Use of NSAIDs and patient safety

Objective: To assess the pattern of use of nonsteroidal anti-inflammatory drugs (NSAIDs) and propose methods whereby pharmacists can help to improve patient safety when these drugs are used. Method: A psychometrically-evaluated questionnaire was administered to 261 patients aged 18 and over who visited 13 different community pharmacies, 1 from each electoral district in Malta and Gozo, chosen by stratified random sampling. Information about the sociodemographic status, symptoms and disease states and the drugs taken in the past 6 months was collected. Analysis of data was carried out using Microsoft Office Excel 2007 and the Biomedical Data Package (BMDP ) Software. Key findings: Results show a high prevalence of analgesic (>80% per district) and NSAID use (about 50% per district). The first drug of choice to relieve analgesia was paracetamol (67.1%) followed by diclofenac (37.2%). Ibuprofen was the fourth drug of choice (7.3%). About 65% of patients who took diclofenac stated that they self-prescribe the medication. Statistical analysis of data showed an association between the use of NSAIDs, musculoskeletal pain and menstrual pain (both p=0.010). A number of patients at risk of gastro-intestinal bleeds, cardiovascular events and those suffering from asthma reported taking NSAIDs occasionally. The presence of risks of drug interactions was identified with various drugs. Conclusion: NSAIDs are overused in Malta and are often administered indiscriminately. Pharmacist intervention could ensure the rational and safe use of NSAIDs. This could be achieved by having a shared protocol between pharmacists and prescribers for appropriate prescribing and dispensing and by identifying scenarios where pharmacist prescribing can be carried out to ensure that the analgesic used is appropriate for the individual patient.peer-reviewe

A different appetite for sovereignty? Independence movements in subnational island jurisdictions

Local autonomy in a subnational jurisdiction is more likely to be gained, secured or enhanced where there are palpable movements or political parties agitating for independence in these smaller territories. A closer look at the fortunes, operations and dynamics of independence parties from subnational island jurisdictions can offer some interesting insights on the appetite for sovereignty and independence, but also the lack thereof, in the twenty-first century.peer-reviewe

Understanding the use of telemedicine across different Opioid Use Disorder (OUD) treatment models : a scoping review

Introduction The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. Methods The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. Results A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. Conclusions Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.Publisher PDFPeer reviewe

Neuropsychological functioning and chronic methadone use:a systematic review and meta-analysis

The authors would like to thank the NHS Fife Research and Development Department for supporting this project.Introduction: There is a presumption that neurocognition is commonly impaired in chronicmethadone exposed individuals (CM) when compared with healthy controls (HP).Additionally, it remains unclear if short term (< 1 year) abstinence (AP) is associated with an altered cognitive profile when compared with CM. Method: A random effect model approach was used on data assembled into the Comprehensive Meta-Analysis programme.Cohen’s d effect sizes and a significance levels of p<0.01 were calculated for each domain. Results: Data from a total cohort of 1063 CM, 412 AP and 879 HP participants, from 23 independent studies indicate global impairments in neurocognitive function in CM relative to HP participants. The smaller body of evidence comparing CM to AP participants is inconclusive. Conclusion: Methodological issues such as small sample sizes, heterogeneity and poor quality limited the interpretation of the results and does not address whether the observed impairments reflect co-morbid functioning, methadone-related sedation and/or other factors. Only higher quality longitudinal studies will permit confident interpretation of the results observed in this meta-analysis.PostprintPeer reviewe

Revision shoulder hemiarthroplasty and total shoulder arthroplasty a systematic review and meta-analysis.

The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected improvement in shoulder function and implant survival following revision of a hemiarthroplasty and revision of an anatomical total shoulder arthroplasty (TSA). A systematic review and meta-analysis were performed of all studies reporting shoulder scores or implant survival following revision hemiarthroplasty or revision TSA. MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports were searched. 15 studies were included, reporting on 593 revision anatomical shoulder replacements. There was large variation in the magnitude of improvement in shoulder scores following revision surgery. Over 80% of revision replacements last 5 years and over 70% last 10 years. There was no significant difference in shoulder scores or implant survival according to the type of primary implant. The belief that revision of a shoulder hemiarthroplasty may lead to improved outcomes compared to revision of a TSA is not supported by the current literature

Decision support in addiction: the development of an e-health tool to assess and prevent risk of fatal overdose. The ORION project

Background and Objective. The application of e-health technology to the field of substance use disorders is at a relatively early stage, and methodological quality is still variable. Few have explored the extent of utilization of communication technology in exploring risk perception by patients enrolled in substance abuse services. The Overdose RIsk InfOrmatioN (ORION) project is a European Commission funded programme, aimed to develop and pilot an e-health psycho-educational tool to provide information to drug using individuals about the risks of suffering a drug overdose. Methods. In this article we report on phase 1 (risk estimation), phase 2 (design), and phase 3 (feasibility) of the ORION project. Results. The development of ORION e-health tool underlined the importance of an evidence-based intervention aimed in obtaining reliable evaluation of risk. The ORION tool supported a decision making process aimed at influencing the substance users' self-efficacy and the degree to which the substance users' understand risk factors. Therefore its innovative power consisted in translating risks combination into a clear estimation for the user who will then appear more likely to be interested in his/her risk perception. Conclusion. Exploratory field testing and validation confirmed the next stage of evaluation, namely, collection of routine patient samples in study clinics. The associations between risk perception of overdose, engagement with the ORION tool and willingness to alter overdose risk factors, in a clinical setting across various EU member states will further confirm the ORION tool's generalisability and effectiveness.PostprintPeer reviewe

