scholarly journals Medical Assessment of Cannabis Efficacy and Side-effects Scale (MACESS©): a simple evidence-based scale to determine clinical benefits and adverse events following medical cannabis use

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Peter H. Silverstone .
Keyword(s):  
Side Effects ◽  
Adverse Events ◽  
Cannabis Use ◽  
Evidence Based ◽  
Medical Cannabis ◽  
Medical Assessment ◽  
Clinical Benefits

scholarly journals Risk and Protective Factors Associated with Cannabis Use in Massachusetts Youth

2021 ◽  
Author(s):  
Julie Johnson ◽  
Samantha Doonan
Keyword(s):  
Protective Factors ◽  
Risk Behavior ◽  
Sexual Behaviors ◽  
Risky Behaviors ◽  
Risk And Protective Factors ◽  
Cannabis Use ◽  
Sensitivity Analyses ◽  
Evidence Based ◽  
Medical Cannabis ◽  
Cannabis Policy

Cannabis policies are continuously evolving, over half of U.S. youth now live in a state with a form of legalized cannabis. Monitoring risk and protective factors is critical to ensure evidence-based youth prevention in this post cannabis-prohibition era. Massachusetts has enacted and implemented three forms of legalization: (1) Decriminalization (2008), (2) medical cannabis (2012), and (3) adult-use cannabis (2016). This study used state Youth Risk Behavior Survey (YRBS) data of participants in grades 9-12 from 2007-2017 (N=17,691). Logistical regression models were run to assess effects of varying cannabis policy and risk or protective behaviors on cannabis use outcomes: (1) Lifetime use; (2) Past 30-day; and (3) Past 30-day heavy use. The enactment of cannabis policies was not associated with greater odds of youth reporting Lifetime and Past 30-day cannabis use behaviors. Any adult-support [heavy use OR=0.43 (95% CI=0.37,0.50), p<.001], better grades [heavy use OR=0.25 (95% CI=0.21,0.29), p<.001], and being heterosexual [heavy use OR=0.42 (95% CI=0.34,0.51), p<.001] were associated with lower odds of all cannabis use outcomes. Multiple risk factors broadly categorized under: risky sexual behaviors, non-heterosexual orientation, weapon carrying/exposure, hopelessness and suicidality behaviors, driving behaviors, and disability were associated with greater odds of cannabis use. Sensitivity analyses showed only one risk behavior was moderate by cannabis policy enactment. Results suggest that cannabis prevention efforts should not occur in a silo, rather evidence-based models for reducing risky behaviors generally may have the largest impact. Building and supporting relationships with trusted adults for youth at higher risk should be emphasized.

Sense and non-sense of polypharmacy: increasing efficacy, decreasing compliance?

2003 ◽  
Vol 18 (S2) ◽  
pp. 54s-61s ◽  
Author(s):  
Patrice Boyer
Keyword(s):  
Side Effects ◽  
Adverse Events ◽  
Evidence Based Medicine ◽  
Symptom Control ◽  
Single Agent ◽  
Effective Control ◽  
Evidence Based ◽  
Drug Classes ◽  
Psychotropic Agents ◽  
Based Medicine

The objective in managing patients with schizophrenia is to provide effective control of symptoms and enable the patient to reintegrate into society. Pharmacotherapy should, therefore, aim to provide optimum symptom control with minimal side effects using a simple dosage regimen. Ideally, this would be achieved through the use of a single agent. Some patients are successfully managed with a single antipsychotic drug, but it is often necessary or thought to be necessary to use a combination of agents to provide effective treatment. One European survey reported that most patients receive two to three psychotropic agents on average, but at least 5-22% receive five or more agents [53]. Unfortunately, the addition of more agents increases the risk of drug interactions, adverse events and non-compliance. This is amplified by the paucity of evidence-based medicine currently available to guide physicians in the use of combinations of agents, and the tendency of polypharmaceutical practice to be mostly driven by personal preference, clinical experience and marketing. This article therefore briefly looks at the feasibility of using various drug classes as adjunctive therapy in patients with schizophrenia.

