Supplementary Material for: The Influence of Patient Characteristics on Anticholinergic Events in Older People

<b><i>Aims:</i></b> To examine patient characteristics that predict adverse anticholinergic-type events in older people. <b><i>Methods:</i></b> This retrospective population-level study included 2,248 hospitalised patients. Individual data on medicines that are commonly associated with anticholinergic events (delirium, constipation and urinary retention) were identified. Patient characteristics examined were medicines with anticholinergic effects (ACh burden), age, sex, non-anticholinergic medicines (non-ACM), Charlson comorbidity index scores and ethnicity. The Akaike information criterion was used for model selection. The data were analysed using logistic regression models for anticholinergic events using the software NONMEM. <b><i>Results:</i></b> ACh burden was found to be a significant independent predictor for developing an anticholinergic event [adjusted odds ratio (aOR): 3.21, 95% CI: 1.23-5.81] for those taking an average of 5 anticholinergic medicines compared to those taking 1. Both non-ACM and age were also independent risk factors (aOR: 1.41, 95% CI: 1.31-1.51 and aOR: 1.08, 95% CI: 1.05-1.10, respectively). <b><i>Conclusion:</i></b> To our knowledge, this is the first study that has examined population-level data in a nonlinear model framework to predict anticholinergic-type adverse events. This study evaluated the relationship between important patient characteristics and the occurrence of anticholinergic-type events. These findings reinforce the clinical significance of reviewing anticholinergic medicines in older people

Más allá de la victimización. Resistencias, creaciones y cuestionamientos = Beyond victimization. Resistances, creations and questionings

Resumen: Este artículo nace de una investigación doctoral que analiza las re-formulaciones identitarias de las mujeres indígenas desplazadas en el contexto de conflicto armado en Colombia. El objetivo del mismo es mostrar cómo la condición de víctimas trae consigo estrategias de resistencia, creaciones y cuestionamientos. Desde las circunstancias que viven muestro cómo las identidades de género, etnia y desplazada son base de vulneración de sus derechos. Asimismo, las mujeres indígenas, como sujetos activas, re-formulan sus identidades tras pasar por situaciones de ruptura de las mismas. Se posicionan como agentes de cambio, generadoras de nuevos discursos y prácticas. A través de estas realidades advertimos las redes y movilizaciones que las mujeres indígenas están llevando a cabo, así como las reflexiones y cuestionamientos que se dan desde el activismo y el campo teórico. Palabras clave: identidad de género, identidad étnica, violencia, resistencia, discursos propios. Abstract: This article builds on my doctoral research which analyzed reformulations of identity of displaced indigenous women in the context of armed conflict in Colombia. The objective is to show how the condition of victims bring about resistance strategies, creations and questions. Focusing on the case of displaced indigenous women, I show how identities of gender, ethnicity and displacement are based on infringement of their rights. Furthermore, indigenous women, as active subjects, reformulate their identities after going through situations of rupture. They position themselves as agents of change, generating new discourses and practices. Through these realities we advise the networks and mobilizations that indigenous women are carrying out, as well as reflections and questions which they make, both from the perspectives of activism and theory. Keywords: gender identity, ethnic identity, violence, resistance, own discourses.doi: https://doi.org/10.20318/femeris.2017.3550

Some considerations on the design of population pharmacokinetic studies

The goal of this manuscript is to introduce a framework for consideration of designs for population pharmacokinetic orpharmacokinetic-pharmacodynamic studies. A standard one compartment pharmacokinetic model with first-order input and elimination is considered. A series of theoretical designs are considered that explore the influence of optimizing the allocation of sampling times, allocating patients to elementary designs, consideration of sparse sampling and unbalanced designs and also the influence of single vs. multiple dose designs. It was found that what appears to be relatively sparse sampling (less blood samples per patient than the number of fixed effects parameters to estimate) can also be highly informative. Overall, it is evident that exploring the population design space can yield many parsimonious designs that are efficient for parameter estimation and that may not otherwise have been considered without the aid of optimal design theory

Promethazine overdose: clinical effects, predicting delirium and the effect of charcoal

Objective: The aim of this study was to describe the clinical effects of promethazine in overdose and explore the relationship between delirium and possible predictor variables. Methods: A case series of promethazine poisonings was identified from a prospective database of poisoning admissions to a regional toxicology service. Data were extracted including demographics, details of ingestion, clinical features including delirium, complications and medical outcomes. In addition to descriptive statistics, a fully Bayesian approach using logistic regression was undertaken to investigate the relationship between predictor variables and delirium. Results: There were 199 patients with 237 presentations, including 57 patients with 78 promethazine alone overdoses. Of these 57 patients who ingested promethazine alone the median age was 22 years [interquartile range (IQR): 17–31] and 42 were female (74%). The median dose ingested was 625 mg (IQR: 350–1250 mg). Median length of stay was 19 h (IQR: 13–27 h), ten were admitted to the intensive care unit (ICU) and four were ventilated. Delirium occurred in 33 patients (42%), tachycardia (HR>100) occurred on 44 occasions (56%) and hypotension only twice. There were no seizures, dysrhythmias or deaths. Multivariate analysis of 215 presentations (in 181 patients) where dose of promethazine ingested was known demonstrated that dose, administration of charcoal within 2 h and co-ingestants predicted whether patients developed delirium. No relationship was shown for sex and age. A plot of probability that a patient will develop delirium vs. dose was constructed which showed the probability of delirium for 250 mg was 31%, 500 mg was 42% and for 1 g was 55% for promethazine alone overdoses. Conclusion: The main feature of promethazine toxicity is delirium, the probability of which can be predicted from the dose ingested. The administration of charcoal and the presence of co-ingestants appears to reduce the probability of delirium in a predictable manner

Does body mass index affect progression-free or overall survival in patients with ovarian cancer? Results from SCOTROC I trial

Background: Previous studies have indicated an association between obesity and poor survival in several tumour types, including ovarian cancer. We sought to test the hypothesis that obesity reduces survival in a large, well-characterised and relatively homogeneous cohort of ovarian cancer patients. Patients and methods: The relationship between body mass index (BMI) and overall survival (OS) and progression-free survival (PFS) in 1067 patients participating in the Scottish Randomised Trial in Ovarian Cancer I trial was assessed. All patients received first-line carboplatin/taxane chemotherapy. The dose of carboplatin was determined by a measured glomerular filtration rate (GFR), ensuring accurate dosing in all categories of BMI and the dose of taxane was not capped. Patients were assigned to one of four categories: underweight (BMI &lt; 18.5), ideal weight (BMI 18.5-24.9), overweight (BMI 25-29.9) or obese (BMI &gt;= 30). Results: There were neither statistically significant differences in PFS or OS between these four groups nor were there any differences in taxane or carboplatin dose intensity. Furthermore, there was no association between BMI and tumour stage or grade at presentation, or completeness of debulking surgery. Conclusions: Obese patients with epithelial ovarian cancer do not have a poorer prognosis, provided that they receive optimal doses of chemotherapy based on measured GFR and actual body weight