anaesthesiologica Scandinavica VO - 47 IP - 8 PG - 1031-3 PI - Journal available in: Print PI - Citation processed from: Print JC - 0370270 IO - Acta Anaesthesiol Scand SB - Index Medicus CP - England MH - Adult MH - *Buprenorphine/po [Poisoning] MH - Drug Overdose MH - Female MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Retrospective Studies AB - BACKGROUND: Buprenorphine is used as maintenance therapy for opioid-dependent patients. In comparison with other opioids it is thought to be safer because it is less likely to cause serious respiratory depression. However, concomitant use of psychotropics, especially benzodiazepines, and intravenous injection of dissolved buprenorphine tablets increase the risk of a serious overdose. AB - METHODS: As part of a larger retrospective study of opioid overdoses in Helsinki, the emergency medical services (EMS) records from January 1995 to April 2002 were reviewed for overdoses involving buprenorphine. Hospital records were reviewed when available. AB - RESULTS: We report 11 overdoses in which buprenorphine was involved. The classic symptoms and signs of an opioid overdose (respiratory depression, miosis and central nervous system depression) were present in most of the cases. At least eight of the patients had an overdose that was potentially fatal. One of the patients had a heroin overdose and was reportedly 'treated' by his friends with intravenously administered buprenorphine. AB - CONCLUSION: The high-dosage formulation of buprenorphine used for opioid-dependent patients might have caused several dangerous and potentially fatal overdoses in Helsinki. However, it does cause considerably less serious overdoses than heroin. Drug abusers might be intravenously administering buprenorphine themselves to treat heroin overdoses. RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) IS - 0001-5172 IL - 0001-5172 PT - Journal Article ID - 201 [pii] PP - ppublish LG - English DP - 2003 Sep EZ - 2003/08/09 05:00 DA - 2004/01/24 05:00 DT - 2003/08/09 05:00 YR - 2003 ED - 20040122 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12904197 <743. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14652965 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Brink CF AU - Erasmus J FA - Brink, C F FA - Erasmus, J IN - Brink, C F. University of Pretoria. TI - Etorphine poisoning. SO - South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 93(10):761-2, 2003 Oct AS - SAMJ, S. Afr. med. j.. 93(10):761-2, 2003 Oct NJ - South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde VO - 93 IP - 10 PG - 761-2 PI - Journal available in: Print PI - Citation processed from: Print JC - 0404520 IO - S. Afr. Med. J. SB - Index Medicus CP - South Africa MH - Adult MH - *Analgesics, Opioid/po [Poisoning] MH - *Etorphine/po [Poisoning] MH - Humans MH - Injections MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Poisoning/th [Therapy] MH - Respiration, Artificial RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 42M2Y6NU9O (Etorphine) IS - 0256-9574 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 2003 Oct EZ - 2003/12/05 05:00 DA - 2003/12/19 05:00 DT - 2003/12/05 05:00 YR - 2003 ED - 20031218 RD - 20140912 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=14652965 <744. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12973508 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Castro MC AU - Guinsburg R AU - Almeida MF AU - Peres CA AU - Yanaguibashi G AU - Kopelman BI FA - Castro, M Cristina F Z FA - Guinsburg, Ruth FA - Almeida, M Fernanda B FA - Peres, Clovis A FA - Yanaguibashi, Gianni FA - Kopelman, Benjamin I IN - Castro, M Cristina F Z. Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina, Sao Paulo, SP, Brazil. dpn@osite.com.br TI - [Profile of opioid prescriptions for intubated and mechanically ventilated neonates]. [Portuguese] OT - Perfil da indicacao de analgesicos opioides em recem-nascidos em ventilacao pulmonar mecanica. SO - Jornal de Pediatria. 79(1):41-8, 2003 Jan-Feb AS - J Pediatr (Rio J). 79(1):41-8, 2003 Jan-Feb NJ - Jornal de pediatria VO - 79 IP - 1 PG - 41-8 PI - Journal available in: Print PI - Citation processed from: Print JC - jmf, 2985188r IO - J Pediatr (Rio J) SB - Index Medicus CP - Brazil MH - Analgesia/mt [Methods] MH - Analgesia/sn [Statistics & Numerical Data] MH - *Analgesia MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - Female MH - Humans MH - Infant, Newborn MH - *Intubation MH - Male MH - *Respiration, Artificial MH - Retrospective Studies AB - OBJECTIVE: To identify factors that affect the decision of prescribing opioids for intubated and ventilated neonates. AB - MATERIAL AND METHOD: Retrospective study of intubated and ventilated newborn infants for periods longer than one hour, admitted to the NICU from January 1995 to June 1997. During this period, 203 patients fulfilled inclusion criteria and data of 176 charts were reviewed. Charts were analyzed regarding demographic data, characteristics of analgesia and respiratory support, invasive procedures performed and clinical entities diagnosed during the period of mechanical ventilation. Discriminative analysis was used to understand factors that lead to opioid use by some of these patients. AB - RESULTS: Ninety-seven neonates received at least one dose of opioids during the period of mechanical ventilation. None of these patients was evaluated with pain scales, and in 63% of them we could not retrieve any reason for opioid prescription in their charts. Discriminative analysis showed that the main differences between groups were birthweight, gestational age, oxygenation index at intubation, and number of arterial sticks during the first 72 hours of mechanical ventilation. The most mature and heaviest neonates with a more severe respiratory insufficiency received opioid analgesia during ventilation. AB - CONCLUSION: The decision to use opioids in intubated and ventilated neonates was based on the infants' aspect and respiratory status. It did not consider the pain these patients might be suffering and it was not based on the evaluation of pain. RN - 0 (Analgesics, Opioid) IS - 0021-7557 IL - 0021-7557 PT - English Abstract PT - Journal Article PP - ppublish LG - Portuguese DP - 2003 Jan-Feb EZ - 2003/09/16 05:00 DA - 2003/12/19 05:00 DT - 2003/09/16 05:00 YR - 2003 ED - 20031218 RD - 20061115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12973508 <745. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12514147 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Roy S AU - Fortier LP FA - Roy, Sebastien FA - Fortier, Louis-Philippe IN - Roy, Sebastien. Departement d'anesthesiologie, Universite de Montreal, Quebec, Canada. TI - Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine. SO - Canadian Journal of Anaesthesia. 50(1):32-5, 2003 Jan AS - Can J Anaesth. 50(1):32-5, 2003 Jan NJ - Canadian journal of anaesthesia = Journal canadien d'anesthesie VO - 50 IP - 1 PG - 32-5 PI - Journal available in: Print PI - Citation processed from: Print JC - c8l, 8701709 IO - Can J Anaesth SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Anesthesia Recovery Period MH - *Anesthesia, General MH - *Antidepressive Agents, Second-Generation/ae [Adverse Effects] MH - *Cyclohexanols/ae [Adverse Effects] MH - Drug Synergism MH - Female MH - *Fentanyl/ae [Adverse Effects] MH - Humans MH - Muscle Rigidity/dt [Drug Therapy] MH - *Muscle Rigidity/et [Etiology] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Venlafaxine Hydrochloride AB - PURPOSE: To present and discuss a case of opioid-induced rigidity with low-dose fentanyl during recovery from anesthesia. AB - CLINICAL FEATURES: A 41-yr-old woman underwent laparotomy for total abdominal hysterectomy and bilateral salpingo- oophorectomy under general anesthesia. She received a total of 500 micro g of fentanyl by iv intermittent boluses during the three-hour anesthetic. During emergence from anesthesia, while intubated, the patient presented with rigidity. No changes in ventilatory parameters were measured during the episode. The only notable predisposing factor was treatment with venlafexine, an antidepressant that modifies serotonin and norepinephrine levels. She was successfully treated with iv naloxone 20 micro g. The rest of the postoperative period was uneventful. AB - CONCLUSION: We observed an atypical case of opioid-induced rigidity in contrast to the classical syndrome, which presents at induction with high-dose opioids. This syndrome has many clinical presentations with neurologic and ventilatory signs of varying intensity. Early recognition of the syndrome and adequate treatment is crucial. If treated adequately, opioid-induced rigidity is self-limited with few complications. RN - 0 (Analgesics, Opioid) RN - 0 (Antidepressive Agents, Second-Generation) RN - 0 (Cyclohexanols) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 7D7RX5A8MO (Venlafaxine Hydrochloride) RN - UF599785JZ (Fentanyl) IS - 0832-610X IL - 0832-610X PT - Case Reports PT - Journal Article ID - 10.1007/BF03020183 [doi] PP - ppublish LG - English DP - 2003 Jan EZ - 2003/01/07 04:00 DA - 2003/12/19 05:00 DT - 2003/01/07 04:00 YR - 2003 ED - 20031218 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12514147 <746. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14609900 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pitetti RD AU - Singh S AU - Pierce MC FA - Pitetti, Raymond D FA - Singh, Sonia FA - Pierce, Mary Clyde IN - Pitetti, Raymond D. Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA. piterd@chp.edu TI - Safe and efficacious use of procedural sedation and analgesia by nonanesthesiologists in a pediatric emergency department. SO - Archives of Pediatrics & Adolescent Medicine. 157(11):1090-6, 2003 Nov AS - Arch Pediatr Adolesc Med. 157(11):1090-6, 2003 Nov NJ - Archives of pediatrics & adolescent medicine VO - 157 IP - 11 PG - 1090-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 9422751, bwf IO - Arch Pediatr Adolesc Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Analgesia/ae [Adverse Effects] MH - *Analgesia/mt [Methods] MH - Chi-Square Distribution MH - Child MH - Child, Preschool MH - Conscious Sedation/ae [Adverse Effects] MH - *Conscious Sedation/mt [Methods] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - *Pediatrics MH - Prospective Studies MH - Statistics, Nonparametric AB - BACKGROUND: Children often require relief of pain and anxiety when undergoing diagnostic or therapeutic procedures in the emergency department (ED). Procedural sedation and analgesia (PSA) has become standard practice in the outpatient setting for such procedures. Few studies have looked at the overall success and incidence of complications of PSA as performed by nonanesthesiologists. AB - OBJECTIVES: To prospectively describe PSA as performed in a pediatric ED and to report the success of sedation and incidence of complications. AB - DESIGN: Prospective descriptive study. Setting and Population Subjects aged 0 to 21 years presenting to the ED of an urban, tertiary care, children's hospital between May 1, 1997, and April 30, 1999, requiring PSA for a diagnostic or therapeutic procedure. AB - METHODS: A PSA form was designed and used by ED personnel to record pertinent clinical and demographic characteristics of patients, information related to the procedure, vital signs, and occurrence of complications. Success of sedation was defined a priori as successful completion of the procedure in a minimally responsive subject. Complications were defined as apnea, hypoxia (sustained pulse oximetry, <93%), seizure, arrhythmia, laryngospasm, stridor, hypotension, rash, vomiting, disinhibition, or aspiration. Follow-up telephone calls were made to families within 24 to 48 hours of discharge from the ED to document further complications. AB - MAIN OUTCOME MEASURES: Rate of success of sedation and incidence of complications. AB - RESULTS: Procedural sedation and analgesia was performed 1244 times in 1215 patients during the study. The median age of the patients was 5.9 years (mean age, 6.9 years; range, 2 months to 19.4 years). There were 791 boys (65.1%) and 424 girls (34.9%). A little more than half of the patients (643 or 52.9%) required PSA for fracture reduction and 396 (32.6%) for laceration repair. Intravenous (IV) fentanyl citrate and midazolam hydrochloride was provided in 734 sedation events (59.0%); IV ketamine hydrochloride, midazolam, and atropine sulfate in 293 (23.6%); and intramuscular ketamine, midazolam, and atropine in 82 (6.6%). Procedural sedation and analgesia was successfully provided in 1177 (98.6%) of 1194 sedation events. Complications occurred in 207 (17.8%) of 1161 events. The most common complication was hypoxia (79.1% of patients), followed by vomiting (6.2% of patients). No patient required intubation. One patient had an oral airway placed, 3 patients received flumazenil, 3 patients received naloxone hydrochloride, and 1 patient received naloxone and bag-valve-mask ventilation. Seventy (9.8%) of 717 patients, following discharge from the ED, reported minor complications related to PSA. The most common complication was vomiting (76.7% of patients), followed by persistent dizziness (6.8% of patients). Patients who received IV fentanyl and midazolam were significantly more likely to experience a complication during PSA (P<.001), while patients sedated using IV ketamine, midazolam, and atropine (P =.006) or IV midazolam alone (P =.005) were less likely. No difference in success of sedation or incidence of complications at follow-up was found between the types of PSA provided. AB - CONCLUSIONS: Complications related to PSA occurred in 17.9% of patients, but most commonly consisted of hypoxia that was easily treated. Sedation was successful in 98.6% of patients. Procedural sedation and analgesia can be safely and effectively provided by nonanesthesiologists in a pediatric ED. IS - 1072-4710 IL - 1072-4710 PT - Journal Article ID - 10.1001/archpedi.157.11.1090 [doi] ID - 157/11/1090 [pii] PP - ppublish LG - English DP - 2003 Nov EZ - 2003/11/12 05:00 DA - 2003/12/17 05:00 DT - 2003/11/12 05:00 YR - 2003 ED - 20031216 RD - 20091103 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=14609900 <747. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14589479 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Deer TR AU - Caraway DL AU - Kim CK AU - Dempsey CD AU - Stewart CD AU - McNeil KF FA - Deer, Timothy R FA - Caraway, David L FA - Kim, Christopher K FA - Dempsey, Connie Dee FA - Stewart, C Douglas FA - McNeil, Kenneth F IN - Deer, Timothy R. Center for Pain Relief, 1201 Washington Street, Suite 100, Charleston, WV 25301, USA. DocTDeer@aol.com TI - Clinical experience with intrathecal bupivacaine in combination with opioid for the treatment of chronic pain related to failed back surgery syndrome and metastatic cancer pain of the spine. SO - Spine Journal: Official Journal of the North American Spine Society. 2(4):274-8, 2002 Jul-Aug AS - Spine J. 2(4):274-8, 2002 Jul-Aug NJ - The spine journal : official journal of the North American Spine Society VO - 2 IP - 4 PG - 274-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 101130732 IO - Spine J SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Anesthetics, Local/ad [Administration & Dosage] MH - *Anesthetics, Local/tu [Therapeutic Use] MH - *Back Pain/dt [Drug Therapy] MH - Back Pain/et [Etiology] MH - Bupivacaine/ad [Administration & Dosage] MH - *Bupivacaine/tu [Therapeutic Use] MH - Drug Combinations MH - Female MH - Humans MH - Infusion Pumps, Implantable/ae [Adverse Effects] MH - Injections, Spinal MH - Male MH - Middle Aged MH - Pain Measurement MH - *Pain, Postoperative/dt [Drug Therapy] MH - Patient Satisfaction MH - Retrospective Studies MH - Spinal Neoplasms/co [Complications] MH - Spinal Neoplasms/sc [Secondary] MH - Spine/su [Surgery] AB - BACKGROUND CONTEXT: Bupivacaine is a local anesthetic agent of the amide class. This drug has been used in many clinical situations including intrathecal infusion. The literature regarding intrathecal bupivacaine is limited to small case studies, and anecdotal reports. This article examines a large patient group receiving bupivacaine with opioids over an extended period of time and analyzes efficacy and safety. The patients had pain related to failed back surgery syndrome or metastatic cancer to the spine. AB - PURPOSE: The purpose of this study was to determine the efficacy and safety of intrathecal bupivacaine combined with opioids for treatment of pain of spinal origin when opioids alone were inadequate. The secondary purpose of this study was to determine if the combination of bupivacaine and opioids created a neurological safety risk. AB - STUDY DESIGN/SETTING: The study design was retrospective, and involved consecutive medical records review by a disinterested third party. AB - PATIENT SAMPLE: One hundred nine consecutive patients were studied for a total of 6,780 patient weeks of bupivacaine/opioid infusion. These data were compared with a comparable time in the opioid alone treatment arm. The population included 84 noncancer patients and 25 cancer patients. AB - OUTCOME MEASURES: The primary outcome measure was pain relief obtained by a group of patients with a combination of bupivacaine and opioids as compared with opioid alone when delivered by intrathecal infusion. The visual analog scale was used to measure pain levels. Secondary objectives included measuring the amount of oral and transdermal medication required (opioid and nonopioid), emergency visits, routine office visits and patient satisfaction. These secondary objectives give a measure of health-care utilization. We also reviewed neurological complications during the combined arm of treatment. AB - METHODS: The study was done retrospectively with 109 consecutive patients. Patient chart reviews were used to determine the visual analog scales, amount of oral opioids, oral nonopioid adjuvant and patient satisfaction ratings. Patient satisfaction and pain rating was measured by a visual analog scale. Other factors recorded were emergency room visits, doctor's visits (other than the primary pain physician) and pain center visits. We also reviewed records for neurological deficits in the opioid arm and the combined arm. The t test was used to analyze statistical significance. AB - RESULTS: The findings suggested that in the combination arm the pain relief was significantly better (p=.008), the number of oral opioids used were significantly less (p=.008), the number of oral nonopioid adjuvants were reduced, the number of doctor's visits were less in the combined arm (p=.008), the number of pain clinic visits were less (p=.03), the number of emergency visits were significantly less (p=.01) and patient satisfaction was better (p=.003). The total dose of morphine was reduced by 23% in the combined arm (p=.005). During the course of treatment with intrathecal bupivacaine, there were no irreversible complications. AB - CONCLUSION: Bupivacaine, when used in combination with opioids, is a helpful and safe method of treatment in a select population of patients who have not responded to intrathecal opioids alone. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Local) RN - 0 (Drug Combinations) RN - Y8335394RO (Bupivacaine) IS - 1529-9430 IL - 1529-9430 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S1529943002001997 [pii] PP - ppublish LG - English DP - 2002 Jul-Aug EZ - 2003/11/01 05:00 DA - 2003/12/16 05:00 DT - 2003/11/01 05:00 YR - 2002 ED - 20031215 RD - 20140728 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=14589479 <748. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12896894 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Vilke GM AU - Sloane C AU - Smith AM AU - Chan TC FA - Vilke, Gary M FA - Sloane, Christian FA - Smith, Alan M FA - Chan, Theodore C IN - Vilke, Gary M. Department of Emergency Medicine, University of California-San Diego Medical Center, 200 West Arbor Drive, Mailcode #8676, San Diego, CA 92103, USA. gmvilke@ucsd.edu TI - Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport. CM - Comment in: Acad Emerg Med. 2004 Mar;11(3):323; author reply 323-4; PMID: 15001421 SO - Academic Emergency Medicine. 10(8):893-6, 2003 Aug AS - Acad Emerg Med. 10(8):893-6, 2003 Aug NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 10 IP - 8 PG - 893-6 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Drug Overdose/mo [Mortality] MH - Emergency Medical Services MH - Female MH - Health Policy MH - *Heroin/po [Poisoning] MH - *Heroin Dependence/dt [Drug Therapy] MH - Heroin Dependence/mo [Mortality] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - *Patient Discharge MH - Treatment Outcome MH - Treatment Refusal AB - UNLABELLED: Naloxone frequently is used to treat suspected heroin and opioid overdoses in the out-of-hospital setting. The authors' emergency medical services system has operated a policy of allowing these patients, when successfully treated, to sign out against medical advice (AMA) in the field. AB - OBJECTIVES: To evaluate the safety of this AMA policy. AB - METHODS: This is a retrospective review of out-of-hospital and medical examiner (ME) databases over a five-year period. The authors reviewed all ME cases in which opioid overdoses were listed as contributing to the cause of death. These cases were cross-compared with all patients who received naloxone by field paramedics and then refused transport. The charts were reviewed by dates, times, age, sex, location, and ethnicity when available. AB - RESULTS: There were 998 out-of-hospital patients who received naloxone and refused further treatment and 601 ME cases of opioid overdose deaths. When compared by age, time, date, sex, location, and ethnicity, there were no cases in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opioid overdose. AB - CONCLUSIONS: Giving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 1069-6563 IL - 1069-6563 PT - Journal Article PP - ppublish LG - English DP - 2003 Aug EZ - 2003/08/05 05:00 DA - 2003/12/06 05:00 DT - 2003/08/05 05:00 YR - 2003 ED - 20031205 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12896894 <749. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12896887 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Armstrong J AU - Little M AU - Murray L FA - Armstrong, Jason FA - Little, Mark FA - Murray, Lindsay IN - Armstrong, Jason. Department of Emergency Medicine, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, Western Australia 6009, Australia. TI - Emergency department presentations of naltrexone-accelerated detoxification. SO - Academic Emergency Medicine. 10(8):860-6, 2003 Aug AS - Acad Emerg Med. 10(8):860-6, 2003 Aug NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 10 IP - 8 PG - 860-6 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Cohort Studies MH - *Emergency Service, Hospital MH - Female MH - Hospital Mortality MH - Humans MH - Inactivation, Metabolic MH - Male MH - Middle Aged MH - Morbidity MH - Naltrexone/ae [Adverse Effects] MH - *Naltrexone/tu [Therapeutic Use] MH - Narcotic Antagonists/ae [Adverse Effects] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Retrospective Studies MH - Substance Withdrawal Syndrome/th [Therapy] AB - OBJECTIVES: To analyze emergency department (ED) presentations after naltrexone-accelerated detoxification. AB - METHODS: This was a retrospective cohort analysis of patient presentations to Sir Charles Gairdner Hospital Emergency Department over a six-month period (November 2000 to April 2001). AB - RESULTS: During the six-month study period, 42 patients presented to the ED after naltrexone-accelerated detoxification. This represented 7% of patients treated at a single clinic over the same period. Presentation occurred within 24 hours in 40% of cases and within 48 hours in 74%. Clinical features on presentation included gastrointestinal (GI) symptoms (vomiting, 60%; abdominal pain, 55%; diarrhea, 45%), central nervous system [CNS] symptoms (excessive drowsiness, 55%; agitation requiring sedation, 50%), and respiratory symptoms (tachypnea, 33%; respiratory difficulties, 19%). Gastrointestinal symptoms were managed adequately with supportive therapy in most cases (intravenous fluids; antiemetics). Agitation sometimes required large doses of intravenous benzodiazepines (up to 730 mg in 44 hours), one-to-one nursing, and security staff. Two of 14 patients presenting with predominantly CNS disturbance required intubation (14%). Mean in-hospital stay for all patients was 18 hours (range 1 to 92 hours). AB - CONCLUSIONS: A few patients undergoing outpatient naltrexone-accelerated detoxification during a six-month period subsequently required ED management. The clinical features encountered in this group of patients can be subdivided into GI or CNS predominance, with different management strategies. Most presentations can be managed in the ED or an associated observation ward, but departmental resources must be available for one-to-one nursing and security personnel. Patients presenting with agitation should be sedated with benzodiazepines; large doses may be required. Close monitoring of respiratory function is mandatory, and advanced airway management may be required. RN - 0 (Narcotic Antagonists) RN - 5S6W795CQM (Naltrexone) IS - 1069-6563 IL - 1069-6563 PT - Journal Article PP - ppublish LG - English DP - 2003 Aug EZ - 2003/08/05 05:00 DA - 2003/12/06 05:00 DT - 2003/08/05 05:00 YR - 2003 ED - 20031205 RD - 20141120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12896887 <750. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 14556395 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ishoy T AU - Hogskilde SA AU - Haastrup L FA - Ishoy, Torben FA - Hogskilde, Steffen A FA - Haastrup, Lene IN - Ishoy, Torben. Socialmedicinsk Klinik, Kobenhavn. ti@dgma.dk TI - [Prehospital treatment of patients with opiate overdose in Copenhagen 1995-1998]. [Danish] OT - Praehospital behandling af opioidoverdosering i Kobenhavn 1995-1998. SO - Ugeskrift for Laeger. 165(38):3624-7, 2003 Sep 15 AS - Ugeskr Laeger. 165(38):3624-7, 2003 Sep 15 NJ - Ugeskrift for laeger VO - 165 IP - 38 PG - 3624-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 0141730, wm8 IO - Ugeskr. Laeg. SB - Index Medicus CP - Denmark MH - Adult MH - Antidotes/ad [Administration & Dosage] MH - Cardiopulmonary Resuscitation MH - Cause of Death MH - Denmark/ep [Epidemiology] MH - Drug Overdose/ep [Epidemiology] MH - *Emergency Medical Services/mt [Methods] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/mo [Mortality] MH - Registries RN - 0 (Antidotes) IS - 0041-5782 IL - 0041-5782 PT - Journal Article PP - ppublish LG - Danish DP - 2003 Sep 15 EZ - 2003/10/15 05:00 DA - 2003/11/05 05:00 DT - 2003/10/15 05:00 YR - 2003 ED - 20031104 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=14556395 <751. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12847541 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kumar M AU - Paes B FA - Kumar, Manoj FA - Paes, Bosco IN - Kumar, Manoj. Department of Pediatrics, McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, Canada. TI - Epidural opioid analgesia and neonatal respiratory depression. SO - Journal of Perinatology. 23(5):425-7, 2003 Jul-Aug AS - J Perinatol. 23(5):425-7, 2003 Jul-Aug NJ - Journal of perinatology : official journal of the California Perinatal Association VO - 23 IP - 5 PG - 425-7 PI - Journal available in: Print PI - Citation processed from: Print JC - jfp, 8501884 IO - J Perinatol SB - Index Medicus CP - United States MH - *Analgesia, Epidural/ae [Adverse Effects] MH - Analgesia, Epidural/mt [Methods] MH - Analgesia, Obstetrical/ae [Adverse Effects] MH - Analgesia, Obstetrical/mt [Methods] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Female MH - Follow-Up Studies MH - Humans MH - Infant, Newborn MH - Male MH - Pregnancy MH - Respiration, Artificial/mt [Methods] MH - *Respiratory Distress Syndrome, Newborn/ci [Chemically Induced] MH - Respiratory Distress Syndrome, Newborn/pp [Physiopathology] MH - Respiratory Distress Syndrome, Newborn/th [Therapy] MH - Risk Assessment MH - Severity of Illness Index MH - Treatment Outcome AB - Epidural opioid analgesia is commonly employed as a therapeutic modality in the management of pain during labor. The general perception among health-care providers is that administered drugs remain in the maternal epidural space and do not compromise the respiratory status of newborns. We describe the clinical course of two newborns who developed respiratory depression following epidural fentanyl analgesia requiring administration of naloxone. The article further reviews the maternal-fetal-placental pharmacokinetics of epidural fentanyl and the possible mechanisms for the causation of neonatal respiratory depression. RN - 0 (Analgesics, Opioid) IS - 0743-8346 IL - 0743-8346 PT - Case Reports PT - Journal Article ID - 10.1038/sj.jp.7210905 [doi] ID - 7210905 [pii] PP - ppublish LG - English DP - 2003 Jul-Aug EZ - 2003/07/09 05:00 DA - 2003/09/27 05:00 DT - 2003/07/09 05:00 YR - 2003 ED - 20030926 RD - 20041117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12847541 <752. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12791805 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Seal KH AU - Downing M AU - Kral AH AU - Singleton-Banks S AU - Hammond JP AU - Lorvick J AU - Ciccarone D AU - Edlin BR FA - Seal, Karen H FA - Downing, Moher FA - Kral, Alex H FA - Singleton-Banks, Shannon FA - Hammond, Jon-Paul FA - Lorvick, Jennifer FA - Ciccarone, Dan FA - Edlin, Brian R IN - Seal, Karen H. Department of Family and Community Medicine, University of California, San Francisco, CA 94110, USA. karens@itsa.ucsf.edu TI - Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area. SO - Journal of Urban Health. 80(2):291-301, 2003 Jun AS - J Urban Health. 80(2):291-301, 2003 Jun NJ - Journal of urban health : bulletin of the New York Academy of Medicine VO - 80 IP - 2 PG - 291-301 PI - Journal available in: Print PI - Citation processed from: Print JC - c5l, 9809909 IO - J Urban Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456285 SB - Index Medicus CP - United States MH - Adult MH - *Attitude to Health MH - Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/pc [Prevention & Control] MH - Emergency Medical Services/ut [Utilization] MH - Female MH - Health Care Surveys MH - Heroin Dependence/dt [Drug Therapy] MH - *Heroin Dependence/px [Psychology] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - San Francisco MH - *Substance Abuse, Intravenous/px [Psychology] MH - Surveys and Questionnaires MH - Urban Health AB - Naloxone, an injectable opiate antagonist, can immediately reverse an opiate overdose and prevent overdose death. We sought to determine injection drug users' (IDUs) attitudes about being prescribed take-home naloxone. During November 1999 to February 2000, we surveyed 82 street-recruited IDUs from the San Francisco Bay Area of California who had experienced one or more heroin overdose events. We used a questionnaire that included structured and open-ended questions. Most respondents (89%) had witnessed an overdose, and 90% reported initially attempting lay remedies in an effort to help companions survive. Only 51% reported soliciting emergency assistance (calling 911) for the last witnessed overdose, with most hesitating due to fear of police involvement. Of IDUs surveyed, 87% were strongly in favor of participating in an overdose management training program to receive take-home naloxone and training in resuscitation techniques. Nevertheless, respondents expressed a variety of concerning attitudes. If provided naloxone, 35% predicted that they might feel comfortable using greater amounts of heroin, 62% might be less inclined to call 911 for an overdose, 30% might leave an overdose victim after naloxone resuscitation, and 46% might not be able to dissuade the victim from using heroin again to alleviate withdrawal symptoms induced by naloxone. Prescribing take-home naloxone to IDUs with training in its use and in resuscitation techniques may represent a life-saving, peer-based adjunct to accessing emergency services. Nevertheless, strategies for overcoming potential risks associated with the use of take-home naloxone would need to be emphasized in an overdose management training program. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1099-3460 IL - 1099-3460 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 10.1093/jurban/jtg032 [doi] ID - PMC3456285 [pmc] PP - ppublish LG - English DP - 2003 Jun EZ - 2003/06/07 05:00 DA - 2003/08/30 05:00 DT - 2003/06/07 05:00 YR - 2003 ED - 20030829 RD - 20170219 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12791805 <753. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12819163 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McGuire W AU - Fowlie PW FA - McGuire, W FA - Fowlie, P W IN - McGuire, W. Tayside Institute of Child Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK. w.mcguire@dundee.ac.uk TI - Naloxone for narcotic exposed newborn infants: systematic review. [Review] [17 refs] SO - Archives of Disease in Childhood Fetal & Neonatal Edition. 88(4):F308-11, 2003 Jul AS - Arch Dis Child Fetal Neonatal Ed. 88(4):F308-11, 2003 Jul NJ - Archives of disease in childhood. Fetal and neonatal edition VO - 88 IP - 4 PG - F308-11 PI - Journal available in: Print PI - Citation processed from: Print JC - b9p, 9501297 IO - Arch. Dis. Child. Fetal Neonatal Ed. PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721582 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Analgesia, Obstetrical/ae [Adverse Effects] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Female MH - Humans MH - Infant, Newborn MH - Intensive Care, Neonatal MH - *Meperidine/ae [Adverse Effects] MH - Meperidine/tu [Therapeutic Use] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Pregnancy MH - *Prenatal Exposure Delayed Effects MH - Randomized Controlled Trials as Topic MH - Respiration, Artificial AB - BACKGROUND: Naloxone, a specific opiate antagonist, is available for the treatment of newborn infants with respiratory depression that may be due to transplacentally acquired opiates. AB - AIMS: To determine if this treatment has any clinically important benefits, and whether there are any harmful effects. AB - METHODS: Randomised controlled trials that compared naloxone with placebo or no drug for newborn infants with transplacental exposure to narcotics were systematically reviewed. The Cochrane Controlled Trials Register (CCTR; 2002, Issue 3), Medline (1966 to June 2002), and Embase (1988 to June 2002) were searched. Data were extracted, analysed, and synthesised using the standard methods of the Cochrane Neonatal Collaborative Review Group. AB - RESULTS: Nine trials were found that fulfilled the specified inclusion criteria. Although there was evidence that naloxone increased alveolar ventilation, no data were found on the specified primary outcomes of this review: the need for assisted ventilation or admission to a neonatal unit. AB - CONCLUSIONS: There is a need for a randomised controlled trial to determine if naloxone confers any clinically important benefits on newborn infants with respiratory depression that may be due to transplacentally acquired narcotic. [References: 17] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 9E338QE28F (Meperidine) IS - 1359-2998 IL - 1359-2998 PT - Journal Article PT - Review ID - PMC1721582 [pmc] PP - ppublish LG - English DP - 2003 Jul EZ - 2003/06/24 05:00 DA - 2003/08/28 05:00 DT - 2003/06/24 05:00 YR - 2003 ED - 20030827 RD - 20140611 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12819163 <754. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12881944 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mitchell A AU - Niday P AU - Boulton J AU - Chance G AU - Dulberg C FA - Mitchell, Ann FA - Niday, Patricia FA - Boulton, Jill FA - Chance, Graham FA - Dulberg, Corinne IN - Mitchell, Ann. Perinatal Partnership Program of Eastern and Southeastern Ontario, Ottawa, Ontario, Canada. mitchela@kgh.kari.net TI - A prospective clinical audit of neonatal resuscitation practices in Canada. SO - Advances in Neonatal Care. 2(6):316-26, 2002 Dec AS - ADV NEONAT CARE. 2(6):316-26, 2002 Dec NJ - Advances in neonatal care : official journal of the National Association of Neonatal Nurses VO - 2 IP - 6 PG - 316-26 PI - Journal available in: Print PI - Citation processed from: Print JC - 101125644 IO - Adv Neonatal Care SB - Index Medicus CP - United States MH - Canada MH - Cardiopulmonary Resuscitation/mt [Methods] MH - Cardiopulmonary Resuscitation/st [Standards] MH - *Clinical Competence/st [Standards] MH - Delivery Rooms/st [Standards] MH - Guideline Adherence/st [Standards] MH - Guideline Adherence/sn [Statistics & Numerical Data] MH - Humans MH - Infant, Newborn MH - *Intensive Care Units, Neonatal/st [Standards] MH - Intensive Care Units, Neonatal/sn [Statistics & Numerical Data] MH - *Medical Audit MH - Practice Guidelines as Topic MH - Prospective Studies MH - Research Design MH - *Resuscitation/mt [Methods] MH - *Resuscitation/st [Standards] MH - Resuscitation/sn [Statistics & Numerical Data] MH - Surveys and Questionnaires AB - PURPOSE: This is a prospective audit to determine the frequency of resuscitation interventions in the clinical setting and to compare self-reports of clinical performance with the existing Neonatal Resuscitation Program (NRP) and Canadian National Guidelines for Neonatal Resuscitation. AB - SUBJECTS: Fifty-six level I, II, and III hospitals in Canada participated. Any infant requiring resuscitation, as defined by the need for at least positive pressure ventilation (PPV), was eligible for inclusion (n = 783 resuscitations). AB - DESIGN AND METHODS: A prospective self-report audit was chosen and data were collected over a 6-month period in 1998. The audit focused on the use of PPV, intubation, chest compressions, free-flow oxygen, or medications during the resuscitation. The infant's temperature at the end of resuscitation was also noted. The data were analyzed with descriptive statistics. The composition of the resuscitation team and their NRP certification status were recorded. AB - PRINCIPAL RESULTS: The need for resuscitation was not anticipated in 76% of the cases (596 of 783). Errors in the sequencing of care, such as delays in initiating PPV, provision of chest compressions before or without establishing an airway and ventilatory support, and administering naloxone before PPV, were reported. Resuscitations attended by a team of NRP certified providers had improved sequencing when compared with those in which only some individual providers were certified. Chest compressions were provided in 8% of the cases (65 of 783). Medications were used in 14% (113/783) of all cases. Providers in level I hospitals performed chest compressions more frequently than those in level II and III settings. At the end of the resuscitation, 27% of the infants were hypothermic (142 of 520), and 25% were hyperthermic (128 of 520). Overall, 52% were out of the normal neutral range. AB - CONCLUSIONS: Clear differences between the NRP guidelines and actual clinical practice were shown. A high rate of unanticipated resuscitations, delivery room medications, and chest compressions was described. Postresuscitation hypothermia or hyperthermia were common. Improved sequencing was noted when the entire resuscitation team was NRP certified. Certification in NRP does not assure competency, nor does it ensure compliance with established standards of care. IS - 1536-0903 IL - 1536-0903 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2002 Dec EZ - 2003/07/29 05:00 DA - 2003/08/16 05:00 DT - 2003/07/29 05:00 YR - 2002 ED - 20030815 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12881944 <755. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12750829 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Welters I FA - Welters, I IN - Welters, I. Abteilung fur Anaesthesiologie, Intensivmedizin und Schmerztherapie, Universitatsklinikum Giessen. Ingeborg.D.Welters@chiru.med.uni-giessen.de TI - [Opioids and immunosuppression. Clinical relevance?]. [Review] [103 refs] [German] OT - Opioide und Immunsuppression. Klinische Relevanz? SO - Anaesthesist. 52(5):442-52, 2003 May AS - Anaesthesist. 52(5):442-52, 2003 May NJ - Der Anaesthesist VO - 52 IP - 5 PG - 442-52 PI - Journal available in: Print PI - Citation processed from: Print JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/pd [Pharmacology] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Anesthesia MH - Animals MH - Critical Care MH - Drug Interactions MH - Emergency Medical Services MH - Humans MH - *Immune System/de [Drug Effects] MH - Immunity, Cellular/de [Drug Effects] MH - *Immunosuppressive Agents MH - Pain/dt [Drug Therapy] MH - Receptors, Opioid/de [Drug Effects] AB - First observations that opioids may have disadvantageous effects on the immune response have been made more than 100 years ago. Today the immunosuppressive effect of morphine is well established.Drug-induced immunomodulation is of growing importance in modern anesthetic concepts. The reduced stress response observed after morphine application contributes to this effect as well as direct impairment of immune effector cells such as bactericidal activity, intracellular killing,proliferative response or cytokine synthesis. Opioid-induced immunomodulation is mediated by opioid receptors found on immunocytes and in the central nervous system.A negative feedback mechanism via the hypothalamo-pituitary-adrenal axis may potentiate the direct inhibitory effect of morphine on the immune response.A final statement regarding the clinical relevance of opioid-induced immunosuppression cannot be made at this point, since the existing clinical data are preliminary and inconclusive.Therefore, further clinical studies are mandatory to elucidate the influence of opioid treatment on immune regulation in different clinical settings in anesthesia, critical care, pain therapy and emergency medicine. Further investigations may help to not only provide sufficient analgesia by application of opioids, but also to assess advantages and disadvantages on immune function. [References: 103] RN - 0 (Analgesics, Opioid) RN - 0 (Immunosuppressive Agents) RN - 0 (Receptors, Opioid) IS - 0003-2417 IL - 0003-2417 PT - English Abstract PT - Journal Article PT - Review ID - 10.1007/s00101-003-0506-y [doi] PP - ppublish LG - German DP - 2003 May EZ - 2003/05/17 05:00 DA - 2003/07/15 05:00 DT - 2003/05/17 05:00 YR - 2003 ED - 20030714 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12750829 <756. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12776791 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rodriguez-Perez M AU - Sanchez-Galicia A AU - de Cabrera LC FA - Rodriguez-Perez, Mary FA - Sanchez-Galicia, Amada FA - de Cabrera, Lourdes Calderon IN - Rodriguez-Perez, Mary. Toxicology Unit, Department of Pharmacology and Toxicology, Universidad de los Andes School of Medicine, Merida 5101, Venezuela. TI - Intoxication by cholinesterase inhibitors versus opioid intoxication. SO - Veterinary & Human Toxicology. 45(3):146-7, 2003 Jun AS - Vet Hum Toxicol. 45(3):146-7, 2003 Jun NJ - Veterinary and human toxicology VO - 45 IP - 3 PG - 146-7 PI - Journal available in: Print PI - Citation processed from: Print JC - xbv, 7704194 IO - Vet Hum Toxicol SB - Index Medicus CP - United States MH - *Alcoholic Intoxication MH - *Cholinesterase Inhibitors/to [Toxicity] MH - Diagnosis, Differential MH - Emergency Treatment MH - Epilepsy, Tonic-Clonic/ci [Chemically Induced] MH - *Epilepsy, Tonic-Clonic/di [Diagnosis] MH - Epilepsy, Tonic-Clonic/th [Therapy] MH - Humans MH - Male MH - Middle Aged MH - Narcotics/to [Toxicity] MH - Pulmonary Edema AB - A 47 y-old male shopkeeper from a rural area ingested an unknown substance while under the effects of ethylic alcohol. He was admitted at the University Hospital of the Andes in generally poor condition with a cholinergic syndrome. An erroneous diagnosis of acute pulmonary edema and opioid intoxication was reached. The value of a patient's history (background) and careful evaluation of the physical examination findings without underestimating critical clinical signs are very important when handling a clinical intoxication. RN - 0 (Cholinesterase Inhibitors) RN - 0 (Narcotics) IS - 0145-6296 IL - 0145-6296 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 2003 Jun EZ - 2003/06/05 05:00 DA - 2003/07/11 05:00 DT - 2003/06/05 05:00 YR - 2003 ED - 20030710 RD - 20041117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12776791 <757. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12768114 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Molina PE FA - Molina, Patricia E IN - Molina, Patricia E. Department of Physiology, Louisiana State University Health Sciences Center, New Orleans 70112, USA. pmolin@lsuhsc.edu TI - Endogenous opioid analgesia in hemorrhagic shock. SO - Journal of Trauma-Injury Infection & Critical Care. 54(5 Suppl):S126-32, 2003 May AS - J Trauma. 54(5 Suppl):S126-32, 2003 May NJ - The Journal of trauma VO - 54 IP - 5 Suppl PG - S126-32 PI - Journal available in: Print PI - Citation processed from: Print JC - kaf, 0376373 IO - J Trauma SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Animals MH - Capsaicin/tu [Therapeutic Use] MH - Disease Models, Animal MH - *Fluid Therapy MH - Hemodynamics/de [Drug Effects] MH - Male MH - *Opioid Peptides/tu [Therapeutic Use] MH - Rats MH - Rats, Sprague-Dawley MH - *Resuscitation MH - Sense Organs/de [Drug Effects] MH - *Shock, Hemorrhagic/th [Therapy] MH - Time Factors AB - BACKGROUND: Hemorrhagic shock produces an immediate activation of the autonomic nervous system and endogenous opioid pathways. Our studies have demonstrated that endogenous opioid activation aggravates the hemodynamic and inflammatory responses to shock. However, it is unclear whether endogenous opioid activation is triggered by noxious stimuli and furthermore whether it produces analgesia. AB - METHODS: Experiments were conducted in chronically catheterized, conscious, unrestrained, nonheparinized, male, Sprague-Dawley rats subjected to fixed pressure hemorrhage. Blood samples were obtained for determinations of circulating beta-endorphin and substance P. Analgesia was measured using the tail-flick response to a noxious stimulus before and during hemorrhage. The contribution of sensory neurons to eliciting the neuroendocrine, opioid, and inflammatory responses to hemorrhage was investigated in capsaicin-treated animals. AB - RESULTS: Hemorrhagic shock produced marked naltrexone-sensitive analgesia without significant modulation of substance P. Peripheral sensory denervation did not alter the hemodynamic, neuroendocrine, or inflammatory responses to shock. AB - CONCLUSION: Endogenous opioid activation during shock produces analgesia. Sensory neuron activation appears to have limited effect on shock-induced hemodynamic and proinflammatory responses. Furthermore, these results suggest that the activation of neuroendocrine and opioid pathways during shock is not likely to be a response to noxious stimuli. RN - 0 (Analgesics, Opioid) RN - 0 (Opioid Peptides) RN - S07O44R1ZM (Capsaicin) IS - 0022-5282 IL - 0022-5282 PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. ID - 10.1097/01.TA.0000065266.02401.AA [doi] PP - ppublish LG - English DP - 2003 May EZ - 2003/05/28 05:00 DA - 2003/06/25 05:00 DT - 2003/05/28 05:00 YR - 2003 ED - 20030624 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12768114 <758. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12774790 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lindstrom AM FA - Lindstrom, Ann-Marie TI - Heroin addicts to receive CPR training and Narcan. SO - Journal of Emergency Medical Services. 28(5):142-4, 2003 May AS - J Emerg Med Serv JEMS. 28(5):142-4, 2003 May NJ - JEMS : a journal of emergency medical services VO - 28 IP - 5 PG - 142-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - Baltimore/ep [Epidemiology] MH - *Cardiopulmonary Resuscitation/ed [Education] MH - *Community Health Services/og [Organization & Administration] MH - *Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/mo [Mortality] MH - *Emergency Medical Services MH - *Heroin Dependence/dt [Drug Therapy] MH - Heroin Dependence/mo [Mortality] MH - Humans MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Program Evaluation RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 PT - Journal Article PP - ppublish LG - English DP - 2003 May EZ - 2003/05/31 05:00 DA - 2003/06/20 05:00 DT - 2003/05/31 05:00 YR - 2003 ED - 20030619 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12774790 <759. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12609650 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mycyk MB AU - Szyszko AL AU - Aks SE FA - Mycyk, Mark B FA - Szyszko, Amy L FA - Aks, Steven E IN - Mycyk, Mark B. Toxikon Consortium/Cook County Hospital, Chicago, Illinois 60611, USA. TI - Nebulized naloxone gently and effectively reverses methadone intoxication. SO - Journal of Emergency Medicine. 24(2):185-7, 2003 Feb AS - J Emerg Med. 24(2):185-7, 2003 Feb NJ - The Journal of emergency medicine VO - 24 IP - 2 PG - 185-7 PI - Journal available in: Print PI - Citation processed from: Print JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Female MH - Humans MH - *Methadone/po [Poisoning] MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] MH - *Nebulizers and Vaporizers AB - A 46-year-old woman presented to the Emergency Department with lethargy and respiratory depression after ingesting methadone. Initial oxygen saturation of 61% on room air did not improve with supplemental oxygenation. As venous access was initially unobtainable, naloxone was administered by nebulizer. Within 5 min oxygen saturation was 100% and mental status was normal. The patient did not develop severe withdrawal symptoms. Naloxone hydrochloride has been administered by various routes to treat opioid toxicity. Our report describes the successful use of nebulized naloxone for methadone toxicity. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) IS - 0736-4679 IL - 0736-4679 PT - Case Reports PT - Journal Article ID - S0736467902007230 [pii] PP - ppublish LG - English DP - 2003 Feb EZ - 2003/03/01 04:00 DA - 2003/06/11 05:00 DT - 2003/03/01 04:00 YR - 2003 ED - 20030610 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12609650 <760. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12696355 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Attard N AU - Baraton S AU - Pistre E AU - Aboukrat C AU - Visigny S AU - Bertuzzi MC AU - Moraly J AU - Alazia M FA - Attard, N FA - Baraton, S FA - Pistre, E FA - Aboukrat, C FA - Visigny, S FA - Bertuzzi, M C FA - Moraly, J FA - Alazia, M IN - Attard, N. Sau des hopitaux Sud, 270, bd Sainte-Marguerite, BP 29, 13274 Marseille, France. TI - [Non-opiate analgesia: level I and II emergency drugs (indications, undesirable effects and evaluation of their efficacity)]. [French] OT - Analgesie non morphinique: medications de niveaux I et II utilisables en urgence (indications, effets indesirables, evaluation de leur efficacite). SO - Revue de L'Infirmiere. (88):36-8, 2003 Feb AS - Rev Infirm. (88):36-8, 2003 Feb NJ - Revue de l'infirmiere IP - 88 PG - 36-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 1267175, s7t IO - Rev Infirm SB - Nursing Journal CP - France MH - Analgesics/ae [Adverse Effects] MH - Analgesics/cl [Classification] MH - *Analgesics/tu [Therapeutic Use] MH - Drug Monitoring/mt [Methods] MH - *Emergency Medical Services/mt [Methods] MH - Humans MH - Pain/cl [Classification] MH - Pain/di [Diagnosis] MH - *Pain/dt [Drug Therapy] MH - Pain Measurement MH - Patient Selection MH - Severity of Illness Index MH - Treatment Outcome RN - 0 (Analgesics) IS - 1293-8505 IL - 1293-8505 PT - Journal Article PP - ppublish LG - French DP - 2003 Feb EZ - 2003/04/17 05:00 DA - 2003/05/13 05:00 DT - 2003/04/17 05:00 YR - 2003 ED - 20030509 RD - 20050418 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12696355 <761. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12615464 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cassuto J AU - Tarnow P FA - Cassuto, Jean FA - Tarnow, Peter IN - Cassuto, Jean. Department of Intensive Care, Sahlgrenska University Hospital, Molndal, Sweden. jean.cassuto@aniv.gu.se TI - Potent inhibition of burn pain without use of opiates. SO - Burns. 29(2):163-6, 2003 Mar AS - Burns. 29(2):163-6, 2003 Mar NJ - Burns : journal of the International Society for Burn Injuries VO - 29 IP - 2 PG - 163-6 PI - Journal available in: Print PI - Citation processed from: Print JC - afc, 8913178 IO - Burns SB - Index Medicus CP - Netherlands MH - Adolescent MH - *Analgesia/mt [Methods] MH - Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Anesthetics, Local/ad [Administration & Dosage] MH - Bandages MH - *Burns/co [Complications] MH - Burns/th [Therapy] MH - Humans MH - Infusions, Intravenous MH - *Lidocaine/ad [Administration & Dosage] MH - Male MH - Pain/et [Etiology] MH - Pain/pp [Physiopathology] MH - *Pain Management MH - Respiration, Artificial MH - Treatment Outcome RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Local) RN - 98PI200987 (Lidocaine) IS - 0305-4179 IL - 0305-4179 PT - Case Reports PT - Journal Article ID - S0305417902002371 [pii] PP - ppublish LG - English DP - 2003 Mar EZ - 2003/03/05 04:00 DA - 2003/04/29 05:00 DT - 2003/03/05 04:00 YR - 2003 ED - 20030428 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12615464 <762. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12626983 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Meissner W AU - Dohrn B AU - Reinhart K FA - Meissner, Winfried FA - Dohrn, Barbara FA - Reinhart, Konrad IN - Meissner, Winfried. Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University Jena, Germany. TI - Enteral naloxone reduces gastric tube reflux and frequency of pneumonia in critical care patients during opioid analgesia. SO - Critical Care Medicine. 31(3):776-80, 2003 Mar AS - Crit Care Med. 31(3):776-80, 2003 Mar NJ - Critical care medicine VO - 31 IP - 3 PG - 776-80 PI - Journal available in: Print PI - Citation processed from: Print JC - dtf, 0355501 IO - Crit. Care Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Administration, Oral MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Critical Care/mt [Methods] MH - *Cross Infection/et [Etiology] MH - *Cross Infection/pc [Prevention & Control] MH - Defecation/de [Drug Effects] MH - Double-Blind Method MH - *Enteral Nutrition/ae [Adverse Effects] MH - *Enteral Nutrition/mt [Methods] MH - Female MH - *Fentanyl/ae [Adverse Effects] MH - Gastric Emptying/de [Drug Effects] MH - Gastrointestinal Motility/de [Drug Effects] MH - Humans MH - Infection Control/mt [Methods] MH - *Intubation, Gastrointestinal/ae [Adverse Effects] MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/pd [Pharmacology] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/pd [Pharmacology] MH - *Pneumonia, Aspiration/et [Etiology] MH - *Pneumonia, Aspiration/pc [Prevention & Control] MH - Prospective Studies MH - *Respiration, Artificial/ae [Adverse Effects] AB - OBJECTIVE: Opioid analgesia impairs gastrointestinal motility. Enteral administration of naloxone theoretically allows selective blocking of intestinal opioid receptors caused by extensive presystemic metabolism. Therefore, we studied the effect of enteral naloxone on the amount of gastric tube reflux, the frequency of pneumonia, and the time until first defecation in mechanically ventilated patients with fentanyl analgesia. AB - DESIGN: Prospective, randomized, double-blinded study. AB - SETTING: University hospital intensive care unit. AB - PATIENTS: Eighty-four mechanically ventilated, fentanyl-treated patients without gastrointestinal surgery or diseases. AB - INTERVENTIONS: Patients were assigned to receive 8 mg naloxone or placebo four times daily via a gastric tube during fentanyl administration. AB - MEASUREMENTS AND MAIN RESULTS: Thirty-eight patients received naloxone and 43 placebo; three patients were excluded because of protocol violation. Median gastric tube reflux volume (54 vs. 129 mL, p =.03) and frequency of pneumonia (34% vs. 56%, p =.04) were significantly lower in the naloxone group. In both groups, time until first defecation, ventilation time, and length of intensive care unit stay did not differ. There was no difference in fentanyl requirements between the naloxone and the placebo group (7 vs. 6.5 microg/kg/hr, p =.15). AB - CONCLUSIONS: Our results provide evidence that the administration of enteral opioid antagonists in ventilated patients with opioid analgesia might be a simple-and possibly preventive-treatment of increased gastric tube reflux and reduces frequency of pneumonia. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0090-3493 IL - 0090-3493 PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 10.1097/01.CCM.0000053652.80849.9F [doi] PP - ppublish LG - English DP - 2003 Mar EZ - 2003/03/11 04:00 DA - 2003/04/12 05:00 DT - 2003/03/11 04:00 YR - 2003 ED - 20030411 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12626983 <763. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12580688 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Traub SJ AU - Kohn GL AU - Hoffman RS AU - Nelson LS FA - Traub, Stephen J FA - Kohn, Gary L FA - Hoffman, Robert S FA - Nelson, Lewis S IN - Traub, Stephen J. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA. straub@caregroup.harvard.edu TI - Pediatric "body packing". CM - Comment in: Arch Pediatr Adolesc Med. 2003 Jul;157(7):703; PMID: 12860794 SO - Archives of Pediatrics & Adolescent Medicine. 157(2):174-7, 2003 Feb AS - Arch Pediatr Adolesc Med. 157(2):174-7, 2003 Feb NJ - Archives of pediatrics & adolescent medicine VO - 157 IP - 2 PG - 174-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 9422751, bwf IO - Arch Pediatr Adolesc Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Charcoal/tu [Therapeutic Use] MH - Child MH - *Crime MH - *Digestive System/dg [Diagnostic Imaging] MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/th [Therapy] MH - *Foreign Bodies MH - *Heroin/po [Poisoning] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Radiography, Abdominal MH - Therapeutic Irrigation/mt [Methods] MH - Tomography, X-Ray Computed AB - BACKGROUND: Recent events in the United States have led to increased security at national borders, resulting in an unexpected increase in drug seizures. In response, drug smugglers may begin using children as couriers, including using them as "body packers." AB - OBJECTIVE: To look at the occurrence of body packing, the concealing of contraband within the human body, which is well documented in adults, in the pediatric literature. AB - PATIENT REPORTS: Two cases of pediatric body packing, in boys aged 16 years and 12 years. Patient 1, a 16-year-old boy, presented with findings consistent with opioid intoxication after arriving in the United States on a transcontinental flight. His mental status improved after he received naloxone hydrochloride, and he subsequently confessed to body packing heroin. He was treated with a naloxone infusion and aggressive gastrointestinal decontamination. He ultimately passed 53 packets of heroin, one of which had ruptured. He recovered uneventfully. Patient 2, a 12-year-old boy, presented to the emergency department with rectal bleeding. He had recently arrived in the United States from Europe, and he confessed to body packing heroin. He was treated with whole-bowel irrigation and activated charcoal, and he subsequently passed 84 packets. He also recovered uneventfully. AB - CONCLUSIONS: We report the first 2 cases of body packing in the pediatric literature and review the diagnosis and management of this clinical entity. Pediatricians should be aware that body packing, regrettably, is not confined to the adult population. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 16291-96-6 (Charcoal) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 1072-4710 IL - 1072-4710 PT - Case Reports PT - Journal Article ID - poa20173 [pii] PP - ppublish LG - English DP - 2003 Feb EZ - 2003/02/13 04:00 DA - 2003/03/22 04:00 DT - 2003/02/13 04:00 YR - 2003 ED - 20030321 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12580688 <764. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12564425 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pore C FA - Pore, Chad TI - Rethinking coma cocktails. CM - Comment on: JEMS. 2002 Nov;27(11):54-60; PMID: 12483195 SO - Journal of Emergency Medical Services. 28(1):14; author reply 14, 2003 Jan AS - J Emerg Med Serv JEMS. 28(1):14; author reply 14, 2003 Jan NJ - JEMS : a journal of emergency medical services VO - 28 IP - 1 PG - 14; author reply 14 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Coma/dt [Drug Therapy] MH - *Emergency Medical Services/st [Standards] MH - Glucose/ad [Administration & Dosage] MH - Humans MH - Naloxone/ad [Administration & Dosage] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Quality Assurance, Health Care MH - United States RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - IY9XDZ35W2 (Glucose) IS - 0197-2510 IL - 0197-2510 PT - Comment PT - Letter PP - ppublish LG - English DP - 2003 Jan EZ - 2003/02/05 04:00 DA - 2003/03/14 04:00 DT - 2003/02/05 04:00 YR - 2003 ED - 20030313 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12564425 <765. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12426012 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barlas D AU - Margouleff D AU - Vignogna-Barlas L AU - Lesser ML FA - Barlas, David FA - Margouleff, Donald FA - Vignogna-Barlas, Lisa FA - Lesser, Martin L IN - Barlas, David. Department of Emergency Medicine, North Shore University Hospital, New York University School of Medicine, Manhasset, New York 11030, USA. TI - Opioids prolong nuclear hepatobiliary imaging when given prior to scanning. SO - Journal of Emergency Medicine. 23(3):231-6, 2002 Oct AS - J Emerg Med. 23(3):231-6, 2002 Oct NJ - The Journal of emergency medicine VO - 23 IP - 3 PG - 231-6 PI - Journal available in: Print PI - Citation processed from: Print JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - *Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/pd [Pharmacology] MH - Cohort Studies MH - Common Bile Duct/dg [Diagnostic Imaging] MH - *Common Bile Duct/de [Drug Effects] MH - Drug Administration Schedule MH - Female MH - Humans MH - Male MH - Middle Aged MH - Radionuclide Imaging MH - Radiopharmaceuticals MH - Retrospective Studies MH - Technetium Tc 99m Disofenin MH - Time Factors AB - Opioid-mediated contraction of the distal common bile duct (CBD) may delay tracer passage during nuclear hepatobiliary imaging (NHI), mimicking pathologic obstruction. We sought to determine if opioid administration before NHI delays CBD visualization and prolongs imaging. The records of 198 Emergency Department patients who underwent NHI were reviewed (after excluding those with evidence for pathologic CBD obstruction). Opioids were administered before NHI in 56 cases. Delayed CBD visualization occurred in 28.6% of subjects who had received opioids and in 12.0% of those who had not (p < 0.01). Delayed imaging was performed in 77.8% of those who had received opioids and in 53.5% of those who had not (p < 0.01). The relative risk of delayed CBD visualization was 1.46 [95%CI 0.65-3.28] for meperidine, 4.18 [95%CI 2.00-8.82] for morphine, and 2.38 [95%CI 1.29-4.39] for any opioid. We conclude that opioids given before NHI are associated with delayed CBD visualization and more imaging sessions. Copyright 2002 Elsevier Science Inc. RN - 0 (Analgesics, Opioid) RN - 0 (Radiopharmaceuticals) RN - QTJ2VIW97T (Technetium Tc 99m Disofenin) IS - 0736-4679 IL - 0736-4679 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0736467902005231 [pii] PP - ppublish LG - English DP - 2002 Oct EZ - 2002/11/12 04:00 DA - 2003/03/13 04:00 DT - 2002/11/12 04:00 YR - 2002 ED - 20030312 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12426012 <766. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12563576 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sterrett C AU - Brownfield J AU - Korn CS AU - Hollinger M AU - Henderson SO FA - Sterrett, Christopher FA - Brownfield, Joseph FA - Korn, Carrie S FA - Hollinger, Mark FA - Henderson, Sean O IN - Sterrett, Christopher. Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. TI - Patterns of presentation in heroin overdose resulting in pulmonary edema. CM - Comment in: Am J Emerg Med. 2004 Jul;22(4):316; PMID: 15258878 SO - American Journal of Emergency Medicine. 21(1):32-4, 2003 Jan AS - Am J Emerg Med. 21(1):32-4, 2003 Jan NJ - The American journal of emergency medicine VO - 21 IP - 1 PG - 32-4 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Cohort Studies MH - Drug Overdose MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - *Heroin/po [Poisoning] MH - *Heroin Dependence/co [Complications] MH - Heroin Dependence/ep [Epidemiology] MH - Heroin Dependence/th [Therapy] MH - *Hospitals, Urban/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - Middle Aged MH - *Narcotics/po [Poisoning] MH - *Pulmonary Edema/ci [Chemically Induced] MH - Pulmonary Edema/ep [Epidemiology] MH - Pulmonary Edema/th [Therapy] MH - Retrospective Studies MH - Risk Factors MH - Time Factors AB - The study objective was to describe the morbidity of patients presenting with heroin overdose (HOD)-induced noncardiogenic pulmonary edema (NCPE) at an urban ED. A retrospective chart review of patients presenting between 1996 and 1999 with the diagnosis of HOD was conducted. Using a standardized data abstraction form, information on prehospital care, ED care, demographics, and cointoxications was collected. One hundred twenty-five charts (78%) were available for review. Of these, 13 (10%) were diagnosed with NCPE and all were male. In the field, NCPE patients had an average relative risk of 6, a Glasgow Coma Scale of 4, and all needed naloxone. The average admitted duration of use was 2.9 years for those who developed NCPE compared with 13.2 years for those who did not. Five (42%) NCPE patients tested positive for cocaine use and 7 (58%) tested positive for alcohol. In this cohort, the NCPE patients were male and less experienced users with initial low relative risk and Glasgow Coma Scale which demanded prehospital naloxone use. (Am J Emerg Med 2003;21:32-34. Copyright 2003, Elsevier Science (USA). All rights reserved.) RN - 0 (Narcotics) RN - 70D95007SX (Heroin) IS - 0735-6757 IL - 0735-6757 PT - Journal Article ID - 10.1053/ajem.2003.50006 [doi] ID - S0735675702422073 [pii] PP - ppublish LG - English DP - 2003 Jan EZ - 2003/02/04 04:00 DA - 2003/02/26 04:00 DT - 2003/02/04 04:00 YR - 2003 ED - 20030225 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12563576 <767. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12109584 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wang HE FA - Wang, Henry E IN - Wang, Henry E. Department of Emergency Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center-McKeesport Hospital, Pennsylvania 15238, USA. wanghe@msx.upmc.edu TI - Street drug toxicity resulting from opiates combined with anticholinergics. SO - Prehospital Emergency Care. 6(3):351-4, 2002 Jul-Sep AS - Prehosp Emerg Care. 6(3):351-4, 2002 Jul-Sep NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 6 IP - 3 PG - 351-4 PI - Journal available in: Print PI - Citation processed from: Print JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adult MH - *Alprazolam/po [Poisoning] MH - *Cholinergic Antagonists/po [Poisoning] MH - Combined Modality Therapy MH - Drug Interactions MH - Drug Overdose MH - Emergency Medical Services/mt [Methods] MH - Emergency Service, Hospital MH - Female MH - First Aid/mt [Methods] MH - Follow-Up Studies MH - *Heroin MH - Humans MH - Risk Assessment MH - *Substance Abuse, Intravenous/di [Diagnosis] MH - Substance Abuse, Intravenous/dt [Drug Therapy] RN - 0 (Cholinergic Antagonists) RN - 70D95007SX (Heroin) RN - YU55MQ3IZY (Alprazolam) IS - 1090-3127 IL - 1090-3127 PT - Case Reports PT - Journal Article ID - S1090312702501234 [pii] PP - ppublish LG - English DP - 2002 Jul-Sep EZ - 2002/07/12 10:00 DA - 2003/01/11 04:00 DT - 2002/07/12 10:00 YR - 2002 ED - 20030110 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12109584 <768. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12483195 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bledsoe BE FA - Bledsoe, Bryan E IN - Bledsoe, Bryan E. bbledsoe@earthlink.net TI - No more coma cocktails. Using science to dispel myths & improve patient care. CM - Comment in: JEMS. 2003 Jan;28(1):14; author reply 14; PMID: 12564425 CM - Comment in: JEMS. 2003 Jan;28(1):14; author reply 14; PMID: 12632571 SO - Journal of Emergency Medical Services. 27(11):54-60, 2002 Nov AS - J Emerg Med Serv JEMS. 27(11):54-60, 2002 Nov NJ - JEMS : a journal of emergency medical services VO - 27 IP - 11 PG - 54-60 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Coma/dt [Drug Therapy] MH - Drug Combinations MH - *Emergency Medical Services/st [Standards] MH - *Evidence-Based Medicine MH - Flumazenil/ad [Administration & Dosage] MH - GABA Modulators/ad [Administration & Dosage] MH - Glucose/ad [Administration & Dosage] MH - Humans MH - Hypoglycemia/dt [Drug Therapy] MH - Naloxone/ad [Administration & Dosage] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Quality Assurance, Health Care/mt [Methods] MH - Thiamine/ad [Administration & Dosage] MH - United States AB - It should be clear from this discussion that coma cocktails are a bad idea and should be immediately abandoned. In fact, the indiscriminate use of the coma cocktail may indeed harm patients, EMS has evolved to a point where any EMS provider should be able to reasonably determine the most likely cause of coma, or, in a worst-case scenario, narrow the cause to but a few possibilities. Certainly, patients with bona fide hypoglycemia should receive IV glucose. Because the consequences of prolonged hypoglycemia are severe, if there's a doubt about whether hypoglycemia is present, then glucose should be empirically administered. Naloxone should be used only for those cases in which a narcotic overdose appears likely. Similarly thiamine administration should be limited to patients suspected of chronic alcohol abuse and who exhibit at least one of the three symptoms of WE described above. Flumazenil has no role in the routine treatment of coma unless the patient is known to not be benzodiazepine dependent and the overdose is known to result only from benzos--two very difficult requirements to verify in the back of an ambulance at 2 a.m. Coma cocktails are bad medicine. Let's banish them from our EMS armamentarium. RN - 0 (Drug Combinations) RN - 0 (GABA Modulators) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 40P7XK9392 (Flumazenil) RN - IY9XDZ35W2 (Glucose) RN - X66NSO3N35 (Thiamine) IS - 0197-2510 IL - 0197-2510 PT - Journal Article ID - S0197251002500036 [pii] PP - ppublish LG - English DP - 2002 Nov EZ - 2002/12/17 04:00 DA - 2003/01/08 04:00 DT - 2002/12/17 04:00 YR - 2002 ED - 20030107 RD - 20160803 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12483195 <769. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12359034 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gueye PN AU - Megarbane B AU - Borron SW AU - Adnet F AU - Galliot-Guilley M AU - Ricordel I AU - Tourneau J AU - Goldgran-Toledano D AU - Baud FJ FA - Gueye, P N FA - Megarbane, B FA - Borron, S W FA - Adnet, F FA - Galliot-Guilley, M FA - Ricordel, I FA - Tourneau, J FA - Goldgran-Toledano, D FA - Baud, F J IN - Gueye, P N. Reanimation Medicale et Toxicologique, Groupe hospitalier Lariboisiere - Fernand Widal Assistance Publique-Hopitaux de Paris and INSERM U-26, Paris, France. p.gueye@wanadoo.fr TI - Trends in opiate and opioid poisonings in addicts in north-east Paris and suburbs, 1995-99. SO - Addiction. 97(10):1295-304, 2002 Oct AS - Addiction. 97(10):1295-304, 2002 Oct NJ - Addiction (Abingdon, England) VO - 97 IP - 10 PG - 1295-304 PI - Journal available in: Print PI - Citation processed from: Print JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Adult MH - Buprenorphine/tu [Therapeutic Use] MH - Drug Overdose/ep [Epidemiology] MH - Female MH - Hospitalization/td [Trends] MH - Humans MH - Male MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/rh [Rehabilitation] MH - Paris/ep [Epidemiology] MH - Retrospective Studies AB - AIMS: (1). To assess the trends in the number, mortality and the nature of severe opiate/opioid poisonings from 1995 to 1999 in north-east Paris and adjacent suburbs and (2). to examine the effects of the introduction of high-dose buprenorphine on these parameters. AB - DESIGN: Retrospective, 5-year study with review of pre-hospital, hospital and post-mortem data. AB - SETTING AND PARTICIPANTS: Eighty patients from the toxicological intensive care unit (TICU) in north-east Paris, 421 patients from the pre-hospital emergency medical service in a north-east suburb of Paris (SAMU 93) and 40 deaths from the coroner's office in Paris. AB - MEASUREMENTS AND RESULTS: We found that the number of pre-hospital opiate/opioid poisonings and deaths decreased over 5 years. During the same time frame, opiate/opioid poisoning admissions to our TICU remained steady, but the number of deaths declined. From 1995 to 1999, the detection of buprenorphine among opiate/opioid-poisoned TICU patients increased from two to eight occurrences per year while detection of opiates diminished from 17 to 10 occurrences per year. Increased buprenorphine detection correlated directly with increasing sales over this time period. In spite of the increased use of buprenorphine, the mortality associated with opiate/opioid poisonings has diminished in the pre-hospital environment from 9% in 1995 to 0% in 1999, and in the TICU from 12% in 1995 to 0% in 1997 and thereafter. We found a high frequency of multiple opiate/opioid use in severe poisonings, as well as the frequent association of other psychoactive drugs including ethanol. AB - CONCLUSIONS: The number and the mortality of opiate/opioid poisonings appear to be stable or decreasing in our region. The association of multiple opiates/ opioids appears nearly as common as the association with other psychoactive drugs. The introduction of high-dose buprenorphine coincides with a decrease in opiate/opioid poisoning mortality. Further study will be necessary to clarify this observation. RN - 0 (Narcotic Antagonists) RN - 40D3SCR4GZ (Buprenorphine) IS - 0965-2140 IL - 0965-2140 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 189 [pii] PP - ppublish LG - English DP - 2002 Oct EZ - 2002/10/03 04:00 DA - 2002/12/28 04:00 DT - 2002/10/03 04:00 YR - 2002 ED - 20021227 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12359034 <770. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12442734 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Haas DA FA - Haas, Daniel A IN - Haas, Daniel A. Department of Clinical Sciences, Discipline of Anesthesia, Faculty of Dentistry, Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. daniel.haas@utoronto.ca TI - Emergency drugs. [Review] [25 refs] SO - Dental Clinics of North America. 46(4):815-30, 2002 Oct AS - Dent Clin North Am. 46(4):815-30, 2002 Oct NJ - Dental clinics of North America VO - 46 IP - 4 PG - 815-30 PI - Journal available in: Print PI - Citation processed from: Print JC - e10, 0217440, 0217440 IO - Dent. Clin. North Am. SB - Dental Journals SB - Index Medicus CP - United States MH - Adrenergic Agonists/tu [Therapeutic Use] MH - Adult MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Anti-Allergic Agents/tu [Therapeutic Use] MH - Anti-Inflammatory Agents/tu [Therapeutic Use] MH - Bronchodilator Agents/tu [Therapeutic Use] MH - Child MH - *Dental Care MH - *Drug Therapy MH - Emergencies MH - *Emergency Treatment MH - Histamine H1 Antagonists/tu [Therapeutic Use] MH - Humans MH - Hypnotics and Sedatives/tu [Therapeutic Use] MH - Hypoglycemic Agents/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Oxygen Inhalation Therapy MH - Parasympatholytics/tu [Therapeutic Use] MH - Platelet Aggregation Inhibitors/tu [Therapeutic Use] MH - Steroids MH - Vasodilator Agents/tu [Therapeutic Use] AB - There is universal agreement that dentists require emergency drugs to be readily available. Opinions differ as to the specific drugs that should comprise an emergency kit. This article has provided one opinion. Oxygen, epinephrine, nitroglycerin, injectable diphenhydramine or chlorpheniramine, albuterol, and aspirin should be readily available in a dental office. Other drugs such as glucagon, atropine, ephedrine, hydrocortisone, morphine or nitrous oxide, naloxone, midazolam or lorazepam, and flumazenil should also be considered. There are differences in the level of training of dentists in the management of medical emergencies [25]. Therefore the final decision should be made by the individual dentist who is in the best position to determine the appropriateness of these agents for the particular practice. Despite the best efforts at prevention, emergencies may still arise. Plans to manage these events are needed and there is the possibility that the drugs discussed above may be required. Their presence may save a life. [References: 25] RN - 0 (Adrenergic Agonists) RN - 0 (Analgesics, Opioid) RN - 0 (Anti-Allergic Agents) RN - 0 (Anti-Inflammatory Agents) RN - 0 (Bronchodilator Agents) RN - 0 (Histamine H1 Antagonists) RN - 0 (Hypnotics and Sedatives) RN - 0 (Hypoglycemic Agents) RN - 0 (Narcotic Antagonists) RN - 0 (Parasympatholytics) RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (Steroids) RN - 0 (Vasodilator Agents) IS - 0011-8532 IL - 0011-8532 PT - Journal Article PT - Review ID - S0011-8532(02)00027-7 [pii] PP - ppublish LG - English DP - 2002 Oct EZ - 2002/11/22 04:00 DA - 2002/12/27 04:00 DT - 2002/11/22 04:00 YR - 2002 ED - 20021226 RD - 20171219 UP - 20171219 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=12442734 <771. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12442238 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Paoloni R AU - Talbot-Stern J FA - Paoloni, Richard FA - Talbot-Stern, Janet IN - Paoloni, Richard. Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, Australia. TI - Low incidence of nausea and vomiting with intravenous opiate analgesia in the ED. SO - American Journal of Emergency Medicine. 20(7):604-8, 2002 Nov AS - Am J Emerg Med. 20(7):604-8, 2002 Nov NJ - The American journal of emergency medicine VO - 20 IP - 7 PG - 604-8 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Antiemetics/ad [Administration & Dosage] MH - *Antiemetics/tu [Therapeutic Use] MH - Double-Blind Method MH - *Emergency Treatment/ut [Utilization] MH - Female MH - Guideline Adherence/sn [Statistics & Numerical Data] MH - Hemodynamics MH - Humans MH - Incidence MH - Infusions, Intravenous MH - Male MH - Metoclopramide/ad [Administration & Dosage] MH - *Metoclopramide/tu [Therapeutic Use] MH - Middle Aged MH - Nausea/ci [Chemically Induced] MH - *Nausea/ep [Epidemiology] MH - Nausea/pc [Prevention & Control] MH - New South Wales/ep [Epidemiology] MH - Practice Guidelines as Topic MH - Prospective Studies MH - Vomiting/ci [Chemically Induced] MH - *Vomiting/ep [Epidemiology] MH - Vomiting/pc [Prevention & Control] AB - Two double-blind, placebo-controlled, prospective randomized trials in the emergency department (ED) setting have examined the use of metoclopramide for the prevention of opiate-induced nausea and vomiting. Both showed a low incidence of vomiting in the control group. This prospective observational study in 205 unselected ED patients with acute pain syndromes measured nausea and vomiting before intravenous opiate administration and 30 and 60 minutes posttreatment. Cumulative incidence of vomiting was 1.5% at 30 minutes and 2.4% at 60 minutes. Corresponding figures for nausea were 4.9% at 30 minutes and 9.3% at 60 minutes, with more than 75% of patients rating their nausea as mild. Prevalence of both nausea and vomiting were higher at baseline than after analgesia. These data support the findings of previous randomized trials that the incidence of nausea and vomiting after intravenous opiate analgesia in the ED is low and argues against routine use of prophylactic antiemetic administration in combination with opiate analgesia. Copyright 2002, Elsevier Science (USA). All rights reserved.) RN - 0 (Analgesics, Opioid) RN - 0 (Antiemetics) RN - L4YEB44I46 (Metoclopramide) IS - 0735-6757 IL - 0735-6757 PT - Journal Article ID - 10.1053/ajem.2002.35457 [doi] ID - S0735675702000992 [pii] PP - ppublish LG - English DP - 2002 Nov EZ - 2002/11/21 04:00 DA - 2002/12/17 04:00 DT - 2002/11/21 04:00 YR - 2002 ED - 20021213 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12442238 <772. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12239500 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schneir AB AU - Vadeboncoeur TF AU - Offerman SR AU - Barry JD AU - Ly BT AU - Williams SR AU - Clark RF FA - Schneir, Aaron B FA - Vadeboncoeur, Tyler F FA - Offerman, Steven R FA - Barry, James D FA - Ly, Binh T FA - Williams, Saralyn R FA - Clark, Richard F IN - Schneir, Aaron B. Division of Medical Toxicology, Department of Emergency Medicine, University of California San Diego Medical Center, 92103-8925, USA. aschneir@ucsd.edu TI - Massive OxyContin ingestion refractory to naloxone therapy. SO - Annals of Emergency Medicine. 