scholarly journals THE ROLE OF KETAMINE IN THE TREATMENT OF CHRONIC CANCER PAIN

2015 ◽  
Vol 88 (4) ◽  
pp. 457-461 ◽  
Author(s):  
Armeana Olimpia Zgaia ◽  
Alexandru Irimie ◽  
Dorel Sandesc ◽  
Catalin Vlad ◽  
Cosmin Lisencu ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Neuropathic Pain ◽  
Side Effects ◽  
Cancer Pain ◽  
Nmda Receptors ◽  
Evidence Based ◽  
Chronic Cancer Pain ◽  
Clinical Benefits

         Background and aim. Ketamine is a drug used for the induction and maintenance of general anesthesia, for the treatment of postoperative and posttraumatic acute pain, and more recently, for the reduction of postoperative opioid requirements. The main mechanism of action of ketamine is the antagonization of N-methyl-D-aspartate (NMDA) receptors that are associated with central sensitization. In the pathogenesis of chronic pain and particularly in neuropathic pain, an important role is played by the activation of NMDA receptors. Although ketamine is indicated and used for the treatment of chronic cancer pain as an adjuvant to opioids, there are few clinical studies that clearly demonstrate the effectiveness of ketamine in this type of pain.The aim of this study is to analyze evidence-based clinical data on the effectiveness and safety of ketamine administration in the treatment of chronic neoplastic pain, and to summarize the evidence-based recommendations for the use of ketamine in the treatment of chronic cancer pain.Method. We reviewed the literature from the electronic databases of MEDLINE, COCHRANE, PUBMED, MEDSCAPE (1998-2014), as well as chapters of specialized books (palliative care, pain management, anesthesia).Results. A number of studies support the effectiveness of ketamine in the treatment of chronic cancer pain, one study does not evidence clear clinical benefits for the use of ketamine, and some studies included too few patients to be conclusive.Conclusions. Ketamine represents an option for neoplasic pain that no longer responds to conventional opioid treatment, but this drug should be used with caution, and the development of potential side effects should be carefully monitored.

scholarly journals Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e043400
Author(s):  
Chinazo O Cunningham ◽  
Joanna L Starrels ◽  
Chenshu Zhang ◽  
Marcus A Bachhuber ◽  
Nancy L Sohler ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Adverse Events ◽  
Opioid Analgesic ◽  
Monitoring Program ◽  
Cannabis Use ◽  
People Living With Hiv ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Analgesic Use

IntroductionIn the USA, opioid analgesic use and overdoses have increased dramatically. One rapidly expanding strategy to manage chronic pain in the context of this epidemic is medical cannabis. Cannabis has analgesic effects, but it also has potential adverse effects. Further, its impact on opioid analgesic use is not well studied. Managing pain in people living with HIV is particularly challenging, given the high prevalence of opioid analgesic and cannabis use. This study’s overarching goal is to understand how medical cannabis use affects opioid analgesic use, with attention to Δ9-tetrahydrocannabinol and cannabidiol content, HIV outcomes and adverse events.Methods and analysesWe are conducting a cohort study of 250 adults with and without HIV infection with (a) severe or chronic pain, (b) current opioid use and (c) who are newly certified for medical cannabis in New York. Over 18 months, we collect data via in-person visits every 3 months and web-based questionnaires every 2 weeks. Data sources include: questionnaires; medical, pharmacy and Prescription Monitoring Program records; urine and blood samples; and physical function tests. Using marginal structural models and comparisons within participants’ 2-week time periods (unit of analysis), we will examine how medical cannabis use (primary exposure) affects (1) opioid analgesic use (primary outcome), (2) HIV outcomes (HIV viral load, CD4 count, antiretroviral adherence, HIV risk behaviours) and (3) adverse events (cannabis use disorder, illicit drug use, diversion, overdose/deaths, accidents/injuries, acute care utilisation).Ethics and disseminationThis study is approved by the Montefiore Medical Center/Albert Einstein College of Medicine institutional review board. Findings will be disseminated through conferences, peer-reviewed publications and meetings with medical cannabis stakeholders.Trial registration numberClinicalTrials.gov Registry (NCT03268551); Pre-results.

