Bimodal release ondansetron for acute gastroenteritis among adolescents and adults: A randomized clinical trial

Importance: Vomiting resulting from acute gastroenteritis is commonly treated with intravenous antiemetics in acute care settings. If oral treatment were beneficial, patients might not need intravenous administered hydration or medication. Furthermore, a long-acting treatment could provide sustained relief from nausea and vomiting. Objective: To determine whether an experimental long-acting bimodal release ondansetron tablet decreases gastroenteritis-related vomiting and eliminates the need for intravenous therapy for 24 hours after administration. Design, Setting, and Participants: This placebo-controlled, double-blind, randomized clinical trial included patients from 19 emergency departments and 2 urgent care centers in the United States from December 8, 2014, to February 17, 2017. Patients 12 years and older with at least 2 vomiting episodes from presumed gastroenteritis in the previous 4 hours and symptoms with less than 36 hours\u27 duration were randomized using a 3:2 active to placebo ratio. Analyses were performed on an intent-to-treat basis and conducted from June 1, 2017, to November 1, 2017. Intervention: Bimodal release ondansetron tablet containing 6 mg of immediate release ondansetron and 18 mg of a 24-hour release matrix for a total of 24 mg of ondansetron. Main Outcomes and Measures: Treatment success was defined as no further vomiting, no need for rescue medication, and no intravenous hydration for 24 hours after bimodal release ondansetron administration. Results: Analysis included 321 patients (mean [SD] age, 29.0 [11.1] years; 195 [60.7%] women), with 192 patients in the bimodal release ondansetron group and 129 patients in the placebo group. Treatment successes were observed in 126 patients in the bimodal release ondansetron group (65.6%) compared with 70 patients in the placebo group (54.3%), with an 11.4% (95% CI, 0.3%-22.4%) absolute probability difference. The proportion of treatment success was 21% higher among patients who received bimodal release ondansetron compared with those who received a placebo (relative risk, 1.21; 95% CI, 1.00-1.46; P = .04). In an analysis including only patients with a discharge diagnosis of acute gastroenteritis and no major protocol violations, there were 123 treatment successes (69.5%) in the bimodal release ondansetron group compared with 67 treatment successes (54.9%) in the placebo group (relative risk, 1.27; 95% CI, 1.05-1.53; P = .01). Adverse effects were infrequent and similar to the known safety profile of ondansetron. Conclusions and Relevance: This randomized clinical trial found that a long-acting bimodal release oral ondansetron tablet was an effective antiemetic among adolescents and adults with moderate to severe vomiting from acute gastroenteritis. The drug benefits extended to 24 hours after administration. Bimodal release ondansetron may decrease the need for intravenous access and emergency department care to manage acute gastroenteritis. Trial Registration: ClinicalTrials.gov identifier: NCT02246439

Development and Evaluation of the Assessment of Opioid Taking Behaviors and Adherence Scale (AOTBA) in Patients with Sickle Cell Disease

The rapid growth in opioid therapy for non-cancer pain has occurred without an adequate appreciation of the consequences of this growth. Few studies provide patient-centered evidence that can be used to inform the current proposed standards for efficacious (safe and effective) opioid prescribing in non-cancer pain. Furthermore, different terms may be used interchangeably in the literature to refer to opioid-taking behaviors, resulting in imprecise or vague interpretation of existing evidence. We therefore sought to explore patterns of opioid-taking behavior and their biopsychosocial-spiritual determinants in African-American adults with sickle cell disease (SCD). Many questions surround opioid use for non-cancer pain, but little has been published about behavioral patterns of taking opioids in these conditions. The main objective of this study was to develop a disease-specific scale for describing prescribed opioid taking in patients with sickle cell disease (SCD). As part of a multiphase, mixed-methods study, we used an adaptation of several published methods to construct 9 sequential, chronological steps for developing a new scale. We report here wide-ranging quantitative and semi-structured, qualitative interviews of 13 male and 11 female African-American adults with SCD, average age 36 years, from various socioeconomic and educational levels. We used grounded theory, priori and posteriori procedures to analyze the qualitative data, and to conduct an appraisal of translational validity. Scale development results have led to inclusion in the draft scale of new concepts namely momentary medication-taking behavior. The scale also captures concrete patterns of adherence for as-needed and scheduled medication and allows for several discovered conceptual domains that explain observed opioid-taking behaviors. These concepts challenge the current theories and models of medication-taking behavior and adherence. In summary, we found that contextual factors may drastically affect opioid-taking behaviors. Together, These uncovered phenomena raise new hypotheses that may challenge current theories and models of medication-taking behaviors and methods of assessing adherence. These hypotheses call for a new round of research on opioid-taking behavior, and need to be rigorously tested in future researc

