The use of opioids for breakthrough pain in acute palliative care unit by using doses proportional to opioid basal regimen.

OBJECTIVES: To determine the efficacy and safety of different opioids used in doses proportional to the basal opioid regimen for the management of breakthrough pain (BP). METHODS: In 66 patients consecutive patients admitted to a pain relief and palliative care unit, the efficacy and safety of different opioids used in doses proportional to the basal opioid regimen for the management of breakthrough pain (BP) were assessed. The choice of the opioid to be administered as rescue medication was based on the characteristics of patients, clinical stability, compliance, preference, and so on. For each episode, nurses were instructed to routinely collect changes in pain intensity and emerging problems when pain became severe (T0), and to re-assess the patient 15 minutes after the opioid given as a rescue medication (T15). RESULTS: Six hundred twenty four episodes of BP were recorded during admission. Intravenous morphine (IV-MO) and oral transmucosal fentanyl (OTFC) were most frequently administered. Of 503 events available, 427 episodes were defined as successfully treated, while 76 episodes required a further administration of opioids. Pain intensity significantly decreased at T15 in all the groups (P<0.001). In 97.2% and 90.7% of cases treated with IV-MO, BP events had a reduction in pain intensity of more than 33% and 50%, respectively. In 99.2% and 97.6% patients receiving OTFC, BP events had a reduction in pain intensity of more than 33% and 50%, respectively. DISCUSSION: This survey suggests that doses of opioids for BP proportional to the basal opioid regimen, are very effective and safe in clinical practice, regardless the opioid and modality used

Transmucosal fentanyl vs intravenous morphine in doses proportional to basal opioid regimen for episodic-breakthrough pain

The use of supplemental doses of opioids is commonly suggested to manage breakthrough pain. A comparative study of intravenous morphine (IV-MO) and oral transmucosal fentanyl citrate (OTFC) given in doses proportional to the basal opioid regimen was performed in 25 cancer patients receiving stable opioid doses. For each episode, when it occurred and 15 and 30 min after the treatment, pain intensity and opioid-related symptoms were recorded. Fifty-three couples of breakthrough events, each treated with IV-MO and OTFC, were recorded. In episodes treated with IV-MO, pain intensity decreased from a mean of 6.9 to 3.3 and to 1.7 at T1 and T2, respectively. In episodes treated with OTFC, pain intensity decreased from a mean of 6.9 to 4.1 and to 2.4 at T1 and T2, respectively. Statistical differences between the two treatments were found at T1 (P=0.013), but not at T2 (P=0.059). Adverse effects were comparable and were not significantly related with the IV-MO and OTFC doses. Intravenous morphine and OTFC in doses proportional to the scheduled daily dose of opioids were both safe and effective, IV-MO having a shorter onset than OTFC. Future comparative studies with appropriate design should compare titration methods and proportional methods of OTFC dosing

Finite capacity planning algorithm for semiconductor industry considering lots priority

International audienceA finite capacity planning heuristic is developed for semiconductor manufacturing with high-mix low-volume production, complex processes, variable cycle times and reentrant flows characteristics. The proposed algorithm projects production lots trajectories (start and end dates) for the remaining process steps, estimates the expected load for all machines and balances the workload against bottleneck tools capacities. It takes into account lots' priorities, cycle time variability and equipment saturation. This algorithm helps plant management to define feasible target production plans. It is programmed in java, and tested on real data instances from STMicroelectronics Crolles300 production plant which allowed its assessment on the effectiveness and efficiency. The evaluation demonstrates that the proposed heuristic outperforms current practices for capacity planning and opens new perspectives for the production line management

Evaluating weighted models of measuring job satisfaction: A cinderella story

Data obtained from a national probability sample of 1533 American workers were used to assess the validity of ten methods of weighting job satisfaction ratings by importance ratings. The methods varied systematically in terms of the input they employed, scale treatment, and the types of mathematical operations used for weighting. Each method was evaluated with data from two subsamples of workers who differed in terms of the magnitude of their intraindividual correlations between satisfaction and importance ratings. The four criterion variables used to evaluate the weighting methods were measures of overall job satisfaction, job-related tension, likelihood of leaving one's present job, and mental health. The data not only failed to support the hypothesis that the validity of job satisfaction ratings may be increased by weighting them by importance ratings but indicated, on the contrary, that importance-weighting actually reduced the validity of satisfaction ratings. This reduction was attributed to several statistical problems, principally the failure of satisfaction and importance ratings to meet the demanding scaling assumptions of weighting models. An inconsistency was pointed out between the research activities necessary for providing an ideal test of a weighting model and those necessary for developing a generally useful measure of job satisfaction based on the model.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/33833/1/0000090.pd

