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Adverse Consequences (adverse + consequence)
Selected AbstractsThe Global Diversion of Pharmaceutical DrugsADDICTION, Issue 9 2010Opiate treatment, the diversion of pharmaceutical opiates: a clinician's perspective ABSTRACT Aim To provide a clinician's perspective on the problem of diversion of prescribed pharmaceuticals. Methods The paper provides a personal account of working in a treatment context where diversion from opioid substitution treatment (OST) became a political issue potentially compromising the continued delivery of OST. It summarizes evidence on the impact of diversion, and measures to contain it, from the United Kingdom 1986,2006, Australia 1996,2008 and the United States and France from the mid-1990s. Results Opioid diversion to the black market occurs in proportion to the amount of opioids prescribed to be taken without supervision, and in inverse proportion to the availability of heroin. Diversion for OST programmes using supervision of dosing is less than diversion of opioids prescribed for pain, which is now a growing public health problem. Adverse consequences of diversion include opioid overdose fatalities, an increased incidence of addiction (particularly in jurisdictions where heroin is scarce) and compromising the public acceptance of long-term opioid prescribing. All long-term opioid prescribing requires monitoring of risk and appropriate dispensing arrangements,including dilution of methadone take-aways, supervision of administration for high-risk patients and random urine testing. Clinical guidelines influence practice, although prescribing often deviates from guidelines. Conclusion Clinical guidelines and clinical audit to enhance compliance with guidelines are helpful in maintaining the quality and integrity of the treatment system, and can contribute to keeping diversion within acceptable levels. [source] Hydrogen ,leakage' during methanogenesis from methanol and methylamine: implications for anaerobic carbon degradation pathways in aquatic sedimentsENVIRONMENTAL MICROBIOLOGY, Issue 4 2007Niko Finke Summary The effect of variations in H2 concentrations on methanogenesis from the non-competitive substrates methanol and methylamine (used by methanogens but not by sulfate reducers) was investigated in methanogenic marine sediments. Imposed variations in sulfate concentration and temperature were used to drive systematic variations in pore water H2 concentrations. Specifically, increasing sulfate concentrations and decreasing temperatures both resulted in decreasing H2 concentrations. The ratio of CO2 and CH4 produced from 14C-labelled methylamine and methanol showed a direct correlation with the H2 concentration, independent of the treatment, with lower H2 concentrations resulting in a shift towards CO2. We conclude that this correlation is driven by production of H2 by methylotrophic methanogens, followed by loss to the environment with a magnitude dependent on the extracellular H2 concentrations maintained by hydrogenotrophic methanogens (in the case of the temperature experiment) or sulfate reducers (in the case of the sulfate experiment). Under sulfate-free conditions, the loss of reducing power as H2 flux out of the cell represents a loss of energy for the methylotrophic methanogens while, in the presence of sulfate, it results in a favourable free energy yield. Thus, hydrogen leakage might conceivably be beneficial for methanogens in marine sediments dominated by sulfate reduction. In low-sulfate systems such as methanogenic marine or freshwater sediments it is clearly detrimental , an adverse consequence of possessing a hydrogenase that is subject to externally imposed control by pore water H2 concentrations. H2 leakage in methanogens may explain the apparent exclusion of acetoclastic methanogenesis in sediments dominated by sulfate reduction. [source] Separating Sense from Nonsense in the US Debate on the Financial MeltdownPOLITICAL STUDIES REVIEW, Issue 1 2010David Coates The US debate on the causes of the financial meltdown and the policies appropriate for its resolution have a different center of gravity to that prevalent in Western Europe. Free-market solutions continue to be canvassed by conservative and libertarian politicians and political commentators with an intensity that is rarely found elsewhere, reflecting the extent to which a significant minority of American voters and policy makers remain wedded to a principled anti-statism. This article surveys those views, and the rebuttals to them now coming from more center-left elements of the US political class. It argues for the superiority of the latter, while noting that one serious adverse consequence of this positioning of the US debate is its capacity to distract attention from important underlying structural causes of the housing crisis and associated credit crunch. [source] Hyponatremia and Heart Failure,Treatment ConsiderationsCONGESTIVE HEART FAILURE, Issue 1 2006Domenic A. Sica MD Hyponatremia as it occurs in the heart failure patient is a multifactorial process. The presence of hyponatremia in the heart failure patient correlates with both the severity of the disease and its ultimate outcome. The therapeutic approach to the treatment of hyponatremia in heart failure has traditionally relied on attempts to improve cardiac function while at the same time limiting fluid intake. In more select circumstances, hypertonic saline, loop diuretics, and/or lithium or demeclocycline have been used. The latter two compounds act by retarding the antidiuretic effect of vasopressin but carry with their use the risk of serious renal and/or cardiovascular side effects. Alternatively, agents that selectively block the type 2 vasopressin receptor increase free water excretion without any of the adverse consequences of other therapies. Conivaptan, lixivaptan, and tolvaptan are three such aquaretic drugs. Vasopressin receptor antagonists will redefine the treatment of heart failure-related hyponatremia and may possibly evolve as adjunct therapies to loop diuretics in diuretic-resistant patients. [source] Role of ß Blockers in Congestive