Parenthood, child care, and heroin use: outcomes after three years.

BACKGROUND: Internationally there is a lack of measurement on the impact of childcare on people who use drugs. OBJECTIVES: The aim of this article was to longitudinally measure drug use, familial and social status and criminal involvement between parents and nonparents who use heroin and have children in their care. METHODS: From 2003 to 2006, 404 participants were recruited to the Research Outcome Study in Ireland Evaluating Drug Treatment Effectiveness (ROSIE) as part of a longitudinal cohort study design. Participants completed the Maudsley Addiction Profile and 88% (n = 356) completed interviews at the 3-year period. One way between groups ANOVA with post hoc tests and backward, stepwise multiple regression were employed for analysis. RESULTS: At follow-up, parents who had children in their care used heroin (p = .004), illicit methadone (p ≤ .001) and cocaine (p = .024) on fewer days than those who had no children, or those who had children but did not have children in their care. These differences were not observed at intake. Living with someone at intake who used drugs was found to be significantly associated with increased heroin (p ≤ .001), benzodiazepine (p = .039), and tobacco (p = .030) use at 3 years. Furthermore, a change in childcare status to caring for a child was associated with increased cannabis use (p = .025). Conclusion/Importance: While caring for children was associated with reduced heroin use at 3 years, living with a person who used at intake removed this effect, thus indicating that while individual based addiction theories reflected observed outcomes, social network connectedness was more influential

Enhancing Safe Medication Use for Pediatric Patients in the Emergency Department

INTRODUCTIONA Canadian study assessing the incidence of medication errors in a pediatric emergency department found prescribing errors in 10.1% of charts reviewed and administration errors in 3.9%.1 The authors cited earlier work by others indicating that preventable errors are significantly more common in the emergency department than in other hospital departments.2,3 This heightened risk in the emergency department is thought to result from the need for medications to be given urgently, which means that many drugs are kept in ward stock. In addition, there is generally no pharmacist review of medication orders originating in the emergency department; patients seen in the emergency department may have only a brief, focused encounter with the physician and nurse before medications are ordered and given; a complete medical and drug history may not be available; physicians and nurses are often caring for several patients at the same time in an environment where interruptions are common; and use of high-alert drugs is common.1,4,5 The authors suggested that of the approximately 50 000 children seen annually in their emergency department, 5000 may be subjected to a medication error, and half of these errors might be clinically significant. Adding to these identified risks for emergency departments in pediatric specialty hospitals is the fact that many Canadian hospitals provide care to pediatric patients alongside adults in the emergency department, which greatly increases the risk of harm associated with an “incorrect patient” error. This risk of harm is compounded when a high-alert medication is involved, as is illustrated by the following case, in which an infant inadvertently received a dose of hydromorphone intended for an adult patient. This incident was highlighted in a recent ISMP Canada Safety Bulletin.6 The current article describes findings from an analysis of the incident and suggests opportunities for pharmacist intervention in the emergency department to reduce the likelihood of medication errors

Zinc isotopes from archaeological bones provide reliable trophic level information for marine mammals

International audienceIn marine ecology, dietary interpretations of faunal assemblages often rely on nitrogen isotopes as the main or only applicable trophic level tracer. We investigate the geographic variability and trophic level isotopic discrimination factors of bone zinc 66 Zn/ 64 Zn ratios (δ 66 Zn value) and compared it to collagen nitrogen and carbon stable isotope (δ 15 N and δ 13 C) values. Focusing on ringed seals (Pusa hispida) and polar bears (Ursus maritimus) from multiple Arctic archaeological sites, we investigate trophic interactions between predator and prey over a broad geographic area. All proxies show variability among sites, influenced by the regional food web baselines. However, δ 66 Zn shows a significantly higher homogeneity among different sites. We observe a clear trophic spacing for δ 15 N and δ 66 Zn values in all locations, yet δ 66 Zn analysis allows a more direct dietary comparability between spatially and temporally distinct locations than what is possible by δ 15 N and δ 13 C analysis alone. When combining all three proxies, a more detailed and refined dietary analysis is possible

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons