Pattern and probability of dispensing of prescription opioids and benzodiazepines among the new users in Australia: a retrospective cohort study

ObjectiveOpioids and benzodiazepines are recommended to use for a short duration. Clinicians face a challenge to appraise the risk of new users to become long-term users. This study examined the pattern and probability of opioids and benzodiazepines dispensing among the new users.DesignA unit-record data of an incident and a point-incident cohort of new users, who were not dispensed in the previous 2 years, was examined and retrospectively followed up for 24 months.SettingAustralia.ParticipantsA random 10% national sample.Primary and secondary outcome measuresDistribution of total dispensing in calendar months. Probability of staying in the cohort in each successive month. Effect of first month’s dispensing pattern on the total duration of dispensing during 2nd–24th month in total number of calendar months the dispensing was recorded.ResultsIn the incident cohort, 68.24% were dispensed opioids, 23.96% were dispensed benzodiazepines and 7.80% were dispensed both medicines. Over 70% in the incident cohort and 50% in the point-incident cohort were dispensed for a month only. Codeine was the most prevalent opioid, dispensed to 52% of opioid users; and diazepam was the most prevalent benzodiazepines, dispensed to 45.34% of benzodiazepine users. The probability of staying in the cohort and hence receiving further dispensing continued to be very high if dispensing did not end in the first month. The quantity (in defined daily dose) and the total number of dispensing episodes in the first month were significant predictors of the total duration of dispensing in the later period.ConclusionsSince harms from long-term use of these medicines may outweigh the benefits, and since the probability of further dispensing was high for those who were dispensed for more than a month, clinicians should endeavour to keep the dispensing duration and quantity as small as possible while initiating a prescription for the new users.

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Abstract 204: Cardiovascular Mortality and Non-fatal Cardiovascular Events After Diagnosis of Acute Aortic Syndrome

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.204 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Salome Weiss ◽

Indrani Sen ◽

Ying Huang ◽

Jill M Killian ◽

W. Scott Harmsen ◽

...

Keyword(s):

Proportional Hazards ◽

Intramural Hematoma ◽

Cox Proportional Hazards ◽

Secondary Outcome ◽

Acute Aortic Syndrome ◽

Increased Risk ◽

Incident Cohort ◽

First Time ◽

Overall Mortality

Background: Acute aortic syndrome (AAS) includes aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU) and confers high rates of aortic related events. However, the risk of cardiovascular (CV) events in this patient group is unknown. The aim of this study was to define the rates of CV events in an incident cohort of AAS patients. Methods: Medical records and death certificates of all Olmsted County, MN residents with a diagnosis of AAS from 1995-2015 were reviewed and compared to age- and sex- matched population controls. Primary outcome was non-aortic CV mortality. Secondary outcome was overall mortality and first time non-fatal CV event (myocardial infarction (MI), heart failure (HF) or stroke). Events were analyzed using Cox proportional hazards regression adjusting for comorbidities. Results: Of 133 patients with AAS (77 AD, 21 IMH, 35 PAU) 57% were male, median age was 72 (SD 14) and median follow-up was 10 years. Overall survival in AAS cases and controls was 62% versus 83% at 5 years and 44% versus 60% at 10 years (adj HR 1.8, p<.001, 95% CI 1.3-2.4). CV death occurred in 21 (29%) of 73 AAS decedents due to HF (9), MI (5), other cardiac causes (5), stroke (1) and peripheral vascular disease (1). CV-related survival at 5 and 10 years after AAS diagnosis (91% and 81%) was not significantly different from controls (95% and 86%) after adjustment for comorbidities (adj HR 1.8, p=.1, 95% CI 0.9-3.6). AAS was associated with an increased risk of any first time CV event (adj HR 2.6, p<.001, 95% CI 1.6-4.4; Figure), first time diagnosis of MI (adj HR 2.8, p<.001, 95% CI 1.7-4.7) and HF (adj HR 3.2, p<.001, 95% CI 1.6-6.2) but not stroke. When excluding acute events within 14 days of diagnosis, AAS was still associated with a significantly higher mortality (adj HR 1.6, p=.011, 95% CI 1.1-2.4) and an increased risk of any first time CV event (adj HR 2.2, p=.018, 95% CI 1.1-4.1), first time MI (adj HR 2.2, p=.012, 95% CI 1.2-4.1) and HF (adj HR 2.9, p=.006, 95% CI 1.4-6.2) but not stroke. Conclusions: AAS is associated with a higher overall mortality and an increased risk of any first time CV event, first time MI and HF that persists beyond the acute phase. These data highlight the risk of CV events among those with AAS and implicate the need for long-term cardiovascular management in these patients.