The Geant4-DNA project

The Geant4-DNA project proposes to develop an open-source simulation software based and fully included in the general-purpose Geant4 Monte Carlo simulation toolkit. The main objective of this software is to simulate biological damages induced by ionising radiation at the cellular and sub-cellular scale. This project was originally initiated by the European Space Agency for the prediction of deleterious effects of radiation that may affect astronauts during future long duration space exploration missions. In this paper, the Geant4-DNA collaboration presents an overview of the whole ongoing project, including its most recent developments already available in the last Geant4 public release (9.3 BETA), as well as an illustration example simulating the direct irradiation of a chromatin fibre. Expected extensions involving several research domains, such as particle physics, chemistry and cellular and molecular biology, within a fully interdiciplinary activity of the Geant4 collaboration are also discussed.Comment: presented by S. Incerti at the ASIA SIMULATION CONFERENCE 2009, October 7-9, 2009, Ritsumeikan University, Shiga, Japa

Transcultural aspects of cannabis use : a descriptive overview of cannabis use across cultures

Purpose of Review: This narrative review summarises cultural aspects of cannabis use across different (sub)cultures, nations, and gender, racial, and ethnic groups. Specifically, we aimed to overview historical and traditional contexts of cannabis use and physical and mental health-related correlates, as well as emerging cannabis-related policies and their impacts on medicinal and recreational use of cannabis. In addition, we discuss how cultural factors may affect cannabis use behaviours and sociocultural underpinnings of cannabis use disorder trajectories. Recent Findings: Cannabis is the most widely cultivated, trafficked, and used illicit drug worldwide, although cannabis is being legalised in many jurisdictions. More than 4% of individuals globally have used cannabis in the last year. Being traditionally used for religious and ritualistic purposes, today cannabis use is interwoven with, and influenced by, social, legal, economic, and cultural environments which often differ across countries and cultures. Notably, empirical data on distinct aspects of cannabis use are lacking in selected underrepresented countries, geographical regions, and minority groups. Summary: Emerging global policies and legislative frameworks related to cannabis use have impacted the prevalence and attitudes toward cannabis in different subcultures, but not all in the same way. Therefore, it remains to be elucidated how and why distinct cultures differ in terms of cannabis use. In order to understand complex and bidirectional relationships between cannabis use and cultures, we recommend the use of cross-cultural frameworks for the study of cannabis use and its consequences and to inform vulnerable people, clinical practitioners, and legislators from different world regions.Publisher PDFPeer reviewe

Research priorities in children requiring elective surgery for conditions affecting the lower limbs: a James Lind Alliance Priority Setting Partnership

Objective: To identify and prioritise research questions concerning the elective surgical management of children with conditions affecting the lower limb by engaging patients, carers and healthcare professionals. Design: A modified nominal group technique. Setting: UK. Participants: 388 individuals (29 patients, 155 parents/carers, 204 healthcare professionals) were recruited through hospital clinics, patient charities and professional organisations and participated in the initial prioritisation survey; 234 individuals took part in the interim prioritisation survey. 33 individuals (3 patients, 9 parents/carers, 11 healthcare professionals, 7 individuals representing the project’s steering group and 3 James Lind Alliance (JLA) facilitators) attended the final face-to-face workshop to rank the top 10 research priorities. Interventions: Surveys were distributed using various media resources such as newsletters, internet messaging boards and the ‘Paediatric Lower Limb Surgery Priority Setting Partnership (PSP) website. Printed copies of the questionnaire were also made available to families in outpatient clinics. Outcome measures: Survey results, top 10 and top 26 priority rankings Results: The process took 18 months to complete (July 2017–January 2019); 388 people generated 1023 questions; a total of 801 research questions were classified as true uncertainties. Following the JLA methodology, 75 uncertainties were developed from the initial 801 questions. Twenty six of those were selected through a second survey and were taken to the final face-to-face workshop where the top 10 research priorities were selected. The top10 priorities included questions on cerebral palsy, common hip conditions (ie, Perthes’ disease and developmental dysplasia of the hip) as well as rehabilitation techniques and methods to improve shared decision-making between clinicians and patients/families. Conclusions: This is the first JLA PSP in children’s orthopaedic surgery, a particularly under-researched and underfunded area. We have identified important research topics which will guide researchers and funders and direct their efforts in future research

Harm reduction and abstinence-based models for treatment of substance use disorders during the COVID-19 pandemic : a global perspective

M.F. is an employee of the US Federal Government and is supported by National Institutes of Health (NIH) intramural funding (ZIA-DA000635 and ZIA-AA000218), outside of this research.The COVID-19 pandemic has significantly affected treatment services for people with substance use disorders (SUDs). Based on the perspectives of service providers from eight countries, we discuss the impact of the pandemic on SUD treatment services. Although many countries quickly adapted in provision of harm reduction services by changes in policy and service delivery, some went into a forced abstinence-based strategy. Similarly, disruption of abstinence-based approaches such as therapeutic communities has been reported. Global awareness is crucial for responsible management of SUDs during the pandemic, and the development of international health policy guidelines is an urgent need in this area.Publisher PDFPeer reviewe