Heart FailureCONGESTIVE HEART FAILURE, Issue 6 2000MPhil, Nazim Uddin Azam Khan MD Prolonged activation of the adrenergic nervous system has adverse consequences on the cardiovascular system in patients with congestive heart failure. , adrenergic receptor,blocker therapy modifies these deleterious effects. , blockers have been shown to improve myocardial function and survival when used in conjunction with conventional treatment with diuretics, angiotensinconverting enzyme inhibitors, and digoxin. , blocker therapy in mild-to-moderate heart failure should not be delayed because it causes some reversal of both neurohormonal compensatory mechanisms and the deletorious myocardial remodeling process. This paper reviews the beneficial effects of , adrenergic receptor-blocker therapy on the pathophysiology, symptoms, left ventricular function, morbidity, and mortality in patients with congestive heart failure. [source] Screening and diagnosis of prediabetes: where are we headed?DIABETES OBESITY & METABOLISM, Issue 2007K. G. M. M. Alberti It is currently estimated that more than 300 million people have impaired glucose tolerance (IGT), putting them at increased risk for type 2 diabetes mellitus (T2DM) and its adverse consequences. In addition, many others are at risk on the basis of a family history of T2DM, obesity, dyslipidaemia and hypertension. Screening for risk should include both blood glucose testing in high-risk populations and prescreening (e.g. by questionnaire, waist circumference measurement) to identify high-risk individuals in overall low-risk populations; these individuals should then undergo glucose testing. Fasting plasma glucose measurement cannot diagnose IGT; the preferred definite test for diagnosis is oral glucose tolerance testing. [source] The social and economic consequences of childhood-onset Type 1 diabetes mellitus across the lifecourse: a systematic reviewDIABETIC MEDICINE, Issue 8 2006B. Milton Abstract Background The incidence of childhood-onset (Type 1) diabetes is high, and increasing, particularly among the very young. The aim of this review was to determine the longer-term social consequences of having diabetes as a child and to determine whether adverse consequences are more severe for disadvantaged children. Methods Results from published and unpublished studies were synthesized narratively to examine the impact of diabetes on education, employment and income in adulthood. The question of whether the impact differed for different social groups was also examined. Results Case-control studies found that children with diabetes missed more school than healthy children. Most studies of attainment found no differences between children with diabetes and non-diabetic control subjects or the local population, although poor metabolic control, early-onset, longer illness duration and serious hypoglycaemic events were associated with underachievement. People with childhood-onset diabetes may experience disadvantage in employment, and have a lower income in adulthood, although diabetic complications appear to be the most important determinant of social consequences in later life. Conclusions Many children with diabetes,especially late-onset,perform equally well at school despite increased rates of absence, but it is not yet clear whether specific subgroups are at greater risk of educational underperformance. People with childhood-onset diabetes, however, do appear to experience some disadvantage in adult employment. Qualitative research and cohort studies are needed to fill key gaps in the existing evidence base. Future research must also examine the impact of diabetes-related risk factors on socio-economic consequences. [source] The rise of Viagra among British illicit drug users: 5-year survey dataDRUG AND ALCOHOL REVIEW, Issue 2 2006JIM McCAMBRIDGE Abstract Viagra use among British nightclubbers, a sentinel population of illicit drug users, was first reported in 1999. There has since been little attention paid to the evolution of patterns of non-prescribed use, apart from among men who have sex with men. Beginning in 1999 an annual survey has been conducted with a specialist dance music magazine, permitting cross-sectional comparisons over time. Rising levels of lifetime and current use prevalence and data on patterns of both male and female use are reported, along with elevated prevalence levels among both gay men and women. Experimentation with Viagra appears increasingly to have become established among British nightclubbers who use recreational drugs. Ethnographic and epidemiological study and monitoring of adverse consequences is now needed to fully appreciate reasons for use and the extent of possible harms. [source] Neuronal plasticity: implications in epilepsy progression and managementDRUG DEVELOPMENT RESEARCH, Issue 8 2007Sherifa A. HamedArticle first published online: 12 FEB 200 Abstract Epilepsy is a common neurological disease. A growing number of research studies provide evidence regarding the progressive neuronal damage induced by prolonged seizures or status epilepticus (SE), as well as recurrent brief seizures. Importantly, seizure is only one aspect of epilepsy. However, cognitive and behavioral deficits induced by progressive seizures or antiepileptic treatment can be detrimental to individual function. The neurobiology of epilepsy is poorly understood involving complex cellular and molecular mechanisms. The brain undergoes changes in its basic structure and function, e.g., neural plasticity with an increased susceptibility in neuronal synchronization and network circuit alterations. Some of these changes are transient, while others are permanent with an involvement of both glutamatergic and ,-aminobutyric acid (GABA)ergic systems. Recent data suggest that impaired neuronal plasticity may underlie the cognitive impairment and behavioral changes associated with epilepsy. Many neurologists recognize that the prevention or suppression of seizures by the use of antiepileptic drugs (AEDs) alone is insufficient without clear predictions of disease outcome. Hence, it is important to understand the molecular mechanisms underlying epileptogenesis