Disrupting effect of methanolic extract from Prosopis torquata (CAV. EX LAG.) fruits on male Wistar rats

Los disruptores endocrinos de plantas causan anomalías en el sistema reproductivo de los mamíferos. Estudiamos los efectos del extracto metanólico (MEx) del fruto de Prosopis torquata en la reproducción, histología y morfología del sistema reproductivo de las ratas Wistar macho. Las crías se distribuyeron al azar en cuatro grupos. Tres con dieta libre de fitoestrógeno más inyección por vía subcutánea con MEx, estradiol (E) y vehículo (Ve) respectivamente. El cuarto fue alimentado con dieta que contiene fitoestrógenos comerciales (Cf + Ve). No hubo cambios en valores de hormonas ni en concentración de espermatozoides entre grupos. MEx exhibió una maduración más lenta de testículos, escaso número de espermátidas alargadas y desorganización epitelial en órganos reproductores. El efecto disruptor de MEx, se ha observado previamente en ratas Wistar hembras.Endocrine disruptors from plants cause anomalies in the reproductive system of mammals. We studied the effects of methanolic extract (MEx) from the Prosopis torquata fruit on the reproductive functions, histology and morphology of the reproductive system of male Wistar rats. Offspring were randomly distributed in four groups. Three with a phytoestrogen-free diet and injected subcutaneously with MEx, estradiol (E) and vehicle (Ve), respectively. The fourth was fed with a commercial diet containing phytoestrogens (Cf + Ve). No significant changes were observed in hormones values and in sperm concentration between the groups. The MEx group exhibited a slower testicle maturation, scarce number of elongated spermatids, and epithelial disorganization in the reproductive organs. Disruptive effect of MEx has been observed in our laboratory on female Wistar rats.Fil: Díaz, Yésica. Universidad Nacional de San Luis. Facultad de Quimica, Bioquimica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; ArgentinaFil: Salinas, Adriana P.. Universidad Nacional de San Luis. Facultad de Quimica, Bioquimica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; ArgentinaFil: Aguilera Merlo, Claudia. Universidad Nacional de San Luis. Facultad de Quimica, Bioquimica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; ArgentinaFil: Carrasco, Mirta. Universidad Nacional de San Luis. Facultad de Quimica, Bioquimica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; ArgentinaFil: Mangione, Antonio Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico San Luis. Instituto Multidisciplinario de Investigaciones Biológicas de San Luis; Argentina. Universidad Nacional de San Luis. Facultad de Quimica, Bioquimica y Farmacia. Departamento de Bioquímica y Ciencias Biológicas; Argentin

Low-dose synthetic adrenocorticotropic hormone-analog therapy for nephrotic patients: results from a single-center pilot study.

Introduction: This report describes our experience using a low-dose synthetic adrenocorticotropic hormone (ACTH) analog for patients affected by nephrotic syndrome who had not responded to or had relapsed after steroid and immunosuppressive treatments. Patients and methods: Eighteen adult nephrotic patients with an estimated glomerular filtration rate.30 mL/min were recruited. Histological pictures included ten of membranous nephropathy, three of membranous proliferative glomerulonephritis, three of minimal change, and two of focal segmental glomerular sclerosis. All patients received the synthetic ACTH analog tetracosactide 1 mg intramuscularly once a week for 12 months. Estimated glomerular filtration rate, proteinuria, serum lipids, albumin, glucose, and potassium were determined before and during the treatment. Results: One of the 18 patients discontinued the treatment after 1 month because of severe fluid retention, and two patients were lost at follow-up. Complete remission occurred in six cases, while partial remission occurred in four cases (55.5% responder rate). With respect to baseline, after 12 months proteinuria had decreased from 7.24±0.92 to 2.03±0.65 g/day (P,0.0001), and serum albumin had increased from 2.89±0.14 to 3.66±0.18 g/dL (P,0.0001). Total and low-density lipoprotein cholesterol had decreased from 255±17 to 193±10 mg/dL (P=0.01), and from 168±18 to 114±7 mg/dL (P=0.03), respectively. No cases of severe worsening of renal function, hyperglycemia, or hypokalemia were observed, and no admissions for cardiovascular or infectious events were recorded. Conclusion: Tetracosactide administration at the dosage of 1 mg intramuscularly per week for 12 months seems to be an acceptable alternative for nephrotic patients unresponsive or relapsing after steroid-immunosuppressive regimens. Further studies should be planned to assess the effect of this low-dose ACTH regimen also in nephrotic patients not eligible for kidney biopsy or immunosuppressive protocols.Introduction: This report describes our experience using a low-dose synthetic adrenocorticotropic hormone (ACTH) analog for patients affected by nephrotic syndrome who had not responded to or had relapsed after steroid and immunosuppressive treatments.Patients and methods: Eighteen adult nephrotic patients with an estimated glomerular filtration rate.30 mL/min were recruited. Histological pictures included ten of membranous nephropathy, three of membranous proliferative glomerulonephritis, three of minimal change, and two of focal segmental glomerular sclerosis. All patients received the synthetic ACTH analog tetracosactide 1 mg intramuscularly once a week for 12 months. Estimated glomerular filtration rate, proteinuria, serum lipids, albumin, glucose, and potassium were determined before and during the treatment.Results: One of the 18 patients discontinued the treatment after 1 month because of severe fluid retention, and two patients were lost at follow-up. Complete remission occurred in six cases, while partial remission occurred in four cases (55.5% responder rate). With respect to baseline, after 12 months proteinuria had decreased from 7.24±0.92 to 2.03±0.65 g/day (P,0.0001), and serum albumin had increased from 2.89±0.14 to 3.66±0.18 g/dL (P,0.0001). Total and low-density lipoprotein cholesterol had decreased from 255±17 to 193±10 mg/dL (P=0.01), and from 168±18 to 114±7 mg/dL (P=0.03), respectively. No cases of severe worsening of renal function, hyperglycemia, or hypokalemia were observed, and no admissions for cardiovascular or infectious events were recorded.Conclusion: Tetracosactide administration at the dosage of 1 mg intramuscularly per week for 12 months seems to be an acceptable alternative for nephrotic patients unresponsive or relapsing after steroid-immunosuppressive regimens. Further studies should be planned to assess the effect of this low-dose ACTH regimen also in nephrotic patients not eligible for kidney biopsy or immunosuppressive protocols