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11 Therapeutic Equivalences in Long-term Antipsychotics

CNS Spectrums ◽

10.1017/s1092852919000075 ◽

2019 ◽

Vol 24 (1) ◽

pp. 178-179

Author(s):

C. Gómez Sánchez-Lafuente

Keyword(s):

Meta Analysis ◽

Oral Dosage ◽

Alternative Methods ◽

World Health ◽

Consensus Method ◽

Defined Daily Dose ◽

Dose Method ◽

Daily Dose ◽

Long Acting

AbstractStudy ObjectivesThe concept of dose equivalence is very useful when it comes to using drugs. In the case of antipsychotics, the first comparison was established by Davis in 1974, called the classical comparison method. Subsequently, other methods have appeared, such as the minimum effective dose method, the dose response method, the consensus among experts such as consensus method by Gardner, and the Daily Dose method of the World Health Organization. In 2016, Leucht et al performed the meta-analysis comparing the equivalence by the alternative methods of second-generation antipsychotics orally, based on Olanzapine. However, therapeutic equivalences between injectable antipsychotics have not yet been made.The objective of the study is to establish a pattern of therapeutic equivalences between long-acting antipsychotics, based on the method of the Defined Daily Dose (DDD).MethodThe DDD is the dose of the maintenance medium of a drug for its main indication in adults of 70kg. In the case of antipsychotics, psychosis is the most important indication. DDDs are different for each route of administration, especially if the bioavailability of the drug varies between one route and another. To establish the DDD of a drug, 3 measures are taken: firstly, the dose ranges of the drug approved by at least 1 major regulatory authority. Secondly, doses used in clinical trials. Thirdly, post marketing data on dose used in clinical practice when the drug is commercialized. Depot formulations are usually assigned the same DDDs as the ordinary oral dosage form. Based on the DDD according to the WHO classification at http://www.whocc.no/.For comparison, Olanzapine 210mg was used as the main drug and equivalences were established from it. Therapeutic deposit of Aripiprazole (ARI), Flufenazine decanoate (FLU), Haloperidol Decanoate (HAL) Olanzapine pamoate (OLA), Paliperidone palmitate (PAL), Risperidone depot (RIS), and Zuclopenthixol decanoate (ZUC).ResultsThe results will be shown in a 8x8 table.ConclusionsDDD is available for almost all antipsychotics and is an accepted method as well as a clinical level as a researcher. They are based on a wide variety of data from different sources. Several studies have found a strong correlation between this method and other methods of equivalence. This method also has limitations. First, the DDDs were not established for the purpose of therapeutic equivalences. Secondly, the daily dose can be applied mainly to the efficacy of the drug, when the dose could cause some adverse effects.The establishment of therapeutic equivalences may help when a clinician needs to change one long-term antipsychotic. This could reduce psychotic relapses. It may enhance therapeutic adherence avoiding undesirable side effects. On the other hand, long-acting antipsychotics have corroborated the adherence and decrease of relapses, which is why it is increasingly used as a good alternative to oral drugs.

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SATELLITE DATA FOR INVESTIGATION OF RECENT STATE AND PROCESSES IN THE SIVASH BAY

Proceedings of International Conference "Managinag risks to coastal regions and communities in a changinag world" (EMECS'11 - SeaCoasts XXVI) ◽

10.21610/conferencearticle_58b43159b0693 ◽

2017 ◽

Author(s):

Ekaterina Shchurova ◽

Rimma Stanichnaya ◽

Sergey Stanichny ◽

...

Keyword(s):

Satellite Data ◽

Water Exchange ◽

High Salinity ◽

Meteorological Data ◽

Sea Surface ◽

Azov Sea ◽

Seasonal Wind ◽

Ice Regime ◽

Very High

Sivash bay is the shallow-water lagoon of the Azov Sea. Restricted water exchange and high evaporation form Sivash as the basin with very high salinity. This factor leads to different from the Azov Sea thermal and ice regimes of Sivash. Maine aim of the study presented to investigate recent state and changes of the characteristics and processes in the basin using satellite data. Landsat scanners TM, ETM+, OLI, TIRS together with MODIS and AVHRR were used. Additionally NOMADS NOAA and MERRA meteorological data were analyzed. The next topics are discussed in the work: 1. Changes of the sea surface temperature, ice regime and relation with salinity. 2. Coastal line transformation – long term and seasonal, wind impact. 3. Manifestation of the Azov waters intrusions through the Arabat spit, preferable wind conditions.