because this may allow the development of innovative strategies to prevent or cure this condition. In addition, this realization would have significant impact in reducing the long-term adverse consequences of the disease, including neurocognitive and behavioral adverse effects. Drug Dev Res 68:498,511, 2007. © 2008 Wiley-Liss, Inc. [source] Genetic and non-genetic influences on the development of co-occurring alcohol problem use and internalizing symptomatology in adolescence: a reviewADDICTION, Issue 7 2009Luca Saraceno ABSTRACT Aims Alcohol problem use during adolescence has been linked to a variety of adverse consequences, including cigarette and illicit drug use, delinquency, adverse effects on pubertal brain development and increased risk of morbidity and mortality. In addition, heavy alcohol-drinking adolescents are at increased risk of comorbid psychopathology, including internalizing symptomatology (especially depression and anxiety). A range of genetic and non-genetic factors have been implicated in both alcohol problem use as well as internalizing symptomatology. However, to what extent shared risk factors contribute to their comorbidity in adolescence is poorly understood. Design We conducted a systematic review on Medline, PsycINFO, Embase and Web of Science to identify epidemiological and molecular genetic studies published between November 1997 and November 2007 that examined risk factors that may be shared in common between alcohol problem use and internalizing symptomatology in adolescence. Findings Externalizing disorders, family alcohol problems and stress, as well as the serotonin transporter (5-HTT) S-allele, the monoamine oxidase A (MAOA) low-activity alleles and the dopamine D2 receptor (DDR2) Taq A1 allele have been associated most frequently with both traits. An increasing number of papers are focusing upon the role of gene,gene (epistasis) and gene,environment interactions in the development of comorbid alcohol problem use and internalizing symptomatology. Conclusions Further research in adolescents is warranted; the increasing availability of large longitudinal genetically informative studies will provide the evidence base from which effective prevention and intervention strategies for comorbid alcohol problems and internalizing symptomatology can be developed. [source] Ten years after the United Nations General Assembly Special Session (UNGASS): assessing drug problems, policies and reform proposalsADDICTION, Issue 4 2009Peter Reuter ABSTRACT In 1998 the United Nations General Assembly Special Session resolved that governments would reduce drug production and consumption greatly within 10 years. With that period now elapsed, there is an interest in reviewing how successful this was and considering how drug policy could be improved. The demand for drugs in the world has stabilized mainly as a result of the interaction of epidemic forces, culture and economic development. Supply has become more concentrated and the menu of drugs has changed surprisingly slowly. Drug policy is shifting to a more explicitly tolerant configuration in Europe and a few other countries, but retains its ferocity in most of the world. The most prominent innovations under discussion have limited potential effects (heroin maintenance), have as yet been unproductive of policy interventions (,addiction is a brain disease') or have no political appeal (legalization). The option with the most scope is increased effort at diverting arrested drug users out of criminal justice systems. No prevention, treatment or enforcement strategies have demonstrated an ability to substantially affect the extent of drug use and addiction. The best that government interventions can do is to reduce the damaging consequences of drug use and drug control. More attention should be given to reductions in the intensity of drug enforcement, which has many unintended adverse consequences and yields few of the claimed gains. [source] Cannabis use and later life outcomesADDICTION, Issue 6 2008David M. Fergusson ABSTRACT Aim To examine the associations between the extent of cannabis use during adolescence and young adulthood and later education, economic, employment, relationship satisfaction and life satisfaction outcomes. Design A longitudinal study of a New Zealand birth cohort studied to age 25 years. Measurements Measures of: cannabis use at ages 14,25; university degree attainment to age 25; income at age 25; welfare dependence during the period 21,25 years; unemployment 21,25 years; relationship quality; life satisfaction. Also, measures of childhood socio-economic disadvantage, family adversity, childhood and early adolescent behavioural adjustment and cognitive ability and adolescent and young adult mental health and substance use. Findings There were statistically significant bivariate associations between increasing levels of cannabis use at ages 14,21 and: lower levels of degree attainment by age 25 (P < 0.0001); lower income at age 25 (P < 0.01); higher levels of welfare dependence (P < 0.0001); higher unemployment (P < 0.0001); lower levels of relationship satisfaction (P < 0.001); and lower levels of life satisfaction (P < 0.0001). These associations were adjusted for a range of potentially confounding factors including: family socio-economic background; family functioning; exposure to child abuse; childhood and adolescent adjustment; early adolescent academic achievement; and comorbid mental disorders and substance use. After adjustment, the associations between increasing cannabis use and all outcome measures remained statistically significant (P < 0.05). Conclusions The results of the present study suggest that increasing cannabis use in late adolescence and early adulthood is associated with a range of adverse outcomes in later life. High levels of cannabis use are related to poorer educational outcomes, lower income, greater welfare dependence and unemployment and lower relationship and life satisfaction. The findings add to a growing body of knowledge regarding the adverse consequences of heavy cannabis use. [source] Comparative study of microcystin-LR-induced behavioral changes of two fish species, Danio rerio and Leucaspius delineatusENVIRONMENTAL TOXICOLOGY, Issue 6 2004Daniela Baganz Abstract The spontaneous locomotor behavior separated into day/night activity phases of two fish species Danio rerio and Leucaspius delineatus was recorded and quantified continuously under sublethal long-term exposure to microcystin-LR in tanks. Microcystin-LR was applied in concentrations of 0.5, 5, 15, and 50 ,g L,1. By using an automated video-monitoring and object-tracing system, the average motility (swimming velocity) and the average number of turns were assessed. Clear dose-dependent effects of microcystin-LR on the behavior of both test fish were measured. During the daytime, the motility of Danio rerio as well as Leucaspius delineatus increased significantly by exposure to the lowest concentrations, whereas higher concentrations led to significantly decreased motility. Influenced by microcystin-LR, the swimming time of Leucaspius delineatus reversed, going from a prominently diurnal activity to a nocturnal one; Danio rerio remained active during the daytime. Most of the relative changes in the behavioral patterns of Danio rerio and Leucaspius delineatus suggest these fish have comparable susceptibility to microcystin-LR and may indicate some adverse consequences for fish populations, for example, in connection with reproduction and predator,prey interactions. © 2004 Wiley Periodicals, Inc. Environ Toxicol 19: 564,570, 2004. [source] Supply control and harm reduction: lessons from the Australian heroin ,drought'ADDICTION, Issue 1 2003Don Weatherburn ABSTRACT Aims, To examine the effects of supply-side drug law enforcement on the dynamics of the Australian heroin market and the harms associated with heroin. Setting, Around Christmas 2000, heroin users in Sydney and other large capital cities in Australia began reporting sudden and significant reductions in the availability of heroin. The changes, which appear to have been caused at least in part by drug law enforcement, provided a rare opportunity to examine the potential impact of such enforcement on the harm associated with heroin. Design, Data were drawn from a survey of 165 heroin users in South-Western Sydney, Australia; from the Drug Use Monitoring in Australia (DUMA) project; from NSW Health records of heroin overdoses; and from the Computerized Operational Policing System (COPS) database. Findings, Heroin price increased, while purity, consumption and expenditure on the drug decreased as a result of the shortage. The fall in overall heroin use was accompanied by a significant reduction in the rate of overdose in NSW. However, the health benefits associated with the fall in overdose may have been offset by an increase in the use of other drugs (mainly cocaine) since the onset of the heroin shortage. There does not appear to have been any enduring impact on crime rates as a result of the heroin ,drought'. Conclusion, Supply control has an important part to play in harm reduction; however, proponents of supply-side drug law enforcement need to be mindful of the unintended adverse consequences that might flow from successfully disrupting the market for a particular illegal drug. [source] Alcoholic macrocytosis,is there a role for acetaldehyde and adducts?ADDICTION BIOLOGY, Issue 1 2004Onni Niemelä Although alcohol abuse is known to cause a wide array of adverse effects on blood cell formation, the molecular mechanisms by which alcohol exerts its toxic actions have remained poorly defined. Elevated mean corpuscular volume (MCV), macrocytosis, is the most typical morphological abnormality induced by excessive ethanol consumption. This paper reviews recent data indicating that acetaldehyde, the first metabolite of ethanol, may play a role in the haematological derangements in peripheral blood cells and in bone marrow of alcoholic patients. Studies in experimental animals and in human alcoholics have shown that acetaldehyde can bind to proteins and cellular constituents forming stable adducts. Elevated adduct levels have been found from the erythrocytes of alcohol abusers, which may also be associated with ethanol-induced effects in haematopoiesis and adverse consequences in cellular functions. [source] Abnormal associative encoding in orbitofrontal neurons in cocaine-experienced rats during decision-makingEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 9 2006Thomas A. Stalnaker Abstract Recent evidence has linked exposure to addictive drugs to an inability to employ information about adverse consequences, or outcomes, to control behavior. For instance, addicts and drug-experienced animals fail to adapt their behavior to avoid adverse outcomes in gambling and reversal tasks or after changes in the value of expected rewards. These deficits are similar to those caused by damage to the orbitofrontal cortex, suggesting that addictive drugs may cause long-lasting changes in the representation of outcome associations in a circuit that includes the orbitofrontal cortex. Here we test this hypothesis by recording from orbitofrontal neurons in a discrimination task in rats previously exposed to cocaine (30 mg/kg i.p. for 14 days). We found that orbitofrontal neurons recorded in cocaine-experienced rats failed to signal the adverse outcome at the time a decision was made in the task. The loss of this signal was associated with abnormal changes in response latencies on aversive trials. Furthermore, upon reversal of the cue,outcome associations, orbitofrontal neurons in cocaine-treated rats with enduring reversal impairments failed to reverse their cue-selectivity, while orbitofrontal neurons in cocaine-treated rats with normal performance showed an increase in the plasticity of cue-selective firing after reversal. These results provide direct neurophysiological evidence that exposure to cocaine can cause behaviorally relevant changes in the processing of associative information in a circuit that includes the orbitofrontal cortex. [source] Authoritarianism is good for you: Right-wing authoritarianism as a buffering factor for mental distressEUROPEAN JOURNAL OF PERSONALITY, Issue 1 2009Alain Van Hiel Abstract Although