40(4):425-8, 2002 Oct AS - Ann Emerg Med. 40(4):425-8, 2002 Oct NJ - Annals of emergency medicine VO - 40 IP - 4 PG - 425-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Female MH - Humans MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Oxycodone/ai [Antagonists & Inhibitors] MH - *Oxycodone/po [Poisoning] MH - Respiration, Artificial MH - Severity of Illness Index MH - Suicide, Attempted MH - Treatment Outcome AB - OxyContin (oxycodone hydrochloride controlled release) is a long-acting preparation of oxycodone that is used as an opioid analgesic to treat chronic pain conditions. We report a patient who ingested a massive quantity of OxyContin and had altered mental status, noncardiogenic pulmonary edema, and hypoventilation that proved refractory to naloxone administration. She required mechanical ventilation for 3 days before recovering completely. The severity and length of poisoning was likely related both to the quantity and formulation of the oxycodone ingested. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - CD35PMG570 (Oxycodone) IS - 0196-0644 IL - 0196-0644 PT - Case Reports PT - Journal Article ID - S0196064402000653 [pii] PP - ppublish LG - English DP - 2002 Oct EZ - 2002/09/20 10:00 DA - 2002/10/17 04:00 DT - 2002/09/20 10:00 YR - 2002 ED - 20021016 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12239500 <773. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12101174 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kelly AM AU - Koutsogiannis Z FA - Kelly, A-M FA - Koutsogiannis, Z TI - Intranasal naloxone for life threatening opioid toxicity. SO - Emergency Medicine Journal. 19(4):375, 2002 Jul AS - Emerg Med J. 19(4):375, 2002 Jul NJ - Emergency medicine journal : EMJ VO - 19 IP - 4 PG - 375 PI - Journal available in: Print PI - Citation processed from: Print JC - b0u, 100963089 IO - Emerg Med J PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725919 SB - Index Medicus CP - England MH - Administration, Intranasal MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services MH - *Heroin Dependence/dt [Drug Therapy] MH - Humans MH - Injections MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1472-0205 IL - 1472-0205 PT - Letter ID - PMC1725919 [pmc] PP - ppublish LG - English DP - 2002 Jul EZ - 2002/07/09 10:00 DA - 2002/09/28 04:00 DT - 2002/07/09 10:00 YR - 2002 ED - 20020927 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12101174 <774. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12162157 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Leblanc A AU - Benbrick N AU - Moreau MH FA - Leblanc, A FA - Benbrick, N FA - Moreau, M H IN - Leblanc, A. Service de pediatrie-neonatologie, centre hospitalier sud-francilien, 91014 Evry, France. antoine.leblanc@easynet.fr TI - [Methadone poisoning in a 1-year-old child treated by continuous infusion of naloxone]. [French] OT - Intoxication par la methadone chez un enfant d'un an traite par perfusion continue de naloxone. SO - Archives de Pediatrie. 9(7):694-6, 2002 Jul AS - Arch Pediatr. 9(7):694-6, 2002 Jul NJ - Archives de pediatrie : organe officiel de la Societe francaise de pediatrie VO - 9 IP - 7 PG - 694-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 9421356, bwh IO - Arch Pediatr SB - Index Medicus CP - France MH - Accidents MH - Age Factors MH - Emergencies MH - Humans MH - Infant MH - Male MH - *Methadone/po [Poisoning] MH - *Naloxone/ad [Administration & Dosage] MH - Time Factors AB - UNLABELLED: Methadone is a synthetic narcotic used in opioid dependent situations. Child intoxications are harmful, sometimes responsible for death. AB - CASE REPORT: An one-year-old infant was seen in the emergency room, two hours after accidental methadone ingestion. He presented with coma, myosis and respiratory depression. After intubation, symptoms disappeared with naloxone injection. For maintaining this child safe, naloxone was given by continuous infusion during 48 hours. AB - CONCLUSION: Patients, families and professionals should be informed of the risks of methadone intoxication. Owing to methadone long duration of action, initial injection of naloxone, the specific opioid antagonist, must be followed by continuous infusion. RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) IS - 0929-693X IL - 0929-693X PT - Case Reports PT - English Abstract PT - Journal Article PP - ppublish LG - French DP - 2002 Jul EZ - 2002/08/07 10:00 DA - 2002/09/21 10:01 DT - 2002/08/07 10:00 YR - 2002 ED - 20020920 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12162157 <775. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11789651 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barton ED AU - Ramos J AU - Colwell C AU - Benson J AU - Baily J AU - Dunn W FA - Barton, Erik D FA - Ramos, Joseph FA - Colwell, Christopher FA - Benson, Jeff FA - Baily, Jeff FA - Dunn, William IN - Barton, Erik D. Division of Emergency Medicine, University of Utah Health Sciences Center, Salt Lake City 84132, USA. edbarton@worldnet.att.net TI - Intranasal administration of naloxone by paramedics. SO - Prehospital Emergency Care. 6(1):54-8, 2002 Jan-Mar AS - Prehosp Emerg Care. 6(1):54-8, 2002 Jan-Mar NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 6 IP - 1 PG - 54-8 PI - Journal available in: Print PI - Citation processed from: Print JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Administration, Intranasal MH - Colorado MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services MH - *Emergency Medical Technicians MH - Humans MH - Injections, Intravenous MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/ae [Adverse Effects] MH - Prospective Studies MH - Risk Factors AB - INTRODUCTION: Naloxone is a medication that is frequently administered in the field by paramedics for suspected opioid overdoses. Most prehospital protocols, however, require this medication to be given to patients intravenously (i.v.) or intramuscularly (i.m.). Unfortunately, intravenous line placement may be problematic and time-consuming in chronic i.v. drug users. There may also be a delay in patient response to opioid reversal with i.m. absorption of naloxone. Additionally, routine use of needles in high-risk populations poses an increased risk of occupational blood exposures to paramedics. AB - OBJECTIVE: To prospectively test the effectiveness of intranasal (i.n.) naloxone administration by paramedics. This preliminary report summarizes the first month's experience in the city of Denver. AB - METHODS: Naloxone was first administered to patients found unconscious in the field using a nasal mucosal atomizer device (MAD). Patients were then treated using standard prehospital protocols, which included i.v. line placement and medications, if they did not immediately respond to i.n. naloxone. Time to patient response was recorded. AB - RESULTS: A total of 30 patients received i.n. naloxone in the field over a one-month period. Of these, 11 patients responded to either i.n. or i.v. naloxone. Ten (91%) patients responded to i.n. naloxone alone, with an average response time of 3.4 minutes. Seven patients (64%) did not require an i.v. in the field after response to i.n. naloxone. AB - CONCLUSIONS: Intranasal naloxone may provide a safe, rapid, effective way to manage suspected opioid overdoses in the field. Use of this route may decrease paramedic exposures to blood-borne diseases. The addition of i.n. naloxone administration to prehospital protocols should be considered as an initial therapy for suspected opioid abusers. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 1090-3127 IL - 1090-3127 PT - Journal Article ID - S1090312702501659 [pii] PP - ppublish LG - English DP - 2002 Jan-Mar EZ - 2002/01/16 10:00 DA - 2002/07/13 10:01 DT - 2002/01/16 10:00 YR - 2002 ED - 20020712 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11789651 <776. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 12063717 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Klockgether-Radke AP AU - Gaus P AU - Neumann P FA - Klockgether-Radke, A P FA - Gaus, P FA - Neumann, P IN - Klockgether-Radke, A P. Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universitat Gottingen, Robert-Koch-Strasse 40, 37075 Gottingen. Klockgether-Radke@gmx.de TI - [Opioid intoxication following transdermal administration of fentanyl]. [German] OT - Opioidintoxikation durch transdermales Fentanyl. SO - Anaesthesist. 51(4):269-71, 2002 Apr AS - Anaesthesist. 51(4):269-71, 2002 Apr NJ - Der Anaesthesist VO - 51 IP - 4 PG - 269-71 PI - Journal available in: Print PI - Citation processed from: Print JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Administration, Cutaneous MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/po [Poisoning] MH - Female MH - Fentanyl/ad [Administration & Dosage] MH - *Fentanyl/po [Poisoning] MH - Humans MH - Medication Errors MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] AB - The case of a 77-year-old woman is described, who was found unconscious, with decreased respiration and miotic pupils, having previously experienced dizziness, nausea and drowsiness before. In the emergency room a fentanyl patch was detected, which had obviously been mistakenly applied by the patient the day before. Opioid intoxication was assumed and successfully treated with naloxon. The patient was supervised in an ICU for 24 h and sent home the next day without serious sequelae. The consequences following inappropriate use of transdermal fentanyl are discussed. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0003-2417 IL - 0003-2417 PT - Case Reports PT - English Abstract PT - Journal Article PP - ppublish LG - German DP - 2002 Apr EZ - 2002/06/18 10:00 DA - 2002/07/04 10:01 DT - 2002/06/18 10:00 YR - 2002 ED - 20020703 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=12063717 <777. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11971843 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Clarke S AU - Dargan P FA - Clarke, Simon FA - Dargan, Paul TI - Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Intravenous or intramuscular/subcutaneous naloxone in opioid overdose. SO - Emergency Medicine Journal. 19(3):249, 2002 May AS - Emerg Med J. 19(3):249, 2002 May NJ - Emergency medicine journal : EMJ VO - 19 IP - 3 PG - 249 PI - Journal available in: Print PI - Citation processed from: Print JC - b0u, 100963089 IO - Emerg Med J PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725871 SB - Index Medicus CP - England MH - Adult MH - *Antidotes/ad [Administration & Dosage] MH - Evidence-Based Medicine MH - Heroin Dependence/th [Therapy] MH - Humans MH - Injections, Intramuscular MH - Injections, Intravenous MH - Injections, Subcutaneous MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] AB - A short cut review was carried out to establish whether intramuscular/subcutaneous naloxone is better than intravenous naloxone in opioid overdose. Altogether 185 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated. RN - 0 (Antidotes) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1472-0205 IL - 1472-0205 PT - Case Reports PT - Journal Article ID - PMC1725871 [pmc] PP - ppublish LG - English DP - 2002 May EZ - 2002/04/25 10:00 DA - 2002/06/19 10:01 DT - 2002/04/25 10:00 YR - 2002 ED - 20020618 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11971843 <778. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11971844 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Clarke S AU - Dargan P FA - Clarke, Simon FA - Dargan, Paul TI - Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Discharge of patients who have taken an overdose of opioids. SO - Emergency Medicine Journal. 19(3):250-1, 2002 May AS - Emerg Med J. 19(3):250-1, 2002 May NJ - Emergency medicine journal : EMJ VO - 19 IP - 3 PG - 250-1 PI - Journal available in: Print PI - Citation processed from: Print JC - b0u, 100963089 IO - Emerg Med J PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725865 SB - Index Medicus CP - England MH - Adult MH - Drug Overdose MH - *Evidence-Based Medicine MH - Female MH - *Heroin Dependence/th [Therapy] MH - Humans MH - *Length of Stay MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Patient Discharge AB - A short cut review was carried out to establish whether patients with no recurrence of symptoms one hour after receiving naloxone for an opioid overdose can safely be discharged. Altogether 195 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1472-0205 IL - 1472-0205 PT - Case Reports PT - Journal Article ID - PMC1725865 [pmc] PP - ppublish LG - English DP - 2002 May EZ - 2002/04/25 10:00 DA - 2002/06/19 10:01 DT - 2002/04/25 10:00 YR - 2002 ED - 20020618 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11971844 <779. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11971842 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Clarke S AU - Dargan P FA - Clarke, Simon FA - Dargan, Paul TI - Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Intravenous bolus or infusion of naloxone in opioid overdose. SO - Emergency Medicine Journal. 19(3):249-50, 2002 May AS - Emerg Med J. 19(3):249-50, 2002 May NJ - Emergency medicine journal : EMJ VO - 19 IP - 3 PG - 249-50 PI - Journal available in: Print PI - Citation processed from: Print JC - b0u, 100963089 IO - Emerg Med J PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725855 SB - Index Medicus CP - England MH - Adult MH - *Antidotes/ad [Administration & Dosage] MH - Drug Overdose/th [Therapy] MH - Evidence-Based Medicine MH - Heroin Dependence/th [Therapy] MH - Humans MH - Infusions, Intravenous MH - Male MH - *Methadone/po [Poisoning] MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Opioid-Related Disorders/th [Therapy] AB - A short cut review was carried out to establish whether intravenous boluses of naloxone are better than intravenous infusion in opioid overdose. Altogether 188 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper is tabulated. A clinical bottom line is stated. RN - 0 (Antidotes) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - UC6VBE7V1Z (Methadone) IS - 1472-0205 IL - 1472-0205 PT - Case Reports PT - Comparative Study PT - Journal Article ID - PMC1725855 [pmc] PP - ppublish LG - English DP - 2002 May EZ - 2002/04/25 10:00 DA - 2002/06/19 10:01 DT - 2002/04/25 10:00 YR - 2002 ED - 20020618 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11971842 <780. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11789468 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kattwinkel J AU - Niermeyer S AU - Nadkarni V AU - Tibballs J AU - Phillips B AU - Zideman D AU - Van Reempts P AU - Osmond M AU - Pediatric Working Group of the International Liaison Committee on Resuscitation FA - Kattwinkel, J FA - Niermeyer, S FA - Nadkarni, V FA - Tibballs, J FA - Phillips, B FA - Zideman, D FA - Van Reempts, P FA - Osmond, M FA - Pediatric Working Group of the International Liaison Committee on Resuscitation TI - An advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation. SO - Middle East Journal of Anesthesiology. 16(3):315-51, 2001 Oct AS - Middle East J Anesthesiol. 16(3):315-51, 2001 Oct NJ - Middle East journal of anaesthesiology VO - 16 IP - 3 PG - 315-51 PI - Journal available in: Print PI - Citation processed from: Print JC - 8604187 IO - Middle East J Anaesthesiol SB - Index Medicus CP - Lebanon MH - Environment MH - Epinephrine/tu [Therapeutic Use] MH - Female MH - Hemodynamics MH - Humans MH - *Infant, Newborn/ph [Physiology] MH - Meconium/ph [Physiology] MH - *Pediatrics/st [Standards] MH - Pregnancy MH - Respiration, Artificial MH - Respiratory System Agents/tu [Therapeutic Use] MH - Resuscitation/is [Instrumentation] MH - Resuscitation/mt [Methods] MH - *Resuscitation/st [Standards] MH - Terminology as Topic AB - The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly born infant included the following principles: Personnel trained in the basic skills of resuscitation should be in attendance at every delivery. A minority (fewer than 10%) of newly born infants require active resuscitative interventions to establish a vigorous cry and regular respirations, maintain a heart rate > 100 beats per minute (bpm), and maintain good color and tone. When meconium is present in the amniotic fluid, it should be suctioned from the hypopharynx on delivery of the head. If the meconium-stained newly born infant has absent or depressed respirations, heart rate, or muscle tone, residual meconium should be suctioned from the trachea. Attention to ventilation should be of primary concern. Assisted ventilation with attention to oxygen delivery, inspiratory time, and effectiveness judged by chest rise should be provided if stimulation does not achieve prompt onset of spontaneous respirations and/or the heart rate is < 100 bpm. Chest compressions should be provided if the heart rate is absent or remains < 60 bpm despite adequate assisted ventilation for 30 seconds. Chest compressions should be coordinated with ventilations at a ratio of 3:1 and a rate of 120 "events" per minute to achieve approximately 90 compressions and 30 rescue breaths per minute. Epinephrine should be administered intravenously or intratracheally if the heart rate remains < 60 bpm despite 30 seconds of effective assisted ventilation and chest compression circulation. Common or controversial medications (epineprine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines. RN - 0 (Respiratory System Agents) RN - YKH834O4BH (Epinephrine) IS - 0544-0440 IL - 0544-0440 PT - Guideline PT - Journal Article PP - ppublish LG - English DP - 2001 Oct EZ - 2002/01/16 10:00 DA - 2002/06/12 10:01 DT - 2002/01/16 10:00 YR - 2001 ED - 20020611 RD - 20141010 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11789468 <781. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11675848 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Zolezzi M AU - Al Mohaimeed SA FA - Zolezzi, M FA - Al Mohaimeed, S A IN - Zolezzi, M. Department of Pharmaceutical Services, Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia. monizolezzi@yahoo.com TI - Seizures with intravenous codeine phosphate. SO - Annals of Pharmacotherapy. 35(10):1211-3, 2001 Oct AS - Ann Pharmacother. 35(10):1211-3, 2001 Oct NJ - The Annals of pharmacotherapy VO - 35 IP - 10 PG - 1211-3 PI - Journal available in: Print PI - Citation processed from: Print JC - bbx, 9203131 IO - Ann Pharmacother SB - Index Medicus CP - United States MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Anemia, Sickle Cell MH - Anticonvulsants/tu [Therapeutic Use] MH - Child MH - Codeine/ad [Administration & Dosage] MH - *Codeine/ae [Adverse Effects] MH - Diazepam/tu [Therapeutic Use] MH - Humans MH - Injections, Intravenous MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - *Seizures/ci [Chemically Induced] MH - Seizures/dt [Drug Therapy] MH - Treatment Outcome AB - OBJECTIVE: To describe an adverse effect with intravenous codeine in a chid diagnosed with sickle cell anemia. AB - CASE SUMMARY: A seven-year-old boy with sickle cell anemia was admitted to the emergency department with severe pain unresponsive to high doses of oral acetaminophen; subsequently, intravenous codeine phosphate was administered. The patient immediately developed a tonic-clonic seizure, which was treated with intravenous diazepam and naloxone. AB - DISCUSSION: Seizures associated with the intravenous administration of codeine phosphate have not been extensively reported in the literature, and special precautions for using the parenteral route for this drug have been vague and limited. Because of the frequent need for acute pain control in children with sicke cell crisis, they may be exposed to this type of reaction when intravenous narcotics are administered. The need for clear guidelines regarding the drug's appropriate parenteral dosing and administration is essential. AB - CONCLUSIONS: Codeine phosphate-induced seizures are not common. The need for special instructions for its intravenous administration may prevent this type of reaction, especially in patients in need of acute pain control requiring intravenous narcotics. RN - 0 (Analgesics, Opioid) RN - 0 (Anticonvulsants) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - Q3JTX2Q7TU (Diazepam) RN - Q830PW7520 (Codeine) IS - 1060-0280 IL - 1060-0280 PT - Case Reports PT - Journal Article ID - 10.1345/aph.10326 [doi] PP - ppublish LG - English DP - 2001 Oct EZ - 2001/10/26 10:00 DA - 2002/03/07 10:01 DT - 2001/10/26 10:00 YR - 2001 ED - 20020305 RD - 20170214 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11675848 <782. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11772672 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hamilton RJ AU - Olmedo RE AU - Shah S AU - Hung OL AU - Howland MA AU - Perrone J AU - Nelson LS AU - Lewin NL AU - Hoffman RS FA - Hamilton, Richard J FA - Olmedo, Ruben E FA - Shah, Sachin FA - Hung, Oliver L FA - Howland, Mary Ann FA - Perrone, Jeanmarie FA - Nelson, Lewis S FA - Lewin, Neal L FA - Hoffman, Robert S IN - Hamilton, Richard J. MCP Hahnemann University, Philadelphia, PA 19129, USA. richard.hamilton@drexel.edu TI - Complications of ultrarapid opioid detoxification with subcutaneous naltrexone pellets. CM - Comment in: Acad Emerg Med. 2002 Sep;9(9):960; PMID: 12208688 CM - Comment in: Acad Emerg Med. 2002 Sep;9(9):960-2; PMID: 12208687 SO - Academic Emergency Medicine. 9(1):63-8, 2002 Jan AS - Acad Emerg Med. 9(1):63-8, 2002 Jan NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 9 IP - 1 PG - 63-8 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Administration, Cutaneous MH - Adult MH - Delayed-Action Preparations/ae [Adverse Effects] MH - *Drug Implants/ae [Adverse Effects] MH - Emergency Treatment/ae [Adverse Effects] MH - Emergency Treatment/mt [Methods] MH - Epilepsy, Tonic-Clonic/et [Etiology] MH - Fatal Outcome MH - Female MH - Humans MH - Male MH - *Naltrexone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Pulmonary Edema/et [Etiology] MH - Risk Assessment MH - *Substance Withdrawal Syndrome/pc [Prevention & Control] MH - Time Factors MH - Unconsciousness/et [Etiology] MH - Vomiting/et [Etiology] AB - UNLABELLED: Rapid and ultrarapid opioid detoxification (ROD and UROD) centers promise quick, painless, same-day detoxification treatment for patients with opioid addiction. The goal of ROD and UROD is to provide a rapid transition from opioid dependency to oral naltrexone therapy. The patient is given general anesthesia and high-dose opioid antagonists. This induces a severe withdrawal but spares the patient the experience. In theory, the process is complete within four to five hours. The patient awakens without opioid dependency and is started on oral naltrexone. Any subsequent, persistent withdrawal symptoms are treated symptomatically. A novel, unapproved approach is to compound a pellet of naltrexone and implant it in the subcutaneous tissue. In theory, this should result in continuous therapeutic levels for this drug, and avoid issues with noncompliance. AB - CASE SERIES: This article reports six cases of complications from the same detoxification center that performed UROD with naltrexone pellet implantation, including pulmonary edema, prolonged withdrawal, drug toxicity, withdrawal from cross-addiction to alcohol and benzodiazepines, variceal rupture, aspiration pneumonia, and death. AB - CONCLUSIONS: The risks of this procedure are great and further studies should assess its safety and the novel use of naltrexone. RN - 0 (Delayed-Action Preparations) RN - 0 (Drug Implants) RN - 0 (Narcotic Antagonists) RN - 5S6W795CQM (Naltrexone) IS - 1069-6563 IL - 1069-6563 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 2002 Jan EZ - 2002/01/05 10:00 DA - 2002/02/09 10:01 DT - 2002/01/05 10:00 YR - 2002 ED - 20020208 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11772672 <783. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11672939 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Risser D AU - Honigschnabl S AU - Stichenwirth M AU - Pfudl S AU - Sebald D AU - Kaff A AU - Bauer G FA - Risser, D FA - Honigschnabl, S FA - Stichenwirth, M FA - Pfudl, S FA - Sebald, D FA - Kaff, A FA - Bauer, G IN - Risser, D. Institute of Forensic Medicine, University of Vienna, Sensengasse 2, A-1090 Vienna, Austria. daniele.risser@univie.ac.at TI - Mortality of opiate users in Vienna, Austria. SO - Drug & Alcohol Dependence. 64(3):251-6, 2001 Nov 01 AS - Drug Alcohol Depend. 64(3):251-6, 2001 Nov 01 NJ - Drug and alcohol dependence VO - 64 IP - 3 PG - 251-6 PI - Journal available in: Print PI - Citation processed from: Print JC - ebs, 7513587 IO - Drug Alcohol Depend SB - Index Medicus CP - Ireland MH - Adolescent MH - Adult MH - Austria/ep [Epidemiology] MH - Chi-Square Distribution MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Opioid-Related Disorders/mo [Mortality] MH - Opioid-Related Disorders/th [Therapy] MH - Retrospective Studies MH - Statistics, Nonparametric MH - Substance Abuse Treatment Centers/sn [Statistics & Numerical Data] AB - The purpose of this study was to investigate whether there are differences in overall and cause-specific mortality rates of opiate users in maintenance treatment and of opiate users not in any drug treatment program in Vienna, Austria. A cohort of opiate-users enrolled in maintenance treatment in Vienna and a cohort of individuals involved in opiate-related emergencies from 1995 to 1997 were retrospectively analyzed. The standardized mortality rate of opiate-users enrolled in maintenance treatment was 12.1 and that of individuals involved in opiate-related emergencies was 48.8. Excess mortality was found for all categories for both groups. In the face of the extremely high excess mortality of opiate users involved in opiate-related emergencies, measures have to be taken to get these individuals in drug treatment programs as soon as possible. IS - 0376-8716 IL - 0376-8716 PT - Journal Article ID - S0376871601001314 [pii] PP - ppublish LG - English DP - 2001 Nov 01 EZ - 2001/10/24 10:00 DA - 2002/01/05 10:01 DT - 2001/10/24 10:00 YR - 2001 ED - 20020103 RD - 20041117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11672939 <784. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11698998 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chumpa A AU - Kaplan RL AU - Burns MM AU - Shannon MW FA - Chumpa, A FA - Kaplan, R L FA - Burns, M M FA - Shannon, M W IN - Chumpa, A. Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. atima.delaney@tch.harvard.edu TI - Nalmefene for elective reversal of procedural sedation in children. SO - American Journal of Emergency Medicine. 19(7):545-8, 2001 Nov AS - Am J Emerg Med. 19(7):545-8, 2001 Nov NJ - The American journal of emergency medicine VO - 19 IP - 7 PG - 545-8 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid MH - Anesthetics, Intravenous/ae [Adverse Effects] MH - *Anesthetics, Intravenous MH - *Antidotes MH - Child MH - Child, Preschool MH - Emergency Medical Services MH - Female MH - Fentanyl/ae [Adverse Effects] MH - Humans MH - Infant MH - Male MH - Midazolam/ae [Adverse Effects] MH - *Naltrexone/aa [Analogs & Derivatives] MH - *Naltrexone/tu [Therapeutic Use] MH - Narcotic Antagonists/pd [Pharmacology] MH - *Narcotic Antagonists/tu [Therapeutic Use] AB - Nalmefene is a newer, long-acting opioid antagonist. Its use in children for the elective reversal of emergency department procedures has not been investigated. The objective was to evaluate the safety of nalmefene in children. An open-label pediatric clinical trial was performed. The study was conducted at the emergency department of an urban, university-affiliated children's hospital and consisted of children aged 6 months to 12 years who required procedural sedation where an opioid agent was administered. Patients were excluded if there was altered mental status, history of head trauma, history of opioid allergy, or the anticipated need for opioid agents for pain relief after the procedure. At the completion of the procedure, nalmefene was administered in a dose of 0.25 microg/kg increments (max 10 microg) until sedation was resolved, or to a maximum of 1.0 microg/kg (max 40 microg). Serial ECGs, vital signs, and oxygen saturation were recorded. Sedation was assessed using the Clinical Global Impression Scale (CGIS) at baseline, 2, 4, 6, 8, and 10 minutes after the initial nalmefene dose. The observer's assessment of alertness and sedation (OAA/S) was measured at baseline, 10, 30, 60, 90, and 120 minutes after the first dose of nalmefene. Episodes of resedation were recorded. All patients received follow-up by telephone at 4 and 24 hours after the initial dose of nalmefene to identify any potential late adverse effects. Over the study interval 15 patients were enrolled. Mean age was 59.1 +/- 41.5 months. Procedures involved fracture reduction (n=8), laceration repair (n = 4), abscess drainage (n = 2), and arthrocentesis (n = 1). All patients received IV fentanyl and midazolam. The mean dosage of fentanyl and midazolam was 3.21 +/- 1.03 microg/kg and 0.07 +/- 0.03 mg/kg, respectively. The mean dose of nalmefene at the time of complete response (CGIS = 1 or 2) was 0.55 +/- 0.29 microg/kg. The median number of nalmefene doses was 2. All but one patient (93%) had a complete response based on CGIS at 10 minutes after the initial dose of nalmefene was given. Nalmefene resulted in a significant improvement in CGIS (1.60 +/- 0.82 v 3.26 +/- 0.88, P =.001) and OAA/S (median score 5 v 4) when compared at baseline with 10 minutes after the initial dose of nalmefene. Nalmefene also resulted in increased diastolic blood pressure (62.6 +/- 10.5 v 55.8 +/- 10.7, P =.04) as well as improved oxygen saturation when compared at 120 minutes to baseline (99.5 +/- 0.74% v 98.5 +/- 0.4%, P =.03). There were no significant changes in pulse, systolic blood pressure, respiratory rate, and ECG. None of the patients became resedated after nalmefene was given. One patient developed nausea and vomiting within the first 2 hours after nalmefene; this resolved without intervention before discharge. No adverse events occurred in any of the patients at 4 and 24 hours postadministration. The results of this study showed that nalmefene is effective and safe for reversal of procedural sedation by opioids in children. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Intravenous) RN - 0 (Antidotes) RN - 0 (Narcotic Antagonists) RN - 5S6W795CQM (Naltrexone) RN - R60L0SM5BC (Midazolam) RN - TOV02TDP9I (nalmefene) RN - UF599785JZ (Fentanyl) IS - 0735-6757 IL - 0735-6757 PT - Clinical Trial PT - Journal Article ID - S0735-6757(01)16729-X [pii] ID - 10.1053/ajem.2001.27141 [doi] PP - ppublish LG - English DP - 2001 Nov EZ - 2001/11/08 10:00 DA - 2002/01/05 10:01 DT - 2001/11/08 10:00 YR - 2001 ED - 20011214 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11698998 <785. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11688626 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Degenhardt L AU - Hall W AU - Adelstein BA FA - Degenhardt, L FA - Hall, W FA - Adelstein, B A IN - Degenhardt, L. National Drug and Alcohol Research Centre, University of New South Wales. l.degenhardt@unsw.edu.au TI - Ambulance calls to suspected overdoses: New South Wales patterns July 1997 to June 1999. SO - Australian & New Zealand Journal of Public Health. 25(5):447-50, 2001 Oct AS - Aust N Z J Public Health. 25(5):447-50, 2001 Oct NJ - Australian and New Zealand journal of public health VO - 25 IP - 5 PG - 447-50 PI - Journal available in: Print PI - Citation processed from: Print JC - ck2, 9611095 IO - Aust N Z J Public Health SB - Index Medicus CP - Australia MH - Adolescent MH - Adult MH - Age Distribution MH - *Ambulances/ut [Utilization] MH - *Drug Overdose/ep [Epidemiology] MH - Drug Overdose/th [Therapy] MH - Emergency Medical Services/ut [Utilization] MH - Female MH - Geography MH - Heroin/ae [Adverse Effects] MH - Humans MH - Male MH - New South Wales/ep [Epidemiology] MH - Sex Distribution MH - Time Factors AB - AIM: Using data on New South Wales ambulance calls to suspected overdoses from July 1997 to June 1999 to: a) examine temporal and geographic trends in calls; and b) compare geographic patterns of fatal and non-fatal opioid overdose. AB - METHOD: The NSW Ambulance Service provided data on the occasions when an ambulance attended a person on whom the drug overdose/poisonings protocol was used, and to whom naloxone was administered. The geographic distribution of ambulance attendances was approximated to the Australian Bureau of Statistics Statistical Local Area (SLA) and Statistical Subdivision (SSD). Estimates of social disadvantage were correlated with the rate of ambulance attendances for each region. AB - RESULTS: 9,116 callouts were made. In cases with data on age and gender, 89% were aged 15-44 years, and 31% were female. South Sydney (n=1,819) and Liverpool (n=1,602) SLAs accounted for 37% of calls; the higher rates outside Sydney were in Newcastle, Orange and Kiama. There was a strong correlation between rates of ambulance callouts and fatal heroin overdoses. The number of calls increased from an average of 361 calls per month in 1997-98 to 399 in 1998-99. The majority of calls (54%) were made between midday and 9 pm. AB - CONCLUSIONS: Rates of ambulance attendance at suspected overdoses is a promising indicator that allows monitoring of trends and identification of areas with high rates of opioid use. RN - 70D95007SX (Heroin) IS - 1326-0200 IL - 1326-0200 PT - Journal Article PP - ppublish LG - English DP - 2001 Oct EZ - 2001/11/02 10:00 DA - 2002/01/05 10:01 DT - 2001/11/02 10:00 YR - 2001 ED - 20011207 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11688626 <786. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11494899 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Buniatian AA AU - Mizikov VM AU - Lovtsevich NV AU - Stamov VI AU - Flerov EV FA - Buniatian, A A FA - Mizikov, V M FA - Lovtsevich, N V FA - Stamov, V I FA - Flerov, E V TI - [Esterase-metabolized remifentanil hydrochloride opioid (Ultiva-TM), a new step towards the solution of the problem of regulation of analgetic components of general anesthesia]. [Russian] OT - Esterazometaboliziruemyi opioid remifentanila gidrokhlorid (Ultiva-TM)--novyi shag v reshenii problemy upravliaemosti anal'geticheskim komponentom obshchei anestezii. SO - Anesteziologiia i Reanimatologiia. (2):4-7, 2001 Mar-Apr AS - Anesteziol Reanimatol. (2):4-7, 2001 Mar-Apr NJ - Anesteziologiia i reanimatologiia IP - 2 PG - 4-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 4st, 7705399 IO - Anesteziol Reanimatol SB - Index Medicus CP - Russia (Federation) MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/me [Metabolism] MH - *Analgesics, Opioid/pd [Pharmacology] MH - *Anesthesia, Intravenous MH - Anesthetics, Intravenous/ad [Administration & Dosage] MH - Anesthetics, Intravenous/me [Metabolism] MH - *Anesthetics, Intravenous/pd [Pharmacology] MH - Cholecystectomy, Laparoscopic MH - Data Interpretation, Statistical MH - Esterases/me [Metabolism] MH - Fentanyl/ad [Administration & Dosage] MH - Fentanyl/pd [Pharmacology] MH - Heart/de [Drug Effects] MH - Hemodynamics/de [Drug Effects] MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - Hypnotics and Sedatives/pd [Pharmacology] MH - Middle Aged MH - Pain, Postoperative/dt [Drug Therapy] MH - Piperidines/ad [Administration & Dosage] MH - Piperidines/me [Metabolism] MH - *Piperidines/pd [Pharmacology] MH - Propofol/ad [Administration & Dosage] MH - Propofol/pd [Pharmacology] MH - Pulmonary Gas Exchange/de [Drug Effects] MH - Respiration, Artificial MH - Time Factors AB - Hemodynamics, gas exchange, velocity of psychomotor recovery, pain intensity during and after laparoscopic cholecystectomy were studied in patients anesthetized (total intravenous anesthesia) by two methods: 1) remifentanyl and propofol, forced ventilation of the lungs, and myoplegia (n = 21, ASA I-III) and 2) fentanyl and propofol, forced ventilation of the lungs, and myoplegia (n = 18, ASA I-III). Total intravenous anesthesia based on remifentanyl was characterized by stability of hemodynamic and gas exchange parameters at all stages of the intervention. This method ensured a smooth and rapid course of resuscitation, characterized by absence of signs of central respiration depression, predictable normalization of psychomotor status, and low incidence of factors provoking postoperative nausea and vomiting, on condition of their prevention. Further studies of remifentanyl are needed in interventions of different degree of traumatism and within the framework of different protocols of postoperative analgesia. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Intravenous) RN - 0 (Hypnotics and Sedatives) RN - 0 (Piperidines) RN - EC 3-1 (Esterases) RN - P10582JYYK (remifentanil) RN - UF599785JZ (Fentanyl) RN - YI7VU623SF (Propofol) IS - 0201-7563 IL - 0201-7563 PT - Comparative Study PT - English Abstract PT - Journal Article PP - ppublish LG - Russian DP - 2001 Mar-Apr EZ - 2001/08/10 10:00 DA - 2002/01/05 10:01 DT - 2001/08/10 10:00 YR - 2001 ED - 20011205 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11494899 <787. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11693142 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Graham CA AU - McNaughton GW AU - Ireland AJ AU - Cassells K FA - Graham, C A FA - McNaughton, G W FA - Ireland, A J FA - Cassells, K TI - Take home naloxone for opiate addicts. Drug misusers may benefit from training in cardiopulmonary resuscitation. CM - Comment on: BMJ. 2001 Apr 14;322(7291):895-6; PMID: 11302902 CM - Comment on: BMJ. 2001 Oct 20;323(7318):935; PMID: 11693144 CM - Comment on: BMJ. 2001 Oct 20;323(7318):934-5; author reply 935; PMID: 11693141 CM - Comment on: BMJ. 2001 Oct 20;323(7318):934; author reply 935; PMID: 11693143 SO - BMJ. 323(7318):934; author reply 935, 2001 Oct 20 AS - BMJ. 323(7318):934; author reply 935, 2001 Oct 20 NJ - BMJ (Clinical research ed.) VO - 323 IP - 7318 PG - 934; author reply 935 PI - Journal available in: Print PI - Citation processed from: Print JC - 8900488, bmj, 101090866 IO - BMJ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121450 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Cardiopulmonary Resuscitation MH - Drug Overdose/th [Therapy] MH - Humans MH - *Patient Education as Topic MH - Pilot Projects MH - *Substance-Related Disorders IS - 0959-8138 IL - 0959-535X PT - Comment PT - Letter ID - PMC1121450 [pmc] PP - ppublish LG - English DP - 2001 Oct 20 EZ - 2001/11/06 10:00 DA - 2002/01/05 10:01 DT - 2001/11/06 10:00 YR - 2001 ED - 20011204 RD - 20140613 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11693142 <788. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11554869 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bristow K AU - Meek R AU - Clark N FA - Bristow, K FA - Meek, R FA - Clark, N IN - Bristow, K. Emergency Department, Dandenong Hospital, Victoria, Australia. TI - Acute opioid withdrawal in the emergency department: inadvertent naltrexone abuse?. SO - Emergency Medicine (Fremantle, W.A.). 13(3):359-63, 2001 Sep AS - Emerg Med (Fremantle). 13(3):359-63, 2001 Sep NJ - Emergency medicine (Fremantle, W.A.) VO - 13 IP - 3 PG - 359-63 PI - Journal available in: Print PI - Citation processed from: Print JC - 9421464, d3y IO - Emerg Med (Fremantle) SB - Index Medicus CP - Australia MH - Acute Disease MH - Adult MH - *Colic/ci [Chemically Induced] MH - *Emergency Medical Services MH - Female MH - Heroin/ad [Administration & Dosage] MH - Heroin/ae [Adverse Effects] MH - Heroin Dependence MH - Humans MH - Injections, Intravenous MH - Naltrexone/ad [Administration & Dosage] MH - Naltrexone/ae [Adverse Effects] MH - *Narcotics/ae [Adverse Effects] MH - *Substance Withdrawal Syndrome MH - *Vomiting/ci [Chemically Induced] AB - From July 1999 it became evident that a rising number of heroin users were presenting to the Dandenong Hospital Emergency Department with a rapid onset, florid opioid withdrawal syndrome following the intravenous injection of what they had believed to be heroin. We suspect that the injected substance was in fact naltrexone. This paper describes two such cases and reviews the literature on naltrexone. Recommendations regarding the management of the acute opioid withdrawal syndrome are made. RN - 0 (Narcotics) RN - 5S6W795CQM (Naltrexone) RN - 70D95007SX (Heroin) IS - 1035-6851 IL - 1035-6851 PT - Case Reports PT - Journal Article ID - emm240 [pii] PP - ppublish LG - English DP - 2001 Sep EZ - 2001/09/14 10:00 DA - 2002/01/05 10:01 DT - 2001/09/14 10:00 YR - 2001 ED - 20011204 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11554869 <789. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11593374 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Singhal N AU - McMillan DD AU - Yee WH AU - Akierman AR AU - Yee YJ FA - Singhal, N FA - McMillan, D D FA - Yee, W H FA - Akierman, A R FA - Yee, Y J IN - Singhal, N. University of Calgary, Calgary, Alberta, Canada. TI - Evaluation of the effectiveness of the standardized neonatal resuscitation program. SO - Journal of Perinatology. 21(6):388-92, 2001 Sep AS - J Perinatol. 21(6):388-92, 2001 Sep NJ - Journal of perinatology : official journal of the California Perinatal Association VO - 21 IP - 6 PG - 388-92 PI - Journal available in: Print PI - Citation processed from: Print JC - jfp, 8501884 IO - J Perinatol SB - Index Medicus CP - United States MH - *Guideline Adherence MH - Humans MH - Infant, Newborn MH - Intubation, Intratracheal MH - Respiration, Artificial MH - *Resuscitation MH - Surveys and Questionnaires AB - OBJECTIVE: To determine if health care personnel trained in the Neonatal Resuscitation Program (NRP) used the NRP guidelines in the resuscitation of newborn babies. To determine differences between self-reporting and documentation of resuscitation in medical records. AB - STUDY DESIGN: Using a validated questionnaire, individuals participating in resuscitation of newborns voluntarily phoned and answered questions on an Interactive Voice Response (IVR) system. The study was undertaken in level II hospitals in Southern Alberta with 7500 deliveries per year. AB - RESULTS: Of the 5155 babies delivered during the study, 16% required resuscitation (bag and mask ventilation 10.6%, intubation for meconium or intermittent positive pressure ventilation, IPPV, 3.6%, cardiac massage, CM, 0.3%, epinephrine 0.1%, naloxone 6.9%). Of babies whose interventions could be assessed, bag and mask was correct in 99%, endotracheal intubation for IPPV in 100%, and CM in 100%. Only 75% of babies had meconium managed correctly and 92% had naloxone administered according to guidelines. There were more instances where IVR (48) reported a procedure, which was not charted versus charted and not reported by IVR (21). Educational needs identified by IVR included skills of resuscitation and NRP indications for management. AB - CONCLUSION: Bag and mask ventilation and intubation for neonatal resuscitation are more common than previously reported. Management of the meconium-stained baby and use of naloxone require further education. Compared to charts, use of IVR system allows more complete documentation with rationale of interventions and identification of continuing educational needs. IS - 0743-8346 IL - 0743-8346 PT - Evaluation Studies PT - Journal Article PT - Multicenter Study ID - 10.1038/sj.jp.7210551 [doi] PP - ppublish LG - English DP - 2001 Sep EZ - 2001/10/11 10:00 DA - 2001/11/03 10:01 DT - 2001/10/11 10:00 YR - 2001 ED - 20011101 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11593374 <790. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11520190 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wyckoff MH AU - Perlman J AU - Niermeyer S FA - Wyckoff, M H FA - Perlman, J FA - Niermeyer, S IN - Wyckoff, M H. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA. myra.wycoff@utsouthwestern.edu TI - Medications during resuscitation -- what is the evidence?. [Review] [89 refs] SO - Seminars in Neonatology. 6(3):251-9, 2001 Jun AS - Semin Neonatol. 6(3):251-9, 2001 Jun NJ - Seminars in neonatology : SN VO - 6 IP - 3 PG - 251-9 PI - Journal available in: Print PI - Citation processed from: Print JC - 9606001, dmm IO - Semin Neonatol SB - Index Medicus CP - Netherlands MH - *Asphyxia Neonatorum/th [Therapy] MH - *Cardiopulmonary Resuscitation MH - Combined Modality Therapy MH - Epinephrine/tu [Therapeutic Use] MH - Humans MH - Infant, Newborn MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Plasma Substitutes/tu [Therapeutic Use] MH - Sodium Bicarbonate/tu [Therapeutic Use] MH - Vasoconstrictor Agents/tu [Therapeutic Use] AB - Medication use during neonatal resuscitation is uncommon. The infrequent use of resuscitation medications has impeded rigorous investigations to determine the most effective agents and/or dosing regimens. The medications most commonly used during delivery room resuscitation include epinephrine, sodium bicarbonate, naloxone hydrochloride and volume expanders. The available evidence for each of these medications is reviewed in this article. Copyright 2001 Harcourt Publishers Ltd. [References: 89] RN - 0 (Narcotic Antagonists) RN - 0 (Plasma Substitutes) RN - 0 (Vasoconstrictor Agents) RN - 36B82AMQ7N (Naloxone) RN - 8MDF5V39QO (Sodium Bicarbonate) RN - YKH834O4BH (Epinephrine) IS - 1084-2756 IL - 1084-2756 PT - Journal Article PT - Review ID - 10.1053/siny.2001.0053 [doi] ID - S1084-2756(01)90053-3 [pii] PP - ppublish LG - English DP - 2001 Jun EZ - 2001/08/25 10:00 DA - 2001/10/26 10:01 DT - 2001/08/25 10:00 YR - 2001 ED - 20011025 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11520190 <791. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11386621 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Molina PE FA - Molina, P E IN - Molina, P E. Department of Physiology Louisiana State University Health Sciences Center, New Orleans 70112, USA. TI - Opiate modulation of hemodynamic, hormonal, and cytokine responses to hemorrhage. SO - Shock. 15(6):471-8, 2001 Jun AS - Shock. 15(6):471-8, 2001 Jun NJ - Shock (Augusta, Ga.) VO - 15 IP - 6 PG - 471-8 PI - Journal available in: Print PI - Citation processed from: Print JC - cae, 9421564 IO - Shock SB - Index Medicus CP - United States MH - Adrenocorticotropic Hormone/bl [Blood] MH - Animals MH - Apoptosis MH - Blood Pressure/de [Drug Effects] MH - Corticosterone/bl [Blood] MH - *Cytokines/me [Metabolism] MH - Disease Models, Animal MH - Hemodynamics/de [Drug Effects] MH - *Hemodynamics/ph [Physiology] MH - Interleukin-1/me [Metabolism] MH - Interleukin-10/me [Metabolism] MH - Interleukin-6/me [Metabolism] MH - Lung/de [Drug Effects] MH - *Lung/im [Immunology] MH - Male MH - *Naltrexone/pd [Pharmacology] MH - Narcotic Antagonists/pd [Pharmacology] MH - Neutrophils/ph [Physiology] MH - Peroxidase/an [Analysis] MH - Rats MH - Rats, Sprague-Dawley MH - Resuscitation MH - Shock, Hemorrhagic/bl [Blood] MH - Shock, Hemorrhagic/im [Immunology] MH - *Shock, Hemorrhagic/pp [Physiopathology] MH - Spleen/de [Drug Effects] MH - *Spleen/im [Immunology] MH - Time Factors MH - Tumor Necrosis Factor-alpha/me [Metabolism] MH - *beta-Endorphin/bl [Blood] AB - The aim of the present study was to examine the role of opiate receptor activation in modulating the hemodynamic, neuroendocrine, and tissue (lung and spleen) cytokine responses to fixed pressure (40 mm Hg) hemorrhage. Chronically catheterized, conscious unrestrained non-heparinized male Sprague-Dawley rats were pretreated with either naltrexone (15 mg/kg intraperitoneally in 0.5 mL of saline) or saline (0.5 mL) 15 min prior to hemorrhage followed by fluid resuscitation with Ringer's lactate. Animals were sacrificed at completion of the 60-min resuscitation period. Blood loss required to achieve mean arterial blood pressure (MABP) of 40 mm Hg was higher in naltrexone-treated animals than in time-matched saline controls (4.4+/-0.2 versus 3.7+/-0.2 mL/100 g BW, P< 0.05). Hemorrhage increased plasma levels of corticosterone (30%) and ACTH (3-fold) within 15 min. Naltrexone prevented the hemorrhage-induced rise in corticosterone without affecting the rise in ACTH. Hemorrhage increased beta-endorphin levels (4-fold) and produced an immediate (5 min) and progressive increase in circulating epinephrine and norepinephrine levels reaching values that were 50- and 20-fold, respectively, higher than basal. Pre-treatment with naltrexone did not alter the time course or magnitude of the hemorrhage-induced increases in plasma beta-endorphin or catecholamines. Hemorrhage increased lung and spleen content of TNF (60%), IL-1alpha (300%), IL-6 (40%-60%), and IL-10 (80%) above values of time-matched sham control animals. Pre-treatment with naltrexone blunted the magnitude of the increases in tissue cytokine content in response to a given blood loss. These results indicate that endogenous opiates modulate the hemodynamic instability, neuroendocrine, and cytokine responses to hemorrhagic shock. RN - 0 (Cytokines) RN - 0 (Interleukin-1) RN - 0 (Interleukin-6) RN - 0 (Narcotic Antagonists) RN - 0 (Tumor Necrosis Factor-alpha) RN - 130068-27-8 (Interleukin-10) RN - 5S6W795CQM (Naltrexone) RN - 60617-12-1 (beta-Endorphin) RN - 9002-60-2 (Adrenocorticotropic Hormone) RN - EC 1-11-1-7 (Peroxidase) RN - W980KJ009P (Corticosterone) IS - 1073-2322 IL - 1073-2322 PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PP - ppublish LG - English DP - 2001 Jun EZ - 2001/06/02 10:00 DA - 2001/10/19 10:01 DT - 2001/06/02 10:00 YR - 2001 ED - 20011018 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11386621 <792. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11535910 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Soderstrom CA AU - Dischinger PC AU - Kerns TJ AU - Kufera JA AU - Mitchell KA AU - Scalea TM FA - Soderstrom, C A FA - Dischinger, P C FA - Kerns, T J FA - Kufera, J A FA - Mitchell, K A FA - Scalea, T M IN - Soderstrom, C A. R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S. Greene St., Baltimore, MD 21201, USA. csoderstrom@umm.edu TI - Epidemic increases in cocaine and opiate use by trauma center patients: documentation with a large clinical toxicology database. SO - Journal of Trauma-Injury Infection & Critical Care. 51(3):557-64, 2001 Sep AS - J Trauma. 51(3):557-64, 2001 Sep NJ - The Journal of trauma VO - 51 IP - 3 PG - 557-64 PI - Journal available in: Print PI - Citation processed from: Print JC - kaf, 0376373 IO - J Trauma SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Age Distribution MH - Cocaine-Related Disorders/di [Diagnosis] MH - *Cocaine-Related Disorders/ep [Epidemiology] MH - Databases, Factual MH - Ethanol/bl [Blood] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Retrospective Studies MH - Sex Distribution MH - *Trauma Centers/sn [Statistics & Numerical Data] MH - Violence AB - BACKGROUND: Although reports have documented alcohol and other drug use by trauma patients, no studies of long-term trends have been published. We assessed substance use trends in a large cohort of patients admitted to a regional Level I adult trauma center between July 1984 and June 2000. AB - METHODS: Positive toxicology results, collected via retrospective database review, were analyzed for patients admitted directly to the center. Data were abstracted from a clinical toxicology database for 53,338 patients. Results were analyzed for alcohol, cocaine, and opiates relative to sex, age (< 40/> or = 40 years), and injury type (nonviolence/violence). Positive toxicology test result trends were assessed for the 3 years at the beginning and end of the period (chi2). Testing biases were assessed for sex, race, and injury type. AB - RESULTS: The patient profile was as follows: men, 72%; age < 40 years, 69%; nonviolence victims, 77%. Alcohol-positive results decreased 37%, but cocaine-positive and opiate-positive results increased 212% and 543%, respectively (all p < 0.001). Cocaine-positive/opiate-positive results increased 152%/640% for nonviolence and 226%/258% for violence victims, respectively (all p < 0.001). In fiscal year 2000, cocaine-positive and opiate-positive results were highest among violence victims (27.4% for both drugs). Cocaine-positive and opiate-positive results among nonviolence victims were 9.4% and 17.6%, respectively. Patients who were minorities or victims of violence were not tested more frequently than other patients. AB - CONCLUSION: Epidemic increases in cocaine and opiate use were documented in all groups of trauma patients, with the greatest increases being in violence victims. Alcohol use decreased for all groups. RN - 3K9958V90M (Ethanol) IS - 0022-5282 IL - 0022-5282 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish GI - No: AA-09050-04A2 Organization: (AA) *NIAAA NIH HHS* Country: United States LG - English DP - 2001 Sep EZ - 2001/09/06 10:00 DA - 2001/09/28 10:01 DT - 2001/09/06 10:00 YR - 2001 ED - 20010927 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11535910 <793. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11489400 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Butler KC AU - Selden B AU - Pollack CV Jr FA - Butler, K C FA - Selden, B FA - Pollack, C V Jr IN - Butler, K C. Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona 85008, USA. TI - Relief by naloxone of morphine-induced spasm of the sphincter of Oddi in a post-cholecystectomy patient. CM - Comment in: J Emerg Med. 2002 Aug;23(2):207-8; author reply 208; PMID: 12359295 SO - Journal of Emergency Medicine. 21(2):129-31, 2001 Aug AS - J Emerg Med. 21(2):129-31, 2001 Aug NJ - The Journal of emergency medicine VO - 21 IP - 2 PG - 129-31 PI - Journal available in: Print PI - Citation processed from: Print JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/ai [Antagonists & Inhibitors] MH - Biliary Tract Diseases/di [Diagnosis] MH - Cholecystectomy MH - Colic/di [Diagnosis] MH - *Emergency Service, Hospital MH - Female MH - Humans MH - *Morphine/ae [Adverse Effects] MH - Morphine/ai [Antagonists & Inhibitors] MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Pain/ci [Chemically Induced] MH - *Pain/dt [Drug Therapy] MH - Postoperative Period MH - *Spasm/ci [Chemically Induced] MH - *Sphincter of Oddi/de [Drug Effects] AB - Spasm of the sphincter of Oddi is a well-recognized effect of the narcotic class of drugs. Although it is usually clinically silent, such spasm occasionally causes debilitating pain that may be mistaken for more serious disorders. We present the case of a patient who had undergone cholecystectomy previously, but in whom morphine given in the Emergency Department precipitated pain consistent with biliary colic; the pain resolved promptly after administration of naloxone. This entity may considered in the differential diagnosis of acute onset of colicky abdominal pain in the patient given narcotics. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 76I7G6D29C (Morphine) IS - 0736-4679 IL - 0736-4679 PT - Case Reports PT - Journal Article ID - S0736467901003559 [pii] PP - ppublish LG - English DP - 2001 Aug EZ - 2001/08/08 10:00 DA - 2001/09/21 10:01 DT - 2001/08/08 10:00 YR - 2001 ED - 20010920 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11489400 <794. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11327148 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gintzler AR AU - Chakrabarti S FA - Gintzler, A R FA - Chakrabarti, S IN - Gintzler, A R. Department of Biochemistry, State University of New York Health Science Center at Brooklyn, 11203, USA. agintzler@netmail.hscbklyn.edu TI - Opioid tolerance and the emergence of new opioid receptor-coupled signaling. [Review] [90 refs] SO - Molecular Neurobiology. 21(1-2):21-33, 2000 Feb-Apr AS - Mol Neurobiol. 21(1-2):21-33, 2000 Feb-Apr NJ - Molecular neurobiology VO - 21 IP - 1-2 PG - 21-33 PI - Journal available in: Print PI - Citation processed from: Print JC - ah6, 8900963 IO - Mol. Neurobiol. SB - Index Medicus CP - United States MH - Adenylyl Cyclases/me [Metabolism] MH - Analgesics, Opioid/pd [Pharmacology] MH - Animals MH - *Drug Tolerance/ph [Physiology] MH - Humans MH - Morphine/pd [Pharmacology] MH - *Narcotics/pd [Pharmacology] MH - *Receptors, Opioid/ph [Physiology] MH - *Signal Transduction/de [Drug Effects] MH - Signal Transduction/ph [Physiology] AB - Multiple cellular adaptations are elicited by chronic exposure to opioids. These include diminution of spare opioid receptors, decreased opioid receptor density, and G-protein content and coupling thereof. All imply that opioid tolefance is a manifestation of a loss of opioid function, i.e., desensitization. Recent observations challenge the exclusiveness of this formulation and indicate that opioid tolerance also results from qualitative changes in opioid signaling. In this article, Gintzler and Chakrabarti discuss the evidence that suggests that opioid tolerance results not only from impaired opioid receptor functionality, but also from altered consequences of coupling. Underlying the latter are fundamental changes in the nature of effectors that are coupled to the opioid receptor/G-protein signaling pathway. These molecular changes include the upregulation of adenylyl cyclase isoforms of the type II family as well as a substantial increase in their phosphorylation state. As a result, there is a shift in opioid receptor/G-protein signaling from predominantly Gialpha inhibitory to Gbetagamma stimulatory following chronic in vivo morphine exposure. These adaptations to chronic morphine indicate the plasticity of opioid-signal transduction mechanisms and the ability of chronic morphine to augment new signaling strategies. [References: 90] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotics) RN - 0 (Receptors, Opioid) RN - 76I7G6D29C (Morphine) RN - EC 4-6-1-1 (Adenylyl Cyclases) IS - 0893-7648 IL - 0893-7648 PT - Journal Article PT - Review ID - MN:21:1-2:021 [pii] ID - 10.1385/MN:21:1-2:021 [doi] PP - ppublish LG - English DP - 2000 Feb-Apr EZ - 2001/05/01 10:00 DA - 2001/09/21 10:01 DT - 2001/05/01 10:00 YR - 2000 ED - 20010920 RD - 20171108 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11327148 <795. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11477845 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bai J AU - Zeng Q AU - Chai Z FA - Bai, J FA - Zeng, Q FA - Chai, Z IN - Bai, J. Department of Emergency Medicine, China-Japan Friendship Hospital, Beijing 100029. TI - [Clinical and experimental study on treatment of acute alcohol intoxication with xiangnaojing injection]. [Chinese] SO - Zhongguo Zhong Xi Yi Jie He Za Zhi Zhongguo Zhongxiyi Jiehe Zazhi/Chinese Journal of Integrated Traditional & Western Medicine/Zhongguo Zhong Xi Yi Jie He Xue Hui, Zhongguo Zhong Yi Yan Jiu Yuan Zhu Ban. 18(10):607-9, 1998 Oct AS - Zhongguo Zhong Xi Yi Jie He Za Zhi. 18(10):607-9, 1998 Oct NJ - Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine VO - 18 IP - 10 PG - 607-9 PI - Journal available in: Print PI - Citation processed from: Print JC - bif, 9211576 IO - Zhongguo Zhong Xi Yi Jie He Za Zhi SB - Index Medicus CP - China MH - Adult MH - Alcoholic Intoxication/bl [Blood] MH - *Alcoholic Intoxication/dt [Drug Therapy] MH - Animals MH - Antioxidants/tu [Therapeutic Use] MH - *Drugs, Chinese Herbal/tu [Therapeutic Use] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Rabbits MH - Superoxide Dismutase/bl [Blood] MH - beta-Endorphin/bl [Blood] AB - OBJECTIVE: To study the therapeutical mechanism of traditional Chinese medicine Xingnaojing injection (XNJI) for acute alcohol intoxication. AB - METHODS: XNJI was used in treating the experimental model rabbits (n = 26) and the patients (n = 8) admitted to the emergency department with acute alcoholism. Before and after the treatment, beta-EP, superoxide anion (free radicals) and SOD were measured. AB - RESULTS: XNJI could enhance the regaining consciousness of rabbits and patients, simultaneously reduce the concentration of beta-EP in plasma to the normal level (drunk rabbits 127.09 +/- 13.67 ng/L, normal rabbits 41.48 +/- 7.46 ng/L. P < 0.01, drunk patients 292.97 +/- 14.85 ng/L, normal people 221.60 +/- 15.95 ng/L, P < 0.01). The concentration change of superoxide anion (free radicals) in plasma of rabbits and patients was similar to beta-EP (drunk rabbits 313.39 +/- 15.64 u/L, normal rabbits 254.27 +/- 21.71 u/L, P < 0.01; drunk patients 278.47 +/- 11.48 u/L, normal people 159.92 +/- 11.51 u/L, P < 0.01), and SOD was inversely changed (drunk rabbits 53.57 +/- 6.48%, normal rabbits 77.18 +/- 7.89%, P < 0.01; drunk patients 43.76 +/- 7.84%, normal people 82.53 +/- 4.33%, P < 0.01). AB - CONCLUSIONS: XNJI is similar to Naloxone in pharmacologic action. And it is an effective antioxidant. It can be used for treating alcoholism. RN - 0 (Antioxidants) RN - 0 (Drugs, Chinese Herbal) RN - 60617-12-1 (beta-Endorphin) RN - EC 1-15-1-1 (Superoxide Dismutase) IS - 1003-5370 IL - 1003-5370 PT - English Abstract PT - Journal Article PP - ppublish LG - Chinese DP - 1998 Oct EZ - 2001/08/02 10:00 DA - 2001/08/17 10:01 DT - 2001/08/02 10:00 YR - 1998 ED - 20010816 RD - 20161018 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11477845 <796. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11173556 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kozaki Y AU - Tadaki E AU - Koeda T AU - Kumazawa T FA - Kozaki, Y FA - Tadaki, E FA - Koeda, T FA - Kumazawa, T IN - Kozaki, Y. Department of Neural Regulation, Research Institute of Environmental Medicine, Nagoya University, Nagoya, 464-8601 Japan. kozaki@riem.nagoya-u.ac.jp TI - Effects of prestimulus respiratory levels on inhibitory respiratory response by nociceptive muscular afferents. SO - Japanese Journal of Physiology. 50(6):605-13, 2000 Dec AS - Jpn J Physiol. 50(6):605-13, 2000 Dec NJ - The Japanese journal of physiology VO - 50 IP - 6 PG - 605-13 PI - Journal available in: Print PI - Citation processed from: Print JC - kon, 2985184r IO - Jpn. J. Physiol. SB - Index Medicus CP - Japan MH - Animals MH - Cats MH - Denervation MH - Electric Stimulation MH - Hypercapnia MH - Hypoxia MH - Muscle, Skeletal/ir [Innervation] MH - Muscle, Skeletal/ph [Physiology] MH - *Nociceptors/ph [Physiology] MH - *Phrenic Nerve/ph [Physiology] MH - Reflex MH - Respiration MH - Respiration, Artificial MH - *Respiratory Physiological Phenomena AB - We have previously shown that the inhibitory respiratory response, which we call post-stimulus suppression, is induced by nociceptive muscular afferents. This phenomenon is thought to be caused by a negative feedback induced by excessive afferent inputs. In the present study, we investigated whether augmented levels of prestimulus respiration would influence the magnitude of poststimulus suppression by recording the phrenic nerve discharges in chloralose-urethane anesthetized, vagotomized, paralyzed and artificially ventilated cats. The respiratory level was augmented by means of either hypercapnia, hypoxia or naloxone administration, all of which markedly facilitated the peak amplitude (PK) of integrated phrenic discharges, neural tidal volume. When the electrical stimulation of thin-fiber muscular afferents was performed at these augmented PK levels, the magnitude of poststimulus suppression in the PK was markedly attenuated without consistently altering the facilitatory response during the stimulation period. It seems that the facilitatory component of the augmented level of resting respiration may reduce the inhibitory component of poststimulus suppression. The results indicate that prestimulus respiratory activity is an important factor in determining the magnitude of poststimulus suppression. IS - 0021-521X IL - 0021-521X PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2000 Dec EZ - 2001/02/15 11:00 DA - 2001/07/13 10:01 DT - 2001/02/15 11:00 YR - 2000 ED - 20010712 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11173556 <797. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11282681 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Su M AU - Hoffman RS FA - Su, M FA - Hoffman, R S TI - Prediction rule in opioid overdose. CM - Comment on: Acad Emerg Med. 2000 Oct;7(10):1110-8; PMID: 11015242 SO - Academic Emergency Medicine. 8(4):403-4, 2001 Apr AS - Acad Emerg Med. 8(4):403-4, 2001 Apr NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 8 IP - 4 PG - 403-4 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Drug Overdose MH - Emergency Medical Services MH - *Emergency Treatment/st [Standards] MH - Female MH - *Guidelines as Topic MH - Humans MH - Male MH - *Narcotics/po [Poisoning] MH - *Opioid-Related Disorders/mo [Mortality] MH - *Opioid-Related Disorders/th [Therapy] MH - Patient Discharge/st [Standards] MH - Predictive Value of Tests MH - Survival Analysis MH - United States RN - 0 (Narcotics) IS - 1069-6563 IL - 1069-6563 PT - Comment PT - Letter PP - ppublish LG - English DP - 2001 Apr EZ - 2001/04/03 10:00 DA - 2001/07/11 10:01 DT - 2001/04/03 10:00 YR - 2001 ED - 20010705 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11282681 <798. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11233676 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Buylaert WA FA - Buylaert, W A IN - Buylaert, W A. Department of Emergency Medicine, University Hospital, Gent, Belgium. TI - Coma induced by intoxication. [Review] [4 refs] SO - Acta Neurologica Belgica. 100(4):221-4, 2000 Dec AS - Acta Neurol Belg. 100(4):221-4, 2000 Dec NJ - Acta neurologica Belgica VO - 100 IP - 4 PG - 221-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 0247035 IO - Acta Neurol Belg SB - Index Medicus CP - Italy MH - Accidental Falls MH - Alcohol-Induced Disorders, Nervous System/co [Complications] MH - Alcohol-Induced Disorders, Nervous System/di [Diagnosis] MH - Alcohol-Induced Disorders, Nervous System/th [Therapy] MH - *Alcohol-Induced Disorders, Nervous System MH - *Alcoholic Intoxication/co [Complications] MH - Alcoholic Intoxication/di [Diagnosis] MH - Alcoholic Intoxication/th [Therapy] MH - Antidotes/tu [Therapeutic Use] MH - Brain Injuries/di [Diagnosis] MH - *Coma/ci [Chemically Induced] MH - Coma/th [Therapy] MH - Diabetic Coma/di [Diagnosis] MH - Diagnosis, Differential MH - Diagnostic Tests, Routine MH - Drug Overdose/di [Diagnosis] MH - Emergencies MH - *Ethanol/po [Poisoning] MH - First Aid MH - Flumazenil/tu [Therapeutic Use] MH - Glucagon/tu [Therapeutic Use] MH - Glucose/tu [Therapeutic Use] MH - Humans MH - Hypoglycemia/co [Complications] MH - Hypoxia, Brain/et [Etiology] MH - Hypoxia, Brain/pc [Prevention & Control] MH - Monitoring, Physiologic MH - Naloxone/tu [Therapeutic Use] MH - Neurologic Examination MH - Stroke/di [Diagnosis] MH - Thiamine/tu [Therapeutic Use] AB - Clinicians in the emergency department are often confronted with coma patients due to poisoning. A systematic general approach involving early consultation with a neurologist is of paramount importance. A high index of suspicion, a systematic first assessment already in the prehospital phase and early stabilisation of vital functions are the essential first steps. Specific antidotes like hypertonic glucose and thiamine are part of a "coma cocktail". The opiate antagonist naloxone should be used only when clinically indicated and in a titrated way. Flumazenil should only be used with caution and in restricted cases. Clinical neurological evaluation and technical investigations like CT-scan and laboratory tests should make part of a careful diagnostic plan. Toxicological tests deserve their place in the diagnostic work up of a coma patient with suspected poisoning. Knowledge of the possibilities of the toxicology lab and optimal communication with the clinical toxicologist is important for optimal patient care. [References: 4] RN - 0 (Antidotes) RN - 36B82AMQ7N (Naloxone) RN - 3K9958V90M (Ethanol) RN - 40P7XK9392 (Flumazenil) RN - 9007-92-5 (Glucagon) RN - IY9XDZ35W2 (Glucose) RN - X66NSO3N35 (Thiamine) IS - 0300-9009 IL - 0300-9009 PT - Journal Article PT - Review PP - ppublish LG - English DP - 2000 Dec EZ - 2001/03/10 10:00 DA - 2001/06/02 10:01 DT - 2001/03/10 10:00 YR - 2000 ED - 20010531 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11233676 <799. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11229303 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lapostolle F AU - Alayrac L AU - Adnet F AU - Maistre JP AU - Leseur A AU - Lapandry C FA - Lapostolle, F FA - Alayrac, L FA - Adnet, F FA - Maistre, J P FA - Leseur, A FA - Lapandry, C IN - Lapostolle, F. SAMU 93, Hopital Avicenne, 125, route de Stalingrad, F93009 Bobigny. frederic.lapostolle@avc.ap-hop-paris.fr TI - [Availability of antidotes in French emergency medical aid units]. [French] OT - Disponibilite des antidotes dans l'aide medicale urgente. SO - Presse Medicale. 30(4):159-62, 2001 Feb 03 AS - Presse Med. 30(4):159-62, 2001 Feb 03 NJ - Presse medicale (Paris, France : 1983) VO - 30 IP - 4 PG - 159-62 PI - Journal available in: Print PI - Citation processed from: Print JC - 8302490, pmt IO - Presse Med SB - Index Medicus CP - France MH - *Ambulances MH - *Antidotes/sd [Supply & Distribution] MH - *Emergency Medical Services/st [Standards] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Emergency Service, Hospital/st [Standards] MH - Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - France MH - Health Care Surveys MH - Humans AB - OBJECTIVE: To study the availability of antidotes in French emergency medical aid units (SAMU). AB - METHODS: The physicians or nurses responsible for antidotes in French emergency medical aid units (SAMU) were interviewed by phone. The study involved 102 SAMU in metropolitan France. Four answers on availability of 37 antidotes were possible: the antidote was available in the emergency vehicle used for interventions; the antidote was available in the hospital-located SAMU; the antidote was available in the referral hospital (emergency unit, intensive care unit, operating room, pharmacy); the antidote was not available or not known to be available. AB - RESULTS: Adrenaline and atropine were available in all the intervention vehicles. Nine other antidotes were available in more than two-thirds of the vehicles: 30% glucose (101/102), isoprenaline (100/102), dobutamine (98/112), sodium bicarbonate (97/102), naloxone (95/102), calcium chloride or bicarbonate (89/102), flumazenil (83/102), sodium lactate (77/102), and magnesium sulfate (66/102). Among the other antidotes, hydroxocobalamine and propranolol were available in 24/102 intervention vehicles and activated charcoal in 22/102. Antidigitalic antibodies and 4-methylpyrazole were not available in any vehicle, and were available in less than 25% of the hospitals. AB - CONCLUSION: There is a great disparity of antidote availability. Certain essential antidotes, for which there is no alternative, are not available in emergency intervention vehicles and even in the hospital. The SAMU should develop an economically acceptable departmental management scheme for exceptional-use antidotes. RN - 0 (Antidotes) IS - 0755-4982 IL - 0755-4982 PT - English Abstract PT - Journal Article PP - ppublish LG - French DP - 2001 Feb 03 EZ - 2001/03/07 10:00 DA - 2001/03/17 10:01 DT - 2001/03/07 10:00 YR - 2001 ED - 20010315 RD - 20161209 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11229303 <800. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11118966 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bailey B AU - Bussieres JF FA - Bailey, B FA - Bussieres, J F IN - Bailey, B. Hopital Sainte Justine, Montreal, Canada. baileyb@med.umontreal.ca TI - Antidote availability in Quebec hospital pharmacies: impact of N-acetylcysteine and naloxone consumption. SO - Canadian Journal of Clinical Pharmacology. 7(4):198-204, 2000 AS - Can J Clin Pharmacol. 7(4):198-204, 2000 NJ - The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique VO - 7 IP - 4 PG - 198-204 PI - Journal available in: Print PI - Citation processed from: Print JC - dh4, 9804162 IO - Can J Clin Pharmacol SB - Index Medicus CP - Canada MH - Acetylcysteine/sd [Supply & Distribution] MH - Antidotes/ec [Economics] MH - *Antidotes/st [Standards] MH - *Antidotes/sd [Supply & Distribution] MH - Drug Utilization Review MH - Humans MH - Naloxone/sd [Supply & Distribution] MH - *Pharmacy Service, Hospital/og [Organization & Administration] MH - Quebec MH - Surveys and Questionnaires AB - OBJECTIVES: To study the availability of 13 specific antidotes in hospitals and correlate the availability of those antidotes to the number of poisonings seen in hospitals using N-acetylcysteine and naloxone consumption as a surrogate. AB - METHODS: Pharmacy directors of hospitals with an emergency department were surveyed for number of adequately stocked antidotes (N-acetylcysteine, ethanol, cyanide antidote kit or hydroxycobalamine, deferoxamine, digoxin-immune FAB, dimercaprol, flumazenil, glucagon, methylene blue, naloxone, physostigmine, pralidoxime and pyridoxine). AB - RESULTS: Data were obtained from 96 of 112 (86%) of the pharmacies surveyed. Number of adequately stocked antidotes per hospital ranged from zero to nine of 13. There was a correlation between all hospital characteristics evaluated and the number of adequately stocked antidotes (P<0.05). Correlations between the number of adequately stocked antidotes and the amount of N-acetylcysteine and naloxone consumed were significant (rs=0.58, P<0.001; r(s)=0.53, P<0.001). The amount of N-acetylcysteine consumed, the number of annual visits to the emergency department and the number of hours of pharmacy coverage on weekends independently predicted the presence of adequately stocked antidotes. AB - CONCLUSIONS: Larger hospitals are more likely to have adequate stocks of antidotes. Adequate stocking of antidotes is significantly correlated with the amount of N-acetyl- cysteine and naloxone consumed. This suggests that hospitals more likely to see serious acetaminophen and opiate poisonings are more likely to maintain adequate stocks of antidotes. RN - 0 (Antidotes) RN - 36B82AMQ7N (Naloxone) RN - WYQ7N0BPYC (Acetylcysteine) IS - 1198-581X IL - 1198-581X PT - Journal Article PP - ppublish LG - English DP - 2000 EZ - 2000/12/19 11:00 DA - 2001/03/03 10:01 DT - 2000/12/19 11:00 YR - 2000 ED - 20010215 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11118966 <801. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11185966 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hamilton RJ AU - Perrone J AU - Hoffman R AU - Henretig FM AU - Karkevandian EH AU - Marcus S AU - Shih RD AU - Blok B AU - Nordenholz K FA - Hamilton, R J FA - Perrone, J FA - Hoffman, R FA - Henretig, F M FA - Karkevandian, E H FA - Marcus, S FA - Shih, R D FA - Blok, B FA - Nordenholz, K IN - Hamilton, R J. New York University School of Medicine, New York City Poison Center, New York, USA. richard.hamilton@drexel.edu TI - A descriptive study of an epidemic of poisoning caused by heroin adulterated with scopolamine. SO - Journal of Toxicology - Clinical Toxicology. 38(6):597-608, 2000 AS - J Toxicol Clin Toxicol. 38(6):597-608, 2000 NJ - Journal of toxicology. Clinical toxicology VO - 38 IP - 6 PG - 597-608 PI - Journal available in: Print PI - Citation processed from: Print JC - kan, 8213460 IO - J. Toxicol. Clin. Toxicol. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Disease Outbreaks MH - *Drug Contamination MH - Female MH - Gas Chromatography-Mass Spectrometry MH - Heroin/ch [Chemistry] MH - Heroin Dependence/co [Complications] MH - *Heroin Dependence/pa [Pathology] MH - Humans MH - Male MH - Mid-Atlantic Region/ep [Epidemiology] MH - Middle Aged MH - Muscarinic Antagonists/an [Analysis] MH - *Muscarinic Antagonists/po [Poisoning] MH - *Poisoning/ep [Epidemiology] MH - Poisoning/et [Etiology] MH - *Poisoning/pa [Pathology] MH - Prospective Studies MH - Retrospective Studies MH - Scopolamine Hydrobromide/an [Analysis] MH - *Scopolamine Hydrobromide/po [Poisoning] AB - OBJECTIVE: Adulterants, contaminants, and diluents are all examples of additives to street drugs. Some of these additives may be pharmacologically active; however, it is unusual for them to cause toxic side effects. In the spring of 1995, a new form of heroin appeared in New York City, spreading to other East Coast cities, that was adulterated with scopolamine. It caused severe anticholinergic toxicity in heroin users with patients often presenting to emergency departments in great numbers. This is a report of the demographics and clinical characteristics of the epidemic. AB - METHODS: A combination of prospective and retrospective data collection from the New York City, New Jersey, Delaware Valley, and Maryland Poison Centers. The primary measurements were age, sex, route of drug use, vital signs, signs and symptoms, disposition, and treatment. AB - RESULTS: Of the 370 cases reported to the participating poison centers, 129 were excluded from the final analysis because of insufficient data. Of the patients who used this product, 55% presented with signs and symptoms of heroin toxicity but then became severely agitated with anticholinergic symptoms when naloxone was used to reverse respiratory depression. Nasal insufflation was the route of administration in 34% of the cases. Seizures were rare (3%). Ninety percent required admission, and half were admitted to a critical care unit. AB - CONCLUSIONS: Adulteration of street drugs can lead to toxic epidemics. Poison centers are essential for identification of these trends and are the primary source of information on diagnosis and treatment. RN - 0 (Muscarinic Antagonists) RN - 451IFR0GXB (Scopolamine Hydrobromide) RN - 70D95007SX (Heroin) IS - 0731-3810 IL - 0731-3810 PT - Journal Article PP - ppublish LG - English DP - 2000 EZ - 2001/02/24 12:00 DA - 2001/02/28 10:01 DT - 2001/02/24 12:00 YR - 2000 ED - 20010201 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11185966 <802. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11138378 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Werfel P FA - Werfel, P IN - Werfel, P. University Medical Center, State University of New York, Stony Brooke, USA. pwerfel@epo.hsc.sunysb.edu TI - Case of the month. The masquerade. SO - Journal of Emergency Medical Services. 25(12):20, 2000 Dec AS - J Emerg Med Serv JEMS. 25(12):20, 2000 Dec NJ - JEMS : a journal of emergency medical services VO - 25 IP - 12 PG - 20 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - *Cerebral Hemorrhage/di [Diagnosis] MH - Diagnostic Errors MH - *Emergency Treatment/st [Standards] MH - Fatal Outcome MH - Heroin Dependence/di [Diagnosis] MH - *Heroin Dependence/th [Therapy] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Prejudice MH - United States RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0197-2510 IL - 0197-2510 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 2000 Dec EZ - 2001/01/04 11:00 DA - 2001/02/28 10:01 DT - 2001/01/04 11:00 YR - 2000 ED - 20010118 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11138378 <803. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11130352 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lenton SR AU - Hargreaves KM FA - Lenton, S R FA - Hargreaves, K M IN - Lenton, S R. National Drug Research Institute, Curtin University, Perth, WA. simon@ndri.curtin.edu.au TI - Should we conduct a trial of distributing naloxone to heroin users for peer administration to prevent fatal overdose?. SO - Medical Journal of Australia. 173(5):260-3, 2000 Sep AS - Med J Aust. 173(5):260-3, 2000 Sep NJ - The Medical journal of Australia VO - 173 IP - 5 PG - 260-3 PI - Journal available in: Print PI - Citation processed from: Print JC - 0400714, m26 IO - Med. J. Aust. SB - Index Medicus CP - Australia MH - Australia/ep [Epidemiology] MH - Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/mo [Mortality] MH - First Aid MH - *Health Planning MH - Health Policy MH - *Heroin/po [Poisoning] MH - Heroin Dependence MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Peer Group MH - Pilot Projects MH - *Preventive Health Services AB - Heroin overdose is a major cause of death among heroin users, and often occurs in the company of other users. However, sudden death after injection is rare, giving ample opportunity for intervention. Naloxone hydrochloride, an injectable opioid antagonist which reverses the respiratory depression, sedation and hypotension associated with opioids, has long been used to treat opioid overdose. Experts have suggested that, as part of a comprehensive overdose prevention strategy, naloxone should be provided to heroin users for peer administration after an overdose. A trial could be conducted to determine whether this intervention improves the management of overdose or results in a net increase in harm (by undermining existing prevention strategies, precipitating naloxone-related complications, or resulting in riskier heroin use). RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 0025-729X IL - 0025-729X PT - Journal Article PP - ppublish LG - English DP - 2000 Sep EZ - 2000/12/29 11:00 DA - 2001/02/28 10:01 DT - 2000/12/29 11:00 YR - 2000 ED - 20010111 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11130352 <804. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11092069 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Smyth BP AU - O'Brien M AU - Barry J FA - Smyth, B P FA - O'Brien, M FA - Barry, J IN - Smyth, B P. Addiction Research Section, Cherry Orchard Hospital, Dublin 10, Eire. bobbypsmyth@hotmail.com TI - Trends in treated opiate misuse in Dublin: the emergence of chasing the dragon. SO - Addiction. 95(8):1217-23, 2000 Aug AS - Addiction. 