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Positive Emotions

The Oxford Handbook of Positive Psychology ◽

10.1093/oxfordhb/9780195187243.013.0003 ◽

2009 ◽

pp. 12-24 ◽

Cited By ~ 2

Author(s):

Michael A. Cohn ◽

Barbara L. Fredrickson

Keyword(s):

Positive Emotions ◽

Well Being ◽

Life Outcomes ◽

Short Term ◽

Future Success ◽

Broaden And Build Theory ◽

Mental And Physical Health ◽

Very High ◽

Future Growth

Positive emotions include pleasant or desirable situational responses, ranging from interest and contentment to love and joy, but are distinct from pleasurable sensation and undifferentiated positive affect. These emotions are markers of people's overall well-being or happiness, but they also enhance future growth and success. This has been demonstrated in work, school, relationships, mental and physical health, and longevity. The broaden-and-build theory of positive emotions suggests that all positive emotions lead to broadened repertoires of thoughts and actions and that broadening helps build resources that contribute to future success. Unlike negative emotions, which are adapted to provide a rapid response to a focal threat, positive emotions occur in safe or controllable situations and lead more diffusely to seeking new resources or consolidating gains. These resources outlast the temporary emotional state and contribute to later success and survival. This chapter discusses the nature of positive emotions both as evolutionary adaptations to build resources and as appraisals of a situation as desirable or rich in resources. We discuss the methodological challenges of evoking positive emotions for study both in the lab and in the field and issues in observing both short-term (“broaden”) and long-term (“build”) effects. We then review the evidence that positive emotions broaden perception, attention, motivation, reasoning, and social cognition and ways in which these may be linked to positive emotions' effects on important life outcomes. We also discuss and contextualize evidence that positive emotions may be detrimental at very high levels or in certain situations. We close by discussing ways in which positive emotions theory can be harnessed by both basic and applied positive psychology research.

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Treatment Retention of Crack and Cocaine Users in a National Sample of Long Term Residential Clients

Addiction Research ◽

10.3109/16066350009004409 ◽

2000 ◽

Vol 8 (1) ◽

pp. 51-64 ◽

Cited By ~ 16

Author(s):

Grace A. Rowan-Szal ◽

George W. Joe ◽

D. Dwayne Simpson

Keyword(s):

National Sample ◽

Treatment Retention ◽

Cocaine Users

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Control of Graves’ hyperthyroidism with very long-term methimazole treatment: a clinical trial

BMC Endocrine Disorders ◽

10.1186/s12902-020-00670-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fereidoun Azizi ◽

Hengameh Abdi ◽

Atieh Amouzegar

Keyword(s):

Low Dose ◽

Reference Range ◽

Antithyroid Drug ◽

Therapeutic Modality ◽

Thyroid Status ◽

Antithyroid Drug Therapy ◽

Daily Dose ◽

Prevention Of Relapse

Abstract Background Long-term antithyroid drug therapy has become one of the options for treatment of Graves’ hyperthyroidism. The aim of this study was to compare thyroid status in those who discontinued methimazole (MMI) treatment after 12.8 years with those who continued MMI as long as 24 years. Methods Fifty nine patients with Graves’ disease on long-term MMI for 14.2 ± 2.9 years were recruited; 32 patients (54%) decided to discontinue MMI and 27 (46%) preferred additional years of MMI treatment. All patients were followed for a mean of 6 additional years. Results Of 27 patients who continued MMI up to 24 years, suppressed serum thyrotropin (TSH) was not observed in any patient after the seventh year of treatment. Serum free thyroxine, triiodothyronine, TSH and TSH receptor antibody concentrations remained normal up to the length of the study. Mean daily dose of MMI to maintain TSH in the reference range decreased gradually and reached to 2.8 ± 1.7 mg by 24 years of MMI treatment. No adverse reaction related to MMI occured during additional years of therapy. In 32 patients who discontinued MMI, hyperthyroidism relapsed in 6 patients (19%), one left follow-up and 25 (78%) remained euthyroid during the study. Conclusions Long-term low dose MMI treatment may be a lifelong effective and safe therapeutic modality in patients with Graves’ hyperthyroidism for prevention of relapse, if studies from other centers confirm findings of this research. Trial registration IRCT201009224794N1, 2010-10-25. Retrospectively registered. https://www.irct.ir/trial/5143.

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Comparison of Official and Friendly Matches through Acceleration, Deceleration and Metabolic Power Measures: A Full-Season Study in Professional Soccer Players

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115980 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5980

Author(s):

Hadi Nobari ◽

Sara Mahmoudzadeh Khalili ◽

Rafael Oliveira ◽

Alfonso Castillo-Rodríguez ◽

Jorge Pérez-Gómez ◽

...