common knowledge seems to agree that authoritarianism is ,bad to the self', previous studies yielded inconclusive results with respect to the relationship between authoritarianism and mental distress. The present research explores whether the impact of facilitators of mental distress on actual mental distress depends on the level of authoritarianism. Study 1 includes a sample of 132 adults and demonstrated less negative consequences of D-type personality on depression for individuals with high rather than low levels of authoritarianism. Study 2 conducted in a sample of 109 elderly revealed that the effects of negative stressful life events on mental distress were curbed by higher levels of authoritarianism. It is concluded that while previous studies have amply shown that authoritarianism has adverse consequences for other people, these negative effects do not appear to be particularly present for the self. Copyright © 2008 John Wiley & Sons, Ltd. [source] Cost inefficiency and hospital health outcomesHEALTH ECONOMICS, Issue 7 2008Niccie L. McKay Abstract This study explores the association between cost inefficiency and health outcomes in a national sample of acute-care hospitals in the US over the period 1999,2001, with health outcomes being measured by both mortality and complications rates. The empirical analysis examines health outcomes as a function of cost inefficiency and other determinants of outcomes, using stochastic frontier analysis to obtain hospital cost inefficiency scores. The results showed no systematic pattern of association between cost inefficiency and hospital health outcomes; the basic results were unchanged regardless of whether cost inefficiency was measured with or without using instrumental variables. The analysis also indicated, however, that the association between cost inefficiency and health outcomes may vary substantially across geographical regions. The study highlights the importance of distinguishing between ,good' costs that reflect the efficient use of resources and ,bad' costs that stem from waste and other forms of inefficiency. In particular, the study's results suggest that hospital programs focused on reducing cost inefficiency are unlikely to be associated with worsened hospital-level mortality or complications rates, while, on the other hand, across-the-board reductions in cost could well have adverse consequences on health outcomes by reducing efficient as well as inefficient costs. Copyright © 2007 John Wiley & Sons, Ltd. [source] Systematic review of the effectiveness of integrated care pathways: what works, for whom, in which circumstances?INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2009Davina Allen RGN BA(Hons) PhD Abstract Aim, Integrated care pathways (ICP) are management technologies which formalise multidisciplinary team-working and enable professionals to examine their roles and responsibilities. ICPs are now being implemented across international healthcare arena, but evidence to support their use is equivocal. The aim of this study was to identify the circumstances in which ICPs are effective, for whom and in what contexts. Methods, A systematic review of high-quality randomised controlled trials published between 1980 and 2008 (March) evaluating ICP use in child and adult populations in the full range of healthcare settings. Results 1For relatively predictable trajectories of care ICPs can be effective in supporting proactive care management and ensuring that patients receive relevant clinical interventions and/or assessments in a timely manner. This can lead to improvements in service quality and service efficiency without adverse consequences for patients. 2ICPs are an effective mechanism for promoting adherence to guidelines or treatment protocols thereby reducing variation in practice. 3ICPs can be effective in improving documentation of treatment goals, documentation of communication with patients, carers and health professionals. 4ICPs can be effective in improving physician agreement about treatment options. 5ICPs can be effective in supporting decision-making when they incorporate a decision-aide. 6The evidence considered in this review indicates that ICPs may be particularly effective in changing professional behaviours in the desired direction, where there is scope for improvement or where roles are new. 7Even in contexts in which health professionals are already experienced with a particular pathway, ICP use brings additional beneficial effects in directing professional practice in the desired direction. 8ICPs may be less effective in bringing about service quality and efficiency gains in variable patient trajectories. 9ICPs may be less effective in bringing about quality improvements in circumstances in which services are already based on best evidence and multidisciplinary working is well established. 10Depending on their purpose, the benefits of ICPs may be greater for certain patient subgroups than others. 11We do not know whether the costs of ICP development and implementation are justified by any of their reported benefits. 12ICPs may need supporting mechanisms to underpin their implementation and ensure their adoption in practice, particularly in circumstances in which ICP use is a significant change in organisational culture. 