scholarly journals Cannabis related side effects in otolaryngology: a scoping review

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Jobanjit S. Phulka ◽  
Joel W. Howlett ◽  
Amanda Hu
Keyword(s):  
Side Effects ◽  
Scoping Review ◽  
Risk Of Bias ◽  
Cannabis Use ◽  
Therapeutic Effects ◽  
Evidence Based ◽  
High Quality Research ◽  
Levels Of Evidence ◽  
Randomized Studies ◽  
Scoping Reviews

Abstract Background Cannabis has been rapidly legalized in North America; however, limited evidence exists around its side effects. Health Canada defines side effect as a harmful and unintended response to a health product. Given drug safety concerns, this study’s purpose was to review the unintended side effects of cannabis in otolaryngology. Methods The Preferred Reporting Items For Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) protocol was used to conduct a scoping review of the MEDLINE, EMBASE, CINAHL, and CENTRAL databases. (PROSPERO: CRD42020153022). English studies in adults were included from inception to the end of 2019. In-vitro, animal, and studies with n < 5 were excluded. Primary outcome was defined as unintended side effects (defined as any Otolaryngology symptom or diagnosis) following cannabis use. Oxford Centre for Evidence-Based Medicine: Levels of Evidence and risk of bias using the Risk of Bias in randomized trials (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tools were assessed.. Two authors independently reviewed all studies; the senior author settled any discrepancies. Results Five hundred and twenty-one studies were screened; 48 studies were analysed. Subspecialties comprised: Head and Neck (32), Otology (8), Rhinology (5), Airway (5), Laryngology (1). Cannabis use was associated with unintended tinnitus, vertigo, hearing loss, infection, malignancy, sinusitis, allergic rhinitis, thyroid dysfunction, and dyspnea. About half (54.1%) of studies showed increased side effects, or no change in symptoms following cannabis use. Oxford Levels of Evidence was 2–4 with substantial heterogeneity. Risk of bias assessment with RoB2 was low to high and ROBINS-1 was moderate to critical. Conclusion This was the first comprehensive scoping review of unintended side effects of cannabis in Otolaryngology. The current literature is limited and lacks high-quality research Future randomized studies are needed to focus on therapeutic effects of cannabis in otolaryngology. Substantial work remains to guide clinicians to suggest safe, evidence-based choices for cannabis use. Graphic abstract

Therapeutic Aspects of Squill; An Evidence-Based Review

2020 ◽  
Vol 17 (3) ◽  
pp. 318-324 ◽  
Author(s):  
Khadije Saket ◽  
Jalil T. Afshari ◽  
Ehsan Saburi ◽  
Mahdi Yousefi ◽  
Roshanak Salari
Keyword(s):  
Side Effects ◽  
Traditional Medicine ◽  
Respiratory Diseases ◽  
Low Cost ◽  
Current Evidence ◽  
Evidence Based ◽  
Helminthic Infections ◽  
Traditional Persian Medicine ◽  
Healing Of Wounds ◽  
Bioactive Agents

From ancient times, medicinal plants have been usually utilized to treat many disorders, but today, interest in these herbs is again aroused, because of their fewer side effects and low-cost. In traditional medicine, for many diseases, various medicinal herbs have been suggested so far. Drimia maritime, also named squill, is an important medicinal plant for the treatment of many diseases, especially respiratory diseases. In the current evidence-based study, we conducted a review of the general characteristics, ingredients, administration form, and side effects of squill in traditional medicine. For this purpose, traditional Persian medicine literatures and electronic databases were examined including PubMed, Scopus, and Google Scholar. Many compounds are isolated from D.maritima, including scillaren, scillirubroside, scillarenin, and bufadienolide glycosides. Oxymel is the most commonly used form of squill for various diseases, especially respiratory diseases. Besides, squill has been used in the treatment of cardiovascular, digestive, and dermatological disorders, it is also used against various cancer cells for its antioxidant and cytotoxic properties. Moreover, there is relatively reliable evidence of its benefits for bacterial and helminthic infections, rheumatism, edema, gout, abortion induction, healing of wounds and urine induction. It seems that supplementary studies are required to explore the bioactive agents and their effective mechanisms.

