Drug Trials in Children: Ethical, Legal, and Practical Issues

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97247/1/j.1552-4604.1994.tb01996.x.pd

Applying the Lessons of Tobacco and Alcohol Control to Cannabis

It is clear there is agreement on numerous issues. First, cannabis is associated with psychosis, although there is some divergence on the degree of certainty about direct causality, especially in chronic psychosis. Second, reliance on a single legal remedy has been ineffective. Third, education should play a greater role in strategies to tackle cannabis use

Left Ventricular Outflow Tract Obstruction Defined by Active Three-Dimensional Echocardiography Using Rotational Transthoracic Acquisition

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75675/1/j.1540-8175.1994.tb01105.x.pd

Potential sources of cessation support for high smoking prevalence groups: a qualitative study

Objective: This study aimed to: i) explore potential sources of cessation support as nominated by disadvantaged smokers; and ii) identify factors influencing decisions to use these sources. Methods: Semi-structured interviews were conducted with 84 smokers accessing community service organisations from the alcohol and other drugs, homeless, and mental health sectors. Transcripts were coded and thematically analysed. Results: Doctors emerged as the most commonly recognised source of cessation support, followed by Quitline, community service organisation staff; and online resources. The main factors contributing to the possible use of these sources of support were identified as awareness, perceived usefulness and anticipated emotional support. Conclusions: The results suggest that doctors are an important group to consider when developing cessation interventions for disadvantaged smokers due to their recognised ability to provide practical and emotional support. However, efforts are needed to ensure doctors are aware of the benefits of cessation for these groups. Community service organisations appear to be another potentially effective source of cessation support for disadvantaged smokers. Implications for public health The results indicate that cessation interventions among high-priority groups should endeavour to provide personalised emotional and practical support. Doctors and community service organisation staff appear to be well-placed to deliver this support

Effects of Level of Consciousness on Urodynamic Procedure in Female Cats

Urodynamic evaluation is an invasive and uncomfortable procedure that can cause physical distress and is difficult to perform in uncooperative patients. The aim of this study was to evaluate the effects of consciousness on urodynamic evaluation in an animal model. Repeated cystometry, electromyogram, and measurement of serum cortisol concentrations were performed in female cats under conscious (CON), conscious sedation (CS) and deep anesthesia (DA) conditions. Urodynamic evaluation showed that there were no statistical differences in maximum detrusor pressure or bladder capacity observed among the three conditions. Under the DA condition, but not the CON and CS conditions, bladder contraction was accompanied by an un-relaxed anal sphincter. Residue urine volume significantly increased in the DA condition compared to the CON and CS conditions. The levels of serum cortisol significantly increased after performing urodynamic evaluation under the CON condition, whereas these levels were not significantly increased under the CS and DA conditions. This study showed that conscious sedation has no adverse effects on the urodynamic variables, and that it significantly reduces distress in cats undergoing the examination. These results may provide novel insights for performing urodynamic studies in uncooperative patients

Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome.

AIMS: More than half of infants exposed to opioids in utero develop neonatal abstinence syndrome (NAS) of severity to require pharmacological therapy. Current treatments are associated with prolonged hospitalization. We sought to optimize the dose of sublingual buprenorphine in the treatment of NAS. DESIGN: Randomized, Phase 1, open-label, active-control clinical trial comparing sublingual buprenorphine to oral morphine. SETTING: Large, urban, tertiary care hospital. PARTICIPANTS: Twenty-four term infants requiring pharmacological treatment for NAS. MEASUREMENTS: Outcomes were neonatal safety, length of treatment and length of hospitalization. FINDINGS: Sublingual buprenorphine was safe and effective. Infants treated with buprenorphine had a 23-day length of treatment compared to 38 days for those treated with morphine (P = 0.01), representing a 40% reduction. Length of hospital stay in the buprenorphine group was reduced 24%, from 42 to 32 days (P = 0.05). CONCLUSIONS: Sublingual buprenorphine was safe in NAS, with a substantial efficacy advantage over standard of care therapy with oral morphine

