Preventing Unintentional Prescription Drug Poisoning Project: 2012 Annual Report

This narrative addresses the three broad categories of project objectives for 2012: (1) Transition of the Prescription Drug Poisoning Coalition to the Montgomery County Opiate Task Force. (2) The continued development and operation of a Poison Death Review process focusing on prescription drugs. (3) The facilitation and conduct of targeted Information, Training and Educational Activities to help address and prevent prescription drug overdoses

Montgomery County Poisoning Death Review - 2012

In 2012, 162 unintentional drug overdose deaths, the highest number on record, occurred in Montgomery County, Ohio. This finding comes from the Poisoning Death Review (PDR), a process involving the compilation and interpretation of multiple data sets from the Montgomery County Coroner’s Office. The PDR is carried out by faculty and staff at the Wright State University Boonshoft School of Medicine in collaboration with the Montgomery County Coroner’s Office. The designation of deaths being either unintentional (accident) or intentional (suicide) is made by the Montgomery County Coroner. This is the third year the PDR has been conducted. In 2011, 130 unintentional drug overdose deaths occurred in Montgomery County; 127 in 2010

Prescription Drug Abuse and Diversion: Results of a Survey of Physicians & Dentists

To identify the training needs of prescribers for prevention and intervention efforts to address the problem of Unintentional Prescription Drug Poisoning, a web-based survey was created and administered in September, 2010. The survey was publicized to the Dayton area health care providers (largely physicians and dentists) via postcards, Medical and Dental Societies, and list-serves. The survey contained 17 questions and took about 5 minutes to complete. A total of 130 people completed the on-line survey. As seen from the Figure 1, the majority of respondents were physicians, and about 70% were male. More than 80% reported prescribing opioids at their practice. About 10% did not prescribe any controlled substances, and they were excluded from responding to some of the questions, as indicated below

Dayton Area 9th Grade Lifetime Use Table

Survey results of the percentage of 9th graders in the Dayton, OH area reporting lifetime drug use between 1992 and 2012

A thematic synthesis of the experiences of adults living with hemodialysis

Background and objectives In-center dialysis patients spend significant amounts of time on the dialysis unit; additionally managing ESKD affects many aspects of life outside the dialysis unit. To improve the care provided to patients requiring hemodialysis their experiences and beliefs regarding treatment must be understood. This systematic review aimed to synthesise the experiences of patients receiving in-center hemodialysis. Design, setting, participants, and measurements Embase, MEDLINE, CINAHL and PsychINFO, Google scholar and reference lists were searched for primary qualitative studies exploring the experiences of adult patients receiving treatment with in-center hemodialysis. A thematic synthesis was conducted. Results 17 studies involving 576 patients were included in the synthesis. 4 analytical themes were developed. The first theme “a new dialysis dependent self” describes the changes in identity and perceptions of self that could result from dialysis dependence. The second theme, “a restricted life”, describes the physical and emotional constraints patients described as a consequence of their dependence. Some patients reported strategies that allowed them to regain a sense of optimism and influence over the future and these contributed to the third theme, “regaining control”. The first three themes describe a potential for change through acceptance, adaption and re-gaining a sense of control. The final theme, “relationships with health professionals” describes the importance of these relationships for in-center patients and their influence on perceptions of power and support. These relationships are seen to influence the other three themes through information sharing, continuity and personalized support. Conclusions This synthesis has resulted in a framework that can be utilized to consider interventions to improve patients’ experiences of in-center hemodialysis care. Focusing on interventions that are incorporated into the established relationships patients have with their health care professionals may enable patients’ to progress towards a sense of control and improve satisfaction with care

The effects of an individual, multistep intervention on adherence to treatment in hemodialysis patients