95(8):1217-23, 2000 Aug NJ - Addiction (Abingdon, England) VO - 95 IP - 8 PG - 1217-23 PI - Journal available in: Print PI - Citation processed from: Print JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Adult MH - Age Distribution MH - Cross-Sectional Studies MH - Drug Administration Routes MH - Female MH - Heroin MH - Humans MH - Ireland/ep [Epidemiology] MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Sex Distribution MH - *Substance Abuse, Intravenous/ep [Epidemiology] AB - AIMS: To examine trends in treated opiate misuse and identify factors associated with route of heroin use. AB - DESIGN: Cross-sectional survey. AB - SETTING: Services providing addiction treatment in Dublin. AB - PARTICIPANTS: Individuals making their first ever contact seeking treatment for current opiate misuse, between January 1991 and December 1996. AB - MEASUREMENTS: Data on socio-demographics and current drug use. AB - FINDINGS: The study population was 3981. Over the 6-year period, there was a 330% increase in the number of new attenders. The proportion of females increased. The mean age of first opiate use declined and users began presenting earlier in their opiate-using careers, causing a decline in the age profile of new attenders. Heroin users were more likely to smoke (chase) rather than inject after 1994 (odds ratio 3.3, 95% confidence interval 2.4-4.5). Apart from year of presentation, the other significant independent predictors of chasing as the preferred route of heroin use were being in employment, shorter history of use, less frequent use, younger age, longer period in education and absence of polydrug use. Gender did not independently predict route of use. AB - CONCLUSIONS: Ireland has joined the growing number of European countries witnessing a movement towards heroin chasing. This has coincided with a surge in the number of people entering treatment. We are concerned that the greater acceptability of this route of use may be drawing increased numbers of individuals into heroin use. RN - 70D95007SX (Heroin) IS - 0965-2140 IL - 0965-2140 PT - Journal Article PP - ppublish LG - English DP - 2000 Aug EZ - 2000/11/25 11:00 DA - 2001/02/28 10:01 DT - 2000/11/25 11:00 YR - 2000 ED - 20001214 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11092069 <805. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11015242 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Christenson J AU - Etherington J AU - Grafstein E AU - Innes G AU - Pennington S AU - Wanger K AU - Fernandes C AU - Spinelli JJ AU - Gao M FA - Christenson, J FA - Etherington, J FA - Grafstein, E FA - Innes, G FA - Pennington, S FA - Wanger, K FA - Fernandes, C FA - Spinelli, J J FA - Gao, M IN - Christenson, J. St. Paul's Hospital Department of Emergency Medicine, The Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada. jimchris@interchange.ubc.ca TI - Early discharge of patients with presumed opioid overdose: development of a clinical prediction rule. CM - Comment in: Acad Emerg Med. 2001 Apr;8(4):403-4; PMID: 11282681 SO - Academic Emergency Medicine. 7(10):1110-8, 2000 Oct AS - Acad Emerg Med. 7(10):1110-8, 2000 Oct NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 7 IP - 10 PG - 1110-8 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Analysis of Variance MH - British Columbia MH - Cohort Studies MH - Drug Administration Schedule MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Medicine/mt [Methods] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] MH - *Opioid-Related Disorders/di [Diagnosis] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/mo [Mortality] MH - *Patient Discharge MH - Predictive Value of Tests MH - Prognosis MH - Prospective Studies MH - Reproducibility of Results MH - Sensitivity and Specificity MH - Severity of Illness Index MH - Survival Rate AB - OBJECTIVE: To develop a clinical prediction rule to identify patients who can be safely discharged one hour after the administration of naloxone for presumed opioid overdose. AB - METHODS: Patients who received naloxone for known or presumed opioid overdose were formally evaluated one hour later for multiple potential predictor variables. Patients were classified into two groups: those with adverse events within 24 hours and those without. Using classification and regression tree methodology, a decision rule was developed to predict safe discharge. AB - RESULTS: Clinical findings from 573 patients allowed us to develop a clinical prediction rule with a sensitivity of 99% (95% CI = 96% to 100%) and a specificity of 40% (95% CI = 36% to 45%). Patients with presumed opioid overdose can be safely discharged one hour after naloxone administration if they: 1) can mobilize as usual; 2) have oxygen saturation on room air of >92%; 3) have a respiratory rate >10 breaths/min and <20 breaths/min; 4) have a temperature of >35.0 degrees C and <37.5 degrees C; 5) have a heart rate >50 beats/min and <100 beats/min; and 6) have a Glasgow Coma Scale score of 15. AB - CONCLUSIONS: This prediction rule for safe early discharge of patients with presumed opioid overdose performs well in this derivation set but requires validation followed by confirmation of safe implementation. RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 1069-6563 IL - 1069-6563 PT - Clinical Trial PT - Journal Article PP - ppublish LG - English DP - 2000 Oct EZ - 2000/10/04 11:00 DA - 2001/02/28 10:01 DT - 2000/10/04 11:00 YR - 2000 ED - 20001129 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11015242 <806. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11043991 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lee JS AU - Stiell IG AU - Wells GA AU - Elder BR AU - Vandemheen K AU - Shapiro S FA - Lee, J S FA - Stiell, I G FA - Wells, G A FA - Elder, B R FA - Vandemheen, K FA - Shapiro, S IN - Lee, J S. Clinical Epidemiology Unit, Ottawa Hospital Loeb Health Research Institute, Ottawa, Ontario. jslee@ican.ca TI - Adverse outcomes and opioid analgesic administration in acute abdominal pain. SO - Academic Emergency Medicine. 7(9):980-7, 2000 Sep AS - Acad Emerg Med. 7(9):980-7, 2000 Sep NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 7 IP - 9 PG - 980-7 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Abdominal Pain/co [Complications] MH - *Abdominal Pain/dt [Drug Therapy] MH - Acute Disease MH - Adult MH - Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Feasibility Studies MH - Female MH - Humans MH - Logistic Models MH - Male MH - Prospective Studies MH - Treatment Outcome AB - UNLABELLED: To the authors' knowledge, no outcome-based, randomized clinical trial of the safety of opioid analgesics in acute abdominal pain exists. AB - OBJECTIVES: 1) To assess the feasibility of a randomized clinical trial of opioid safety by estimating the adverse outcome rate among patients with abdominal pain severe enough to necessitate opioid analgesics. 2) To explore the association of opioid administration with adverse outcomes in acute abdominal pain. AB - METHODS: The authors conducted a prospective observational study of emergency department (ED) abdominal pain patients, and followed them by telephone at three weeks to determine whether an adverse outcome occurred (defined as obstruction, perforation, ischemia, hemorrhage, peritonitis, sepsis, or death). A logistic regression of factors predicting adverse outcome was performed. AB - RESULTS: Adverse outcomes occurred in 67 of 860 abdominal pain patients (7.8%, 95% CI = 6.1% to 9.8%), and 252 of 860 (29%) received opioids. The adverse outcome rate was 12.7% (95% CI = 9.0% to 17.0%) among patients who received opioids. Variables predictive of adverse outcome in logistic regression included: ED diagnosis of adverse outcome (OR 12.4), age (OR 1.6 per decade), fever (OR 4.6), received opioids (OR 2.1), pain duration (OR 1.5 per day), and leukocytosis (OR 2.0). AB - CONCLUSIONS: A clinical trial would need to randomize more than 1,500 patients to establish the equivalent adverse outcome rates of opioids and placebo: the sample size of all existing studies combined is insufficient to make such a conclusion. Although opioids were associated with a higher adverse outcome rate in this logistic regression, the authors believe this may be due to confounding by pain severity. They emphasize that the study's design precludes conclusion of a causal link. No change in clinical practice is warranted. A randomized clinical trial of sufficient size to definitively resolve this issue is needed. RN - 0 (Analgesics, Opioid) IS - 1069-6563 IL - 1069-6563 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2000 Sep EZ - 2000/10/24 11:00 DA - 2001/02/28 10:01 DT - 2000/10/24 11:00 YR - 2000 ED - 20001121 RD - 20061115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11043991 <807. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11037697 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gitter MF AU - Cox R FA - Gitter, M F FA - Cox, R IN - Gitter, M F. Department of Emergency Medicine, University of Mississippi Medical Center, Jackson 39216-4505, USA. TI - Clonidine toxicity in an adolescent patient. SO - Journal of the Mississippi State Medical Association. 41(10):757-9, 2000 Oct AS - J Miss State Med Assoc. 41(10):757-9, 2000 Oct NJ - Journal of the Mississippi State Medical Association VO - 41 IP - 10 PG - 757-9 PI - Journal available in: Print PI - Citation processed from: Print JC - j6f, 7505622 IO - J Miss State Med Assoc SB - Index Medicus CP - United States MH - Accidents, Home MH - *Antihypertensive Agents/po [Poisoning] MH - Child MH - *Clonidine/po [Poisoning] MH - Drug Overdose/th [Therapy] MH - Emergency Service, Hospital MH - Emergency Treatment/mt [Methods] MH - Humans MH - Male MH - Treatment Outcome AB - Clonidine is a central acting a2-agonist used primarily as an antihypertensive agent. Recently, it has been used for the treatment of attention deficit hyperactivity disorder in children and adolescents. When taken in excess, it can produce profound CNS depression, apnea, bradycardia and hypotension. A transient period of hypertension can sometimes occur. Treatment is primarily supportive, including respiratory support, atropine for bradycardia, and fluids and dopamine for hypotension. The CNS depression sometimes responds to naloxone. Young children are very sensitive to the toxic effects of clonidine. A case of an 11 year old adolescent who took an overdose of his clonidine is described to illustrate the toxicity of this agent. RN - 0 (Antihypertensive Agents) RN - MN3L5RMN02 (Clonidine) IS - 0026-6396 IL - 0026-6396 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 2000 Oct EZ - 2000/10/19 11:00 DA - 2001/02/28 10:01 DT - 2000/10/19 11:00 YR - 2000 ED - 20001107 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11037697 <808. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11015529 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Herschel M AU - Khoshnood B AU - Lass NA FA - Herschel, M FA - Khoshnood, B FA - Lass, N A IN - Herschel, M. Department of Pediatrics, University of Chicago Pritzker School of Medicine, University of Chicago Chicago, IL 60637, USA. mhersche@midway.uchicago.edu TI - Role of naloxone in newborn resuscitation. SO - Pediatrics. 106(4):831-4, 2000 Oct AS - Pediatrics. 106(4):831-4, 2000 Oct NJ - Pediatrics VO - 106 IP - 4 PG - 831-4 PI - Journal available in: Print PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Index Medicus CP - United States MH - Female MH - *Guideline Adherence MH - Humans MH - Infant, Newborn MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Narcotics/ae [Adverse Effects] MH - Practice Guidelines as Topic MH - Pregnancy MH - Respiratory Insufficiency/ci [Chemically Induced] MH - *Respiratory Insufficiency/dt [Drug Therapy] MH - *Resuscitation/mt [Methods] MH - Retrospective Studies AB - OBJECTIVE: Because of questions about the basis for the use of naloxone in resuscitation of the newborn, we wished to evaluate the use of naloxone at our institution and an affiliated hospital. AB - METHODOLOGY: Evaluation of the actual use of naloxone at a university hospital and a community hospital: we document naloxone use by daily survey for a month in one; in the other, we perform a retrospective record review of 1 year's use. AB - RESULTS: The university hospital had 240 births during February, 1998. Naloxone was given twice: once, 7 minutes before delivery to a woman at term who had received opiates about 2 hours previously; and once, intramuscularly, to a premature infant for apnea, before being intubated. The community hospital had 2044 births during fiscal 1998. Twenty-six neonates were identified as having received naloxone. Of the 26, 13 received naloxone without needing ventilatory support; all 13 with respiratory depression had a predisposing perinatal complication. AB - CONCLUSION: The use of naloxone in practice may not conform to the American Academy of Pediatrics' guidelines for use in resuscitation of the newborn. The use of naloxone in resuscitation of the newborn should be reevaluated. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) ES - 1098-4275 IL - 0031-4005 PT - Evaluation Studies PT - Journal Article PT - Multicenter Study PP - ppublish LG - English DP - 2000 Oct EZ - 2000/10/04 11:00 DA - 2001/02/28 10:01 DT - 2000/10/04 11:00 YR - 2000 ED - 20001031 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11015529 <809. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11015505 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Carbine DN AU - Finer NN AU - Knodel E AU - Rich W FA - Carbine, D N FA - Finer, N N FA - Knodel, E FA - Rich, W IN - Carbine, D N. Department of Pediatrics, Division of Neonatology, University of California, San Diego, San Diego, California, USA. TI - Video recording as a means of evaluating neonatal resuscitation performance. SO - Pediatrics. 106(4):654-8, 2000 Oct AS - Pediatrics. 106(4):654-8, 2000 Oct NJ - Pediatrics VO - 106 IP - 4 PG - 654-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Index Medicus CP - United States MH - California MH - *Guideline Adherence/sn [Statistics & Numerical Data] MH - Humans MH - Incubators, Infant MH - Infant, Newborn MH - Intensive Care Units, Neonatal MH - Practice Guidelines as Topic MH - Resuscitation/mt [Methods] MH - Resuscitation/st [Standards] MH - *Resuscitation MH - *Video Recording AB - OBJECTIVE: To determine the compliance to Neonatal Resuscitation Program (NRP) guidelines in our institution, by the use of videotaped newborn resuscitations. AB - BACKGROUND: NRP is the standard of care for newborn resuscitation. The application of NRP guidelines and resuscitation skills in actual clinical settings is undocumented. AB - DESIGN/METHODS: A video recorder, mounted to the radiant warmer in the main obstetrical operating room, was used to record all high-risk resuscitations. All members of the resuscitation team were NRP-certified. The videotapes were reviewed within 14 days of the resuscitation and then erased. This ongoing review was approved as a quality assurance (QA) project ensuring confidentiality under California law. The first 100 resuscitations were evaluated to assess NRP compliance. Each step in the resuscitation (positioning, oxygen delivery, ventilation, chest compressions, intubation, and medication) was graded. A score was devised, with 2 points being awarded for every correct decision and proper procedure, 1 point for delayed interventions or inadequate technique, and zero points for indicated procedures that were omitted or for interventions that were not indicated. The total points were divided by the total possible points for that patient. The scores for the first 25 resuscitations (group 1) and the last 25 resuscitations (group 2) were compared. AB - RESULTS: Fifty-four percent of the 100 resuscitations had deviations from the NRP guidelines. Ten percent received overly aggressive stimulation and 22% had poor suction technique. Of the 78 infants given oxygen, this decision was considered incorrect in 15% and the delivery technique was poor in 10% of the infants given oxygen. Of those requiring mask ventilation (n = 18), 24% had poor chest expansion, 11% used an incorrect rate, and 17% had inadequate reevaluation. Twelve infants were intubated; only 7 were successfully intubated on the first attempt and only 4 were intubated in <20 seconds. The longest intubation attempt was 50 seconds. Naloxone was given to 2 patients. One was breathing spontaneously with a heart rate >100. Resuscitations receiving a perfect evaluation score were more likely to occur in infants needing less intervention. The level of resuscitation required for groups 1 and 2 were statistically similar. There was no difference in resuscitation scores between the 2 groups. Only the inappropriate use of deep suctioning improved, with 8 of 25 events in group 1, and 0 of 25 in group 2. AB - CONCLUSIONS: We have found a significant number of deviations from the NRP guidelines. Video recording of actual clinical practice is a useful QA tool for monitoring the conduct of newborn resuscitation. We are now conducting repeat video assessments of individual NRP providers to determine whether there is improved performance. ES - 1098-4275 IL - 0031-4005 PT - Comparative Study PT - Journal Article PP - ppublish LG - English DP - 2000 Oct EZ - 2000/10/04 11:00 DA - 2001/02/28 10:01 DT - 2000/10/04 11:00 YR - 2000 ED - 20001031 RD - 20071115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11015505 <810. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 11022581 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Doyle DJ FA - Doyle, D J TI - Battling opiate overdoses. CM - Comment on: CMAJ. 2000 Jun 13;162(12):1688-9; PMID: 10870498 SO - CMAJ Canadian Medical Association Journal. 163(6):697, 2000 Sep 19 AS - CMAJ. 163(6):697, 2000 Sep 19 NJ - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne VO - 163 IP - 6 PG - 697 PI - Journal available in: Print PI - Citation processed from: Print JC - 9711805 IO - CMAJ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80160 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - Canada MH - Drug Overdose/pc [Prevention & Control] MH - *First Aid/mt [Methods] MH - *Heroin Dependence/pc [Prevention & Control] MH - Humans MH - Interpersonal Relations MH - Naloxone/sd [Supply & Distribution] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/sd [Supply & Distribution] MH - *Narcotic Antagonists/tu [Therapeutic Use] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0820-3946 IL - 0820-3946 PT - Comment PT - Letter ID - PMC80160 [pmc] PP - ppublish LG - English DP - 2000 Sep 19 EZ - 2000/10/07 11:00 DA - 2001/02/28 10:01 DT - 2000/10/07 11:00 YR - 2000 ED - 20001023 RD - 20140615 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=11022581 <811. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10918103 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dart RC AU - Goldfrank LR AU - Chyka PA AU - Lotzer D AU - Woolf AD AU - McNally J AU - Snodgrass WR AU - Olson KR AU - Scharman E AU - Geller RJ AU - Spyker D AU - Kraft M AU - Lipsy R FA - Dart, R C FA - Goldfrank, L R FA - Chyka, P A FA - Lotzer, D FA - Woolf, A D FA - McNally, J FA - Snodgrass, W R FA - Olson, K R FA - Scharman, E FA - Geller, R J FA - Spyker, D FA - Kraft, M FA - Lipsy, R IN - Dart, R C. Rocky Mountain Poison and Drug Center, Denver Health & Hospital Authority, Denver, CO 80230, USA, TI - Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. [Review] [19 refs] SO - Annals of Emergency Medicine. 36(2):126-32, 2000 Aug AS - Ann Emerg Med. 36(2):126-32, 2000 Aug NJ - Annals of emergency medicine VO - 36 IP - 2 PG - 126-32 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Antidotes/ec [Economics] MH - *Antidotes/st [Standards] MH - *Antidotes/sd [Supply & Distribution] MH - *Emergency Service, Hospital/st [Standards] MH - *Evidence-Based Medicine/st [Standards] MH - Health Care Costs MH - Humans MH - *Practice Guidelines as Topic MH - Sensitivity and Specificity MH - United States AB - STUDY OBJECTIVE: To develop guidelines for the stocking of antidotes at hospitals that accept emergency admissions using combined evidence-based and consensus methods. AB - METHODS: Study participants were 12 medical care providers from disciplines that are affected by insufficient stocking of emergency antidotes (clinical pharmacology, critical care, clinical pharmacy, emergency medicine, hospital pharmacy, internal medicine, managed care pharmacy, clinical toxicology, pediatrics, poison control centers, pulmonary medicine, regulatory medicine). Selection of individuals for the study panel was based on evidence of previous antidote research or perspective regarding the purchase and use of antidotes. The literature regarding each antidote was systematically amassed using pre-1966 literature files, current MEDLINE searches, the reference lists of major medical textbooks, and citations solicited from the consensus panel. Articles relevant to 4 defined core questions were included. These articles formed the basis of an evidence-based analysis performed by the principal investigator. After literature analysis, a literature summary and proposed guidelines for antidote stocking were submitted to the panel. Consensus was formed by electronic iterative presentation of alternatives to each panel member using a modified Delphi method. All panel members participated in 5 rounds of guideline analysis of 20 antidotes. AB - RESULTS: Of the 20 antidotes, 16 antidotes were ultimately recommended for stocking (N -acetylcysteine, atropine, Crotalid snake antivenin, calcium gluconate and chloride, cyanide antidote kit, deferoxamine, digoxin immune Fab, dimercaprol, ethanol, fomepizole, glucagon, methylene blue, naloxone, pralidoxime, physostigmine, sodium bicarbonate), 2 were not recommended for stocking (black widow antivenin, ethylenediamine tetraacetic acid), and consensus could not be reached for 2 antidotes (flumazenil, physostigmine). AB - CONCLUSION: These guidelines provide a tool to be used in revising or creating policies and procedures with regard to the stocking of antidotes in hospitals that accept emergency patients. [References: 19] RN - 0 (Antidotes) IS - 0196-0644 IL - 0196-0644 PT - Consensus Development Conference PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Review ID - S0196-0644(00)09472-5 [pii] ID - 10.1067/mem.2000.108182 [doi] PP - ppublish LG - English DP - 2000 Aug EZ - 2000/08/05 11:00 DA - 2000/09/19 11:01 DT - 2000/08/05 11:00 YR - 2000 ED - 20000908 RD - 20071115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10918103 <812. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10941951 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Seidler D AU - Schmeiser-Rieder A AU - Schlarp O AU - Laggner AN FA - Seidler, D FA - Schmeiser-Rieder, A FA - Schlarp, O FA - Laggner, A N IN - Seidler, D. Department of Emergency Medicine, AKH, General Hospital, Vienna, Austria. dan.seidler@akh-wien.ac.at TI - Heroin and opiate emergencies in Vienna: analysis at the municipal ambulance service. SO - Journal of Clinical Epidemiology. 53(7):734-41, 2000 Jul AS - J Clin Epidemiol. 53(7):734-41, 2000 Jul NJ - Journal of clinical epidemiology VO - 53 IP - 7 PG - 734-41 PI - Journal available in: Print PI - Citation processed from: Print JC - jce, 8801383 IO - J Clin Epidemiol SB - Index Medicus CP - United States MH - Adult MH - Austria/ep [Epidemiology] MH - Drug Overdose/ep [Epidemiology] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - *Heroin Dependence/ep [Epidemiology] MH - Humans MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] AB - Vienna suffered an epidemic of heroin abuse in recent years, with drug-deaths due to opioids increasing from 62 in 1991 to 143 in 1993. The aim of this study was to make observations about illicit opioid-use with the ambulance service as a data source. From June 1994 to August 1995, the structured run records of the ambulance service were reviewed. Those with a presumptive diagnosis of "heroin or opiate" overdose were collected, characteristics of emergencies and patients were analyzed. The run records demonstrated a large number of non-fatal emergencies due to opioids, involving 528 men and 179 women in 1087 emergencies. These emergencies were on the average 6.8 times as prevalent as drug-fatalities. A group of 189 persons could be identified, who caused 52.2% of all emergencies and showed a threefold mortality rate during the observation period. In Vienna, the records of the municipal ambulance service provided valuable insights on opioid-abuse. We suggest local analysis of non-fatal emergencies due to opioids, as this might lead to a new source of information on illicit abuse of these drugs. IS - 0895-4356 IL - 0895-4356 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0895-4356(99)00216-4 [pii] PP - ppublish LG - English DP - 2000 Jul EZ - 2000/08/15 11:00 DA - 2000/09/02 11:01 DT - 2000/08/15 11:00 YR - 2000 ED - 20000825 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10941951 <813. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10830076 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schafer G AU - Smoltczyk H AU - Dengler W AU - Buchkremer G FA - Schafer, G FA - Smoltczyk, H FA - Dengler, W FA - Buchkremer, G IN - Schafer, G. Universitatsklinik fur Psychiatrie und Psychotherapie Tubingen. gerd.schaefer@med-uni-tuebingen.de TI - [Self-reported substance abuse related emergencies: frequency and nature]. [German] OT - Drogennotfalle: Haufigkeit und Umstande aus der Sicht der Betroffenen. SO - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie. 35(4):237-42, 2000 Apr AS - Anasthesiol Intensivmed Notfallmed Schmerzther. 35(4):237-42, 2000 Apr NJ - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS VO - 35 IP - 4 PG - 237-42 PI - Journal available in: Print PI - Citation processed from: Print JC - 9109478, a4c IO - Anasthesiol Intensivmed Notfallmed Schmerzther SB - Index Medicus CP - Germany MH - Accidents, Traffic/sn [Statistics & Numerical Data] MH - Adult MH - Alcoholism/ep [Epidemiology] MH - Alcoholism/px [Psychology] MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/th [Therapy] MH - *Emergencies MH - Female MH - Germany/ep [Epidemiology] MH - Humans MH - Male MH - Opioid-Related Disorders/co [Complications] MH - Opioid-Related Disorders/px [Psychology] MH - Seizures/ci [Chemically Induced] MH - Seizures/ep [Epidemiology] MH - Seizures/px [Psychology] MH - Substance-Related Disorders/ep [Epidemiology] MH - Substance-Related Disorders/px [Psychology] MH - *Substance-Related Disorders/th [Therapy] MH - Suicide, Attempted/px [Psychology] MH - Suicide, Attempted/sn [Statistics & Numerical Data] AB - OBJECTIVE: The aim of this study was to estimate the frequency and nature of self-reported and drug-related emergencies. AB - METHODS: 47 patients of a ward for opiate detoxification were interviewed about their experiences with drug-related emergencies. Typical categories had to be found like overdoses, seizures, accidents and suicide attempts respectively. AB - RESULTS: 68% had own experience with drug-related emergency. A majority suffered opiate overdose with different extensions as unconsciousness or breath-depression. Alcohol and polydrug use was associated with overdose. Drug-related accidents were only reported by men. Half the number of drug-related emergencies were treated in hospital. Most emergencies occurred alone either in a home environment or outside. AB - CONCLUSION: Harm reduction interventions like observed user rooms should be established. Furthermore other strategies to reduce the number of emergencies as sharing naloxon or resuscitation programs in wards for detoxification could also be an effective method to prevent near fatal or fatal overdoses in dependent subjects. IS - 0939-2661 IL - 0939-2661 PT - Clinical Trial PT - English Abstract PT - Journal Article ID - 10.1055/s-2000-11989 [doi] PP - ppublish LG - German DP - 2000 Apr EZ - 2000/06/01 09:00 DA - 2000/06/24 11:00 DT - 2000/06/01 09:00 YR - 2000 ED - 20000621 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10830076 <814. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10755497 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Joranson DE AU - Ryan KM AU - Gilson AM AU - Dahl JL FA - Joranson, D E FA - Ryan, K M FA - Gilson, A M FA - Dahl, J L IN - Joranson, D E. Pain and Policy Studies Group, Comprehensive Cancer Center, University of Wisconsin Medical School, Madison, USA. joranson@facstaff.wisc.edu TI - Trends in medical use and abuse of opioid analgesics. CM - Comment in: JAMA. 2000 Aug 2;284(5):564; PMID: 10918695 SO - JAMA. 283(13):1710-4, 2000 Apr 05 AS - JAMA. 283(13):1710-4, 2000 Apr 05 NJ - JAMA VO - 283 IP - 13 PG - 1710-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 7501160 IO - JAMA OI - Source: KIE. 65131 SB - Core Clinical Journals (AIM) SB - Bioethics Journals SB - Index Medicus CP - United States MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Drug Utilization/td [Trends] MH - Fentanyl/tu [Therapeutic Use] MH - Humans MH - Hydromorphone/tu [Therapeutic Use] MH - Meperidine/tu [Therapeutic Use] MH - Morphine/tu [Therapeutic Use] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Oxycodone/tu [Therapeutic Use] MH - *Pain/dt [Drug Therapy] MH - Retrospective Studies MH - Risk Assessment MH - Social Change MH - United States/ep [Epidemiology] KW - Empirical Approach; Professional Patient Relationship AB - CONTEXT: Pain often is inadequately treated due in part to reluctance about using opioid analgesics and fear that they will be abused. Although international and national expert groups have determined that opioid analgesics are essential for the relief of pain, little information has been available about the health consequences of the abuse of these drugs. AB - OBJECTIVE: To evaluate the proportion of drug abuse related to opioid analgesics and the trends in medical use and abuse of 5 opioid analgesics used to treat severe pain: fentanyl, hydromorphone, meperidine, morphine, and oxycodone. AB - DESIGN AND SETTING: Retrospective survey of medical records from 1990 to 1996 stored in the databases of the Drug Abuse Warning Network (source of abuse data) and the Automation of Reports and Consolidated Orders System (source of medical use data). AB - PATIENTS: Nationally representative sample of hospital emergency department admissions resulting from drug abuse. AB - MAIN OUTCOME MEASURES: Medical use in grams and grams per 100,000 population and mentions of drug abuse by number and percentage of the population. AB - RESULTS: From 1990 to 1996, there were increases in medical use of morphine (59%; 2.2 to 3.5 million g), fentanyl (1168%; 3263 to 41,371 g), oxycodone (23%; 1.6 to 2.0 million g), and hydromorphone (19%; 118,455 to 141,325 g), and a decrease in the medical use of meperidine (35%; 5.2 to 3.4 million g). During the same period, the total number of drug abuse mentions per year due to opioid analgesics increased from 32,430 to 34,563 (6.6%), although the proportion of mentions for opioid abuse relative to total drug abuse mentions decreased from 5.1% to 3.8%. Reports of abuse decreased for meperidine (39%; 1335 to 806), oxycodone (29%; 4526 to 3190), fentanyl (59%; 59 to 24), and hydromorphone (15%; 718 to 609), and increased for morphine (3%; 838 to 865). AB - CONCLUSIONS: The trend of increasing medical use of opioid analgesics to treat pain does not appear to contribute to increases in the health consequences of opioid analgesic abuse. NT - KIE BoB Subject Heading: patient care/drugs NT - Full author name: Joranson, David E NT - Full author name: Ryan, Karen M NT - Full author name: Gilson, Aaron M NT - Full author name: Dahl, June L RN - 0 (Analgesics, Opioid) RN - 76I7G6D29C (Morphine) RN - 9E338QE28F (Meperidine) RN - CD35PMG570 (Oxycodone) RN - Q812464R06 (Hydromorphone) RN - UF599785JZ (Fentanyl) IS - 0098-7484 IL - 0098-7484 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - joc90972 [pii] PP - ppublish LG - English DP - 2000 Apr 05 EZ - 2001/02/07 11:00 DA - 2001/02/07 11:01 DT - 2001/02/07 11:00 YR - 2000 ED - 20000413 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10755497 <815. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10678589 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hattab EM AU - Goldberger BA AU - Johannsen LM AU - Kindland PW AU - Ticino F AU - Chronister CW AU - Bertholf RL FA - Hattab, E M FA - Goldberger, B A FA - Johannsen, L M FA - Kindland, P W FA - Ticino, F FA - Chronister, C W FA - Bertholf, R L IN - Hattab, E M. Department of Pathology, University of Florida Health Science Center, Jacksonville 32209, USA. TI - Modification of screening immunoassays to detect sub-threshold concentrations of cocaine, cannabinoids, and opiates in urine: use for detecting maternal and neonatal drug exposures. SO - Annals of Clinical & Laboratory Science. 30(1):85-91, 2000 Jan AS - Ann Clin Lab Sci. 30(1):85-91, 2000 Jan NJ - Annals of clinical and laboratory science VO - 30 IP - 1 PG - 85-91 PI - Journal available in: Print PI - Citation processed from: Print JC - 532, 0410247 IO - Ann. Clin. Lab. Sci. SB - Index Medicus CP - United States MH - Adult MH - *Cannabinoids/an [Analysis] MH - Cannabinoids/ur [Urine] MH - *Cocaine/an [Analysis] MH - Cocaine/ur [Urine] MH - *Dopamine Uptake Inhibitors/an [Analysis] MH - Dopamine Uptake Inhibitors/ur [Urine] MH - Female MH - Gas Chromatography-Mass Spectrometry MH - Humans MH - Immunoassay/mt [Methods] MH - Immunoassay/st [Standards] MH - Infant, Newborn MH - *Narcotics/an [Analysis] MH - Narcotics/ur [Urine] MH - Neonatal Abstinence Syndrome/di [Diagnosis] MH - Neonatal Abstinence Syndrome/ur [Urine] MH - Reproducibility of Results MH - Sensitivity and Specificity MH - Street Drugs/an [Analysis] MH - Street Drugs/ur [Urine] MH - *Substance Abuse Detection/mt [Methods] AB - Testing for drugs of abuse in urine is commonplace in emergency departments and neonatal units. However, the clinical sensitivity of immunochemical screening methods is limited by the threshold concentrations used to distinguish between positive and negative specimens. Immunochemical screening methods for cocaine metabolite (benzoylecgonine), cannabinoids, and opiates in urine were recalibrated to detect drugs at lower threshold concentrations. The precision and linearity of the signals at the modified thresholds were verified by diluting drug-positive urine specimens to concentrations below the conventional cutoff concentration and measuring the rate signals in triplicate. To assess the clinical performance of the modified methods, specimens that tested negative using the unmodified assays were re-screened at the lower threshold, and specimens that re-screened positive were submitted for gas chromatographic/mass spectrometric (GC/MS) confirmation. Reproducibility of sub-threshold measurements was comparable to the unmodified assays, and rate separations between successive dilutions were sufficient to give semi-quantitative results. Using the lower thresholds, drugs were detected in 4-5% of the subjects that had screened negative at the conventional threshold concentration. GC/MS analysis confirmed the presence of cannabinoids and cocaine metabolite in 74% and 84%, respectively, of urine specimens that re-screened positive. Morphine, codeine, hydromorphone, or hydrocodone was detected by GC/MS analysis in 31% of opiate-positive re-screens. RN - 0 (Cannabinoids) RN - 0 (Dopamine Uptake Inhibitors) RN - 0 (Narcotics) RN - 0 (Street Drugs) RN - I5Y540LHVR (Cocaine) IS - 0091-7370 IL - 0091-7370 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 2000 Jan EZ - 2000/03/18 DA - 2000/03/18 00:01 DT - 2000/03/18 00:00 YR - 2000 ED - 20000316 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10678589 <816. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10667520 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wichmann MW AU - Zellweger R AU - Ayala A AU - Chaudry IH FA - Wichmann, M W FA - Zellweger, R FA - Ayala, A FA - Chaudry, I H IN - Wichmann, M W. Center for Surgical Research and the Department of Surgery, Brown University School of Medicine and Rhode Island Hospital, Providence 02903, USA. TI - Effect of naloxone on immune responses after hemorrhagic shock. CM - Comment in: Crit Care Med. 2000 Jan;28(1):279; PMID: 10667551 SO - Critical Care Medicine. 28(1):184-9, 2000 Jan AS - Crit Care Med. 28(1):184-9, 2000 Jan NJ - Critical care medicine VO - 28 IP - 1 PG - 184-9 PI - Journal available in: Print PI - Citation processed from: Print JC - dtf, 0355501 IO - Crit. Care Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Animals MH - Cell Line MH - *Interleukins/bl [Blood] MH - Macrophages/de [Drug Effects] MH - Macrophages/im [Immunology] MH - Macrophages, Peritoneal/de [Drug Effects] MH - Macrophages, Peritoneal/im [Immunology] MH - Male MH - Mice MH - Mice, Inbred C3H MH - *Naloxone/pd [Pharmacology] MH - *Narcotic Antagonists/pd [Pharmacology] MH - Radioimmunoassay MH - Random Allocation MH - Resuscitation/mt [Methods] MH - *Resuscitation MH - Shock, Hemorrhagic/bl [Blood] MH - *Shock, Hemorrhagic/im [Immunology] MH - Spleen/cy [Cytology] MH - Spleen/im [Immunology] AB - OBJECTIVE: To determine whether naloxone administration after hemorrhagic shock has any beneficial or deleterious effect on immune responses. AB - BACKGROUND DATA: Hemorrhagic shock is known to produce immunodepression in both humans and experimental animals. Although studies suggest that endogenous opioids play a role in immune regulation in adverse circulatory conditions, it remains controversial whether these opioids exert beneficial or detrimental effects on immunity after shock. Moreover, little information is available concerning the effects of opioid receptor blockade using naloxone on cell-mediated immunity and endocrine responses after shock. AB - METHODS: Male C3H/HeN mice (25 g) were bled to and maintained at a mean arterial blood pressure of 35+/-5 mm Hg for 1 hr. The shed blood was then returned along with lactated Ringer's solution (two times the shed blood volume) to provide fluid resuscitation. The animals were randomized to receive either naloxone (1 mg/kg i.v.) or an equal volume of vehicle (saline) after the shed blood was returned, i.e., immediately before crystalloid resuscitation, and were killed at 2 hrs after resuscitation to obtain splenocytes, macrophages (peritoneal and splenic), and blood. AB - MEASUREMENTS AND MAIN RESULTS: Bioassays revealed significantly decreased release of all studied interleukins (interleukins-1, -2, -3, and -6) by peritoneal and splenic macrophages as well as significantly decreased splenocyte proliferative capacity after shock in vehicle-treated mice. Naloxone administration after hemorrhage resulted in either similar or even more decreased levels of interleukin release compared with vehicle-treated hemorrhaged mice. Significantly increased plasma corticosterone concentrations were observed in vehicle-treated animals compared with control animals. Naloxone administration did not have any significant effects on corticosterone plasma concentrations after hemorrhage. AB - CONCLUSIONS: These findings indicate the importance of the endogenous opioid system for the maintenance of immunity in adverse circulatory conditions, i.e., hemorrhage. Although additional studies involving different doses and/or times of naloxone administration may provide different results, the present findings raise the concern that naloxone administration in the traumatized host may have deleterious effects because it decreases peritoneal macrophage and splenic immune functions. RN - 0 (Interleukins) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0090-3493 IL - 0090-3493 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish GI - No: R01 GM39519 Organization: (GM) *NIGMS NIH HHS* Country: United States LG - English DP - 2000 Jan EZ - 2000/02/10 09:00 DA - 2000/02/26 09:00 DT - 2000/02/10 09:00 YR - 2000 ED - 20000224 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10667520 <817. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10670828 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Molina PE AU - Abumrad NN FA - Molina, P E FA - Abumrad, N N IN - Molina, P E. Department of Physiology, LSUMC, New Orleans, LA 70112, USA. TI - Differential effects of hemorrhage and LPS on tissue TNF-alpha, IL-1 and associate neuro-hormonal and opioid alterations. SO - Life Sciences. 66(5):399-409, 2000 AS - Life Sci. 66(5):399-409, 2000 NJ - Life sciences VO - 66 IP - 5 PG - 399-409 PI - Journal available in: Print PI - Citation processed from: Print JC - l62, 0375521 IO - Life Sci. SB - Index Medicus CP - Netherlands MH - Animals MH - Blood Pressure/de [Drug Effects] MH - *Catecholamines/bl [Blood] MH - Corticosterone/bl [Blood] MH - Disease Models, Animal MH - Epinephrine/bl [Blood] MH - Hemorrhage/bl [Blood] MH - *Hemorrhage/me [Metabolism] MH - Hemorrhage/pp [Physiopathology] MH - Inflammation/bl [Blood] MH - Inflammation/me [Metabolism] MH - Inflammation/pp [Physiopathology] MH - Interleukin-1/bl [Blood] MH - *Interleukin-1/me [Metabolism] MH - *Lipopolysaccharides/pd [Pharmacology] MH - Male MH - *Narcotics/bl [Blood] MH - Norepinephrine/bl [Blood] MH - Rats MH - Rats, Sprague-Dawley MH - Resuscitation MH - Stress, Physiological/bl [Blood] MH - Stress, Physiological/me [Metabolism] MH - Stress, Physiological/pp [Physiopathology] MH - Time Factors MH - Tumor Necrosis Factor-alpha/an [Analysis] MH - *Tumor Necrosis Factor-alpha/me [Metabolism] MH - beta-Endorphin/bl [Blood] AB - LPS administration and hemorrhage are frequently used models for the in vivo study of the stress response. Both challenges stimulate cytokine production as well as activate opiate and neuro-endocrine pathways; which in turn modulate the inflammatory process. Differences in the magnitude and tissue specificity of the proinflammatory cytokine and neuro-hormonal responses to these stressors are not well established. We contrasted the tissue specificity and magnitude of the increase in circulating and tissue cytokine (TNF-alpha, IL-1alpha and IL-1beta) content in response to either fixed-pressure hemorrhage (approximately 40 mm Hg) followed by fluid resuscitation (HEM) or lipopolysaccharide (LPS; 100 microg/100 g BW) administration. LPS and HEM elevated circulating levels of TNF-alpha, while neither stress altered circulating IL-1-alpha and IL-beta. LPS-induced increases in TNF-alpha content were greater than those elicited by HEM in all tissues studied except for the lung, where both stressors produced similar increases. Tissue (lung, spleen and heart) content of IL-1alpha was increased by HEM but was not affected by LPS. Tissue (lung, spleen, and heart) content of IL-1beta was increased by LPS but was not affected by HEM. HEM produced greater increases than LPS in epinephrine (16- vs. 4-fold) and norepinephrine (4-fold vs. 60%) levels and similar elevations in beta-endorphin. LPS produced greater elevation in corticosterone levels (2-fold) than HEM (50%). These results suggest differential tissue cytokine modulation to HEM and LPS, both with respect to target tissue and cytokine type. The hormonal milieu to HEM is characterized by marked catecholaminergic and moderate glucocorticoid while that of LPS is characterized by marked glucocorticoid with moderate catecholaminergic influence. RN - 0 (Catecholamines) RN - 0 (Interleukin-1) RN - 0 (Lipopolysaccharides) RN - 0 (Narcotics) RN - 0 (Tumor Necrosis Factor-alpha) RN - 60617-12-1 (beta-Endorphin) RN - W980KJ009P (Corticosterone) RN - X4W3ENH1CV (Norepinephrine) RN - YKH834O4BH (Epinephrine) IS - 0024-3205 IL - 0024-3205 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0024320599006062 [pii] PP - ppublish LG - English DP - 2000 EZ - 2000/02/12 09:00 DA - 2000/02/19 09:00 DT - 2000/02/12 09:00 YR - 2000 ED - 20000217 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10670828 <818. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10613955 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bulthuis D AU - Diaz JE FA - Bulthuis, D FA - Diaz, J E TI - Ultrarapid opiate detoxification. SO - Annals of Emergency Medicine. 35(1):100-1, 2000 Jan AS - Ann Emerg Med. 35(1):100-1, 2000 Jan NJ - Annals of emergency medicine VO - 35 IP - 1 PG - 100-1 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Emergency Treatment/mt [Methods] MH - *Heroin Dependence/dt [Drug Therapy] MH - Humans MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Substance Withdrawal Syndrome/dt [Drug Therapy] MH - Time Factors MH - Treatment Outcome RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0196-0644 IL - 0196-0644 PT - Case Reports PT - Letter ID - S019606440012640X [pii] PP - ppublish LG - English DP - 2000 Jan EZ - 1999/12/30 DA - 1999/12/30 00:01 DT - 1999/12/30 00:00 YR - 2000 ED - 20000128 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10613955 <819. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10583357 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lorenzi P AU - Marsili M AU - Boncinelli S AU - Fabbri LP AU - Fontanari P AU - Zorn AM AU - Mannaioni PF AU - Masini E FA - Lorenzi, P FA - Marsili, M FA - Boncinelli, S FA - Fabbri, L P FA - Fontanari, P FA - Zorn, A M FA - Mannaioni, P F FA - Masini, E IN - Lorenzi, P. Department of Clinical Pathophysiology, University of Florence, Careggi General Hospital, Italy. TI - Searching for a general anaesthesia protocol for rapid detoxification from opioids. SO - European Journal of Anaesthesiology. 16(10):719-27, 1999 Oct AS - Eur J Anaesthesiol. 16(10):719-27, 1999 Oct NJ - European journal of anaesthesiology VO - 16 IP - 10 PG - 719-27 PI - Journal available in: Print PI - Citation processed from: Print JC - ems, 8411711 IO - Eur J Anaesthesiol SB - Index Medicus CP - England MH - Adult MH - *Anesthesia, General MH - Female MH - Heroin Dependence/rh [Rehabilitation] MH - Humans MH - Infusions, Intravenous MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Opioid-Related Disorders/rh [Rehabilitation] MH - Respiration, Artificial MH - Substance Withdrawal Syndrome/pc [Prevention & Control] AB - The technique for ultra rapid opioid detoxification is designed to shorten the detoxification period by precipitating withdrawal by the administration of opioid antagonists such as naloxone or naltrexone. This procedure is performed under deep sedation or general anaesthesia to ensure that the patient does not consciously experience the acute withdrawal phase. This strategy has aroused controversy regarding the risk of sedation or anaesthesia in this situation. In the present study, ultra rapid opioid detoxification was carried out in 12 opiate-addicted patients by infusion of naloxone 4 mg for a period of 5 h using controlled ventilation during general anaesthesia, induced and maintained with midazolam, propofol and atracurium. Invasive cardiovascular and respiratory monitoring was performed, and withdrawal signs were evaluated using a graduated scale. Anaesthesia was maintained for another hour after the completion of the naloxone infusion. The validity of this anaesthesia protocol was confirmed by the relative lack of change in the patients' haemodynamic values associated with mild signs of withdrawal. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0265-0215 IL - 0265-0215 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - eja572 [pii] PP - ppublish LG - English DP - 1999 Oct EZ - 1999/12/03 DA - 1999/12/03 00:01 DT - 1999/12/03 00:00 YR - 1999 ED - 19991222 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10583357 <820. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10525597 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dworzak H AU - Fuss F AU - Buttner T FA - Dworzak, H FA - Fuss, F FA - Buttner, T IN - Dworzak, H. Abteilung fur Anasthesie und Intensivmedizin, Kreiskrankenhaus Muhldorf am Inn. TI - [Persisting respiratory depression following intrathecal administration of morphine and simultaneous sedation with midazolam]. [German] OT - Langanhaltende Atem- depression nach intrathekaler Morphinapplikation und gleichzeitiger Sedierung mit Midazolam. SO - Anaesthesist. 48(9):639-41, 1999 Sep AS - Anaesthesist. 48(9):639-41, 1999 Sep NJ - Der Anaesthesist VO - 48 IP - 9 PG - 639-41 PI - Journal available in: Print PI - Citation processed from: Print JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Aged MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Flumazenil/tu [Therapeutic Use] MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - *Hypnotics and Sedatives/ae [Adverse Effects] MH - Injections, Spinal MH - Intubation, Intratracheal MH - Male MH - Midazolam/ad [Administration & Dosage] MH - *Midazolam/ae [Adverse Effects] MH - Morphine/ad [Administration & Dosage] MH - *Morphine/ae [Adverse Effects] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Respiration, Artificial MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Respiratory Insufficiency/th [Therapy] AB - A 72-year-old patient received 0.1 mg morphine by the intrathecal route and 2 x 1.5 mg midazolam as adjuvant therapy. Severe respiratory depression and somnolence supervened 3.5 h later, which lasted over the next 24 h and necessitated intubation and mechanical ventilation. Continuous administration of >6 mg naloxone to antagonize the supposed effect of the morphine had no effect. The patient's condition was not normalized until a single dose of 0.3 mg flumazenil was administered. For the time being, especially in the case of elderly patients, we recommend that strict indications are adhered to when intrathecal administration of morphine is considered and that less than 0.1 mg morphine is given. Diazepines should be avoided. Respiration should be monitored for quite some time. RN - 0 (Analgesics, Opioid) RN - 0 (Hypnotics and Sedatives) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 40P7XK9392 (Flumazenil) RN - 76I7G6D29C (Morphine) RN - R60L0SM5BC (Midazolam) IS - 0003-2417 IL - 0003-2417 PT - Case Reports PT - English Abstract PT - Journal Article ID - 90480639.101 [pii] ID - 10.1007/s001010050764 [doi] PP - ppublish LG - German DP - 1999 Sep EZ - 1999/10/20 DA - 1999/10/20 00:01 DT - 1999/10/20 00:00 YR - 1999 ED - 19991207 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10525597 <821. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10562867 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Brugal MT AU - Domingo-Salvany A AU - Maguire A AU - Cayla JA AU - Villalbi JR AU - Hartnoll R FA - Brugal, M T FA - Domingo-Salvany, A FA - Maguire, A FA - Cayla, J A FA - Villalbi, J R FA - Hartnoll, R IN - Brugal, M T. Servei d'Epidemiologia, Institut Municipal de Salut Publica de Barcelona, Spain. TI - A small area analysis estimating the prevalence of addiction to opioids in Barcelona, 1993. SO - Journal of Epidemiology & Community Health. 53(8):488-94, 1999 Aug AS - J Epidemiol Community Health. 53(8):488-94, 1999 Aug NJ - Journal of epidemiology and community health VO - 53 IP - 8 PG - 488-94 PI - Journal available in: Print PI - Citation processed from: Print JC - i1p, 7909766 IO - J Epidemiol Community Health PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1756943 SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Prevalence MH - Regression Analysis MH - Small-Area Analysis MH - Social Class MH - Spain/ep [Epidemiology] AB - STUDY OBJECTIVE: To determine the distribution of opioid use prevalence in small areas and its relation with socioeconomic indicators. AB - DESIGN: Capture-recapture was applied using data from the Barcelona Drug Information System for 1993 (treatment demands, hospital emergency room visits, deaths from heroin acute adverse reaction and pre-trial prison admissions). To avoid dependence between sources, a log-linear regression model with interactions was fitted. For small neighbourhoods, where capture-recapture estimates were not obtainable, the Heroin Problem Index (HPI) was used to predict prevalence rates from a regression model. The correlation between estimated opioid use prevalence by neighbourhoods and their socioeconomic level was computed. AB - MAIN RESULTS: The city's estimated prevalence was 12.9 opioid addicts per 1000 inhabitants aged 15 to 44 years (95% CI: 10.1, 17.2), which represents 9176 persons. The highest rate was found in the inner city neighbourhood. Comparing rates obtained for each neighbourhood with their unemployment rates, a high correlation coefficient was obtained (r = 0.80, p < 0.001). AB - CONCLUSION: The main contribution of this study is that of combining capture-recapture with the HPI to produce small area prevalence estimates, which would not have been possible using only one method. Areas with higher socioeconomic status showed proportionally low addiction prevalences, but in depressed areas, prevalences varied widely. IS - 0143-005X IL - 0143-005X PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - PMC1756943 [pmc] PP - ppublish LG - English DP - 1999 Aug EZ - 1999/11/24 DA - 1999/11/24 00:01 DT - 1999/11/24 00:00 YR - 1999 ED - 19991123 RD - 20140615 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10562867 <822. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10534037 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Haynes BE AU - Pritting J FA - Haynes, B E FA - Pritting, J IN - Haynes, B E. Emergency Medical Services Agency, Public Health Department, County of Imperial, California, USA. behaynes@worldnet.att.net TI - A rural emergency medical technician with selected advanced skills. SO - Prehospital Emergency Care. 3(4):343-6, 1999 Oct-Dec AS - Prehosp Emerg Care. 3(4):343-6, 1999 Oct-Dec NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 3 IP - 4 PG - 343-6 PI - Journal available in: Print PI - Citation processed from: Print JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - *Allied Health Personnel/ed [Education] MH - California MH - Clinical Competence MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Rural Health Services/sn [Statistics & Numerical Data] MH - Time Factors AB - OBJECTIVE: To educate rural emergency medical technician basics (EMTs) in selected advanced skills, and then evaluate the safety and effectiveness of practice. AB - METHODS: After a minimum 72 hours of training, EMTs employed three skills (Combitube, glucometry, automated external defibrillation) and seven medications (albuterol, nitroglycerin, naloxone, epinephrine, glucagon, activated charcoal, and aspirin). Written patient care records and audiotapes were reviewed. Congruence between prehospital assessment and emergency department (ED) diagnosis was assessed, along with correct use of airway skills (18 of 36 months). The completeness of documentation, appropriateness of treatment, and patient response (by explicit criteria) were determined. Errors and complications were recorded. AB - RESULTS: During three years of the program, 266 patients were treated, primarily for chest pain and respiratory distress. No significant errors or complications occurred. Treatment was judged 94% appropriate, with improvement in 60% of patients. Documentation had major omissions in 3% of cases. Field and ED diagnostic congruence was present in 97/129 (75%) when evaluated during the first 18 months. EMT skill levels were maintained. The mean time to traditional advanced life support (ALS) care was 41 minutes. AB - CONCLUSIONS: Basic-level EMTs in rural areas can be trained in selected advanced skills, and provide ALS-level care quickly and appropriately. Close medical oversight involving review of care and follow-up education is an important part of the program. IS - 1090-3127 IL - 1090-3127 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1999 Oct-Dec EZ - 1999/10/26 DA - 1999/10/26 00:01 DT - 1999/10/26 00:00 YR - 1999 ED - 19991123 RD - 20061115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10534037 <823. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10530541 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Thomas SH AU - Borczuk P AU - Shackelford J AU - Ostrander J AU - Silver D AU - Evans M AU - Stein J FA - Thomas, S H FA - Borczuk, P FA - Shackelford, J FA - Ostrander, J FA - Silver, D FA - Evans, M FA - Stein, J IN - Thomas, S H. Harvard Medical School, and the Department of Emergency Medicine, Massachusetts General Hospital, Boston 02114, USA. TI - Patient and physician agreement on abdominal pain severity and need for opioid analgesia. SO - American Journal of Emergency Medicine. 17(6):586-90, 1999 Oct AS - Am J Emerg Med. 17(6):586-90, 1999 Oct NJ - The American journal of emergency medicine VO - 17 IP - 6 PG - 586-90 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Abdominal Pain/di [Diagnosis] MH - *Abdominal Pain/dt [Drug Therapy] MH - Adult MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - Emergencies MH - Female MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Observer Variation MH - *Pain Measurement/mt [Methods] MH - Prospective Studies MH - Self-Assessment MH - Statistics, Nonparametric AB - Whereas controversy surrounds emergency department (ED) analgesia administration to patients with undifferentiated abdominal pain, few studies have addressed the level of patient-physician agreement on abdominal pain severity and need for opioid analgesia. This prospective study was undertaken to assess concordance between emergency physicians and patients on abdominal pain severity. Study subjects were a convenience sample of 30 adults seen in an urban university-affiliated tertiary care ED (annual census 65,000) who had undifferentiated abdominal pain meeting an initial severity threshold of 5 on a 10 cm visual analog scale (VAS) marked by the patient. Patients' and physicians' VAS scores, obtained in blinded fashion at presentation (t0) and at one (t1) and two (t2) hours into the ED stay, were compared with t test (VAS scores) and sign-rank (percent change in VAS scores) analyses. In addition, patients and physicians were asked at each assessment time, in blinded fashion, "Is the pain severe enough to warrant morphine?" The kappa statistic was used to characterize the degree of agreement between physician and patient assessments as to whether opioids were indicated. At t0, t1, and t2, patients' mean VAS scores (7.5, 6.7, and 5.1) were significantly (P < .05) higher than the corresponding physicians' VAS scores (5.3, 4.7, and 3.9). Though VAS scores for physicians started lower than those of patients, the percentage changes in scores from one assessment to the next were similar by Wilcoxon sign-rank testing (P > .50 for time intervals t0 - t1 and t1 - t2). Overall, patients and physicians agreed on the question of whether pain was sufficient to warrant opioids in 71 of 90 (78.9%) assessments; the corresponding kappa statistic of .57 indicated moderate agreement (P < .0001). These results, indicating that patients and physicians usually agree on whether opioids are warranted for abdominal pain, have important implications for further research on ED analgesia in this population. RN - 0 (Analgesics, Opioid) IS - 0735-6757 IL - 0735-6757 PT - Journal Article ID - S0735-6757(99)90203-6 [pii] PP - ppublish LG - English DP - 1999 Oct EZ - 1999/10/26 DA - 1999/10/26 00:01 DT - 1999/10/26 00:00 YR - 1999 ED - 19991104 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10530541 <824. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10499949 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pena BM AU - Krauss B FA - Pena, B M FA - Krauss, B IN - Pena, B M. Division of Emergency Medicine, Department of Pediatrics, Children's Hospital, Harvard Medical School, Boston, MA, USA. pena_b@al.tch.harvard.edu TI - Adverse events of procedural sedation and analgesia in a pediatric emergency department. CM - Comment in: Ann Emerg Med. 2001 Jul;38(1):92-5; PMID: 11423823 SO - Annals of Emergency Medicine. 34(4 Pt 1):483-91, 1999 Oct AS - Ann Emerg Med. 34(4 Pt 1):483-91, 1999 Oct NJ - Annals of emergency medicine VO - 34 IP - 4 Pt 1 PG - 483-91 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Analgesia/ae [Adverse Effects] MH - Child MH - Child, Preschool MH - *Conscious Sedation/ae [Adverse Effects] MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Fentanyl MH - Hospitals, Teaching MH - Hospitals, Urban MH - Humans MH - *Iatrogenic Disease/ep [Epidemiology] MH - Infant MH - Infant, Newborn MH - Ketamine MH - Midazolam MH - Pediatrics MH - Sufentanil MH - United States AB - STUDY OBJECTIVE: To determine the adverse event and complication rate for the use of procedural sedation and analgesia for painful procedures and diagnostic imaging studies performed in a pediatric emergency department. AB - METHODS: This prospective case series was conducted in the ED of a large, urban pediatric teaching hospital. Subjects were patients younger than 21 years seen between August 1997 and July 1998, who required intravenous, intramuscular, oral, rectal, intranasal, or inhalational agents for painful procedures or diagnostic imaging. All patients who underwent procedural sedation and analgesia were continually monitored. Adverse events and complications were recorded. The ED controlled substance log was checked weekly and all sedations were reviewed. Adverse events were defined as follows: oxygen desaturation less than 90%, apnea, stridor, laryngospasm, bronchospasm, cardiovascular instability, paradoxical reactions, emergence reactions, emesis, and aspiration. Complications were defined as adverse events that negatively affected outcome or delayed recovery. AB - RESULTS: Of 1,180 patients who underwent procedural sedation and analgesia in the ED, 27 (2.3%) experienced adverse events, which included oxygen desaturation less than 90% requiring intervention (10 patients) [supplemental oxygen (9), bag-mask ventilation (1)], paradoxical reactions (7), emesis (3), paradoxical reaction and oxygen desaturation requiring supplemental oxygen (2), apnea requiring bag-mask ventilation (1), laryngospasm requiring bag-mask ventilation (1), bradycardia (1), stridor and emesis (1) and oxygen desaturation requiring bag-mask ventilation with subsequent emesis (1). There was no statistically significant difference in mean doses for all procedural sedation and analgesia medication regimens between those children who experienced adverse events and those who did not. No single drug or drug regimen was associated with a higher adverse event rate. In addition, there was no significant difference in the adverse event rate between males and females, among the different ages, or among the different indications for procedural sedation and analgesia. No patient required reversal of sedation with naloxone or flumazenil, endotracheal intubation, or hospital admission because of complications from procedural sedation and analgesia. AB - CONCLUSION: The adverse event rate for procedural sedation and analgesia performed by pediatric emergency physicians was 2.3% with no serious complications noted. RN - 690G0D6V8H (Ketamine) RN - AFE2YW0IIZ (Sufentanil) RN - R60L0SM5BC (Midazolam) RN - UF599785JZ (Fentanyl) IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - S0196064499003340 [pii] PP - ppublish LG - English DP - 1999 Oct EZ - 1999/09/28 DA - 1999/09/28 00:01 DT - 1999/09/28 00:00 YR - 1999 ED - 19991021 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10499949 <825. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10217672 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Perez Gonzalez K AU - Domingo-Salvany A AU - Hartnoll R FA - Perez Gonzalez, K FA - Domingo-Salvany, A FA - Hartnoll, R IN - Perez Gonzalez, K. Institut Municipal d'Investigacio Medica, Barcelona, Barcelona, 08003, Espana. TI - [Prevalence of human immunodeficiency virus and risk behaviours among opioid users seen in an emergency room]. [Spanish] OT - Prevalencia de la infeccion por el virus de la inmunodeficiencia humana y conductas de riesgo en consumidores de opioides visitados en un servicio de urgencias. SO - Gaceta Sanitaria. 13(1):7-15, 1999 Jan-Feb AS - Gac Sanit. 13(1):7-15, 1999 Jan-Feb NJ - Gaceta sanitaria VO - 13 IP - 1 PG - 7-15 PI - Journal available in: Print PI - Citation processed from: Print JC - 0370727, 8901623, gsz, 8901623 IO - Gac Sanit SB - Index Medicus SB - AIDS/HIV Journals CP - Spain MH - Adolescent MH - Adult MH - Comorbidity MH - Condoms/ut [Utilization] MH - Cross-Sectional Studies MH - *Emergency Service, Hospital/sn [Statistics & Numerical Data] MH - Female MH - *HIV Infections/ep [Epidemiology] MH - HIV Infections/tm [Transmission] MH - *HIV Seroprevalence MH - HIV-1 MH - Humans MH - Male MH - Middle Aged MH - Needle Sharing/sn [Statistics & Numerical Data] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Risk Factors MH - Risk-Taking MH - Sexual Behavior/sn [Statistics & Numerical Data] MH - Socioeconomic Factors MH - Spain/ep [Epidemiology] MH - Substance Abuse, Intravenous/ep [Epidemiology] AB - INTRODUCTION: As prevalence of HIV-1 among drug users in Spain is high and it is difficult to contact them because of their hidden behaviors, emergency rooms are one of the health facilities where they can be located. A cross-sectional interview study was planned. The aims of the study were to estimate prevalence of HIV-1 and to describe risk behaviors. AB - METHODS: The sample included all patients that in spring 1992 were detected and referred by the doctor as being current opiate users, defined as any use in the 30 days prior the interview. Drug users who did not know their HIV status or were negative for more than six months were asked to provide a urine sample to test HIV serology. A descriptive analysis with simple stratification was carried out. Row and adjusted odds ratio were used to analyse association between different variables and HIV status. Logistic regression was used to examine variables associated with HIV infection and risk behaviors (injecting drug use, sharing needles, and no use of condom). AB - RESULTS: Three hundred and eighty three opiate users were interviewed. It was possible to know HIV status of 94% of the subjects. Of them, 61% were positive (219). The best adjusted logistic model to predict associated variables with HIV included being female, primary school level, sickness absence, to attend because of organic pathology, and more years of parenteral use. Seventy five percent of the sample injected drugs during the past 30 days, and among them 30% shared syringes. The variables associated with a higher probability of having injected heroin or cocaine in the last 30 days were to have completed at least primary education, to be unemployed or reliant on illegal activities, not to be in drug treatment, and a larger number of drugs used in the last 30 days. A higher probability of sharing syringes was associated with a lower educational level, not to be in drug treatment, to live alone and a higher number of drugs used during last 30 days. Twenty one percent of the subjects who were sexually active always or nearly always used condom with regular partners and 56% with casual partners. Women were more likely to use condom than men with casual partners. Subjects who shared syringes during last 30 days were nearly three times more likely not to use condom with casual partners. AB - CONCLUSIONS: Although a high prevalence of HIV-1 was estimated among opioid users seen in an emergency room, it is not higher than estimates for intravenous drug users recruited from treatment centres, prison or needles exchange programs. A high frequency of risk behavior was also observed indicating a need to develop specific prevention programs for drug users. IS - 0213-9111 IL - 0213-9111 PT - English Abstract PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0213-9111(99)71316-6 [pii] PP - ppublish LG - Spanish DP - 1999 Jan-Feb EZ - 1999/04/27 DA - 1999/04/27 00:01 DT - 1999/04/27 00:00 YR - 1999 ED - 19991021 RD - 20171121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10217672 <826. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10461561 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - De Giacomo M AU - Gaspari R AU - Stefanelli A AU - Barelli A AU - Mannelli P FA - De Giacomo, M FA - Gaspari, R FA - Stefanelli, A FA - Barelli, A FA - Mannelli, P IN - De Giacomo, M. Poison Control Centre, Policlinico Agostino Gemelli, School of Medicine, Catholic University of Rome, Italy. TI - Emergency therapeutical approach simulating ultrarapid opioid detoxification in methadone withdrawal precipitated by erroneous administration of naltrexone. SO - European Journal of Emergency Medicine. 6(2):153-5, 1999 Jun AS - Eur J Emerg Med. 6(2):153-5, 1999 Jun NJ - European journal of emergency medicine : official journal of the European Society for Emergency Medicine VO - 6 IP - 2 PG - 153-5 PI - Journal available in: Print PI - Citation processed from: Print JC - cl2, 9442482 IO - Eur J Emerg Med SB - Index Medicus CP - England MH - Adult MH - *Anesthetics, Intravenous/tu [Therapeutic Use] MH - Emergencies MH - Humans MH - Male MH - *Methadone/ae [Adverse Effects] MH - *Naltrexone/po [Poisoning] MH - *Narcotic Antagonists/po [Poisoning] MH - *Propofol/tu [Therapeutic Use] MH - *Substance Withdrawal Syndrome/dt [Drug Therapy] MH - Substance Withdrawal Syndrome/et [Etiology] AB - We report the case of a 30-year-old male, heroin dependent, receiving methadone treatment, who, while staying at home, ingested 50 mg of naltrexone. He immediately developed serious withdrawal symptoms and was admitted to the hospital. In the emergency department the drugs given to counteract the agitation were ineffective, and the patient developed respiratory distress. Anaesthesia with propofol was then started and the patient was intubated, ventilated and hospitalized in the intensive care unit. He was then sedated for 48 hours due to persistent withdrawal signs. When medically stable the patient was transferred to the medical ward where daily treatment with naltrexone and psychological support where started. After 4 days the patient was discharged. Afterwards he did not attend his scheduled outpatient follow-up visits. Treatment with propofol is effective in the case of a patient with a serious withdrawal syndrome secondary to naltrexone overdose during methadone therapy. Despite the actual possibility of getting through the withdrawal symptoms the patient failed to return for follow-up visits, which might be related to a lack of motivation. RN - 0 (Anesthetics, Intravenous) RN - 0 (Narcotic Antagonists) RN - 5S6W795CQM (Naltrexone) RN - UC6VBE7V1Z (Methadone) RN - YI7VU623SF (Propofol) IS - 0969-9546 IL - 0969-9546 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1999 Jun EZ - 1999/08/26 DA - 1999/08/26 00:01 DT - 1999/08/26 00:00 YR - 1999 ED - 19991019 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10461561 <827. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10424852 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Vilke GM AU - Buchanan J AU - Dunford JV AU - Chan TC FA - Vilke, G M FA - Buchanan, J FA - Dunford, J V FA - Chan, T C IN - Vilke, G M. Department of Emergency Medicine, University of California, San Diego Medical Center, 92103, USA. gmvilke@ucsd.edu TI - Are heroin overdose deaths related to patient release after prehospital treatment with naloxone?. SO - Prehospital Emergency Care. 3(3):183-6, 1999 Jul-Sep AS - Prehosp Emerg Care. 3(3):183-6, 1999 Jul-Sep NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 3 IP - 3 PG - 183-6 PI - Journal available in: Print PI - Citation processed from: Print JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Aged MH - *Cause of Death MH - Confidence Intervals MH - *Drug Overdose/dt [Drug Therapy] MH - *Drug Overdose/mo [Mortality] MH - *Emergency Medical Services/mt [Methods] MH - Female MH - *Heroin/po [Poisoning] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Patient Discharge/sn [Statistics & Numerical Data] MH - Registries MH - Retrospective Studies MH - Substance-Related Disorders/dt [Drug Therapy] MH - Substance-Related Disorders/mo [Mortality] MH - Survival Analysis MH - Treatment Refusal MH - United States AB - OBJECTIVE: Naloxone is frequently used by prehospital care providers to treat suspected heroin and opioid overdoses. The authors' EMS system has operated a policy of allowing these patients, once successfully treated, to sign out against medical advice (AMA) in the field. This study was performed to evaluate the safety of this practice. AB - METHODS: The authors retrospectively reviewed all 1996 San Diego County Medical Examiner's (ME's) cases in which opioid overdoses contributed to the cause of death. The records of all patients who were found dead in public or private residences or died in emergency departments of reasons other than natural causes or progression of disease, are forwarded to the ME office. ME cases associated with opiate use as a cause of death were cross-compared with all patients who received naloxone by field paramedics and then refused transport. The charts were reviewed by dates, times, age, sex, location, and, when available, ethnicity. AB - RESULTS: There were 117 ME cases of opiate overdose deaths and 317 prehospital patients who received naloxone and refused further treatment. When compared by age, time, date, sex, location, and ethnicity, there was no case in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opiate overdose. AB - CONCLUSIONS: Giving naloxone to heroin overdoses in the field and then allowing the patients to sign out AMA resulted in no death in the one-year period studied. This study did not evaluate for return visits by paramedics nor whether patients were later taken to hospitals by private vehicles. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 1090-3127 IL - 1090-3127 PT - Comparative Study PT - Journal Article PP - ppublish LG - English DP - 1999 Jul-Sep EZ - 1999/07/29 DA - 1999/07/29 00:01 DT - 1999/07/29 00:00 YR - 1999 ED - 19990922 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10424852 <828. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10420314 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pfab R AU - Zilker T FA - Pfab, R FA - Zilker, T IN - Pfab, R. Toxikologische Abteilung, II. Medizinischen Klinik der Technischen Universitat, Munchen. TI - [Drug-related emergencies with opiates]. [Review] [52 refs] [German] OT - Drogennotfalle mit Opiaten. SO - Internist. 40(6):611-6, 1999 Jun AS - Internist (Berl). 40(6):611-6, 1999 Jun NJ - Der Internist VO - 40 IP - 6 PG - 611-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 0264620, gvx IO - Internist (Berl) SB - Index Medicus CP - Germany MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/rh [Rehabilitation] MH - *Emergencies MH - Heroin Dependence/co [Complications] MH - Heroin Dependence/di [Diagnosis] MH - Heroin Dependence/rh [Rehabilitation] MH - Humans MH - Internal Medicine MH - Methadone/ae [Adverse Effects] MH - Methadone/po [Poisoning] MH - *Narcotics/ae [Adverse Effects] MH - Narcotics/po [Poisoning] MH - *Opioid-Related Disorders/co [Complications] MH - Opioid-Related Disorders/di [Diagnosis] MH - Opioid-Related Disorders/rh [Rehabilitation] MH - Patient Care Team MH - Substance Withdrawal Syndrome/di [Diagnosis] MH - Substance Withdrawal Syndrome/rh [Rehabilitation] RN - 0 (Narcotics) RN - UC6VBE7V1Z (Methadone) IS - 0020-9554 IL - 0020-9554 PT - Journal Article PT - Review PP - ppublish LG - German DP - 1999 Jun EZ - 1999/07/27 DA - 1999/07/27 00:01 DT - 1999/07/27 00:00 YR - 1999 ED - 19990917 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10420314 <829. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10354528 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Perez Gonzalez K AU - Domingo-Salvany A AU - Hartnoll R FA - Perez Gonzalez, K FA - Domingo-Salvany, A FA - Hartnoll, R IN - Perez Gonzalez, K. Institut Municipal d'Investigacio Medica, Barcelona, 08003, Espana. TI - [The characteristics of opiate users seen in an emergency service]. [Spanish] OT - Caracteristicas de los consumidores de opioides visitados en un servicio de urgencias. CM - Comment in: Gac Sanit. 1999 Mar-Apr;13(2):79-81; PMID: 10354526 SO - Gaceta Sanitaria. 13(2):88-95, 1999 Mar-Apr AS - Gac Sanit. 13(2):88-95, 1999 Mar-Apr NJ - Gaceta sanitaria VO - 13 IP - 2 PG - 88-95 PI - Journal available in: Print PI - Citation processed from: Print JC - 0370727, 8901623, gsz, 8901623 IO - Gac Sanit SB - Index Medicus CP - Spain MH - Adult MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Chi-Square Distribution MH - *Cocaine-Related Disorders/co [Complications] MH - Cocaine-Related Disorders/ep [Epidemiology] MH - Cocaine-Related Disorders/rh [Rehabilitation] MH - Cross-Sectional Studies MH - Emergencies MH - Female MH - Humans MH - Interviews as Topic MH - Male MH - Methadone/tu [Therapeutic Use] MH - *Opioid-Related Disorders/co [Complications] MH - Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/rh [Rehabilitation] MH - Socioeconomic Factors MH - Spain/ep [Epidemiology] AB - INTRODUCTION: Despite of the fact that it was reported for years that emergency rooms are the first health services where drug users attend, there are very few direct studies of this population. In most emergency room studies, the information was obtained from data available in the clinical records, and in very few drug users were interviewed. With the aim of having a deeper knowledge of opiate users who attend the emergency room it was planned to carry out a cross-sectional study interviewing them. The aims of this paper are to describe demographic characteristics, patterns of drug use and to know whether they contact first to an emergency room or to a treatment centre. AB - METHODS: The sample included all patients detected and referred by the doctor as being current opiate users, defined as any use in the 30 days prior the interview. A descriptive bivariate analysis with simple stratification was carried out. AB - RESULTS: Of the subjects referred by the doctor 383 opiate users were interviewed and 76 were not interviewed. The male/female ratio for the 383 interviewed opiates users was 2. Women were younger than men (25.8 vs 28.3, p (3/4) 0.001). Heroin or cocaine ever injected was reported by 93% and 76% reported injecting in the last 30 days. The mean age at the first use of heroin was higher for those who started use during 1989 or after (21.6) than those who started before 1989 (17.9) (p (3/4) 0.0001). Patients attending the emergency room for organic pathology were older (28.5) than those who attended for withdrawal (26.2) and those who attended for overdose (27.3) (p (3/4) 0.05). Thirty eight percent reported to attend first an emergency room for a drug related problem since they started drug use, and 47% to contact first with a treatment centre for drug dependence. AB - CONCLUSION: Drug users interviewed seem to be more heavy users than those who started drug treatment in the public centres of Barcelona in 1992. Also, the hypothesis that emergency rooms are for this population the first contact point with health services is not supported by this study. RN - 0 (Analgesics, Opioid) RN - UC6VBE7V1Z (Methadone) IS - 0213-9111 IL - 0213-9111 PT - English Abstract PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0213-9111(99)71332-4 [pii] PP - ppublish LG - Spanish DP - 1999 Mar-Apr EZ - 1999/06/04 DA - 1999/06/04 00:01 DT - 1999/06/04 00:00 YR - 1999 ED - 19990811 RD - 20171121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10354528 <830. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10381993 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kaplan JL AU - Marx JA AU - Calabro JJ AU - Gin-Shaw SL AU - Spiller JD AU - Spivey WL AU - Gaddis GM AU - Zhao N AU - Harchelroad FP Jr FA - Kaplan, J L FA - Marx, J A FA - Calabro, J J FA - Gin-Shaw, S L FA - Spiller, J D FA - Spivey, W L FA - Gaddis, G M FA - Zhao, N FA - Harchelroad, F P Jr IN - Kaplan, J L. Department of Emergency Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA. kaplanj@aehn2.einstein.edu TI - Double-blind, randomized study of nalmefene and naloxone in emergency department patients with suspected narcotic overdose. SO - Annals of Emergency Medicine. 34(1):42-50, 1999 Jul AS - Ann Emerg Med. 34(1):42-50, 1999 Jul NJ - Annals of emergency medicine VO - 34 IP - 1 PG - 42-50 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Double-Blind Method MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Treatment/mt [Methods] MH - Humans MH - Injections, Intravenous MH - *Naloxone/tu [Therapeutic Use] MH - *Naltrexone/aa [Analogs & Derivatives] MH - Naltrexone/pd [Pharmacology] MH - Naltrexone/tu [Therapeutic Use] MH - Narcotic Antagonists/pd [Pharmacology] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Neurologic Examination MH - Respiration/de [Drug Effects] MH - Time Factors MH - Treatment Outcome AB - STUDY OBJECTIVES: To compare the efficacy, safety, and withdrawal symptoms in emergency department patients with suspected narcotic overdose treated with nalmefene, an opioid antagonist with a 4- to 10-hour duration of action, with those treated with naloxone. AB - METHODS: Adults in 9 centers who would otherwise receive naloxone for altered consciousness levels were randomly assigned to receive intravenous study drug (1 mg nalmefene, or 2 mg nalmefene or 2 mg naloxone, double-blinded) every 5 minutes as needed for up to 4 doses in a 4-hour study. Outcomes were 20-minute and 4-hour posttreatment changes in respiratory rates, Neurobehavioral Assessment Scale scores, Opioid Withdrawal Scale scores, and incidences of adverse events. AB - RESULTS: Opioid positivity was recorded for 30 of 63 (1-mg nalmefene), 23 of 55 (2-mg nalmefene), and 24 of 58 (naloxone) cases, 75% of whom also had nonopioid central nervous system depressants. Most patients received only 1 dose of study drug. Similar, clinically meaningful improvements in respiratory rates and Neurobehavioral Assessment Scale scores were seen with all treatments. No statistical differences in efficacy or withdrawal outcomes were seen between treatment groups, and no significant overall time-treatment interactions occurred, in either the entire patient group or among opioid-positive cases (P >.21, all comparisons). Adverse events occurred in 30.9% (2 mg nalmefene), 15.9% (1 mg nalmefene), and 15.5% (naloxone) of patients (P >.08); none were associated with morbidity. AB - CONCLUSION: In this study of patients with varied potential causes of altered consciousness, nalmefene (1 mg and 2 mg) and naloxone (2 mg) appeared to be efficacious, safe, and to yield similar clinical outcomes. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 5S6W795CQM (Naltrexone) RN - TOV02TDP9I (nalmefene) IS - 0196-0644 IL - 0196-0644 PT - Clinical Trial PT - Clinical Trial, Phase III PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - S0196064499002255 [pii] PP - ppublish LG - English DP - 1999 Jul EZ - 1999/06/26 10:00 DA - 2001/03/28 10:01 DT - 1999/06/26 10:00 YR - 1999 ED - 19990715 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10381993 <831. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10225280 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kattwinkel J AU - Niermeyer S AU - Nadkarni V AU - Tibballs J AU - Phillips B AU - Zideman D AU - Van Reempts P AU - Osmond M FA - Kattwinkel, J FA - Niermeyer, S FA - Nadkarni, V FA - Tibballs, J FA - Phillips, B FA - Zideman, D FA - Van Reempts, P FA - Osmond, M IN - Kattwinkel, J. American Academy of Pediatrics, Elk Grove Village, IL, USA. jk3f@virginia.edu TI - Resuscitation of the newly born infant: an advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation. [Review] [85 refs] SO - Resuscitation. 40(2):71-88, 1999 Feb-Mar AS - Resuscitation. 40(2):71-88, 1999 Feb-Mar NJ - Resuscitation VO - 40 IP - 2 PG - 71-88 PI - Journal available in: Print PI - Citation processed from: Print JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Humans MH - Infant, Newborn/ph [Physiology] MH - *Infant, Newborn MH - International Cooperation MH - Life Support Care MH - Resuscitation/mt [Methods] MH - *Resuscitation AB - The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours following birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly. born infant included the following principles. (i) Personnel trained in the basic skills of resuscitation should be in attendance at every delivery. A minority (fewer than 10%) of newly born infants require active resuscitative interventions to establish a vigorous cry and regular respirations, maintain a heart rate greater than 100 beats per minute (bpm), and maintain good color and tone. (ii) When meconium is present in the amniotic fluid, it should be suctioned from the hypopharynx on delivery of the head. If the meconium-stained newly born infant has absent or depressed respirations, heart rate, or muscle tone, residual meconium should be suctioned from the trachea. (ii) Attention to ventilation should be of primary concern. Assisted ventilation with attention to oxygen delivery, inspiratory time, and effectiveness judged by chest rise should be provided if stimulation does not achieve prompt onset of spontaneous respirations and/or the heart rate is less than 100 bpm. (iv) Chest compressions should be provided if the heart rate is absent or remains less than 60 bpm despite adequate assisted ventilation for 30 s. Chest compressions should be coordinated with ventilations at a ratio of 3:1 and a rate of 120 'events' per minute to achieve approximately 90 compressions and 30 rescue breaths per minute. (v) Epinephrine should be administered intravenously or intratracheally if the heart rate remains less than 60 bpm despite 30 s of effective assisted ventilation and chest compression circulation. Common or controversial medications (epinephrine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines. [References: 85] IS - 0300-9572 IL - 0300-9572 PT - Consensus Development Conference PT - Guideline PT - Journal Article PT - Practice Guideline PT - Review ID - S030095729900012X [pii] PP - ppublish LG - English DP - 1999 Feb-Mar EZ - 1999/05/04 DA - 1999/05/04 00:01 DT - 1999/05/04 00:00 YR - 1999 ED - 19990616 RD - 20090825 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10225280 <832. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10200857 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lalkin A AU - Kapur BM AU - Verjee ZH AU - Koren G FA - Lalkin, A FA - Kapur, B M FA - Verjee, Z H FA - Koren, G IN - Lalkin, A. Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada. TI - Contamination of antibiotics resulting in severe pediatric methadone poisoning.[Erratum appears in Ann Pharmacother 1999 Sep;33(9):1011] SO - Annals of Pharmacotherapy. 33(3):314-7, 1999 Mar AS - Ann Pharmacother. 33(3):314-7, 1999 Mar NJ - The Annals of pharmacotherapy VO - 33 IP - 3 PG - 314-7 PI - Journal available in: Print PI - Citation processed from: Print JC - bbx, 9203131 IO - Ann Pharmacother SB - Index Medicus CP - United States MH - *Amoxicillin MH - Canada MH - Child, Preschool MH - *Drug Contamination MH - Humans MH - Male MH - Methadone/bl [Blood] MH - *Methadone/po [Poisoning] MH - Methadone/ur [Urine] MH - Narcotics/bl [Blood] MH - *Narcotics/po [Poisoning] MH - Narcotics/ur [Urine] MH - *Penicillins MH - Pharmacy MH - Poisoning/bl [Blood] MH - *Poisoning/di [Diagnosis] MH - Poisoning/et [Etiology] MH - Poisoning/ur [Urine] MH - Suspensions AB - OBJECTIVE: To report an accidental contamination of antibiotic suspension by methadone that occurred in a retail Canadian pharmacy, leading to severe poisoning in a young child. AB - CASE SUMMARY: A 4 1/2-year-old healthy Asian boy was prescribed amoxicillin suspension for cough and fever. Shortly after receiving the second dose of 5 mL he became drowsy and less responsive. On admission, he was arousable by deep pain, and pinpoint pupils were noted. A urine sample sent for a toxicology screen revealed the presence of methadone and its metabolite. Blood methadone concentrations were 0.23 and 0.14 mg/L, five and nine hours after the second dose of amoxicillin was given, respectively. The amoxicillin suspension was tested for methadone and was found to have a concentration of 2.4 g/L. The child gradually improved and was discharged on day 4 in good condition. The pharmacy in which the antibiotic was dispensed has been a dispensing center for a local methadone maintenance program, and methadone was accidentally mixed with the antibiotics. AB - DISCUSSION: In this case, a near fatal outcome occurred when methadone was inadvertently mixed with antibiotics in a community pharmacy. A literature search revealed two previous reports of opiate toxicity in children following ingestion of oral antibiotic preparations. AB - CONCLUSIONS: Prompt action is needed in Canadian pharmacies that dispense methadone in order to minimize such errors in the future. General practitioners, pediatricians, and emergency department physicians should recognize and suspect this rare cause of opiate toxicity in a child. In a patient presenting with a decreased level of consciousness and miosis, with or without respiratory depression, naloxone administration should be considered, whether or not a history of opioid ingestion is obtained. RN - 0 (Narcotics) RN - 0 (Penicillins) RN - 0 (Suspensions) RN - 804826J2HU (Amoxicillin) RN - UC6VBE7V1Z (Methadone) IS - 1060-0280 IL - 1060-0280 PT - Case Reports PT - Journal Article ID - 10.1345/aph.18132 [doi] PP - ppublish LG - English DP - 1999 Mar EZ - 1999/04/14 02:02 DA - 2000/03/11 09:00 DT - 1999/04/14 02:02 YR - 1999 ED - 19990602 RD - 20170214 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10200857 <833. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10103348 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kattwinkel J AU - Niermeyer S AU - Nadkarni V AU - Tibballs J AU - Phillips B AU - Zideman D AU - Van Reempts P AU - Osmond M FA - Kattwinkel, J FA - Niermeyer, S FA - Nadkarni, V FA - Tibballs, J FA - Phillips, B FA - Zideman, D FA - Van Reempts, P FA - Osmond, M IN - Kattwinkel, J. American Academy of Pediatrics. TI - An advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation. [Review] [85 refs] SO - Pediatrics. 103(4):e56, 1999 Apr AS - Pediatrics. 103(4):e56, 1999 Apr NJ - Pediatrics VO - 103 IP - 4 PG - e56 PI - Journal available in: Print PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Index Medicus CP - United States MH - Documentation MH - Equipment and Supplies/st [Standards] MH - Ethics, Medical MH - Humans MH - Infant, Newborn/ph [Physiology] MH - *Infant, Newborn MH - Infant, Premature MH - Life Support Care/mt [Methods] MH - Life Support Care/st [Standards] MH - Resuscitation/is [Instrumentation] MH - Resuscitation/mt [Methods] MH - *Resuscitation/st [Standards] MH - Risk Factors AB - The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly born infant included the following principles: Common or controversial medications (epinephrine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines. [References: 85] ES - 1098-4275 IL - 0031-4005 PT - Consensus Development Conference PT - Guideline PT - Journal Article PT - Practice Guideline PT - Review PP - ppublish LG - English DP - 1999 Apr EZ - 1999/04/02 DA - 1999/04/02 00:01 DT - 1999/04/02 00:00 YR - 1999 ED - 19990415 RD - 20041117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10103348 <834. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9928640 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kappagoda C AU - Schell DN AU - Hanson RM AU - Hutchins P FA - Kappagoda, C FA - Schell, D N FA - Hanson, R M FA - Hutchins, P IN - Kappagoda, C. Royal Alexandra Hospital for Children, Parramatta, New South Wales, Australia. TI - Clonidine overdose in childhood: implications of increased prescribing. CM - Comment in: J Paediatr Child Health. 1998 Dec;34(6):501-2; PMID: 9928638 SO - Journal of Paediatrics & Child Health. 34(6):508-12, 1998 Dec AS - J Paediatr Child Health. 34(6):508-12, 1998 Dec NJ - Journal of paediatrics and child health VO - 34 IP - 6 PG - 508-12 PI - Journal available in: Print PI - Citation processed from: Print JC - arp, 9005421 IO - J Paediatr Child Health SB - Index Medicus CP - Australia MH - *Adrenergic alpha-Agonists/ae [Adverse Effects] MH - Adrenergic alpha-Agonists/tu [Therapeutic Use] MH - Attention Deficit Disorder with Hyperactivity/dt [Drug Therapy] MH - Bradycardia/ci [Chemically Induced] MH - Child MH - Child, Preschool MH - *Clonidine/ae [Adverse Effects] MH - Clonidine/tu [Therapeutic Use] MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - Drug Overdose/ep [Epidemiology] MH - Drug Therapy, Combination MH - Drug Utilization MH - Female MH - Humans MH - Hypertension/ci [Chemically Induced] MH - Infant MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Sleep Stages MH - *Sympatholytics/ae [Adverse Effects] MH - Sympatholytics/tu [Therapeutic Use] AB - OBJECTIVE: To highlight the increase in the number of cases of clonidine overdose admitted to a specialist paediatric hospital, with particular reference to the clinical features, clinical course and circumstances surrounding the incident. AB - METHODS: Cases of clonidine overdose were identified by review of the emergency department attendance register, the intensive care unit database and inpatient statistics collection. Case notes were reviewed to determine the clinical features, history and clinical course in each case. AB - RESULTS: Fifteen patients experienced 16 overdoses during the period 1990-97 inclusive. Only one case occurred before 1994. Depressed level of consciousness and bradycardia were the most common clinical manifestations, and were observed in 75 and 88% of cases respectively. There were no fatalities. Five patients received naloxone. Other treatment modalities included gastrointestinal decontamination, atropine, ventilation and inotropic support. Fourteen cases occurred in association with medication prescribed for attention-deficit hyperactivity disorder (ADHD). AB - CONCLUSION: Clonidine overdose is a potentially serious condition, often requiring intensive care management. Our experience suggests that it is a growing problem, related in part to its increased use in the treatment of ADHD. Preventive strategies, including raising the level of awareness of risks, changes to packaging and appropriate selection of patients for treatment, need consideration if further overdoses are to be prevented. RN - 0 (Adrenergic alpha-Agonists) RN - 0 (Narcotic Antagonists) RN - 0 (Sympatholytics) RN - 36B82AMQ7N (Naloxone) RN - MN3L5RMN02 (Clonidine) IS - 1034-4810 IL - 1034-4810 PT - Journal Article PP - ppublish LG - English DP - 1998 Dec EZ - 1999/02/03 DA - 1999/02/03 00:01 DT - 1999/02/03 00:00 YR - 1998 ED - 19990309 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9928640 <835. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9926561 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cook S AU - Moeschler O AU - Michaud K AU - Yersin B FA - Cook, S FA - Moeschler, O FA - Michaud, K FA - Yersin, B IN - Cook, S. University Hospital (CHUV), Lausanne, Switzerland. TI - Acute opiate overdose: characteristics of 190 consecutive cases. SO - Addiction. 93(10):1559-65, 1998 Oct AS - Addiction. 93(10):1559-65, 1998 Oct NJ - Addiction (Abingdon, England) VO - 93 IP - 10 PG - 1559-65 PI - Journal available in: Print PI - Citation processed from: Print JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/th [Therapy] MH - Emergencies MH - Emergency Medical Services/ut [Utilization] MH - Female MH - Hospitalization/sn [Statistics & Numerical Data] MH - Humans MH - Male MH - *Narcotics/po [Poisoning] MH - Referral and Consultation MH - Switzerland/ep [Epidemiology] AB - AIMS: To characterize the population of drug users consulting the Emergency Room (ER) of a university hospital with acute opiate overdose (AOO) and to assess rate of referral to specialized treatment programme. AB - DESIGN: Survey of a 12-month sample of AOO patients. AB - MEASUREMENTS: Medical and psychosocial features of the drug users, details of emergency treatment and referral by a mobile resuscitation team (SMUR) and the ER of our hospital (CHUV-Lausanne, Switzerland). In addition fatal AOO cases were collected by the Institute of Forensic Medicine (IFM) during the same period. AB - FINDINGS: One hundred and eighty-four cases of AOO (134 patients) were treated. The files of the IFM detailed six additional deceased cases. This population of drug users was characterized by an over-representation of men (73%), by young age (27.4 years), by a high rate of multi-drugs use (90%) and by a high rate of multiple previous overdoses (2.6). Average length of stay was 20.1 hours but 41% of cases stayed less than 8 hours. Only one patient was readmitted within an 8-hour period. When discharged, 78% returned home. Unexpectedly, 67% of patients were not referred to any therapeutic programme for drug addiction. AB - CONCLUSION: This study shows the low mortality of AOO when treated but also demonstrates the need to improve psychosocial evaluation and referral of drug addicts admitted with AOO. RN - 0 (Narcotics) IS - 0965-2140 IL - 0965-2140 PT - Journal Article PP - ppublish LG - English DP - 1998 Oct EZ - 1999/02/02 DA - 1999/02/02 00:01 DT - 1999/02/02 00:00 YR - 1998 ED - 19990208 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9926561 <836. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9818112 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Katsiris S AU - Williams S AU - Leighton BL AU - Halpern S FA - Katsiris, S FA - Williams, S FA - Leighton, B L FA - Halpern, S IN - Katsiris, S. Department of Anaesthesia, Women's College Hospital, University of Toronto, Ontario, Canada. TI - Respiratory arrest following intrathecal injection of sufentanil and bupivacaine in a parturient. CM - Comment in: Can J Anaesth. 1999 Feb;46(2):199; PMID: 10084007 CM - Comment in: Can J Anaesth. 1999 Feb;46(2):198-9; author reply 199; PMID: 10084006 SO - Canadian Journal of Anaesthesia. 45(9):880-3, 1998 Sep AS - Can J Anaesth. 45(9):880-3, 1998 Sep NJ - Canadian journal of anaesthesia = Journal canadien d'anesthesie VO - 45 IP - 9 PG - 880-3 PI - Journal available in: Print PI - Citation processed from: Print JC - c8l, 8701709 IO - Can J Anaesth SB - Index Medicus CP - United States MH - Adult MH - Analgesia, Epidural/ae [Adverse Effects] MH - Analgesia, Obstetrical/ae [Adverse Effects] MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/ai [Antagonists & Inhibitors] MH - *Anesthesia, Epidural/ae [Adverse Effects] MH - *Anesthesia, Obstetrical/ae [Adverse Effects] MH - *Anesthesia, Spinal/ae [Adverse Effects] MH - Anesthetics, Local/ad [Administration & Dosage] MH - *Anesthetics, Local/ae [Adverse Effects] MH - *Apnea/ci [Chemically Induced] MH - Bupivacaine/ad [Administration & Dosage] MH - *Bupivacaine/ae [Adverse Effects] MH - Female MH - Humans MH - Injections, Intravenous MH - Injections, Spinal MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Pregnancy MH - Respiration, Artificial MH - Resuscitation MH - Sufentanil/ad [Administration & Dosage] MH - *Sufentanil/ae [Adverse Effects] MH - Sufentanil/ai [Antagonists & Inhibitors] AB - PURPOSE: To present a case of respiratory arrest following the use of intrathecal sufentanil and bupivacaine for combined spinal-epidural anaesthesia in a healthy labouring parturient. AB - CLINICAL FEATURES: A 20-yr-old term parturient received 10 micrograms sufentanil and 2.5 mg bupivacaine intrathecally as part of a combined spinal-epidural technique for labour analgesia. She had received no previous analgesics. Twenty-three minutes after the intrathecal injection she became unresponsive and suffered a respiratory arrest. Resuscitation included manual bag/mask ventilation with oxygen and intravenous naloxone. AB - CONCLUSION: Respiratory arrest is a rare but potentially life-threatening complication associated with the use of intrathecal opioids for labour analgesia. Vigilance in post-procedure patient monitoring is imperative. RN - 0 (Analgesics, Opioid) RN - 0 (Anesthetics, Local) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - AFE2YW0IIZ (Sufentanil) RN - Y8335394RO (Bupivacaine) IS - 0832-610X IL - 0832-610X PT - Case Reports PT - Journal Article ID - 10.1007/BF03012223 [doi] PP - ppublish LG - English DP - 1998 Sep EZ - 1998/11/18 DA - 1998/11/18 00:01 DT - 1998/11/18 00:00 YR - 1998 ED - 19990122 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9818112 <837. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9814395 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - DeVellis P AU - Thomas SH AU - Wedel SK AU - Stein JP AU - Vinci RJ FA - DeVellis, P FA - Thomas, S H FA - Wedel, S K FA - Stein, J P FA - Vinci, R J IN - DeVellis, P. Boston MedFlight, MA, USA. TI - Prehospital fentanyl analgesia in air-transported pediatric trauma patients. SO - Pediatric Emergency Care. 14(5):321-3, 1998 Oct AS - Pediatr Emerg Care. 14(5):321-3, 1998 Oct NJ - Pediatric emergency care VO - 14 IP - 5 PG - 321-3 PI - Journal available in: Print PI - Citation processed from: Print JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Adolescent MH - Air Ambulances MH - *Analgesia MH - *Analgesics, Opioid MH - Boston MH - Child MH - Child, Preschool MH - Clinical Protocols MH - Emergency Treatment/st [Standards] MH - *Emergency Treatment MH - *Fentanyl MH - Humans MH - Infant MH - *Pain/dt [Drug Therapy] MH - Retrospective Studies MH - Wounds and Injuries/pp [Physiopathology] MH - *Wounds and Injuries AB - OBJECTIVE: To review the 5.5-year safety record of a protocol guiding fentanyl administration to pediatric trauma patients undergoing aeromedical transport. AB - METHODS: Retrospective review of an urban aeromedical program's trauma scene responses from October 1991 to March 1997 identified the study population as all pediatric patients (age <15 years) receiving fentanyl for analgesia during air transport. Patients receiving fentanyl concurrently with other agents, eg, paralytics, were not studied. The air transport team consisted of a flight nurse and flight paramedic who provided protocol-driven patient care with off-line medical control. Study patients' flight records were reviewed to determine vital signs (systolic blood pressure [SBP], heart rate [HR], and oxygen saturation [SAT]) before and after fentanyl administration. Postfentanyl vital signs were reviewed for evidence of hemodynamic or ventilatory compromise. Pre- and postfentanyl vital signs were compared with the paired t test (P < 0.05). Flight records were also analyzed for narrative information, eg, naloxone administration and assisted ventilation, indicative of fentanyl side effects. AB - RESULTS: Fentanyl (0.33-5.0 microg/kg) was administered 211 times to 131 patients who had a median age of 6.2 years (0.1-14 years), median Glasgow coma score (GCS) of 9 (3-15), and a mean pediatric trauma score of 8.3+/-2.4. Seventy-nine (60.3%) patients were intubated; these patients received 139 (65.9 %) of the 211 total fentanyl doses. No adverse effects from fentanyl were noted in flight record narratives. The median interval between fentanyl administration and postfentanyl vital sign assessment was 9.5 minutes (1-35 minutes). Median postfentanyl changes in SBP and HR were -4.7 and -2.9%, respectively. No patient became hypotensive after fentanyl administration. In nonintubated patients, mean postfentanyl SAT (99.2+/-1.3%) was not significantly different (P = 0.70) from prefentanyl SAT (99.1+/-1.3%), and no patient was noted to have clinically significant SAT decrement after fentanyl. AB - CONCLUSION: Retrospective review of more than five years of prehospital fentanyl administration revealed no untoward events. Although prospective definitive demonstration of fentanyl's field use is pending, it is reasonable to continue discretionary fentanyl administration to injured pediatric children in pain. RN - 0 (Analgesics, Opioid) RN - UF599785JZ (Fentanyl) IS - 0749-5161 IL - 0749-5161 PT - Journal Article PP - ppublish LG - English DP - 1998 Oct EZ - 1998/11/14 DA - 1998/11/14 00:01 DT - 1998/11/14 00:00 YR - 1998 ED - 19990108 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9814395 <838. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9799024 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hicks SD AU - Wolfson AB AU - Asplin BR AU - Lipinski CA AU - Callaway CW FA - Hicks, S D FA - Wolfson, A B FA - Asplin, B R FA - Lipinski, C A FA - Callaway, C W IN - Hicks, S D. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA. TI - Anticholinergic syndrome precipitated by opioid reversal. SO - Prehospital Emergency Care. 2(4):328-9, 1998 Oct-Dec AS - Prehosp Emerg Care. 2(4):328-9, 1998 Oct-Dec NJ - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors VO - 2 IP - 4 PG - 328-9 PI - Journal available in: Print PI - Citation processed from: Print JC - c5i, 9703530 IO - Prehosp Emerg Care SB - Index Medicus CP - England MH - Adult MH - Akathisia, Drug-Induced/et [Etiology] MH - *Cholinergic Antagonists/po [Poisoning] MH - *Dyspnea/ci [Chemically Induced] MH - *Dyspnea/dt [Drug Therapy] MH - Emergency Treatment MH - Female MH - Hallucinations/ci [Chemically Induced] MH - *Headache/di [Diagnosis] MH - *Headache/dt [Drug Therapy] MH - *Heroin Dependence/co [Complications] MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - *Scopolamine Hydrobromide/po [Poisoning] RN - 0 (Cholinergic Antagonists) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 451IFR0GXB (Scopolamine Hydrobromide) IS - 1090-3127 IL - 1090-3127 PT - Case Reports PT - Clinical Conference PT - Journal Article PP - ppublish LG - English DP - 1998 Oct-Dec EZ - 1998/11/03 DA - 1998/11/03 00:01 DT - 1998/11/03 00:00 YR - 1998 ED - 19981229 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9799024 <839. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9867720 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Stopfkuchen H FA - Stopfkuchen, H IN - Stopfkuchen, H. Kinderklinik und Kinderpoliklinik der Universitat Mainz. TI - [Resuscitation in newborn infants]. [German] OT - Reanimation bei Neugeborenen. SO - Anaesthesist. 47(9):787, 1998 Sep AS - Anaesthesist. 47(9):787, 1998 Sep NJ - Der Anaesthesist VO - 47 IP - 9 PG - 787 PI - Journal available in: Print PI - Citation processed from: Print JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Epinephrine/ad [Administration & Dosage] MH - Humans MH - Infant, Newborn MH - Naloxone/ad [Administration & Dosage] MH - Prognosis MH - *Resuscitation MH - Sodium Bicarbonate/ad [Administration & Dosage] RN - 36B82AMQ7N (Naloxone) RN - 8MDF5V39QO (Sodium Bicarbonate) RN - YKH834O4BH (Epinephrine) IS - 0003-2417 IL - 0003-2417 PT - Journal Article PP - ppublish LG - German DP - 1998 Sep EZ - 1998/12/29 DA - 1998/12/29 00:01 DT - 1998/12/29 00:00 YR - 1998 ED - 19981217 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9867720 <840. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10187003 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pedersen CB AU - Steentoft A AU - Worm K AU - Sprehn M AU - Mogensen T AU - Sorensen MB FA - Pedersen, C B FA - Steentoft, A FA - Worm, K FA - Sprehn, M FA - Mogensen, T FA - Sorensen, M B IN - Pedersen, C B. Mobile Intensive Care Unit of Copenhagen, Denmark. TI - Prehospital treatment of patients with i.v. heroin overdose: what are we treating?. SO - Prehospital & Disaster Medicine. 12(2):163-6, 1997 Apr-Jun AS - Prehospital Disaster Med. 12(2):163-6, 1997 Apr-Jun NJ - Prehospital and disaster medicine VO - 12 IP - 2 PG - 163-6 PI - Journal available in: Print PI - Citation processed from: Print JC - bdf, 8918173 IO - Prehosp Disaster Med SB - Health Technology Assessment Journals CP - United States MH - Adult MH - Denmark MH - Drug Overdose/bl [Blood] MH - Drug Overdose/et [Etiology] MH - *Drug Overdose/th [Therapy] MH - *Emergency Medical Services/mt [Methods] MH - Female MH - Heroin/bl [Blood] MH - *Heroin/po [Poisoning] MH - Humans MH - Male MH - Middle Aged MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotics/bl [Blood] MH - *Narcotics/po [Poisoning] MH - Substance Abuse, Intravenous/bl [Blood] MH - *Substance Abuse, Intravenous/co [Complications] MH - Treatment Outcome AB - OBJECTIVE: To measure blood levels of morphine and additional drugs in patients suspected of intravenous (i.v.) heroin abuse and to evaluate the effects of antidote treatment. AB - DESIGN: Prehospital blood sampling in 52 patients. AB - RESULTS: Forty-five patients were blood-positive for heroin, eight of whom were hospitalized. Forty-one patients also had abused additional drugs: minor tranquilizers, ethanol, amphetamine, cocaine, and/or carbamazepine. Seven patients had taken either only methadone or ketobemidione: one was admitted. Treatment with increasing doses of naloxone indicated a necessity for hospitalization. Six of 14 patients treated with naloxone (1.8 mg were hospitalized. Seven patients had an extremely high blood level of morphine (0.2 mg/kg), that could be reverted with naloxone in moderate doses. AB - CONCLUSION: This study indicates that under prehospital conditions, it is difficult to identify a patient intoxicated only with intravenous heroin. Nearly all patients treated were cases of multiple drug/alcohol overdoses. Even the symptoms associated with extremely high blood levels of morphine could be reversed with naloxone in moderate doses. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 70D95007SX (Heroin) IS - 1049-023X IL - 1049-023X PT - Clinical Trial PT - Journal Article PP - ppublish LG - English DP - 1997 Apr-Jun EZ - 1997/03/08 DA - 1997/03/08 00:01 DT - 1997/03/08 00:00 YR - 1997 ED - 19981204 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=10187003 <841. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9786228 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Domingo-Salvany A AU - Hartnoll RL AU - Maguire A AU - Brugal MT AU - Albertin P AU - Cayla JA AU - Casabona J AU - Suelves JM FA - Domingo-Salvany, A FA - Hartnoll, R L FA - Maguire, A FA - Brugal, M T FA - Albertin, P FA - Cayla, J A FA - Casabona, J FA - Suelves, J M IN - Domingo-Salvany, A. Institut Municipal d'Investigacio Medica, Barcelona, Spain. TI - Analytical considerations in the use of capture-recapture to estimate prevalence: case studies of the estimation of opiate use in the metropolitan area of Barcelona, Spain. SO - American Journal of Epidemiology. 148(8):732-40, 1998 Oct 15 AS - Am J Epidemiol. 148(8):732-40, 1998 Oct 15 NJ - American journal of epidemiology VO - 148 IP - 8 PG - 732-40 PI - Journal available in: Print PI - Citation processed from: Print JC - 3h3, 7910653 IO - Am. J. Epidemiol. SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Age Distribution MH - Case-Control Studies MH - *Epidemiologic Methods MH - Female MH - Humans MH - Linear Models MH - Logistic Models MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Prevalence MH - Sex Distribution MH - Spain/ep [Epidemiology] MH - Urban Health/sn [Statistics & Numerical Data] AB - Capture-recapture, an indirect method widely used to estimate undetected populations, has been criticized because it causes problems due to a lack of compliance with several important assumptions and model selection strategies. This paper expands on the problems encountered when applying this methodology to drug abuse estimations, specifically the prevalence of opiate use in the metropolitan area of Barcelona, Spain, in 1993. Three samples of opiate users (from hospital emergency rooms, treatment centers, and prisons) were available in the area studied; an additional sample (mortality data) was analyzed for the city of Barcelona. Log-linear models that provided a good fit were considered, to which further model selection strategies were applied. A total of 3,207 unique individuals aged 15-44 years were identified in the three samples from the greater Barcelona area; the mortality sample from the city of Barcelona contained an additional 83 individuals. Heterogeneity was observed in different age, sex, and residence area subgroups. Population estimates differed widely according to the log-linear model chosen. Minimum Akaike's information criterion model and saturated model estimates were used to produce population prevalence rates. The main problems the authors encountered in this study were related to population definition, source heterogeneity, and assessment of an adequate model, a problem associated with sample size. IS - 0002-9262 IL - 0002-9262 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1998 Oct 15 EZ - 1998/10/24 DA - 1998/10/24 00:01 DT - 1998/10/24 00:00 YR - 1998 ED - 19981110 RD - 20061115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9786228 <842. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9760858 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Stokland O AU - Hansen TB AU - Nilsen JE FA - Stokland, O FA - Hansen, T B FA - Nilsen, J E IN - Stokland, O. Klinikk for akuttmedisin, Ulleval sykehus, Oslo. TI - [Prehospital treatment of heroin intoxication in Oslo in 1996]. [Norwegian] OT - Prehospital behandling av heroinforgiftning i Oslo i 1996. SO - Tidsskrift for Den Norske Laegeforening. 118(20):3144-6, 1998 Aug 30 AS - Tidsskr Nor Laegeforen. 118(20):3144-6, 1998 Aug 30 NJ - Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke VO - 118 IP - 20 PG - 3144-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 0413423, 101086543, vrv IO - Tidsskr. Nor. Laegeforen. SB - Index Medicus CP - Norway MH - Adult MH - Ambulances MH - Cardiopulmonary Resuscitation MH - Cost-Benefit Analysis MH - Drug Overdose MH - Emergency Medical Services/ec [Economics] MH - Female MH - *Heroin/po [Poisoning] MH - *Heroin Dependence/co [Complications] MH - Heroin Dependence/mo [Mortality] MH - Humans MH - Male MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Norway/ep [Epidemiology] AB - The number of heroin overdoses among drug addicts in Oslo is increasing. In 1996 overdoses counted for 1,248 (12%) of all emergency call-outs by the ambulance service. Heroin can cause fatal respiratory insufficiency, and in 1996 a total of 104 deaths related to heroin overdoses were reported in Oslo. Heroin overdoses are treated on site by ambulance personnel. Advanced cardiopulmonary resuscitation was started on 18 of the 79 addicts who were found unconscious, and 11 persons were treated successfully. A total of 846 drug addicts had to be given the antidote naloxone, and among these 678 (80%) persons were found in a coma. Only 29 persons had to be transported to hospital. Early treatment probably prevented both morbidity and mortality, no time being wasted transporting the patients to hospital. Ambulance personnel treat all drug addicts with the same respect as they do other patients. They have no police escort; they are familiar with the addicts and their environment and they have gained their confidence. Prehospital treatment saves on health services resources, and should, in our experience, be carried out in collaboration with a hospital or other health institutions for mutual and optimal benefit. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 0029-2001 IL - 0029-2001 PT - English Abstract PT - Journal Article PP - ppublish LG - Norwegian DP - 1998 Aug 30 EZ - 1998/10/07 DA - 1998/10/07 00:01 DT - 1998/10/07 00:00 YR - 1998 ED - 19981027 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9760858 <843. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9688353 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lapatto-Reiniluoto O AU - Kivisto KT AU - Pohjola-Sintonen S AU - Luomanmaki K AU - Neuvonen PJ FA - Lapatto-Reiniluoto, O FA - Kivisto, K T FA - Pohjola-Sintonen, S FA - Luomanmaki, K FA - Neuvonen, P J IN - Lapatto-Reiniluoto, O. Department of Internal Medicine, Helsinki University Central Hospital, Finland. TI - A prospective study of acute poisonings in Finnish hospital patients. SO - Human & Experimental Toxicology. 17(6):307-11, 1998 Jun AS - Hum Exp Toxicol. 17(6):307-11, 1998 Jun NJ - Human & experimental toxicology VO - 17 IP - 6 PG - 307-11 PI - Journal available in: Print PI - Citation processed from: Print JC - aql, 9004560 IO - Hum Exp Toxicol SB - Index Medicus CP - England MH - Acute Disease MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - Charcoal/pd [Pharmacology] MH - Circadian Rhythm MH - *Emergency Service, Hospital MH - Female MH - Finland/ep [Epidemiology] MH - Hazardous Substances/po [Poisoning] MH - *Hospitals, University MH - Humans MH - Male MH - Middle Aged MH - Patient Admission MH - *Poisoning/ep [Epidemiology] MH - Poisoning/pa [Pathology] MH - Poisoning/th [Therapy] MH - Prospective Studies MH - Sex Distribution AB - 1. We have carried out a prospective study of all adult patients presenting with acute poisoning during one month to the Helsinki University Central Hospital (Meilahti Hospital). 2. Two hundred and twenty-six cases of acute poisoning (113 males and 113 females) presented to the emergency department. Most cases in both men (66%) and women (67%) involved alcohol. As to drugs, psychotropic agents predominated in both men and women. The frequency of patient presentation peaked between 7 p.m. and 9 p.m. and was lowest between 8 a.m. and 10 a.m. In most cases, the delay from ingestion of the poison to presentation was longer than 4 h. 3. The clinical status of the patients on arrival was generally good; more than half (55%) of them were fully awake. Serious symptoms (e.g. unconsciousness, insufficient respiration necessitating intubation, aspiration, convulsions or hypotension) occurred in 15% of the presentations. There were no fatalities. 4. One hundred and thirty-five patients (60%) received at least one 50-g dose of activated charcoal. However, charcoal was given in 86% of the cases of drug poisoning. Gastric lavage was performed in 112 cases (50%), and 106 cases (47%) involved both gastric lavage and administration of charcoal. Twenty-one patients received antidotes (flumazenil, calcium gluconate or naloxone) and three patients were hemodialysed. 5. Of the 226 cases, 142 (63%) were managed solely in the emergency department. Of the 84 cases admitted to the hospital, eight had to be managed in the intensive care unit. Almost all patients (94%) were discharged within 24 h. 6. In this survey on 226 consecutive cases of acute poisoning, about two-thirds of the cases involved alcohol, while the most common drugs taken were psychotropic agents. The poisoning was mild in the great majority of the cases. Activated charcoal was generally administered in all but trivial cases of drug poisoning. RN - 0 (Hazardous Substances) RN - 16291-96-6 (Charcoal) IS - 0960-3271 IL - 0960-3271 PT - Journal Article ID - 10.1177/096032719801700604 [doi] PP - ppublish LG - English DP - 1998 Jun EZ - 1998/08/04 DA - 1998/08/04 00:01 DT - 1998/08/04 00:00 YR - 1998 ED - 19981002 RD - 20170214 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9688353 <844. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9658502 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ramirez-Moreno JM AU - Cordero JA AU - Duran-Herrera C FA - Ramirez-Moreno, J M FA - Cordero, J A FA - Duran-Herrera, C TI - [Transitory comatose situation secondary to an infarction of the posterior circulation, reversed by naloxone?]. [Spanish] OT - Situacion de coma transitorio secundario a un infarto de circulacion posterior, revertido por naloxona? SO - Revista de Neurologia. 26(154):1076-7, 1998 Jun AS - Rev Neurol. 26(154):1076-7, 1998 Jun NJ - Revista de neurologia VO - 26 IP - 154 PG - 1076-7 PI - Journal available in: Print PI - Citation processed from: Print JC - cg9, 7706841 IO - Rev Neurol SB - Index Medicus CP - Spain MH - Adult MH - Brain Ischemia/dt [Drug Therapy] MH - Brain Ischemia/et [Etiology] MH - Brain Ischemia/pp [Physiopathology] MH - *Cerebral Infarction/co [Complications] MH - *Coma/dt [Drug Therapy] MH - Coma/et [Etiology] MH - Coma/pp [Physiopathology] MH - Drug Therapy, Combination MH - Emergency Medical Services MH - Female MH - Flumazenil/ad [Administration & Dosage] MH - Flumazenil/tu [Therapeutic Use] MH - GABA Modulators/ad [Administration & Dosage] MH - GABA Modulators/tu [Therapeutic Use] MH - Glucose/ad [Administration & Dosage] MH - Glucose/tu [Therapeutic Use] MH - Humans MH - Hypertonic Solutions/ad [Administration & Dosage] MH - Hypertonic Solutions/tu [Therapeutic Use] MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/pd [Pharmacology] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/pd [Pharmacology] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Thiamine/ad [Administration & Dosage] MH - Thiamine/tu [Therapeutic Use] MH - Vasodilator Agents/ad [Administration & Dosage] MH - Vasodilator Agents/tu [Therapeutic Use] RN - 0 (GABA Modulators) RN - 0 (Hypertonic Solutions) RN - 0 (Narcotic Antagonists) RN - 0 (Vasodilator Agents) RN - 36B82AMQ7N (Naloxone) RN - 40P7XK9392 (Flumazenil) RN - IY9XDZ35W2 (Glucose) RN - X66NSO3N35 (Thiamine) IS - 0210-0010 IL - 0210-0010 PT - Case Reports PT - Letter PP - ppublish LG - Spanish DP - 1998 Jun EZ - 1998/07/11 DA - 1998/07/11 00:01 DT - 1998/07/11 00:00 YR - 1998 ED - 19980908 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9658502 <845. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9610980 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wang DS AU - Sternbach G AU - Varon J FA - Wang, D S FA - Sternbach, G FA - Varon, J IN - Wang, D S. Division of Emergency Medicine, Stanford University Medical Center, California 94305, USA. TI - Nalmefene: a long-acting opioid antagonist. Clinical applications in emergency medicine. [Review] [28 refs] SO - Journal of Emergency Medicine. 16(3):471-5, 1998 May-Jun AS - J Emerg Med. 16(3):471-5, 1998 May-Jun NJ - The Journal of emergency medicine VO - 16 IP - 3 PG - 471-5 PI - Journal available in: Print PI - Citation processed from: Print JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - Conscious Sedation MH - Drug Overdose/dt [Drug Therapy] MH - *Emergency Medicine/mt [Methods] MH - Humans MH - *Naltrexone/aa [Analogs & Derivatives] MH - Naltrexone/pd [Pharmacology] MH - Naltrexone/tu [Therapeutic Use] MH - Narcotic Antagonists/pd [Pharmacology] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Postoperative Care AB - The use of the opioid antagonist naloxone is well known to the experienced health care provider. The availability of the longer acting opioid antagonist nalmefene has several potential benefits in clinical practice. Nalmefene has a plasma half-life of almost 11 h, compared to 60-90 min for naloxone. Nalmefene has been shown to reverse opioid intoxication for as long as 8 h, reducing the need for continuous monitoring of intoxicated patients and repeated dosing of naloxone. Single dose administration has also been used effectively in the reversal of opiate-assisted conscious sedation. In addition, this agent has been used in the treatment of diseases as diverse as interstitial cystitis and chronic alcohol dependence. However, the long duration of action enables extended withdrawal reactions in the chronically opioid-dependent patient. The prolonged opioid antagonism of nalmefene has several applications in the clinical practice of emergency medicine, and is a useful addition in certain situations to the pharmacologic armamentarium of the practicing emergency physician. [References: 28] RN - 0 (Narcotic Antagonists) RN - 5S6W795CQM (Naltrexone) RN - TOV02TDP9I (nalmefene) IS - 0736-4679 IL - 0736-4679 PT - Journal Article PT - Review ID - S0736-4679(98)00019-5 [pii] PP - ppublish LG - English DP - 1998 May-Jun EZ - 1998/06/04 DA - 1998/06/04 00:01 DT - 1998/06/04 00:00 YR - 1998 ED - 19980723 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9610980 <846. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9605377 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Westerling D AU - Sawe J AU - Eklundh G FA - Westerling, D FA - Sawe, J FA - Eklundh, G IN - Westerling, D. Department of Anesthesiology and Intensive Care, Lund University Hospital, Sweden. TI - Near fatal intoxication with controlled-release morphine tablets in a depressed woman. SO - Acta Anaesthesiologica Scandinavica. 42(5):586-9, 1998 May AS - Acta Anaesthesiol Scand. 42(5):586-9, 1998 May NJ - Acta anaesthesiologica Scandinavica VO - 42 IP - 5 PG - 586-9 PI - Journal available in: Print PI - Citation processed from: Print JC - 0370270 IO - Acta Anaesthesiol Scand SB - Index Medicus CP - England MH - Absorption MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/bl [Blood] MH - *Analgesics, Opioid/po [Poisoning] MH - Analgesics, Opioid/ur [Urine] MH - Coma/ci [Chemically Induced] MH - Delayed-Action Preparations MH - *Depression/px [Psychology] MH - Female MH - Follow-Up Studies MH - Humans MH - Middle Aged MH - Morphine/ad [Administration & Dosage] MH - Morphine/bl [Blood] MH - *Morphine/po [Poisoning] MH - Morphine/ur [Urine] MH - Morphine Derivatives/bl [Blood] MH - Morphine Derivatives/ur [Urine] MH - Respiratory Insufficiency/ci [Chemically Induced] MH - Seizures/ci [Chemically Induced] MH - Suicide, Attempted/px [Psychology] MH - Tablets AB - BACKGROUND: A 46-year-old woman suffering from a reactive depression was admitted to the emergency room in coma and with severe respiratory failure. She later developed cardiovascular instability and general convulsions. Two days following admission the patient had no respiratory effort but was able to communicate in writing that she had ingested a large amount of controlled-release morphine tablets. Following treatment with naloxone she was successfully weaned from the respirator the next day. AB - METHODS: Sampling for determination of plasma and urine concentrations of morphine and its metabolites morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) was started 60 h after the presumed time of intake and continued up to 8 days after admission. AB - RESULTS: The initial plasma concentrations of morphine, M3G and M6G were 2160, 13100 and 2330 nM, respectively, compatible with a lethal dose in an opioid-naive patient. The urinary recovery of morphine, M3G and M6G corresponded to 6.8 mmol, equivalent to an oral intake of at least 2500 mg. AB - CONCLUSION: The plasma concentrations of morphine and morphine metabolites documented in this case, indicative of considerable absorption of drug, demonstrate that prolonged observation is necessary following intoxications with controlled-release morphine tablets. This case also highlights the importance of continuous follow-up of oral morphine therapy, so that unused drug is not left unaccounted for in the patient's home. RN - 0 (Analgesics, Opioid) RN - 0 (Delayed-Action Preparations) RN - 0 (Morphine Derivatives) RN - 0 (Tablets) RN - 64Y9KYM60R (morphine-6-glucuronide) RN - 76I7G6D29C (Morphine) RN - O27Z9CH39A (morphine-3-glucuronide) IS - 0001-5172 IL - 0001-5172 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1998 May EZ - 1998/05/30 DA - 1998/05/30 00:01 DT - 1998/05/30 00:00 YR - 1998 ED - 19980723 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9605377 <847. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9624312 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Li J AU - Stokes SA AU - Woeckener A FA - Li, J FA - Stokes, S A FA - Woeckener, A IN - Li, J. Department of Emergency Medicine, Charity Hospital, New Orleans, LA, USA. jamesli@warren.med.harvard.edu TI - A tale of novel intoxication: seven cases of gamma-hydroxybutyric acid overdose. CM - Comment in: Ann Emerg Med. 1999 Apr;33(4):475-6; PMID: 10092734 SO - Annals of Emergency Medicine. 31(6):723-8, 1998 Jun AS - Ann Emerg Med. 31(6):723-8, 1998 Jun NJ - Annals of emergency medicine VO - 31 IP - 6 PG - 723-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Adjuvants, Anesthesia/po [Poisoning] MH - Adolescent MH - Adult MH - Drug Overdose/pp [Physiopathology] MH - Drug Overdose/th [Therapy] MH - Electrocardiography MH - Emergency Service, Hospital MH - Female MH - Gastric Lavage MH - Humans MH - Male MH - Respiration, Artificial MH - *Sodium Oxybate/po [Poisoning] MH - *Substance-Related Disorders/pp [Physiopathology] MH - Substance-Related Disorders/th [Therapy] MH - Substance-Related Disorders/ur [Urine] AB - STUDY OBJECTIVE: We describe seven patients presenting with combination substance abuse involving gamma-hydroxybutyric acid (GHB). AB - METHODS: During a 3 month period, we identified consecutive patients with GHB ingestion confirmed by urine mass spectrometry presenting to a high-volume urban emergency department. AB - RESULTS: All patients presented with acute delirium and transient but severe respiratory depression. With supportive care, including intubation and mechanical ventilation in four cases, normal mentation and respiratory function returned within 2 to 6 hours. None of these patients had documented seizures, and none of the four patients who received naloxone had a reversal response. This clinical observation supports previous experimental work in GHB-intoxicated human subjects demonstrating neither epileptiform changes on electroencephalography nor reversal with naloxone. Two findings are remarkable in this series. The first is the observation of a peculiar state of violent aggression present on stimulation of the GHB-intoxicated patient despite near or total apnea. The fact that patients fully recovered from this state may be the result of a previously demonstrated GHB hypoxia-sparing effect. The second is the observation of ECG abnormalities in several cases, including U waves in five patients. AB - CONCLUSION: Emergency physicians should be alerted to this agent, its characteristic effects, and its potential for serious sequelae including respiratory arrest and death. RN - 0 (Adjuvants, Anesthesia) RN - 7G33012534 (Sodium Oxybate) IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - S0196064498001668 [pii] PP - ppublish LG - English DP - 1998 Jun EZ - 1998/06/13 DA - 1998/06/13 00:01 DT - 1998/06/13 00:00 YR - 1998 ED - 19980630 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9624312 <848. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9606233 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Perry HE AU - Wright RO AU - Shannon MW AU - Woolf AD FA - Perry, H E FA - Wright, R O FA - Shannon, M W FA - Woolf, A D IN - Perry, H E. Department of Pediatrics, University of Cincinnati College of Medicine, Ohio, USA. TI - Baclofen overdose: drug experimentation in a group of adolescents. SO - Pediatrics. 101(6):1045-8, 1998 Jun AS - Pediatrics. 101(6):1045-8, 1998 Jun NJ - Pediatrics VO - 101 IP - 6 PG - 1045-8 PI - Journal available in: Print PI - Citation processed from: Internet JC - oxv, 0376422 IO - Pediatrics SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Apnea/ci [Chemically Induced] MH - Baclofen/bl [Blood] MH - *Baclofen/po [Poisoning] MH - Coma/ci [Chemically Induced] MH - Drug Overdose/pp [Physiopathology] MH - Drug Overdose/th [Therapy] MH - Female MH - GABA Agonists/po [Poisoning] MH - Humans MH - Male MH - Muscle Relaxants, Central/bl [Blood] MH - *Muscle Relaxants, Central/po [Poisoning] MH - Respiration, Artificial AB - BACKGROUND: Baclofen, a lipophilic analog of gamma-aminobutyric acid, is clinically used to control spasticity. We report a mass exposure to baclofen in adolescents seeking intoxication; toxicokinetic data are included. AB - CASE SERIES: A group of adolescents became symptomatic after ingesting 3 to 30 20-mg tablets of baclofen during a party at a suburban Boys' Club. Several children were noted to be very lethargic by chaperones, ingestion was suspected, and paramedics were called. Some white tablets were found in a couch at the site of the party. The Massachusetts Poison Control Center was called, and the tablets were identified as baclofen (20 mg). Fourteen patients were taken to local hospitals; 9 required intubation. Eight adolescents were transferred to our institution. In these 8 patients, symptoms were noted within 1 to 2 hours after overdose. The most common clinical findings included coma (7), hypothermia (6), bradycardia (5), hypertension (4), and hyporeflexia (8). Mean length of mechanical ventilation was 40 hours. Three patients had unifocal premature ventricular contractions. Two patients had tonic-clonic seizures. A single dose of activated charcoal was given to all patients. Drugs administered included nifedipine (1), flumazenil (1), naloxone (1), lorazepam (2), and phosphenytion (2). All patients recovered and were discharged home within 5 days of ingestion. Serial serum baclofen levels were obtained in all intubated patients (range, 0.049 to 6.0; normal, 0.08 to .40 microgram/mL). Levels obtained 14 hours after ingestion showed a linear correlation with length of mechanical ventilation (R2 = 0.9863). Persistent symptoms were noted in some patients, despite nondetectable baclofen levels. Toxicologic screening for drugs of abuse was negative except in 2 patients with ethanol levels, both < 5 mg/dL. AB - CONCLUSION: Baclofen overdose may result in coma, apnea, autonomic disturbances, cardiac conduction abnormalities, and seizures. Levels obtained shortly after overdose correlate with length of mechanical ventilation. RN - 0 (GABA Agonists) RN - 0 (Muscle Relaxants, Central) RN - H789N3FKE8 (Baclofen) ES - 1098-4275 IL - 0031-4005 PT - Journal Article PP - ppublish LG - English DP - 1998 Jun EZ - 1998/06/02 DA - 1998/06/02 00:01 DT - 1998/06/02 00:00 YR - 1998 ED - 19980616 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9606233 <849. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9593444 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Konotey-Ahulu FI FA - Konotey-Ahulu, F I TI - Opiates for sickle-cell crisis?. CM - Comment in: Lancet. 1998 Jun 27;351(9120):1965; PMID: 9654297 CM - Comment in: Lancet. 1998 Jun 27;351(9120):1965; PMID: 9654298 CM - Comment in: Lancet. 1998 Jun 27;351(9120):1964-5; PMID: 9654296 SO - Lancet. 351(9113):1438, 1998 May 09 AS - Lancet. 351(9113):1438, 1998 May 09 NJ - Lancet (London, England) VO - 351 IP - 9113 PG - 1438 PI - Journal available in: Print PI - Citation processed from: Print JC - 2985213r, l0s, 0053266 IO - Lancet SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Analgesics, Opioid/ec [Economics] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - *Anemia, Sickle Cell/dt [Drug Therapy] MH - Emergency Treatment MH - *Heroin/ae [Adverse Effects] MH - Heroin/ec [Economics] MH - Heroin/tu [Therapeutic Use] MH - Humans MH - *Morphine/ae [Adverse Effects] MH - Morphine/ec [Economics] MH - Morphine/tu [Therapeutic Use] MH - United Kingdom RN - 0 (Analgesics, Opioid) RN - 70D95007SX (Heroin) RN - 76I7G6D29C (Morphine) IS - 0140-6736 IL - 0140-6736 PT - Letter ID - S0140-6736(05)79487-3 [pii] ID - 10.1016/S0140-6736(05)79487-3 [doi] PP - ppublish LG - English DP - 1998 May 09 EZ - 1998/05/21 DA - 1998/05/21 00:01 DT - 1998/05/21 00:00 YR - 1998 ED - 19980610 RD - 20161124 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9593444 <850. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9523071 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ginsberg HG AU - Goldsmith JP FA - Ginsberg, H G FA - Goldsmith, J P IN - Ginsberg, H G. Section of Neonatology, Ochsner Clinic, New Orleans, Louisiana, USA. TI - Controversies in neonatal resuscitation. [Review] [57 refs][Erratum appears in Clin Perinatol 1998 Sep;25(3):xii] SO - Clinics in Perinatology. 25(1):1-15, 1998 Mar AS - Clin Perinatol. 25(1):1-15, 1998 Mar NJ - Clinics in perinatology VO - 25 IP - 1 PG - 1-15 PI - Journal available in: Print PI - Citation processed from: Print JC - dhh, 7501306 IO - Clin Perinatol SB - Index Medicus CP - United States MH - Adrenergic alpha-Agonists/tu [Therapeutic Use] MH - *Cardiopulmonary Resuscitation/mt [Methods] MH - Decision Making MH - Epinephrine/tu [Therapeutic Use] MH - Humans MH - *Infant, Newborn MH - Infant, Premature MH - Infant, Very Low Birth Weight MH - Intubation, Intratracheal MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Oxygen/tu [Therapeutic Use] MH - Sodium Bicarbonate/tu [Therapeutic Use] AB - In the delivery room, pediatricians are frequently required to make immediate decisions about resuscitating infants. Is the baby too small, too immature, or too asphyxiated to be revived? To achieve the best outcome, resuscitation once initiated, must be performed expeditiously, safely, and with the utmost diligence. Not all the tools and medications have undergone the intense scrutiny that might otherwise be assumed. In this article, resuscitation topics are discussed and recommendation offered. [References: 57] RN - 0 (Adrenergic alpha-Agonists) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 8MDF5V39QO (Sodium Bicarbonate) RN - S88TT14065 (Oxygen) RN - YKH834O4BH (Epinephrine) IS - 0095-5108 IL - 0095-5108 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1998 Mar EZ - 1998/04/02 DA - 1998/04/02 00:01 DT - 1998/04/02 00:00 YR - 1998 ED - 19980609 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9523071 <851. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9562190 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wanger K AU - Brough L AU - Macmillan I AU - Goulding J AU - MacPhail I AU - Christenson JM FA - Wanger, K FA - Brough, L FA - Macmillan, I FA - Goulding, J FA - MacPhail, I FA - Christenson, J M IN - Wanger, K. British Columbia Ambulance Service, Vancouver, Canada. karen.wanger@moh.hnet.bc.ca TI - Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose. CM - Comment in: Acad Emerg Med. 1998 Apr;5(4):283-5; PMID: 9562188 SO - Academic Emergency Medicine. 5(4):293-9, 1998 Apr AS - Acad Emerg Med. 5(4):293-9, 1998 Apr NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 5 IP - 4 PG - 293-9 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Cohort Studies MH - Drug Overdose MH - Emergency Medical Services/ec [Economics] MH - Female MH - Humans MH - Injections, Intravenous MH - Injections, Subcutaneous MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/pp [Physiopathology] MH - Prospective Studies MH - Respiration MH - *Resuscitation AB - OBJECTIVE: To determine whether naloxone administered i.v. to out-of-hospital patients with suspected opioid overdose would have a more rapid therapeutic onset than naloxone given subcutaneously (s.q.). AB - METHODS: A prospective, sequential, observational cohort study of 196 consecutive patients with suspected opioid overdose was conducted in an urban out-of-hospital setting, comparing time intervals from arrival at the patient's side to development of a respiratory rate > or =10 breaths/min, and durations of bag-valve-mask ventilation. Subjects received either naloxone 0.4 mg i.v. (n = 74) or naloxone 0.8 mg s.q. (n = 122), for respiratory depression of <10 breaths/min. AB - RESULTS: Mean interval from crew arrival to respiratory rate > or =10 breaths/min was 9.3 +/- 4.2 min for the i.v. group vs 9.6 +/- 4.58 min for the s.q. group (95% CI of the difference -1.55, 1.00). Mean duration of bag-valve-mask ventilation was 8.1 +/- 6.0 min for the i.v. group vs 9.1 +/- 4.8 min for the s.q. group. Cost of materials for administering naloxone 0.4 mg i.v. was $12.30/patient, compared with $10.70/patient for naloxone 0.8 mg s.q. AB - CONCLUSION: There was no clinical difference in the time interval to respiratory rate > or =10 breaths/min between naloxone 0.8 mg s.q. and naloxone 0.4 mg i.v. for the out-of-hospital management of patients with suspected opioid overdose. The slower rate of absorption via the s.q. route was offset by the delay in establishing an i.v. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1069-6563 IL - 1069-6563 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1998 Apr EZ - 1998/04/30 DA - 1998/04/30 00:01 DT - 1998/04/30 00:00 YR - 1998 ED - 19980605 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9562190 <852. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9562188 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Horowitz Z FA - Horowitz, Z TI - Subcutaneous naloxone: a less rude awakening?. CM - Comment on: Acad Emerg Med. 1998 Apr;5(4):293-9; PMID: 9562190 SO - Academic Emergency Medicine. 5(4):283-5, 1998 Apr AS - Acad Emerg Med. 5(4):283-5, 1998 Apr NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 5 IP - 4 PG - 283-5 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Drug Overdose MH - Emergency Medical Services MH - Humans MH - Injections, Intramuscular MH - Injections, Subcutaneous MH - *Naloxone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Opioid-Related Disorders/dt [Drug Therapy] RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 1069-6563 IL - 1069-6563 PT - Comment PT - Editorial PP - ppublish LG - English DP - 1998 Apr EZ - 1998/04/30 DA - 1998/04/30 00:01 DT - 1998/04/30 00:00 YR - 1998 ED - 19980605 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9562188 <853. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9541035 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Watson WA AU - Steele MT AU - Muelleman RL AU - Rush MD FA - Watson, W A FA - Steele, M T FA - Muelleman, R L FA - Rush, M D IN - Watson, W A. University of Missouri-Kansas City; Truman Medical Center, 64108, USA. WaWatson@CCTR.UMKC.EDU TI - Opioid toxicity recurrence after an initial response to naloxone. SO - Journal of Toxicology - Clinical Toxicology. 36(1-2):11-7, 1998 AS - J Toxicol Clin Toxicol. 36(1-2):11-7, 1998 NJ - Journal of toxicology. Clinical toxicology VO - 36 IP - 1-2 PG - 11-7 PI - Journal available in: Print PI - Citation processed from: Print JC - kan, 8213460 IO - J. Toxicol. Clin. Toxicol. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Administration, Oral MH - Adult MH - Case-Control Studies MH - Delphi Technique MH - Emergencies MH - Female MH - Humans MH - Injections, Intravenous MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Narcotics/ad [Administration & Dosage] MH - Narcotics/cl [Classification] MH - *Narcotics/po [Poisoning] MH - Poisoning/dt [Drug Therapy] MH - Recurrence MH - Retrospective Studies MH - Substance-Related Disorders/di [Diagnosis] MH - Substance-Related Disorders/th [Therapy] MH - Suicide, Attempted MH - Treatment Outcome AB - OBJECTIVE: To determine the frequency and potential predictors of opioid toxicity recurrence after a response to naloxone in adult Emergency Department patients. AB - METHODS: A retrospective case-control study of naloxone-treated patients with opioid toxicity over an 8-year period. Both the patient response to naloxone and recurrence of opioid toxicity was determined by an expert Delphi Panel. The frequency of opioid toxicity recurrence was compared by the duration of opioid effect, the route of opioid exposure, and the presence of other CNS depressant drugs. AB - RESULTS: Ninety of 221 (41%) cases with a discharge diagnosis of opioid toxicity were treated with naloxone; six patients were excluded because of a lack of toxicity. There was a response to naloxone in 50% of the 84 cases, and recurrence of toxicity in 31% (95% CI 17-45%) of naloxone responders. The most common opioids were codeine, heroin, propoxyphene, and oxycodone/hydrocodone. Recurrence of toxicity was more common with long-acting opioids (p = 0.04), and was not associated with the route of opioid exposure (p = 0.42), or presence of ethanol and other CNS depressants (p > or = 0.87). AB - CONCLUSION: Opioid toxicity recurrence after a response to naloxone occurred in approximately 1/3 of adult Emergency Department opioid overdose cases. Recurrence was more common with long-acting opioids and was not associated with the route of opioid exposure. Other clinically useful predictors of toxicity recurrence were not identified. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0731-3810 IL - 0731-3810 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1998 EZ - 1998/04/16 DA - 1998/04/16 00:01 DT - 1998/04/16 00:00 YR - 1998 ED - 19980421 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9541035 <854. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9517681 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wax PM AU - Cobaugh DJ FA - Wax, P M FA - Cobaugh, D J IN - Wax, P M. Department of Emergency Medicine and Finger Lakes Regional Poison Control Center, University of Rochester Medical Center, NY 14642, USA. TI - Prehospital gastrointestinal decontamination of toxic ingestions: a missed opportunity. SO - American Journal of Emergency Medicine. 16(2):114-6, 1998 Mar AS - Am J Emerg Med. 16(2):114-6, 1998 Mar NJ - The American journal of emergency medicine VO - 16 IP - 2 PG - 114-6 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Administration, Oral MH - Adult MH - Antidotes/ad [Administration & Dosage] MH - Antidotes/tu [Therapeutic Use] MH - Charcoal/ad [Administration & Dosage] MH - Charcoal/tu [Therapeutic Use] MH - Digestive System MH - Drug Overdose/th [Therapy] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Emetics/tu [Therapeutic Use] MH - Feasibility Studies MH - Female MH - Follow-Up Studies MH - Hospitals, University MH - Humans MH - Ipecac/tu [Therapeutic Use] MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - New York/ep [Epidemiology] MH - *Poisoning/th [Therapy] MH - Retrospective Studies MH - Single-Blind Method MH - *Sorption Detoxification/sn [Statistics & Numerical Data] MH - Sorption Detoxification/ut [Utilization] MH - Time Factors AB - The purpose of this study was to determine if emergency medical services (EMS) providers routinely initiate field gastrointestinal decontamination of adult drug overdose patients transported to the emergency department (ED). A retrospective prehospital chart review was performed on adult patients identified as drug overdose who were transported by EMS. ED charts on patients transported to a university hospital were reviewed for follow-up data. Prehospital care records showed that gastrointestinal decontamination was initiated in only 6 of 361 (2%) patients, all of whom received ipecac. No patient received activated charcoal. The median transport time was 25 minutes (range, 5 to 66 minutes). Follow-up data on patients transported to the university hospital revealed that 30 of 43 (70%) patients who might have been suitable candidates for prehospital activated charcoal actually received activated charcoal in the ED. Median time to activated charcoal in the ED was 82 minutes (range, 32 to 329 min). Use of activated charcoal in the field appears to be deferred despite its known loss of efficacy over time. The failure to start activated charcoal in the field contributes to the delay in initiating activated charcoal therapy. RN - 0 (Antidotes) RN - 0 (Emetics) RN - 0 (Narcotic Antagonists) RN - 16291-96-6 (Charcoal) RN - 36B82AMQ7N (Naloxone) RN - 8012-96-2 (Ipecac) IS - 0735-6757 IL - 0735-6757 PT - Journal Article ID - S0735-6757(98)90024-9 [pii] PP - ppublish LG - English DP - 1998 Mar EZ - 1998/03/28 DA - 1998/03/28 00:01 DT - 1998/03/28 00:00 YR - 1998 ED - 19980407 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9517681 <855. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9472189 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Moss ST AU - Chan TC AU - Buchanan J AU - Dunford JV AU - Vilke GM FA - Moss, S T FA - Chan, T C FA - Buchanan, J FA - Dunford, J V FA - Vilke, G M IN - Moss, S T. Department of Emergency Medicine University of California, San Diego, Medical Center 92103, USA. TI - Outcome study of prehospital patients signed out against medical advice by field paramedics. SO - Annals of Emergency Medicine. 31(2):247-50, 1998 Feb AS - Ann Emerg Med. 31(2):247-50, 1998 Feb NJ - Annals of emergency medicine VO - 31 IP - 2 PG - 247-50 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Emergency Medical Technicians MH - Female MH - Health Status MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - *Outcome Assessment (Health Care)/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - *Treatment Refusal/sn [Statistics & Numerical Data] AB - STUDY OBJECTIVE: To describe the incidence and demographic data of prehospital patients who contact paramedics by way of the 911 system, refuse transport against medical advice (AMA), then call 911 and are subsequently reevaluated by paramedics in the following 48 hours. AB - METHODS: We conducted a retrospective observational review of records using the San Diego County Quality Assurance Network database for prehospital providers. All paramedic 911 responses that made base hospital contact over a 3-month period were reviewed to identify patients who signed out AMA. The main outcome measure was to identify patients who signed out AMA and then called 911 again within 48 hours. The demographics, complaints, treatments, and dispositions of these patients are described. AB - RESULTS: Of 6,512 total 911 responses reviewed, 443 (7%) involved patients who signed out AMA. Of these patients, 156 cases (35.2%) were listed as trauma and 287 (64.8%) were medical, with cardiac chest pain, seizure, and respiratory distress/shortness of breath the most frequently noted medical subcategories. Fifty-one (11.5%) such patients received treatment; 34 received dextrose, 12 naloxone, 4 albuterol, and 1 a splint. Patient names were available in 5,515, of the total 6,512 responses and 431 of the 443 AMA cases, permitting computer searching of reevaluations by paramedics. Of the 431 AMA patients for whom a name was available, 10 (2%) called 911 again within 48 hours. All 10 callbacks were made for a related chief compliant, and all 10 of these patients were transported (4 admitted to hospital, 1 died en route, 1 transferred to another facility, 4 discharged from the ED). Of these 10 patients, 7 (70%) were older than 65 years, compared with 17% of all AMA patients older than 65 years. AB - CONCLUSION: On the basis of our findings, patients over the age of 65 years have a propensity to recontact paramedics and should be aggressively encouraged to seek emergency medical treatment. Future prospective studies should be mounted to examine at patient outcome and to assess why patients sign out AMA after making contact with paramedics. IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - S0196064498000626 [pii] PP - ppublish LG - English DP - 1998 Feb EZ - 1998/02/24 DA - 1998/02/24 00:01 DT - 1998/02/24 00:00 YR - 1998 ED - 19980305 RD - 20041117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9472189 <856. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9422191 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Osterwalder JJ FA - Osterwalder, J J IN - Osterwalder, J J. Department of Emergency Medicine and Surgery, Kantonsspital St Gallen, Switzerland. TI - Patients intoxicated with heroin or heroin mixtures: how long should they be monitored?. SO - European Journal of Emergency Medicine. 2(2):97-101, 1995 Jun AS - Eur J Emerg Med. 2(2):97-101, 1995 Jun NJ - European journal of emergency medicine : official journal of the European Society for Emergency Medicine VO - 2 IP - 2 PG - 97-101 PI - Journal available in: Print PI - Citation processed from: Print JC - cl2, 9442482 IO - Eur J Emerg Med SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Benzodiazepines/po [Poisoning] MH - Cannabis/po [Poisoning] MH - Drug Interactions MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/mo [Mortality] MH - Drug Overdose/th [Therapy] MH - Emergency Service, Hospital MH - *Emergency Treatment/mt [Methods] MH - Ethanol/po [Poisoning] MH - Female MH - Glasgow Coma Scale MH - *Heroin/po [Poisoning] MH - Heroin Dependence/mo [Mortality] MH - Heroin Dependence/th [Therapy] MH - Humans MH - Male MH - *Monitoring, Physiologic/mt [Methods] MH - *Narcotics/po [Poisoning] MH - Prospective Studies MH - Survival Rate MH - Switzerland/ep [Epidemiology] MH - Time Factors AB - Our investigation was carried out in subjects intoxicated with heroin or heroin mixtures to find out the time interval during which delayed life-threatening complications become manifest, such as pulmonary oedema or relapse into respiratory depression or coma after naloxone treatment. We studied prospectively all drug intoxications between 1991 and 1992. Of the 538 intoxications, we assessed in detail 160 outpatients who lived within the catchment area of our hospital. The outcome variables studied were (1) rehospitalization for pulmonary oedema, (2) relapse into coma, and/or (3) death and cause within 24 h after release from hospital. Deaths occurring outside our hospital have to be reported, as decreed by law, to the Institute for Forensic Medicine. The results of our investigation showed no rehospitalization owing to pulmonary oedema or coma, but one death, outside the hospital, owing to delayed pulmonary oedema. This delayed complication had an incidence of 0.6% (95% confidence interval 0-3.8%). A reintoxication could be excluded in this patient. Based on reliable report, the pulmonary oedema occurred between approximately 2 1/4 and 8 1/4 hours after intoxication. In the literature, only two cases of delayed pulmonary oedema have been reported with reliable time statements (4 and 6 h after hospitalization). We therefore conclude that surveillance for at least 8 h is essential after successful treatment to exclude delayed pulmonary oedema in patients intoxicated with heroin or heroin mixtures. RN - 0 (Narcotics) RN - 12794-10-4 (Benzodiazepines) RN - 3K9958V90M (Ethanol) RN - 70D95007SX (Heroin) IS - 0969-9546 IL - 0969-9546 PT - Clinical Trial PT - Journal Article PP - ppublish LG - English DP - 1995 Jun EZ - 1995/06/01 00:00 DA - 1998/01/09 00:01 DT - 1995/06/01 00:00 YR - 1995 ED - 19980205 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=9422191 <857. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9305315 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hardwick WE Jr AU - King WD AU - Palmisano PA FA - Hardwick, W E Jr FA - King, W D FA - Palmisano, P A IN - Hardwick, W E Jr. Department of Pediatrics, University of Alabama School of Medicine, Birmingham, USA. TI - Respiratory depression in a child unintentionally exposed to transdermal fentanyl patch. SO - Southern Medical Journal. 90(9):962-4, 1997 Sep AS - South Med J. 90(9):962-4, 1997 Sep NJ - Southern medical journal VO - 90 IP - 9 PG - 962-4 PI - Journal available in: Print PI - Citation processed from: Print JC - uvh, 0404522 IO - South. Med. J. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Administration, Cutaneous MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - Child, Preschool MH - Environmental Exposure MH - Fentanyl/ad [Administration & Dosage] MH - *Fentanyl/ae [Adverse Effects] MH - Humans MH - Injections, Intravenous MH - Intubation, Intratracheal MH - Male MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Oxygen/bl [Blood] MH - Respiration/de [Drug Effects] MH - Respiration, Artificial MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Sleep AB - A 2-year-old boy was found unresponsive after sleeping in bed with his grandmother. After the patient was intubated and ventilated, paramedics discovered a transdermal fentanyl patch on the victim's back. Removal of the patch and treatment with naloxone resolved symptoms. This is the first reported case of secondary exposure to a fentanyl patch causing clinically significant respiratory depression in the pediatric population, and it emphasizes a new hazard of such drug use. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - S88TT14065 (Oxygen) RN - UF599785JZ (Fentanyl) IS - 0038-4348 IL - 0038-4348 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1997 Sep EZ - 1997/09/26 DA - 2001/03/28 10:01 DT - 1997/09/26 00:00 YR - 1997 ED - 19971016 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9305315 <858. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9312754 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Trevisanuto D AU - Ferrarese P AU - Cantarutti F AU - Zanardo V FA - Trevisanuto, D FA - Ferrarese, P FA - Cantarutti, F FA - Zanardo, V IN - Trevisanuto, D. Dipartimento di Pediatria, Universita degli Studi di Padova, Italia. TI - [Resuscitation in the delivery room: experience in 3 Veneto Centers]. [Italian] OT - La rianimazione in sala parto: esperienza in 3 Centri del Veneto. SO - Pediatria Medica e Chirurgica. 19(2):77-80, 1997 Mar-Apr AS - Pediatr Med Chir. 19(2):77-80, 1997 Mar-Apr NJ - La Pediatria medica e chirurgica : Medical and surgical pediatrics VO - 19 IP - 2 PG - 77-80 PI - Journal available in: Print PI - Citation processed from: Print JC - paq, 8100625 IO - Pediatr Med Chir SB - Index Medicus CP - Italy MH - Atropine/ad [Administration & Dosage] MH - Bronchodilator Agents/ad [Administration & Dosage] MH - Delivery Rooms MH - Humans MH - *Infant, Newborn MH - Intubation, Intratracheal MH - Isoproterenol/ad [Administration & Dosage] MH - Italy MH - Naloxone/ad [Administration & Dosage] MH - Parasympatholytics/ad [Administration & Dosage] MH - Respiration, Artificial MH - Resuscitation/mt [Methods] MH - *Resuscitation MH - Sympathomimetics/ad [Administration & Dosage] AB - On the basis of the classical USA guidelines for neonatal resuscitation, we examined the personnel activity in delivery room in 3 Veneto's Centres of different level (level I, II, III). Totally, we studied 3492 neonates in the period January, 1-December, 31, 1994. Three hundred and seven (8.7%) of them needed resuscitation at birth; respectively 5.6%, 4.6% and 14.2% in the level I, II and III Centres. The management of the first neonatal resuscitation's step was similar in the 3 studied Hospitals, while the second phases (ventilation) was different among the Centres. In fact, in the level I and II Hospitals the most part of the neonates were treated by ventilation bag (81.8% and 74.6%, respectively), while only a little part of them received endotracheal intubation (18.2% and 25.4%, respectively). In the level III Centre, endotracheal intubation (87.4%) was more frequently used respect to ventilation bag (12.6%). The third phases, chest compressions, was performed in many resuscitated infants in the level I (54.5%) and II (22.8%) Hospitals, while no infant needed it in the 3th Centre. The last step, drug and fluid administration, interested few patients in every Centre. Furthermore, the physicians of the 3 examined Institutions followed no protocol for neonatal resuscitation. The differences in neonatal resuscitation policy among the 3 studied Centres demonstrate the absence of a protocol and an educational program for the personnel. Theoretical and practical guidelines for correct neonatal resuscitation have to be implemented in our Region. RN - 0 (Bronchodilator Agents) RN - 0 (Parasympatholytics) RN - 0 (Sympathomimetics) RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - L628TT009W (Isoproterenol) IS - 0391-5387 IL - 0391-5387 PT - Comparative Study PT - English Abstract PT - Journal Article PP - ppublish LG - Italian DP - 1997 Mar-Apr EZ - 1997/03/01 00:00 DA - 1997/10/06 00:01 DT - 1997/03/01 00:00 YR - 1997 ED - 19970926 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9312754 <859. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9270402 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cobaugh DJ AU - Schneider SM AU - Benitez JG AU - Donahoe MP FA - Cobaugh, D J FA - Schneider, S M FA - Benitez, J G FA - Donahoe, M P IN - Cobaugh, D J. Finger Lakes Regional Poison Center, University of Rochester Medical Center, NY 14642, USA. TI - Cocaine balloon aspiration: successful removal with bronchoscopy. SO - American Journal of Emergency Medicine. 15(5):544-6, 1997 Sep AS - Am J Emerg Med. 15(5):544-6, 1997 Sep NJ - The American journal of emergency medicine VO - 15 IP - 5 PG - 544-6 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - *Bronchoscopy MH - *Cocaine/po [Poisoning] MH - Emergencies MH - *Foreign Bodies/th [Therapy] MH - Humans MH - *Inhalation MH - Male AB - Ingestion of balloons containing illicit substances along with the potential toxic sequelae associated with these ingestions have been described in the literature. This report describes the successful bronchoscopic retrieval of a cocaine balloon after aspiration. A 39-year-old man was witnessed swallowing several balloons that were thought to contain heroin. Shortly after ingestion, the patient became unconscious and required nasotracheal intubation. Before intubation, several balloons were removed from the oropharynx. Naloxone 4 mg was administered en route to the emergency department (ED). Following naloxone, the patient awoke and became agitated and combative. On arrival in the ED, midazolam, succinylcholine, and vecuronium were required to manage his combativeness. Vital signs were: heart rate, 130 beats/min; blood pressure, 128/86 mm Hg; respirations, 12 breaths/min; temperature, 96.5 degrees F. A balloon and balloon tip were removed during lavage. Whole bowel irrigation with a polyethylene glycol electrolyte solution was initiated. A right upper lobe infiltrate was identified on chest X-ray and aspiration of a balloon was suspected. At bronchoscopy, a small yellow, intact balloon visualized in the basilar segment of the right lower lobe was removed. Toxicologic analysis of the balloon contents found cocaine. The rest of the patient's hospital course was unremarkable and he was discharged 5 days after admission. This case brings to light the potential concerns, such as respiratory compromise, associated with aspiration of small balloons in the body stuffer. Additionally, the potential for the development of toxicity if the balloon ruptures and toxin absorption occurs through through the lungs should be considered. Emergency physicians and toxicologists should be aware of this significant complication of packet ingestion in the body packer or stuffer and be prepared to intervene early during the course of the patient's treatment. RN - I5Y540LHVR (Cocaine) IS - 0735-6757 IL - 0735-6757 PT - Case Reports PT - Journal Article ID - S0735-6757(97)90207-2 [pii] PP - ppublish LG - English DP - 1997 Sep EZ - 1997/09/01 DA - 1997/09/01 00:01 DT - 1997/09/01 00:00 YR - 1997 ED - 19970910 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9270402 <860. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9178387 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gervais HW AU - Eberle B AU - Hennes HJ AU - Grimm W AU - Kilian A AU - Konietzke D AU - Massing C AU - Dick W FA - Gervais, H W FA - Eberle, B FA - Hennes, H J FA - Grimm, W FA - Kilian, A FA - Konietzke, D FA - Massing, C FA - Dick, W IN - Gervais, H W. Department of Anesthesiology, Johannes Gutenberg-University Mainz, Germany. TI - High dose naloxone does not improve cerebral or myocardial blood flow during cardiopulmonary resuscitation in pigs. SO - Resuscitation. 34(3):255-61, 1997 Jun AS - Resuscitation. 34(3):255-61, 1997 Jun NJ - Resuscitation VO - 34 IP - 3 PG - 255-61 PI - Journal available in: Print PI - Citation processed from: Print JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Acid-Base Equilibrium/de [Drug Effects] MH - Animals MH - *Cardiopulmonary Resuscitation MH - *Cerebrovascular Circulation/de [Drug Effects] MH - *Coronary Circulation/de [Drug Effects] MH - Dose-Response Relationship, Drug MH - Hemodynamics/de [Drug Effects] MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/pd [Pharmacology] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/pd [Pharmacology] MH - Swine AB - In a prospective, randomized, placebo-controlled, double-blind trial we tested the hypothesis that naloxone given during cardiopulmonary resuscitation (CPR) enhances cerebral and myocardial blood flow. Twenty-one anesthetized, normoventilated pigs were instrumented for measurements of right atrial and aortic pressures, and regional organ blood flow (radiolabeled microspheres). After 5 min of untreated fibrillatory arrest, CPR was commenced using a pneumatic chest compressor/ventilator. With onset of CPR, an i.v. bolus of 40 micrograms/kg b.w. of epinephrine was given, followed by an infusion of 0.4 micrograms/kg per min. After 5 min of CPR, either naloxone, 10 mg/kg b.w. (group N, n = 11) or normal saline (group S, n = 10) was given i.v. Prior to, and after 1, 15, and 30 min of CPR, hemodynamic and blood flow measurements were obtained. After 30 min of CPR, mean arterial pressure was significantly higher in group N (26 +/- 5 vs. 13 +/- 3 mmHg, P < 0.05). Groups did not differ with respect to myocardial perfusion pressure or arterial blood gases at any time during the observation period. Regional brain and heart blood flows were not different between N and S at any point of measurement. We conclude that high-dose naloxone does not augment cerebral or myocardial blood flow during prolonged closed-chest CPR. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0300-9572 IL - 0300-9572 PT - Journal Article ID - S0300957296010660 [pii] PP - ppublish LG - English DP - 1997 Jun EZ - 1997/06/01 DA - 1997/06/01 00:01 DT - 1997/06/01 00:00 YR - 1997 ED - 19970811 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9178387 <861. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9204095 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Spiller HA AU - Gorman SE AU - Villalobos D AU - Benson BE AU - Ruskosky DR AU - Stancavage MM AU - Anderson DL FA - Spiller, H A FA - Gorman, S E FA - Villalobos, D FA - Benson, B E FA - Ruskosky, D R FA - Stancavage, M M FA - Anderson, D L IN - Spiller, H A. Kentucky Regional Poison Center, Louisville 40232-5070, USA. haspiller@aol.com TI - Prospective multicenter evaluation of tramadol exposure. SO - Journal of Toxicology - Clinical Toxicology. 35(4):361-4, 1997 AS - J Toxicol Clin Toxicol. 35(4):361-4, 1997 NJ - Journal of toxicology. Clinical toxicology VO - 35 IP - 4 PG - 361-4 PI - Journal available in: Print PI - Citation processed from: Print JC - kan, 8213460 IO - J. Toxicol. Clin. Toxicol. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Analgesics, Opioid/ai [Antagonists & Inhibitors] MH - *Analgesics, Opioid/po [Poisoning] MH - Child MH - Child, Preschool MH - Drug Overdose/ep [Epidemiology] MH - Female MH - Humans MH - Infant MH - Male MH - Middle Aged MH - Naloxone/ae [Adverse Effects] MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ae [Adverse Effects] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Poison Control Centers MH - Prospective Studies MH - Seizures/ci [Chemically Induced] MH - Tramadol/ai [Antagonists & Inhibitors] MH - *Tramadol/po [Poisoning] AB - BACKGROUND: Tramadol is a novel analgesic possessing both opiate and noradrenergic effects. Its low potential for abuse suggests increasing use, but there are limited data on the toxicity in overdose. AB - METHODS: Multicenter prospective case series. All exposures from October 1995 through August 1996 reported to seven Poison Centers were evaluated. AB - RESULTS: There were 126 cases of which 87 were tramadol alone. Of the tramadol alone cases, 51 were female (59%). Age ranged from 1 to 86 y with a mean and median of 26.8 y (SD 17.2) and 25 y, respectively. There were 15 cases of children less than 6 years old. Symptoms reported with overdose were: lethargy 26 (30%), nausea 12 (14%), tachycardia 11 (13%), agitation 9 (10%), seizures 7 (8%), 4 each (5%) of coma and hypertension, and respiratory depression 2 (2%). All seizures were brief. Naloxone reversed sedation and apnea in 4 of 8 patients. One patient experienced a seizure immediately after administration of naloxone. Other treatments were: diazepam (3 patients), and phenytoin, lorazepam and nifedipine (1 patient each). Tramadol 500 mg was the lowest dose associated with seizure, tachycardia, hypertension or agitation while 800 mg was the lowest dose associated with coma and respiratory depression. Urine drug screens performed on 19 patients were negative for opiates. All symptomatic cases exhibited effects within 4 h of ingestion. Mean hospital stay was 15.2 h (range 2-96 h, SD 15.8). Nineteen patients were admitted to an intensive care unit with a mean stay of 25 h (SD 20). AB - DISCUSSION: Much of the toxicity in tramadol overdose appears to be attributable to the monoamine uptake inhibition rather than its opioid effects. Agitation, tachycardia, confusion and hypertension suggest a possible mild serotonin syndrome. No arrhythmias beyond tachycardia were seen. AB - CONCLUSION: This study suggests significant neurologic toxicity from tramadol overdose. Serious cardiovascular toxicity was not seen. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 39J1LGJ30J (Tramadol) IS - 0731-3810 IL - 0731-3810 PT - Journal Article PT - Multicenter Study PP - ppublish LG - English DP - 1997 EZ - 1997/01/01 DA - 1997/01/01 00:01 DT - 1997/01/01 00:00 YR - 1997 ED - 19970722 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9204095 <862. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9023621 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Taylor M AU - Bourke J AU - Anderson M AU - Davey R AU - Kelly AM AU - Guthrie B FA - Taylor, M FA - Bourke, J FA - Anderson, M FA - Davey, R FA - Kelly, A M FA - Guthrie, B IN - Taylor, M. Department of Emergency Medicine, Western Hospital, Footscray, Australia. TI - Titrated intravenous opioids from the same syringe: an infection risk?. SO - Journal of Accident & Emergency Medicine. 14(1):33-5, 1997 Jan AS - J Accid Emerg Med. 14(1):33-5, 1997 Jan NJ - Journal of accident & emergency medicine VO - 14 IP - 1 PG - 33-5 PI - Journal available in: Print PI - Citation processed from: Print JC - b0u, 9433751 IO - J Accid Emerg Med PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1342842 SB - Index Medicus CP - England MH - *Analgesia/mt [Methods] MH - Australia MH - Confidence Intervals MH - *Drug Contamination MH - Emergency Service, Hospital MH - Equipment Contamination MH - *Equipment Reuse MH - Humans MH - Infection Control MH - *Narcotics/ad [Administration & Dosage] MH - Pharmacy Service, Hospital MH - Prospective Studies MH - Quality Control MH - *Syringes AB - OBJECTIVE: (1) To compare the rate of contamination of syringes prepared under laminar flow conditions in pharmacy with those prepared by nurses in the emergency department; (2) to determine whether the time elapsed since preparation or number of doses given affected the contamination rate; (3) to determine whether any adverse effects resulted from bacterially contaminated drugs. AB - METHODS: Prospective, blinded trial exploring the effect of method of preparation, time since preparation, and number of doses given on contamination rates and infective adverse events associated with bacterially contaminated specimens. AB - RESULTS: The rate of bacterial contamination was 12% (95% confidence interval 6% to 18%). There was no difference in contamination rate in respect of method of preparation, number of doses given, or time since preparation. No infective complications were identified. AB - CONCLUSIONS: Abandonment of titrated intravenous opioids is not justified by the results. However, there is concern about the use of this technique of pain control for immunocompromised patients and those with prosthetic heart valves. RN - 0 (Narcotics) IS - 1351-0622 IL - 1351-0622 PT - Clinical Trial PT - Comparative Study PT - Journal Article ID - PMC1342842 [pmc] PP - ppublish LG - English DP - 1997 Jan EZ - 1997/01/01 DA - 1997/01/01 00:01 DT - 1997/01/01 00:00 YR - 1997 ED - 19970514 RD - 20081120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9023621 <863. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9095013 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Nichols MH AU - King WD AU - James LP FA - Nichols, M H FA - King, W D FA - James, L P IN - Nichols, M H. Department of Pediatric Emergency Medicine, University of Alabama, Birmingham, USA. TI - Clonidine poisoning in Jefferson County, Alabama. [Review] [64 refs] SO - Annals of Emergency Medicine. 29(4):511-7, 1997 Apr AS - Ann Emerg Med. 29(4):511-7, 1997 Apr NJ - Annals of emergency medicine VO - 29 IP - 4 PG - 511-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - African Americans MH - Alabama/ep [Epidemiology] MH - *Antihypertensive Agents/po [Poisoning] MH - Child, Preschool MH - *Clonidine/po [Poisoning] MH - Female MH - Humans MH - Infant MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - Poisoning/dt [Drug Therapy] MH - Poisoning/ep [Epidemiology] MH - Retrospective Studies AB - STUDY OBJECTIVE: To describe the epidemiology of clonidine-related hospitalization in children, to evaluate the efficacy of naloxone, and to review the clinical effects of clonidine toxicity. AB - METHODS: This was a retrospective analysis in an urban teaching pediatric emergency department with an annual census of 55,000 involving 80 children younger than 6 years who were admitted for clonidine ingestion during a 6-year period. AB - RESULTS: Clonidine commonly belonged to the patient's grand-mother (54%). Black children were twice as likely to be hospitalized for clonidine ingestion than white children compared with children hospitalized for any injury. Average time to onset of symptoms was 35 minutes. Decreased level of consciousness was the most common presenting symptom (96%). Mean ED vital signs were systolic blood pressure, 102 mm Hg; pulse, 98; respirations, 25 (six patients intubated); and temperature, 36.6 degrees C, Naloxone was administered to 49% of patients, 84% of whom demonstrated no response. AB - CONCLUSION: Clonidine ingestion is endemic in our area. Serious clinical effects mandate that all children with clonidine ingestion be triaged to a health care facility. Naloxone as an antidote for clonidine remains controversial. [References: 64] RN - 0 (Antihypertensive Agents) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - MN3L5RMN02 (Clonidine) IS - 0196-0644 IL - 0196-0644 PT - Journal Article PT - Review ID - S0196-0644(97)70225-7 [pii] PP - ppublish LG - English DP - 1997 Apr EZ - 1997/04/01 DA - 1997/04/01 00:01 DT - 1997/04/01 00:00 YR - 1997 ED - 19970505 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9095013 <864. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9115538 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sachdeva DK AU - Jolly BT FA - Sachdeva, D K FA - Jolly, B T TI - Tramadol overdose requiring prolonged opioid antagonism. SO - American Journal of Emergency Medicine. 15(2):217-8, 1997 Mar AS - Am J Emerg Med. 15(2):217-8, 1997 Mar NJ - The American journal of emergency medicine VO - 15 IP - 2 PG - 217-8 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Analgesics, Opioid/pk [Pharmacokinetics] MH - *Analgesics, Opioid/po [Poisoning] MH - Emergency Service, Hospital MH - Humans MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - Time Factors MH - Tramadol/pk [Pharmacokinetics] MH - *Tramadol/po [Poisoning] RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - 39J1LGJ30J (Tramadol) IS - 0735-6757 IL - 0735-6757 PT - Case Reports PT - Letter ID - S0735-6757(97)90116-9 [pii] PP - ppublish LG - English DP - 1997 Mar EZ - 1997/03/01 DA - 1997/03/01 00:01 DT - 1997/03/01 00:00 YR - 1997 ED - 19970424 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9115538 <865. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9082080 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Perez K AU - Domingo-Salvany A AU - Garces JM AU - Hartnoll RL FA - Perez, K FA - Domingo-Salvany, A FA - Garces, J M FA - Hartnoll, R L IN - Perez, K. Institut Municipal d'Investigacio, Medica, Barcelona. TI - [Information on opiate and cocaine consumption in the emergency room clinical records: validity and reliability]. [Spanish] OT - Informacion sobre el consumo de opioides y cocaina en la anamnesis de urgencias: validez y fiabilidad. SO - Medicina Clinica. 107(18):702-5, 1996 Nov 23 AS - Med Clin (Barc). 107(18):702-5, 1996 Nov 23 NJ - Medicina clinica VO - 107 IP - 18 PG - 702-5 PI - Journal available in: Print PI - Citation processed from: Print JC - ltq, 0376377 IO - Med Clin (Barc) SB - Index Medicus CP - Spain MH - Adult MH - *Cocaine MH - *Emergencies MH - Female MH - Humans MH - Male MH - *Narcotics MH - *Population Surveillance MH - Reproducibility of Results MH - *Substance-Related Disorders/ep [Epidemiology] AB - BACKGROUND: Data on drug consumption obtained from emergency room clinical records have been used for various epidemiological purposes. However the validity and reliability of these data remain unknown. This paper assesses the reliability and validity of an Emergency Room Toxicological Register (HMR) which has collected information on drug misuse from emergency room clinical records since 1979, and examines the implications for epidemiological applications. AB - SUBJECTS AND METHODS: An Emergency Room Survey (ERS) was carried out in a Barcelona Hospital including opiate or cocaine users identified by the physician and a systematic sample of other patients age 15 to 49 years old. Data on clinical records of interviewed patients were also reviewed. Episodes from identified drug users (686) and HMR (676) for the same study period were linked and validity and reliability were analyzed. AB - RESULTS: Sensitivity ranged between 63 and 86%, and specificity was 98%, Kappa index higher than 0.72 and intraclass correlation coefficient was 0.99. AB - CONCLUSIONS: Information about drug users included in emergency room clinical records proved to be valid as an information system for drug use surveillance. However data about patterns of less heavy users, as cocaine use, are underreported. RN - 0 (Narcotics) RN - I5Y540LHVR (Cocaine) IS - 0025-7753 IL - 0025-7753 PT - English Abstract PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - Spanish DP - 1996 Nov 23 EZ - 1996/11/23 DA - 1996/11/23 00:01 DT - 1996/11/23 00:00 YR - 1996 ED - 19970403 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9082080 <866. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8911587 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bartter T AU - Gooberman LL FA - Bartter, T FA - Gooberman, L L IN - Bartter, T. Chronic Pain and Addiction Center, Merchantville, New Jersey, USA. TI - Rapid opiate detoxification. SO - American Journal of Drug & Alcohol Abuse. 22(4):489-95, 1996 Nov AS - Am J Drug Alcohol Abuse. 22(4):489-95, 1996 Nov NJ - The American journal of drug and alcohol abuse VO - 22 IP - 4 PG - 489-95 PI - Journal available in: Print PI - Citation processed from: Print JC - 3gw, 7502510 IO - Am J Drug Alcohol Abuse SB - Index Medicus CP - England MH - Adult MH - *Anesthetics, Intravenous/ad [Administration & Dosage] MH - Critical Care MH - Female MH - *Heroin Dependence/rh [Rehabilitation] MH - Humans MH - Hypnotics and Sedatives/ad [Administration & Dosage] MH - Length of Stay MH - Male MH - Middle Aged MH - *Naloxone/ad [Administration & Dosage] MH - Naltrexone/ad [Administration & Dosage] MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - Neuromuscular Nondepolarizing Agents/tu [Therapeutic Use] MH - *Propofol/ad [Administration & Dosage] MH - Respiration, Artificial MH - *Substance Withdrawal Syndrome/pc [Prevention & Control] MH - Time Factors MH - Treatment Outcome MH - Vecuronium Bromide/tu [Therapeutic Use] AB - We report on clinical and practical aspects of treatment of opiate addiction with a relatively new approach, rapid opiate detoxification (ROD). The goal is to induce rapid narcotic withdrawal in a controlled environment using narcotic antagonists while suppressing withdrawal symptoms with sedative drugs, thus effecting a dramatic abbreviation of the traditional withdrawal schedule. Twenty-five consecutive heroin-addicted patients presenting for detoxification were treated at a university hospital. There were 14 women and 11 men, with a mean age 32.6 years (range, 24-48). They underwent 29 separate detoxifications over a 4-month period. All but 3 of the detoxifications were effected with ROD. Several different techniques were used over the 4-month period, ranging from intramuscular and oral sedation to intravenous sedation, paralysis, and intubation. Efficacy of detoxification was demonstrated for all patients undergoing ROD; all were given 50 mg of naltrexone PO prior to discharge, and none had withdrawal symptoms. (The three patients treated with abstinence were not so tested.) We derive three conclusions from this early clinical experience: First, ROD appears to be a valuable tool in the treatment of heroin addiction. ROD is an efficient, effective technique that can play an important role in an integrated rehabilitation program. Second, the optimal method of ROD is yet to be determined; a continuum of approaches is available. Third, ROD is probably most suited to designated outpatient centers. RN - 0 (Anesthetics, Intravenous) RN - 0 (Hypnotics and Sedatives) RN - 0 (Narcotic Antagonists) RN - 0 (Neuromuscular Nondepolarizing Agents) RN - 36B82AMQ7N (Naloxone) RN - 5S6W795CQM (Naltrexone) RN - 7E4PHP5N1D (Vecuronium Bromide) RN - YI7VU623SF (Propofol) IS - 0095-2990 IL - 0095-2990 PT - Journal Article PP - ppublish LG - English DP - 1996 Nov EZ - 1996/11/01 DA - 1996/11/01 00:01 DT - 1996/11/01 00:00 YR - 1996 ED - 19970313 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8911587 <867. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8907145 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Manfredi PL AU - Ribeiro S AU - Chandler SW AU - Payne R FA - Manfredi, P L FA - Ribeiro, S FA - Chandler, S W FA - Payne, R IN - Manfredi, P L. Department of Neuro-Oncology, Section of Pain and Symptom Management, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. TI - Inappropriate use of naloxone in cancer patients with pain. SO - Journal of Pain & Symptom Management. 11(2):131-4, 1996 Feb AS - J Pain Symptom Manage. 11(2):131-4, 1996 Feb NJ - Journal of pain and symptom management VO - 11 IP - 2 PG - 131-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 8605836, ijj IO - J Pain Symptom Manage SB - Index Medicus CP - United States MH - Aged MH - Humans MH - Male MH - *Naloxone/ae [Adverse Effects] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - *Neoplasms/co [Complications] MH - *Pain/dt [Drug Therapy] MH - *Substance Withdrawal Syndrome AB - Opioid overdose is rarely the primary cause of altered mental status in cancer patients receiving opioid therapy. The inappropriate administration of naloxone to reverse an abnormal mental status can cause severe withdrawal symptoms and pain. To illustrate this problem, we report the case of a patient inappropriately treated with naloxone and the results of a retrospective review of the medical records of 15 consecutive patients with cancer treated with naloxone in the emergency department over a 5-month period. We offer guidelines for a more thoughtful approach to the management of patients with cancer who present with encephalopathy. RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) IS - 0885-3924 IL - 0885-3924 PT - Case Reports PT - Journal Article ID - 0885392495001506 [pii] PP - ppublish LG - English DP - 1996 Feb EZ - 1996/02/01 DA - 1996/02/01 00:01 DT - 1996/02/01 00:00 YR - 1996 ED - 19970311 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8907145 <868. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 9022646 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Litovitz T AU - Clancy C AU - Korberly B AU - Temple AR AU - Mann KV FA - Litovitz, T FA - Clancy, C FA - Korberly, B FA - Temple, A R FA - Mann, K V IN - Litovitz, T. National Capital Poison Center, Washington, DC 20016, USA. TI - Surveillance of loperamide ingestions: an analysis of 216 poison center reports. CM - Comment in: J Toxicol Clin Toxicol. 1997;35(1):21-3; PMID: 9022647 SO - Journal of Toxicology - Clinical Toxicology. 35(1):11-9, 1997 AS - J Toxicol Clin Toxicol. 35(1):11-9, 1997 NJ - Journal of toxicology. Clinical toxicology VO - 35 IP - 1 PG - 11-9 PI - Journal available in: Print PI - Citation processed from: Print JC - kan, 8213460 IO - J. Toxicol. Clin. Toxicol. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Antidiarrheals/po [Poisoning] MH - Charcoal/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - *Drug Overdose/th [Therapy] MH - Female MH - Humans MH - Infant MH - Ipecac/tu [Therapeutic Use] MH - *Loperamide/po [Poisoning] MH - Male MH - *Poison Control Centers MH - Prospective Studies AB - BACKGROUND: Loperamide was approved for nonprescription use in 1988. While efficacy is well documented, there are few data on loperamide overdose and management. AB - METHODS: Eight poison centers participated in a prospective study enrolling 216 patients. AB - RESULTS: Where the amount ingested was known, it ranged from 0.03 to 0.94 mg/kg. One- to 3-year-olds were involved in 57.9% of ingestions. Ingestion was unintentional in 182 cases (84.3%), including 59 patients with therapeutic errors (27.3% of all cases). Dispensing cup errors were implicated in 23 cases; 15 patients assumed the dispensing cup was the unit of measure. No symptoms developed in 63.0%; 27.8% had related symptoms. No related symptoms were life-threatening, and no fatalities occurred. The most frequent symptoms were drowsiness (15.7%), vomiting (4.2%), and abdominal pain or burning (3.7%). The frequency of related symptoms was compared in patients receiving the most frequently utilized decontamination modalities: ipecac alone, activated charcoal alone, lavage and activated charcoal, and ipecac and activated charcoal. Compared to the 112 patients who received no decontamination, only the ipecac-treated group demonstrated a significant reduction in the frequency of related symptoms; 13.9% of patients given ipecac alone (without other gastric decontamination) had related symptoms compared to 33.0% of patients who received no decontamination. Three patients received naloxone for CNS symptoms related to loperamide; two responded and the response of the third was unknown. AB - CONCLUSION: Within the range of doses implicated in this study (up to 0.94 mg/kg), there were no life threatening clinical effects and no fatalities. Development of a management protocol is complicated by the absence of a predictable clinical response in each dose range. The data suggest that children over six months with single acute ingestions up to 0.4 mg/kg, and possibly higher, can be safely managed at home, without gastric decontamination. RN - 0 (Antidiarrheals) RN - 16291-96-6 (Charcoal) RN - 6X9OC3H4II (Loperamide) RN - 8012-96-2 (Ipecac) IS - 0731-3810 IL - 0731-3810 PT - Case Reports PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1997 EZ - 1997/01/01 DA - 1997/01/01 00:01 DT - 1997/01/01 00:00 YR - 1997 ED - 19970306 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=9022646 <869. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8896050 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Marsden AK AU - Mora FM FA - Marsden, A K FA - Mora, F M IN - Marsden, A K. Scottish Ambulance Service NHS Trust, Edinburgh, UK. TI - Case report--the successful use of naloxone in an asystolic pre-hospital arrest. SO - Resuscitation. 32(2):109-10, 1996 Sep AS - Resuscitation. 32(2):109-10, 1996 Sep NJ - Resuscitation VO - 32 IP - 2 PG - 109-10 PI - Journal available in: Print PI - Citation processed from: Print JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Acetaminophen/po [Poisoning] MH - Adult MH - Dextropropoxyphene/po [Poisoning] MH - Drug Combinations MH - Emergencies MH - Female MH - Heart Arrest/ci [Chemically Induced] MH - *Heart Arrest/dt [Drug Therapy] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Resuscitation/mt [Methods] MH - Suicide, Attempted RN - 0 (Drug Combinations) RN - 0 (Narcotic Antagonists) RN - 362O9ITL9D (Acetaminophen) RN - 36B82AMQ7N (Naloxone) RN - 39400-85-6 (acetaminophen, dextropropoxyphene, drug combination) RN - S2F83W92TK (Dextropropoxyphene) IS - 0300-9572 IL - 0300-9572 PT - Case Reports PT - Journal Article ID - 0300957296010118 [pii] PP - ppublish LG - English DP - 1996 Sep EZ - 1996/09/01 DA - 1996/09/01 00:01 DT - 1996/09/01 00:00 YR - 1996 ED - 19970211 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8896050 <870. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8998112 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gaeta TJ AU - Capodano RJ AU - Spevack TA FA - Gaeta, T J FA - Capodano, R J FA - Spevack, T A TI - Potential danger of nalmefene use in the emergency department. SO - Annals of Emergency Medicine. 29(1):193-4, 1997 Jan AS - Ann Emerg Med. 29(1):193-4, 1997 Jan NJ - Annals of emergency medicine VO - 29 IP - 1 PG - 193-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Emergency Service, Hospital MH - *Heroin/ae [Adverse Effects] MH - Humans MH - Naltrexone/ae [Adverse Effects] MH - *Naltrexone/aa [Analogs & Derivatives] MH - *Narcotic Antagonists/ae [Adverse Effects] MH - *Patient Discharge MH - *Substance Withdrawal Syndrome RN - 0 (Narcotic Antagonists) RN - 5S6W795CQM (Naltrexone) RN - 70D95007SX (Heroin) RN - TOV02TDP9I (nalmefene) IS - 0196-0644 IL - 0196-0644 PT - Letter ID - S0196064497000425 [pii] PP - ppublish LG - English DP - 1997 Jan EZ - 1997/01/01 DA - 1997/01/01 00:01 DT - 1997/01/01 00:00 YR - 1997 ED - 19970205 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8998112 <871. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8814402 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Perry HE AU - Shannon MW FA - Perry, H E FA - Shannon, M W IN - Perry, H E. Division of Emergency Medicine, Children's Hospital, Boston, MA 02115, USA. TI - Diagnosis and management of opioid- and benzodiazepine-induced comatose overdose in children. [Review] [36 refs] SO - Current Opinion in Pediatrics. 8(3):243-7, 1996 Jun AS - Curr Opin Pediatr. 8(3):243-7, 1996 Jun NJ - Current opinion in pediatrics VO - 8 IP - 3 PG - 243-7 PI - Journal available in: Print PI - Citation processed from: Print JC - but, 9000850 IO - Curr. Opin. Pediatr. SB - Index Medicus CP - United States MH - Adolescent MH - Antidotes/pd [Pharmacology] MH - Antidotes/tu [Therapeutic Use] MH - *Benzodiazepines/ae [Adverse Effects] MH - Benzodiazepines/pd [Pharmacology] MH - Child MH - Child, Preschool MH - *Coma/di [Diagnosis] MH - *Coma/th [Therapy] MH - Drug Overdose/di [Diagnosis] MH - *Drug Overdose/th [Therapy] MH - Flumazenil/pd [Pharmacology] MH - Flumazenil/tu [Therapeutic Use] MH - Humans MH - Infant MH - Infant, Newborn MH - Naloxone/pd [Pharmacology] MH - Naloxone/tu [Therapeutic Use] MH - *Narcotics/ae [Adverse Effects] MH - Narcotics/pd [Pharmacology] AB - Opioids and benzodiazepines are two of the most common exposures that cause depressed mental status in children. Establishing a diagnosis of these intoxications may be difficult and is complicated by drugs from these two classes that are not detectable by routine toxicologic screening techniques. Naloxone and flumazenil can be used as diagnostic as well as therapeutic medications in these ingestions. We present a brief review of the mechanism of action, administration recommendations, and adverse effects of naloxone and flumazenil. Although the empiric use of naloxone and flumazenil in the comatose adult patient who presents to the emergency department is being reexamined, many of the concerns do not apply to children. There is still an important role for empiric administration of both naloxone and flumazenil. [References: 36] RN - 0 (Antidotes) RN - 0 (Narcotics) RN - 12794-10-4 (Benzodiazepines) RN - 36B82AMQ7N (Naloxone) RN - 40P7XK9392 (Flumazenil) IS - 1040-8703 IL - 1040-8703 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1996 Jun EZ - 1996/06/01 DA - 1996/06/01 00:01 DT - 1996/06/01 00:00 YR - 1996 ED - 19970108 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8814402 <872. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8917916 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Seidler D AU - Stuhlinger GH AU - Fischer G AU - Woisetschlaeger C AU - Berzlanovich A AU - Schmid R AU - Hirschl MM AU - Laggner AN FA - Seidler, D FA - Stuhlinger, G H FA - Fischer, G FA - Woisetschlaeger, C FA - Berzlanovich, A FA - Schmid, R FA - Hirschl, M M FA - Laggner, A N IN - Seidler, D. Department of Emergency Medicine, University of Vienna, Austria. TI - After antagonization of acute opiate overdose: a survey at hospitals in Vienna. SO - Addiction. 91(10):1479-87, 1996 Oct AS - Addiction. 91(10):1479-87, 1996 Oct NJ - Addiction (Abingdon, England) VO - 91 IP - 10 PG - 1479-87 PI - Journal available in: Print PI - Citation processed from: Print JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Austria/ep [Epidemiology] MH - Cross-Sectional Studies MH - *Drug Overdose/ep [Epidemiology] MH - *Emergencies MH - Female MH - Humans MH - Incidence MH - Length of Stay/sn [Statistics & Numerical Data] MH - Male MH - *Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotics/po [Poisoning] MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Opioid-Related Disorders/rh [Rehabilitation] MH - Patient Acceptance of Health Care/sn [Statistics & Numerical Data] MH - *Urban Population/sn [Statistics & Numerical Data] AB - This study describes the clinical management and characteristics of people who, following acute opioid overdose, are taken to hospital after efficient antagonization by the pre-hospital emergency service. In addition, it defines areas of interest for further research. Over a 4-month period (September-December 1993) we collected data by a structured protocol sheet on patients' characteristics, anamnestic data on abuse and emergencies, clinical presentation, treatment by specific antidote and routine laboratory investigations. Outcome was verified by retrospective review of prehospital and forensic data. We studied 77 subjects, predominantly young males, who were involved in 83 emergencies, mostly occurring at weekends. In more than 60% of cases a single administration of specific antidote sufficed to stabilize the patients; 64% of patients left hospital against medical advice after an average stay of less than 6 hours; 46% denied daily opioid abuse and half the subjects, especially younger drug-users, seemed interested in counselling. This hospital-based study did not provide reliable data on the epidemiology of opioid overdose. Clinical management is determined by experience, pragmatism and beliefs. Efforts towards secondary prevention of drug problems at emergency departments might be warranted, and further research on pattern and management of opioid overdose is needed. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) IS - 0965-2140 IL - 0965-2140 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1996 Oct EZ - 1996/10/01 DA - 1996/10/01 00:01 DT - 1996/10/01 00:00 YR - 1996 ED - 19970106 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8917916 <873. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8942603 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kofke WA AU - Garman RH AU - Stiller RL AU - Rose ME AU - Garman R FA - Kofke, W A FA - Garman, R H FA - Stiller, R L FA - Rose, M E FA - Garman, R IN - Kofke, W A. Department of Anesthesiology, University of Pittsburgh, Pennsylvania, USA. TI - Opioid neurotoxicity: fentanyl dose-response effects in rats. SO - Anesthesia & Analgesia. 83(6):1298-306, 1996 Dec AS - Anesth Analg. 83(6):1298-306, 1996 Dec NJ - Anesthesia and analgesia VO - 83 IP - 6 PG - 1298-306 PI - Journal available in: Print PI - Citation processed from: Print JC - 4r8, 1310650 IO - Anesth. Analg. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Anesthetics, Inhalation/ad [Administration & Dosage] MH - Animals MH - Blood Pressure/de [Drug Effects] MH - Body Temperature/de [Drug Effects] MH - *Brain/de [Drug Effects] MH - Brain/pa [Pathology] MH - Brain Damage, Chronic/ci [Chemically Induced] MH - Brain Damage, Chronic/pa [Pathology] MH - Cell Death MH - Dose-Response Relationship, Drug MH - Electroencephalography/de [Drug Effects] MH - Eosinophilia/ci [Chemically Induced] MH - Fentanyl/ad [Administration & Dosage] MH - *Fentanyl/ae [Adverse Effects] MH - Fentanyl/bl [Blood] MH - Halothane/ad [Administration & Dosage] MH - Intubation, Intratracheal MH - Limbic System/de [Drug Effects] MH - Male MH - Narcotics/ad [Administration & Dosage] MH - *Narcotics/ae [Adverse Effects] MH - Narcotics/bl [Blood] MH - Nerve Degeneration MH - Neurons/de [Drug Effects] MH - Neurons/pa [Pathology] MH - Nitrous Oxide/ad [Administration & Dosage] MH - Oxygen/bl [Blood] MH - Random Allocation MH - Rats MH - Rats, Sprague-Dawley MH - Respiration, Artificial MH - Single-Blind Method AB - Opioids, when administered in large doses, produce brain damage, primarily in the limbic system and association areas in rats. This investigation examined the relationship between opioid dose and severity and frequency of brain damage in rats. Forty male Sprague-Dawley rats were anesthetized with halothane/N2O and underwent tracheal intubation, mechanical ventilation, arterial/venous cannulation, and insertion of a rectal temperature probe and biparietal electroencephalogram electrodes. After surgery, halothane was discontinued and O2/N2O 30%/70% was administered for 1 h. Rats were then randomly assigned to one of eight groups. The control group received a loading dose (LD) of 4 mL/kg of 0.9% normal saline solution (NSS) and a maintenance dose (MD) of 4 mL.kg-1.h-1 NSS. The other groups were given fentanyl lypophilized and reconstituted in NSS with the LD ranging from 50 to 3200 micrograms/kg and the MD from 2 to 128 micrograms.kg-1.min-1. After 2 h of fentanyl or NSS infusion; all rats received 100% O2 and, when alert, their tracheas were extubated; after 7 days the rats underwent cerebral perfusion fixation, followed by light microscopic evaluation. Histopathologic lesions (primarily eosinophilic neuron degeneration) were subjectively graded by a pathologist unaware of the experimental treatment; the grades were based on the percentage of dead neurons. There were no lesions observed in the brain areas in any of the control or 200-8 (LD, microgram/kg; MD, microgram.kg-1.min-1) groups. Eleven of 20 rats in the 400-16, 800-32, 1600-64, and 3200-18 groups showed evidence of brain damage primarily in limbic system structures and association areas (P < 0.05). Our data confirm that fentanyl produces limbic system brain damage in rats, and that the damage occurs over a broad range of doses. RN - 0 (Anesthetics, Inhalation) RN - 0 (Narcotics) RN - K50XQU1029 (Nitrous Oxide) RN - S88TT14065 (Oxygen) RN - UF599785JZ (Fentanyl) RN - UQT9G45D1P (Halothane) IS - 0003-2999 IL - 0003-2999 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1996 Dec EZ - 1996/12/01 DA - 1996/12/01 00:01 DT - 1996/12/01 00:00 YR - 1996 ED - 19961230 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8942603 <874. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8903263 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Dart RC AU - Stark Y AU - Fulton B AU - Koziol-McLain J AU - Lowenstein SR FA - Dart, R C FA - Stark, Y FA - Fulton, B FA - Koziol-McLain, J FA - Lowenstein, S R IN - Dart, R C. Rocky Mountain Poison and Drug Center, Denver Department of Health and Hospitals, Denver, CO 80220, USA. TI - Insufficient stocking of poisoning antidotes in hospital pharmacies. SO - JAMA. 276(18):1508-10, 1996 Nov 13 AS - JAMA. 276(18):1508-10, 1996 Nov 13 NJ - JAMA VO - 276 IP - 18 PG - 1508-10 PI - Journal available in: Print PI - Citation processed from: Print JC - 7501160 IO - JAMA SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analysis of Variance MH - *Antidotes/sd [Supply & Distribution] MH - Antivenins MH - Colorado MH - Deferoxamine/sd [Supply & Distribution] MH - *Emergency Medical Services MH - Ethanol/sd [Supply & Distribution] MH - Immunoglobulin Fab Fragments MH - Montana MH - Naloxone/sd [Supply & Distribution] MH - Nevada MH - *Pharmacy Service, Hospital MH - Pralidoxime Compounds/sd [Supply & Distribution] MH - Regression Analysis AB - OBJECTIVE: To determine whether antidotes for poisoning and overdose are available in hospitals that provide emergency department care. AB - DESIGN: Written survey of hospital pharmacy directors, each of whom reported the amount currently in stock of 8 different antidotes: antivenin (Crotalidae) polyvalent, cyanide kit, deferoxamine mesylate, digoxin immune Fab, ethanol, naloxone hydrochloride, pralidoxime chloride, and pyridoxine hydrochloride. AB - PARTICIPANTS: Pharmacy directors of all hospitals with emergency departments in Colorado, Montana, and Nevada. AB - MAIN OUTCOME MEASURES: Proportions of hospitals with insufficient stocking of each antidote, defined as complete lack of the antidote or an amount inadequate to initiate treatment of 1 seriously poisoned 70-kg patient. AB - RESULTS: Questionnaires were mailed to 137 hospital pharmacy directors and 108 (79%) responded. Only 1 (0.9%) of the 108 hospitals stocked all 8 antidotes in adequate amounts. The rate of insufficient stocking for individual antidotes ranged from 2% (for naloxone) to 98% (for digoxin immune Fab). In a multiple regression analysis, smaller hospital size and lack of a formal review of antidote stocking were independent predictors of the number of antidotes stocked insufficiently. AB - CONCLUSIONS: Insufficient stocking of antidotes is a widespread problem in Colorado, Montana, and Nevada. Although these states are served by a certified regional poison center, potentially lifesaving antidotes are frequently not available when and where they might be needed to treat a single poisoned patient. RN - 0 (Antidotes) RN - 0 (Antivenins) RN - 0 (Immunoglobulin Fab Fragments) RN - 0 (Pralidoxime Compounds) RN - 0 (digoxin antibodies Fab fragments) RN - 36B82AMQ7N (Naloxone) RN - 3K9958V90M (Ethanol) RN - J06Y7MXW4D (Deferoxamine) RN - P7MU9UTP52 (pralidoxime) IS - 0098-7484 IL - 0098-7484 PT - Journal Article PP - ppublish LG - English DP - 1996 Nov 13 EZ - 1996/11/13 DA - 1996/11/13 00:01 DT - 1996/11/13 00:00 YR - 1996 ED - 19961204 RD - 20161017 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8903263 <875. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8816181 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sporer KA AU - Firestone J AU - Isaacs SM FA - Sporer, K A FA - Firestone, J FA - Isaacs, S M IN - Sporer, K A. Department of Emergency Services, University of California, Los Angeles, School of Medicine, USA. karl.sporer@quickmail.ucsf.edu TI - Out-of-hospital treatment of opioid overdoses in an urban setting. CM - Comment in: Acad Emerg Med. 1996 Jul;3(7):657; PMID: 8816179 SO - Academic Emergency Medicine. 3(7):660-7, 1996 Jul AS - Acad Emerg Med. 3(7):660-7, 1996 Jul NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 3 IP - 7 PG - 660-7 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Chi-Square Distribution MH - Cohort Studies MH - Drug Overdose/di [Diagnosis] MH - Drug Overdose/th [Therapy] MH - Emergency Medical Services/mt [Methods] MH - *Emergency Medical Services MH - Female MH - Humans MH - Life Support Care/mt [Methods] MH - Male MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Retrospective Studies MH - Treatment Outcome MH - Urban Population AB - OBJECTIVES: To investigate clinical outcomes in a cohort of opioid overdose patients treated in an out-of-hospital urban setting noted for a high prevalence of i.v. opioid use. AB - METHODS: A retrospective review was performed of presumed opioid overdoses that were managed in 1993 by the emergency medical services (EMS) system in a single-tiered, urban advanced life support (ALS) EMS system. Specifically, all patients administered naloxone by the country paramedics were reviewed. Those patients with at least 3 of 5 objective criteria of an opioid overdose [respiratory rate < 6/min, pinpoint pupils, evidence of i.v. drug use. Glasgow Coma Scale (GCS) score < 12, or cyanosis] were included. A response to naloxone was defined as improvement to a GCS > or = 14 and a respiratory rate > or = 10/min within 5 minutes of naloxone administration. ED dispositions of opioid-overdose patients brought to the county hospital were reviewed. All medical examiner's cases deemed to be opioid-overdose-related deaths by postmortem toxicologic levels also were reviewed. AB - RESULTS: There were 726 patients identified with presumed opioid overdoses. Most patients (609/726, 85.4%) had an initial pulse and blood pressure (BP). Most (94%) of this group responded to naloxone and all were transported. Of the remainder, 101 (14%) had obvious signs of death and 16 (2.2%) were in cardiopulmonary arrest without obvious signs of death. Of the patients in full arrest, 2 had return of spontaneous circulation but neither survived. Of the 609 patients who had initial BPs, 487 (80%) received naloxone i.m. (plus bag-valve-mask ventilation) and 122 (20%) received the drug i.v. Responses to naloxone were similar; 94% i.m. vs 90% i.v. Of 443 patients transported to the country hospital, 12 (2.7%) were admitted. The admitted patients had noncardiogenic pulmonary edema (n = 4), pneumonia (n = 2), other infections (n = 2), persistent respiratory depression (n = 2), and persistent alteration in mental status (n = 2). The patients with pulmonary edema were clinically obvious upon ED arrival. Hypotension was never noted and bradycardia was seen in only 2% of our presumed-opioid-overdose population. AB - CONCLUSIONS: The majority of the opioid-overdose patients who had initial BPs responded readily to naloxone, with few patients requiring admission. Noncardiogenic pulmonary edema was uncommon and when present, hypoxia was evident upon arrival to the ED. Naloxone administered i.m. in conjunction with bag-valve-mask ventilation was effective in this patient population. The opioid-overdose patients in cardiopulmonary arrest did not survive. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 1069-6563 IL - 1069-6563 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish GI - No: R49/CCR903697-06 Organization: *PHS HHS* Country: United States LG - English DP - 1996 Jul EZ - 1996/07/01 DA - 1996/07/01 00:01 DT - 1996/07/01 00:00 YR - 1996 ED - 19961204 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8816181 <876. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8816179 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Meador SA FA - Meador, S A TI - Another piece of the puzzle. CM - Comment on: Acad Emerg Med. 1996 Jul;3(7):660-7; PMID: 8816181 SO - Academic Emergency Medicine. 3(7):657, 1996 Jul AS - Acad Emerg Med. 3(7):657, 1996 Jul NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 3 IP - 7 PG - 657 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Medical Services/td [Trends] MH - Humans MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/tu [Therapeutic Use] MH - *Naloxone MH - Narcotic Antagonists/ad [Administration & Dosage] MH - Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotic Antagonists MH - *Narcotics/po [Poisoning] RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 1069-6563 IL - 1069-6563 PT - Comment PT - Editorial PP - ppublish LG - English DP - 1996 Jul EZ - 1996/07/01 DA - 1996/07/01 00:01 DT - 1996/07/01 00:00 YR - 1996 ED - 19961204 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8816179 <877. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8829455 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tiniakov RL AU - Parin SB AU - Krylov VN AU - Sokolova NA AU - Bespalova ZhD AU - Dubynin VA AU - Kamenskii AA AU - Ashmarin IP FA - Tiniakov, R L FA - Parin, S B FA - Krylov, V N FA - Sokolova, N A FA - Bespalova, Zh D FA - Dubynin, V A FA - Kamenskii, A A FA - Ashmarin, I P TI - [Reviving effect of FMRFA-like peptides in clinical death in rats]. [Russian] OT - Reanimiruiushchee deistvie FMRFA-podobnykh peptidov pri klinicheskoi smerti u krys. SO - Biulleten Eksperimentalnoi Biologii i Meditsiny. 121(4):417-9, 1996 Apr AS - Biull Eksp Biol Med. 121(4):417-9, 1996 Apr NJ - Biulleten' eksperimental'noi biologii i meditsiny VO - 121 IP - 4 PG - 417-9 PI - Journal available in: Print PI - Citation processed from: Print JC - a74, 0370627 IO - Biull Eksp Biol Med SB - Index Medicus CP - Russia (Federation) MH - Amino Acid Sequence MH - Animals MH - *Blood Pressure/de [Drug Effects] MH - Death MH - Disease Models, Animal MH - FMRFamide MH - Female MH - *Heart Rate/de [Drug Effects] MH - Molecular Sequence Data MH - *Naloxone/pd [Pharmacology] MH - Neuropeptides/ch [Chemistry] MH - *Neuropeptides/pd [Pharmacology] MH - Rats MH - *Resuscitation MH - Shock, Hemorrhagic RN - 0 (Neuropeptides) RN - 36B82AMQ7N (Naloxone) RN - 64190-70-1 (FMRFamide) IS - 0365-9615 IL - 0365-9615 PT - Comparative Study PT - Journal Article PP - ppublish LG - Russian DP - 1996 Apr EZ - 1996/04/01 DA - 1996/04/01 00:01 DT - 1996/04/01 00:00 YR - 1996 ED - 19961016 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8829455 <878. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8780298 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Burkle H AU - Dunbar S AU - Van Aken H FA - Burkle, H FA - Dunbar, S FA - Van Aken, H IN - Burkle, H. Department of Anesthesiology and Intensive Care Medicine, Westfalische Wilhelms-Universitat, Munster, Germany. TI - Remifentanil: a novel, short-acting, mu-opioid. [Review] [52 refs] SO - Anesthesia & Analgesia. 83(3):646-51, 1996 Sep AS - Anesth Analg. 83(3):646-51, 1996 Sep NJ - Anesthesia and analgesia VO - 83 IP - 3 PG - 646-51 PI - Journal available in: Print PI - Citation processed from: Print JC - 4r8, 1310650 IO - Anesth. Analg. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Analgesics, Opioid/pd [Pharmacology] MH - *Analgesics, Opioid MH - Anesthesia, General MH - Animals MH - Humans MH - Piperidines/pd [Pharmacology] MH - *Piperidines AB - Because of remifentanil's unique pharmacokinetics, its systemic administration may be suitable for clinical settings where a potent, fast-acting, systemic mu-opioid with a rapid recovery is required, e.g., short painful intervention in the emergency room or the intensive care unit, or procedures in the day surgery or endoscopy suite. Total intravenous anesthesia for longer lasting procedures may become more promising because of the predictability of the offset of remifentanil even after long infusions. Its closest competitor, alfentanil, depends on its small volume of distribution for rapid termination of its effect, but still possesses the potential to accumulate because of its relatively long terminal elimination half-life. Remifentanil might be the first potent mu-opioid that does not accumulate in this fashion, and therefore it opens promising new clinical perspectives (52). However, as mentioned above, the relative short-lasting analgesic effect after cessation of the remifentanil infusion might require new, sophisticated techniques from the anesthetist to prevent immediate onset of postoperative pain. [References: 52] RN - 0 (Analgesics, Opioid) RN - 0 (Piperidines) RN - P10582JYYK (remifentanil) IS - 0003-2999 IL - 0003-2999 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1996 Sep EZ - 1996/09/01 DA - 1996/09/01 00:01 DT - 1996/09/01 00:00 YR - 1996 ED - 19961009 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8780298 <879. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8671555 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Orti RM AU - Domingo-Salvany A AU - Munoz A AU - Macfarlane D AU - Suelves JM AU - Anto JM FA - Orti, R M FA - Domingo-Salvany, A FA - Munoz, A FA - Macfarlane, D FA - Suelves, J M FA - Anto, J M IN - Orti, R M. Department of Epidemiology and Public Health, Institut Municipal d'Investigacio Medica, Universitat Autonoma de Barcelona, Dr. Aiguader 80, E-08004, Barcelona, Spain. TI - Mortality trends in a cohort of opiate addicts, Catalonia, Spain. SO - International Journal of Epidemiology. 25(3):545-53, 1996 Jun AS - Int J Epidemiol. 25(3):545-53, 1996 Jun NJ - International journal of epidemiology VO - 25 IP - 3 PG - 545-53 PI - Journal available in: Print PI - Citation processed from: Print JC - gr6, 7802871 IO - Int J Epidemiol SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Female MH - Humans MH - Male MH - *Opioid-Related Disorders/mo [Mortality] MH - Proportional Hazards Models MH - Retrospective Studies MH - Spain/ep [Epidemiology] AB - BACKGROUND: Opiate addiction affects young adults whose life expectancy is reduced as a consequence of their habit. In the midst of the AIDS epidemic, the present study objective was to analyse recent overall and cause-specific mortality trends among opiate addicts in Catalonia (Spain). AB - METHODS: Mortality was assessed retrospectively in an opiate addict cohort assembled from admissions to hospital emergency wards and drug treatment centres during the period 1985-1991. The cohort included 12 711 opiate addicts (12 045 men and 3666 women) aged 15-44 years. Overall and cause-specific mortality trends were analysed using age as the time scale and Cox regression with staggered entry determined by the age at entry in the study. Annual trends were adjusted by sex and source of entry, and were stratified by length of opiate use. AB - RESULTS: Mortality rates increased throughout the entire period from 13.8 to 34.8 deaths per 1000 person-years, with a statistically significant increase in 1987-1988 and 1988-1989. In a model including age, gender, source of entry and length of drug use, risk increased significantly in men and for longer length of use, but not with age and for source of entry into the study cohort. The causes of death associated with high mortality rates were AIDS and the causes directly related to addiction. AB - CONCLUSIONS: A threefold increase in mortality rates was observed during the period, mainly accounted for by AIDS and direct addiction-related causes. Length of opiate use was an important determinant of mortality. IS - 0300-5771 IL - 0300-5771 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1996 Jun EZ - 1996/06/01 DA - 1996/06/01 00:01 DT - 1996/06/01 00:00 YR - 1996 ED - 19960916 RD - 20100324 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8671555 <880. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8768175 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Seidler D AU - Woisetschlaeger C AU - Schmeiser-Rieder A AU - Hirschl MM AU - Kaff A AU - Laggner AN FA - Seidler, D FA - Woisetschlaeger, C FA - Schmeiser-Rieder, A FA - Hirschl, M M FA - Kaff, A FA - Laggner, A N IN - Seidler, D. Department of Emergency Medicine, AKH, General Hospital, Austria. TI - Prehospital opiate emergencies in Vienna. SO - American Journal of Emergency Medicine. 14(4):436-9, 1996 Jul AS - Am J Emerg Med. 14(4):436-9, 1996 Jul NJ - The American journal of emergency medicine VO - 14 IP - 4 PG - 436-9 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adult MH - Age Distribution MH - Austria/ep [Epidemiology] MH - Drug Overdose/ep [Epidemiology] MH - Emergencies MH - Emergency Medical Services/og [Organization & Administration] MH - *Emergency Medical Services/sn [Statistics & Numerical Data] MH - Female MH - Heroin/po [Poisoning] MH - Humans MH - Male MH - *Narcotics/po [Poisoning] MH - Sex Distribution AB - To establish baseline data on prehospital emergencies caused by opiates during a 4-month period, a retrospective analysis of run records of the Emergency Medical System in Vienna, the capital of Austria, was conducted. During the study period, there were 308 opioid emergencies involving 240 persons, an average of 2.5 overdoses per day. Severely compromised patients were treated in 67.8% of the 308 emergencies, and 79.3% of emergencies were transported to hospital; 52.5% of the involved persons were younger than 22 years of age. Sex distribution and periodicity and frequency of emergencies differed among age groups. A subgroup of individuals involved repeatedly in emergencies was identified, partly showing temporal clustering of fatal and nonfatal overdoses. Persons involved in opiate emergencies belong to heterogenous subgroups. At a local level, research should be initiated to clarify the pattern and impact of these emergencies on overall drug abuse prevention. RN - 0 (Narcotics) RN - 70D95007SX (Heroin) IS - 0735-6757 IL - 0735-6757 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - S0735-6757(96)90069-8 [pii] ID - 10.1016/S0735-6757(96)90069-8 [doi] PP - ppublish LG - English DP - 1996 Jul EZ - 1996/07/01 DA - 1996/07/01 00:01 DT - 1996/07/01 00:00 YR - 1996 ED - 19960913 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8768175 <881. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8677176 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Graff KJ AU - Kennedy RM AU - Jaffe DM FA - Graff, K J FA - Kennedy, R M FA - Jaffe, D M IN - Graff, K J. Section of General and Emergency Pediatrics, University of Colorado School of Medicine, Denver, USA. TI - Conscious sedation for pediatric orthopaedic emergencies. SO - Pediatric Emergency Care. 12(1):31-5, 1996 Feb AS - Pediatr Emerg Care. 12(1):31-5, 1996 Feb NJ - Pediatric emergency care VO - 12 IP - 1 PG - 31-5 PI - Journal available in: Print PI - Citation processed from: Print JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Acute Disease MH - Adolescent MH - Child MH - Child, Preschool MH - *Conscious Sedation/ae [Adverse Effects] MH - Emergencies MH - Female MH - *Fentanyl/ae [Adverse Effects] MH - Fentanyl/pd [Pharmacology] MH - *Fractures, Bone/th [Therapy] MH - Humans MH - Infant MH - *Joint Dislocations/th [Therapy] MH - Male MH - *Manipulation, Orthopedic MH - *Midazolam/ae [Adverse Effects] MH - Midazolam/pd [Pharmacology] MH - Monitoring, Physiologic MH - Respiration/de [Drug Effects] MH - Retrospective Studies MH - Risk Factors MH - Sex Factors AB - The objective of this study was to assess complications and risk factors among children undergoing conscious sedation (CS) with fentanyl (F) and midazolam (M) for reduction of fractures and dislocations. A 22-month retrospective review was made of an urban pediatric emergency department's records after implementing a CS protocol for the administration of F/M. Data collection was facilitated by standard CS forms, and data were analyzed using descriptive statistics, chi 2 analysis, Fisher's exact test, t test, odds ratio, and logistic regression. A total of 339 children (65% boys), mean age of 8.4 years, were enrolled in the study. The mean time to sedation was 11.3 +/- 6.2 minutes and to discharge was 92 +/- 36.3 minutes. The mean total doses of M and F were 0.17 +/- 0.08 mg/kg and 1.5 +/- 0.8 micrograms/kg, respectively. An alteration in respiratory status occurred in 37 (11.0%) patients: 28 (8.3%) had oxygen saturation < 90%; 16 (4.7%) received oxygen; 12 (3.6%) were given verbal breathing reminders, eight (2.4%) received airway positioning maneuvers, and 2 (0.6%) received naloxone. Four patients (1.2%) vomited. None required assisted ventilation, intubation, or admission resulting from complications of CS. Characteristics associated with the respiratory events included female sex (odds ratio = 2.2) and deep sedation (odds ratio = 2.7). We conclude that complications associated with F/M administered by protocol were few, minor, and easily managed. Patients who are female or who enter a state of deep sedation may be at modestly increased risk for alterations in respiratory status. Careful attention to monitoring vital functions on all patients is necessary to provide safe CS. RN - R60L0SM5BC (Midazolam) RN - UF599785JZ (Fentanyl) IS - 0749-5161 IL - 0749-5161 PT - Journal Article PP - ppublish LG - English DP - 1996 Feb EZ - 1996/02/01 DA - 1996/02/01 00:01 DT - 1996/02/01 00:00 YR - 1996 ED - 19960812 RD - 20161123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8677176 <882. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8623968 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Jamali S AU - Ravussin P AU - Archer D AU - Goutallier D AU - Parker F AU - Ecoffey C FA - Jamali, S FA - Ravussin, P FA - Archer, D FA - Goutallier, D FA - Parker, F FA - Ecoffey, C IN - Jamali, S. Departement of Anesthesiology and Surgical Intensive Care, Bicetre Hospital, France. TI - The effects of bolus administration of opioids on cerebrospinal fluid pressure in patients with supratentorial lesions. SO - Anesthesia & Analgesia. 82(3):600-6, 1996 Mar AS - Anesth Analg. 82(3):600-6, 1996 Mar NJ - Anesthesia and analgesia VO - 82 IP - 3 PG - 600-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 4r8, 1310650 IO - Anesth. Analg. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Aged MH - Anesthetics, Inhalation/ad [Administration & Dosage] MH - Anti-Arrhythmia Agents/ad [Administration & Dosage] MH - Atropine/ad [Administration & Dosage] MH - Blood Pressure/de [Drug Effects] MH - Bradycardia/pc [Prevention & Control] MH - Cerebral Arteries/de [Drug Effects] MH - *Cerebrospinal Fluid Pressure/de [Drug Effects] MH - Double-Blind Method MH - *Fentanyl/pd [Pharmacology] MH - Heart Rate/de [Drug Effects] MH - Homeostasis/de [Drug Effects] MH - Humans MH - Hypotension/pc [Prevention & Control] MH - Injections, Intravenous MH - Isoflurane/ad [Administration & Dosage] MH - Middle Aged MH - Phenylephrine/ad [Administration & Dosage] MH - Placebos MH - Prospective Studies MH - Respiration, Artificial MH - *Sufentanil/pd [Pharmacology] MH - *Supratentorial Neoplasms/su [Surgery] MH - Treatment Outcome MH - Vasoconstrictor Agents/ad [Administration & Dosage] MH - Vasodilation AB - In many studies reporting an increase in cerebrospinal fluid pressure (CSFP) after opioid administration, concomitant decreases in mean arterial pressure (MAP) have been observed. Autoregulatory cerebral vasodilation may therefore have been a factor in the CSFP increases. We tested the hypothesis that increases in CSFP after bolus injection of opioids could be minimized by modifying concomitant decreases in MAP with phenylephrine. Thirty-three patients with supratentorial mass lesions were studied in a randomized, prospective, double-blind, saline-controlled comparative trial. The principal outcome measures were lumbar CSFP, MAP, and heart rate (HR). Study drugs, sufentanil 0.8 micrograms/kg (n = 12), fentanyl 4.5 micrograms/kg (n = 11), or normal saline (n = 10), were injected intravenously (IV) during stable general anesthesia with 0.3-0.7 minimum alveolar anesthetic concentration (MAC) of isoflurane in oxygen and controlled ventilation (end-tidal carbon dioxide 32-35 mm Hg). Phenylephrine 50-100 micrograms was injected IV when MAP decreased by more than 15% of initial values, and atropine 0.5 mg IV when HR decreased to less than 45 bpm. Opioid administration was associated with significant decreases in MAP, 21 +/- 9 mm Hg (mean +/- SD) in the sufentanil group and 16 +/- 7 mm Hg in the fentanyl group; P < 0.001. These decreases in MAP were of short duration (i.e., corrected with 1-2 min). Patients in the sufentanil group needed more phenylephrine than patients in the fentanyl group (170 +/- 89 micrograms vs 100 +/- 47 micrograms; P < 0.05). No significant change in the CSFP was seen in either the sufentanil (1 +/- 6 mm Hg) or fentanyl-treated patients (O +/- 2 mm Hg). No significant changes in MAP or CSFP were observed in the saline-treated patients. HR decreased after injection of either study drug (P < 0.01) but remained unchanged in the saline group. In summary, during stable anesthesia with isoflurane in oxygen, bolus injections of fentanyl or sufentanil, despite producing rapidly corrected mean decreases in MAP of 18% and 25%, respectively, were not associated with any change in CSFP. RN - 0 (Anesthetics, Inhalation) RN - 0 (Anti-Arrhythmia Agents) RN - 0 (Placebos) RN - 0 (Vasoconstrictor Agents) RN - 1WS297W6MV (Phenylephrine) RN - 7C0697DR9I (Atropine) RN - AFE2YW0IIZ (Sufentanil) RN - CYS9AKD70P (Isoflurane) RN - UF599785JZ (Fentanyl) IS - 0003-2999 IL - 0003-2999 PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PP - ppublish LG - English DP - 1996 Mar EZ - 1996/03/01 DA - 1996/03/01 00:01 DT - 1996/03/01 00:00 YR - 1996 ED - 19960614 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=8623968 <883. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8602392 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gora-Harper ML AU - Sunahara JF AU - Gray MS FA - Gora-Harper, M L FA - Sunahara, J F FA - Gray, M S IN - Gora-Harper, M L. Division of Pharmacy Practice and Science, University of Kentucky Medical Center, Lexington, USA. TI - Intranasal butorphanol-induced apraxia reversed by naloxone. CM - Comment in: Pharmacotherapy. 1996 Sep-Oct;16(5):969; PMID: 8888097 SO - Pharmacotherapy:The Journal of Human Pharmacology & Drug Therapy. 15(6):798-800, 1995 Nov-Dec AS - Pharmacotherapy. 15(6):798-800, 1995 Nov-Dec NJ - Pharmacotherapy VO - 15 IP - 6 PG - 798-800 PI - Journal available in: Print PI - Citation processed from: Print JC - par, 8111305 IO - Pharmacotherapy SB - Index Medicus CP - United States MH - Administration, Intranasal MH - Adult MH - Analgesics, Opioid/ad [Administration & Dosage] MH - *Analgesics, Opioid/ae [Adverse Effects] MH - *Analgesics, Opioid/ai [Antagonists & Inhibitors] MH - *Apraxias/ci [Chemically Induced] MH - Apraxias/dt [Drug Therapy] MH - Butorphanol/ad [Administration & Dosage] MH - *Butorphanol/ae [Adverse Effects] MH - *Butorphanol/ai [Antagonists & Inhibitors] MH - Female MH - Humans MH - *Naloxone/pd [Pharmacology] MH - *Narcotic Antagonists/pd [Pharmacology] AB - Intranasal butorphanol is an opioid agonist-antagonist that is effective for the treatment of acute pain. Common adverse effects associated with the agent are somnolence, dizziness, nausea, and vomiting; they are readily reversed with naloxone. A patient developed signs and symptoms consistent with apraxia after a single dose of intranasal butorphanol. She was mentally alert, but she was unable to move or speak despite normal muscle tone and reflex movements. When she attempted to speak she had no voluntary control. At the emergency room she was administered naloxone 2 mg intramuscularly, which resulted in complete reversal of the symptoms in a short time. No other published cases describe these findings with butorphanol. Health care professionals should be aware that patients who are prescribed intranasal butorphanol, even in typical doses, may be at risk for such a reaction. This is important because, unlike the injectable formulation, the intranasal product is primarily used in the outpatient setting. RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 36B82AMQ7N (Naloxone) RN - QV897JC36D (Butorphanol) IS - 0277-0008 IL - 0277-0008 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1995 Nov-Dec EZ - 1995/11/01 DA - 1995/11/01 00:01 DT - 1995/11/01 00:00 YR - 1995 ED - 19960509 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8602392 <884. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8590619 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Aguirre JC AU - del Arbol JL AU - Rico J AU - Raya J AU - Ruiz-Requena ME FA - Aguirre, J C FA - del Arbol, J L FA - Rico, J FA - Raya, J FA - Ruiz-Requena, M E IN - Aguirre, J C. Department of Medicine, School of Medicine, University of Granada, Spain. TI - Effect of acute alcohol intoxication on the opioid system in humans. SO - Alcohol. 12(6):559-62, 1995 Nov-Dec AS - Alcohol. 12(6):559-62, 1995 Nov-Dec NJ - Alcohol (Fayetteville, N.Y.) VO - 12 IP - 6 PG - 559-62 PI - Journal available in: Print PI - Citation processed from: Print JC - ag9, 8502311 IO - Alcohol SB - Index Medicus CP - United States MH - Adolescent MH - *Adrenocorticotropic Hormone/bl [Blood] MH - Adult MH - *Alcoholic Intoxication/bl [Blood] MH - Central Nervous System Depressants/bl [Blood] MH - Ethanol/bl [Blood] MH - Female MH - Humans MH - *Hydrocortisone/bl [Blood] MH - Male MH - Radioimmunoassay MH - *beta-Endorphin/bl [Blood] AB - We investigated the possible relations between the endogenous opioid system and acute alcoholic intoxication in 21 subjects, of whom 13 were drinkers who came to the emergency service with evident symptoms of drunkenness, and 8 were nondrinkers who consumed 1 g alcohol per kg body weight over a short period. Different patterns of changes were found in the two groups for plasma concentrations of beta-endorphin and adrenocorticotropic hormone. In drinkers, plasma levels of both substances increased, whereas in nondrinkers both concentrations decreased, the declines being especially notable 15, 30, and 45 min after ingestion. We found no differences between the two groups in plasma cortisol concentrations. The different levels of these substances may reflect differences in drinking behavior between the two groups. RN - 0 (Central Nervous System Depressants) RN - 3K9958V90M (Ethanol) RN - 60617-12-1 (beta-Endorphin) RN - 9002-60-2 (Adrenocorticotropic Hormone) RN - WI4X0X7BPJ (Hydrocortisone) IS - 0741-8329 IL - 0741-8329 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 0741832995020020 [pii] PP - ppublish LG - English DP - 1995 Nov-Dec EZ - 1995/11/01 DA - 1995/11/01 00:01 DT - 1995/11/01 00:00 YR - 1995 ED - 19960403 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8590619 <885. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8542487 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pohlgeers AP AU - Friedland LR AU - Keegan-Jones L FA - Pohlgeers, A P FA - Friedland, L R FA - Keegan-Jones, L IN - Pohlgeers, A P. Children's Emergency Center, Wolfson Children's Hospital, Emergency Physicians, Inc., Jacksonville, FL 32207, USA. TI - Combination fentanyl and diazepam for pediatric conscious sedation. SO - Academic Emergency Medicine. 2(10):879-83, 1995 Oct AS - Acad Emerg Med. 2(10):879-83, 1995 Oct NJ - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine VO - 2 IP - 10 PG - 879-83 PI - Journal available in: Print PI - Citation processed from: Print JC - ce1, 9418450 IO - Acad Emerg Med SB - Index Medicus CP - United States MH - *Anesthetics, Intravenous MH - Child MH - Conscious Sedation/ae [Adverse Effects] MH - *Conscious Sedation MH - Diazepam/ae [Adverse Effects] MH - *Diazepam MH - Drug Combinations MH - Emergencies MH - Fentanyl/ae [Adverse Effects] MH - *Fentanyl MH - Fractures, Bone/su [Surgery] MH - Humans MH - Joint Dislocations/su [Surgery] MH - Retrospective Studies AB - OBJECTIVES: To evaluate the safety and to describe the use of combination IV diazepam and fentanyl in the pediatric emergency department (PED) as outpatient conscious sedation (CS) for orthopedic procedures. AB - METHODS: A retrospective chart review of a standardized protocol for CS administered to 133 consecutive patients requiring CS for outpatient orthopedic procedures. The patients were continuously monitored for heart rate, respiratory rate, and arterial O2 saturation (Sao2) by pulse oximetry. The study was conducted at a large urban PED and regional referral center. AB - RESULTS: A total of 133 children (mean age 8.5 years) received 138 orthopedic procedures. Mean (+/- SD) total diazepam dose was 0.12 +/- 0.05 mg/kg; mean total fentanyl dose was 3.18 +/- 1.04 micrograms/kg. Mean time intervals were 4.6 minutes from initial drug administration to start of procedure, 15.5 minutes to end of procedure, and 56 minutes to meeting criteria for release home. Complications included Sao2 < 90% for 15 patients (11%, 95% CI 6.4-17.4%), vomiting for one (0.7%, 95% CI 0.1-4.2%), and severe pruritus for one (0.7%, 95% CI 0.1-4.2%). An episode of Sao2 < 90% was associated with a higher initial mean fentanyl dose (2.60 vs 1.95 micrograms/kg; p = 0.0005), but was not associated with a higher initial mean diazepam dose (p = 0.28). Parenteral opioid use for pain management prior to CS was not associated with an increased risk for Sao2 < 90% (p = 0.42). Heart rate, respiratory rate, and blood pressure were stable during the observational period. No patient required naloxone, flumazenil, artificial airway control, or admission to the hospital. AB - CONCLUSIONS: At the doses given in the study, the use of combination diazepam and fentanyl for outpatient CS of PED patients during orthopedic procedures was not associated with serious complications. A higher initial fentanyl dose was associated with episodes of Sao2 < 90%. Therefore, an initial dose of < or = 2.0 micrograms/kg fentanyl titrated to effect is recommended. RN - 0 (Anesthetics, Intravenous) RN - 0 (Drug Combinations) RN - Q3JTX2Q7TU (Diazepam) RN - UF599785JZ (Fentanyl) IS - 1069-6563 IL - 1069-6563 PT - Journal Article PP - ppublish LG - English DP - 1995 Oct EZ - 1995/10/01 DA - 1995/10/01 00:01 DT - 1995/10/01 00:00 YR - 1995 ED - 19960212 RD - 20161123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8542487 <886. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7501621 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Staikowsky F AU - Uzan D AU - Grillon N AU - Pevirieri F AU - Hafi A AU - Michard F FA - Staikowsky, F FA - Uzan, D FA - Grillon, N FA - Pevirieri, F FA - Hafi, A FA - Michard, F IN - Staikowsky, F. Service d'Accueil des Urgences medicales, Hopital Bichat-Claude Bernard, Paris. TI - [Voluntary drug poisoning cases admitted to an emergency care unit]. [French] OT - Intoxications medicamenteuses volontaires recues dans un service d'accueil des urgences. SO - Presse Medicale. 24(28):1296-300, 1995 Sep 30 AS - Presse Med. 24(28):1296-300, 1995 Sep 30 NJ - Presse medicale (Paris, France : 1983) VO - 24 IP - 28 PG - 1296-300 PI - Journal available in: Print PI - Citation processed from: Print JC - 8302490, pmt IO - Presse Med SB - Index Medicus CP - France MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Analgesics/to [Toxicity] MH - *Anti-Anxiety Agents/to [Toxicity] MH - *Anticonvulsants/to [Toxicity] MH - Benzodiazepines MH - Charcoal/tu [Therapeutic Use] MH - Emergency Medicine MH - Female MH - Gastric Lavage/mt [Methods] MH - Humans MH - Male MH - Middle Aged MH - *Poisoning/th [Therapy] MH - *Psychotropic Drugs/to [Toxicity] MH - Retrospective Studies MH - Suicide, Attempted AB - OBJECTIVES: The aim of this study was to ascertain the specific nature of voluntary drug intoxications seen in emergency wards receiving adult patients. AB - METHODS: From July 1992 to June 1993, all patients presenting at the emergency room with voluntary drug intoxication were assessed retrospectively. There were 727 patients (482 females and 245 males, mean age 33.3 +/- 12 years, age range 15-92) admitted for 804 episodes of voluntary drug intoxication. AB - RESULTS: A past history of psychiatric problems or drug abuse was found in 42.8 and 9.1% of the patients respectively. The time laps between ingestion and consultation was noted for 43% (5 h 30 +/- 9 h, range 15-4320 min). The drug ingested was identified in 89% of the cases and 1.7 drugs were ingested per episode (range 1-8). Generally, only 1 (52%) or 2 (21%) drugs were ingested. Nonbarbituric psychotropic agents were ingested in 79.7% of the cases. Alcohol had also been consumed in 36.5% of the cases. Treatment was gastric lavage in 34.4%, activated carbon in 16.7%, flumazenil in 16.9%, naloxone and N-acetyl-cysteine in 3.4%. Twelve patients required intubation. Patients were admitted to a medical (n = 156) or psychiatric (n = 67) ward or an intensive care unit (n = 61). Nearly 25% of the patients left hospital either against medical advice or left without notice. AB - CONCLUSION: Voluntary drug intoxications seen in emergency rooms require care by a well coordinated team of clinicians and psychiatrists. RN - 0 (Analgesics) RN - 0 (Anti-Anxiety Agents) RN - 0 (Anticonvulsants) RN - 0 (Psychotropic Drugs) RN - 12794-10-4 (Benzodiazepines) RN - 16291-96-6 (Charcoal) IS - 0755-4982 IL - 0755-4982 PT - English Abstract PT - Journal Article PP - ppublish LG - French DP - 1995 Sep 30 EZ - 1995/09/30 DA - 1995/09/30 00:01 DT - 1995/09/30 00:00 YR - 1995 ED - 19960116 RD - 20161209 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7501621 <887. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7489075 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rosenberg NM AU - Marino D AU - Meert KL AU - Kauffman RF FA - Rosenberg, N M FA - Marino, D FA - Meert, K L FA - Kauffman, R F IN - Rosenberg, N M. Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Medical Center, USA. TI - Comparison of cocaine and opiate exposures between young urban and suburban children. SO - Archives of Pediatrics & Adolescent Medicine. 149(12):1362-4, 1995 Dec AS - Arch Pediatr Adolesc Med. 149(12):1362-4, 1995 Dec NJ - Archives of pediatrics & adolescent medicine VO - 149 IP - 12 PG - 1362-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 9422751, bwf IO - Arch Pediatr Adolesc Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Child, Preschool MH - *Cocaine/aa [Analogs & Derivatives] MH - Cocaine/ur [Urine] MH - Humans MH - Infant MH - *Narcotics/ur [Urine] MH - Prevalence MH - Street Drugs MH - Substance-Related Disorders/ep [Epidemiology] MH - *Suburban Health MH - United States MH - *Urban Health AB - OBJECTIVE: To determine the prevalence of cocaine and opiate metabolites in the urine of young urban and suburban children. AB - DESIGN: Survey. AB - SETTING: Urban and suburban emergency departments and private pediatric practices. AB - PATIENTS: A convenience sample of 1469 children between 1 and 60 months of age who required a urinalysis for investigation of the chief complaint. AB - INTERVENTION: None. AB - MAIN OUTCOME MEASURES: Urine was screened for benzoylecogonine and opiates using an enzyme-multiplied immunoassay technique and a fluorescence-polarization immunoassay, both with a sensitivity of 50 ng/mL. AB - RESULTS: Benzoylecogonine was identified in the urine of 45 children (3.1%) (95% CI, 2.2% to 3.9%) and opiates in the urine of 38 children (2.6%) (95% CI, 1.8% to 3.4%). No difference was observed between urban and suburban health care facilities in the percentage of patients whose urine tested positive for benzoylecgonine (29 of 1011 vs 16 of 458, P = .6) or opiates (28 of 1011 vs 10 of 458, P = .6). AB - CONCLUSION: Exposure to illicit drugs, as reflected by urinary metabolites, is similar for urban and suburban children. RN - 0 (Narcotics) RN - 0 (Street Drugs) RN - 5353I8I6YS (benzoylecgonine) RN - I5Y540LHVR (Cocaine) IS - 1072-4710 IL - 1072-4710 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1995 Dec EZ - 1995/12/01 DA - 1995/12/01 00:01 DT - 1995/12/01 00:00 YR - 1995 ED - 19960104 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7489075 <888. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7491730 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kristensen BB AU - Mikkelsen SS FA - Kristensen, B B FA - Mikkelsen, S S IN - Kristensen, B B. Anaestesiologisk afdeling, Bispebjerg Hospital, Kobenhavn. TI - [Pharmacological routes of administration in circulatory collapse]. [Review] [35 refs] [Danish] OT - Farmakologiske administrationsveje ved cirkulationssvigt. CM - Comment in: Ugeskr Laeger. 1996 Feb 19;158(8):1093; PMID: 8638347 SO - Ugeskrift for Laeger. 157(49):6864-8, 1995 Dec 04 AS - Ugeskr Laeger. 157(49):6864-8, 1995 Dec 04 NJ - Ugeskrift for laeger VO - 157 IP - 49 PG - 6864-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 0141730, wm8 IO - Ugeskr. Laeg. SB - Index Medicus CP - Denmark MH - Cardiopulmonary Resuscitation/mt [Methods] MH - *Cardiopulmonary Resuscitation MH - Catheterization, Peripheral MH - *Drug Administration Routes MH - Humans MH - Injections, Intravenous MH - *Shock/dt [Drug Therapy] MH - Trachea AB - A review of different ways of injecting drugs during cardiopulmonary resuscitation (CPR) and during states of shock is presented. On the basis of this review, central or peripheral intravenous injection is recommended as first choice. If a peripheral vein is used, the drug injection should be followed by infusion of a large volume of normal saline to facilitate the entry of the drug into the central circulation. In case of endotracheal intubation, several drugs can be injected into the tracheal tube. Atropine, lidocaine and naloxone are shown to be effective when given by this route. Adrenalin is probably not effective when injected endotracheally. Intraosseous injection of drugs, crystalloids and colloids is an alternative in all states except for hypovolaemic shock due to lower infusion rates. Intracardiac injection of drugs during CPR is recommended as a last resort. [References: 35] IS - 0041-5782 IL - 0041-5782 PT - English Abstract PT - Journal Article PT - Review PP - ppublish LG - Danish DP - 1995 Dec 04 EZ - 1995/12/04 DA - 1995/12/04 00:01 DT - 1995/12/04 00:00 YR - 1995 ED - 19960103 RD - 20061115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7491730 <889. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7481100 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bertolini A FA - Bertolini, A IN - Bertolini, A. Department of Biomedical Sciences, University of Modena, Italy. TI - The opioid/anti-opioid balance in shock: a new target for therapy in resuscitation. [Review] [177 refs] SO - Resuscitation. 30(1):29-42, 1995 Aug AS - Resuscitation. 30(1):29-42, 1995 Aug NJ - Resuscitation VO - 30 IP - 1 PG - 29-42 PI - Journal available in: Print PI - Citation processed from: Print JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Adrenocorticotropic Hormone/tu [Therapeutic Use] MH - Animals MH - Cholecystokinin/ph [Physiology] MH - Female MH - Humans MH - Male MH - Melanocyte-Stimulating Hormones/ph [Physiology] MH - *Neuropeptides/ph [Physiology] MH - *Opioid Peptides/ph [Physiology] MH - Rats MH - *Resuscitation MH - *Shock, Hemorrhagic/pp [Physiopathology] MH - *Shock, Hemorrhagic/th [Therapy] MH - Thyrotropin-Releasing Hormone/ph [Physiology] AB - Teleologically, pain is of paramount importance for survival and induces the organism to cope in an active way with aggressions from a basically hostile environment. While the activation of endogenous analgesic (opioid) systems typically occurs in conditions of surrender (pre-terminal conditions, sustained tortures, etc.), the activation of endogenous anti-analgesic systems triggers mechanisms of active or passive defence (such as camouflage) aimed at survival. The distinctive features of the main anti-analgesic systems (melanocortinergic, cholecystokininergic, thyroliberinergic) and the dramatic results obtained in experimental pre-terminal conditions (hemorrhagic shock, prolonged respiratory arrest) with the administration of their neuropeptide transmitters (ACTH and several ACTH-fragments, including alpha-MSH, CCK peptides and thyrotropin-releasing hormone) are here reviewed. The study of the mechanisms underlying the resuscitating effects of these neuropeptides has led to the discovery of the (often extremely potent) resuscitating effect of other drugs (protoveratrines, nicotine, centrally-acting cholinergic agents, ganglion-stimulating drugs). It is particularly remarkable that in pre-terminal conditions these neuropeptides and drugs have highly impressive effects on cardiocirculatory parameters at doses that are almost or actually inactive under normal conditions, and that their resuscitating effect is obtained without the need for any other supportive treatment and at dose-levels well below toxic ranges. Finally, in hemorrhage-shocked animals, the treatment with anti-analgesic neuropeptides shortly after bleeding considerably extends the time-limit for an effective and definitively curing blood reinfusion. This would be of self-evident importance in clinical practice, because an extremely simple, non-toxic first-aid treatment in the field, shortly after a massive hemorrhage, could resuscitate the patient for a period sufficient to effectively set up the most appropriate in-hospital treatment. [References: 177] RN - 0 (Neuropeptides) RN - 0 (Opioid Peptides) RN - 5Y5F15120W (Thyrotropin-Releasing Hormone) RN - 9002-60-2 (Adrenocorticotropic Hormone) RN - 9002-79-3 (Melanocyte-Stimulating Hormones) RN - 9011-97-6 (Cholecystokinin) IS - 0300-9572 IL - 0300-9572 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review ID - 030095729400863B [pii] PP - ppublish LG - English DP - 1995 Aug EZ - 1995/08/01 DA - 1995/08/01 00:01 DT - 1995/08/01 00:00 YR - 1995 ED - 19951214 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7481100 <890. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7662056 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Waldrop RD AU - Mandry C FA - Waldrop, R D FA - Mandry, C IN - Waldrop, R D. Department of Emergency Medicine, Earl K. Long Medical Center, Baton Rouge, LA 70805, USA. TI - Health professional perceptions of opioid dependence among patients with pain. SO - American Journal of Emergency Medicine. 13(5):529-31, 1995 Sep AS - Am J Emerg Med. 13(5):529-31, 1995 Sep NJ - The American journal of emergency medicine VO - 13 IP - 5 PG - 529-31 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Analysis of Variance MH - *Anemia, Sickle Cell/pp [Physiopathology] MH - *Attitude of Health Personnel MH - Emergency Service, Hospital MH - Humans MH - *Narcotics MH - *Pain/dt [Drug Therapy] MH - *Personnel, Hospital/px [Psychology] MH - *Substance-Related Disorders AB - The purpose of this study was to determine the percentage of patients perceived by health professionals to be opioid dependent among all patients presenting with pain and specifically among sickle cell patients with pain. Surveys were completed by all staff, residents, and nurses at an urban teaching hospital with an emergency department population consisting primarily of lower socioeconomic patients of African-American origin. The surveys requested a percentage estimate of all pain patients and sickle cell patients with pain presenting to this hospital who they perceived to be opioid dependent. The estimated percentage of opioid dependent patients presenting to the emergency department with pain was 4% for staff (P < .05, n = 14), 9% for residents (n = 31), and 7% for nurses (n = 41), and the estimates for sickle cell patients presenting with pain only were 8%, 17%, and 13% respectively (P < .05). All health professional groups surveyed estimated opioid dependence in patients with pain far in excess of that shown in previous studies. It is unknown whether pain medication are withheld inappropriately by physicians who perceived patients with pain to be opioid dependent, and that this deserved further study especially among sickle cell patients. RN - 0 (Narcotics) IS - 0735-6757 IL - 0735-6757 PT - Comparative Study PT - Journal Article ID - 0735-6757(95)90163-9 [pii] ID - 10.1016/0735-6757(95)90163-9 [doi] PP - ppublish LG - English DP - 1995 Sep EZ - 1995/09/01 DA - 1995/09/01 00:01 DT - 1995/09/01 00:00 YR - 1995 ED - 19951006 RD - 20061115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7662056 <891. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7651872 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rosenberg NM AU - Meert KL AU - Marino D AU - Yee H AU - Kauffman RE FA - Rosenberg, N M FA - Meert, K L FA - Marino, D FA - Yee, H FA - Kauffman, R E IN - Rosenberg, N M. Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit Medical Center 48201-2196, USA. TI - Occult cocaine and opiate exposure in children and associated physical findings. SO - Pediatric Emergency Care. 11(3):167-9, 1995 Jun AS - Pediatr Emerg Care. 11(3):167-9, 1995 Jun NJ - Pediatric emergency care VO - 11 IP - 3 PG - 167-9 PI - Journal available in: Print PI - Citation processed from: Print JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Blood Pressure/de [Drug Effects] MH - Body Constitution MH - Body Weight/de [Drug Effects] MH - Child MH - Child, Preschool MH - Cocaine/aa [Analogs & Derivatives] MH - Cocaine/me [Metabolism] MH - Cocaine/pd [Pharmacology] MH - Cocaine/ur [Urine] MH - *Cocaine MH - Emergency Service, Hospital MH - Environmental Exposure/sn [Statistics & Numerical Data] MH - *Environmental Exposure MH - Female MH - Head/ph [Physiology] MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Michigan/ep [Epidemiology] MH - Narcotics/pd [Pharmacology] MH - Narcotics/ur [Urine] MH - *Narcotics MH - Pediatrics MH - Prospective Studies MH - Urban Population AB - We determined the prevalence of cocaine and opiate exposure and the association of exposure with objective physical findings in children presenting to an urban pediatric emergency department. The study included 942 children between one and 60 months of age who required urinalysis for investigation of their chief complaint. Anonymously and without informed consent, urine was screened for benzoylecgonine (BE) and opiates, using an enzyme multiplied immunoassay technique (EMIT) with sensitivity of 50 ng/ml. EMIT-positive samples were rescreened using a fluorescence polarization immunoassay (FPIA). Specimens positive by both EMIT and FPIA were confirmed by gas chromatography/mass spectrometry (GC/MS) if sufficient quantity of urine was available. BE was identified in 41 (4.4%) and opiates in 46 (4.9%) patients by both EMIT and FPIA. The presence of BE or opiate was confirmed by GC/MS in all 34 cases where sufficient urine was available. The age- and sex-adjusted systolic and diastolic blood pressure percentiles were greater, and head circumference and weight percentiles were lower in BE-positive patients compared to those with negative drug screens. There were no associations between opiate exposure and any of these variables. We conclude that occult postnatal cocaine exposure is associated with measurable physical and physiologic differences. RN - 0 (Narcotics) RN - 5353I8I6YS (benzoylecgonine) RN - I5Y540LHVR (Cocaine) IS - 0749-5161 IL - 0749-5161 PT - Comparative Study PT - Journal Article PP - ppublish LG - English DP - 1995 Jun EZ - 1995/06/01 DA - 1995/06/01 00:01 DT - 1995/06/01 00:00 YR - 1995 ED - 19950927 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7651872 <892. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7797894 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Slucky AV AU - Eismont FJ FA - Slucky, A V FA - Eismont, F J IN - Slucky, A V. Hospital for Special Surgery, New York, New York, USA. TI - Treatment of acute injury of the cervical spine. [Review] [115 refs] SO - Instructional Course Lectures. 44:67-80, 1995 AS - Instr Course Lect. 44:67-80, 1995 NJ - Instructional course lectures VO - 44 PG - 67-80 PI - Journal available in: Print PI - Citation processed from: Print JC - ifc, 7507149 IO - Instr Course Lect SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - *Cervical Vertebrae/in [Injuries] MH - Cervical Vertebrae/su [Surgery] MH - Diagnostic Imaging MH - Emergency Medical Services MH - Female MH - G(M1) Ganglioside/tu [Therapeutic Use] MH - Humans MH - Hypothermia, Induced MH - Lipid Peroxides/ai [Antagonists & Inhibitors] MH - Male MH - Methylprednisolone/tu [Therapeutic Use] MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Physical Examination MH - Pregnatrienes/tu [Therapeutic Use] MH - Resuscitation MH - Spinal Cord Injuries/cl [Classification] MH - Spinal Cord Injuries/pp [Physiopathology] MH - *Spinal Cord Injuries/th [Therapy] MH - Thyrotropin-Releasing Hormone/tu [Therapeutic Use] RN - 0 (Lipid Peroxides) RN - 0 (Pregnatrienes) RN - 36B82AMQ7N (Naloxone) RN - 37758-47-7 (G(M1) Ganglioside) RN - 5Y5F15120W (Thyrotropin-Releasing Hormone) RN - X4W7ZR7023 (Methylprednisolone) RN - YD064E883I (tirilazad) IS - 0065-6895 IL - 0065-6895 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1995 EZ - 1995/01/01 DA - 1995/01/01 00:01 DT - 1995/01/01 00:00 YR - 1995 ED - 19950803 RD - 20161123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7797894 <893. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7900724 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Domingo-Salvany A AU - Hartnoll RL AU - Maguire A AU - Suelves JM AU - Anto JM FA - Domingo-Salvany, A FA - Hartnoll, R L FA - Maguire, A FA - Suelves, J M FA - Anto, J M IN - Domingo-Salvany, A. Department of Epidemiology and Public Health, Universitat Autonoma de Barcelona, Spain. TI - Use of capture-recapture to estimate the prevalence of opiate addiction in Barcelona, Spain, 1989. SO - American Journal of Epidemiology. 141(6):567-74, 1995 Mar 15 AS - Am J Epidemiol. 141(6):567-74, 1995 Mar 15 NJ - American journal of epidemiology VO - 141 IP - 6 PG - 567-74 PI - Journal available in: Print PI - Citation processed from: Print JC - 3h3, 7910653 IO - Am. J. Epidemiol. SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Chi-Square Distribution MH - Confidence Intervals MH - *Data Collection/mt [Methods] MH - Emergency Service, Hospital/ut [Utilization] MH - Episode of Care MH - Female MH - Humans MH - Likelihood Functions MH - Male MH - Medical Record Linkage MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Prevalence MH - Regression Analysis MH - Reproducibility of Results MH - Research Design MH - Selection Bias MH - Spain/ep [Epidemiology] MH - *Substance Abuse, Intravenous/ep [Epidemiology] AB - It is difficult to obtain accurate prevalence estimates of opiate addiction with direct methods. The capture-recapture method has been used to estimate the prevalence of hidden populations, including opiate addicts. In this study, we applied capture-recapture, including log-linear modeling, to estimate the prevalence of opiate addicts in Barcelona, Spain. Anonymous identification data from three 1989 sources (hospital emergency rooms, treatment admissions, and heroin overdose deaths) in Barcelona were used to obtain population samples. For prevalence estimation, two strategies were followed: 1) emergency room data only, divided into trimesters; and 2) all three sources used simultaneously. Estimates based only on emergency room data were lower than estimates obtained by the simultaneous analysis of all three data sources; the latter estimates gave narrower confidence intervals (6,324-7,414 addicts), giving a prevalence for Barcelona in 1989 of between 8.5 and 9.9 opiate addicts per 1,000 residents aged 15-44 years. The estimated prevalence varied by sex and age group and was highest in males aged 15-29 years (between 17.1 and 21.2). At least 42% had contacted one or more of the services studied, although only one in seven had been admitted for treatment during 1989. Capture-recapture is the election method for prevalence estimation when direct methods are not feasible. IS - 0002-9262 IL - 0002-9262 PT - Journal Article PP - ppublish LG - English DP - 1995 Mar 15 EZ - 1995/03/15 DA - 1995/03/15 00:01 DT - 1995/03/15 00:00 YR - 1995 ED - 19950425 RD - 20041117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7900724 <894. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7870275 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ting P AU - Pan Y FA - Ting, P FA - Pan, Y IN - Ting, P. Department of Pediatrics and Child Health, College of Medicine, Howard University, Washington, DC 20059. TI - The effects of naloxone on the post-asphyxic cerebral pathophysiology of newborn lambs. SO - Neurological Research. 16(5):359-64, 1994 Oct AS - Neurol Res. 16(5):359-64, 1994 Oct NJ - Neurological research VO - 16 IP - 5 PG - 359-64 PI - Journal available in: Print PI - Citation processed from: Print JC - ny9, 7905298 IO - Neurol. Res. SB - Index Medicus CP - England MH - Animals MH - Animals, Newborn MH - *Asphyxia Neonatorum/pp [Physiopathology] MH - Blood Pressure/de [Drug Effects] MH - *Blood-Brain Barrier/de [Drug Effects] MH - Blood-Brain Barrier/ph [Physiology] MH - Body Temperature/de [Drug Effects] MH - Brain/pa [Pathology] MH - Brain/ph [Physiology] MH - Brain/pp [Physiopathology] MH - Humans MH - Infant, Newborn MH - *Intracranial Pressure/de [Drug Effects] MH - *Naloxone/pd [Pharmacology] MH - Neurologic Examination MH - Reference Values MH - Resuscitation MH - Sheep AB - Both early post-ischaemic blood-brain barrier disruption and enhanced brain endogenous opioid system activity have been implicated in the pathogeneses of ischaemic neuronal damage; however, their roles in neonatal asphyxia have not been evaluated. Under alpha-Chloralose anaesthesia, 17 newborn lambs were asphyxiated until their mean arterial pressures were < or = 25 mmHg. They were then immediately resuscitated, and assigned to two groups. Group I, but not group II lambs received IV bolus of 10 mg kg-1 Naloxone within 5 min of resuscitation. The infusion was continued at the same dose hourly until sacrificed 24 h post-asphyxia. Arterial pH/gases, intracranial/arterial pressures, and rectal temperature were monitored. Neurological examinations were performed on both groups prior to sacrifice, and the blood-brain barrier integrity was assessed by Evans blue. Despite aggressive resuscitation, 5 lambs died during asphyxia, but 12 survived and were assigned according to the protocol. There were no significant group differences in the magnitude of asphyxia, arterial and intracranial pressures. However, blood-brain barrier disruption was observed in 5 out of 6 untreated, and in only 1 of the 6 lambs treated with Naloxone (p < 0.05). Severe neurological abnormalities were observed in 75% of lambs with disrupted, but in none of the animals with intact blood-brain barrier (p < 0.05). Our study suggests that post-asphyxia blood-brain barrier disruption is causally related to poor neurological outcome, and that Naloxone prevents both the disruption, and the neurological dysfunction among those survivors with intact blood-brain barrier. RN - 36B82AMQ7N (Naloxone) IS - 0161-6412 IL - 0161-6412 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1994 Oct EZ - 1994/10/01 DA - 1994/10/01 00:01 DT - 1994/10/01 00:00 YR - 1994 ED - 19950327 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7870275 <895. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7996534 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wittmaack FM AU - Greer FR AU - FitzSimmons J FA - Wittmaack, F M FA - Greer, F R FA - FitzSimmons, J IN - Wittmaack, F M. Department of Obstetrics and Gynecology, University of Wisconsin, Madison. TI - Neonatal depression after a protamine sulfate injection. A case report. [Review] [3 refs] SO - Journal of Reproductive Medicine. 39(8):655-6, 1994 Aug AS - J Reprod Med. 39(8):655-6, 1994 Aug NJ - The Journal of reproductive medicine VO - 39 IP - 8 PG - 655-6 PI - Journal available in: Print PI - Citation processed from: Print JC - jwt, 0173343 IO - J Reprod Med SB - Index Medicus CP - United States MH - Adolescent MH - Cardiopulmonary Resuscitation MH - Female MH - *Femoral Vein MH - Humans MH - Infant, Newborn MH - Injections, Intravenous MH - Naloxone/tu [Therapeutic Use] MH - Pregnancy MH - *Pregnancy Complications, Cardiovascular/dt [Drug Therapy] MH - *Protamines/ae [Adverse Effects] MH - *Respiratory Insufficiency/ci [Chemically Induced] MH - Respiratory Insufficiency/th [Therapy] MH - *Thrombosis/dt [Drug Therapy] AB - The intravenous administration of protamine sulfate in adults has been associated with acute hypotension, bradycardia and anaphylactoid reactions. However, no reports of its use in pregnancy have been available before. We describe a case of severe neonatal depression following maternal protamine sulfate injection immediately prior to delivery. [References: 3] RN - 0 (Protamines) RN - 36B82AMQ7N (Naloxone) IS - 0024-7758 IL - 0024-7758 PT - Case Reports PT - Journal Article PT - Review PP - ppublish LG - English DP - 1994 Aug EZ - 1994/08/01 DA - 1994/08/01 00:01 DT - 1994/08/01 00:00 YR - 1994 ED - 19950119 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7996534 <896. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7988973 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mielke L AU - Entholzner E AU - Hargasser S AU - Hipp R FA - Mielke, L FA - Entholzner, E FA - Hargasser, S FA - Hipp, R TI - [Drug administration via the endobronchial route. Possibilities of drug administration in emergency medicine]. [German] OT - Medikamentengabe uber den endobronchialen Zugang. Moglichkeiten der Applikation in der Notfallmedizin. SO - Fortschritte der Medizin. 112(27):377-80, 1994 Sep 30 AS - Fortschr Med. 112(27):377-80, 1994 Sep 30 NJ - Fortschritte der Medizin VO - 112 IP - 27 PG - 377-80 PI - Journal available in: Print PI - Citation processed from: Print JC - f62, 2984763r IO - Fortschr. Med. SB - Index Medicus CP - Germany MH - Administration, Inhalation MH - *Atropine/ad [Administration & Dosage] MH - Atropine/pk [Pharmacokinetics] MH - *Cardiopulmonary Resuscitation MH - Diazepam/ad [Administration & Dosage] MH - Diazepam/pk [Pharmacokinetics] MH - *Emergencies MH - *Epinephrine/ad [Administration & Dosage] MH - Epinephrine/pk [Pharmacokinetics] MH - Humans MH - Lidocaine/ad [Administration & Dosage] MH - Lidocaine/pk [Pharmacokinetics] MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/pk [Pharmacokinetics] AB - For cardiopulmonary resuscitation, the endobronchial route represents a good means of administering drugs with a systemic effect, such as adrenaline and atropine, even without a venous line. Via this route, however, higher doses are needed (2.5 times as much as those normally given intravenously). In order to produce a larger surface area within the bronchio-alveolar space and thus speed up absorption, the drugs are diluted in 5-10 ml solvent (isotonic saline solution or distilled water). For endobronchial administration of a drug, various techniques are employed, for example, simply injecting it into the upper end of the (endotracheal) tube, puncture of the tube the use of an application probe introduced into the endobronchial tube, aspiration or venacaval catheter, or the EDGAR tube with an injection needle incorporated within the tube wall. After injection, the diluted medication is distributed into the tiny branches of the bronchial tree by repeated hyperventilation. Despite the need for an adequate alternative to the venous route in the field of cardiopulmonary resuscitation, we still have very few reliable facts about the endobronchial application technique. RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 98PI200987 (Lidocaine) RN - Q3JTX2Q7TU (Diazepam) RN - YKH834O4BH (Epinephrine) IS - 0015-8178 IL - 0015-8178 PT - English Abstract PT - Journal Article PP - ppublish LG - German DP - 1994 Sep 30 EZ - 1994/09/30 DA - 1994/09/30 00:01 DT - 1994/09/30 00:00 YR - 1994 ED - 19950112 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7988973 <897. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7978599 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Storrow AB AU - Wians FH Jr AU - Mikkelsen SL AU - Norton J FA - Storrow, A B FA - Wians, F H Jr FA - Mikkelsen, S L FA - Norton, J IN - Storrow, A B. Department of Emergency Medicine, Wilford Hall Medical Center, San Antonio, Texas. TI - Does naloxone cause a positive urine opiate screen?. SO - Annals of Emergency Medicine. 24(6):1151-3, 1994 Dec AS - Ann Emerg Med. 24(6):1151-3, 1994 Dec NJ - Annals of emergency medicine VO - 24 IP - 6 PG - 1151-3 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Double-Blind Method MH - Emergencies MH - Enzyme Multiplied Immunoassay Technique MH - False Positive Reactions MH - Humans MH - Middle Aged MH - Naloxone/ch [Chemistry] MH - Naloxone/pk [Pharmacokinetics] MH - *Naloxone/ur [Urine] MH - *Narcotics/ur [Urine] MH - Oxymorphone/ch [Chemistry] MH - Oxymorphone/ur [Urine] MH - Pilot Projects MH - Prospective Studies MH - *Substance Abuse Detection/mt [Methods] AB - STUDY OBJECTIVE: To determine whether the excreted metabolites of naloxone hydrochloride cause positive urine toxicologic screens for opiates. AB - DESIGN: Prospective, randomized, double-blinded human protocol. AB - SETTING: Urban Level I military emergency department. AB - PARTICIPANTS: Fourteen adult volunteers who took no routine medications, were not pregnant, had no known sensitivity to naloxone, and who were negative for a pretest urine and serum toxicologic screen. AB - INTERVENTIONS: We administered either 2 or 4 mg IV naloxone to 14 subjects. Urine drug screening was obtained before administration and at 60 minutes, 6 hours, and 48 hours after administration. AB - RESULTS: All urine drug screens using the enzyme-multiplied immunoassay technique were negative for opiates at both dosage levels. The sample size of 14 yielded a power of more than .99 to detect the difference between positive and negative samples. AB - CONCLUSION: Although the metabolites of naloxone hydrochloride are similar in structure to oxymorphone and are excreted in human urine for several days, naloxone was not associated with a positive enzymatic urine screen for opiates. RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) RN - 9VXA968E0C (Oxymorphone) IS - 0196-0644 IL - 0196-0644 PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial ID - S0196064494002362 [pii] PP - ppublish LG - English DP - 1994 Dec EZ - 1994/12/01 DA - 2001/03/28 10:01 DT - 1994/12/01 00:00 YR - 1994 ED - 19941229 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7978599 <898. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7969831 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Duh MS AU - Shepard MJ AU - Wilberger JE AU - Bracken MB FA - Duh, M S FA - Shepard, M J FA - Wilberger, J E FA - Bracken, M B IN - Duh, M S. Department of Epidemiology and Public Health, Yale University Medical School, New Haven, Connecticut. TI - The effectiveness of surgery on the treatment of acute spinal cord injury and its relation to pharmacological treatment. SO - Neurosurgery. 35(2):240-8; discussion 248-9, 1994 Aug AS - Neurosurgery. 35(2):240-8; discussion 248-9, 1994 Aug NJ - Neurosurgery VO - 35 IP - 2 PG - 240-8; discussion 248-9 PI - Journal available in: Print PI - Citation processed from: Print JC - nzl, 7802914 IO - Neurosurgery SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Combined Modality Therapy MH - Disability Evaluation MH - Double-Blind Method MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - *Methylprednisolone/tu [Therapeutic Use] MH - *Naloxone/tu [Therapeutic Use] MH - Neurologic Examination/de [Drug Effects] MH - *Neurologic Examination MH - *Postoperative Complications/di [Diagnosis] MH - *Spinal Cord Injuries/su [Surgery] MH - Treatment Outcome AB - Using data from the Second National Acute Spinal Cord Injury Study (NASCIS II), the authors sought to characterize the role of surgery in the management of traumatic spinal cord injury and to examine the interaction between pharmacological treatment and surgery. Patients who did not undergo surgery had more severe spinal cord injuries initially than those who had surgery. However, no differences in neurological improvement at 1-year follow-up were found between those who underwent surgery and those who did not. The results suggest that either early surgery (< or = 25 hours after injury) or late surgery (> 200 hours) may be associated with increased neurological recovery, particularly motor function, but these results are equivocal. Surgery was not shown to interact with pharmacological treatments, indicating that the effect of drug treatment in NASCIS II, reported elsewhere, is not influenced by surgery. Other independent variables that best predicted improvement in motor score were age of 25 years or younger, incomplete injury, and lower baseline emergency department neurological scores. This study does not provide clinically relevant evidence concerning the efficacy of timing or the value of surgery in treating patients with spinal cord injuries. A randomized study on the timing and efficacy of spinal cord surgery is needed to obtain valid comparisons of the efficacy of surgical treatments. RN - 36B82AMQ7N (Naloxone) RN - X4W7ZR7023 (Methylprednisolone) IS - 0148-396X IL - 0148-396X PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish GI - No: NS 15078 Organization: (NS) *NINDS NIH HHS* Country: United States LG - English DP - 1994 Aug EZ - 1994/08/01 DA - 1994/08/01 00:01 DT - 1994/08/01 00:00 YR - 1994 ED - 19941220 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7969831 <899. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7945608 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chamberlain JM AU - Klein BL FA - Chamberlain, J M FA - Klein, B L IN - Chamberlain, J M. Emergency Medical Trauma Center, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC. TI - A comprehensive review of naloxone for the emergency physician. [Review] [190 refs] SO - American Journal of Emergency Medicine. 12(6):650-60, 1994 Nov AS - Am J Emerg Med. 12(6):650-60, 1994 Nov NJ - The American journal of emergency medicine VO - 12 IP - 6 PG - 650-60 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Acute Disease MH - Adult MH - Animals MH - Asphyxia Neonatorum/dt [Drug Therapy] MH - Cerebrovascular Disorders/dt [Drug Therapy] MH - Child MH - *Emergency Medicine/mt [Methods] MH - Humans MH - Infant, Newborn MH - Naloxone/pd [Pharmacology] MH - *Naloxone/tu [Therapeutic Use] MH - Poisoning/dt [Drug Therapy] MH - Shock/dt [Drug Therapy] MH - Spinal Cord Injuries/dt [Drug Therapy] MH - Treatment Outcome AB - Naloxone has enjoyed long-standing success as a safe and effective opioid antagonist and has been invaluable in defining the role of endogenous opioid pathways in the response to pathological states such as sepsis and hypovolemia. We look forward to exciting research to further elucidate these pathways and to improve outcome by modulating the patient's physiological response to these stresses. [References: 190] RN - 36B82AMQ7N (Naloxone) IS - 0735-6757 IL - 0735-6757 PT - Journal Article PT - Review ID - 0735-6757(94)90033-7 [pii] PP - ppublish LG - English DP - 1994 Nov EZ - 1994/11/01 DA - 1994/11/01 00:01 DT - 1994/11/01 00:00 YR - 1994 ED - 19941220 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7945608 <900. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7945602 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Abarbanell NR FA - Abarbanell, N R IN - Abarbanell, N R. Department of Surgery, Health Science Center Jacksonville, University of Florida 32209-6511. TI - Prehospital pharmacotherapeutic interventions: recommendations for medication administration by EMT-A and EMT-I personnel. SO - American Journal of Emergency Medicine. 12(6):625-30, 1994 Nov AS - Am J Emerg Med. 12(6):625-30, 1994 Nov NJ - The American journal of emergency medicine VO - 12 IP - 6 PG - 625-30 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Child MH - Clinical Protocols MH - Databases, Factual MH - Drug Therapy/sn [Statistics & Numerical Data] MH - *Drug Therapy/ut [Utilization] MH - Emergency Medical Services/sn [Statistics & Numerical Data] MH - *Emergency Medical Services/ut [Utilization] MH - *Emergency Medical Technicians MH - Health Services Accessibility MH - Health Services Needs and Demand MH - Humans MH - Illinois MH - Life Support Care/sn [Statistics & Numerical Data] MH - *Life Support Care/ut [Utilization] MH - Medically Underserved Area MH - Middle Aged MH - Retrospective Studies MH - Time Factors AB - Because many communities lack prehospital advanced life support (ALS) services, increasing public access to such care is important. The present study was completed to establish an epidemiological database defining prehospital pharmacotherapeutic interventions by ALS rescue teams, in the hope of developing recommendations for medication administration by non-ALS personnel. Data were collected on 333 patients, including indication for pharmacotherapy, patient age, ambulance field time, route of medication administration, adverse effects of pharmacotherapy, efficacy of pharmacotherapy, additional ALS interventions, and patient medication/past medical history. Medications studied included albuterol nebulizer treatments (albuterol), aminophylline, amyl nitrite, atropine, bretylium tosylate, dexamethasone sodium phosphate, dextrose 50% (D-50), diazepam, diphenhydramine, dopamine, epinephrine 1 mg/1 mL, epinephrine 1 mg/10 mL, furosemide, glucagon, ipecac, isoproterenol, lidocaine, morphine sulfate, naloxone, nitroglycerin tablets (nitroglycerin), sodium bicarbonate, and verapamil. Albuterol, D-50, and nitroglycerin were used more often than other medications, accounting for total pharmacotherapeutic interventions for 228 persons (68.47% of total patients), including 100% of all pediatric patients. Partial pharmacological needs for an additional 20 patients also were satisfied by these agents. In all, albuterol, D-50, and nitroglycerin accounted for 250 of 395 total medication interventions (63.29%). No inappropriate use, point estimate [(0)/(333) (0.00% to 0.90%)], or unmet need, point estimate [(0)/(3,613) (0.00% to 0.08%)], of care was noted. When faced with communities lacking ALS rescue services, albuterol, D-50, and nitroglycerin are recommended for administration by emergency medical technician-ambulance and intermediate level rescuers, because of the high rate of use, relative ease of administration, and high benefit/low complication rates associated with these medications. IS - 0735-6757 IL - 0735-6757 PT - Journal Article ID - 0735-6757(94)90027-2 [pii] PP - ppublish LG - English DP - 1994 Nov EZ - 1994/11/01 DA - 1994/11/01 00:01 DT - 1994/11/01 00:00 YR - 1994 ED - 19941220 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7945602 <901. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7936779 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Leuthner SR AU - Jansen RD AU - Hageman JR FA - Leuthner, S R FA - Jansen, R D FA - Hageman, J R IN - Leuthner, S R. Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois. TI - Cardiopulmonary resuscitation of the newborn. An update. [Review] [63 refs] SO - Pediatric Clinics of North America. 41(5):893-907, 1994 Oct AS - Pediatr Clin North Am. 41(5):893-907, 1994 Oct NJ - Pediatric clinics of North America VO - 41 IP - 5 PG - 893-907 PI - Journal available in: Print PI - Citation processed from: Print JC - oum, 0401126 IO - Pediatr. Clin. North Am. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Asphyxia Neonatorum/th [Therapy] MH - Atropine/tu [Therapeutic Use] MH - *Cardiopulmonary Resuscitation/mt [Methods] MH - Delivery Rooms MH - Epinephrine/tu [Therapeutic Use] MH - Ethics, Medical MH - Humans MH - Infant, Newborn MH - Intensive Care, Neonatal MH - Meconium Aspiration Syndrome/th [Therapy] MH - Naloxone/tu [Therapeutic Use] MH - Sodium Bicarbonate/tu [Therapeutic Use] AB - The abrupt transition from intrauterine to extrauterine life represents a series of profound physiologic changes. This process puts the baby at risk for asphyxia. At birth, the newborn is, therefore, more frequently in need of resuscitation than at any other age. This article reviews the rationale for the sequence and process of neonatal resuscitation, emphasizing recent changes in recommendations. [References: 63] RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 8MDF5V39QO (Sodium Bicarbonate) RN - YKH834O4BH (Epinephrine) IS - 0031-3955 IL - 0031-3955 PT - Journal Article PT - Review ID - S0031-3955(16)38837-X [pii] PP - ppublish LG - English DP - 1994 Oct EZ - 1994/10/01 DA - 1994/10/01 00:01 DT - 1994/10/01 00:00 YR - 1994 ED - 19941123 RD - 20171216 UP - 20171218 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medc&AN=7936779 <902. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7923525 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Elliott RD FA - Elliott, R D IN - Elliott, R D. Department of Anaesthesia, Ottawa General Hospital, Ontario. TI - Neonatal resuscitation: the NRP guidelines. CM - Comment in: Can J Anaesth. 1995 Jan;42(1):88-9; PMID: 7889592 SO - Canadian Journal of Anaesthesia. 41(8):742-52; quiz 752-3, 1994 Aug AS - Can J Anaesth. 41(8):742-52; quiz 752-3, 1994 Aug NJ - Canadian journal of anaesthesia = Journal canadien d'anesthesie VO - 41 IP - 8 PG - 742-52; quiz 752-3 PI - Journal available in: Print PI - Citation processed from: Print JC - c8l, 8701709 IO - Can J Anaesth SB - Index Medicus CP - United States MH - Asphyxia Neonatorum/th [Therapy] MH - Body Temperature MH - Cyanosis/th [Therapy] MH - Education, Medical, Continuing MH - Epinephrine/tu [Therapeutic Use] MH - Heart Rate/ph [Physiology] MH - Humans MH - *Infant, Newborn MH - Intubation, Intratracheal MH - Laryngoscopy MH - Masks MH - Meconium MH - Naloxone/tu [Therapeutic Use] MH - Plasma Substitutes/tu [Therapeutic Use] MH - Positive-Pressure Respiration MH - Practice Guidelines as Topic MH - Respiration/ph [Physiology] MH - Respiration, Artificial/is [Instrumentation] MH - Respiration, Artificial/mt [Methods] MH - Resuscitation/is [Instrumentation] MH - Resuscitation/mt [Methods] MH - *Resuscitation MH - Suction AB - The Neonatal Resuscitation Programme, sponsored by the Canadian Heart and Stroke Foundation and by the American Heart Association, is a structured learning package and workshop for all individuals who provide resuscitation for newborns. The emphasis is on rapid, decisive action using algorithms based on clearly stated criteria. This CME article serves as an introduction to the NRP and discusses some of the new guidelines regarding concurrent ventilation and chest compressions, tracheal suction for meconium and the use of medications. The author encourages readers who find this article helpful to register in an accredited NRP course to receive the extensive illustrated textbook and to benefit from the "hands-on" nature of the workshop. RN - 0 (Plasma Substitutes) RN - 36B82AMQ7N (Naloxone) RN - YKH834O4BH (Epinephrine) IS - 0832-610X IL - 0832-610X PT - Journal Article ID - 10.1007/BF03015632 [doi] PP - ppublish LG - English DP - 1994 Aug EZ - 1994/08/01 DA - 1994/08/01 00:01 DT - 1994/08/01 00:00 YR - 1994 ED - 19941117 RD - 20170907 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7923525 <903. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8092587 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Manfredini R AU - Gallerani M AU - Calo G AU - Pasin M AU - Govoni M AU - Fersini C FA - Manfredini, R FA - Gallerani, M FA - Calo, G FA - Pasin, M FA - Govoni, M FA - Fersini, C IN - Manfredini, R. Institute of Internal Medicine, University of Ferrara, Italy. TI - Emergency admissions of opioid drug abusers for overdose: a chronobiological study of enhanced risk. SO - Annals of Emergency Medicine. 24(4):615-8, 1994 Oct AS - Ann Emerg Med. 24(4):615-8, 1994 Oct NJ - Annals of emergency medicine VO - 24 IP - 4 PG - 615-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Chronobiology Phenomena/ph [Physiology] MH - *Circadian Rhythm MH - Coma/ci [Chemically Induced] MH - Coma/pp [Physiopathology] MH - Drug Overdose MH - Female MH - Heroin Dependence/pp [Physiopathology] MH - Humans MH - Male MH - *Opioid-Related Disorders/pp [Physiopathology] MH - Prospective Studies MH - Time Factors AB - STUDY OBJECTIVE: To determine whether there is a specific temporal risk for opioid drug overdose. AB - DESIGN: To study patients presenting to the ED in a comatose state from accidental drug opioid overdose. AB - PARTICIPANTS: Two hundred seventy-four patients were admitted to the ED of the Hospital of Ferrara, Italy, from 1988 to 1990, 225 men (82.1%; mean age, 25 +/- 3.4 years) and 49 women (17.9%; mean age, 23.5 +/- 2.8 years). AB - INTERVENTIONS: Month, day, and hour and minute of admissions were recorded, and time-qualified frequency data were analyzed by the single cosinor method. AB - RESULTS: Cosinor analysis demonstrated a significant circadian rhythm for both the total number of observations and the separate male and female subgroups with an early evening peak ("acrophase") at about 7:00 PM. No significant circannual rhythm was evident, but for the total group a significant 6-month rhythm was demonstrable with peaks in late November and late May. AB - CONCLUSION: There is a distinct "chronorisk" of opioid drug overdose in the early evening hours. IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - A58491 [pii] PP - ppublish LG - English DP - 1994 Oct EZ - 1994/10/01 DA - 1994/10/01 00:01 DT - 1994/10/01 00:00 YR - 1994 ED - 19941020 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8092587 <904. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8034388 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Loimer N AU - Hofmann P AU - Chaudhry HR FA - Loimer, N FA - Hofmann, P FA - Chaudhry, H R IN - Loimer, N. Psychiatrische Universitatsklinik Wien, Austria. TI - Nasal administration of naloxone is as effective as the intravenous route in opiate addicts. SO - International Journal of the Addictions. 29(6):819-27, 1994 Apr AS - Int J Addict. 29(6):819-27, 1994 Apr NJ - The International journal of the addictions VO - 29 IP - 6 PG - 819-27 PI - Journal available in: Print PI - Citation processed from: Print JC - gq8, 0123640 IO - Int J Addict SB - Index Medicus CP - United States MH - Administration, Intranasal MH - Analysis of Variance MH - Emergency Services, Psychiatric MH - Humans MH - Infusions, Intravenous MH - Injections, Intramuscular MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - Naloxone/pd [Pharmacology] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - *Substance Withdrawal Syndrome/dt [Drug Therapy] AB - Naloxone is used intravenously in opiate addiction in emergency cases, in rapid opiate detoxification, and as a diagnostic tool. This is a study comparing the efficacy of intranasal naloxone to other routes (intravenous/intramuscular) in 17 opiate-dependent patients. The nasal drug administration of naloxone was found to be as effective as the intravenous route. The nasal drug application offers a wide margin of safety for patients and medical staff, especially in emergency situations in regard to infection risks associated with vessel puncture. RN - 36B82AMQ7N (Naloxone) IS - 0020-773X IL - 0020-773X PT - Comparative Study PT - Journal Article PP - ppublish LG - English DP - 1994 Apr EZ - 1994/04/01 DA - 1994/04/01 00:01 DT - 1994/04/01 00:00 YR - 1994 ED - 19940818 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8034388 <905. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7912590 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wang ML AU - Lin JL AU - Liaw SJ AU - Bullard MJ FA - Wang, M L FA - Lin, J L FA - Liaw, S J FA - Bullard, M J IN - Wang, M L. Department of Emergency, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C. TI - Heroin lung: report of two cases. SO - Journal of the Formosan Medical Association. 93(2):170-2, 1994 Feb AS - J Formos Med Assoc. 93(2):170-2, 1994 Feb NJ - Journal of the Formosan Medical Association = Taiwan yi zhi VO - 93 IP - 2 PG - 170-2 PI - Journal available in: Print PI - Citation processed from: Print JC - 9214933, blq IO - J. Formos. Med. Assoc. SB - Index Medicus CP - Singapore MH - Adult MH - *Heroin/po [Poisoning] MH - Humans MH - Male MH - *Pulmonary Edema/ci [Chemically Induced] MH - Pulmonary Edema/th [Therapy] AB - Heroin lung is the most frequent complication of heroin intoxication. In September 1991 and January 1993, two young men aged 19 and 22 years presented with a sudden loss of consciousness and cyanosis after injecting heroin. They were both brought to our emergency department in the night and were immediately intubated and given 100% oxygen. Following intravenous naloxone, they both regained consciousness. The first patient's chest X ray revealed increased bilateral perihilar lung markings and mild patchy alveolar edema while the second patient showed a bat's wing shaped confluent alveolar edema. The blood gases in both cases revealed hypoxemia and hypercapnia. Follow-up chest roentgenograms on the second hospital day in case 1 and the third hospital day in case 2 revealed partial clearing of the lung fields. Fever developed on the second hospital day and they both received two weeks of antibiotics prior to discharge. Case 1 had normal pulmonary function testing, but case 2 developed mild restrictive lung changes. Review of the literature shows that heroin can cause a fulminant but rapidly reversible form of pulmonary edema. The treatment for this noncardiogenic pulmonary edema is adequate ventilation, good pulmonary toilet, and naloxone to reverse the respiratory and central nervous system depression. Diuretics, digitalis and morphine are not recommended in the treatment of heroin lung. RN - 70D95007SX (Heroin) IS - 0929-6646 IL - 0929-6646 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1994 Feb EZ - 1994/02/01 DA - 1994/02/01 00:01 DT - 1994/02/01 00:00 YR - 1994 ED - 19940803 RD - 20161013 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7912590 <906. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7695672 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wyllie HR AU - Dunn FG FA - Wyllie, H R FA - Dunn, F G IN - Wyllie, H R. Cardiac Department, Stobhill General Hospital, Glasgow. TI - Pre-hospital opiate and aspirin administration in patients with suspected myocardial infarction. CM - Comment in: BMJ. 1994 Apr 30;308(6937):1160; PMID: 7695678 CM - Comment in: BMJ. 1994 Apr 30;308(6937):1159; PMID: 8173462 CM - Comment in: BMJ. 1994 Jun 25;308(6945):1713-4; PMID: 8025482 SO - BMJ. 308(6931):760-1, 1994 Mar 19 AS - BMJ. 308(6931):760-1, 1994 Mar 19 NJ - BMJ (Clinical research ed.) VO - 308 IP - 6931 PG - 760-1 PI - Journal available in: Print PI - Citation processed from: Print JC - 8900488, bmj, 101090866 IO - BMJ PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539681 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Aspirin/ad [Administration & Dosage] MH - Coronary Care Units MH - Emergency Medical Services MH - Family Practice MH - Female MH - Humans MH - Male MH - *Myocardial Infarction/dt [Drug Therapy] MH - Myocardial Infarction/mo [Mortality] MH - *Narcotics/ad [Administration & Dosage] MH - Referral and Consultation RN - 0 (Narcotics) RN - R16CO5Y76E (Aspirin) IS - 0959-8138 IL - 0959-535X PT - Journal Article ID - PMC2539681 [pmc] PP - ppublish LG - English DP - 1994 Mar 19 EZ - 1994/03/19 DA - 1994/03/19 00:01 DT - 1994/03/19 00:00 YR - 1994 ED - 19940503 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=7695672 <907. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10146302 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bartkus EA AU - Daya M AU - Hedges JR AU - Jui J FA - Bartkus, E A FA - Daya, M FA - Hedges, J R FA - Jui, J IN - Bartkus, E A. Department of Emergency Medicine, Oregon Health Sciences University, Portland 97201. TI - ExacTech blood glucose meter clinical trial. SO - Prehospital & Disaster Medicine. 8(3):217-27, 1993 Jul-Sep AS - Prehospital Disaster Med. 8(3):217-27, 1993 Jul-Sep NJ - Prehospital and disaster medicine VO - 8 IP - 3 PG - 217-27 PI - Journal available in: Print PI - Citation processed from: Print JC - bdf, 8918173 IO - Prehosp Disaster Med SB - Health Technology Assessment Journals CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - *Blood Glucose/an [Analysis] MH - *Blood Glucose Self-Monitoring/is [Instrumentation] MH - Blood Glucose Self-Monitoring/mt [Methods] MH - Child MH - Emergency Medical Services MH - Equipment Failure MH - Evaluation Studies as Topic MH - Female MH - Humans MH - Male MH - Middle Aged MH - Reagent Strips MH - Sensitivity and Specificity AB - INTRODUCTION: Current prehospital protocols for the management of patients with altered mental status include the empiric administration of hypertonic glucose, naloxone, and thiamine. The injudicious use of 50% dextrose (D50W) may result in hyperosmolarity, a worsening of hypokalemia, and unwarranted additional health-care costs for the patient. The administration of D50W also may worsen the neurological outcome of patients with local or generalized ischemia. AB - OBJECTIVE: To evaluate the ExacTech blood glucose meter's ability to estimate blood glucose levels accurately and rapidly. AB - METHODS: Emergency medical technicians (EMTs) from selected advanced life support (ALS) units in the Portland, Ore., metropolitan area participated in a prospective clinical trial of the ExacTech blood glucose meter. A convenience sample was drawn from emergency medical services (EMS) patients with suspected diabetic emergencies, altered mental status, and other neurological deficits. Venous blood samples were drawn from these populations at the same time as the ExacTech readings were obtained. The venous blood was submitted to the receiving hospitals for laboratory analysis of blood glucose levels, and a comparison was made between the results of the two methods. AB - RESULTS: A total of 80 matched sets of data were obtained from 1 April 1990 through 6 May 1991. The hospital blood glucose values ranged from 8 to 1233 mg/dl. Sixteen (20%) of the patients were hypoglycemic (&.lt.60 mg/dl) and 23 (28.8%) were hyperglycemic ( greater than 180 mg/dl). The ExacTech device sensitivity and specificity for hypoglycemia using venous samples were 94.6% and 89.2%, respectively. For hyperglycemia, these same parameters were 87.5% and 97.1%. Pearson's r over the range of the instrument (40-450 mg/dl) was 0.8656 (p less than .001). If the prehospital "definition" of hypoglycemia (for threshold-to-treat) is raised to 65 mg/dl, the device has 100% sensitivity in the sample population. AB - CONCLUSION: The device functioned accurately and consistently in the prehospital environment over a wide range of temperatures, and in the hands of many different individuals. RN - 0 (Blood Glucose) RN - 0 (Reagent Strips) IS - 1049-023X IL - 1049-023X PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Multicenter Study PP - ppublish LG - English DP - 1993 Jul-Sep EZ - 1993/06/07 DA - 1993/06/07 00:01 DT - 1993/06/07 00:00 YR - 1993 ED - 19940127 RD - 20111215 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=10146302 <908. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8241924 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Domingo-Salvany A AU - Hartnoll RL AU - Anto JM FA - Domingo-Salvany, A FA - Hartnoll, R L FA - Anto, J M IN - Domingo-Salvany, A. Institut Municipal d'Investigacio Medica, Barcelona, Spain. TI - Opiate and cocaine consumers attending Barcelona emergency rooms: a one year survey (1989). SO - Addiction. 88(9):1247-56, 1993 Sep AS - Addiction. 88(9):1247-56, 1993 Sep NJ - Addiction (Abingdon, England) VO - 88 IP - 9 PG - 1247-56 PI - Journal available in: Print PI - Citation processed from: Print JC - bm3, 9304118 IO - Addiction SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - Age Factors MH - *Cocaine MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Health Surveys MH - Heroin Dependence/ep [Epidemiology] MH - Hospital Records MH - Hospitalization MH - Humans MH - Male MH - *Opioid-Related Disorders/ep [Epidemiology] MH - Prevalence MH - Reproducibility of Results MH - Retrospective Studies MH - Sex Factors MH - Spain/ep [Epidemiology] MH - *Substance-Related Disorders/ep [Epidemiology] AB - Due to the limitations of standard epidemiological methods, indirect indicators have often been used to describe the characteristics of drug abusing populations and to assess prevalence trends in illegal drug use. In Barcelona (Spain), a study of emergency room (ER) attendance was carried out to describe the population of opiate/cocaine consumers across the whole city who use this service. Three thousand four hundred and five consumers of opiates and/or cocaine, aged 15-44 years, who attended ERs during 1989, were identified. They accounted for 6807 episodes in the hospitals surveyed. Their mean age was 26 years, men (73%) being 1 year older than women (25.2 years). The drug of abuse was specified in the clinical records of 60% of individuals, heroin being the most frequently specified (56%). The main reason for attendance was 'other medical condition' (OMC) (55% of episodes), followed by withdrawal (34%) and overdoses (6%). Seventy-one percent of individuals were residents of Barcelona city, yielding a rate of 3.2 opiate/cocaine consumers attending ERs per thousand Barcelona residents aged 15-44. The geographical distribution of the rates in the city showed a very large difference between districts, the most deprived ones having a higher rate of consumers attending ERs. ER data can provide valuable insights into the nature and dimensions of drug abuse problems. RN - I5Y540LHVR (Cocaine) IS - 0965-2140 IL - 0965-2140 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1993 Sep EZ - 1993/09/01 DA - 1993/09/01 00:01 DT - 1993/09/01 00:00 YR - 1993 ED - 19940103 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8241924 <909. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8214858 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Curka PA AU - Pepe PE AU - Ginger VF AU - Sherrard RC AU - Ivy MV AU - Zachariah BS FA - Curka, P A FA - Pepe, P E FA - Ginger, V F FA - Sherrard, R C FA - Ivy, M V FA - Zachariah, B S IN - Curka, P A. City of Houston Center for Resuscitation and Emergency Medical Services, Texas. TI - Emergency medical services priority dispatch. SO - Annals of Emergency Medicine. 22(11):1688-95, 1993 Nov AS - Ann Emerg Med. 22(11):1688-95, 1993 Nov NJ - Annals of emergency medicine VO - 22 IP - 11 PG - 1688-95 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Algorithms MH - *Emergency Medical Services/og [Organization & Administration] MH - Humans MH - *Life Support Care MH - Retrospective Studies MH - Texas MH - *Triage/og [Organization & Administration] AB - STUDY OBJECTIVE: To test the ability of a locally designed priority dispatch system to safely exclude the need for advanced life support (ALS). AB - DESIGN: Retrospective review of emergency medical services (EMS) incident records to determine how often the lone dispatch of basic life support (BLS) units, staffed with basic emergency medical technicians, subsequently required or involved ALS care. AB - SETTING: A large centralized municipal EMS system with a tiered ALS/BLS ambulance response. All BLS units carry automated defibrillators. AB - MEASUREMENTS: Consecutive EMS records (35,075) were reviewed by computerized search for ALS procedures. Records indicating ALS procedures were tabulated and then manually reviewed for the nature of and probable indication for the ALS intervention. AB - INTERVENTION: Brief sequences of computer-stored questions that help dispatchers identify (or exclude) signs and symptoms indicating the need for ALS. AB - RESULTS: The dispatch triage system spared ALS units from initial dispatch in 14,100 of the EMS incidents (40.2%), increasing their availability and use for more serious calls. Among these 14,100 cases, only 41 patients (0.3%) later received drugs such as nitroglycerin and naloxone; another 27 patients (0.2%) received resuscitative interventions such as epinephrine or defibrillation. Furthermore, on closer analysis, the immediate presence of a paramedic might have provided a true potential for advantage in outcome for only five or six patients (less than 0.04 of the 14,100 BLS dispatches). Meanwhile, many important operational, fiscal, and cost-effective patient care benefits were realized with this system. AB - CONCLUSION: A computer-aided dispatch triage algorithm can facilitate improvements in both EMS system operations and prehospital patient care by safely and reliably identifying EMS incidents requiring only BLS. IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - S0196-0644(05)81307-1 [pii] PP - ppublish LG - English DP - 1993 Nov EZ - 1993/11/01 DA - 1993/11/01 00:01 DT - 1993/11/01 00:00 YR - 1993 ED - 19931124 RD - 20041117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8214858 <910. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8105252 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Marlow N AU - Weindling M AU - Shaw B FA - Marlow, N FA - Weindling, M FA - Shaw, B TI - Opiates, catecholamine concentrations, and ventilated preterm babies. CM - Comment on: Lancet. 1993 Aug 7;342(8867):324-7; PMID: 8101584 SO - Lancet. 342(8877):997-8, 1993 Oct 16 AS - Lancet. 342(8877):997-8, 1993 Oct 16 NJ - Lancet (London, England) VO - 342 IP - 8877 PG - 997-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 2985213r, l0s, 0053266 IO - Lancet SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - *Alfentanil/pd [Pharmacology] MH - *Catecholamines/me [Metabolism] MH - Humans MH - Infant, Newborn MH - *Infant, Premature MH - Respiration, Artificial RN - 0 (Catecholamines) RN - 1N74HM2BS7 (Alfentanil) IS - 0140-6736 IL - 0140-6736 PT - Clinical Trial PT - Comment PT - Letter PT - Randomized Controlled Trial ID - 0140-6736(93)92048-X [pii] PP - ppublish LG - English DP - 1993 Oct 16 EZ - 1993/10/16 DA - 1993/10/16 00:01 DT - 1993/10/16 00:00 YR - 1993 ED - 19931110 RD - 20150616 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8105252 <911. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8363680 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Johansen RB AU - Schafer NC AU - Brown PI FA - Johansen, R B FA - Schafer, N C FA - Brown, P I IN - Johansen, R B. Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City. TI - Effect of extreme temperatures on drugs for prehospital ACLS. SO - American Journal of Emergency Medicine. 11(5):450-2, 1993 Sep AS - Am J Emerg Med. 11(5):450-2, 1993 Sep NJ - The American journal of emergency medicine VO - 11 IP - 5 PG - 450-2 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Analysis of Variance MH - *Atropine/ch [Chemistry] MH - Chromatography, High Pressure Liquid MH - *Cold Temperature/ae [Adverse Effects] MH - Drug Stability MH - Drug Storage MH - *Emergency Medical Services/st [Standards] MH - *Epinephrine/ch [Chemistry] MH - Evaluation Studies as Topic MH - Fluorescence Polarization Immunoassay MH - Gas Chromatography-Mass Spectrometry MH - *Heart Diseases/dt [Drug Therapy] MH - *Hot Temperature/ae [Adverse Effects] MH - Humans MH - *Lidocaine/ch [Chemistry] MH - *Life Support Care/st [Standards] MH - *Naloxone/ch [Chemistry] AB - Advanced cardiac life support drugs undergo a wide range of temperature exposures in the prehospital setting. Although manufacturers place temperature restrictions for drug stability on their products, it has been shown that these limits are often exceeded in the prehospital environment. We exposed four different drugs to temperatures of -20 degrees C (-6 degrees F) and 70 degrees C (150 degrees F) and subsequently performed assays to determine their respective chemical stability compared with that of control samples. We determined that no significant difference in chemical structure occurred between the standard sample and the four drugs exposed to extreme temperatures (P > .05). This information has obvious implications in making further recommendations for drug storage. More work to determine bioactivity of temperature-exposed drugs may show results with implications for success in prehospital cardiac resuscitation. RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 98PI200987 (Lidocaine) RN - YKH834O4BH (Epinephrine) IS - 0735-6757 IL - 0735-6757 PT - Journal Article ID - 0735-6757(93)90080-U [pii] PP - ppublish LG - English DP - 1993 Sep EZ - 1993/09/01 DA - 1993/09/01 00:01 DT - 1993/09/01 00:00 YR - 1993 ED - 19931001 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8363680 <912. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8363118 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barsan WG AU - Tomassoni AJ AU - Seger D AU - Danzl DF AU - Ling LJ AU - Bartlett R FA - Barsan, W G FA - Tomassoni, A J FA - Seger, D FA - Danzl, D F FA - Ling, L J FA - Bartlett, R IN - Barsan, W G. University of Michigan Medical Center, Ann Arbor. TI - Safety assessment of high-dose narcotic analgesia for emergency department procedures. SO - Annals of Emergency Medicine. 22(9):1444-9, 1993 Sep AS - Ann Emerg Med. 22(9):1444-9, 1993 Sep NJ - Annals of emergency medicine VO - 22 IP - 9 PG - 1444-9 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Analysis of Variance MH - Blood Pressure/de [Drug Effects] MH - Body Temperature/de [Drug Effects] MH - Consciousness/de [Drug Effects] MH - Emergency Service, Hospital MH - Female MH - Heart Rate/de [Drug Effects] MH - Hospitals, Urban MH - Humans MH - Infusions, Intravenous MH - Male MH - *Meperidine/ad [Administration & Dosage] MH - Meperidine/pd [Pharmacology] MH - Meperidine/tu [Therapeutic Use] MH - Middle Aged MH - Naloxone/tu [Therapeutic Use] MH - Pain/di [Diagnosis] MH - *Pain/dt [Drug Therapy] MH - Pain/et [Etiology] MH - Prospective Studies MH - Respiration/de [Drug Effects] MH - Resuscitation AB - STUDY OBJECTIVE: To evaluate the safety of high-dose IV narcotics in patients requiring analgesia for painful emergency department procedures. AB - DESIGN: Prospective multicenter clinical trial. AB - SETTING: Five adult urban EDs. AB - METHODS AND MEASUREMENTS: All patients received IV meperidine (1.5 to 3.0 mg/kg) titrated to analgesia followed by a painful procedure. Vital signs and alertness scale were recorded at regular intervals, and patients were observed for four hours. Adverse events were monitored and documented. Comparisons between baseline and postanalgesia intervals were made with a repeated measures ANOVA (Dunnett's test). AB - RESULTS: Although statistically significant changes in vital signs and alertness scale occurred, they were not clinically significant. Opiate reversal with naloxone was not needed in any patient, and no significant respiratory or circulatory compromise occurred. AB - CONCLUSION: This study of 72 patients demonstrates that high-dose narcotic analgesia is appropriate, well tolerated, and safe when used in selected patients before painful procedures in the ED. Narcotic antagonists and resuscitation equipment nonetheless should be available to maximize safety. RN - 36B82AMQ7N (Naloxone) RN - 9E338QE28F (Meperidine) IS - 0196-0644 IL - 0196-0644 PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't ID - S0196-0644(05)81994-8 [pii] PP - ppublish LG - English DP - 1993 Sep EZ - 1993/09/01 DA - 1993/09/01 00:01 DT - 1993/09/01 00:00 YR - 1993 ED - 19930930 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8363118 <913. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8392349 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Meagher MW AU - Chen PS AU - Salinas JA AU - Grau JW FA - Meagher, M W FA - Chen, P S FA - Salinas, J A FA - Grau, J W IN - Meagher, M W. Department of Psychology, Texas A&M University, College Station 77843. TI - Activation of the opioid and nonopioid hypoalgesic systems at the level of the brainstem and spinal cord: does a coulometric relation predict the emergence or form of environmentally induced hypoalgesia?. SO - Behavioral Neuroscience. 107(3):493-505, 1993 Jun AS - Behav Neurosci. 107(3):493-505, 1993 Jun NJ - Behavioral neuroscience VO - 107 IP - 3 PG - 493-505 PI - Journal available in: Print PI - Citation processed from: Print JC - ag4, 8302411 IO - Behav. Neurosci. SB - Index Medicus CP - United States MH - Afferent Pathways/ph [Physiology] MH - Animals MH - Arousal/ph [Physiology] MH - Brain Mapping MH - *Brain Stem/ph [Physiology] MH - Cerebral Cortex/pp [Physiopathology] MH - Electroshock MH - Male MH - Neural Inhibition/ph [Physiology] MH - *Nociceptors/ph [Physiology] MH - *Pain Threshold/ph [Physiology] MH - Rats MH - Reaction Time/ph [Physiology] MH - *Receptors, Opioid/ph [Physiology] MH - *Social Environment MH - *Spinal Cord/ph [Physiology] MH - Tail/ir [Innervation] AB - Prior research suggests that a coulometric relation (Intensity x Duration) determines whether an opioid or nonopioid hypoalgesic system is activated by afferent nociceptive information. Using a paradigm that generates a brainstem-mediated hypoalgesia on the tail-flick test, we found that a coulometric relation does not predict either the emergence or the form of shock-induced hypoalgesia in decerebrate rats. In fact, no evidence was obtained that the brainstem's opioid hypoalgesic system can be activated by ascending neurons. More severe shocks elicited hypoalgesia in spinalized rats. Although a coulometric relation did not predict the emergence of hypoalgesia in spinalized rats, shock severity did predict the form of the hypoalgesia; the least severe shocks elicited an opioid hypoalgesia, and the more severe shocks generated a nonopioid hypoalgesia. A similar pattern of data was observed in intact rats exposed to the least severe shock parameters. RN - 0 (Receptors, Opioid) IS - 0735-7044 IL - 0735-7044 PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish GI - No: R01 MH48994-01A1 Organization: (MH) *NIMH NIH HHS* Country: United States LG - English DP - 1993 Jun EZ - 1993/06/01 DA - 1993/06/01 00:01 DT - 1993/06/01 00:00 YR - 1993 ED - 19930813 RD - 20071114 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8392349 <914. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8347225 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pollack CV Jr AU - Pollack ES FA - Pollack, C V Jr FA - Pollack, E S TI - Neurogenic pulmonary edema. CM - Comment on: J Emerg Med. 1992 Jan-Feb;10(1):45-51; PMID: 1629591 SO - Journal of Emergency Medicine. 11(2):207-10, 1993 Mar-Apr AS - J Emerg Med. 11(2):207-10, 1993 Mar-Apr NJ - The Journal of emergency medicine VO - 11 IP - 2 PG - 207-10 PI - Journal available in: Print PI - Citation processed from: Print JC - ibo, 8412174 IO - J Emerg Med SB - Index Medicus CP - United States MH - *Brain Edema/co [Complications] MH - Brain Edema/dg [Diagnostic Imaging] MH - Emergency Service, Hospital MH - Female MH - Humans MH - *Hypoxia, Brain/co [Complications] MH - Middle Aged MH - Naloxone/po [Poisoning] MH - Neurologic Examination MH - *Pulmonary Edema/et [Etiology] MH - Respiratory Insufficiency/ci [Chemically Induced] MH - Tomography, X-Ray Computed RN - 36B82AMQ7N (Naloxone) IS - 0736-4679 IL - 0736-4679 PT - Case Reports PT - Letter PT - Comment PP - ppublish LG - English DP - 1993 Mar-Apr EZ - 1993/03/01 DA - 2001/03/28 10:01 DT - 1993/03/01 00:00 YR - 1993 ED - 19930708 RD - 20161123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8347225 <915. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8497775 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Monotti R FA - Monotti, R IN - Monotti, R. Medizinische Universitatsklinik, Inselspital Bern. TI - [Drug emergencies]. [Review] [32 refs] [German] OT - Der Drogennotfall. SO - Schweizerische Medizinische Wochenschrift. Journal Suisse de Medecine. 123(17):881-6, 1993 May 01 AS - Schweiz Med Wochenschr. 123(17):881-6, 1993 May 01 NJ - Schweizerische medizinische Wochenschrift VO - 123 IP - 17 PG - 881-6 PI - Journal available in: Print PI - Citation processed from: Print JC - uei, 0404401 IO - Schweiz Med Wochenschr SB - Index Medicus CP - Switzerland MH - Acute Disease MH - Cocaine MH - Combined Modality Therapy MH - Critical Care MH - Drug Overdose MH - Flumazenil/tu [Therapeutic Use] MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - *Opioid-Related Disorders/th [Therapy] AB - Opiate intoxication accounts for the majority of emergencies related to substance abuse. The concomitant intravenous and intramuscular administration of the specific narcotic antagonist naloxone is warranted in such cases. Further threatening complications of opiate abuse include rhabdomyolysis, noncardiogenic pulmonary edema, and both peripheral and central nervous lesions. Opiate abuse is often associated with benzodiazepine abuse. Hence, intravenous administration of the antagonist flumazenil is indicated in patients with suspected acute opiate intoxication resistant to naloxone. Cocaine abuse is not frequent in this country but is usually very severe and clinically heterogeneous. The clinical pattern of cocaine intoxication is initially due to excitatory and later to depressant effects on central nervous, circulatory and respiratory systems. The treatment of acute cocaine intoxication is symptomatic. The internal concealment of cocaine and other drugs in packets (body-packing) may lead to bowel obstruction or to acute intoxication following leaking or breaking of packets. [References: 32] RN - 36B82AMQ7N (Naloxone) RN - 40P7XK9392 (Flumazenil) RN - I5Y540LHVR (Cocaine) IS - 0036-7672 IL - 0036-7672 PT - English Abstract PT - Journal Article PT - Review PP - ppublish LG - German DP - 1993 May 01 EZ - 1993/05/01 DA - 1993/05/01 00:01 DT - 1993/05/01 00:00 YR - 1993 ED - 19930624 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8497775 <916. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8492675 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Coccoli M AU - Rugolo AP AU - Rocchi R AU - Giannini P AU - Ciervo U FA - Coccoli, M FA - Rugolo, A P FA - Rocchi, R FA - Giannini, P FA - Ciervo, U IN - Coccoli, M. Telefono in Aiuto, USL RM/10, Roma. TI - [Naltrexone therapy. Experience with "Telephone Assistance" in Rome]. [Italian] OT - La terapia con naltrexone. Nell'esperienza del "Telefono in Aiuto" di Roma. SO - Minerva Psichiatrica. 34(1):39-43, 1993 Mar AS - Minerva Psichiatr. 34(1):39-43, 1993 Mar NJ - Minerva psichiatrica VO - 34 IP - 1 PG - 39-43 PI - Journal available in: Print PI - Citation processed from: Print JC - mg4, 7707981 IO - Minerva Psichiatr SB - Index Medicus CP - Italy MH - Adult MH - Hotlines MH - Humans MH - Italy MH - *Naltrexone/tu [Therapeutic Use] MH - *Opioid-Related Disorders/dt [Drug Therapy] MH - Opioid-Related Disorders/pc [Prevention & Control] MH - Recurrence AB - From March 1989 to February 1991, at "Telefono in Aiuto" (USL RM/10), Naltrexone has been used in 271 heroin addict patients. Naltrexone, a pure opiate antagonist, nullifies subjective heroin effects, preventing the setting up of tolerance and physical dependence. By administration for one year to drug-free addicts, it proved to be useful in relapse prevention. Naltrexone seems to be safe and without side-effects. Its effectiveness grows if its use is matched with psychological help. RN - 5S6W795CQM (Naltrexone) IS - 0374-9320 IL - 0374-9320 PT - English Abstract PT - Journal Article PP - ppublish LG - Italian DP - 1993 Mar EZ - 1993/03/01 DA - 1993/03/01 00:01 DT - 1993/03/01 00:00 YR - 1993 ED - 19930617 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8492675 <917. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 8427429 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kaplan JL AU - Marx JA FA - Kaplan, J L FA - Marx, J A IN - Kaplan, J L. Emergency Medical Services, Temple University Hospital, Philadelphia, Pennsylvania. TI - Effectiveness and safety of intravenous nalmefene for emergency department patients with suspected narcotic overdose: a pilot study. SO - Annals of Emergency Medicine. 22(2):187-90, 1993 Feb AS - Ann Emerg Med. 22(2):187-90, 1993 Feb NJ - Annals of emergency medicine VO - 22 IP - 2 PG - 187-90 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Injections, Intravenous MH - Male MH - Naltrexone/ad [Administration & Dosage] MH - Naltrexone/ae [Adverse Effects] MH - *Naltrexone/aa [Analogs & Derivatives] MH - Naltrexone/tu [Therapeutic Use] MH - Narcotic Antagonists/ad [Administration & Dosage] MH - *Narcotic Antagonists/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Pilot Projects MH - Prospective Studies MH - Treatment Outcome AB - STUDY OBJECTIVE: To evaluate the efficacy and safety of nalmefene, an investigational narcotic antagonist that has potential advantages over naloxone because of its four- to eight-hour half-life, in emergency department patients with possible narcotic overdose. AB - DESIGN: Multi-institutional, prospective, phase II, open-label study. AB - TYPE OF PARTICIPANTS: Complete data were available for 53 cases from two teaching hospitals. Men 18 years old or older who would otherwise receive naloxone were eligible (two women were enrolled inadvertently). AB - METHODS: Over four hours, one to ten boluses (median, one) of 0.5 or 1.0 mg nalmefene IV were given as often as every two minutes based on clinical need. Respirations, blood pressure, pulse, pupil size, and overall clinical response were monitored. Overall clinical response (1, no change; 2, partial response; 3, complete response), first assessed at two minutes, was analyzed by the Mann-Whitney U test. AB - RESULTS: Fifteen of 25 (0.5 mg) and nine of 28 (1.0 mg) cases were opiate positive. Twelve of 15 (0.5 mg) and six of nine (1.0 mg) opiate-positive cases had a rapid complete response. Coincident causes of depressed sensorium were identified in the remaining six opiate-positive cases. No difference in initial overall clinical response was seen between 0.5-mg and 1.0-mg opiate-positive cases (P = .59). No deterioration requiring repeat nalmefene occurred in opiate-positive cases, even if methadone (four), codeine (two), or pentazocine (one) was found. No serious adverse events were judged to be related to nalmefene. AB - CONCLUSION: Nalmefene is effective in the reversal of opiate overdose and appears to be safe in the management of patients with altered sensorium. RN - 0 (Narcotic Antagonists) RN - 0 (Narcotics) RN - 5S6W795CQM (Naltrexone) RN - TOV02TDP9I (nalmefene) IS - 0196-0644 IL - 0196-0644 PT - Clinical Trial PT - Clinical Trial, Phase II PT - Controlled Clinical Trial PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't ID - S0196-0644(05)80200-8 [pii] PP - ppublish LG - English DP - 1993 Feb EZ - 1993/02/01 DA - 1993/02/01 00:01 DT - 1993/02/01 00:00 YR - 1993 ED - 19930304 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=8427429 <918. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1435476 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chambers JA AU - Baggoley CJ FA - Chambers, J A FA - Baggoley, C J IN - Chambers, J A. Flinders Medical Centre, Adelaide, SA. TI - Pulmonary oedema--prehospital treatment. Caution with morphine dosage. SO - Medical Journal of Australia. 157(5):326-8, 1992 Sep 07 AS - Med J Aust. 157(5):326-8, 1992 Sep 07 NJ - The Medical journal of Australia VO - 157 IP - 5 PG - 326-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 0400714, m26 IO - Med. J. Aust. SB - Index Medicus CP - Australia MH - Acute Disease MH - Aged MH - Aged, 80 and over MH - *Emergency Medical Services MH - Family Practice MH - Female MH - Humans MH - Hypotension/ci [Chemically Induced] MH - Male MH - Morphine/ad [Administration & Dosage] MH - *Morphine/ae [Adverse Effects] MH - *Pulmonary Edema/dt [Drug Therapy] MH - Pulmonary Edema/pp [Physiopathology] MH - South Australia MH - Unconsciousness/ci [Chemically Induced] AB - OBJECTIVE: To inform doctors of potential hazards if opioids are administered in excessive doses to patients with acute pulmonary oedema. AB - CLINICAL FEATURES: Three elderly patients were unresponsive and hypotensive on arrival in the emergency department. All had received morphine parenterally as a component of prehospital treatment for acute pulmonary oedema. AB - INTERVENTIONS AND OUTCOME: All were given naloxone intravenously, regained consciousness and had a rise in blood pressure. AB - CONCLUSION: Parenteral administration of opioids should be used with caution in acute pulmonary oedema. The authors present a protocol for prehospital drug therapy. RN - 76I7G6D29C (Morphine) IS - 0025-729X IL - 0025-729X PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1992 Sep 07 EZ - 1992/09/07 DA - 1992/09/07 00:01 DT - 1992/09/07 00:00 YR - 1992 ED - 19921210 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1435476 <919. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1414685 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shankley CE AU - Anderson CW AU - Adcock JJ FA - Shankley, C E FA - Anderson, C W FA - Adcock, J J IN - Shankley, C E. Department of Pharmacology, Wellcome Research Laboratories, Beckenham, Kent, UK. TI - Effect of BW443C81, a novel opioid, on non-cholinergic bronchoconstrictor responses and neurogenic plasma extravasation in the guinea pig. SO - Agents & Actions. 36(1-2):22-8, 1992 May AS - Agents Actions. 36(1-2):22-8, 1992 May NJ - Agents and actions VO - 36 IP - 1-2 PG - 22-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 2xz, 0213341 IO - Agents Actions SB - Index Medicus CP - Switzerland MH - Anesthesia MH - Animals MH - *Antitussive Agents/pd [Pharmacology] MH - Bronchi/de [Drug Effects] MH - *Bronchoconstrictor Agents/pd [Pharmacology] MH - Guinea Pigs MH - In Vitro Techniques MH - Male MH - Morphine/pd [Pharmacology] MH - Muscle Contraction/de [Drug Effects] MH - Naloxone/pd [Pharmacology] MH - Neurons, Afferent/de [Drug Effects] MH - *Neurons, Afferent/me [Metabolism] MH - *Oligopeptides/pd [Pharmacology] MH - Respiration, Artificial AB - The novel, peripherally acting opioid peptide, BW443C81, which attenuates airway sensory nerve impulses, was examined on non-cholinergic (NC) constrictor responses in vitro and in vivo and neurogenic plasma extravasation in vivo in guinea-pig airways. Non-cholinergic contractions of guinea pig isolated bronchi, evoked by electrical field stimulation, were concentration-dependently inhibited by BW443C81 and morphine (10 nmol/1-100 mumol/l). In anaesthetised, artificially ventilated guinea pigs, frequency-related NC bronchoconstrictor responses evoked by antidromic electrical stimulation of the vagus nerves were reduced by BW443C81 (100 micrograms/kg/min i.v. infusion) and morphine (1 mg/kg i.v.). Neurogenic plasma extravasation produced by bilateral electrical vagal nerve stimulation in spontaneously breathing, anaesthetised guinea pigs was also inhibited by BW443C81 (1 mg/kg i.v.). The inhibitory effects of BW443C81 were reversed/prevented by naloxone. BW443C81 inhibits NC bronchoconstrictor responses and neurogenic plasma extravasation in guinea pig airways, consistent with its previously described mu-opioid receptor-mediated inhibitory action on airway sensory nerve function. RN - 0 (Antitussive Agents) RN - 0 (Bronchoconstrictor Agents) RN - 0 (Oligopeptides) RN - 36B82AMQ7N (Naloxone) RN - 76I7G6D29C (Morphine) RN - 88331-14-0 (BW 443C) IS - 0065-4299 IL - 0065-4299 PT - Journal Article PP - ppublish LG - English DP - 1992 May EZ - 1992/05/01 DA - 1992/05/01 00:01 DT - 1992/05/01 00:00 YR - 1992 ED - 19921120 RD - 20170714 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1414685 <920. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 10120075 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bourn S FA - Bourn, S TI - Hi mom, I'm home. Controversies in clinical care. SO - Journal of Emergency Medical Services. 17(7):95-7, 1992 Jul AS - J Emerg Med Serv JEMS. 17(7):95-7, 1992 Jul NJ - JEMS : a journal of emergency medical services VO - 17 IP - 7 PG - 95-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 8102138, irc IO - JEMS SB - Health Administration Journals CP - United States MH - Data Collection MH - *Drug Therapy/st [Standards] MH - *Emergency Medical Services/st [Standards] MH - Humans MH - Morphine/tu [Therapeutic Use] MH - Naloxone/tu [Therapeutic Use] MH - *Treatment Outcome MH - United States RN - 36B82AMQ7N (Naloxone) RN - 76I7G6D29C (Morphine) IS - 0197-2510 IL - 0197-2510 PT - Journal Article PP - ppublish LG - English DP - 1992 Jul EZ - 1992/06/07 DA - 1992/06/07 00:01 DT - 1992/06/07 00:00 YR - 1992 ED - 19920930 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=10120075 <921. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1639699 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Van Pelt DR AU - Wingfield WE FA - Van Pelt, D R FA - Wingfield, W E IN - Van Pelt, D R. Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins 80523. TI - Controversial issues in drug treatment during cardiopulmonary resuscitation. [Review] [54 refs] SO - Journal of the American Veterinary Medical Association. 200(12):1938-44, 1992 Jun 15 AS - J Am Vet Med Assoc. 200(12):1938-44, 1992 Jun 15 NJ - Journal of the American Veterinary Medical Association VO - 200 IP - 12 PG - 1938-44 PI - Journal available in: Print PI - Citation processed from: Print JC - hav, 7503067 IO - J. Am. Vet. Med. Assoc. SB - Index Medicus CP - United States MH - Animals MH - *Animals, Domestic MH - Arrhythmias, Cardiac/dt [Drug Therapy] MH - Arrhythmias, Cardiac/ve [Veterinary] MH - *Cardiopulmonary Resuscitation/ve [Veterinary] MH - Cerebrovascular Circulation MH - Coronary Circulation MH - Heart Arrest/dt [Drug Therapy] MH - Heart Arrest/th [Therapy] MH - *Heart Arrest/ve [Veterinary] MH - Heart Rate/de [Drug Effects] AB - The goal of advanced life support in CPR must be to restore and maintain respiratory and hemodynamic effectiveness, and to correct the underlying dysrhythmia. Optimal basic life-support techniques must be continued to meet these goals. Many drugs have been suggested in the treatment of cardiac arrest, but unfortunately, drug effects are inconsistent and resuscitation rates remain low. Epinephrine, atropine, lidocaine, bretylium, and naloxone remain important drugs for consideration in CPR in most animals with cardiac arrest. The best chance of survival remains in early recognition of animals susceptible to arrest and in treatment of the underlying cause. [References: 54] IS - 0003-1488 IL - 0003-1488 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1992 Jun 15 EZ - 1992/06/15 DA - 1992/06/15 00:01 DT - 1992/06/15 00:00 YR - 1992 ED - 19920903 RD - 20071115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1639699 <922. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1603710 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Johnston C FA - Johnston, C IN - Johnston, C. Pediatric Emergency Medicine Section, University of Alabama, Birmingham 35233. TI - Endotracheal drug delivery. [Review] [38 refs] SO - Pediatric Emergency Care. 8(2):94-7, 1992 Apr AS - Pediatr Emerg Care. 8(2):94-7, 1992 Apr NJ - Pediatric emergency care VO - 8 IP - 2 PG - 94-7 PI - Journal available in: Print PI - Citation processed from: Print JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Animals MH - Atropine/ad [Administration & Dosage] MH - Cardiopulmonary Resuscitation MH - Disease Models, Animal MH - Epinephrine/ad [Administration & Dosage] MH - Humans MH - *Intubation, Intratracheal/mt [Methods] MH - Lidocaine/ad [Administration & Dosage] MH - Naloxone/ad [Administration & Dosage] MH - *Pediatrics RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 98PI200987 (Lidocaine) RN - YKH834O4BH (Epinephrine) IS - 0749-5161 IL - 0749-5161 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1992 Apr EZ - 1992/04/01 DA - 1992/04/01 00:01 DT - 1992/04/01 00:00 YR - 1992 ED - 19920716 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1603710 <923. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1810489 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pashutin SB FA - Pashutin, S B TI - [The restriction of hemodynamic disorders in acute hypoxia and in situ reoxygenation by using the synthetic peptide bioregulator dalargin]. [Russian] OT - Ogranichenie gemodinamicheskikh narushenii pri ostroi gipoksii i reoksigenatsii in situ s pomoshch'iu sinteticheskogo peptidnogo bioreguliatora dalargina. SO - Biulleten Eksperimentalnoi Biologii i Meditsiny. 112(11):505-7, 1991 Nov AS - Biull Eksp Biol Med. 112(11):505-7, 1991 Nov NJ - Biulleten' eksperimental'noi biologii i meditsiny VO - 112 IP - 11 PG - 505-7 PI - Journal available in: Print PI - Citation processed from: Print JC - a74, 0370627 IO - Biull Eksp Biol Med SB - Index Medicus CP - Russia (Federation) MH - Acute Disease MH - Animals MH - Asphyxia/dt [Drug Therapy] MH - Asphyxia/pp [Physiopathology] MH - Disease Models, Animal MH - Drug Evaluation, Preclinical MH - *Enkephalin, Leucine-2-Alanine/aa [Analogs & Derivatives] MH - Enkephalin, Leucine-2-Alanine/tu [Therapeutic Use] MH - Hemodynamics/de [Drug Effects] MH - *Hypoxia/dt [Drug Therapy] MH - Hypoxia/pp [Physiopathology] MH - Myocardial Reperfusion Injury/pp [Physiopathology] MH - *Myocardial Reperfusion Injury/pc [Prevention & Control] MH - Rats MH - Rats, Inbred Strains MH - Respiration, Artificial MH - Time Factors AB - Development of posthypoxic and reoxygenation depression of cardiac activity following a time-portioned disconnection of the apparatus for artificial ventilation of the lungs in rats was restricted by a preventive intravenous infusion of a synthetic opioid peptide--dalargin. Resistance to a stressor effect of hypoxia (ischemia-reperfusion) which was assessed by the degree of restoration of the integral index of the blood circulation--cardiac output could be mediated by correction of Ca-homeostasis of cardiomyocytes by means of dalargin. Elimination of all side effects with a blocker of opioid receptors--naloxon points to a possibility of realization of a protective antihypoxic action. RN - 63631-40-3 (Enkephalin, Leucine-2-Alanine) RN - V13505565P (enkephalin-Leu, Ala(2)-Arg(6)-) IS - 0365-9615 IL - 0365-9615 PT - Journal Article PP - ppublish LG - Russian DP - 1991 Nov EZ - 1991/11/01 DA - 1991/11/01 00:01 DT - 1991/11/01 00:00 YR - 1991 ED - 19920529 RD - 20161123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1810489 <924. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1777740 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Domingo A AU - Anto JM AU - Cami J FA - Domingo, A FA - Anto, J M FA - Cami, J IN - Domingo, A. Institut Municipal d'Investigacio Medica, Barcelona, Spain. TI - Epidemiological surveillance of opioid-related episodes in an emergency room of Barcelona, Spain (1979-1989).[Erratum appears in Br J Addict 1992 Feb;87(2):322] SO - British Journal of Addiction. 86(11):1459-66, 1991 Nov AS - Br J Addict. 86(11):1459-66, 1991 Nov NJ - British journal of addiction VO - 86 IP - 11 PG - 1459-66 PI - Journal available in: Print PI - Citation processed from: Print JC - bjd, 8804404 IO - Br J Addict SB - Index Medicus CP - England MH - Adolescent MH - Adult MH - *Emergency Service, Hospital/ut [Utilization] MH - Female MH - Humans MH - Male MH - Middle Aged MH - Opium MH - Prevalence MH - Sex Factors MH - Spain/ep [Epidemiology] MH - *Substance-Related Disorders/ep [Epidemiology] AB - In the early 80's opioid addiction was a low prevalence problem in Spain, grew enormously during that decade and became the most important risk factor for AIDS in recent years. The limitations of assessing the prevalence of illegal drug use by means of standard epidemiological methods lead, worldwide, to the use of indirect indicators. A Register of Toxicological Emergencies, developed for research purposes and containing data from 1979 to 1989 at the Hospital del Mar (Barcelona) is described. Results for opioid-related emergencies are presented, showing an epidemic increase in the number of such emergencies after 1981. The total number of opioid-related emergencies was 18,042 with a mean of 2.23 opioid-related emergency admissions per client throughout the whole period, implying that some 8000 persons were seen. In episodes from non-arrestees, mean age increased slightly over time, the male/female ratio being 2.5; withdrawal was the more frequent reason for attendance (53%), overdose accounting for 9% of admissions, and other medical conditions for 33%. Non-arrested women were more likely to attend for other medical conditions and overdoses than men. The importance of this kind of register as well as its limitations for assessing the trend of opioid use prevalence is discussed. RN - 8008-60-4 (Opium) IS - 0952-0481 IL - 0952-0481 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1991 Nov EZ - 1991/11/01 DA - 1991/11/01 00:01 DT - 1991/11/01 00:00 YR - 1991 ED - 19920312 RD - 20061115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1777740 <925. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1750637 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - McCrirrick A AU - Ramage DT FA - McCrirrick, A FA - Ramage, D T IN - McCrirrick, A. Department of Anaesthetics, Fremantle Hospital, Western Australia. TI - Caudal blockade for postoperative analgesia: a useful adjunct to intramuscular opiates following emergency lower leg orthopaedic surgery. SO - Anaesthesia & Intensive Care. 19(4):551-4, 1991 Nov AS - Anaesth Intensive Care. 19(4):551-4, 1991 Nov NJ - Anaesthesia and intensive care VO - 19 IP - 4 PG - 551-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 4m5, 0342017 IO - Anaesth Intensive Care SB - Index Medicus CP - Australia MH - Adult MH - *Analgesia, Epidural MH - *Ankle/su [Surgery] MH - Bupivacaine/ad [Administration & Dosage] MH - *Bupivacaine/tu [Therapeutic Use] MH - Double-Blind Method MH - Emergencies MH - Female MH - Humans MH - Injections, Intramuscular MH - Injections, Intravenous MH - *Leg/su [Surgery] MH - Male MH - *Nerve Block MH - Opium/ad [Administration & Dosage] MH - *Opium/tu [Therapeutic Use] MH - Pain Measurement MH - *Pain, Postoperative/pc [Prevention & Control] MH - Sacrum MH - Time Factors AB - The efficacy of a single caudal epidural injection of bupivacaine 20 ml 0.5% following emergency orthopaedic surgery to the lower leg and ankle was investigated. Forty adult patients were studied, randomised to either the caudal or control group. The mean 24 hour postoperative papaveretum consumption was significantly reduced in the caudal group. Analogue pain scores as assessed in a double-blind manner were also significantly reduced in this group. The duration of analgesia after caudal blockade was approximately eight hours as estimated by the average time to the first dose of papaveretum. Our study demonstrates that caudal blockade represents an effective adjunct to intramuscular opiates following this type of surgery. RN - 8008-60-4 (Opium) RN - Y8335394RO (Bupivacaine) IS - 0310-057X IL - 0310-057X PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PP - ppublish LG - English DP - 1991 Nov EZ - 1991/11/01 DA - 1991/11/01 00:01 DT - 1991/11/01 00:00 YR - 1991 ED - 19920123 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1750637 <926. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1727165 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bracken MB AU - Shepard MJ AU - Collins WF Jr AU - Holford TR AU - Baskin DS AU - Eisenberg HM AU - Flamm E AU - Leo-Summers L AU - Maroon JC AU - Marshall LF AU - et al FA - Bracken, M B FA - Shepard, M J FA - Collins, W F Jr FA - Holford, T R FA - Baskin, D S FA - Eisenberg, H M FA - Flamm, E FA - Leo-Summers, L FA - Maroon, J C FA - Marshall, L F IN - Bracken, M B. Department of Epidemiology and Public Health, Yale University Medical School, New Haven, Connecticut. TI - Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. CM - Comment in: J Neurosurg. 1992 Aug;77(2):324; author reply 325-7; PMID: 1625025 CM - Comment in: J Neurosurg. 1992 Aug;77(2):324-5; author reply 325-7; PMID: 1625026 SO - Journal of Neurosurgery. 76(1):23-31, 1992 Jan AS - J Neurosurg. 76(1):23-31, 1992 Jan NJ - Journal of neurosurgery VO - 76 IP - 1 PG - 23-31 PI - Journal available in: Print PI - Citation processed from: Print JC - jd3, 0253357 IO - J. Neurosurg. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Acute Disease MH - Double-Blind Method MH - Follow-Up Studies MH - Humans MH - *Methylprednisolone Hemisuccinate/tu [Therapeutic Use] MH - *Naloxone/tu [Therapeutic Use] MH - Psychomotor Performance/de [Drug Effects] MH - Spinal Cord Injuries/co [Complications] MH - *Spinal Cord Injuries/dt [Drug Therapy] MH - Spinal Cord Injuries/pp [Physiopathology] MH - Survival Rate MH - Time Factors AB - The 1-year follow-up data of a multicenter randomized controlled trial of methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours) treatment for acute spinal cord injury are reported and compared with placebo results. In patients treated with methylprednisolone within 8 hours of injury, increased recovery of neurological function was seen at 6 weeks and at 6 months and continued to be observed 1 year after injury. For motor function, this difference was statistically significant (p = 0.030), and was found in patients with total sensory and motor loss in the emergency room (p = 0.019) and in those with some preservation of motor and sensory function (p = 0.024). Naloxone-treated patients did not show significantly greater recovery. Patients treated after 8 hours of injury recovered less motor function if receiving methylprednisolone (p = 0.08) or naloxone (p = 0.10) as compared with those given placebo. Complication and mortality rates were similar in either group of treated patients as compared with the placebo group. The authors conclude that treatment with the study dose of methylprednisolone is indicated for acute spinal cord trauma, but only if it can be started within 8 hours of injury. RN - 36B82AMQ7N (Naloxone) RN - 5GMR90S4KN (Methylprednisolone Hemisuccinate) IS - 0022-3085 IL - 0022-3085 PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, P.H.S. ID - 10.3171/jns.1992.76.1.0023 [doi] PP - ppublish GI - No: NS15078 Organization: (NS) *NINDS NIH HHS* Country: United States LG - English DP - 1992 Jan EZ - 1992/01/11 19:15 DA - 2001/03/28 10:01 DT - 1992/01/11 19:15 YR - 1992 ED - 19920114 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1727165 <927. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1876508 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pender ES AU - Parks BR FA - Pender, E S FA - Parks, B R IN - Pender, E S. Department of Pediatrics, University of Mississippi Medical Center, Jackson. TI - Toxicity with dextromethorphan-containing preparations: a literature review and report of two additional cases. SO - Pediatric Emergency Care. 7(3):163-5, 1991 Jun AS - Pediatr Emerg Care. 7(3):163-5, 1991 Jun NJ - Pediatric emergency care VO - 7 IP - 3 PG - 163-5 PI - Journal available in: Print PI - Citation processed from: Print JC - pau, 8507560 IO - Pediatr Emerg Care SB - Index Medicus CP - United States MH - Child, Preschool MH - *Cough/dt [Drug Therapy] MH - Dextromethorphan/pd [Pharmacology] MH - *Dextromethorphan/po [Poisoning] MH - *Drug Overdose/di [Diagnosis] MH - Drug Overdose/dt [Drug Therapy] MH - Emergency Service, Hospital MH - Female MH - Humans MH - Infant, Newborn MH - Male MH - Naloxone/tu [Therapeutic Use] AB - Dextromethorphan-containing cold/cough preparations are frequently prescribed and bought over the counter for use in children. Although generally considered safe, dextromethorphan has been shown to cause CNS side effects, including hyperexcitability, increased muscle tone, and ataxia. Two deaths have been reported with intentional dextromethorphan overdose. A literature review, brief review of pharmacology, and report of two cases of adverse reactions to dextromethorphan-containing preparations are presented. RN - 36B82AMQ7N (Naloxone) RN - 7355X3ROTS (Dextromethorphan) IS - 0749-5161 IL - 0749-5161 PT - Journal Article PP - ppublish LG - English DP - 1991 Jun EZ - 1991/06/01 DA - 1991/06/01 00:01 DT - 1991/06/01 00:00 YR - 1991 ED - 19910926 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1876508 <928. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1678260 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pollock J AU - Kornetsky C FA - Pollock, J FA - Kornetsky, C IN - Pollock, J. Laboratory of Behavioral Pharmacology, Boston University School of Medicine, MA 02118. TI - Naloxone prevents and blocks the emergence of neuroleptic-mediated oral stereotypic behaviors. SO - Neuropsychopharmacology. 4(4):245-9, 1991 Jun AS - Neuropsychopharmacology. 4(4):245-9, 1991 Jun NJ - Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology VO - 4 IP - 4 PG - 245-9 PI - Journal available in: Print PI - Citation processed from: Print JC - adq, 8904907 IO - Neuropsychopharmacology SB - Index Medicus CP - England MH - Animals MH - Antipsychotic Agents/ai [Antagonists & Inhibitors] MH - *Antipsychotic Agents/to [Toxicity] MH - Dextroamphetamine/pd [Pharmacology] MH - *Dyskinesia, Drug-Induced/pc [Prevention & Control] MH - *Haloperidol/to [Toxicity] MH - Male MH - *Naloxone/pd [Pharmacology] MH - Naphthyridines/pd [Pharmacology] MH - Rats MH - Rats, Inbred F344 MH - *Stereotyped Behavior/de [Drug Effects] AB - A commonly used animal model for tardive dyskinesia is the oral stereotypy that is expressed by a challenge dose of a dopamine agonist after daily administration of dopamine antagonists (neuroleptics). In the first of two experiments the expression of this dopamine agonist-induced oral stereotypy was prevented by the concomitant administration of the opiate antagonist naloxone. In a second experiment, if the stereotypy was allowed to be expressed, it could be blocked by the administration of naloxone. To the extent that the effects of chronic neuroleptic treatment in rats is a model for tardive dyskinesia, the results suggest that administration of naloxone can both prevent and block the dyskinetic syndrome associated with neuroleptic use. RN - 0 (Antipsychotic Agents) RN - 0 (Naphthyridines) RN - 36B82AMQ7N (Naloxone) RN - J6292F8L3D (Haloperidol) RN - RR302AR19Y (amfonelic acid) RN - TZ47U051FI (Dextroamphetamine) IS - 0893-133X IL - 0893-133X PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish GI - No: DA00099 Organization: (DA) *NIDA NIH HHS* Country: United States GI - No: DA02326 Organization: (DA) *NIDA NIH HHS* Country: United States LG - English DP - 1991 Jun EZ - 1991/06/01 DA - 1991/06/01 00:01 DT - 1991/06/01 00:00 YR - 1991 ED - 19910919 RD - 20150311 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1678260 <929. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2068418 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Pokorski M AU - Lahiri S FA - Pokorski, M FA - Lahiri, S IN - Pokorski, M. Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia. TI - Endogenous opiates and ventilatory acclimatization to chronic hypoxia in the cat. SO - Respiration Physiology. 83(2):211-21, 1991 Feb AS - Respir Physiol. 83(2):211-21, 1991 Feb NJ - Respiration physiology VO - 83 IP - 2 PG - 211-21 PI - Journal available in: Print PI - Citation processed from: Print JC - r88, 0047142 IO - Respir Physiol SB - Index Medicus CP - Netherlands MH - Acclimatization MH - Animals MH - Carotid Body/de [Drug Effects] MH - Cats MH - Female MH - *Hypoxia/pp [Physiopathology] MH - *Naloxone/pd [Pharmacology] MH - Oxygen/ph [Physiology] MH - Respiration/de [Drug Effects] MH - *Respiration, Artificial MH - Tidal Volume/de [Drug Effects] AB - The effects of the opiate antagonist naloxone (0.4 mg.kg-1, i.v.) on carotid chemoreceptor and ventilatory responses to graded steady-state levels of hypoxia and hypercapnia were investigated in two groups of cats: chronically normoxic and chronically hypoxic. The cats of the latter group were exposed to PIO2 of about 70 mm Hg at sea level for 3-4 weeks and showed an attenuated response to hypoxia. All cats were tested under alpha-chloralose anesthesia. Naloxone treatment did not increase appreciably carotid chemoreceptor activity or its responses to hypoxia and hypercapnia in either cat group. Naloxone caused a small ventilatory stimulation in the chronically hypoxic cats, so that the attenuated response to hypoxia was not relieved. By contrast, the chemoreflex ventilatory response to hypoxia was stimulated by naloxone in the chronically normoxic cats. The findings that the depressed ventilatory chemoreflexes in the chronically hypoxic cat were not ameliorated by the opiate antagonist indicate that an increased elaboration of endogenous opiates does not underlie ventilatory adaptation to chronic hypoxia. RN - 36B82AMQ7N (Naloxone) RN - S88TT14065 (Oxygen) IS - 0034-5687 IL - 0034-5687 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish GI - No: HL-08899-17 Organization: (HL) *NHLBI NIH HHS* Country: United States GI - No: HL-19737-05 Organization: (HL) *NHLBI NIH HHS* Country: United States LG - English DP - 1991 Feb EZ - 1991/02/01 DA - 1991/02/01 00:01 DT - 1991/02/01 00:00 YR - 1991 ED - 19910815 RD - 20161123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2068418 <930. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2058403 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gayle MO AU - Ryan CA AU - Nazarali S FA - Gayle, M O FA - Ryan, C A FA - Nazarali, S IN - Gayle, M O. Pediatric Intensive Care Unit, University of Alberta Hospitals, Edmonton, Alberta. TI - Unusual cause of methadone poisoning. SO - Acta Paediatrica Scandinavica. 80(4):486-7, 1991 Apr AS - Acta Paediatr Scand. 80(4):486-7, 1991 Apr NJ - Acta paediatrica Scandinavica VO - 80 IP - 4 PG - 486-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 0000211 IO - Acta Paediatr Scand SB - Index Medicus CP - Sweden MH - Amoxicillin MH - *Drug Compounding MH - Female MH - Humans MH - Infant MH - *Medication Errors MH - *Methadone/po [Poisoning] MH - Naloxone/tu [Therapeutic Use] MH - Pharmacies MH - Poisoning/dt [Drug Therapy] AB - A child with respiratory distress was found to have been given an antibiotic which was reconstituted with methadone. A delay in standard emergency room management led to a delay in diagnosis and treatment. RN - 36B82AMQ7N (Naloxone) RN - 804826J2HU (Amoxicillin) RN - UC6VBE7V1Z (Methadone) IS - 0001-656X IL - 0001-656X PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1991 Apr EZ - 1991/04/01 DA - 1991/04/01 00:01 DT - 1991/04/01 00:00 YR - 1991 ED - 19910801 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2058403 <931. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2015247 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Seidel JS FA - Seidel, J S IN - Seidel, J S. Department Emergency Medicine, UCLA School of Medicine, Torrance 90509. TI - Emergency medical services and the adolescent patient. SO - Journal of Adolescent Health. 12(2):95-100, 1991 Mar AS - J Adolesc Health. 12(2):95-100, 1991 Mar NJ - The Journal of adolescent health : official publication of the Society for Adolescent Medicine VO - 12 IP - 2 PG - 95-100 PI - Journal available in: Print PI - Citation processed from: Print JC - a0j, 9102136 IO - J Adolesc Health SB - Index Medicus CP - United States MH - Adolescent MH - Age Factors MH - California/ep [Epidemiology] MH - Child MH - Emergency Medical Services/og [Organization & Administration] MH - *Emergency Medical Services/ut [Utilization] MH - Evaluation Studies as Topic MH - Humans MH - Male MH - Risk Factors MH - Rural Health MH - State Health Plans MH - Time Factors MH - United States/ep [Epidemiology] MH - Urban Health MH - Wounds and Injuries/ep [Epidemiology] MH - Wounds and Injuries/th [Therapy] AB - A study of 10,493 prehospital care report forms from 11 counties in California demonstrated that the adolescent age group (ages 12 to 18 years) accessed prehospital care through the emergency medical service (EMS) system more frequently than other pediatric patients (5978 reports). They did so most commonly for trauma (87.6%), but also for behavioral emergencies such as suicide and psychiatric problems. The most common cause of injury was automobiles, and care rendered was most commonly wound care and splinting. The most common substances given to adolescents in the prehospital setting were naloxone and 50% dextrose. EMS systems need to address the need for triage and care of adolescent patients. IS - 1054-139X IL - 1054-139X PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - 0197-0070(91)90450-Z [pii] PP - ppublish GI - No: MCH-064001-01-3 Organization: *PHS HHS* Country: United States LG - English DP - 1991 Mar EZ - 1991/03/01 DA - 1991/03/01 00:01 DT - 1991/03/01 00:00 YR - 1991 ED - 19910520 RD - 20171107 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2015247 <932. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1996818 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hoffman JR AU - Schriger DL AU - Luo JS FA - Hoffman, J R FA - Schriger, D L FA - Luo, J S IN - Hoffman, J R. Department of Medicine, UCLA School of Medicine. TI - The empiric use of naloxone in patients with altered mental status: a reappraisal. SO - Annals of Emergency Medicine. 20(3):246-52, 1991 Mar AS - Ann Emerg Med. 20(3):246-52, 1991 Mar NJ - Annals of emergency medicine VO - 20 IP - 3 PG - 246-52 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Clinical Protocols/st [Standards] MH - *Coma/di [Diagnosis] MH - Coma/et [Etiology] MH - Coma/pp [Physiopathology] MH - Diagnosis, Differential MH - *Drug Overdose/co [Complications] MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/pp [Physiopathology] MH - *Emergency Medical Services/st [Standards] MH - Evaluation Studies as Topic MH - Humans MH - Los Angeles MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/pd [Pharmacology] MH - *Naloxone MH - *Narcotics/po [Poisoning] MH - Reflex, Pupillary/de [Drug Effects] MH - Respiration/de [Drug Effects] MH - Sensitivity and Specificity AB - STUDY OBJECTIVE: To determine whether clinical criteria (respirations of 12 or less, mitotic pupils, and circumstantial evidence of opiate abuse) could predict response to naloxone in patients with acute alteration of mental status (AMS) and to evaluate whether such criteria predict a final diagnosis of presence or absence of opiate overdose as accurately as response to naloxone. AB - CASES AND SETTING: Seven hundred thirty patients with AMS who received naloxone for diagnostic or therapeutic purposes at the discretion of two large, urban, paramedic base teaching hospitals. AB - METHODS: We reviewed paramedic run sheets and audiotapes on all 730 patients as well as available hospital records of all patients who demonstrated any response to naloxone to determine whether overdose was responsible for their clinical presentations. We also reviewed hospital records for a selected sample of naloxone nonresponders. AB - MAIN RESULTS AND CONCLUSION: Only 25 patients (3.4%) demonstrated a complete response to naloxone, whereas 32 (4.4%) manifested a partial or equivocal response. Nineteen of 25 complete responders (76%), two of 26 partial responders (8%) (with known final diagnosis), and four of 195 non-responders (2%) (with known final diagnosis) were ultimately diagnosed as having overdosed. Respirations of 12 or less or the presence of any one of the three clinical findings as a group were each highly sensitive in predicting response to naloxone, and at least as sensitive as response to naloxone in predicting a diagnosis of opiate overdose. Selective administration of naloxone for AMS would have decreased the use of this drug by 75% to 90% while still administering it to virtually all naloxone responders who had a final diagnosis of opiate overdose. RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - S0196-0644(05)80933-3 [pii] PP - ppublish LG - English DP - 1991 Mar EZ - 1991/03/01 DA - 1991/03/01 00:01 DT - 1991/03/01 00:00 YR - 1991 ED - 19910322 RD - 20151119 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1996818 <933. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1996799 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Martin M AU - Hecker J AU - Clark R AU - Frye J AU - Jehle D AU - Lucid EJ AU - Harchelroad F FA - Martin, M FA - Hecker, J FA - Clark, R FA - Frye, J FA - Jehle, D FA - Lucid, E J FA - Harchelroad, F IN - Martin, M. Medical College of Pennsylvania, Pittsburgh 15212. TI - China White epidemic: an eastern United States emergency department experience. SO - Annals of Emergency Medicine. 20(2):158-64, 1991 Feb AS - Ann Emerg Med. 20(2):158-64, 1991 Feb NJ - Annals of emergency medicine VO - 20 IP - 2 PG - 158-64 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Analgesics/po [Poisoning] MH - *Disease Outbreaks MH - Drug Overdose/ep [Epidemiology] MH - Drug Overdose/mo [Mortality] MH - Emergencies MH - Female MH - *Fentanyl/aa [Analogs & Derivatives] MH - Fentanyl/po [Poisoning] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Pennsylvania MH - Poisoning/dt [Drug Therapy] MH - Poisoning/ep [Epidemiology] MH - Retrospective Studies AB - STUDY OBJECTIVE: The purpose of this study was to isolate significant clinical or demographic findings concerning overdose patients treated during a China White (3-methyl fentanyl) epidemic and compare them with data for all unintentional narcotic overdose patients during a 24-month period. AB - DESIGN: We reviewed charts from 85,246 patient visits to our emergency department during the 24-month period of January 1987 through December 1988 to study this narcotic epidemic. Data from the Allegheny County Coroner's Office pertaining to unintentional drug overdose deaths that occurred during this same period also were reviewed. AB - SETTING: The first outbreak of narcotic overdoses in the eastern United States involving China White occurred in Allegheny County, Pennsylvania, in 1988. AB - TYPE OF PARTICIPANTS: Patients were included if they met the criteria of a suspected unintentional narcotic overdose, but excluded if they were not given naloxone. AB - INTERVENTIONS: Emergency physicians became suspicious of China White use after an unusual increase in narcotic overdoses presenting to the ED coupled with "routine drug of abuse" screens negative for opiates despite dramatic patient responses to naloxone. In most of the cases in which specific testing was done, there were positive indicators of fentanyl derivatives. Investigations found China White present in street drugs and paraphernalia. AB - MEASUREMENTS AND MAIN RESULTS: A cluster was defined as a time period with a statistically significant increase in overdoses over the expected number for an interval of equal length. Although there were no significant clinical differences in case presentation during the 24-month period, there was a statistically significant 13-fold increase in overdoses during the September through November 1988 cluster (mean, 13 vs 0.95 per month, P less than .001 by Wilcoxon rank-sum test). A dramatic increase in unintentional drug overdose deaths occurred in the county during this cluster. A total of 18 fentanyl-positive unintentional drug overdose deaths, predominantly male (89%) and black (56%), with an age range of 19 to 44 years (mean, 34.9 years), were reported by the county coroner (13 during the cluster). Narcotic overdoses and unintentional drug overdose deaths declined sharply with confiscation of a clandestine China White laboratory. AB - CONCLUSIONS: China White was responsible for a dramatic rise in unintentional drug overdose deaths in Allegheny County in 1988. There were no significant clinical differences between China White overdose survivors and other unintentional narcotic overdose victims. Overdoses responsive to naloxone with inconsistent routine toxicologic screens may be due to a fentanyl analogue. RN - 0 (Analgesics) RN - 36B82AMQ7N (Naloxone) RN - QVU94XE61A (3-methylfentanyl) RN - UF599785JZ (Fentanyl) IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - S0196-0644(05)81216-8 [pii] PP - ppublish LG - English DP - 1991 Feb EZ - 1991/02/01 DA - 1991/02/01 00:01 DT - 1991/02/01 00:00 YR - 1991 ED - 19910322 RD - 20171116 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1996799 <934. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2219893 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hoffman JR AU - Luo J AU - Schriger DL AU - Silver L FA - Hoffman, J R FA - Luo, J FA - Schriger, D L FA - Silver, L IN - Hoffman, J R. Department of Medicine, University of California, School of Medicine, Los Angeles. TI - Does paramedic-base hospital contact result in beneficial deviations from standard prehospital protocols?. CM - Comment in: West J Med. 1991 Feb;154(2):226-7; PMID: 2053961 SO - Western Journal of Medicine. 153(3):283-7, 1990 Sep AS - West J Med. 153(3):283-7, 1990 Sep NJ - The Western journal of medicine VO - 153 IP - 3 PG - 283-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 0410504, xn5 IO - West. J. Med. PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1002532 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Abdominal Pain/th [Therapy] MH - Adult MH - Aged MH - *Clinical Protocols MH - *Emergency Medical Service Communication Systems MH - *Emergency Medical Services/st [Standards] MH - *Emergency Medical Technicians MH - Female MH - Hospitals, Teaching/st [Standards] MH - Humans MH - Los Angeles MH - Male MH - Medical Staff, Hospital MH - Mental Disorders/th [Therapy] MH - Middle Aged MH - Seizures/th [Therapy] MH - Syncope/th [Therapy] AB - We reviewed written and audio records of paramedic-base hospital radio contact to determine whether care differed from that suggested in standard prehospital care protocols. Records of all 659 contacts for seizure, syncope, abdominal pain, or altered mental state during 1987 (28.4% of all contacts) were scored for the use of standard therapies (such as intravenous access, oxygen, naloxone hydrochloride) and unanticipated therapies (intubation, nitroglycerin). Cases that involved unanticipated treatments were reviewed to determine whether they could have been prospectively identified by simple clinical findings. Standard therapies were used in the majority of patients. Unanticipated therapies were administered to 13 patients, all of whom had abnormal vital signs, diaphoresis, respiratory distress, or a second prominent symptom. Data suggest that protocols could replace radio contact for most patients and that the few who might benefit from radio contact can be easily identified. A 90% reduction in radio contacts in Los Angeles county could save $3 million each year. IS - 0093-0415 IL - 0093-0415 PT - Journal Article ID - PMC1002532 [pmc] PP - ppublish LG - English DP - 1990 Sep EZ - 1990/09/01 DA - 1990/09/01 00:01 DT - 1990/09/01 00:00 YR - 1990 ED - 19901121 RD - 20131002 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2219893 <935. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2212264 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Olsen KS FA - Olsen, K S IN - Olsen, K S. Department of Anesthesia, Central Hospital, Kristianstad, Sweden. TI - Naloxone administration and laryngospasm followed by pulmonary edema. SO - Intensive Care Medicine. 16(5):340-1, 1990 AS - Intensive Care Med. 16(5):340-1, 1990 NJ - Intensive care medicine VO - 16 IP - 5 PG - 340-1 PI - Journal available in: Print PI - Citation processed from: Print JC - h2j, 7704851 IO - Intensive Care Med SB - Index Medicus CP - United States MH - Female MH - Humans MH - Laryngismus/co [Complications] MH - *Laryngismus/et [Etiology] MH - Laryngismus/th [Therapy] MH - *Laryngoscopy/ae [Adverse Effects] MH - Middle Aged MH - *Naloxone/ae [Adverse Effects] MH - Naloxone/tu [Therapeutic Use] MH - Pulmonary Edema/ci [Chemically Induced] MH - Pulmonary Edema/dg [Diagnostic Imaging] MH - *Pulmonary Edema/et [Etiology] MH - Radiography MH - Respiration, Artificial AB - A 50-year-old woman underwent laryngoscopy. Postoperatively she received naloxone and was extubated. She developed severe laryngospasm and one hour later pulmonary edema. Both naloxone administration and laryngospasm can provoke pulmonary edema; the pathophysiology is discussed. It is suggested that naloxone is administered with care to patients who in the preceding hours have had severe laryngospasm. RN - 36B82AMQ7N (Naloxone) IS - 0342-4642 IL - 0342-4642 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1990 EZ - 1990/01/01 DA - 1990/01/01 00:01 DT - 1990/01/01 00:00 YR - 1990 ED - 19901107 RD - 20170713 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2212264 <936. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2209040 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Fiser DH AU - Moss MM AU - Walker W FA - Fiser, D H FA - Moss, M M FA - Walker, W IN - Fiser, D H. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock. TI - Critical care for clonidine poisoning in toddlers. SO - Critical Care Medicine. 18(10):1124-8, 1990 Oct AS - Crit Care Med. 18(10):1124-8, 1990 Oct NJ - Critical care medicine VO - 18 IP - 10 PG - 1124-8 PI - Journal available in: Print PI - Citation processed from: Print JC - dtf, 0355501 IO - Crit. Care Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Atropine/tu [Therapeutic Use] MH - Child, Preschool MH - *Clonidine/po [Poisoning] MH - Consciousness MH - *Critical Care MH - Dopamine/tu [Therapeutic Use] MH - Dose-Response Relationship, Drug MH - Female MH - Fluid Therapy MH - Humans MH - Infant MH - Length of Stay MH - Male MH - Naloxone/tu [Therapeutic Use] MH - Poisoning/dt [Drug Therapy] MH - Poisoning/pp [Physiopathology] MH - *Poisoning/th [Therapy] MH - Resuscitation MH - Retrospective Studies AB - Clonidine may be a source of serious toxicity when ingested by toddlers. We describe 11 cases of clonidine ingestion by toddlers (mean dose 0.15 mg/kg; range 0.01 to 0.57). The source of the clonidine was a grand-parent in six of 11 cases. Symptoms included altered level of consciousness (n = 11), miosis (n = 5), bradycardia (n = 8), hypotension (n = 5), apnea and respiratory depression (n = 6), hypothermia (n = 5) and hypertension (n = 3). Therapeutic interventions included naloxone (n = 8) and atropine (n = 4), dopamine (n = 1), fluid resuscitation (n = 4), and endotracheal intubation (n = 1). There were no deaths. Symptoms of clonidine ingestion were typically mild if the dose ingested was less than 0.01 mg/kg, while bradycardia and hypotension occurred usually with doses of greater than 0.01 mg/kg. Apnea and respiratory depression were common when the dose exceeded 0.02 mg/kg. More effective measures are needed to prevent these potentially serious intoxications. RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - MN3L5RMN02 (Clonidine) RN - VTD58H1Z2X (Dopamine) IS - 0090-3493 IL - 0090-3493 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1990 Oct EZ - 1990/10/01 DA - 1990/10/01 00:01 DT - 1990/10/01 00:00 YR - 1990 ED - 19901102 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2209040 <937. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2388800 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - American Academy of Pediatrics Committee on Drugs: Naloxone dosage and route of administration for infants and children: addendum to emergency drug doses for infants and children. SO - Pediatrics. 86(3):484-5, 1990 Sep AS - Pediatrics. 86(3):484-5, 1990 Sep NJ - Pediatrics VO - 86 IP - 3 PG - 484-5 PI - Journal available in: Print PI - Citation processed from: Print JC - oxv, 0376422 IO - Pediatrics SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Academies and Institutes MH - Child MH - Child, Preschool MH - Emergencies MH - Humans MH - Infant MH - Infant, Newborn MH - *Naloxone/ad [Administration & Dosage] MH - Pediatrics MH - United States RN - 36B82AMQ7N (Naloxone) IS - 0031-4005 IL - 0031-4005 PT - Journal Article PP - ppublish LG - English DP - 1990 Sep EZ - 1990/09/01 DA - 1990/09/01 00:01 DT - 1990/09/01 00:00 YR - 1990 ED - 19900927 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2388800 <938. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1975160 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gillman MA FA - Gillman, M A TI - Opioid action of analgesic nitrous oxide. CM - Comment on: Ann Emerg Med. 1989 Feb;18(2):177-81; PMID: 2916783 SO - Annals of Emergency Medicine. 19(7):843-4, 1990 Jul AS - Ann Emerg Med. 19(7):843-4, 1990 Jul NJ - Annals of emergency medicine VO - 19 IP - 7 PG - 843-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesics, Opioid MH - Child MH - Emergency Service, Hospital MH - Humans MH - *Nitrous Oxide RN - 0 (Analgesics, Opioid) RN - K50XQU1029 (Nitrous Oxide) IS - 0196-0644 IL - 0196-0644 PT - Comment PT - Letter ID - S0196-0644(05)81728-7 [pii] PP - ppublish LG - English DP - 1990 Jul EZ - 1990/07/01 DA - 1990/07/01 00:01 DT - 1990/07/01 00:00 YR - 1990 ED - 19900927 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1975160 <939. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2372173 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Yealy DM AU - Paris PM AU - Kaplan RM AU - Heller MB AU - Marini SE FA - Yealy, D M FA - Paris, P M FA - Kaplan, R M FA - Heller, M B FA - Marini, S E IN - Yealy, D M. Division of Emergency Medicine, University of Pittsburgh, Pennsylvania. TI - The safety of prehospital naloxone administration by paramedics. SO - Annals of Emergency Medicine. 19(8):902-5, 1990 Aug AS - Ann Emerg Med. 19(8):902-5, 1990 Aug NJ - Annals of emergency medicine VO - 19 IP - 8 PG - 902-5 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Emergencies MH - *Emergency Medical Services MH - Female MH - Heart Arrest/ci [Chemically Induced] MH - Humans MH - Hypotension/ci [Chemically Induced] MH - Male MH - Middle Aged MH - *Naloxone/ae [Adverse Effects] MH - Pennsylvania MH - Retrospective Studies MH - Safety MH - Seizures/ci [Chemically Induced] MH - *Unconsciousness/dt [Drug Therapy] MH - Vomiting/ci [Chemically Induced] AB - We performed a retrospective review to investigate the safety of prehospital naloxone administration by paramedics as part of a protocol for all patients presenting with an acutely depressed level of consciousness (LOC). The prevalence of naloxone-induced vomiting, seizures, hypotension, hypertension, and cardiac arrest was sought from the prehospital records of 813 patients treated during a 12-month period. The mean age of the treated patients was 42.4 +/- 9.7 years. The initial dose of naloxone was 0.4 to 0.8 mg, and the mean total dose was 0.9 +/- 0.6 mg. No patients lost a pulse within ten minutes of receiving naloxone. Two patients (0.2%) experienced a significant drop in systolic blood pressure, and one patient (0.1%) demonstrated a significant rise in systolic blood pressure within five minutes of naloxone administration. Vomiting occurred in two patients (0.2%), and one patient (0.1%) suffered a tonic-clonic seizure within five minutes of naloxone administration. Of the 813 patients treated, 60 patients (7.4%: mean age, 32.3 +/- 6.7 years) were judged to have an improved LOC after naloxone, with 27 (3.3%) regaining a normal LOC. We conclude that in the above doses, naloxone is safe as part of prehospital protocols for paramedics treating patients with an acutely depressed LOC. However, the vast majority of patients treated empirically with naloxone in the field demonstrated no benefit. RN - 36B82AMQ7N (Naloxone) IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - S0196-0644(05)81566-5 [pii] PP - ppublish LG - English DP - 1990 Aug EZ - 1990/08/01 DA - 1990/08/01 00:01 DT - 1990/08/01 00:00 YR - 1990 ED - 19900823 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2372173 <940. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2157543 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Zhou D AU - He CQ FA - Zhou, D FA - He, C Q TI - [Cardiopulmonary resuscitation by endotracheal medication]. [Review] [17 refs] [Chinese] SO - Chung-Hua i Hsueh Tsa Chih [Chinese Medical Journal]. 70(1):56-7, 1990 Jan AS - Chung Hua I Hsueh Tsa Chih. 70(1):56-7, 1990 Jan NJ - Zhonghua yi xue za zhi VO - 70 IP - 1 PG - 56-7 PI - Journal available in: Print PI - Citation processed from: Print JC - cdg, 7511141 IO - Zhonghua Yi Xue Za Zhi SB - Index Medicus CP - China MH - Atropine/ad [Administration & Dosage] MH - Epinephrine/ad [Administration & Dosage] MH - Humans MH - Intubation, Intratracheal MH - Lidocaine/ad [Administration & Dosage] MH - Naloxone/ad [Administration & Dosage] MH - *Resuscitation/mt [Methods] RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 98PI200987 (Lidocaine) RN - YKH834O4BH (Epinephrine) IS - 0376-2491 IL - 0376-2491 PT - Journal Article PT - Review PP - ppublish LG - Chinese DP - 1990 Jan EZ - 1990/01/01 DA - 1990/01/01 00:01 DT - 1990/01/01 00:00 YR - 1990 ED - 19900518 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2157543 <941. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 1969468 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wiley JF 2nd AU - Wiley CC AU - Torrey SB AU - Henretig FM FA - Wiley, J F 2nd FA - Wiley, C C FA - Torrey, S B FA - Henretig, F M IN - Wiley, J F 2nd. Department of Emergency Medicine, Children's Hospital of Philadelphia, PA 19104. TI - Clonidine poisoning in young children. SO - Journal of Pediatrics. 116(4):654-8, 1990 Apr AS - J Pediatr. 116(4):654-8, 1990 Apr NJ - The Journal of pediatrics VO - 116 IP - 4 PG - 654-8 PI - Journal available in: Print PI - Citation processed from: Print JC - jlz, 0375410 IO - J. Pediatr. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Atropine/tu [Therapeutic Use] MH - Bradycardia/dt [Drug Therapy] MH - Charcoal/tu [Therapeutic Use] MH - Child MH - Child, Preschool MH - Clonidine/ai [Antagonists & Inhibitors] MH - *Clonidine/po [Poisoning] MH - Female MH - Gastric Lavage MH - Heart Rate MH - Humans MH - Infant MH - Ipecac/tu [Therapeutic Use] MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - Respiration, Artificial AB - We reviewed 47 consecutive inpatient records to determine the clinical course, role of supportive measures, and response to naloxone in children with clonidine poisoning. Severity of illness was assigned by means of the "pediatric risk of mortality" (PRISM) score. The children's ages ranged from 9 to 84 months. Central nervous system effects were noted in 44 patients; bradycardia occurred in 25, and apnea or depressed respiration was seen in 18. Thirty-four patients had symptoms within 1 hour of presentation, but no patient had further clinical deterioration more than 4 hours after presentation. Six patients required endotracheal intubation and mechanical ventilation. There was no difference in PRISM score or duration of symptoms between those patients who received naloxone and those who did not. More patients receiving naloxone required intubation, and only three patients had definite improvement after naloxone administration. We conclude that (1) young children who ingest clonidine have a wide spectrum of serious findings, (2) delayed progression of symptoms after clonidine poisoning is unlikely in a young child with normal renal function, and (3) naloxone is an inconsistent antidote for clonidine poisoning. RN - 16291-96-6 (Charcoal) RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 8012-96-2 (Ipecac) RN - MN3L5RMN02 (Clonidine) IS - 0022-3476 IL - 0022-3476 PT - Journal Article PP - ppublish LG - English DP - 1990 Apr EZ - 1990/04/01 DA - 1990/04/01 00:01 DT - 1990/04/01 00:00 YR - 1990 ED - 19900503 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=1969468 <942. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2180244 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Goodrich PM FA - Goodrich, P M TI - Naloxone hydrochloride: a review. [Review] [9 refs][Erratum appears in AANA J 1990 Jun;58(3):216] SO - AANA Journal. 58(1):14-6, 1990 Feb AS - AANA J. 58(1):14-6, 1990 Feb NJ - AANA journal VO - 58 IP - 1 PG - 14-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 0431420 IO - AANA J SB - Nursing Journal CP - United States MH - Humans MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/ae [Adverse Effects] MH - *Naloxone/tu [Therapeutic Use] MH - Narcotics/po [Poisoning] MH - *Nurse Anesthetists AB - Naloxone hydrochloride is a widely used opioid antagonist. Narcotic analgesics administered to patients bind to opioid receptor sites within the central nervous system. Activation of these receptor sites initiates an analgesic response. Blocking of the receptor sites by opioid antagonists, such as naloxone hydrochloride, reverses the effects of the narcotic agonist. Although often used in an emergency room setting in high doses (up to 2 mg), such doses may not be advantageous in an operating room setting where the goal would be the reversal of the respiratory depressant effects of the narcotic while retaining the analgesic properties. Ultimately, the clinician will find that titrating naloxone hydrochloride in small doses (starting as low as .05 mg) will produce the most desirable response. [References: 9] RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0094-6354 IL - 0094-6354 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1990 Feb EZ - 1990/02/01 DA - 1990/02/01 00:01 DT - 1990/02/01 00:00 YR - 1990 ED - 19900416 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2180244 <943. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2302291 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wright SW AU - Chudnofsky CR AU - Dronen SC AU - Wright MB AU - Borron SW FA - Wright, S W FA - Chudnofsky, C R FA - Dronen, S C FA - Wright, M B FA - Borron, S W IN - Wright, S W. Department of Emergency Medicine, University of Cincinnati Medical Center, OH 45267-0769. TI - Midazolam use in the emergency department. SO - American Journal of Emergency Medicine. 8(2):97-100, 1990 Mar AS - Am J Emerg Med. 8(2):97-100, 1990 Mar NJ - The American journal of emergency medicine VO - 8 IP - 2 PG - 97-100 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Pressure/de [Drug Effects] MH - Drug Therapy, Combination/ae [Adverse Effects] MH - *Emergencies MH - Female MH - Humans MH - Male MH - Midazolam/ad [Administration & Dosage] MH - Midazolam/ae [Adverse Effects] MH - *Midazolam/tu [Therapeutic Use] MH - Middle Aged MH - Respiration/de [Drug Effects] MH - Retrospective Studies AB - Midazolam is the first water-soluble benzodiazepine. As with other benzodiazepines it has amnestic, sedative, hypnotic, anxiolytic, and anticonvulsant properties. Midazolam is about two to four times more potent than diazepam. Midazolam has been extensively used for a variety of outpatient procedures, but there has been no documentation of its safety in emergency department patients. The authors retrospectively reviewed all patients receiving midazolam during a 2-year period at the University of Cincinnati Center for Emergency Care. The study population consisted of 389 patients (men 56%; women 44%) with an average age of 33.3 years. Midazolam was used intravenously for sedation before a wide variety of painful procedures and for agitation control. The average dose was 3.86 mg, with a range of 0.5 mg to 20.0 mg. The majority of patients (79.2%) received narcotics or sedative/hypnotic agents in addition to midazolam. There was an overall complication rate of 1.0%. Two patients (0.5%) developed clinically significant respiratory depression after midazolam use. Both patients had also received fentanyl citrate and the respiratory depression was reversed with naloxone. Two patients (0.5%) receiving several other drugs developed short periods of hypotension. There were no apparent long term sequelae. The authors conclude that midazolam can be safely used in the emergency department setting. Careful dosing and titration to the desired clinical effects is mandatory. Patients should be closely monitored to maximize safety. RN - R60L0SM5BC (Midazolam) IS - 0735-6757 IL - 0735-6757 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 0735-6757(90)90192-3 [pii] PP - ppublish LG - English DP - 1990 Mar EZ - 1990/03/01 DA - 1990/03/01 00:01 DT - 1990/03/01 00:00 YR - 1990 ED - 19900327 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2302291 <944. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2614900 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Takahashi H AU - Dohi S AU - Matsumiya N AU - Takeshima R AU - Naito H FA - Takahashi, H FA - Dohi, S FA - Matsumiya, N FA - Takeshima, R FA - Naito, H TI - [Influence of four opioids on pulmonary oxygenation and naloxone's effects in mechanically ventilated dogs]. [Japanese] SO - Masui - Japanese Journal of Anesthesiology. 38(7):880-7, 1989 Jul AS - Masui. 38(7):880-7, 1989 Jul NJ - Masui. The Japanese journal of anesthesiology VO - 38 IP - 7 PG - 880-7 PI - Journal available in: Print PI - Citation processed from: Print JC - khr, 0413707 IO - Masui SB - Index Medicus CP - Japan MH - Animals MH - Buprenorphine/ai [Antagonists & Inhibitors] MH - *Buprenorphine/pd [Pharmacology] MH - Butorphanol/ai [Antagonists & Inhibitors] MH - *Butorphanol/pd [Pharmacology] MH - Cyclazocine/ai [Antagonists & Inhibitors] MH - *Cyclazocine/pd [Pharmacology] MH - Dogs MH - Hemodynamics/de [Drug Effects] MH - *Morphinans/pd [Pharmacology] MH - Morphine/ai [Antagonists & Inhibitors] MH - Morphine/pd [Pharmacology] MH - *Naloxone/pd [Pharmacology] MH - *Pulmonary Gas Exchange/de [Drug Effects] MH - *Respiration, Artificial AB - In order to examine effects of opioids on pulmonary oxygenation during constant ventilation, we investigated changes in PaO2 following four different opioids and after reversal with naloxone in mechanically ventilated, lightly anesthetized dogs. The systemic administration of morphine 1.0mg.kg-1, buprenorphine 0.03mg.kg-1, butorphanol 0.1mg.kg-1, and cyclazocine 0.05mg.kg-1, did not affect PaO2, although these opioids decreased mean arterial pressure and heart rate significantly. Naloxone 0.04mg.kg-1 after four opioids affected the hemodynamics, significantly, but it did not cause any detrimental effects on pulmonary oxygenation. Although naloxone alone did not affect mean arterial pressure and heart rate at all, subsequent morphine decreased mean arterial pressure and heart rate significantly. Neither naloxone nor subsequent morphine produced any change in PaO2. The results suggest that reversal with naloxone may not cause any significant influences on pulmonary oxygenation in mechanically ventilated and anesthetized patients. RN - 0 (Morphinans) RN - 36B82AMQ7N (Naloxone) RN - 40D3SCR4GZ (Buprenorphine) RN - 76I7G6D29C (Morphine) RN - J5W1B1159C (Cyclazocine) RN - QV897JC36D (Butorphanol) IS - 0021-4892 IL - 0021-4892 PT - English Abstract PT - Journal Article PP - ppublish LG - Japanese DP - 1989 Jul EZ - 1989/07/01 DA - 1989/07/01 00:01 DT - 1989/07/01 00:00 YR - 1989 ED - 19900307 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2614900 <945. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2810409 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tuggle DW AU - Horton JW FA - Tuggle, D W FA - Horton, J W IN - Tuggle, D W. Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City. TI - Effects of naloxone on splanchnic perfusion in hemorrhagic shock. SO - Journal of Trauma-Injury Infection & Critical Care. 29(10):1341-5, 1989 Oct AS - J Trauma. 29(10):1341-5, 1989 Oct NJ - The Journal of trauma VO - 29 IP - 10 PG - 1341-5 PI - Journal available in: Print PI - Citation processed from: Print JC - kaf, 0376373 IO - J Trauma SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Animals MH - Dogs MH - Hemodynamics/de [Drug Effects] MH - *Naloxone/tu [Therapeutic Use] MH - Resuscitation/mt [Methods] MH - *Shock, Hemorrhagic/dt [Drug Therapy] MH - *Splanchnic Circulation/de [Drug Effects] AB - Endogenous opiate peptides are released in early hemorrhagic shock and may mediate hypotension during hypovolemia. We compared the effects of naloxone alone versus incomplete volume resuscitation on survival and splanchnic blood flow. Dogs were bled to a MAP of 35 mm Hg for 2 hours. In eight dogs, shed blood was returned; eight dogs received naloxone (2 mg/kg bolus and 2 mg/kg/hr in 0.5 ml/kg/hr normal saline) with no shed blood returned. Seven dogs received normal saline alone without shed blood or naloxone and served as untreated controls. Untreated dogs survived a mean of 18.6 minutes. All other dogs survived for 180 minutes. Naloxone and shed blood were equally effective in improving hepatic and renal blood flow; gastric, intestinal, pancreatic, and splenic blood flow remained unchanged from shock values in both groups. These data indicate that in the face of hypovolemia naloxone improves survival and blood flow (ml/min/gm) to splanchnic organs despite no return of shed blood. RN - 36B82AMQ7N (Naloxone) IS - 0022-5282 IL - 0022-5282 PT - Journal Article PP - ppublish LG - English DP - 1989 Oct EZ - 1989/10/01 DA - 1989/10/01 00:01 DT - 1989/10/01 00:00 YR - 1989 ED - 19891124 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2810409 <946. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2780577 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Villarreal JE AU - Salazar LA AU - Cruz SL FA - Villarreal, J E FA - Salazar, L A FA - Cruz, S L IN - Villarreal, J E. Departamento de Farmacologia y Toxicologia, Centro de Investigacion de Estudios Avanzados del Instituto Politecnico Nacional, Mexico, D.F., Mexico. TI - Quantitative experimental analysis of the emergence of opiate dependence. SO - Proceedings of the Western Pharmacology Society. 32:137-40, 1989 AS - Proc West Pharmacol Soc. 32:137-40, 1989 NJ - Proceedings of the Western Pharmacology Society VO - 32 PG - 137-40 PI - Journal available in: Print PI - Citation processed from: Print JC - pyg, 7505899 IO - Proc. West. Pharmacol. Soc. SB - Index Medicus CP - United States MH - Animals MH - Dose-Response Relationship, Drug MH - Guinea Pigs MH - Ileum/pp [Physiopathology] MH - In Vitro Techniques MH - Muscle, Smooth, Vascular/pp [Physiopathology] MH - *Opioid-Related Disorders/pp [Physiopathology] MH - Substance Withdrawal Syndrome/pp [Physiopathology] IS - 0083-8969 IL - 0083-8969 PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1989 EZ - 1989/01/01 DA - 1989/01/01 00:01 DT - 1989/01/01 00:00 YR - 1989 ED - 19891023 RD - 20141120 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2780577 <947. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2664315 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hartzell CW FA - Hartzell, C W TI - Sleeping beauty: a case of pickwickian syndrome. SO - Journal of Emergency Nursing. 15(1):8-11, 1989 Jan-Feb AS - J Emerg Nurs. 15(1):8-11, 1989 Jan-Feb NJ - Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association VO - 15 IP - 1 PG - 8-11 PI - Journal available in: Print PI - Citation processed from: Print JC - 7605913 IO - J Emerg Nurs SB - Nursing Journal CP - United States MH - Adult MH - Alcoholic Intoxication/di [Diagnosis] MH - Alcoholic Intoxication/th [Therapy] MH - Combined Modality Therapy MH - Critical Care MH - Emergencies MH - Humans MH - Male MH - *Obesity Hypoventilation Syndrome/di [Diagnosis] MH - Obesity Hypoventilation Syndrome/th [Therapy] AB - The patient arriving at the emergency department with somnolence must be evaluated quickly, efficiently, and with a definite goal in mind. Head and neck trauma should always be suspected and protective steps taken in the unconscious patient. The coma mnemonic, AEIOU TIPS, (alcohol, epilepsy, insulin, overdose, uremia, trauma, infection, psychiatric, stroke) provides an excellent memory tool for the evaluation of decreased level of consciousness in the emergency setting. Interventions that provide diagnostic and therapeutic results (naloxone and 50% dextrose) should be initiated immediately while blood samples are drawn for pretreatment documentation. Each of the possible causes of lethargy or somnolence needs to be evaluated with the understanding that a multitude of factors may be present in the patient whose condition precludes a thorough history; the depressed diabetic may have taken an overdose of medications in addition to his insulin. Social preconceptions may also effect the outcome. The intoxicated patient described herein was allowed to "sleep it off" in the emergency department under the watchful eyes (and ears) of a nursing staff who faithfully recorded vital signs and pupil reactivity as the patient's blood gas values deteriorated. IS - 0099-1767 IL - 0099-1767 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1989 Jan-Feb EZ - 1989/01/01 DA - 1989/01/01 00:01 DT - 1989/01/01 00:00 YR - 1989 ED - 19890817 RD - 20051117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2664315 <948. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2729688 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chudnofsky CR AU - Wright SW AU - Dronen SC AU - Borron SW AU - Wright MB FA - Chudnofsky, C R FA - Wright, S W FA - Dronen, S C FA - Borron, S W FA - Wright, M B IN - Chudnofsky, C R. Department of Emergency Medicine, University of Cincinnati Medical Center, Ohio 45267-0769. TI - The safety of fentanyl use in the emergency department. CM - Comment in: Ann Emerg Med. 1990 Jul;19(7):839-40; PMID: 2389873 SO - Annals of Emergency Medicine. 18(6):635-9, 1989 Jun AS - Ann Emerg Med. 18(6):635-9, 1989 Jun NJ - Annals of emergency medicine VO - 18 IP - 6 PG - 635-9 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Drug Evaluation MH - Drug Interactions MH - Drug Therapy, Combination MH - Emergencies MH - *Emergency Service, Hospital MH - Fentanyl/ad [Administration & Dosage] MH - *Fentanyl/ae [Adverse Effects] MH - Humans MH - Middle Aged MH - Ohio MH - Retrospective Studies AB - Fentanyl citrate is a synthetic narcotic 1,000 times as potent as meperidine. It produces minimal hemodynamic effects and is characterized by a rapid onset of sedation and analgesia, a relatively short duration of action (approximately 30 to 40 minutes), and rapid reversal with opiate antagonists. These properties make fentanyl an ideal drug for emergency department use. The safety of fentanyl use in an adult ED population has not previously been studied. We retrospectively reviewed the charts of 841 patients who received fentanyl at the University of Cincinnati Center for Emergency Care between January 1985 and June 1988. The study population included 497 (59%) men and 344 (41%) women, with an average age of 33 years. The average dose of fentanyl was 180 micrograms (range, 25 to 1,400 micrograms). Six patients (1%) experienced mild side effects including nausea (one), emesis (two), urticaria (one), and pruritus (two). Nine patients (1%) developed more serious complications including six cases (0.7%) of respiratory depression and three cases (0.4%) of hypotension. Two of 183 patients (1%) who received midazolam and two of nine patients (22%) who received haloperidol developed respiratory depression. Four of the six patients with respiratory depression and two of the three patients with hypotension were intoxicated. All of the complications were transient, and none resulted in hospitalization. We conclude that fentanyl is a safe drug for use in the ED. To maximize safety, we recommend careful dosing and titration, close patient monitoring, and the availability of naloxone hydrochloride and resuscitation equipment.(ABSTRACT TRUNCATED AT 250 WORDS) RN - UF599785JZ (Fentanyl) IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - S0196-0644(89)80517-7 [pii] PP - ppublish LG - English DP - 1989 Jun EZ - 1989/06/01 DA - 1989/06/01 00:01 DT - 1989/06/01 00:00 YR - 1989 ED - 19890628 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2729688 <949. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2719364 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Terndrup TE AU - Cantor RM AU - Madden CM FA - Terndrup, T E FA - Cantor, R M FA - Madden, C M IN - Terndrup, T E. Department of Pediatrics, SUNY Health Science Center, Syracuse, New York 13210. TI - Intramuscular meperidine, promethazine, and chlorpromazine: analysis of use and complications in 487 pediatric emergency department patients. SO - Annals of Emergency Medicine. 18(5):528-33, 1989 May AS - Ann Emerg Med. 18(5):528-33, 1989 May NJ - Annals of emergency medicine VO - 18 IP - 5 PG - 528-33 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Analgesia MH - Child MH - Child, Preschool MH - *Chlorpromazine/ad [Administration & Dosage] MH - Chlorpromazine/ae [Adverse Effects] MH - Drug Combinations MH - Drug Utilization MH - *Emergency Service, Hospital MH - Female MH - Humans MH - Infant MH - Injections, Intramuscular MH - Male MH - *Meperidine/ad [Administration & Dosage] MH - Meperidine/ae [Adverse Effects] MH - *Promethazine/ad [Administration & Dosage] MH - Promethazine/ae [Adverse Effects] MH - Retrospective Studies AB - Despite widespread use of a parenterally administered mixture of meperidine, promethazine, and chlorpromazine (Demerol, Phenergan, and Thorazine, DPT), there has been no systematic evaluation of its efficacy and complications in emergency department patients. We reviewed the medical records of all patients less than 16 years old who received DPT in our ED during the 24-month period ending December 31, 1987. Of 487 patients who received DPT, the maximum dose was 50/25/25 mg, respectively. Wound repair (69%) and fracture reduction (12%) were the two most common indications. Lacerations most commonly involved the face (65%) or digits (20%). Efficacy was not directly reported, but only eight patients received repeat sedation. Head injuries and a lower mean initial meperidine dosage were more prevalent in patients requiring repeat sedation (P less than .05). Three patients (0.6%) experienced significant complications. All had respiratory depression and received IV naloxone. An abnormal initial mental status examination or an underlying neurologic abnormality was significantly associated with complications (P less than .05). DPT appears to be a safe and relatively effective sedative for selected pediatric ED patients when administered as a ratio of 2:1:1 mg/kg, respectively. Complications are increased in patients with acute or underlying neurologic abnormalities. RN - 0 (Drug Combinations) RN - 9E338QE28F (Meperidine) RN - FF28EJQ494 (Promethazine) RN - U42B7VYA4P (Chlorpromazine) IS - 0196-0644 IL - 0196-0644 PT - Journal Article ID - S0196-0644(89)80838-8 [pii] PP - ppublish LG - English DP - 1989 May EZ - 1989/05/01 DA - 1989/05/01 00:01 DT - 1989/05/01 00:00 YR - 1989 ED - 19890613 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2719364 <950. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2717301 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Anonymous TI - American Academy of Pediatrics. Emergency drug doses for infants and children and naloxone use in newborns: clarification. SO - Pediatrics. 83(5):803, 1989 May AS - Pediatrics. 83(5):803, 1989 May NJ - Pediatrics VO - 83 IP - 5 PG - 803 PI - Journal available in: Print PI - Citation processed from: Print JC - oxv, 0376422 IO - Pediatrics SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Humans MH - Infant, Newborn MH - *Naloxone/ad [Administration & Dosage] MH - Narcotics/po [Poisoning] RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0031-4005 IL - 0031-4005 PT - Journal Article PP - ppublish LG - English DP - 1989 May EZ - 1989/05/01 DA - 1989/05/01 00:01 DT - 1989/05/01 00:00 YR - 1989 ED - 19890613 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2717301 <951. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2645889 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barsan WG AU - Seger D AU - Danzl DF AU - Ling LJ AU - Bartlett R AU - Buncher R AU - Bryan C FA - Barsan, W G FA - Seger, D FA - Danzl, D F FA - Ling, L J FA - Bartlett, R FA - Buncher, R FA - Bryan, C IN - Barsan, W G. Department of Emergency Medicine, University of Cincinnati College of Medicine, OH 45267-0769. TI - Duration of antagonistic effects of nalmefene and naloxone in opiate-induced sedation for emergency department procedures. SO - American Journal of Emergency Medicine. 7(2):155-61, 1989 Mar AS - Am J Emerg Med. 7(2):155-61, 1989 Mar NJ - The American journal of emergency medicine VO - 7 IP - 2 PG - 155-61 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Aged MH - Attention/de [Drug Effects] MH - *Consciousness/de [Drug Effects] MH - Double-Blind Method MH - Emergency Service, Hospital MH - Female MH - Humans MH - Male MH - *Meperidine/ai [Antagonists & Inhibitors] MH - Middle Aged MH - Multicenter Studies as Topic MH - *Naloxone/tu [Therapeutic Use] MH - *Naltrexone/aa [Analogs & Derivatives] MH - Naltrexone/tu [Therapeutic Use] MH - Random Allocation AB - Naloxone is an effective opiate antagonist, but its short half-life limits its usefulness. For outpatient procedures, a longer acting opiate antagonist could eliminate two to four hours of nursing observation in patients postoperatively. A controlled, randomized, double-blind trial comparing the effects of nalmefene, naloxone, and placebo in reversing opiate-induced sedation was carried out to determine efficacy, duration of action, and adverse effects in patients undergoing outpatient procedures. Each patient received 1.5 to 3.0 mg/kg meperidine intravenously before the procedure. After the procedure, each patient received either nalmefene, 1.0 mg; naloxone, 1.0 mg; or saline, 1.0 mL intravenously. Vital signs and assessments for alertness were performed for four hours. Naloxone significantly reversed sedation for only 15 minutes, whereas nalmefene was significantly effective (P less than .05) for up to 210 minutes. Nalmefene was significantly more effective than naloxone in reversing sedation at 60, 90, and 120 minutes. Nalmefene is an effective agent for the reversal of opiate-induced sedation after outpatient procedures. RN - 36B82AMQ7N (Naloxone) RN - 5S6W795CQM (Naltrexone) RN - 9E338QE28F (Meperidine) RN - TOV02TDP9I (nalmefene) IS - 0735-6757 IL - 0735-6757 PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't ID - 0735-6757(89)90128-9 [pii] PP - ppublish LG - English DP - 1989 Mar EZ - 1989/03/01 DA - 1989/03/01 00:01 DT - 1989/03/01 00:00 YR - 1989 ED - 19890420 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2645889 <952. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2851847 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Frischknecht HR AU - Siegfried B FA - Frischknecht, H R FA - Siegfried, B IN - Frischknecht, H R. Institute of Pharmacology, University of Zurich, Switzerland. TI - Emergence and development of stress-induced analgesia and concomitant behavioral changes in mice exposed to social conflict. SO - Physiology & Behavior. 44(3):383-8, 1988 AS - Physiol Behav. 44(3):383-8, 1988 NJ - Physiology & behavior VO - 44 IP - 3 PG - 383-8 PI - Journal available in: Print PI - Citation processed from: Print JC - p72, 0151504 IO - Physiol. Behav. SB - Index Medicus CP - United States MH - Aggression/ph [Physiology] MH - Agonistic Behavior/ph [Physiology] MH - Animals MH - *Arousal/ph [Physiology] MH - Brain/de [Drug Effects] MH - Brain/ph [Physiology] MH - *Conflict (Psychology) MH - Escape Reaction/ph [Physiology] MH - Male MH - Mice MH - Mice, Inbred C57BL MH - Mice, Inbred DBA MH - Naloxone/pd [Pharmacology] MH - Naltrexone/aa [Analogs & Derivatives] MH - Naltrexone/pd [Pharmacology] MH - Nociceptors/de [Drug Effects] MH - *Nociceptors/ph [Physiology] MH - *Receptors, Opioid/ph [Physiology] MH - *Social Environment AB - Mice of the inbred strain DBA/2, when exposed to a social conflict, developed a low intensity, naloxone-insensitive analgesia after 15 bites, and a more pronounced naloxone-sensitive analgesia after 45 bites. The effective inhibition of the antinociceptive response following low and high number of bites by the alkylating opiate antagonist beta-chlornaltrexamine suggests participation of opioid mechanisms at both stress levels. Emergence of an increased tail-flick latency was indicated by the occurrence of defensive upright postures upon contact with the opponent, while animals displaying full analgesic response during the period of bite 31-45 increased their escape reactions without being in contact with the aggressor. Suppression of social conflict analgesia in mice by pretreatment with opiate antagonists facilitated the occurrence of these escape reactions. The display of panic escape responses is discussed in the context of increased fear and helplessness that developed under conditions of sustained attacks. RN - 0 (Receptors, Opioid) RN - 36B82AMQ7N (Naloxone) RN - 5S6W795CQM (Naltrexone) RN - 67025-94-9 (chlornaltrexamine) IS - 0031-9384 IL - 0031-9384 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 0031-9384(88)90041-8 [pii] PP - ppublish LG - English DP - 1988 EZ - 1988/01/01 DA - 1988/01/01 00:01 DT - 1988/01/01 00:00 YR - 1988 ED - 19890323 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2851847 <953. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2913858 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hertzka RE AU - Gauntlett IS AU - Fisher DM AU - Spellman MJ FA - Hertzka, R E FA - Gauntlett, I S FA - Fisher, D M FA - Spellman, M J IN - Hertzka, R E. Department of Anesthesia, University of California, San Francisco 94143-0648. TI - Fentanyl-induced ventilatory depression: effects of age. SO - Anesthesiology. 70(2):213-8, 1989 Feb AS - Anesthesiology. 70(2):213-8, 1989 Feb NJ - Anesthesiology VO - 70 IP - 2 PG - 213-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 4sg, 1300217 IO - Anesthesiology SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Age Factors MH - Child, Preschool MH - Depression, Chemical MH - *Fentanyl/ae [Adverse Effects] MH - Fentanyl/bl [Blood] MH - Humans MH - Infant MH - *Respiration/de [Drug Effects] MH - *Respiration, Artificial AB - To determine whether infants are more sensitive than older patients to the ventilatory-depressant effects of fentanyl, patients were anesthetized with fentanyl and nitrous oxide (N2O) and ventilatory depression was assessed following elimination of N2O and in the immediate postoperative period. Three groups of patients were studied: infants (1-12 mo old, n = 14), children (1-5 yr old, n = 14), and adults (23-38 yr old, n = 13). Skin-surface PCO2 was measured to determine the peak PCO2 occurring at the end of anesthesia when end-tidal N2O concentration was less than 6%. Naloxone was administered if PCO2 exceeded 70 mmHg. During recovery from anesthesia, ventilatory pattern was recorded using impedance pneumography to determine the longest breath-to-breath interval and the number of episodes of central apnea (defined as breath-to-breath intervals greater than or equal to 10 s in infants and children and greater than or equal to 20 s in adults). Elevation of PCO2 correlated with increasing plasma fentanyl concentrations but did not differ between groups. Four patients (two infants, one child, and one adult) required naloxone. The only subject who had a low plasma fentanyl concentration but required naloxone was a 6-wk-old infant; this was the only subject younger than 3 mo. For each range of fentanyl concentrations, the incidence of apnea increased with age, as did the number of episodes of apnea per subject. Fentanyl-induced ventilatory depression, as assessed by elevation of resting PCO2 during emergence from anesthesia and disruption of ventilatory pattern during recovery from anesthesia, is not greater in infants older than 3 mo than in children and adults.(ABSTRACT TRUNCATED AT 250 WORDS) RN - UF599785JZ (Fentanyl) IS - 0003-3022 IL - 0003-3022 PT - Journal Article PP - ppublish LG - English DP - 1989 Feb EZ - 1989/02/01 DA - 1989/02/01 00:01 DT - 1989/02/01 00:00 YR - 1989 ED - 19890303 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2913858 <954. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3056845 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Proudfoot AT FA - Proudfoot, A T IN - Proudfoot, A T. Regional Poisoning Treatment Centre, Royal Infirmary of Edinburgh, UK. TI - Clinical toxicology--past, present and future. [Review] [36 refs] SO - Human Toxicology. 7(5):481-7, 1988 Sep AS - Hum Toxicol. 7(5):481-7, 1988 Sep NJ - Human toxicology VO - 7 IP - 5 PG - 481-7 PI - Journal available in: Print PI - Citation processed from: Print JC - gfr, 8206759 IO - Hum Toxicol SB - Index Medicus CP - England MH - Humans MH - *Poison Control Centers MH - *Poisoning MH - Toxicology/td [Trends] MH - *Toxicology MH - United Kingdom AB - 1. The alarming increase in the incidence of self-poisoning in Western countries in the 1950s prompted the establishment of the National Poisons Information Service in the UK and the designation of certain Regional Poisoning Treatment Centres. 2. The substances taken in acute poisoning episodes largely reflect the poisons available in the community and, in the UK at least, have changed with fashions in prescribing although psychotropic drugs and analgesics always predominate. 3. Intensive supportive care with repeat-dose oral activated charcoal and even haemoperfusion has been proved effective in acute poisoning with central nervous depressant drugs such as barbiturates even though these latter drugs are now rarely encountered in overdose. 4. Other advances in clinical toxicology include the introduction of the opiate antagonist naloxone, Fab antibody fragments for life-threatening digoxin overdosage and proven treatment for paracetamol poisoning. Analytical toxicology has also made a major contribution. 5. On the debit side, formal psychiatric assessment of patients after acute poisoning remains contentious, tricyclic antidepressants are still a major problem and there is no effective treatment for poisoning with paraquat or for paracetamol when presentation is delayed. 6. As to the future, although the 'epidemic' of serious acute poisoning of the 1960s and 70s appears to be past its peak, there will always be unusual and serious problems and the UK poisons information services must develop to make the best use of computer-based technology. [References: 36] IS - 0144-5952 IL - 0144-5952 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1988 Sep EZ - 1988/09/01 DA - 1988/09/01 00:01 DT - 1988/09/01 00:00 YR - 1988 ED - 19881227 RD - 20161123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=3056845 <955. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3142316 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Barsan WG AU - Brott TG AU - Olinger CP AU - Adams HP Jr AU - Haley EC Jr AU - Levy DE FA - Barsan, W G FA - Brott, T G FA - Olinger, C P FA - Adams, H P Jr FA - Haley, E C Jr FA - Levy, D E IN - Barsan, W G. Department of Emergency Medicine, College of Medicine, University of Cincinnati, Ohio. TI - Identification and entry of the patient with acute cerebral infarction. [Review] [35 refs] SO - Annals of Emergency Medicine. 17(11):1192-5, 1988 Nov AS - Ann Emerg Med. 17(11):1192-5, 1988 Nov NJ - Annals of emergency medicine VO - 17 IP - 11 PG - 1192-5 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Cerebral Infarction/di [Diagnosis] MH - Cerebral Infarction/et [Etiology] MH - Cerebral Infarction/th [Therapy] MH - Emergencies MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - Recurrence MH - Time Factors MH - Tissue Plasminogen Activator/tu [Therapeutic Use] AB - Although time has been recognized as a critical factor in the treatment of other arterial occlusive disorders, it has been an underemphasized variable in the treatment of acute stroke. Animal models of cerebral arterial occlusion have demonstrated that neurologic recovery is more likely the shorter the duration of occlusion. Complete recovery does not occur if the occlusion persists more than six hours. Prior trials have only rarely begun treatment within six hours of stroke onset. Over the past five years, we have participated in three stroke trials and have tried to identify factors that lead to delays in treatment. Factors that affect the time from stroke onset to arrival at the hospital include recognition of acute stroke by the patient, prehospital care personnel, and physicians. After arrival at the hospital, factors that can significantly delay treatment include the time to obtain computed tomography and the site of treatment (emergency department vs ICU). With proper attention, the time from patient arrival until treatment should be less than one hour. Future efforts should be directed toward reducing the time from stroke onset until arrival at the hospital. Education of the public, high-risk patients, prehospital care providers, and physicians may aid in these efforts. [References: 35] RN - 36B82AMQ7N (Naloxone) RN - EC 3-4-21-68 (Tissue Plasminogen Activator) IS - 0196-0644 IL - 0196-0644 PT - Journal Article PT - Review ID - S0196-0644(88)80067-2 [pii] PP - ppublish LG - English DP - 1988 Nov EZ - 1988/11/01 DA - 2001/03/28 10:01 DT - 1988/11/01 00:00 YR - 1988 ED - 19881212 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=3142316 <956. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3140692 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Mahla ME AU - White SE AU - Moneta MD FA - Mahla, M E FA - White, S E FA - Moneta, M D IN - Mahla, M E. Department of Surgery, Walter Reed Army Medical Center, Washington, D.C. TI - Delayed respiratory depression after alfentanil. SO - Anesthesiology. 69(4):593-5, 1988 Oct AS - Anesthesiology. 69(4):593-5, 1988 Oct NJ - Anesthesiology VO - 69 IP - 4 PG - 593-5 PI - Journal available in: Print PI - Citation processed from: Print JC - 4sg, 1300217 IO - Anesthesiology SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adolescent MH - Adult MH - Alfentanil MH - Fentanyl/ae [Adverse Effects] MH - *Fentanyl/aa [Analogs & Derivatives] MH - Humans MH - Male MH - Naloxone/tu [Therapeutic Use] MH - *Respiration Disorders/ci [Chemically Induced] MH - Respiration Disorders/dt [Drug Therapy] MH - Respiration Disorders/th [Therapy] MH - Respiration, Artificial MH - Spinal Fusion RN - 1N74HM2BS7 (Alfentanil) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0003-3022 IL - 0003-3022 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1988 Oct EZ - 1988/10/01 DA - 1988/10/01 00:01 DT - 1988/10/01 00:00 YR - 1988 ED - 19881107 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=3140692 <957. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3045281 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Chernick V AU - Manfreda J AU - De Booy V AU - Davi M AU - Rigatto H AU - Seshia M FA - Chernick, V FA - Manfreda, J FA - De Booy, V FA - Davi, M FA - Rigatto, H FA - Seshia, M IN - Chernick, V. Department and Pediatrics, University of Manitoba, Winnipeg, Canada. TI - Clinical trial of naloxone in birth asphyxia. SO - Journal of Pediatrics. 113(3):519-25, 1988 Sep AS - J Pediatr. 113(3):519-25, 1988 Sep NJ - The Journal of pediatrics VO - 113 IP - 3 PG - 519-25 PI - Journal available in: Print PI - Citation processed from: Print JC - jlz, 0375410 IO - J. Pediatr. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Apgar Score MH - *Asphyxia Neonatorum/dt [Drug Therapy] MH - Asphyxia Neonatorum/eh [Ethnology] MH - Clinical Trials as Topic MH - Delivery, Obstetric MH - Female MH - Heart Rate/de [Drug Effects] MH - Humans MH - Infant, Newborn MH - Injections, Intramuscular MH - Labor, Obstetric MH - Male MH - Maternal Age MH - *Naloxone/tu [Therapeutic Use] MH - Pregnancy MH - Respiration/de [Drug Effects] MH - Resuscitation AB - To determine whether endogenous opiates play a role in the pathogenesis of perinatal asphyxia, a blinded clinical trial of naloxone, a competitive opiate receptor blocker, was undertaken in infants with low 1-minute Apgar scores. Of 85 infants with 1-minute Apgar score 0 to 3, 44 received an injection of naloxone (approximately 0.4 mg/kg) and 41 received saline solution. In 108 infants with 1-minute Apgar score 4 to 6, 54 received naloxone and 54 saline solution. In neither group was there a significant effect of naloxone on respiratory frequency or heart rate up to 30 minutes after injection, nor at 24 hours of age. In both groups active muscle tone of upper and lower limbs was increased by naloxone, a response that may not be beneficial in the face of inadequate oxygen delivery to vital organs. We conclude that naloxone at this dose had no readily apparent benefit in the resuscitation of the asphyxiated newborn infant. RN - 36B82AMQ7N (Naloxone) IS - 0022-3476 IL - 0022-3476 PT - Clinical Trial PT - Controlled Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1988 Sep EZ - 1988/09/01 DA - 1988/09/01 00:01 DT - 1988/09/01 00:00 YR - 1988 ED - 19881012 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=3045281 <958. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3382089 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Neal JM FA - Neal, J M TI - Complications of naloxone. SO - Annals of Emergency Medicine. 17(7):765-6, 1988 Jul AS - Ann Emerg Med. 17(7):765-6, 1988 Jul NJ - Annals of emergency medicine VO - 17 IP - 7 PG - 765-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Emergency Service, Hospital MH - Humans MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/ae [Adverse Effects] MH - Narcotics/po [Poisoning] RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0196-0644 IL - 0196-0644 PT - Letter ID - S0196-0644(88)80654-1 [pii] PP - ppublish LG - English DP - 1988 Jul EZ - 1988/07/01 DA - 1988/07/01 00:01 DT - 1988/07/01 00:00 YR - 1988 ED - 19880728 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=3382089 <959. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3335070 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Feneley MP AU - Maier GW AU - Kern KB AU - Gaynor JW AU - Gall SA Jr AU - Sanders AB AU - Raessler K AU - Muhlbaier LH AU - Rankin JS AU - Ewy GA FA - Feneley, M P FA - Maier, G W FA - Kern, K B FA - Gaynor, J W FA - Gall, S A Jr FA - Sanders, A B FA - Raessler, K FA - Muhlbaier, L H FA - Rankin, J S FA - Ewy, G A IN - Feneley, M P. Department of Surgery, Duke University Medical Center, Durham, NC 27710. TI - Influence of compression rate on initial success of resuscitation and 24 hour survival after prolonged manual cardiopulmonary resuscitation in dogs. SO - Circulation. 77(1):240-50, 1988 Jan AS - Circulation. 77(1):240-50, 1988 Jan NJ - Circulation VO - 77 IP - 1 PG - 240-50 PI - Journal available in: Print PI - Citation processed from: Print JC - daw, 0147763 IO - Circulation SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Animals MH - Blood Gas Analysis MH - Dogs MH - Hemodynamics MH - *Resuscitation/mt [Methods] MH - Resuscitation/mo [Mortality] MH - Time Factors MH - Ventricular Fibrillation/mo [Mortality] MH - Ventricular Fibrillation/th [Therapy] AB - The influence of chest compression rate on initial resuscitation success and 24 hr survival after prolonged manual cardiopulmonary resuscitation (CPR) was investigated in 26 morphine-anesthetized dogs (17 to 30 kg). After placement of aortic and right atrial micromanometers and induction of ventricular fibrillation, manual CPR was commenced immediately and continued for 30 min. One group of 13 dogs underwent manual CPR at a compression rate of 60/min, and the other group at a rate of 120/min. The compression durations in the two groups were not significantly different (51.7 +/- 1.8% at 60/min vs 51.6 +/- 1.9% at 120/min). No drugs other than sodium bicarbonate were administered during CPR. A maximum of three attempts was permitted to defibrillate the heart. Successfully defibrillated animals were followed for 24 hr, during which time no treatment, other than naloxone, was given to reverse the effects of morphine. Arterial blood pH, PCO2, and PO2 were not significantly different in the two groups throughout the CPR period. When compared with the compression rate of 60/min, the compression rate of 120/min produced more successfully defibrillated animals (12/13 at 120/min vs 2/13 at 60/min, p less than .002) and more 24 hr survivors (8/13 at 120/min vs 2/13 at 60/min, p less than .03). All 24 hr survivors were conscious and able to sit, stand, and drink normally. One 24 hr survivor in each group had difficulty walking. Improved survival with the high-rate compression technique was consistent with the significantly higher mean aortic (systolic and diastolic) and coronary perfusion pressures attained with high-rate compressions (all p less than .002). Although the clinical applicability of these findings has yet to be demonstrated, they provide empirical support for the recent decision to increase the chest compression rate for manual CPR recommended by the American Heart Association, and indicate that the hemodynamic and survival benefits of faster compression rates in this experimental preparation were not dependent on covariant alterations in compression duration. IS - 0009-7322 IL - 0009-7322 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PP - ppublish GI - No: HL09315 Organization: (HL) *NHLBI NIH HHS* Country: United States GI - No: HL17670 Organization: (HL) *NHLBI NIH HHS* Country: United States GI - No: HL29436 Organization: (HL) *NHLBI NIH HHS* Country: United States LG - English DP - 1988 Jan EZ - 1988/01/01 DA - 2001/03/28 10:01 DT - 1988/01/01 00:00 YR - 1988 ED - 19880205 RD - 20071115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=3335070 <960. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2889589 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sefrin P AU - Lippert HD FA - Sefrin, P FA - Lippert, H D IN - Sefrin, P. Institut fur Anasthesiologie der Universitat, Wurzburg. TI - [Legal problems of the use of opioids in the rescue service]. [German] OT - Rechtliche Probleme beim Einsatz der Opioide im Rettungsdienst. SO - Deutsche Medizinische Wochenschrift. 112(43):1675-7, 1987 Oct 23 AS - Dtsch Med Wochenschr. 112(43):1675-7, 1987 Oct 23 NJ - Deutsche medizinische Wochenschrift (1946) VO - 112 IP - 43 PG - 1675-7 PI - Journal available in: Print PI - Citation processed from: Print JC - ecl, 0006723 IO - Dtsch. Med. Wochenschr. SB - Index Medicus CP - Germany MH - *Analgesics, Opioid/tu [Therapeutic Use] MH - *Emergency Medical Services/lj [Legislation & Jurisprudence] MH - Germany, West MH - Humans MH - Legislation, Drug RN - 0 (Analgesics, Opioid) IS - 0012-0472 IL - 0012-0472 PT - Journal Article ID - 10.1055/s-0029-1235992 [doi] PP - ppublish LG - German DP - 1987 Oct 23 EZ - 1987/10/23 DA - 1987/10/23 00:01 DT - 1987/10/23 00:00 YR - 1987 ED - 19871210 RD - 20041117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=2889589 <961. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3620032 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Foley PJ AU - Tacker WA AU - Voorhees WD AU - Ralston SH AU - Elchisak MA FA - Foley, P J FA - Tacker, W A FA - Voorhees, W D FA - Ralston, S H FA - Elchisak, M A TI - Effects of naloxone on the adrenomedullary response during and after cardiopulmonary resuscitation in dogs. SO - American Journal of Emergency Medicine. 