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Preceding Month (preceding + month)
Selected AbstractsProblems experienced by community pharmacists delivering opioid substitution treatment in New South Wales and Victoria, AustraliaADDICTION, Issue 2 2010Adam R. Winstock ABSTRACT Aims To explore service provision and the range of problems that New South Wales (NSW) and Victoria (VIC) community pharmacists providing opioid substitution treatment (OST) have experienced with clients and prescribers. Design Cross-sectional postal survey. Setting All community pharmacies providing OST in NSW (n = 593) and VIC (n = 393), Australia. Participants Completed questionnaires were received from 669 pharmacists (68% response rate). Measurements The questionnaire addressed pharmacy characteristics, recent problems experienced with clients including refusal to dose, provision of credit for dispensing fees, termination of treatment, responses of pharmacists to problems experienced with clients, as well as problems experienced with OST prescribers. Findings In the preceding month, 41% of pharmacists had refused to dose a client for any reason, due most commonly to expired prescriptions (29%), or ,3 missed doses (23%). Terminating a client's treatment in the past month was reported among 14% of respondents, due most commonly to inappropriate behaviour and missed doses. Treatment termination was reported by a significantly higher proportion of pharmacists in VIC (P < 0.001). Treatment termination in last month was predicted having more clients (P < 0.001), the provision of buprenorphine treatment (P = 0.008), having a separate dosing area (P = 0.021), and being a female pharmacist (P = 0.013). Past month refusal to dose was predicted by the pharmacy being in VIC (P < 0.001) and having more clients (P < 0.001). Problems experienced most commonly in the past month with prescribers were difficulty contacting prescriber (21%) and provision of takeaway doses to clients considered unstable by the pharmacist (19%) (higher in VIC: both P < 0.001). Conclusions This study highlights the range of problems experienced by community pharmacists in the delivery of OST and the consequences for people in treatment. Particular attention should be focused upon considering number of clients per pharmacy and improving professional communication between pharmacists and prescribers. [source] Does prescribing for opiate addiction change after national guidelines?ADDICTION, Issue 5 2007Methadone, buprenorphine prescribing to opiate addicts by general practitioners, hospital doctors in England ABSTRACT Aim To assess changes in opiate prescribing (1995,2005) following a decade of national guidelines to address substandard opiate substitution prescribing for heroin addiction. Design A repeat national survey (1995 and 2005) using random one-in-four samples of all community pharmacies in England, achieving response rates of 75% (1847/2475) in 1995 and 95% (2349/2473) in 2005. Data were obtained on 3732 (1995 data) and 9620 (2005 data) prescriptions dispensed in the preceding month from the 936 and 1463 pharmacies who were currently dispensing. Measurements We have measured impact on practice for seven specific recommended changes. Findings Between 1995 and 2005 the number of substitute opiate prescriptions doubled (×2.03). By 2005, methadone still dominated (down from 97% to 83%), buprenorphine increased (from 1% to 16%) and other opiate medications virtually disappeared. Changes in the direction of national guidelines included: increased daily dose of methadone (from 47.3 mg to 56.3 mg), more frequent dispensing (from 38% to 60% as daily instalments), more supervised consumption (from 0% to 36%) and fewer methadone tablets (from 10.9% to 1.8%). Nevertheless, despite the increased mean daily dose, only 41.0% of prescriptions for methadone were for daily doses in the recommended 60,120 mg dose range. Only one change was not in the direction of the national guidelines,the proportion of prescriptions from GPs fell from 41% to 30%, although this still represented an approximate 50% increase in the extent of GP prescribing. Conclusion Doubling in provision of opiate substitute treatment has occurred, alongside significant improvements in the nature of this treatment. These positive changes have occurred in the direction of six out of seven of the UK national guidelines. [source] Verbal aggression in Alzheimer's disease.INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2001Clinical, functional, neuropsychological correlates Abstract Objectives To determine the clinical, functional and neuropsychological correlates of verbal aggression in Alzheimer's disease in a group of consecutive first attendees to a memory clinic. Methods 150 people were evaluated and diagnosed as suffering with probable Alzheimer's disease. These people were tested using the Behave-AD for the presence of verbal aggression, delusions, depression and agitation. They were also assessed with cognitive, functional and neuropsychological scales. Results Twenty-eight per cent of this group of Alzheimer patients had exhibited some verbal aggression in the preceding