Keyword(s):

Effect Size ◽

Total Duration ◽

Soccer Players ◽

Metabolic Power ◽

Professional Soccer ◽

Premier League ◽

Small Effect Size ◽

Moderate Effect Size ◽

High Effort

Soccer is a popular team sport and highly demanding activity that requires high effort and long-term training plans. The goals of this study were to compare the accelerations, decelerations and metabolic power between official and friendly full matches, between the first and second halves of the matches, and between both halves of official and friendly matches. Twelve professional soccer players (age, 28.6 ± 2.7 years; height, 182.1 ± 8.6 cm; body mass, 75.3 ± 8.2 kg; BMI, 22.6 ± 0.7 kg/m2) participated in this study. A total of 33 official and 10 friendly matches were analyzed from the Iranian Premier League. All matches were monitored using GPSPORTS systems Pty Ltd. The following variables were selected: total duration of the matches, metabolic power, accelerations Zone1 (<2 m·s−2) (AccZ1), accelerations Zone2 (2 to 4 m·s−2) (AccZ2), accelerations Zone3 (>4 m·s−2) (AccZ3), decelerations Zone1 (<−2 m·s−2) (DecZ1), decelerations Zone2 (−2 to −4 m·s−2) (DecZ2) and decelerations Zone3 (>−4 m·s−2) (DecZ3). The major finding was shown in metabolic power, where higher values occurred in friendly matches (p < 0.05 with small effect size). Furthermore, total duration, AccZ3, DecZ1, DecZ2, and DecZ3 were revealed to be higher in official matches, while AccZ1 and AccZ2 were higher in friendly matches. The second half of the official matches revealed higher values for total duration compared to friendly matches (p < 0.05, moderate effect size). In conclusion, this study observed higher values of metabolic power in friendly matches compared to official matches. AccZ3, DecZ1, DecZ2, and DecZ3 were higher in official matches, while AccZ1 and AccZ2 were higher in friendly matches.

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Patient Education and Sacubitril/Valsartan: A Randomized Comparative Trial

Hospital Pharmacy ◽

10.1177/0018578721999808 ◽

2021 ◽

pp. 001857872199980

Author(s):

Christopher Giuliano ◽

Bradley St. Pierre ◽

Jamie George

Keyword(s):

Controlled Trial ◽

Comparative Trial ◽

Text Messages ◽

Phone Call ◽

Secondary Outcome ◽

Short Term ◽

Phone Calls ◽

Video Education ◽

Pharmacist Education

Objective: To compare video to pharmacist education for patients taking sacubitril/valsartan. Methods: We conducted a randomized controlled trial comparing video to pharmacist education with a second randomized intervention of education delivered through text or phone call at 14 days. The primary outcome compared the change in short term knowledge between groups and the secondary outcome was long term knowledge at 1 month. Results: Forty-three patients were included. Scores improved significantly ( P < .05) in the pharmacist group from 54.1% to 85.9% and from 64.3% to 86.1% in the video education group, although there was no difference between groups (31.8% vs 22.9%, P = .13). At 30 days, scores were significantly higher than baseline (difference 16.5%, P < .05) although did decrease from the posttest (difference 7.4%, P < .05). There was no difference at 30 days between those that received text messages versus phone calls (−10% vs −5.5%, respectively; P = .36). Conclusion: We saw improvements in both short term and long term knowledge for patients receiving education through pharmacist or video education. Neither approach was more effective than the other. Clinicians can use either approach based on patient preference.

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Are the needs of people with multiple long-term conditions being met? Evidence from the 2018 General Practice Patient Survey

BMJ Open ◽

10.1136/bmjopen-2020-041569 ◽

2020 ◽

Vol 10 (11) ◽

pp. e041569

Author(s):

Lucina Rolewicz ◽

Eilís Keeble ◽

Charlotte Paddison ◽

Sarah Scobie

Keyword(s):

General Practice ◽

Unmet Need ◽

Patient Survey ◽

Secondary Outcome ◽

Community Based ◽

Long Term Conditions ◽

Local Services ◽

Community Based Services ◽

Practice Patient

ObjectivesTo investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services in England.DesignCross-sectional study using data from 199 150 survey responses.SettingPrimary care and community-based services.ParticipantsRespondents to the 2018 English General Practice Patient Survey with at least one long-term condition.Primary and secondary outcome measuresThe primary outcomes were the levels of unmet need in GP and local services among patients with multiple long-term conditions. Secondary outcomes were the proportion of variation explained by practice and area-level factors.ResultsThere was no relationship between needs being fully met in patients’ last practice appointment and number of long-term conditions once sociodemographic characteristics and health status were taken into account (5+conditions−OR=1.04, 95% CI 0.99 to 1.09), but there was a relationship for having enough support from local services to manage conditions (5+conditions−OR=0.84, 95% CI 0.80 to 0.88). Patients with multimorbidity that were younger, non-white or frail were less likely to have their needs fully met, both in GP and from local services. Differences between practices and local authorities explained minimal variation in unmet need.ConclusionsLevels of unmet need are high, particularly for support from community services to manage multiple conditions. Patients who could be targeted for support include people who feel socially isolated, and those who have difficulties with their day-to-day living. Younger patients and certain ethnic groups with multimorbidity are also more likely to have unmet needs. Increased personalisation and coordination of care among these groups may help in addressing their needs.

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