13ICP documentation can introduce scope for new kinds of error. Conclusions, ICPs are most effective in contexts where patient care trajectories are predictable. Their value in settings in which recovery pathways are more variable is less clear. ICPs are most effective in bringing about behavioural changes where there are identified deficiencies in services; their value in contexts where inter-professional working is well established is less certain. None of the studies reviewed included an economic evaluation and thus it is not known whether their benefits justify the costs of their implementation. [source] Prostate cancer treatment options (observation versus prostatectomy) , the available evidenceINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 3 2007Josephine Hegarty Abstract Advanced screening programmes have led to an increased incidence of prostate cancer worldwide. Prostate Cancer is currently the most common site of male cancers worldwide; accounting for 21% of all male cancers in Ireland. This article presents an in-depth review of the available evidence (January 1997 to April 2007), which directly compares outcomes (in terms of urinary function, bowel function, sexual function, quality-of-life (QOL) outcomes and survival statistics) post radical prostatectomy versus a conservative watch-and-wait approach for the treatment of clinically localized prostate cancer. The aim of this paper is to equip health-care professionals with the best available research evidence. Best research evidence is a component of evidence-based practice, which is very much ,in vogue' in health care today. The authors recommend that practitioners utilize this, the available evidence in combination with their clinical expertise and their patients' opinions in order to assist these patients' to make wise and informed treatment decisions. As this paper will demonstrate, the treatment chosen can have important implications in terms of patient outcomes. Therefore, making an informed decision early on can prevent any regret at a later stage. Overall this review of the literature revealed significant disparity in terms of which treatment option is more favourable. Patients overall are faced with a difficult dilemma when making this treatment decision , to live longer at the expense of potential erectile dysfunction and possible urinary incontinence or to live for a potentially shorter time without these adverse consequences. [source] Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic reviewJOURNAL OF ADVANCED NURSING, Issue 2 2009Michelle Cleary Abstract Title.,Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review. Aim., This study is a report of a systematic review to assess current evidence for the efficacy of psychosocial interventions for reducing substance use, as well as improving mental state and encouraging treatment retention, among people with dual diagnosis. Background., Substance misuse by people with a severe mental illness is common and of concern because of its many adverse consequences and lack of evidence for effective psychosocial interventions. Data sources., Several electronic databases were searched to identify studies published between January 1990 and February 2008. Additional searches were conducted by means of reference lists and contact with authors. Review methods., Results from studies using meta-analysis, randomized and non-randomized trials assessing any psychosocial intervention for people with a severe mental illness and substance misuse were included. Results., Fifty-four studies were included: one systematic review with meta-analysis, 30 randomized controlled trials and 23 non-experimental studies. Although some inconsistencies were apparent, results showed that motivational interviewing had the most quality evidence for reducing substance use over the short term and, when combined with cognitive behavioural therapy, improvements in mental state were also apparent. Cognitive behavioural therapy alone showed little consistent support. Support was found for long-term integrated residential programmes; however, the evidence is of lesser quality. Contingency management shows promise, but there were few studies assessing this intervention. Conclusion., These results indicate the importance of motivational interviewing in psychiatric settings for the reduction of substance use, at least in the short term. Further quality research should target particular diagnoses and substance use, as some interventions may work better for some subgroups. [source] An exploratory study of anxiety in carers of stroke survivorsJOURNAL OF CLINICAL NURSING, Issue 13-14 2010Nan Greenwood Aims and objectives., To investigate anxiety in informal carers of stroke survivors in the first three months after discharge. Background., Informal carers, also called caregivers, play a vital role in supporting stroke survivors. However, caring for stroke survivors can have adverse consequences amongst carers such as burden, stress and reduced quality of life. Emotional distress is also commonly reported but anxiety has received less attention than depression. Design., Prospective, longitudinal, descriptive study. Method., Forty-five carers completed the Hospital Anxiety and Depression Scale on two occasions , within one month and at three months after discharge from stroke and rehabilitation units. Results., Carers were more likely to have scores indicating anxiety than depression. In the first month, half the carers (51·1%) scored in the cut-off for anxiety and a third were in the cut-off for depression (31·1%). At three months, the picture was very similar with nearly identical proportions in the anxious and depressed categories (48·9% and 28·9%, respectively). Changes in numbers of cases of anxiety and depression and in mean anxiety scores were non-significant but there was a significant decrease in depression scores (p = 0·048). Fourteen carers (31·1%) at one month and eleven (24·4%) at three months fell into both anxious and depressed categories. Conclusions., Anxiety is a relatively neglected emotional outcome in stroke carers. Our study suggests anxiety is an important issue very early in caring whilst other research suggests it remains prevalent for many months. Given the significant role carers play in rehabilitation of stroke survivors, greater recognition of their emotional state is required. Further, longitudinal research with larger sample sizes from a range of geographical areas and improved understanding of factors associated with anxiety is needed. Relevance to clinical practice., Nurses working in the community are ideally placed to identify and support carers suffering from anxiety. [source] Historical Analysis of Siderail Use in American HospitalsJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2001Barbara L. Brush Purpose: To explore the social, economic, and legal influences on siderail use in 20th century American hospitals and how use of siderails became embedded in nursing practice. Design: Social historical