Methadone for Analgesia in Children with Life-Limiting Illness: Experience from a Tertiary Children\u27s Health Service.

Methadone has the potential to assist in the management of pain in children with life-limiting illness, but its use is limited by its complex pharmacokinetic profile and limited research on its use in children. This is a retrospective review of the use of methadone as an analgesic in 16 children with life-limiting illness. Efficacy, dosing and side effect profile were analysed. Fifteen (94%) patients had improvements in their analgesia with minimal observed adverse effects. Patients were either rapidly converted from a prior opioid in one change or received methadone as an adjunct medication. Conversions were calculated using ratios frequently in the range of 10:1 to 20:1 from the oral morphine equivalent total daily dose (MEDD). Adjunct initial dosing was a low dose trial, often beginning with 1 mg at night. Only two patients required a dose adjustment due to side effects attributed to methadone. This was despite the cohort having significant underlying illnesses, extensive concurrent medications, and high methadone dosing where needed. Analysis of dosing and ratios indicates that an individualised approach is required. Based on this and on the infrequency of methadone use in this population, specialist assistance with dosing is recommended. Further research, including prospective and pharmacokinetic studies, is recommended

Methadone for analgesia in children with life-limiting illness: experience from a tertiary children’s health service

Methadone has the potential to assist in the management of pain in children with life-limiting illness, but its use is limited by its complex pharmacokinetic profile and limited research on its use in children. This is a retrospective review of the use of methadone as an analgesic in 16 children with life-limiting illness. Efficacy, dosing and side effect profile were analysed. Fifteen (94%) patients had improvements in their analgesia with minimal observed adverse effects. Patients were either rapidly converted from a prior opioid in one change or received methadone as an adjunct medication. Conversions were calculated using ratios frequently in the range of 10:1 to 20:1 from the oral morphine equivalent total daily dose (MEDD). Adjunct initial dosing was a low dose trial, often beginning with 1 mg at night. Only two patients required a dose adjustment due to side effects attributed to methadone. This was despite the cohort having significant underlying illnesses, extensive concurrent medications, and high methadone dosing where needed. Analysis of dosing and ratios indicates that an individualised approach is required. Based on this and on the infrequency of methadone use in this population, specialist assistance with dosing is recommended. Further research, including prospective and pharmacokinetic studies, is recommended

Variation in admission rates between psychiatrists on call in a university teaching hospital

Abstract Background Hospital-based physicians must routinely decide whether patients receiving care in the emergency room require admission to an acute care bed. We endeavoured to understand clinician-related factors that influence the decision to admit. Methods We retrospectively examined data collected between August 1, 2013 and July 31, 2015 for patients triaged as mental health assessments in the emergency department of a university teaching hospital. We identified 1530 unique cases who had been reviewed by the staff psychiatrist for a decision on whether to admit to an acute care bed. Patient and physician characteristics were analyzed by standard descriptive methods, comparative statistics (Chi square and analysis of variance) and regression analyses using SPSS version 24.0 (IBM Corp. Armonk, NY, USA). Results There were no differences in patient characteristics in the clinical encounters reviewed by different staff psychiatrists. The physician factor found significant in deciding whether to admit the patient was assignment to PES (psychiatric emergency services). This appeared to be the only physician variable impacting the decision to admit a patient with PES psychiatrists admitting less often than their colleagues (p = 0.018, Table 3). The effect size of the variable in terms of odds ratio was 0.592. Interpretation Training and practice in emergency psychiatry lead to lower admission rates when these clinicians are on call. Training in emergency psychiatry for all psychiatrists participating in a call pool may result in lowered admission rates

Bereavement interventions to support informal caregivers in the intensive care unit: a systematic review

Abstract Background Informal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers’ ability to cope with grief. Data sources MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020. Study selection Randomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU. Data extraction Two reviewers independently extracted data in duplicate. Narrative synthesis was conducted. Data synthesis Bereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness. Results Three studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up. Conclusions Currently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU

Multidisciplinary perspectives on a video case of children designing and coding for robotics

Spatial reasoning plays a vital role in choice of and success in science, technology, engineering, and mathematics (STEM) careers, yet the topic is scarce in grade school curricula. We conjecture that this absence may be due to limited knowledge of how spatial reasoning is discussed and engaged across STEM professions. This study aimed to address that gap by asking 19 professionals to comment on a video that documented children’s progression through 5 days of building and programming robots. Their written opinions on the skills relevant to their careers demonstrated by the children revealed that spatial thinking and design thinking are central to what they see