month. Male gender (p,=,0.022), the presence of paranoid and delusional ideation (p,=,0.003) and agitation (p,=,0.042) were significantly associated with verbal aggression in a stepwise backward logistic regression analysis. Conclusion The presence of verbal aggression should prompt the clinician to search for delusional ideation, which may respond to phamacotherapy. Copyright © 2001 John Wiley & Sons, Ltd. [source] Temperature acclimation in a biochemical model of photosynthesis: a reanalysis of data from 36 speciesPLANT CELL & ENVIRONMENT, Issue 9 2007JENS KATTGE ABSTRACT The Farquhar et al. model of C3 photosynthesis is frequently used to study the effect of global changes on the biosphere. Its two main parameters representing photosynthetic capacity, Vcmax and Jmax, have been observed to acclimate to plant growth temperature for single species, but a general formulation has never been derived. Here, we present a reanalysis of data from 36 plant species to quantify the temperature dependence of Vcmax and Jmax with a focus on plant growth temperature, i.e. the plants' average ambient temperature during the preceding month. The temperature dependence of Vcmax and Jmax within each data set was described very well by a modified Arrhenius function that accounts for a decrease of Vcmax and Jmax at high temperatures. Three parameters were optimized: base rate, activation energy and entropy term. An effect of plant growth temperature on base rate and activation energy could not be observed, but it significantly affected the entropy term. This caused the optimum temperature of Vcmax and Jmax to increase by 0.44 °C and 0.33 °C per 1 °C increase of growth temperature. While the base rate of Vcmax and Jmax seemed not to be affected, the ratio Jmax : Vcmax at 25 °C significantly decreased with increasing growth temperature. This moderate temperature acclimation is sufficient to double-modelled photosynthesis at 40 °C, if plants are grown at 25 °C instead of 17 °C. [source] Treatment of Nonparaphilic Hypersexuality in Men with a Long-Acting Analog of Gonadotropin-Releasing HormoneTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2009Mohammad R. Safarinejad MD ABSTRACT Introduction., Hypersexuality is one of the most embarrassing behaviors for both patients and their families and there are no effective drug treatments for this sexual inappropriateness. Aim., To evaluate the efficacy and safety of a long-acting analog of gonadotropin-releasing hormone (triptorelin) in men with nonparaphilic hypersexuality (NPH). Main Outcome Measures., Primary outcome measure was the frequency of intercourse. The designated secondary outcome measures were the changes in International Index of Erectile Function (IIEF) questionnaire and responses to the questions from the IIEF in the preceding month: question 11, "How often have you felt sexual desire?" and question 12, "How would you rate your level of sexual desire"? Methods., Seventy-six men (mean age 44.4 years) with NPH were treated with monthly intramuscular injections of 3.75 mg of triptorelin for an indefinite period. During treatment, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, testosterone (T), and free testosterone (fT), were measured monthly, and bone mineral density every 6 months. Results., The mean sexual attempts decreased from 7.6 ± 1.4 per day at baseline to 4.2 ± 1.2 (P = 0.001), 1.2 ± 0.4 (P = 0.001), and <1 per week (P = 0.0001), after 6-, 12-, and 24-month treatment, respectively. The mean scores for questions 11 and 12, improved from 6.8 ± 1.1, and 6.6 ± 1.2, at baseline to 0.7 ± 0.4 (P = 0.0001), and 0.7 ± 0.5 (P = 0.0001), at 24-month treatment, respectively. Positive response to triptorelin was significantly associated with severity of baseline hypersexuality (r = ,0.62, P = 0.01), and treatment duration (r = 0.78, P = 0.001). These beneficial effects persisted 6 months in all men who were treated for at least 24 months. The serum LH and FSH concentrations begun to decrease after two doses of triptorelin. After 3 months, serum T, and fT levels decreased by 50% in 65 (85.5%) of patients (P = 0.01). Conclusions., Triptorelin was very effective and well tolerated in men with NPH. Further studies are needed to replicate our results. Safarinejad MR. Treatment of nonparaphilic hypersexuality in men with a long-acting analog of gonadotropin-releasing hormone. J Sex Med **;**:**,**. [source] Risk behaviours of young Indo-Chinese injecting drug users in Sydney and MelbourneAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2001Lisa Maher Objective: To investigate patterns of drug use and injection-related risk behaviours among young Indo-Chinese injecting drug users (IDUs). Method: Cross-sectional survey. A structured questionnaire was administered to 184 Indo-Chinese IDUs aged 15 to 24 in Sydney and Melbourne. Participants were recruited using snowball sampling techniques; measures included patterns of heroin and other drug use, injection-related risk behaviours, perceived susceptibility to HIV and HCV infection and access to services. Results: Despite perceived high availability of sterile injecting equipment, 36% had ever shared a needle and syringe and 22% had done so in the preceding month. Lifetime sharing was significantly associated with duration of injecting, history of incarceration and residence in Sydney. Sharing of injecting paraphernalia other than needles and syringes was also common, with young women and Sydney residents significantly more likely to report sharing equipment in the preceding month. Conclusions: Young Indo-Chinese IDUs are at high risk of infection with hepatitis C and other blood-borne viruses. Results indicate an urgent need for culturally appropriate and sustainable risk reduction programs which specifically target this population. Implications: Health services must respond swiftly to implement effective blood-borne virus prevention programs for young Indo-Chinese IDUs. Failure to do so may sustain the current epidemic of hepatitis C among IDUs. [source] The use of nationwide on-line prescription records improves the drug history in hospitalized patientsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2008Bente Glintborg What is already known about this subject ,,Structured medication interviews improve the medication history upon hospitalization ,,Pharmacy records are valid lists of the prescribed medications available to individual patients ,,In Denmark, treating doctors now have access to their patients' pharmacy records through a real-time online electronic database What this study adds ,,Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits ,,Pharmacy records may be used to minimize patients' recall bias and improve the medication lists Background Structured medication interviews improve the medication history in hospitalized patients. In Denmark, a nationwide electronic version of individual pharmacy records (PR) has recently been introduced. Use of these records could improve the medication lists in hospitalized patients. Methods We prospectively included 500 patients admitted to an acute medical department. In individual patients, the PR was compared with (i) the medication list written in the patient chart and (ii) drug information provided by the patient during a structured drug interview upon admission and during a home visit after discharge. Results Median patient age was 72 years. Upon admission, patients reported using 1958 prescription-only medications (POM) (median four drugs per patient, range 0,14), of which 114 (6%) were not registered in PR. In PR, 1153 POM (median one per patient, range 0,11) were registered during the month preceding admission. The patients did not report 309 (27%) of these upon admission. Home visits were performed in a subgroup of 115 patients. During home visits, 18% of POM registered in PR during the preceding month were not reported. Drug type was predictive of reporting irrespective of patient sex or age. Cardiovascular drugs were reported most and dermatologicals were reported less frequently. Underreporting might be due to recall bias, non-adherence or discontinuation of drugs. Conclusions Omission errors are frequent despite structured medication interviews. Pharmacy records or medication lists from all treating doctors must be included in medication reviews in order to reduce recall bias. [source] European phenological response to climate change matches the warming patternGLOBAL CHANGE BIOLOGY, Issue 10 2006ANNETTE MENZEL Abstract Global climate change impacts can already be tracked in many physical and biological systems; in particular, terrestrial ecosystems provide a consistent picture of observed changes. One of the preferred indicators is phenology, the science of natural recurring events, as their recorded dates provide a high-temporal resolution of ongoing changes. Thus, numerous analyses have demonstrated an earlier onset of spring events for mid and higher latitudes and a lengthening of the growing season. However, published single-site or single-species studies are particularly open to suspicion of being biased towards predominantly reporting climate change-induced impacts. No comprehensive study or meta-analysis has so far examined the possible lack of evidence for changes or shifts at sites where no temperature change is observed. We used an enormous systematic phenological network data set of more than 125 000 observational series of 542 plant and 19 animal species in 21 European countries (1971,2000). Our results showed that 78% of all leafing, flowering and fruiting records advanced (30% significantly) and only 3% were significantly delayed, whereas the signal of leaf colouring/fall is ambiguous. We conclude that previously published results of phenological changes were not biased by reporting or publication predisposition: the average advance of spring/summer was 2.5 days decade,1 in Europe. Our analysis of 254 mean national time series undoubtedly demonstrates that species' phenology is responsive to temperature of the preceding months (mean advance of spring/summer by 2.5 days°C,1, delay of leaf colouring and fall by 1.0 day°C,1). The pattern of observed change in spring efficiently matches measured national warming across 19 European countries (correlation coefficient r=,0.69, P<0.001). [source] | |||||||||||||