research. Methods: Numerous primary and secondary sources were collected and interpreted to illustrate the pattern of siderail use, the value attached to siderails, and attitudes about using siderails. Findings: The persistent use of siderails in American hospitals indicates a gradual consensus between law and medicine rather than an empirically driven nursing intervention. Use of siderails became embedded in nursing practice as nurses assumed increasing responsibility for their actions as institutional employees. Conclusions: New federal guidelines, based on reports of adverse consequences associated with siderails, are limiting siderail use in hospitals and nursing homes across the United States. Lowering siderails and using alternatives will depend on new norms among health care providers, hospital administrators, bed manufacturers, insurers, attorneys, regulators, and patients and their families. [source] To prosper, organizational psychology should, expand the values of organizational psychology to match the quality of its ethics,JOURNAL OF ORGANIZATIONAL BEHAVIOR, Issue 4 2008Joel Lefkowitz The values of organizational psychology are criticized as (a) having supplanted psychology's humanist tradition and societal responsibilities with corporate economic objectives; (b) being "scientistic" in perpetuating the notion of value-free science while ignoring that it is business values that largely drive our research and practice; (c) failing to include normative perspectives of what organizations ought to be like in moral terms; (d) having a pro-management bias; and (e) having allowed ourselves to be defined largely by technocratic competence, almost to the exclusion of considering desirable societal goods. Illustrations of some adverse consequences of these values are presented. It is suggested we expand our self-image to encompass a scientist,practitioner,humanist (S-P-H) model that includes consideration of different values, advocacy of employee rights and a normative characterization of how organizations ought to be,reflecting the broader societal responsibilities of a true profession. Copyright © 2008 John Wiley & Sons, Ltd. [source] Latent errors and adverse organizational consequences: a conceptualizationJOURNAL OF ORGANIZATIONAL BEHAVIOR, Issue 7 2003Rangaraj Ramanujam We develop the concept of latent errors,uncorrected deviations from procedures and policies that have no direct adverse consequences,and examine the complex relationships between organizational antecedents, latent errors, and adverse consequences. Latent errors, with varying levels of frequency, are present in all organizations whereas extreme adverse outcomes are rare. Thus, all organizations become potential objects of study in research on errors. Latent errors enable the design of ex ante studies of errors that avoid sampling on the dependent variable. The basic elements of our framework focus on two critical linkages. First is the role of antecedent factors such as incentives and goals in contributing to the presence of latent errors. Second, we explore how positive and negative feedback systems and external triggers link an acceleration of latent errors with adverse organizational outcomes. We also discuss how variations in context (e.g., whether work activities are co-located or distributed) may affect these factors. Implications for research on high-reliability organizations are discussed. Copyright © 2003 John Wiley & Sons, Ltd. [source] Neonatal ascites and hyponatraemia following umbilical venous catheterizationJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2002MS Mohan Abstract: The complications associated with umbilical venous catheterization in neonates range from pericardial effusion, portal hypertension, and peritoneal perforation with ascites, to Wharton's jelly embolism. The case of a term neonate who developed ascites and severe hyponatraemia (serum sodium 119 mmol/L) most probably following peritoneal perforation by an umbilical venous catheter is reported. The presenting feature was convulsions associated with dilutional hyponatraemia, probably following absorption of a large quantity of ascitic fluid across the peritoneum. Conservative management was associated with gradual recovery over 24 h. The case highlights that, irrespective of the route, excessive administration of salt-free fluids can lead to dilutional hyponatraemia with adverse consequences. The present case illustrates the importance of confirming intravascular positioning of umbilical catheters by ensuring free flow of blood on aspiration, to prevent/detect inadvertent peritoneal perforation. Ideally, echocardiographic confirmation of optimal intravascular placement of such catheters is preferred as radiographic confirmation is reported to be unreliable. [source] Acute sleep-promoting action of the melatonin agonist, ramelteon, in the ratJOURNAL OF PINEAL RESEARCH, Issue 2 2008Simon P. Fisher Abstract:, Insomnia, which is severe enough to warrant treatment, occurs in ,10% of the general population. It is associated with a range of adverse consequences for human health, economic productivity and quality of life. In animal and human studies, administration of melatonin has been reported to promote sleep, although there has been controversy regarding its effectiveness. The present study used a chronically implanted radiotelemetry transmitter to record electroencephalogram (EEG) and electromyogram (EMG) to enable discrimination of wake (W), nonrapid eye movement (NREM) sleep and rapid eye movement (REM) sleep in un-restrained rats. The acute action of melatonin and ramelteon, a melatonin agonist recently approved for long-term treatment of insomnia in the USA, was examined. Radioligand binding assays on recombinant human MT1/MT2 receptors showed that both the melatonin and ramelteon were both high affinity, nonsubtype selective ligands. Both compounds acted as potent full agonists on a cellular model of melatonin action, the pigment aggregation response in Xenopus laevis melanophores. Both melatonin and ramelteon (10 mg/kg, i/p), administered close to the mid-point of the dark phase of the L:D cycle, significantly reduced