Evaluation of NV556, a Novel Cyclophilin Inhibitor, as a Potential Antifibrotic Compound for Liver Fibrosis

Hepatic fibrosis can result as a pathological response to nonalcoholic steatohepatitis (NASH). Cirrhosis, the late stage of fibrosis, has been linked to poor survival and an increased risk of developing hepatocellular carcinoma, with limited treatment options available. Therefore, there is an unmet need for novel effective antifibrotic compounds. Cyclophilins are peptidyl-prolyl cis-trans isomerases that facilitate protein folding and conformational changes affecting the function of the targeted proteins. Due to their activity, cyclophilins have been presented as key factors in several stages of the fibrotic process. In this study, we investigated the antifibrotic effects of NV556, a novel potent sanglifehrin-based cyclophilin inhibitor, in vitro and in vivo. NV556 potential antifibrotic effect was evaluated in two well-established animal models of NASH, STAM, and methionine-choline-deficient (MCD) mice, as well as in an in vitro 3D human liver ECM culture of LX2 cells, a human hepatic stellate cell line. We demonstrate that NV556 decreased liver fibrosis in both STAM and MCD in vivo models and decreased collagen production in TGFβ1-activated hepatic stellate cells in vitro. Taken together, these results present NV556 as a potential candidate for the treatment of liver fibrosis

Understanding gaps in research networks: using spatial reasoning as a window into the importance of networked educational research

This paper finds its origins in a multidisciplinary research group’s efforts to assemble a review of research in order to better appreciate how “spatial reasoning” is understood and investigated across academic disciplines. We first collaborated to create a historical map of the development of spatial reasoning across key disciplines over the last century. The map informed the structure of our citation search and oriented an examination of connection across disciplines. Next, we undertook a network analysis that was based on highly cited articles in a broad range of domains. Several connection gaps—that is, apparent blockages, one-way flows, and other limitations on communications among disciplines—were identified in our network analysis, and it was apparent that these connection gaps may be frustrating efforts to understand the conceptual complexity and the educational significance of spatial reasoning. While these gaps occur between the academic disciplines that we evaluated, we selected a few examples for closer analysis. To illustrate how this lack of flow can limit development of the field of mathematics education, we selected cases where it is evident that researchers in mathematics education are not incorporating the important work of mathematicians, psychologists, and neuroscientists—and vice versa. Ultimately, we argue, a more pronounced emphasis on transdisciplinary (versus multidisciplinary or interdisciplinary) research might be timely, and perhaps even necessary, in the evolution of educational research

Understanding gaps in research networks: using “spatial reasoning” as a window into the importance of networked educational research

The final publication is available at link.springer.com. Bruce, C.D., Davis, B., Sinclair, N. et al. Educ Stud Math (2017) 95: 143. https://doi.org/10.1007/s10649-016-9743-2 This research was supported in part by federal funding through the Social Sciences and Humanities Research Council of Canada (Bruce, Davis, & Sinclair).This paper finds its origins in a multidisciplinary research group’s efforts to assemble a review of research in order to better appreciate how “spatial reasoning” is understood and investigated across academic disciplines. We first collaborated to create a historical map of the development of spatial reasoning across key disciplines over the last century. The map informed the structure of our citation search and oriented an examination of connection across disciplines. Next, we undertook a network analysis that was based on highly cited articles in a broad range of domains. Several connection gaps—that is, apparent blockages, one-way flows, and other limitations on communications among disciplines—were identified in our network analysis, and it was apparent that these connection gaps may be frustrating efforts to understand the conceptual complexity and the educational significance of spatial reasoning. While these gaps occur between the academic disciplines that we evaluated, we selected a few examples for closer analysis. To illustrate how this lack of flow can limit development of the field of mathematics education, we selected cases where it is evident that researchers in mathematics education are not incorporating the important work of mathematicians, psychologists, and neuroscientists—and vice versa. Ultimately, we argue, a more pronounced emphasis on transdisciplinary (versus multidisciplinary or interdisciplinary) research might be timely, and perhaps even necessary, in the evolution of educational researc