Which quality of life score is best for glaucoma patients and why?

<p>Abstract</p> <p>Background</p> <p>The glaucomas are generally asymptomatic diseases until they are very advanced. They affect 2% of the population over 40 years of age and therefore represent a significant public health issue. There have been a number of attempts to develop quality of life scales for the disease. This review discusses the pros and cons of these scales and suggests the best of the current ones for use in a clinical setting.</p> <p>Methods</p> <p>Medline, Embase and Google Scholar were searched for relevant articles. No time period was defined and all types of article were included.</p> <p>Results</p> <p>11 Quality of Life scores were identified that have been used with glaucoma patients.</p> <p>Conclusion</p> <p>There is no generally accepted 'best' Quality of Life instrument for use in glaucoma. Many of the scales are biased towards physical symptoms and do little to address the personal or social factors of the disease. Further work is needed to produce scales that address all these areas as well as being simple to administer in a clinical setting.</p

Predictive factors of polycystic ovary syndrome in girls with precocious pubarche

Objective: The aim of this study is to clarify, in girls with premature pubarche (PP), the influence of premature androgenization on the prevalence of polycystic ovary syndrome (PCOS). Design and patients: Ninety-nine PP girls, 63 who developed PCOS and 36 who did not develop PCOS, were retrospectively included. Clinical, anthropometric, and metabolic parameters were evaluated at the time of diagnosis of PP and after 10 years from menarche to find predictive factors of PCOS. Results: Young females with PP showed a PCOS prevalence of 64% and showed a higher prevalence of familial history of diabetes (P = 0.004) and a lower prevalence of underweight (P = 0.025) than PP-NO-PCOS. In addition, girls with PP-PCOS showed higher BMI (P &lt; 0.001), waist circumference (P &lt; 0.001), total testosterone (P = 0.026), visceral adiposity index (VAI) (P = 0.013), total cholesterol (P &lt; 0.001), LDL-cholesterol (P &lt; 0.001), non-HDL cholesterol (P &lt; 0.001) and lower age of menarche (P = 0.015), ISI-Matsuda (P &lt; 0.001), DIo (P = 0.002), HDL cholesterol (P = 0.026) than PP-NO-PCOS. Multivariate analysis showed that WC (P = 0.049), ISI-Matsuda (P &lt; 0.001), oral disposition index (DIo) (P &lt; 0.001), VAI (P &lt; 0.001), total testosterone (P &lt; 0.001) and LDL-cholesterol (P &lt; 0.001) are independent predictive factors for PCOS in girls with PP. Conclusions: Our study established a strong association between multiple risk factors and development of PCOS in PP girls. These risk factors are predominantly related to the regulation of glucose, lipid, and androgen metabolism. Among these factors, WC, ISI-Matsuda, DIo, VAI, total testosterone, and LDL-cholesterol predict PCOS