Purpose: The present study was conducted to investigate the effect of individual, multistep intervention on adherence to treatment in hemodialysis patients referred to a hemodialysis center in Shahrekord, Iran. Method: In this interventional study, hemodialysis patients referring the center of the study were randomly assigned into two control and intervention groups (each 33). The control group received routine treatment, recommended dietary and fluid restrictions. The intervention group participated in eight individual interventional sessions accompanied routine treatment. At the beginning and the end of the study, routine laboratory tests and end-stage renal disease-adherence questionnaire were filled out for patients in both groups. The data were analyzed using Mann-Whitney and Wilcoxon tests. Results: At the end of the study, the two groups showed a significant difference in all domains of adherence except adherence to diet and adherence was better in the intervention group (p < 0.05). In demographic characteristic, only age indicated a positive correlation with adherence to dialysis program (p = 0.04, r = 0.254). After intervention, serum phosphorus decreased significantly in the intervention group (p < 0.05). Conclusions: Adherence to treatment is one of the major problems in hemodialysis patients; however, comprehensive interventions are required in view of individual condition. ▸ Implications for Rehabilitation • Adherence to treatment means that all patients behaviors (diet, fluids and drugs intake) should be in line with the recommendations given by healthcare professionals. • There is evidence on the association between adherence to treatment and decreased risk of hospitalization in dialysis patients. • Individual structured programs are most likely to be successful in encouraging adherence to treatment. © 2015 Informa UK Ltd. All rights reserved

A functional analysis of two transdiagnostic, emotion-focused interventions on nonsuicidal self-injury

OBJECTIVE: Nonsuicidal self-injury (NSSI) is prevalent and associated with clinically significant consequences. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the critical components for NSSI treatment remain largely unknown. The aim of this study was to examine the specific effects of mindful emotion awareness training and cognitive reappraisal, 2 transdiagnostic treatment strategies that purportedly address the functional processes thought to maintain self-injurious behavior, on NSSI urges and acts. METHOD: Using a counterbalanced, combined series (multiple baseline and data-driven phase change) aggregated single-case experimental design, the unique and combined impact of these 2 4-week interventions was evaluated among 10 diagnostically heterogeneous self-injuring adults. Ecological momentary assessment was used to provide daily ratings of NSSI urges and acts during all study phases. RESULTS: Eight of 10 participants demonstrated clinically meaningful reductions in NSSI; 6 participants responded to 1 intervention alone, whereas 2 participants responded after the addition of the alternative intervention. Group analyses indicated statistically significant overall effects of study phase on NSSI, with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in self-reported levels of anxiety and depression, and large improvements in mindful emotion awareness and cognitive reappraisal skills. CONCLUSIONS: Findings suggest that brief mindful emotion awareness and cognitive reappraisal interventions can lead to reductions in NSSI urges and acts. Transdiagnostic, emotion-focused therapeutic strategies delivered in time-limited formats may serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals.Dr. Barlow receives royalties from Oxford University Press, Guilford Publications Inc., Cengage Learning, and Pearson Publishing. Grant monies for various projects come from the National Institute of Mental Health (F31MH100761), the National Institute of Alcohol and Alcohol Abuse, and Colciencias (Government of Columbia Initiative for Science, Technology, and Health Innovation). Consulting and honoraria during the past several years have come from the Agency for Healthcare Research and Quality, the Foundation for Informed Medical Decision Making, the Department of Defense, the Renfrew Center, the Chinese University of Hong Kong, Universidad Catolica de Santa Maria (Arequipa, Peru), New Zealand Psychological Association, Hebrew University of Jerusalem, Mayo Clinic, and various American Universities. (F31MH100761 - National Institute of Mental Health; National Institute of Alcohol and Alcohol Abuse; Colciencias (Government of Columbia Initiative for Science, Technology, and Health Innovation))Accepted manuscrip

Combining optimal nutrition and exercise in a multimodal approach for patients with active cancer and risk for losing weight: Rationale and practical approach

