Analytical Testing for Marijuana

As part of the mini-symposium entitled The Problems with Marijuana and Driving: Medical, Legal, and Public Health Perspectives, Dr. Babu describes the state of the science on measurement of marijuana in the context of driving impairment

Characterisation of the role of bifocal and its interacting partners in Drosophila development

Ph.DDOCTOR OF PHILOSOPH

Prevention of Opioid Overdose

This review explains harm-reduction strategies for three groups of patients: those who have not received previous opioid therapy, those receiving long-term opioid therapy, and those with an opioid use disorder. It explains both risk assessment and the current approach to the use of medications for opioid use disorder

Pattern of cutaneous adverse drug reactions at a tertiary care hospital in southern India

Background: The objective of the study was to assess the pattern of cutaneous adverse drug reactions reported by active surveillance to the Pharmacovigilance center of a tertiary care hospital in southern india, and also to establish the drugs causing the same and observe the age wise and gender based incidence of such reactions.Methods: The cutaneous ADRs (CADRs) reported to the Pharmacovigilance center of the institution were analysed retrospectively during the period of March 2013 to December 2015. The various pattern of skin reactions and the most frequent drugs causing the same were established. An age wise and gender based incidence of CADRs and drugs causing them were also reported.Results: A total of 293 cases were taken for analysis. The male female ratio was 0.89-1.in our study. Among the age wise distribution of CADRs, 57(19.4%) were seen in paediatric, 194(66.2%) in adults and 33(11.2%) in geriatric age groups. The most frequent drugs to cause the CADRs were antimicrobials 183(62.4%) followed by NSAIDs 38(12.9%) and antacids 17(5.8%).Among the skin reactions urticaria/ angioedema was the most common 109(37.2%) followed by generalised pruritis 57(19.5%) and fixed drug eruption 37(12.6%). In all the age groups and both the sexes urticaria/angioedema and generalised pruritis were the leading skin reactions observed.Conclusions: As CADRs are the most common ADRs among others, it is prudent to monitor them closely, as any change in pattern with older or newer agents can alert the health care personnel in instituting the appropriate prescription patterns, which can overall impact the quality of health care positively

Comparative study of oral ivermectin, topical permethrin and benzyl benzoate in the treatment of scabies

Background: Efficacy of these modalities as shown by various investigations are inconsistent and ambiguous. Thus, evidence based effective treatment option is warranted. Aim of the study was to compare the efficacy of oral ivermectin, topical permethrin and benzyl benzoate in the treatment of uncomplicated scabies.Methods: Patients with confirmed diagnosis of scabies were included in this study. One hundred and ninety-five subjects were included in this investigation as per inclusion and exclusion criteria laid down. Equal numbers of patients were randomly allocated to one of the three treatment groups. Efficacy of three groups [oral ivermectin (Group A), topical permethrin (Group B) and benzyl benzoate (Group C)] of drugs was compared in terms of improvement in clinical grading of disease (%) and improvement in clinical grading of pruritus (%) during follow up visits.Results: Those subjects receiving topical permethrin, at 1st follow up 56.9% showed cure rate which increased to 89.2% at 2nd follow up with respect to clinical improvement in pruritus. Maximum relief in severity of pruritus at the end of 6th week was reported by 58(89.2%) patients receiving group B treatment modality followed by 52 patients (80%) in arm A. Regarding efficacy of three treatment groups in terms of improvement in severity of lesion at the end of 6 weeks, maximum number of patients 57(87.7%), receiving group B treatment reported improvement which is better than other two treatment groups.Conclusions: maximum number of patients receiving topical Permethrin treatment reported improvement better than other Oral Ivermectin therapy and topical benzyl benzoate. Oral ivermectin may serve a good alternative for managing scabies under certain conditions like poor compliance to topical scabicides

Emergency Medicine Providers Systematically Underestimate Their Opioid Prescribing Practices

Background: Opioid misuse is a known public health problem, nationwide and in Massachusetts. The Massachusetts Hospital Association (MHA) developed recommendations to address opioid prescribing in the ED setting, and UMassMemorial Health Care recently implemented a system-wide opioid practice guideline mirroring the MHA policy. Little is known about methods to influence behavior change among ED providers related to opioid prescribing practices. Guideline implementation provided a unique opportunity for a natural experiment related to prescribing patterns, and we hypothesized that a simultaneous experimental intervention to provide clinicians with their individual prescribing data would alter their practices beyond any effect achieved solely by being subject to the new guidelines. Methods: As part of an ongoing, prospective, randomized trial of an intervention hypothesized to influence providers’ opioid prescribing, we developed a survey instrument consisting of graphical depictions of the distributions of three measures of opioid prescribing among all ED providers at four UMass-affiliated EDs (attending and resident physicians and advanced practice providers). Clinicians randomized to the intervention arm were asked to identify his/her perceived position on each distribution. We compared each provider’s self-perception to their actual decile. Results: Fifty-one providers were randomized to the intervention arm. Forty-eight completed the survey (94%). Providers underestimated their decile of opioid prescriptions per hundred total prescriptions by a median of one decile (p=0.0399 for difference from zero). Attendings underestimated their decile of percentage of patients dispositioned with an opioid prescription by a median of two deciles (p=0.0292), while residents did not exhibit a significant difference. Providers showed systematic disagreement with their raw number of prescriptions for extended-release opioid formulations (kappa -0.18), underestimating by a median of one. Conclusions: Based upon three measures of ED opioid prescribing, providers’ self-perceptions of their practices systematically underestimated their actual prescribing, which likely has implications related to efforts to influence clinician behavior change