5(5):357-61, 1987 Sep AS - Am J Emerg Med. 5(5):357-61, 1987 Sep NJ - The American journal of emergency medicine VO - 5 IP - 5 PG - 357-61 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus CP - United States MH - *Adrenal Medulla/de [Drug Effects] MH - Animals MH - Dogs MH - Epinephrine/bl [Blood] MH - Heart Arrest/me [Metabolism] MH - *Heart Arrest/th [Therapy] MH - Hemodynamics/de [Drug Effects] MH - *Naloxone/pd [Pharmacology] MH - Naloxone/tu [Therapeutic Use] MH - Norepinephrine/bl [Blood] MH - *Resuscitation AB - To determine the effects of naloxone, an opiate antagonist, on the adrenomedullary response to cardiac arrest, plasma epinephrine and norepinephrine levels were measured before, during, and after cardiac arrest in dogs. Ventricular fibrillation was induced in 12 dogs anesthetized with pentobarital sodium (30 mg/kg) and standard American Heart Association cardiopulmonary resuscitation (CPR) was begun using a mechanical device. At 6.5 minutes of CPR, naloxone (10 mg/kg) or 0.9% saline (10 ml) was given intravenously. At 12 minutes of CPR, the cardiac ventricles were electrically defibrillated. Plasma epinephrine and norepinephrine levels were measured before ventricular fibrillation; at 2.5, 4.5, 9.5, and 11.5, minutes of CPR; and at 5, 10, 15, and 20 minutes after resuscitation. Epinephrine and norepinephrine increased from prearrest levels of 3.66 +/- 0.67 (+/- SE) and 24.02 +/- 3.67 ng/ml to 66.67 +/- 9.65 and 74.00 +/- 9.91 ng/ml, respectively, at 4.5 minutes of CPR. After resuscitation, norepinephrine levels remained slightly elevated, while epinephrine fell to prearrest levels. Naloxone did not cause a significant change in either epinephrine or norepinephrine from 6.5 minutes of CPR (time of treatment) through 20 minutes postresuscitation. In addition, naloxone had no effect on either the end-diastolic pressure difference during CPR or resuscitation outcome. We conclude that cardiac arrest causes significant increases in plasma epinephrine and norepinephrine levels, which remain elevated for the duration of the arrest, and that naloxone has no effect on these levels. RN - 36B82AMQ7N (Naloxone) RN - X4W3ENH1CV (Norepinephrine) RN - YKH834O4BH (Epinephrine) IS - 0735-6757 IL - 0735-6757 PT - Journal Article PT - Research Support, Non-U.S. Gov't ID - 0735-6757(87)90381-0 [pii] PP - ppublish LG - English DP - 1987 Sep EZ - 1987/09/01 DA - 1987/09/01 00:01 DT - 1987/09/01 00:00 YR - 1987 ED - 19871020 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3620032 <962. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3112855 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Baum C AU - Hsu JP AU - Nelson RC FA - Baum, C FA - Hsu, J P FA - Nelson, R C TI - The impact of the addition of naloxone on the use and abuse of pentazocine. SO - Public Health Reports. 102(4):426-9, 1987 Jul-Aug AS - Public Health Rep. 102(4):426-9, 1987 Jul-Aug NJ - Public health reports (Washington, D.C. : 1974) VO - 102 IP - 4 PG - 426-9 PI - Journal available in: Print PI - Citation processed from: Print JC - 9716844, qja IO - Public Health Rep PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477863 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Coroners and Medical Examiners MH - Drug Combinations/tu [Therapeutic Use] MH - Drug Prescriptions MH - Emergency Service, Hospital MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - Pentazocine/ad [Administration & Dosage] MH - *Pentazocine/tu [Therapeutic Use] MH - Substance-Related Disorders/ep [Epidemiology] MH - Substance-Related Disorders/pc [Prevention & Control] MH - *Substance-Related Disorders MH - United States AB - An epidemic of abuse with "T's and blues" began in the late 1970's in which pentazocine-Talwin tablets ("T")--and the antihistamine tripelennamine (known as blues) were crushed, dissolved together, filtered, and injected intravenously. The resulting high was reported to be similar to that of heroin. In 1981, the manufacturer and the Food and Drug Administration met to discuss a possible solution. As a result, 0.5 mg of naloxone hydrochloride, a narcotic antagonist that is pharmacologically inactive at that dose orally but active if administered parenterally, was added to the tablet formulation. The reformulated product, Talwin Nx, was approved for marketing in late 1982 and introduced in the second quarter of 1983. Distribution of Talwin tablets in the United States was discontinued. The Drug Abuse Warning Network (DAWN) of the National Institute of Drug Abuse and IMS America's National Prescription Audit were used to review the use and abuse patterns of pentazocine before and after the naloxone intervention. The number of prescriptions dispensed quarterly for pentazocine products remained fairly stable from 1981 through the first quarter of 1983 and increased after the introduction of Talwin Nx. In contrast, DAWN emergency room and medical examiner mentions decreased after the product reformulation. The rates of both emergency room and medical examiner mentions per million prescriptions were substantially lower in the 2 years following the introduction of Talwin Nx (decreases of 70 percent by emergency rooms and 71 percent by medical examiners), indicating that the product reformulation successfully reduced pentazocine abuse. RN - 0 (Drug Combinations) RN - 126663-39-6 (talwin Nx) RN - 36B82AMQ7N (Naloxone) RN - RP4A60D26L (Pentazocine) IS - 0033-3549 IL - 0033-3549 PT - Journal Article ID - PMC1477863 [pmc] PP - ppublish LG - English DP - 1987 Jul-Aug EZ - 1987/07/01 DA - 1987/07/01 00:01 DT - 1987/07/01 00:00 YR - 1987 ED - 19870908 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3112855 <963. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3617047 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Schmid G AU - Russe M FA - Schmid, G FA - Russe, M TI - [Resuscitation of puppies after cesarean section]. [German] OT - Zur Reanimation der Welpen bei der Schnittentbindung. SO - Tierarztliche Praxis. 15(2):219-20, 1987 AS - Tierarztl Prax. 15(2):219-20, 1987 NJ - Tierarztliche Praxis VO - 15 IP - 2 PG - 219-20 PI - Journal available in: Print PI - Citation processed from: Print JC - vs4, 7501042 IO - Tierarztl Prax SB - Index Medicus CP - Germany MH - Animals MH - Animals, Newborn MH - Cesarean Section/ae [Adverse Effects] MH - *Cesarean Section/ve [Veterinary] MH - *Dog Diseases/dt [Drug Therapy] MH - Dogs MH - Female MH - Injections, Intravenous/ve [Veterinary] MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - Pregnancy MH - Respiratory Insufficiency/dt [Drug Therapy] MH - *Respiratory Insufficiency/ve [Veterinary] MH - *Resuscitation/ve [Veterinary] AB - The neonatal depression of puppies, developed by C-section, can be treated effectively by the application of 0.1-0.2 ml Narcanti respectively Narcanti Neonatal (Naloxon) right after development. The technique of the intravenous injection in newborn puppies is simple and easy to learn. RN - 36B82AMQ7N (Naloxone) IS - 0303-6286 IL - 0303-6286 PT - English Abstract PT - Journal Article PP - ppublish LG - German DP - 1987 EZ - 1987/01/01 DA - 1987/01/01 00:01 DT - 1987/01/01 00:00 YR - 1987 ED - 19870828 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3617047 <964. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2887020 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Otsuka H FA - Otsuka, H TI - [Are respiratory stimulants necessary? Yes]. [Review] [10 refs] [Japanese] SO - Kokyu to Junkan - Respiration & Circulation. 35(4):373-6, 1987 Apr AS - Kokyu To Junkan. 35(4):373-6, 1987 Apr NJ - Kokyu to junkan. Respiration & circulation VO - 35 IP - 4 PG - 373-6 PI - Journal available in: Print PI - Citation processed from: Print JC - r83, 0413532 IO - Kokyu To Junkan SB - Index Medicus CP - Japan MH - Almitrine MH - *Central Nervous System Stimulants/tu [Therapeutic Use] MH - *Doxapram/tu [Therapeutic Use] MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - *Piperazines/tu [Therapeutic Use] MH - Progesterone/tu [Therapeutic Use] MH - Respiration, Artificial MH - Respiratory Insufficiency/pp [Physiopathology] MH - *Respiratory Insufficiency/th [Therapy] MH - Theophylline/tu [Therapeutic Use] RN - 0 (Central Nervous System Stimulants) RN - 0 (Piperazines) RN - 36B82AMQ7N (Naloxone) RN - 4G7DS2Q64Y (Progesterone) RN - 94F3830Q73 (Doxapram) RN - 9A1222NBG4 (Almitrine) RN - C137DTR5RG (Theophylline) IS - 0452-3458 IL - 0452-3458 PT - Journal Article PT - Review PP - ppublish LG - Japanese DP - 1987 Apr EZ - 1987/04/01 DA - 1987/04/01 00:01 DT - 1987/04/01 00:00 YR - 1987 ED - 19870828 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=2887020 <965. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3589439 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Baud FJ AU - Bismuth C FA - Baud, F J FA - Bismuth, C TI - [Emergency treatment of overdose]. [French] OT - Traitement d'urgence de l'overdose. SO - Revue du Praticien. 37(29):1723-7, 1987 May 21 AS - Rev Prat. 37(29):1723-7, 1987 May 21 NJ - La Revue du praticien VO - 37 IP - 29 PG - 1723-7 PI - Journal available in: Print PI - Citation processed from: Print JC - t1d, 0404334 IO - Rev Prat SB - Foreign Journals CP - France MH - Coma/th [Therapy] MH - Emergencies MH - *Heroin/po [Poisoning] MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - Respiration, Artificial MH - Respiratory Insufficiency/et [Etiology] MH - *Respiratory Insufficiency/th [Therapy] RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) IS - 0035-2640 IL - 0035-2640 PT - English Abstract PT - Journal Article PP - ppublish LG - French DP - 1987 May 21 EZ - 1987/05/21 DA - 1987/05/21 00:01 DT - 1987/05/21 00:00 YR - 1987 ED - 19870708 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3589439 <966. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3592007 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tennant FS Jr AU - Wild J FA - Tennant, F S Jr FA - Wild, J TI - Naltrexone treatment for postconcussional syndrome. SO - American Journal of Psychiatry. 144(6):813-4, 1987 Jun AS - Am J Psychiatry. 144(6):813-4, 1987 Jun NJ - The American journal of psychiatry VO - 144 IP - 6 PG - 813-4 PI - Journal available in: Print PI - Citation processed from: Print JC - 0370512, 3vg IO - Am J Psychiatry SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Accidental Falls MH - Accidents, Traffic MH - Adult MH - *Brain Concussion/dt [Drug Therapy] MH - Brain Concussion/et [Etiology] MH - Brain Concussion/px [Psychology] MH - Female MH - Humans MH - *Naltrexone/tu [Therapeutic Use] MH - Syndrome AB - Two patients with postconcussional syndrome whose most severe symptoms were blackouts, headaches, and amnesia episodes appeared to respond to naltrexone. Because life-saving emergency trauma services are widely available, it is likely that the incidence of postconcussional syndrome will increase. RN - 5S6W795CQM (Naltrexone) IS - 0002-953X IL - 0002-953X PT - Case Reports PT - Journal Article ID - 10.1176/ajp.144.6.813 [doi] PP - ppublish LG - English DP - 1987 Jun EZ - 1987/06/01 DA - 2001/03/28 10:01 DT - 1987/06/01 00:00 YR - 1987 ED - 19870701 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3592007 <967. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3744788 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Roytblat L AU - Bear R AU - Gesztes T FA - Roytblat, L FA - Bear, R FA - Gesztes, T TI - Seizures after pentazocine overdose. SO - Israel Journal of Medical Sciences. 22(5):385-6, 1986 May AS - Isr J Med Sci. 22(5):385-6, 1986 May NJ - Israel journal of medical sciences VO - 22 IP - 5 PG - 385-6 PI - Journal available in: Print PI - Citation processed from: Print JC - gy0, 0013105 IO - Isr. J. Med. Sci. SB - Index Medicus CP - Israel MH - Adolescent MH - Coma/ci [Chemically Induced] MH - Coma/th [Therapy] MH - Female MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - *Pentazocine/po [Poisoning] MH - Respiration, Artificial MH - Respiratory Insufficiency/ci [Chemically Induced] MH - Respiratory Insufficiency/th [Therapy] MH - *Seizures/ci [Chemically Induced] AB - A patient with seizures, coma and respiratory depression after pentazocine overdose was treated successfully with naloxone and artificial ventilation. Pentazocine is an antagonist of the mu opioid receptors and a partial agonist of the kappa and sigma receptors. Because naloxone has less affinity for kappa and sigma receptors than for mu receptors, larger doses of naloxone are frequently required in the treatment of pentazocine overdose. Our case lends support to the view that large doses of the narcotic antagonist naloxone may be effective in pentazocine overdose. RN - 36B82AMQ7N (Naloxone) RN - RP4A60D26L (Pentazocine) IS - 0021-2180 IL - 0021-2180 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1986 May EZ - 1986/05/01 DA - 1986/05/01 00:01 DT - 1986/05/01 00:00 YR - 1986 ED - 19861021 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3744788 <968. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3529631 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Benitz WE AU - Frankel LR AU - Stevenson DK FA - Benitz, W E FA - Frankel, L R FA - Stevenson, D K TI - The pharmacology of neonatal resuscitation and cardiopulmonary intensive care. Part II--Extended intensive care. [Review] [21 refs] SO - Western Journal of Medicine. 145(1):47-51, 1986 Jul AS - West J Med. 145(1):47-51, 1986 Jul NJ - The Western journal of medicine VO - 145 IP - 1 PG - 47-51 PI - Journal available in: Print PI - Citation processed from: Print JC - 0410504, xn5 IO - West. J. Med. PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1306814 SB - Index Medicus CP - United States MH - Alprostadil/pd [Pharmacology] MH - Cardiac Output/de [Drug Effects] MH - Coronary Circulation/de [Drug Effects] MH - Ductus Arteriosus/de [Drug Effects] MH - Humans MH - Indomethacin/pd [Pharmacology] MH - Infant, Newborn MH - Infant, Newborn, Diseases/pp [Physiopathology] MH - *Infant, Newborn, Diseases/th [Therapy] MH - *Intensive Care Units, Neonatal MH - Nitroprusside/pd [Pharmacology] MH - Pulmonary Circulation/de [Drug Effects] MH - Pulmonary Gas Exchange/de [Drug Effects] MH - *Resuscitation MH - Sympathomimetics/pd [Pharmacology] MH - Tolazoline/pd [Pharmacology] MH - Vascular Resistance/de [Drug Effects] AB - An optimal outcome for a distressed newborn infant can be achieved only if immediate resuscitation is followed by appropriate cardiopulmonary intensive care. In the preceding article in this series, we provided recommendations for drug therapy during the initial resuscitation. When an infant is stable enough for transfer to an intensive care nursery, extended cardiopulmonary intensive care should be initiated. If the infant remains distressed, this may require drug therapy to improve cardiac output, either by enhancing cardiac performance (dopamine, dobutamine or epinephrine) or by reducing afterload (nitroprusside). Drugs that alter the distribution of the circulation may be required for infants with persistent hypoxemia due to pulmonary hypertension or congenital heart disease (tolazoline, nitroprusside, prostaglandin E(1)), or with pulmonary congestion due to persistent patency of the ductus arteriosus (indomethacin). Infants with pulmonary disease may benefit from administration of agents that alter pulmonary function (furosemide, nitroprusside or neuromuscular blockers). Finally, treatment of the underlying disorder, with antibiotics or naloxone, for example, must not be neglected. [References: 21] RN - 0 (Sympathomimetics) RN - 169D1260KM (Nitroprusside) RN - CHH9H12AQ3 (Tolazoline) RN - F5TD010360 (Alprostadil) RN - XXE1CET956 (Indomethacin) IS - 0093-0415 IL - 0093-0415 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PT - Review ID - PMC1306814 [pmc] PP - ppublish GI - No: RR-81 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English DP - 1986 Jul EZ - 1986/07/01 DA - 1986/07/01 00:01 DT - 1986/07/01 00:00 YR - 1986 ED - 19860930 RD - 20161019 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3529631 <969. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3527527 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Raehl CL FA - Raehl, C L TI - Endotracheal drug therapy in cardiopulmonary resuscitation. [Review] [62 refs] SO - Clinical Pharmacy. 5(7):572-9, 1986 Jul AS - Clin Pharm. 5(7):572-9, 1986 Jul NJ - Clinical pharmacy VO - 5 IP - 7 PG - 572-9 PI - Journal available in: Print PI - Citation processed from: Print JC - 8207437, dkc IO - Clin Pharm SB - Index Medicus CP - United States MH - Atropine/ad [Administration & Dosage] MH - Atropine/pd [Pharmacology] MH - Bretylium Tosylate/ad [Administration & Dosage] MH - Bretylium Tosylate/pd [Pharmacology] MH - Diazepam/ad [Administration & Dosage] MH - Diazepam/pd [Pharmacology] MH - Epinephrine/ad [Administration & Dosage] MH - Epinephrine/pd [Pharmacology] MH - Humans MH - Intubation, Intratracheal MH - Kinetics MH - Lidocaine/ad [Administration & Dosage] MH - Lidocaine/pd [Pharmacology] MH - Metaraminol/ad [Administration & Dosage] MH - Metaraminol/pd [Pharmacology] MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/pd [Pharmacology] MH - *Pharmaceutical Preparations/ad [Administration & Dosage] MH - *Resuscitation AB - Use of endotracheal drug therapy during cardiopulmonary resuscitation (CPR) is reviewed. Endotracheal drug therapy--instillation of a drug solution directly into an endotracheal tube for absorption into the circulation via the alveoli--may be used during CPR when venous access is limited. Administration of drugs via a central vein is the most efficient route, but a central i.v. line may not be present and peripheral venous administration may not be possible because of vasoconstriction, trauma, other patient-related factors, or absence of personnel trained to insert i.v. catheters. An endotracheal tube is usually inserted during CPR; in most cases, this procedure can be performed outside the hospital by emergency medical personnel. Basic life-support measures are not interrupted during endotracheal administration as they are in intracardiac drug administration. Drugs that may be administered by the endotracheal route include epinephrine, atropine sulfate, lidocaine hydrochloride, naloxone hydrochloride, and metaraminol bitartrate. Endotracheal delivery of calcium salts, sodium bicarbonate, and bretylium tosylate is not recommended. Pharmacokinetic data for drugs administered endotracheally are lacking; therefore, dosage recommendations are empirical. Usually, the same dose is administered endotracheally as by the i.v. route. Little is known about choice and volume of diluent and the best anatomic site of application. Endotracheal drug administration may replace intracardiac injection as the second-line alternative to intravenous drug injection during CPR. [References: 62] RN - 0 (Pharmaceutical Preparations) RN - 36B82AMQ7N (Naloxone) RN - 78ZP3YR353 (Bretylium Tosylate) RN - 7C0697DR9I (Atropine) RN - 818U2PZ2EH (Metaraminol) RN - 98PI200987 (Lidocaine) RN - Q3JTX2Q7TU (Diazepam) RN - YKH834O4BH (Epinephrine) IS - 0278-2677 IL - 0278-2677 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1986 Jul EZ - 1986/07/01 DA - 1986/07/01 00:01 DT - 1986/07/01 00:00 YR - 1986 ED - 19860926 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3527527 <970. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3522848 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lobe TE AU - Dobkin ED AU - Gore D AU - Bhatia J AU - Linares HA AU - Traber DL FA - Lobe, T E FA - Dobkin, E D FA - Gore, D FA - Bhatia, J FA - Linares, H A FA - Traber, D L TI - Comparative effects of dopamine, naloxone, and prostacyclin in the resuscitation of fecal-Escherichia coli peritonitis-induced septic shock in neonatal swine. SO - Journal of Pediatric Surgery. 21(6):539-44, 1986 Jun AS - J Pediatr Surg. 21(6):539-44, 1986 Jun NJ - Journal of pediatric surgery VO - 21 IP - 6 PG - 539-44 PI - Journal available in: Print PI - Citation processed from: Print JC - jmj, 0052631 IO - J. Pediatr. Surg. SB - Index Medicus CP - United States MH - Analysis of Variance MH - Animals MH - Animals, Newborn MH - *Dopamine/tu [Therapeutic Use] MH - Drug Evaluation MH - *Epoprostenol/tu [Therapeutic Use] MH - *Escherichia coli Infections/co [Complications] MH - Feces/mi [Microbiology] MH - Hemodynamics/de [Drug Effects] MH - Intestinal Perforation/co [Complications] MH - Naloxone/ae [Adverse Effects] MH - *Naloxone/tu [Therapeutic Use] MH - *Peritonitis/co [Complications] MH - *Resuscitation MH - *Shock, Septic/dt [Drug Therapy] MH - Shock, Septic/et [Etiology] MH - Swine MH - Time Factors AB - To explain the high neonatal mortality from peritonitis-induced septic shock despite current resuscitation practices, the efficacy of dopamine, naloxone, and prostacyclin was evaluated in an experimental neonatal model. Hemodynamics were monitored and survival was measured in anesthetized neonatal swine, which were subjected to fatal fecal-Escherichia coli peritonitis-induced septic shock. All the animals received fluid resuscitation, antibiotics, and bicarbonate to correct acidosis. Pharmacologic resuscitation began when cardiac output dropped below baseline in the experimental groups. Although significant differences were observed between groups in cardiac output, mean arterial and mean pulmonary arterial pressures, left ventricular stroke work, stroke volume, and pulmonary vascular resistance indices (P less than 0.02), and each animal exhibited favorable hemodynamic responses during the first several hours of dopamine and naloxone infusion, these drugs failed to prolong survival. Also, 5 of the 9 naloxone-treated pigs (56%), died with histologically proven intestinal ischemia (P less than 0.02). Thus, dopamine, naloxone, and prostacyclin (at doses commonly recommended for the treatment of septic shock) fail to positively influence the fatal course of this condition, and the use of naloxone in this model is associated with profound intestinal ischemia. RN - 36B82AMQ7N (Naloxone) RN - DCR9Z582X0 (Epoprostenol) RN - VTD58H1Z2X (Dopamine) IS - 0022-3468 IL - 0022-3468 PT - Comparative Study PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. ID - S0022346886002099 [pii] PP - ppublish GI - No: 2S07-RR07-205-03 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English DP - 1986 Jun EZ - 1986/06/01 DA - 1986/06/01 00:01 DT - 1986/06/01 00:00 YR - 1986 ED - 19860725 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3522848 <971. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3703770 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hankins DG FA - Hankins, D G TI - Controversies in resuscitation. SO - Postgraduate Medicine. 79(7):24-6, 29-30, 33, 1986 May 15 AS - Postgrad Med. 79(7):24-6, 29-30, 33, 1986 May 15 NJ - Postgraduate medicine VO - 79 IP - 7 PG - 24-6, 29-30, 33 PI - Journal available in: Print PI - Citation processed from: Print JC - 0401147, pfk IO - Postgrad Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Calcium/ai [Antagonists & Inhibitors] MH - Calcium/tu [Therapeutic Use] MH - Calcium Channel Blockers/tu [Therapeutic Use] MH - Esophagus MH - Gravity Suits MH - Heart Massage MH - Humans MH - Intubation, Intratracheal/ae [Adverse Effects] MH - Naloxone/tu [Therapeutic Use] MH - Respiration, Artificial MH - Resuscitation/mt [Methods] MH - *Resuscitation MH - Thorax AB - Many controversies, only a few of which have been discussed here, are now raging in the field of resuscitation. Much is expected to change in the next five to ten years. The American Heart Association is now considering changes for its new advanced cardiac life support course, which should be ready this year. The course will not include some of the possible changes mentioned in this article, because too few studies have been done. Physicians and other rescuers should abide by the guidelines of the American Heart Association as a standard of practice because its recommendations are the result of the best possible consensus. Over the next several years, many exciting changes in resuscitation will occur and may lead to improved survival rates and quality. RN - 0 (Calcium Channel Blockers) RN - 36B82AMQ7N (Naloxone) RN - SY7Q814VUP (Calcium) IS - 0032-5481 IL - 0032-5481 PT - Journal Article PP - ppublish LG - English DP - 1986 May 15 EZ - 1986/05/15 DA - 1986/05/15 00:01 DT - 1986/05/15 00:00 YR - 1986 ED - 19860612 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3703770 <972. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3954192 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Soslow AR FA - Soslow, A R TI - Naloxone use during cardiac arrest and CPR. SO - Annals of Emergency Medicine. 15(4):512, 1986 Apr AS - Ann Emerg Med. 15(4):512, 1986 Apr NJ - Annals of emergency medicine VO - 15 IP - 4 PG - 512 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Heart Arrest/dt [Drug Therapy] MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - Resuscitation RN - 36B82AMQ7N (Naloxone) IS - 0196-0644 IL - 0196-0644 PT - Letter ID - S0196-0644(86)80250-5 [pii] PP - ppublish LG - English DP - 1986 Apr EZ - 1986/04/01 DA - 1986/04/01 00:01 DT - 1986/04/01 00:00 YR - 1986 ED - 19860421 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3954192 <973. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3632968 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hasegawa EA FA - Hasegawa, E A TI - The endotracheal use of emergency drugs. SO - Heart & Lung. 15(1):60-3, 1986 Jan AS - Heart Lung. 15(1):60-3, 1986 Jan NJ - Heart & lung : the journal of critical care VO - 15 IP - 1 PG - 60-3 PI - Journal available in: Print PI - Citation processed from: Print JC - g2v, 0330057 IO - Heart Lung SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Animals MH - Atropine/ad [Administration & Dosage] MH - *Emergencies MH - Epinephrine/ad [Administration & Dosage] MH - Humans MH - *Intubation, Intratracheal MH - Lidocaine/ad [Administration & Dosage] MH - Naloxone/ad [Administration & Dosage] MH - *Pharmaceutical Preparations/ad [Administration & Dosage] AB - The endotracheal route for medication is useful in emergency situations. Epinephrine, atropine, and naloxone have proved to be effective when administered by this route. Experience with lidocaine is largely anecdotal, but the available information and the drug's chemical properties indicate that endotracheal lidocaine may be considered if necessary. Drugs that should not be given by the endotracheal route include bretylium, diazepam, calcium salts, isoproterenol, norepinephrine, and sodium bicarbonate. RN - 0 (Pharmaceutical Preparations) RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 98PI200987 (Lidocaine) RN - YKH834O4BH (Epinephrine) IS - 0147-9563 IL - 0147-9563 PT - Journal Article PP - ppublish LG - English DP - 1986 Jan EZ - 1986/01/01 DA - 1986/01/01 00:01 DT - 1986/01/01 00:00 YR - 1986 ED - 19860228 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3632968 <974. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 2417455 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Maier RV AU - Carrico CJ FA - Maier, R V FA - Carrico, C J TI - Developments in the resuscitation of critically ill surgical patients. [Review] [158 refs] SO - Advances in Surgery. 19:271-328, 1986 AS - Adv Surg. 19:271-328, 1986 NJ - Advances in surgery VO - 19 PG - 271-328 PI - Journal available in: Print PI - Citation processed from: Print JC - 2pj, 0045335 IO - Adv Surg SB - Index Medicus CP - United States MH - Adenosine Triphosphate/tu [Therapeutic Use] MH - Albumins/tu [Therapeutic Use] MH - *Blood Substitutes/tu [Therapeutic Use] MH - Blood Volume MH - Dextrans/tu [Therapeutic Use] MH - *Fluid Therapy MH - Fluorocarbons/tu [Therapeutic Use] MH - Humans MH - Hydroxyethyl Starch Derivatives/tu [Therapeutic Use] MH - Isotonic Solutions MH - Magnesium/tu [Therapeutic Use] MH - Magnesium Chloride MH - Naloxone/tu [Therapeutic Use] MH - *Plasma Substitutes/tu [Therapeutic Use] MH - *Resuscitation MH - Saline Solution, Hypertonic/tu [Therapeutic Use] MH - Shock/th [Therapy] MH - Sodium Chloride/tu [Therapeutic Use] MH - *Surgical Procedures, Operative AB - Despite the fact that many new exciting prospects are on the horizon, volume support remains the cornerstone of resuscitation of the critically ill surgical patient. Their limitations not withstanding, balanced electrolyte solutions, properly used, are the most efficacious choice in the majority of patients. The patient's eventual survival depends not only on skillful resuscitation but on the ability to identify and correct the underlying cause. [References: 158] RN - 0 (Albumins) RN - 0 (Blood Substitutes) RN - 0 (Dextrans) RN - 0 (Fluorocarbons) RN - 0 (Hydroxyethyl Starch Derivatives) RN - 0 (Isotonic Solutions) RN - 0 (Plasma Substitutes) RN - 0 (Saline Solution, Hypertonic) RN - 02F3473H9O (Magnesium Chloride) RN - 36B82AMQ7N (Naloxone) RN - 451W47IQ8X (Sodium Chloride) RN - 8L70Q75FXE (Adenosine Triphosphate) RN - I38ZP9992A (Magnesium) IS - 0065-3411 IL - 0065-3411 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1986 EZ - 1986/01/01 DA - 1986/01/01 00:01 DT - 1986/01/01 00:00 YR - 1986 ED - 19860214 RD - 20161123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=2417455 <975. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3934529 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Krottmayer G AU - Kerbel R AU - Muller WD AU - Kurz R FA - Krottmayer, G FA - Kerbel, R FA - Muller, W D FA - Kurz, R TI - [Congenital central hypoventilation syndrome--loss of chemosensitivity in respiratory control]. [German] OT - Kongenitales zentrales Hypoventilationssyndrom--Verlust der Chemosensibilitat in der Atemregulation. SO - Monatsschrift Kinderheilkunde. Organ der Deutschen Gesellschaft fur Kinderheilkunde. 133(10):764-6, 1985 Oct AS - Monatsschr Kinderheilkd. 133(10):764-6, 1985 Oct NJ - Monatsschrift Kinderheilkunde : Organ der Deutschen Gesellschaft fur Kinderheilkunde VO - 133 IP - 10 PG - 764-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 8206462 IO - Monatsschr Kinderheilkd SB - Index Medicus CP - Germany MH - Carbon Dioxide/bl [Blood] MH - *Chemoreceptor Cells/pp [Physiopathology] MH - Combined Modality Therapy MH - Female MH - Humans MH - *Hypoventilation/cn [Congenital] MH - Hypoventilation/pp [Physiopathology] MH - Hypoventilation/th [Therapy] MH - Infant MH - Oxygen/bl [Blood] MH - Respiration, Artificial MH - *Respiratory Center/pp [Physiopathology] AB - This report describes an infant with congenital central hypoventilation. There is no response to 4% CO2-breathing in sleep and in awake state. Hypoxia, behavioral and "behavioral like" inputs increase ventilation, but not to normal levels. Drugs such as theophylline, naloxone, acetazolamide, methylprogesterone, thyroxine and nicethamide have no effect on the respiratory control. Despite the insertion of a phrenic nerve pacemaker intermittent positive pressure ventilation must be provided in addition. RN - 142M471B3J (Carbon Dioxide) RN - S88TT14065 (Oxygen) IS - 0026-9298 IL - 0026-9298 PT - Case Reports PT - English Abstract PT - Journal Article PP - ppublish LG - German DP - 1985 Oct EZ - 1985/10/01 DA - 1985/10/01 00:01 DT - 1985/10/01 00:00 YR - 1985 ED - 19860109 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3934529 <976. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 4002110 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shatney CH AU - Cohen RM AU - Cohen MR AU - Imagawa DK FA - Shatney, C H FA - Cohen, R M FA - Cohen, M R FA - Imagawa, D K TI - Endogenous opioid activity in clinical hemorrhagic shock. SO - Surgery, Gynecology & Obstetrics. 160(6):547-51, 1985 Jun AS - Surg Gynecol Obstet. 160(6):547-51, 1985 Jun NJ - Surgery, gynecology & obstetrics VO - 160 IP - 6 PG - 547-51 PI - Journal available in: Print PI - Citation processed from: Print JC - vbd, 0101370 IO - Surg Gynecol Obstet SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Accidents, Traffic MH - Adolescent MH - Adult MH - Aged MH - Blood Pressure MH - *Endorphins/bl [Blood] MH - Endorphins/me [Metabolism] MH - Female MH - Humans MH - *Hydrocortisone/bl [Blood] MH - Male MH - Middle Aged MH - Radioimmunoassay MH - Shock, Hemorrhagic/bl [Blood] MH - Shock, Hemorrhagic/et [Etiology] MH - *Shock, Hemorrhagic/pp [Physiopathology] MH - Trauma Centers MH - Wounds, Nonpenetrating/bl [Blood] MH - Wounds, Nonpenetrating/et [Etiology] MH - *Wounds, Nonpenetrating/pp [Physiopathology] AB - Plasma beta-endorphin, cortisol and total opioid-like activities were measured upon arrival at the hospital in ten patients with extensive trauma and in a state of shock and 11 patients with minor injury. Patients in a state of shock had significantly (p less than 0.01) higher mean plasma beta-endorphin immunoreactivity than patients with minor trauma (128.8 +/- 24.8 picomolars versus 31.7 +/- 5.6 picomolars). There were no significant intergroup differences in the mean plasma cortisol concentration (27.7 +/- 4.7 micrograms per deciliter versus 20.6 +/- 2.7 micrograms per deciliter) or opioid ligand activity (2.28 +/- 0.62 nanomolars versus 3.17 +/- 0.99 nanomolars). These data are consistent with the hypothesis that certain endogenous opioids may be physiopathologic factors in hemorrhagic shock but provide no proof of a cause and effect relationship. RN - 0 (Endorphins) RN - WI4X0X7BPJ (Hydrocortisone) IS - 0039-6087 IL - 0039-6087 PT - Journal Article PP - ppublish LG - English DP - 1985 Jun EZ - 1985/06/01 DA - 1985/06/01 00:01 DT - 1985/06/01 00:00 YR - 1985 ED - 19850715 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=4002110 <977. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3994086 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Reinhart S AU - Barrett SM FA - Reinhart, S FA - Barrett, S M TI - An acute hypertensive response after intravenous use of a new pentazocine formulation. SO - Annals of Emergency Medicine. 14(6):591-3, 1985 Jun AS - Ann Emerg Med. 14(6):591-3, 1985 Jun NJ - Annals of emergency medicine VO - 14 IP - 6 PG - 591-3 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Clonidine/tu [Therapeutic Use] MH - Female MH - Humans MH - *Hypertension/ci [Chemically Induced] MH - Hypertension/dt [Drug Therapy] MH - Injections, Intravenous MH - *Pentazocine MH - *Substance-Related Disorders MH - *Tripelennamine AB - We present the case of a 27-year-old woman with a history of drug abuse. Following her routine intravenous (IV) injection of solubilized pentazocine and tripelennamine tablets ("Ts and Blues"), the patient developed severe hypertension, a finding not characteristic of either drug alone or of the combination. The manufacturers of Talwin (pentazocine) recently have added naloxone to the tablets to discourage IV abuse of this oral preparation. Our patient unknowingly had injected the new pentazocine formulation, and she subsequently developed narcotic withdrawal symptoms. Her hypertension was treated, and she was discharged from the emergency department. We report the case as an "unusual reaction" that may develop in frequent abusers of pentazocine and its combinations. RN - 3C5ORO99TY (Tripelennamine) RN - MN3L5RMN02 (Clonidine) RN - RP4A60D26L (Pentazocine) IS - 0196-0644 IL - 0196-0644 PT - Case Reports PT - Journal Article ID - S0196-0644(85)80788-5 [pii] PP - ppublish LG - English DP - 1985 Jun EZ - 1985/06/01 DA - 1985/06/01 00:01 DT - 1985/06/01 00:00 YR - 1985 ED - 19850613 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3994086 <978. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3158260 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Steinbrook RA AU - Weinberger SE AU - Carr DB AU - von Gal E AU - Fisher J AU - Leith DE AU - Fencl V AU - Rosenblatt M FA - Steinbrook, R A FA - Weinberger, S E FA - Carr, D B FA - von Gal, E FA - Fisher, J FA - Leith, D E FA - Fencl, V FA - Rosenblatt, M TI - Endogenous opioids and ventilatory responses to hypoxia in normal humans. SO - American Review of Respiratory Disease. 131(4):588-91, 1985 Apr AS - Am Rev Respir Dis. 131(4):588-91, 1985 Apr NJ - The American review of respiratory disease VO - 131 IP - 4 PG - 588-91 PI - Journal available in: Print PI - Citation processed from: Print JC - 426, 0370523 IO - Am. Rev. Respir. Dis. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - *Endorphins/bl [Blood] MH - Humans MH - Hypoxia/et [Etiology] MH - *Hypoxia/pp [Physiopathology] MH - *Lung Volume Measurements MH - Male MH - Naloxone/pd [Pharmacology] MH - Placebos MH - Respiration, Artificial MH - Time Factors MH - beta-Endorphin AB - We studied the putative role of endorphins in modulating hypoxic ventilatory responsiveness. In 12 healthy men, minute ventilation (VE)and mouth occlusion pressure (P0.1) responses to progressive isocapnic hypoxia were determined before and after the intravenous administration of the opioid antagonist naloxone (10 mg) or placebo. Plasma levels of beta-endorphin were measured before and after hypoxia. Naloxone did not affect the slopes or x-intercepts of the relationships between either VE or P0.1 and arterial O2 saturation. There was no correlation between the baseline plasma level of beta-endorphin and any measure of responsiveness to hypoxia. Plasma beta-endorphin levels were not affected by either short-term hypoxia or naloxone alone; however, when hypoxia followed naloxone administration, mean +/- SD beta-endorphin increased from 8.0 +/- 8.9 pg/ml to 20.2 +/- 16.6 pg/ml (p less than 0.005). We concluded that endogenous opioids do not have an important modulating influence on hypoxic ventilatory responsiveness in adult human volunteers. RN - 0 (Endorphins) RN - 0 (Placebos) RN - 36B82AMQ7N (Naloxone) RN - 60617-12-1 (beta-Endorphin) IS - 0003-0805 IL - 0003-0805 PT - Clinical Trial PT - Controlled Clinical Trial PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. ID - 10.1164/arrd.1985.131.4.588 [doi] PP - ppublish GI - No: HL-19170 Organization: (HL) *NHLBI NIH HHS* Country: United States GI - No: RR-01032 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English DP - 1985 Apr EZ - 1985/04/01 DA - 1985/04/01 00:01 DT - 1985/04/01 00:00 YR - 1985 ED - 19850612 RD - 20161123 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3158260 <979. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 3919621 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rothstein RJ AU - Niemann JT AU - Rennie CJ 3rd AU - Suddath WO AU - Rosborough JP FA - Rothstein, R J FA - Niemann, J T FA - Rennie, C J 3rd FA - Suddath, W O FA - Rosborough, J P TI - Use of naloxone during cardiac arrest and CPR: potential adjunct for postcountershock electrical-mechanical dissociation. SO - Annals of Emergency Medicine. 14(3):198-203, 1985 Mar AS - Ann Emerg Med. 14(3):198-203, 1985 Mar NJ - Annals of emergency medicine VO - 14 IP - 3 PG - 198-203 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Animals MH - Blood Pressure/de [Drug Effects] MH - Carbon Dioxide/bl [Blood] MH - Coronary Circulation/de [Drug Effects] MH - Dogs MH - *Electric Countershock MH - Epinephrine/ad [Administration & Dosage] MH - Epinephrine/pd [Pharmacology] MH - Female MH - Heart Arrest/et [Etiology] MH - Heart Arrest/pp [Physiopathology] MH - *Heart Arrest/th [Therapy] MH - *Hemodynamics/de [Drug Effects] MH - Male MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/pd [Pharmacology] MH - Oxygen/bl [Blood] MH - *Resuscitation MH - Stroke Volume/de [Drug Effects] MH - Ventricular Fibrillation/co [Complications] MH - Ventricular Fibrillation/pp [Physiopathology] MH - *Ventricular Fibrillation/th [Therapy] AB - Naloxone has been shown to increase arterial pressure in hemorrhagic and septic shock. To determine if naloxone has salutary effects during cardiac arrest with conventional closed-chest cardiopulmonary resuscitation (CPR), ten dogs were studied during 20 minutes of ventricular fibrillation (VF) and CPR and during a 30-minute postcountershock period. Central aortic (Ao) and right atrial (RA) systolic and end-diastolic (EDP) pressures, instantaneous Ao-RA pressure difference (coronary perfusion pressure), and electromagnetic Ao flow were measured. Ao and RA samples were analyzed during a control period and at five-minute intervals during CPR for PO2, PCO2, and pH. During VF, a piston-cylinder device was used to perform anteroposterior sternal depressions and positive pressure ventilations (100% O2) at standard rates and ratios. After 15 minutes of CPR, animals were randomized and given either naloxone (5 mg/kg) or epinephrine (1 mg). Defibrillation was attempted five minutes later using 1 J/kg and then, if necessary, 2, 4, 8, 12, and 16 J/kg until VF was terminated or the maximum energy dose was reached. If VF persisted or if countershock resulted in asystole or a nonperfusing rhythm (electrical-mechanical dissociation [EMD]), the alternate drug (naloxone or epinephrine) was then given. Measured systolic pressures, coronary perfusion pressures, aortic flow, and blood gases were not significantly different during the control period or at five, ten, and 15 minutes of VF and CPR between animal groups prior to drug administration. When compared to hemodynamic values measured at 15 minutes, naloxone had no significant effect on pressures or aortic flow measured five minutes after administration.(ABSTRACT TRUNCATED AT 250 WORDS) RN - 142M471B3J (Carbon Dioxide) RN - 36B82AMQ7N (Naloxone) RN - S88TT14065 (Oxygen) RN - YKH834O4BH (Epinephrine) IS - 0196-0644 IL - 0196-0644 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. ID - S0196-0644(85)80439-X [pii] PP - ppublish GI - No: RR05541 Organization: (RR) *NCRR NIH HHS* Country: United States LG - English DP - 1985 Mar EZ - 1985/03/01 DA - 1985/03/01 00:01 DT - 1985/03/01 00:00 YR - 1985 ED - 19850404 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=3919621 <980. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6396072 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Boike SC AU - Rybak MJ FA - Boike, S C FA - Rybak, M J TI - Pharmacologic interventions in resuscitation. [Review] [135 refs] SO - Emergency Medicine Clinics of North America. 1(3):553-69, 1983 Dec AS - Emerg Med Clin North Am. 1(3):553-69, 1983 Dec NJ - Emergency medicine clinics of North America VO - 1 IP - 3 PG - 553-69 PI - Journal available in: Print PI - Citation processed from: Print JC - egd, 8219565 IO - Emerg. Med. Clin. North Am. SB - Index Medicus CP - United States MH - Adrenal Cortex Hormones/tu [Therapeutic Use] MH - *Anti-Arrhythmia Agents/tu [Therapeutic Use] MH - Arrhythmias, Cardiac/dt [Drug Therapy] MH - Atropine/tu [Therapeutic Use] MH - Bretylium Tosylate/tu [Therapeutic Use] MH - Calcium Channel Blockers/tu [Therapeutic Use] MH - *Cardiotonic Agents/tu [Therapeutic Use] MH - Dobutamine/tu [Therapeutic Use] MH - Dopamine/tu [Therapeutic Use] MH - Heart Arrest/dt [Drug Therapy] MH - Humans MH - Isoproterenol/tu [Therapeutic Use] MH - Lidocaine/tu [Therapeutic Use] MH - Naloxone/tu [Therapeutic Use] MH - Norepinephrine/tu [Therapeutic Use] MH - *Resuscitation/mt [Methods] MH - *Vasoconstrictor Agents/tu [Therapeutic Use] AB - Pharmacologic agents are used to improve conditions that may contribute to the development of cardiac arrest such as dysrhythmias, hypotension, shock, or anoxia. The authors review the clinical application of several specific agents in resuscitation. [References: 135] RN - 0 (Adrenal Cortex Hormones) RN - 0 (Anti-Arrhythmia Agents) RN - 0 (Calcium Channel Blockers) RN - 0 (Cardiotonic Agents) RN - 0 (Vasoconstrictor Agents) RN - 36B82AMQ7N (Naloxone) RN - 3S12J47372 (Dobutamine) RN - 78ZP3YR353 (Bretylium Tosylate) RN - 7C0697DR9I (Atropine) RN - 98PI200987 (Lidocaine) RN - L628TT009W (Isoproterenol) RN - VTD58H1Z2X (Dopamine) RN - X4W3ENH1CV (Norepinephrine) IS - 0733-8627 IL - 0733-8627 PT - Journal Article PT - Review PP - ppublish LG - English DP - 1983 Dec EZ - 1983/12/01 DA - 1983/12/01 00:01 DT - 1983/12/01 00:00 YR - 1983 ED - 19850326 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6396072 <981. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6393996 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ward JT Jr FA - Ward, J T Jr TI - Endotracheal drug therapy. SO - American Journal of Emergency Medicine. 1(1):71-82, 1983 Jul AS - Am J Emerg Med. 1(1):71-82, 1983 Jul NJ - The American journal of emergency medicine VO - 1 IP - 1 PG - 71-82 PI - Journal available in: Print PI - Citation processed from: Print JC - aa2, 8309942 IO - Am J Emerg Med SB - Index Medicus SB - History of Medicine Journals CP - United States MH - Absorption MH - Atropine/ad [Administration & Dosage] MH - Diazepam/ad [Administration & Dosage] MH - Drug Therapy/hi [History] MH - *Drug Therapy/mt [Methods] MH - *Emergencies MH - Epinephrine/ad [Administration & Dosage] MH - History, 18th Century MH - History, 19th Century MH - Humans MH - Lidocaine/ad [Administration & Dosage] MH - Naloxone/ad [Administration & Dosage] MH - Resuscitation MH - Shock/dt [Drug Therapy] RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 98PI200987 (Lidocaine) RN - Q3JTX2Q7TU (Diazepam) RN - YKH834O4BH (Epinephrine) IS - 0735-6757 IL - 0735-6757 PT - Historical Article PT - Journal Article ID - 0735-6757(83)90039-6 [pii] PP - ppublish LG - English DP - 1983 Jul EZ - 1983/07/01 DA - 2001/03/28 10:01 DT - 1983/07/01 00:00 YR - 1983 ED - 19850315 RD - 20171118 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6393996 <982. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6096940 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Greenberg MI FA - Greenberg, M I TI - The use of endotracheal medication in cardiac emergencies. SO - Resuscitation. 12(3):155-65, 1984 Nov AS - Resuscitation. 12(3):155-65, 1984 Nov NJ - Resuscitation VO - 12 IP - 3 PG - 155-65 PI - Journal available in: Print PI - Citation processed from: Print JC - r8q, 0332173 IO - Resuscitation SB - Index Medicus CP - Ireland MH - Atropine/ad [Administration & Dosage] MH - Bradycardia/dt [Drug Therapy] MH - Diazepam/ad [Administration & Dosage] MH - Electrocardiography MH - *Emergencies MH - Epinephrine/ad [Administration & Dosage] MH - *Heart Arrest/dt [Drug Therapy] MH - Humans MH - *Intubation, Intratracheal MH - Lidocaine/ad [Administration & Dosage] MH - Naloxone/ad [Administration & Dosage] MH - *Respiratory Insufficiency/dt [Drug Therapy] AB - The endotracheal route for drug administration provides a rapid means of accessing the systemic circulation when intravenous routes cannot be established in emergent situations. This route is relatively free of significant complications and has been documented as being successful numerous times in various clinical settings. Currently, the following drugs have been studied by this route: epinephrine, atropine, lidocaine, naloxone, bretylium, and diazepam. The paper reviews the current state of the art of endotracheal drug administration. RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 98PI200987 (Lidocaine) RN - Q3JTX2Q7TU (Diazepam) RN - YKH834O4BH (Epinephrine) IS - 0300-9572 IL - 0300-9572 PT - Journal Article PP - ppublish LG - English DP - 1984 Nov EZ - 1984/11/01 DA - 1984/11/01 00:01 DT - 1984/11/01 00:00 YR - 1984 ED - 19850131 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6096940 <983. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6505476 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Paccaud D FA - Paccaud, D TI - [Massive accidental oral poisoning due to opiates. Details and treatment. Use of naloxone in an emergency situation]. [French] OT - Intoxication per-orale massive, accidentelle, aux opiaces. Particularite et traitement. Utilisation de la naloxone en situation d'urgence. SO - Revue Medicale de la Suisse Romande. 104(9):721-3, 1984 Sep AS - Rev Med Suisse Romande. 104(9):721-3, 1984 Sep NJ - Revue medicale de la Suisse romande VO - 104 IP - 9 PG - 721-3 PI - Journal available in: Print PI - Citation processed from: Print JC - sr5, 0421524 IO - Rev Med Suisse Romande SB - Index Medicus CP - Switzerland MH - Adult MH - Coma/ci [Chemically Induced] MH - Emergencies MH - Gastric Lavage MH - Humans MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Narcotics/po [Poisoning] MH - Respiratory Insufficiency/ci [Chemically Induced] RN - 0 (Narcotics) RN - 36B82AMQ7N (Naloxone) IS - 0035-3655 IL - 0035-3655 PT - Case Reports PT - Journal Article PP - ppublish LG - French DP - 1984 Sep EZ - 1984/09/01 DA - 1984/09/01 00:01 DT - 1984/09/01 00:00 YR - 1984 ED - 19850103 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6505476 <984. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6594113 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Olson LG AU - Saunders NA FA - Olson, L G FA - Saunders, N A TI - Ventilatory control in two asthmatics resuscitated from respiratory arrest. SO - Australian & New Zealand Journal of Medicine. 14(3):231-8, 1984 Jun AS - Aust N Z J Med. 14(3):231-8, 1984 Jun NJ - Australian and New Zealand journal of medicine VO - 14 IP - 3 PG - 231-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 9h9, 1264322 IO - Aust N Z J Med SB - Index Medicus CP - Australia MH - Adult MH - Asphyxia/pp [Physiopathology] MH - Asthma/co [Complications] MH - Asthma/dt [Drug Therapy] MH - *Asthma/pp [Physiopathology] MH - Bronchodilator Agents/tu [Therapeutic Use] MH - Endorphins/ph [Physiology] MH - Female MH - Heart Rate MH - Humans MH - Hypercapnia/pp [Physiopathology] MH - Male MH - Middle Aged MH - Naloxone/ad [Administration & Dosage] MH - Naloxone/pd [Pharmacology] MH - Prochlorperazine/ad [Administration & Dosage] MH - Prochlorperazine/pd [Pharmacology] MH - Pulmonary Ventilation/de [Drug Effects] MH - Receptors, Dopamine/de [Drug Effects] MH - Respiratory Insufficiency/dt [Drug Therapy] MH - Respiratory Insufficiency/et [Etiology] MH - *Respiratory Insufficiency/pp [Physiopathology] MH - Resuscitation MH - Spirometry AB - Two female patients revived from fulminant attacks of asthma are described. Ventilatory responses to asphyxia in these patients were 0.70 +/- 0.10 l min-1 % SaO2-1 and 0.64 +/- 0.21 l min-1 % SaO2-1 (mean +/- SEM), respectively. These values were significantly less than the responses of seven normal female subjects (1.54 +/- 0.11 l min-1 % SaO2-1 mean +/- SEM; p less than 0.01). Ventilatory responses to hypercapnia of the two patients were in the low normal range. Dopamine-receptor blockade with prochlorperazine significantly increased the ventilatory response to asphyxia in normal subjects (p less than 0.05 or less for each subject) but did not alter the depressed responses in the asthmatic patients. In one patient, naloxone in a dose of 400 micrograms reversed the decreased ventilatory responsiveness; the response to asphyxia was increased from 0.72 l min-1 % SaO-1 to 1.80 l min-1 % SaO2-1 (p less than 0.01) and the response to hypercapnia was increased from 0.90 l min-1 mmHg-1 to 4.80 l min-1 mmHg-1 (p less than 0.01). Naloxone had no effect in the second asthmatic patient nor in five normal subjects. Defective chemoreceptor responses to chemical stimuli may play a role in sudden death from asthma; endogenous opioids may mediate this disorder of ventilatory control. RN - 0 (Bronchodilator Agents) RN - 0 (Endorphins) RN - 0 (Receptors, Dopamine) RN - 36B82AMQ7N (Naloxone) RN - YHP6YLT61T (Prochlorperazine) IS - 0004-8291 IL - 0004-8291 PT - Case Reports PT - Journal Article PT - Research Support, Non-U.S. Gov't PP - ppublish LG - English DP - 1984 Jun EZ - 1984/06/01 DA - 1984/06/01 00:01 DT - 1984/06/01 00:00 YR - 1984 ED - 19841220 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6594113 <985. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6148384 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hassen AH AU - Feuerstein G AU - Faden AI FA - Hassen, A H FA - Feuerstein, G FA - Faden, A I TI - Kappa opioid receptors modulate cardiorespiratory function in hindbrain nuclei of rat. SO - Journal of Neuroscience. 4(9):2213-21, 1984 Sep AS - J Neurosci. 4(9):2213-21, 1984 Sep NJ - The Journal of neuroscience : the official journal of the Society for Neuroscience VO - 4 IP - 9 PG - 2213-21 PI - Journal available in: Print PI - Citation processed from: Print JC - jdf, 8102140 IO - J. Neurosci. SB - Index Medicus CP - United States MH - Animals MH - Benzomorphans/pd [Pharmacology] MH - Blood Pressure/de [Drug Effects] MH - Dynorphins/pd [Pharmacology] MH - *Heart/ph [Physiology] MH - Heart Rate/de [Drug Effects] MH - Male MH - *Medulla Oblongata/ph [Physiology] MH - Microinjections MH - Rats MH - Rats, Inbred Strains MH - *Receptors, Opioid/ph [Physiology] MH - Receptors, Opioid, kappa MH - Respiration/de [Drug Effects] MH - Respiration, Artificial MH - *Respiratory Physiological Phenomena MH - Tidal Volume AB - The respiratory and cardiovascular effects of selective kappa opioid agonists were compared following microinjection (0.1 microliter) into the nucleus ambiguus (NA) and the nucleus tractus solitarius (NTS) regions of spontaneously breathing and artificially respired pentobarbital-anesthetized rats. In spontaneously breathing animals, the benzomorphan derivative MRZ 2549 (MRZ, 3 X 10(-11) to 16 X 10(-9) mol) elicited dose-related decreases of mean arterial pressure (MAP), heart rate (HR), and tidal volume (TV) following NA injection; bremazocine (BREM) decreased MAP, HR, and respiratory rate (RR). Following NTS injection, MRZ (3 X 10(-10) to 16 X 10(-9) mol) lowered MAP and TV, the highest dose also lowering HR and RR; BREM (3 X 10(-9) to 16 X 10(-9) mol) decreased MAP and HR. Naloxone (200 micrograms/kg, i.v.) reversed the respiratory effects of MRZ without consistently altering cardiovascular activity. In ventilated animals, NA injections of MRZ or BREM (3 X 10(-9) to 16 X 10(-9) mol) elicited a dose-related decrease of MAP without altering HR. These responses were not reversed by naloxone. The stereoisomer of BREM (+ BREM) was without effect at similar doses (3 X 10(-9) to 16 X 10(-9) mol). MRZ (16 X 10(-9) mol) elicited a naloxone-reversible tachycardia following NTS injection in ventilated animals; no other cardiovascular responses were observed following NTS administration of BREM (16 X 10(-9) mol) or lower doses of MRZ. Dynorphin (1-13) (6 X 10(-9) to 60 X 10(-9) mol) significantly lowered MAP without altering HR following NA microinjections in ventilated animals; the lower dose decreased MAP following NTS injections.(ABSTRACT TRUNCATED AT 250 WORDS) RN - 0 (Benzomorphans) RN - 0 (Receptors, Opioid) RN - 0 (Receptors, Opioid, kappa) RN - 74913-18-1 (Dynorphins) RN - 84774-03-8 (MRZ 2549) RN - ISF76M2DBE (bremazocine) IS - 0270-6474 IL - 0270-6474 PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PP - ppublish LG - English DP - 1984 Sep EZ - 1984/09/01 DA - 1984/09/01 00:01 DT - 1984/09/01 00:00 YR - 1984 ED - 19841106 RD - 20121115 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6148384 <986. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6146539 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Moore PA FA - Moore, P A TI - Clinical pharmacology of opioid analgesics. SO - Dental Clinics of North America. 28(3):389-400, 1984 Jul AS - Dent Clin North Am. 28(3):389-400, 1984 Jul NJ - Dental clinics of North America VO - 28 IP - 3 PG - 389-400 PI - Journal available in: Print PI - Citation processed from: Print JC - e10, 0217440, 0217440 IO - Dent. Clin. North Am. SB - Dental Journals SB - Index Medicus CP - United States MH - Adult MH - Ambulatory Care MH - Analgesics, Opioid/ad [Administration & Dosage] MH - Analgesics, Opioid/ai [Antagonists & Inhibitors] MH - *Analgesics, Opioid/pd [Pharmacology] MH - Analgesics, Opioid/tu [Therapeutic Use] MH - Anesthesia, Dental MH - Anesthesia, General MH - Child MH - *Dental Care MH - Drug Interactions MH - Emergency Medical Services MH - Endorphins/ph [Physiology] MH - Hospitalization MH - Humans MH - Narcotics/ad [Administration & Dosage] MH - Narcotics/pd [Pharmacology] MH - Narcotics/ph [Physiology] MH - Receptors, Opioid/ph [Physiology] AB - Opioid analgesics continue to be the most important drugs in modifying the response to pain. Their versatility is attested by their frequent use in both postoperative and intraoperative management of pain. Recent findings regarding the mechanism of action of opioids may signal the introduction of newer, more effective, and less addictive agents. So far, this has not occurred. However, opioids with mixed agonist-antagonist properties have offered some utility. The adverse effects of nausea and dysphoria and the more serious effects of respiratory depression continue to be a problem, as does the possibility of abuse. Nonetheless, the clinical experience with opioids in control of pain is uncontested. Until better drugs are developed, opioids will form the basis for the control of acute pain by the dental practitioner. RN - 0 (Analgesics, Opioid) RN - 0 (Endorphins) RN - 0 (Narcotics) RN - 0 (Receptors, Opioid) IS - 0011-8532 IL - 0011-8532 PT - Journal Article PP - ppublish LG - English DP - 1984 Jul EZ - 1984/07/01 DA - 1984/07/01 00:01 DT - 1984/07/01 00:00 YR - 1984 ED - 19840917 RD - 20041117 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6146539 <987. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6145484 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Henry J AU - Volans G FA - Henry, J FA - Volans, G TI - ABC of poisoning. Immediate measures outside hospital. SO - British Medical Journal Clinical Research Ed.. 289(6436):39-40, 1984 Jul 07 AS - Br Med J (Clin Res Ed). 289(6436):39-40, 1984 Jul 07 NJ - British medical journal (Clinical research ed.) VO - 289 IP - 6436 PG - 39-40 PI - Journal available in: Print PI - Citation processed from: Print JC - b4x, 8302911 IO - Br Med J (Clin Res Ed) PM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1442082 SB - Core Clinical Journals (AIM) SB - Index Medicus CP - England MH - Atropine/tu [Therapeutic Use] MH - Cyanides/po [Poisoning] MH - Edetic Acid/tu [Therapeutic Use] MH - Emergencies MH - *First Aid MH - Humans MH - Insecticides/po [Poisoning] MH - Ipecac/tu [Therapeutic Use] MH - Naloxone/tu [Therapeutic Use] MH - Narcotics/po [Poisoning] MH - Organophosphorus Compounds MH - Oxygen/tu [Therapeutic Use] MH - *Poisoning/th [Therapy] RN - 0 (Cyanides) RN - 0 (Insecticides) RN - 0 (Narcotics) RN - 0 (Organophosphorus Compounds) RN - 14931-83-0 (cobalt-ethylenediamine tetraacetic acid chelate) RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 8012-96-2 (Ipecac) RN - 9G34HU7RV0 (Edetic Acid) RN - S88TT14065 (Oxygen) IS - 0267-0623 IL - 0267-0623 PT - Journal Article ID - PMC1442082 [pmc] PP - ppublish LG - English DP - 1984 Jul 07 EZ - 1984/07/07 DA - 1984/07/07 00:01 DT - 1984/07/07 00:00 YR - 1984 ED - 19840823 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6145484 <988. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6676478 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Rupreht J AU - Dworacek B AU - Oosthoek H AU - Dzoljic MR AU - Valkenburg M FA - Rupreht, J FA - Dworacek, B FA - Oosthoek, H FA - Dzoljic, M R FA - Valkenburg, M TI - Physostigmine versus naloxone in heroin-overdose. SO - Journal of Toxicology - Clinical Toxicology. 21(3):387-97, 1983-1984 AS - J Toxicol Clin Toxicol. 21(3):387-97, 1983-1984 NJ - Journal of toxicology. Clinical toxicology VO - 21 IP - 3 PG - 387-97 PI - Journal available in: Print PI - Citation processed from: Print JC - kan, 8213460 IO - J. Toxicol. Clin. Toxicol. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - *Heroin/po [Poisoning] MH - Heroin Dependence/co [Complications] MH - Humans MH - Naloxone/ae [Adverse Effects] MH - *Naloxone/tu [Therapeutic Use] MH - *Physostigmine/tu [Therapeutic Use] MH - Random Allocation MH - Respiration Disorders/ci [Chemically Induced] MH - *Respiration Disorders/dt [Drug Therapy] MH - Substance Withdrawal Syndrome/ci [Chemically Induced] AB - Two groups of 10 chronically heroin addicted patients who were admitted to the Emergency Ward because of hypoventilation and coma, were treated random- aselectively with naloxone, 3 micrograms kg-1 BW iv, or with physostigmine salicylate 0,04 mg kg-1 BW iv. Patients in both groups completely regained consciousness and breathed spontaneously, regularly and adequately within 10 minutes. One essential difference in the treatment was that physostigmine caused no signs of acute opiate withdrawal, the patients felt fine and stayed for further control, in contrast with naloxone where the patients felt bad and occasionally escaped prematurely from the ward. Another difference is that the beneficial effect of one dose of physostigmine is shorter lived than that of naloxone. Authors emphasise the fact that treatment of heroin overdose in an addict need not jeopardize the patient's well-being by a withdrawal syndrome. RN - 36B82AMQ7N (Naloxone) RN - 70D95007SX (Heroin) RN - 9U1VM840SP (Physostigmine) IS - 0731-3810 IL - 0731-3810 PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PP - ppublish LG - English DP - 1983-1984 EZ - 1983/01/01 DA - 1983/01/01 00:01 DT - 1983/01/01 00:00 YR - 1983-1984 ED - 19840726 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6676478 <989. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6428259 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - van Leeuwen L AU - Zuurmond WW AU - Helmers JH AU - Noorduin H AU - Deen L FA - van Leeuwen, L FA - Zuurmond, W W FA - Helmers, J H FA - Noorduin, H FA - Deen, L TI - [Continuous alfentanil infusion in surgical interventions of intermediate and long duration]. [German] OT - Alfentanil-Dauerinfusion fur chirurgische Eingriffe mittlerer und langerer Dauer. SO - Anaesthesist. 33(4):173-6, 1984 Apr AS - Anaesthesist. 33(4):173-6, 1984 Apr NJ - Der Anaesthesist VO - 33 IP - 4 PG - 173-6 PI - Journal available in: Print PI - Citation processed from: Print JC - 4my, 0370525 IO - Anaesthesist SB - Index Medicus CP - Germany MH - Adolescent MH - Adult MH - Aged MH - Alfentanil MH - *Anesthesia, Intravenous MH - Female MH - Fentanyl/ae [Adverse Effects] MH - *Fentanyl/aa [Analogs & Derivatives] MH - Heart Rate/de [Drug Effects] MH - Humans MH - Male MH - Middle Aged MH - Muscles/de [Drug Effects] MH - Naloxone/pd [Pharmacology] MH - Preanesthetic Medication MH - Resuscitation MH - Surgical Procedures, Operative MH - Time Factors AB - Alfentanil, a new short-acting narcotic analgesic, was studied as a continuous infusion for surgical procedures of medium and long duration in 80 patients. Anaesthesia was induced with thiopentone immediately followed by 1 mg of alfentanil to attenuate the stress response to intubation. Alfentanil 100 micrograms/kg was then slowly given as a loading dose before surgery started and anaesthesia maintained by a continuous infusion at a rate of 0.5-1 micrograms/kg/min. Patients were ventilated with a 66% nitrous oxide in oxygen. The course of anaesthesia was good in 76 of the patients, while 27 needed small increments of alfentanil on top of the infusion. Cardiovascular stability was a feature in almost all patients. Recovery was extremely rapid and without complications. Naloxone to reverse respiratory depression was only used twice. RN - 1N74HM2BS7 (Alfentanil) RN - 36B82AMQ7N (Naloxone) RN - UF599785JZ (Fentanyl) IS - 0003-2417 IL - 0003-2417 PT - English Abstract PT - Journal Article PP - ppublish LG - German DP - 1984 Apr EZ - 1984/04/01 DA - 1984/04/01 00:01 DT - 1984/04/01 00:00 YR - 1984 ED - 19840718 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6428259 <990. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6328352 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hassen AH AU - Feuerstein G AU - Faden AI FA - Hassen, A H FA - Feuerstein, G FA - Faden, A I TI - Selective cardiorespiratory effects mediated by mu opioid receptors in the nucleus ambiguus. SO - Neuropharmacology. 23(4):407-15, 1984 Apr AS - Neuropharmacology. 23(4):407-15, 1984 Apr NJ - Neuropharmacology VO - 23 IP - 4 PG - 407-15 PI - Journal available in: Print PI - Citation processed from: Print JC - nzb, 0236217 IO - Neuropharmacology SB - Index Medicus CP - England MH - Animals MH - *Blood Pressure/de [Drug Effects] MH - Enkephalin, Ala(2)-MePhe(4)-Gly(5)- MH - Enkephalin, Leucine/aa [Analogs & Derivatives] MH - Enkephalin, Leucine/pd [Pharmacology] MH - Enkephalin, Leucine-2-Alanine MH - Enkephalins/pd [Pharmacology] MH - *Heart Rate/de [Drug Effects] MH - Male MH - *Medulla Oblongata/ph [Physiology] MH - Naloxone/pd [Pharmacology] MH - Rats MH - Rats, Inbred Strains MH - *Receptors, Opioid/ph [Physiology] MH - Receptors, Opioid, mu MH - *Respiration/de [Drug Effects] MH - Respiration, Artificial AB - The respiratory and cardiovascular effects of the highly selective mu opioid agonist, D-Ala2, MePhe4, Gly- ol5 enkephalin ( DAGO ) and the relatively selective delta agonist, D-Leu5 enkephalin (DADL) were compared following injection (0.1 microliter) into the nucleus ambiguus (NA) of spontaneously-breathing and artificially-respired, pentobarbital-anesthetized rats. In non-ventilated animals, the opioids elicited dose-related (3 X 10(-11) -3 X 10(-9) M), naloxone-reversible depression of respiratory rate (RR) without altering the tidal volume. Mean arterial pressure (MAP) was unchanged at small doses and decreased at the largest dose; heart rate (HR) was unchanged. In artificially-respired animals, both peptides elicited dose-related, naloxone-reversible increases in mean arterial pressure and heart rate; DAGO was significantly more potent than DADL (P less than 0.01). Given the relative potency and selectivity of the opioids tested, these findings are consistent with the conclusion that mu receptors may selectively mediate the respiratory and cardiovascular actions of opioids in an important brain stem cardiorespiratory center in the rat. Moreover, these data indicate the importance of respiratory effects on the cardiovascular activity of centrally administered opioids. RN - 0 (Enkephalins) RN - 0 (Receptors, Opioid) RN - 0 (Receptors, Opioid, mu) RN - 100929-53-1 (Enkephalin, Ala(2)-MePhe(4)-Gly(5)-) RN - 36B82AMQ7N (Naloxone) RN - 58822-25-6 (Enkephalin, Leucine) RN - 63631-40-3 (Enkephalin, Leucine-2-Alanine) IS - 0028-3908 IL - 0028-3908 PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PP - ppublish LG - English DP - 1984 Apr EZ - 1984/04/01 DA - 1984/04/01 00:01 DT - 1984/04/01 00:00 YR - 1984 ED - 19840710 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6328352 <991. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6144509 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Haefely W FA - Haefely, W TI - Antagonists of benzodiazepines. [Review] [21 refs] SO - Encephale. 9(4 Suppl 2):143B-150B, 1983 AS - Encephale. 9(4 Suppl 2):143B-150B, 1983 NJ - L'Encephale VO - 9 IP - 4 Suppl 2 PG - 143B-150B PI - Journal available in: Print PI - Citation processed from: Print JC - efb, 7505643 IO - Encephale SB - Index Medicus CP - France MH - Animals MH - *Anti-Anxiety Agents/ai [Antagonists & Inhibitors] MH - Benzodiazepinones/pd [Pharmacology] MH - Binding, Competitive MH - Carbolines/pd [Pharmacology] MH - Flumazenil MH - Humans MH - Models, Chemical MH - Molecular Conformation MH - Pyrazoles/pd [Pharmacology] MH - *Receptors, Cell Surface/de [Drug Effects] MH - Receptors, GABA-A MH - *Receptors, Neurotransmitter/de [Drug Effects] MH - Synaptic Transmission/de [Drug Effects] MH - gamma-Aminobutyric Acid/ph [Physiology] AB - Benzodiazepines (BDZ) interact with specific receptors (R), whose activation improves Cl- -channel gating by the GABA receptor (GABA-R). Neurones, whose GABAergic input has a certain level of activity, will be more inhibited in the presence of BDZ (primary target neurones for BDZ). Secondarily, neurones dependent on the activity of primary target neurones will also be effected. Drugs that interact with GABAergic functions (except the BDZ-R) or with the function of primary or secondary target neurones may inhibit some or all BDZ effects; these are nonspecific BDZ antagonists (e.g. GABA-antagonists, cholinesterase inhibitors, naloxone, methylxanthines). Specific BDZ antagonists inhibit the action of BDZ by blocking competitively the BDZ-R. Ro 15-1788 is the best investigated specific BDZ antagonist. Virtually devoid of any pharmacological action by itself, the compound blocks all typical effects of BDZ. It is well tolerated also in man and will find application in anaesthesiology to shorten the sedative and muscle relaxant effect of BDZ and in emergency services to reverse comatose states after BDZ overdosage. Recently drugs have been found that produce effects opposite to the BDZ tranquilizers by inducing a conformation of the BDZ-R which depresses GABA-mediated Cl- -channel gating. The effects of these inverse agonists (e.g. proconvulsant , convulsant, anxiogenic) are blocked by pure competitive BDZ-R blockers, such as Ro 15-1788. [References: 21] RN - 0 (Anti-Anxiety Agents) RN - 0 (Benzodiazepinones) RN - 0 (Carbolines) RN - 0 (Pyrazoles) RN - 0 (Receptors, Cell Surface) RN - 0 (Receptors, GABA-A) RN - 0 (Receptors, Neurotransmitter) RN - 40P7XK9392 (Flumazenil) RN - 56-12-2 (gamma-Aminobutyric Acid) RN - 74214-62-3 (beta-carboline-3-carboxylic acid ethyl ester) RN - 77779-60-3 (2-phenylpyrazolo(4,3-c)quinolin-3(5H)-one) IS - 0013-7006 IL - 0013-7006 PT - Comparative Study PT - Journal Article PT - Review PP - ppublish LG - English DP - 1983 EZ - 1983/01/01 DA - 1983/01/01 00:01 DT - 1983/01/01 00:00 YR - 1983 ED - 19840622 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6144509 <992. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6701180 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Claperon N AU - Durussel JJ AU - Rossignol P FA - Claperon, N FA - Durussel, J J FA - Rossignol, P TI - Brain ischemic lethal aggression: GABA or naloxone worsen, association GABA and naloxone alleviates. SO - Pharmacological Research Communications. 16(1):63-5, 1984 Jan AS - Pharmacol Res Commun. 16(1):63-5, 1984 Jan NJ - Pharmacological research communications VO - 16 IP - 1 PG - 63-5 PI - Journal available in: Print PI - Citation processed from: Print JC - 0236354, p3w IO - Pharmacol Res Commun SB - Index Medicus CP - United States MH - Animals MH - *Brain Ischemia/pc [Prevention & Control] MH - Drug Therapy, Combination MH - Hypoxia, Brain/pc [Prevention & Control] MH - Male MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/tu [Therapeutic Use] MH - Rats MH - Rats, Inbred Strains MH - Respiration, Artificial MH - gamma-Aminobutyric Acid/ad [Administration & Dosage] MH - *gamma-Aminobutyric Acid/tu [Therapeutic Use] RN - 36B82AMQ7N (Naloxone) RN - 56-12-2 (gamma-Aminobutyric Acid) IS - 0031-6989 IL - 0031-6989 PT - Journal Article PP - ppublish LG - English DP - 1984 Jan EZ - 1984/01/01 DA - 1984/01/01 00:01 DT - 1984/01/01 00:00 YR - 1984 ED - 19840426 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6701180 <993. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6322354 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Powers RD AU - Donowitz LG FA - Powers, R D FA - Donowitz, L G TI - Endotracheal administration of emergency medications. SO - Southern Medical Journal. 77(3):340-1, 346, 1984 Mar AS - South Med J. 77(3):340-1, 346, 1984 Mar NJ - Southern medical journal VO - 77 IP - 3 PG - 340-1, 346 PI - Journal available in: Print PI - Citation processed from: Print JC - uvh, 0404522 IO - South. Med. J. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Adult MH - Anaphylaxis/dt [Drug Therapy] MH - Anti-Arrhythmia Agents/ad [Administration & Dosage] MH - Atropine/ad [Administration & Dosage] MH - Bicarbonates/ad [Administration & Dosage] MH - Diazepam/ad [Administration & Dosage] MH - *Emergencies MH - Epinephrine/ad [Administration & Dosage] MH - Heart Arrest/dt [Drug Therapy] MH - Humans MH - Intubation, Intratracheal MH - Lidocaine/ad [Administration & Dosage] MH - Naloxone/ad [Administration & Dosage] MH - *Pharmaceutical Preparations/ad [Administration & Dosage] MH - Sodium Bicarbonate AB - When vascular access is delayed or unreliable in emergency situations, an endotracheal tube provides a rapid and reliable route for administration of medication. Epinephrine, lidocaine, and atropine have shown clinical efficacy when given by the endotracheal route. There is evidence that other medications including naloxone and diazepam may also be suitable for endotracheal use, but clear-cut recommendations await further studies of pharmacokinetics and toxicity. RN - 0 (Anti-Arrhythmia Agents) RN - 0 (Bicarbonates) RN - 0 (Pharmaceutical Preparations) RN - 36B82AMQ7N (Naloxone) RN - 7C0697DR9I (Atropine) RN - 8MDF5V39QO (Sodium Bicarbonate) RN - 98PI200987 (Lidocaine) RN - Q3JTX2Q7TU (Diazepam) RN - YKH834O4BH (Epinephrine) IS - 0038-4348 IL - 0038-4348 PT - Journal Article PP - ppublish LG - English DP - 1984 Mar EZ - 1984/03/01 DA - 1984/03/01 00:01 DT - 1984/03/01 00:00 YR - 1984 ED - 19840425 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6322354 <994. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6696249 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Shapiro HM FA - Shapiro, H M TI - Brain resuscitation: the chicken should come before the egg. SO - Anesthesiology. 60(2):85-7, 1984 Feb AS - Anesthesiology. 60(2):85-7, 1984 Feb NJ - Anesthesiology VO - 60 IP - 2 PG - 85-7 PI - Journal available in: Print PI - Citation processed from: Print JC - 4sg, 1300217 IO - Anesthesiology SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Animals MH - Barbiturates/tu [Therapeutic Use] MH - *Brain Ischemia/dt [Drug Therapy] MH - Calcium Channel Blockers/tu [Therapeutic Use] MH - Humans MH - Naloxone/tu [Therapeutic Use] MH - *Resuscitation RN - 0 (Barbiturates) RN - 0 (Calcium Channel Blockers) RN - 36B82AMQ7N (Naloxone) IS - 0003-3022 IL - 0003-3022 PT - Journal Article PP - ppublish LG - English DP - 1984 Feb EZ - 1984/02/01 DA - 1984/02/01 00:01 DT - 1984/02/01 00:00 YR - 1984 ED - 19840306 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6696249 <995. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6139443 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Claperon N AU - Durussel JJ AU - Rossignol P FA - Claperon, N FA - Durussel, J J FA - Rossignol, P TI - Effect of naloxone on rat brain hypoxia. SO - Journal of Pharmacy & Pharmacology. 35(10):681-2, 1983 Oct AS - J Pharm Pharmacol. 35(10):681-2, 1983 Oct NJ - The Journal of pharmacy and pharmacology VO - 35 IP - 10 PG - 681-2 PI - Journal available in: Print PI - Citation processed from: Print JC - jnr, 0376363 IO - J. Pharm. Pharmacol. SB - Index Medicus CP - England MH - Animals MH - *Hypoxia, Brain/pp [Physiopathology] MH - Injections, Intraventricular MH - Naloxone/ad [Administration & Dosage] MH - *Naloxone/pd [Pharmacology] MH - Rats MH - Respiration, Artificial RN - 36B82AMQ7N (Naloxone) IS - 0022-3573 IL - 0022-3573 PT - Journal Article PP - ppublish LG - English DP - 1983 Oct EZ - 1983/10/01 DA - 1983/10/01 00:01 DT - 1983/10/01 00:00 YR - 1983 ED - 19840107 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6139443 <996. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6881656 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Wasserberger J AU - Ordog G FA - Wasserberger, J FA - Ordog, G TI - Use of naloxone in CPR. SO - Annals of Emergency Medicine. 12(8):519-20, 1983 Aug AS - Ann Emerg Med. 12(8):519-20, 1983 Aug NJ - Annals of emergency medicine VO - 12 IP - 8 PG - 519-20 PI - Journal available in: Print PI - Citation processed from: Print JC - 4z7, 8002646 IO - Ann Emerg Med SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Animals MH - Dogs MH - Humans MH - *Naloxone/tu [Therapeutic Use] MH - *Resuscitation/mt [Methods] RN - 36B82AMQ7N (Naloxone) IS - 0196-0644 IL - 0196-0644 PT - Letter PT - Research Support, Non-U.S. Gov't ID - S0196-0644(83)80662-3 [pii] PP - ppublish LG - English DP - 1983 Aug EZ - 1983/08/01 DA - 1983/08/01 00:01 DT - 1983/08/01 00:00 YR - 1983 ED - 19830923 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6881656 <997. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6869331 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hasday JD AU - Weintraub M FA - Hasday, J D FA - Weintraub, M TI - Propoxyphene in children with iatrogenic morphine dependence. SO - American Journal of Diseases of Children. 137(8):745-8, 1983 Aug AS - Am J Dis Child. 137(8):745-8, 1983 Aug NJ - American journal of diseases of children (1960) VO - 137 IP - 8 PG - 745-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 3gs, 0370471 IO - Am. J. Dis. Child. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Child MH - Child, Preschool MH - Dextropropoxyphene/ad [Administration & Dosage] MH - *Dextropropoxyphene/tu [Therapeutic Use] MH - Female MH - Humans MH - Iatrogenic Disease MH - Infant MH - Male MH - *Morphine Dependence/co [Complications] MH - Morphine Dependence/dt [Drug Therapy] MH - Respiration, Artificial MH - *Substance Withdrawal Syndrome/dt [Drug Therapy] MH - Substance Withdrawal Syndrome/et [Etiology] AB - In four children with iatrogenic morphine sulfate tolerance and dependence, narcotic withdrawal was successfully accomplished using propoxyphene napsylate. The patients showed signs and symptoms typical of narcotic withdrawal, which resolved with morphine administration and increased during attempts to lower the daily morphine dose. Propoxyphene napsylate at total daily doses of 25 to 65 mg/kg, administered at four-hour intervals, allowed rapid reduction of the morphine dosage, with few withdrawal signs and symptoms, and lessened respiratory depression. This treatment enabled patients to be rapidly weaned from the respirator. One child experienced increasing lethargy and respiratory depression and responded to naloxone hydrochloride and a decrease in the dose of propoxyphene; another had transient agitation, which may have been related to high levels of propoxyphene. Our treatment used alternating doses of propoxyphene and morphine, which allowed the child to be morphine free after four days and narcotic free after nine days. RN - S2F83W92TK (Dextropropoxyphene) IS - 0002-922X IL - 0002-922X PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1983 Aug EZ - 1983/08/01 DA - 1983/08/01 00:01 DT - 1983/08/01 00:00 YR - 1983 ED - 19830826 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6869331 <998. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6135178 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Cetrullo C AU - Di Nino GF AU - Melloni C AU - Pieri C AU - Zanoni A FA - Cetrullo, C FA - Di Nino, G F FA - Melloni, C FA - Pieri, C FA - Zanoni, A TI - [Naloxone antagonism toward opiate analgesic drugs. Clinical experimental study]. [Italian] OT - Sull'antagonismo del naloxone verso gli ipnoanalgesici. Studio clinico sperimentale. SO - Minerva Anestesiologica. 49(4):199-204, 1983 Apr AS - Minerva Anestesiol. 49(4):199-204, 1983 Apr NJ - Minerva anestesiologica VO - 49 IP - 4 PG - 199-204 PI - Journal available in: Print PI - Citation processed from: Print JC - n26, 0375272 IO - Minerva Anestesiol SB - Index Medicus CP - Italy MH - Adult MH - Aged MH - *Analgesics, Opioid/ai [Antagonists & Inhibitors] MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Naloxone/pd [Pharmacology] MH - Postoperative Care MH - Resuscitation RN - 0 (Analgesics, Opioid) RN - 36B82AMQ7N (Naloxone) IS - 0375-9393 IL - 0375-9393 PT - English Abstract PT - Journal Article PP - ppublish LG - Italian DP - 1983 Apr EZ - 1983/04/01 DA - 1983/04/01 00:01 DT - 1983/04/01 00:00 YR - 1983 ED - 19830826 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6135178 <999. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 6848042 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Higgins TL AU - Sivak ED AU - O'Neil DM AU - Graves JW AU - Foutch DG FA - Higgins, T L FA - Sivak, E D FA - O'Neil, D M FA - Graves, J W FA - Foutch, D G TI - Reversal of hypotension by continuous naloxone infusion in a ventilator-dependent patient. SO - Annals of Internal Medicine. 98(1):47-8, 1983 Jan AS - Ann Intern Med. 98(1):47-8, 1983 Jan NJ - Annals of internal medicine VO - 98 IP - 1 PG - 47-8 PI - Journal available in: Print PI - Citation processed from: Print JC - 0372351, 5a6 IO - Ann. Intern. Med. SB - Core Clinical Journals (AIM) SB - Index Medicus CP - United States MH - Aged MH - Heart Failure/th [Therapy] MH - Humans MH - *Hypotension/dt [Drug Therapy] MH - Infusions, Parenteral MH - Male MH - *Naloxone/ad [Administration & Dosage] MH - *Respiration, Artificial MH - Respiratory Insufficiency/th [Therapy] RN - 36B82AMQ7N (Naloxone) IS - 0003-4819 IL - 0003-4819 PT - Case Reports PT - Journal Article PP - ppublish LG - English DP - 1983 Jan EZ - 1983/01/01 DA - 1983/01/01 00:01 DT - 1983/01/01 00:00 YR - 1983 ED - 19830127 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=6848042 <1000. > VN - Ovid Technologies DB - Ovid MEDLINE(R) UI - 7140177 VI - 1 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Accettelli U AU - Ambrosi F AU - Russo L AU - De Petris U AU - Stagnitti F FA - Accettelli, U FA - Ambrosi, F FA - Russo, L FA - De Petris, U FA - Stagnitti, F TI - [Use of naloxone in first aid]. [Italian] OT - Impiego del naloxone in pronto soccorso. SO - Clinica Terapeutica. 102(2):197-201, 1982 Jul 31 AS - Clin Ter. 102(2):197-201, 1982 Jul 31 NJ - La Clinica terapeutica VO - 102 IP - 2 PG - 197-201 PI - Journal available in: Print PI - Citation processed from: Print JC - dkn, 0372604 IO - Clin Ter SB - Index Medicus CP - Italy MH - Adolescent MH - Adult MH - *Coma/dt [Drug Therapy] MH - Female MH - First Aid MH - *Heart Failure/dt [Drug Therapy] MH - Humans MH - Male MH - *Naloxone/tu [Therapeutic Use] MH - *Respiratory Insufficiency/dt [Drug Therapy] MH - *Shock/dt [Drug Therapy] MH - *Wounds and Injuries/dt [Drug Therapy] RN - 36B82AMQ7N (Naloxone) IS - 0009-9074 IL - 0009-9074 PT - Journal Article PP - ppublish LG - Italian DP - 1982 Jul 31 EZ - 1982/07/31 DA - 1982/07/31 00:01 DT - 1982/07/31 00:00 YR - 1982 ED - 19830107 RD - 20131121 UP - 20171128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med2&AN=7140177