Weight loss and functional decline is a common and detrimental consequence of cancer. The interventions that are offered to patients with weight loss and functional decline often seem haphazard and varying from center to center. The lack of stringent management is probably based both on lack of knowledge of existing treatment guidelines and the current weak level of evidence of clinical effects of different nutritional and exercise interventions. Some studies evaluated multimodal interventions with various treatment combinations, including nutrition and exercise, that report clinically significant effects on cachexia outcomes. As of today, however, there is a paucity of large randomized controlled trials that incorporate both a fully structured exercise program and a well-described nutritional intervention. Studies investigating combinations of several interventions in patients with active cancer and risk for losing weight are too few and too heterogeneous to enable firm conclusions about effect, optimal dose, or timing of interventions. However, data presented in this review suggest an overall benefit, especially if interventions are started before weight loss and loss of function become too severe. Thus, the aim of this review was to examine the evidence for combined treatments targeting weight loss in cancer patients.acceptedVersion© 2019. This is the authors’ accepted and refereed manuscript to the article. Locked until 27.06.2020 due to copyright restrictions. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0

Impact of pharmacist intervention in patient counseling at point of hospital discharge in a specialized cardiac center in Saudi Arabia

Purpose: To determine the interventions associated with the pharmacist’s patient counseling and review of discharge prescriptions of patients from a specialized cardiac center in Saudi Arabia.Methods: This was a prospective interventional study conducted at Prince Sultan Cardiac Center (PSCC) in Riyadh, Saudi Arabia for a duration of 12 months. The pharmacist responsible for providing patient counseling reviewed the patient records, collected patient demographics and clinical data, as well as medical and medication history, diagnosis and discharge (treatment) plan.Results: The study included 2008 patients who met the inclusion criteria. The counseling pharmacist identified and provided interventions to 358 (18 %) patients for 508 (3.4 %) items. About half of counseling pharmacist interventions concerned involved the addition of a drug to treatment regimen followed by drug discontinuation (28.1 %). The most common reason for adding the drug during patient counseling was the omission of medications (35 %). Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs), antidiabetics and antihyperlipidemics were the classes of drugs often associated with counseling pharmacist interventions. The cost-saving interventions identified were 200 (39.4 %). Out of these, drug discontinuation (n = 143) was the most frequent suggestion provided by the intervening pharmacist, followed by a dose reduction resulting in cost savings of 66.5 % (US $6,590.10) and 8.9$ 882.32), respectively.Conclusion: The results indicate that discharge medication discrepancies decrease as a result of pharmacist-facilitated patient counseling at the point of hospital discharge.Keywords: Discharged patients, Cardiac, Counseling, Pharmacist-intervention, Coronary artery diseas

YouTube Atherectomy Videos: What Industry is Telling Us About this Endovascular Procedure

BACKGROUND: Patients are turning to the Internet and YouTube for information about their providers, disease states and potential interventions. Endovascular atherectomy is a common procedure undertaken in the treatment of peripheral vascular disease especially in outpatient treatment centers despite its cost. Little is known how this procedure is portrayed in online video content. We set forth to search YouTube to gain insight to how industry and non-industry portrays this endovascular technology. METHODS: YouTube (www.youtube.com) website was accessed in July 2017 with a cleared cached web browser for the key search word “atherectomy”. The top 100 videos with greater than 100 views were examined. All results were separated into two categories - industry (I) or non-industry (NI) sources. The duration of video, age of video, total video views, academic information, cost information and if outpatient treatment center focused care were also collected. RESULTS: A total of 100 videos were examined. The videos were separated into two groups: Industry (n=20) and Non-Industry (n=80). Videos from Industry and Non-Industry were similar in content in terms of duration (4.8 ± 4.5 and 5.6 ± 4.4 minutes), creation time (3.3 ± 2.2 and 3.4 ± 1.9 years), and total views (7386 ± 14,593 and 5560 ± 13,181). Proportions of videos from each group that contained educational content were also similar (70% and 70%). However, only 7% (n=7) of the videos reference the procedure being linked to care in outpatient treatment center. Only 3% (n=3) mentioned the cost of the procedure. All of these videos from each of these categories were from non-industry sources. Conclusion: In our sampling of “Atherectomy” YouTube videos, we find similar video content in terms of duration, creation time, total views and educational content. Interestingly, the cost and its association with outpatient treatment labs is mentioned in only a minority of the videos and only from non-industry sources. These data should inform the vascular surgery community the lack of public understanding of this endovascular technology as evidenced in YouTube videos