Isolation, Identification and Screening of the Yeast Flora from Indian Cashew Apple for Sugar and Ethanol Tolerance

Cashew apple juice is rich in fermentable sugars, minerals and vitamins, which makes it a suitable substrate for production of alcoholic beverages. In the present research work, indigenous flora of cashew apple (Indian variety) was studied. Seven morphologically different strains of Candida spp. were identified and checked for their sugar and ethanol tolerance. All seven isolates were able to tolerate sugar concentrations up to 25% but varied in their ethanol tolerance. Based on the above results it can be concluded that a high sugar and ethanol tolerant Candida spp. could be used as starter culture for commercial production of alcoholic beverages from cashew apple

A Pilot Study of a Telemedicine-based Substance Use Disorder Evaluation to Enhance Access to Treatment Following Near-Fatal Opioid Overdose

The opioid epidemic is a growing public health emergency in the United States, with deaths from opioid overdose having increased five-fold since 1999. Emergency departments (EDs) are the primary sites of medical care after near-fatal opioid overdose but are poorly equipped to provide adequate substance use treatment planning prior to discharge. In many underserved locales, limited access to clinicians trained in addiction medicine and behavioral health exacerbates this disparity. In an effort to improve post- overdose care in the ED, we developed a telemedicine protocol to facilitate timely access to substance use disorder evaluations. In this paper, we describe the conception and refinement of the telemedicine program, our experience with the first 20 participants, and potential implications of the platform on health disparities for individuals with opioid use disorder

Nobody Wants to Be Narcan\u27d: A Pilot Qualitative Analysis of Drug Users\u27 Perspectives on Naloxone

INTRODUCTION: Bystander naloxone distribution is an important component of public health initiatives to decrease opioid-related deaths. While there is evidence supporting naloxone distribution programs, the effects of increasing naloxone availability on the behavior of people who use drugs have not been adequately delineated. In this study we sought to 1) evaluate whether individuals\u27 drug use patterns have changed due to naloxone availability; and 2) explore individuals\u27 knowledge of, access to, experiences with, and perceptions of naloxone. METHODS: We conducted a pilot study of adults presenting to the emergency department whose medical history included non-medical opioid use. Semi-structured interviews were conducted with participants and thematic analysis was used to code and analyze interview transcripts. RESULTS: Ten participants completed the study. All were aware of naloxone by brand name (Narcan) and had been trained in its use, and all but one had either currently or previously possessed a kit. Barriers to naloxone administration included fear of legal repercussions, not having it available, and a desire to avoid interrupting another user\u27s high. Of the eight participants who reported being revived with naloxone at least once during their lifetime, all described experiencing a noxious physical response and expressed a desire to avoid receiving it again. Furthermore, participants did not report increasing their use of opioids when naloxone was available. CONCLUSIONS: Participants were accepting of and knowledgeable about naloxone, and were willing to administer naloxone to save a life. Participants tended to use opioids more cautiously when naloxone was present due to fears of experiencing precipitated withdrawal. This study provides preliminary evidence countering the unsubstantiated narrative that increased naloxone availability begets more high-risk opioid use and further supports increasing naloxone access

The 2016 Model of The Clinical Practice of Emergency Medicine

Emergency medicine (EM) has a scientifically derived and commonly accepted description of the domain of its clinical practice. That document, “The Model of the Clinical Practice of Emergency Medicine” (EM Model), was developed through the collaboration of six organizations: the American Board of Emergency Medicine (ABEM), the administrative organization for the project, the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents\u27 Association (EMRA), the Residency Review Committee for Emergency Medicine (RRC-EM), and the Society for Academic Emergency Medicine (SAEM). Development of the EM Model was based on an extensive practice analysis of the specialty. The practice analysis relied on both empiric data gathered from actual emergency department visits and several expert panels (1). The resulting product was first published in 2001, and has successfully served as the common source document for all EM organizations (2,3). One of its strengths is incorporating the reality that EM is a specialty driven by symptoms not diagnoses, requiring simultaneous therapeutic and diagnostic interventions