Simulated medication errors: A means of evaluating healthcare professionals' knowledge and understanding of medication safety

OBJECTIVE: To determine multi-disciplinary perceptions of the clinical significance of medication errors (MEs), the responsible health professional(s), the contributing factors and potential preventive strategies. METHODS: The five simulated ME cases represented errors from five wards at a children's hospital in Australia. Pre-determined answers for each case were developed through consensus among the researchers. The root cause analysis (RCA) was undertaken via a questionnaire disseminated to physicians, nurses and pharmacists at the study hospital to seek their opinions on the ME cases. Agreement model between the participants and pre-determined responses regarding the contributing factors was conducted using general estimating equation (GEE) analysis. RESULTS: Of the 111 RCA questionnaires distributed, 25 were returned. The majority (93%) of respondents rated the significance of the MEs as either 'moderate' or 'life-threatening'. Furthermore, they correctly identified two contributing factors relevant to all cases: dismissal of policies/procedures or guidelines (90%) and human resources issues (87%). GEE analysis revealed varied agreement patterns across the contributing factors. Suggested prevention strategies focused on policy and procedures, staffing and supervision, and communication. CONCLUSION: Simulated case studies had potential use to seek front-line healthcare professionals' understanding of the clinical significance and contributing factors to MEs, along with preventive measures

Imprisoned and imperiled: access to HIV and TB prevention and treatment, and denial of human rights, in Zambian prisons

<p>Abstract</p> <p>Background</p> <p>Although HIV and tuberculosis (TB) prevalence are high in prisons throughout sub-Saharan Africa, little research has been conducted on factors related to prevention, testing and treatment services.</p> <p>Methods</p> <p>To better understand the relationship between prison conditions, the criminal justice system, and HIV and TB in Zambian prisons, we conducted a mixed-method study, including: facility assessments and in-depth interviews with 246 prisoners and 30 prison officers at six Zambian prisons; a review of Zambian legislation and policy governing prisons and the criminal justice system; and 46 key informant interviews with government and non-governmental organization officials and representatives of international agencies and donors.</p> <p>Results</p> <p>The facility assessments, in-depth interviews and key informant interviews found serious barriers to HIV and TB prevention and treatment, and extended pre-trial detention that contributed to overcrowded conditions. Disparities both between prisons and among different categories of prisoners within prisons were noted, with juveniles, women, pre-trial detainees and immigration detainees significantly less likely to access health services.</p> <p>Conclusions</p> <p>Current conditions and the lack of available medical care in Zambia's prisons violate human rights protections and threaten prisoners' health. In order to protect the health of prisoners, prison-based health services, linkages to community-based health care, general prison conditions and failures of the criminal justice system that exacerbate overcrowding must be immediately improved. International donors should work with the Zambian government to support prison and justice system reform and ensure that their provision of funding in such areas as health services respect human rights standards, including non-discrimination. Human rights protections against torture and cruel, inhuman or degrading treatment, and criminal justice system rights, are essential to curbing the spread of HIV and TB in Zambian prisons, and to achieving broader goals to reduce HIV and TB in Zambia.</p

Is metal theft committed by organized crime groups, and why does it matter?

Using the example of metal theft in the United Kingdom, this study used mixed methods to evaluate the accuracy of police estimates of the involvement of organised crime groups (OCGs) in crime. Police estimate that 20-30% of metal theft is committed by OCGs, but this study found that only 0.5% of metal thieves had previous convictions for offences related to OCGs, that only 1.3% were linked to OCGs by intelligence information, that metal thieves typically offended close to their homes and that almost no metal thefts involved sophisticated offence methods. It appears that police may over-estimate the involvement of OCGs in some types of crime. The reasons for and consequences of this over-estimation are discussed