Recent Advances in Gout

The purpose of this book is to provide an update on the epidemiology, pathophysiology, clinical symptoms, treatment, management, and ongoing research in gout. Accepted submissions are of high scientific value based on previous research and include novel and innovative research. This book is a valuable resource for physical clinicians who have the opportunity to treat gout. The scientific content of this book will be beneficial to patients, students, researchers, educators, and healthcare providers who are interested in the recent progress in gout research and therapy, not only physical clinicians

Magic, Mysticism, and Modern Medicine: The Influence of Alchemy on Seventeenth-Century England

In 1947, historian George Sarton questioned the place of alchemy in the history of science. He was not unlike many historians, who even attacked scholars of the subject, characterizing them as fabulous creatures who seem to be under the wrath of God themselves and who become tinctured with the kind of lunacy they set out to describe. For decades, critics fought hard to keep alchemy out of the history of science. Instead, the emphasis of the Scientific Revolution centered on the mathematical sciences, focusing mainly on the intellectual development from Copernicus to Newton and highlighting astronomy and the studies of motion at the expense of the biological and chemical sciences. It was not until 1945 that the positivism of the history of science was finally challenged by the German historian of medicine, Walter Pagel. In a short 4-page essay entitled, The Vindication of Rubbish, Pagel cautioned historians that interpretations based on the selection of material from the modern point of view, may endanger the presentation of historical truth. Instead of selecting data that \u27make sense\u27 to the acolyte of modern science, Pagel chose to focus on three very different historical figures of the Scientific Revolution; Paracelsus, van Helmont, and Harvey. Paracelsus (1493-1541), who is often recognized as the father of Renaissance alchemy and naturalism, became the focus of Pagel\u27s work. Through his research, Pagel was able to show that both the scientific and the non-scientific emerged not as simply juxtaposed or as having been conceived in spite of each other but as an organic whole in which they support and confirm each other. By the 1950s, Pagel laid the foundation for important future studies to be made in the history of alchemy and magic

Evaluation of the Interaction of Beta-Adrenergic Agonists Supplementation and Heat Stress on Growth Performance and Carcass Composition in Feeder Lambs

Forty-nine crossbred feeder lambs (wethers, n = 49; 53.3 ± 3.7 kg BW) were utilized to evaluate the interaction of b - adrenergic agonist (bAA) supplementation and heat stress on growth performance and carcass composition. Utilizing and 3 x 2 factorial design, lambs were randomly assigned to one of three bAA supplementation: 1) Control, CON, 2) Ractopamine Hydrochloride at 40 mg/hd/d, RHCL, and Zilpaterol Hydrochloride at 2.5 mg/hd/d, ZHCL for a period of 20 d and one of two environmental conditions (Thermal Neutral: TN and Heat Stress: HS). The TN environment had a constant thermal heat index (THI) of 16.6°C. Within the HS environment, a cyclic design was utilized to achieve a THI of 29.5ºC from 10:00 to 20:00 h and a THI of 24.5ºC from 22:00 to 08:00 h. Starting at 08:01 and continuing to 09:59 h, temperature and RH were gradually increased to achieve a THI of 29.5ºC at 10:00 h and reduction of temperature and RH from 20:01 to 21:59 h to achieve a THI of 24.5ºC at 22:00 h. Regardless of bAA supplementation (P = ≥ 0.09), lambs exposed to the HS environment had reduced DMI (P \u3c 0.001), ADG (P = 0.002), and final BW (P = 0.03). In addition, exposure to the HS environment (regardless of bAA supplementation; P = ≥ 0.07) decreased HCW (P \u3c 0.001), percent change in LM area (P = 0.004) and percent change in LM depth (P = 0.005). There was a bAA x environment interaction associated with RHCL supplementation and heat stress (P = 0.003). Lambs supplemented RHCL in the HS environment had reduced (P = 0.003) respiration rates, when compared to CON and ZHCL supplemented lambs. Supplementation of ZHCL decreased adipose tissue (P = 0.05) and increased percent fat free lean (P = 0.01), when compared to RHCL and CON lambs. Within the current study, both heat stress and bAA supplementation had an impact on growth performance and carcass composition. However, the data does not indicate that there was any significant interaction between bAA supplementation within a heat stress environment on growth performance or carcass composition in feeder lambs. Advisor: Ty B. Schmid

Evaluation of the Interaction of Beta-Adrenergic Agonists Supplementation and Heat Stress on Growth Performance and Carcass Composition in Feeder Lambs

Forty-nine crossbred feeder lambs (wethers, n = 49; 53.3 ± 3.7 kg BW) were utilized to evaluate the interaction of b - adrenergic agonist (bAA) supplementation and heat stress on growth performance and carcass composition. Utilizing and 3 x 2 factorial design, lambs were randomly assigned to one of three bAA supplementation: 1) Control, CON, 2) Ractopamine Hydrochloride at 40 mg/hd/d, RHCL, and Zilpaterol Hydrochloride at 2.5 mg/hd/d, ZHCL for a period of 20 d and one of two environmental conditions (Thermal Neutral: TN and Heat Stress: HS). The TN environment had a constant thermal heat index (THI) of 16.6°C. Within the HS environment, a cyclic design was utilized to achieve a THI of 29.5ºC from 10:00 to 20:00 h and a THI of 24.5ºC from 22:00 to 08:00 h. Starting at 08:01 and continuing to 09:59 h, temperature and RH were gradually increased to achieve a THI of 29.5ºC at 10:00 h and reduction of temperature and RH from 20:01 to 21:59 h to achieve a THI of 24.5ºC at 22:00 h. Regardless of bAA supplementation (P = ≥ 0.09), lambs exposed to the HS environment had reduced DMI (P \u3c 0.001), ADG (P = 0.002), and final BW (P = 0.03). In addition, exposure to the HS environment (regardless of bAA supplementation; P = ≥ 0.07) decreased HCW (P \u3c 0.001), percent change in LM area (P = 0.004) and percent change in LM depth (P = 0.005). There was a bAA x environment interaction associated with RHCL supplementation and heat stress (P = 0.003). Lambs supplemented RHCL in the HS environment had reduced (P = 0.003) respiration rates, when compared to CON and ZHCL supplemented lambs. Supplementation of ZHCL decreased adipose tissue (P = 0.05) and increased percent fat free lean (P = 0.01), when compared to RHCL and CON lambs. Within the current study, both heat stress and bAA supplementation had an impact on growth performance and carcass composition. However, the data does not indicate that there was any significant interaction between bAA supplementation within a heat stress environment on growth performance or carcass composition in feeder lambs. Advisor: Ty B. Schmid

Factors Influencing Blood Pressure among Rural Adults with Hypertension in China

The low rate of hypertension control in China has caught the attention of health providers. To achieve better outcomes, providers need to know what factors are significantly predictive of hypertension control. Researchers have rarely studied illness perception in China although it is one of the predictors for illness outcomes often studied in other countries. The purpose of this study was to examine the relationship among demographic and health-related characteristics, illness perception, adherence to medication and to self-management, and blood pressure in a sample of rural adults with hypertension in the Zhejiang Province of China. Leventhal’s Self-Regulation Model guided this cross-sectional, descriptive, correlational study. One hundred sixty-three adults with hypertension in two villages in Zhejiang province participated in the study. Self-report data were collected using structured questionnaires including the Chinese Illness Perception Questionnaire-Revised (CIPQ-R), the Medication Adherence Inventory (MAI), and the Inventory of Adherence to Self-Management (IASM). Additional data included demographics, health-related characteristics, weight, height, and blood pressure. Analysis involved use of descriptive statistics, two-sample-t-test, ANOVA, correlational analysis, and hierarchical regression. Of the 163 participants, 69 were male and 94 were female. The mean body mass index was 24.58 (SD = 3.51). The hypertension control rate was 28.80% with the mean systolic blood pressure of 146.59 mmHg (SD = 16.87) and the mean diastolic blood pressure of 80.52 mmHg (SD = 12.64). Participants rated balancing factors such as feeling overworked and sleeping problems as the main causes for hypertension. Gender, age, and household annual income were associated with diastolic blood pressure, explaining 23% of the variance in the regression model. Illness coherence contributed an additional 2%.The study findings offer implications for health care and future research. Rural adults need education on causes and consequence of hypertension. Recommendations from the study include education on healthful diets and behaviors to manage hypertension, especially for those who have higher incomes. In mainland Chinese populations, illness perception may not be directly associated with blood pressure. Lastly, the CIPQ-R and ISMA measures require validation and potential revision for use with rural Chinese populations