NREM sleep latency (time from injection to the appearance of NREM sleep). Both the drugs also produced a short-lasting increase in NREM sleep duration, but the NREM power spectrum was unaltered. Neither drug altered REM latency, REM sleep duration nor power spectrum during REM sleep. In conclusion, ramelteon administration, like melatonin, exerted an acute, short-lasting sleep-promoting effect in the rat, the model most commonly used to evaluate the activity of novel hypnotic drugs. [source] Adverse Drinking-Related Consequences Among Lower Income, Racial, and Ethnic Minority Drinkers: Cross-Sectional ResultsALCOHOLISM, Issue 4 2009Anna-Marie Vilamovska Objective:, To examine factors associated with adverse consequences of alcohol consumption among a community sample of drinkers in a low-income, racial, and ethnic minority community. Methods:, A sample of 329 drinkers was recruited from 17 randomly selected off-sell alcohol outlets in South Los Angeles. Respondents were interviewed by trained research personnel on their demographic characteristics, income, drinking patterns and preferences, and alcohol-related adverse consequences (using the Drinkers Inventory of Consequences,DrInC), among other items. We developed logistic regression models predicting high scores on DrInC total score and subscales (impulse control, interpersonal, intrapersonal, physical, and social responsibility). Results:, In this sample, we found drinking patterns,bingeing, drinking outdoors, drinking in the morning,to be significantly associated with total DrInC scores and some subscales. Malt liquor beverage (MLB) use was significantly associated with total DrInC score and interpersonal and social responsibility subscales. Previous alcohol treatment predicted all but 1 DrInC subscale and total score. Conclusions:, A diverse array of factors predicted high DrInC total and subscale scores. More research on the association between MLB use and consequences is required. In addition, studies with community samples are likely to further enrich our understanding of the interactions between drinking patterns and preferences, settings, and negative consequences. [source] Alcohol Availability and Intimate Partner Violence Among US CouplesALCOHOLISM, Issue 1 2009Christy M. McKinney Objectives:, We examined the relation between alcohol outlet density (the number of alcohol outlets per capita by zip code) and male-to-female partner violence (MFPV) or female-to-male partner violence (FMPV). We also investigated whether binge drinking or the presence of alcohol-related problems altered the relationship between alcohol outlet density and MFPV or FMPV. Methods:, We linked individual and couple sociodemographic and behavioral data from a 1995 national population-based sample of 1,597 couples to alcohol outlet data and 1990 US Census sociodemographic information. We used logistic regression for survey data to estimate unadjusted and adjusted odds ratios between alcohol outlet density and MFPV or FMPV along with 95% confidence intervals (CIs) and p -values. We used a design-based Wald test to derive a p -value for multiplicative interaction to assess the role of binge drinking and alcohol-related problems. Results:, In adjusted analysis, an increase of one alcohol outlet per 10,000 persons was associated with a 1.03-fold increased risk of MFPV (p -value for linear trend = 0.01) and a 1.011-fold increased risk of FMPV (p -value for linear trend = 0.48). An increase of 10 alcohol outlets per 10,000 persons was associated with 34% and 12% increased risk of MFPV and FMPV respectively, though the CI for the association with FMPV was compatible with no increased risk. The relationship between alcohol outlet density and MFPV was stronger among couples reporting alcohol-related problems than those reporting no problems (p -value for multiplicative interaction = 0.01). Conclusions:, We found that as alcohol outlet density increases so does the risk of MFPV and that this relationship may differ for couples who do and do not report alcohol-related problems. Given that MFPV accounts for the majority of injuries related to intimate partner violence, policy makers may wish to carefully consider the potential benefit of limiting alcohol outlet density to reduce MFPV and its adverse consequences. [source] Trends in self-reported sleep duration and insomnia-related symptoms in Finland from 1972 to 2005: a comparative review and re-analysis of Finnish population samplesJOURNAL OF SLEEP RESEARCH, Issue 1 2008ERKKI KRONHOLM Summary A hypothesis concerning habitual sleep reduction and its adverse consequences among general population in modern societies has received wide publicity in the mass media, although scientific evidence supporting the hypothesis is scarce. Similarly, there is an extensively distributed belief, at least in Finland, that the prevalence of insomnia-related symptoms is increasing, but evidence for this is even sparser. These issues are important because of the known increased risk of mortality and health risks associated with sleep duration deviating from 7 to 8 h. To reveal possible trends in self-reported sleep duration and insomnia-related symptoms, we reanalyzed all available data from surveys carried out in Finland from 1972 to 2005. The main results were that a minor decrease of self-reported sleep duration has taken place in Finland, especially among working aged men. However, the size of the reduction (about 4%) was relatively small, approximately 5.5 min per each 10 years during the 33 years' time interval under study. The proportion of 7 h sleepers has increased and, correspondingly, the proportion of 8 h sleepers has decreased, but the extreme ends of the sleep duration distribution remained unchanged. Tentative evidence suggesting an increase in insomnia-related symptoms among working aged population during the last 10 years was found. In conclusion, the Finnish data during the past 33 years indicate a general decrease in self-reported sleep duration of about 18 min and an increase of sleep complaints, especially among the employed middle-aged population. [source] | |||||||||||||||||||||||||||||||||||||||||||