scholarly journals Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Alina Weise ◽  
Julia Lühnen ◽  
Stefanie Bühn ◽  
Felicia Steffen ◽  
Sandro Zacher ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Informed Consent ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Evidence Based ◽  
Nocebo Effect ◽  
Legal Requirements ◽  
Consent Forms ◽  
Link Type ◽  
Total Knee

Abstract Background Practitioners frequently use informed consent forms to support the physician-patient communication and the informed consent process. Informed consent for surgery often focuses on risk centered information due to high liability risks for treatment errors. This may affect patients’ anxiety of adverse events and the nocebo effect. This study focuses on the optimization of pre-surgical information on risks and complications, and at the same time reconciles these information with legal requirements. Methods The development, piloting, and evaluation of evidence-based informed consent forms for total knee arthroplasty (TKA) and related anesthesia procedures will follow the UK MRC Framework for developing and evaluating complex interventions. Conducting different sub-studies, we will (I) qualitatively explore the information acquisition and decision-making processes, (II) develop and pilot test evidence-based informed consent forms on the example of TKA and related anesthesia procedures, (III) conduct a monocentric interrupted time series (ITS) pilot study to evaluate the effects of evidence-based informed consent forms in comparison with standard consent forms, and (IV) perform a process evaluation to identify barriers and facilitators to the implementation of the intervention and to analyze mechanisms of impact. Discussion The evidence-based and understandable presentation of risks in informed consent forms aims at avoiding distorted risk depiction and strengthening the patients’ competencies to correctly assess the risks of undergoing surgery. This might reduce negative expectations and anxiety of adverse events, which in turn might reduce the nocebo effect. At the same time, the practitioners’ acceptance of evidence-based informed consent forms meeting legal requirements could be increased. Trial registration ClinicalTrials.gov, NCT04669483. Registered 15 December 2020. German Clinical Trials Registry, DRKS00022571. Registered 15 December 2020

scholarly journals Cannabis Use among Older Persons with Arthritis, Cancer and Multiple Sclerosis: Are We Comparing Apples and Oranges?

2021 ◽  
Vol 11 (5) ◽  
pp. 532
Author(s):  
Brian Kaskie ◽  
Hyojung Kang ◽  
Divya Bhagianadh ◽  
Julie Bobitt
Keyword(s):  
Multiple Sclerosis ◽  
Older Persons ◽  
Behavioral Outcomes ◽  
Cannabis Use ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Quality Of Sleep ◽  
Impact Processes ◽  
Lower Baseline

Although researchers have identified medications that relieve symptoms of multiple sclerosis (MS), none are entirely effective and some persons with multiple sclerosis (PwMS) use alternatives. Our study compared cannabis use among PwMS (N = 135) and persons diagnosed with arthritis (N = 582) or cancer (N = 622) who were age 60 and older, enrolled in the State of Illinois Medical Cannabis Program, and invited to complete a survey fielded between June and September, 2019. We used logistic regression to identify significant differences in self-reported effects of cannabis on psychological wellbeing, quality of life, and three behavioral outcomes, and we also considered effects of past year opioid use relative to these outcomes. We found that the majority of individuals from all groups used cannabis to address pain and improve quality of sleep. While PwMS reported lower baseline levels across all five outcomes, we found that the reported effects of cannabis were largely comparable across the groups. We also found that cannabis benefitted persons with sleep and digestive issues regardless of condition, whereas persons who used opioids in addition to cannabis were less likely to experience an improvement in any of the outcomes. This comparative evaluation suggests that cannabis’ effects are not specific to MS, arthritis, or cancer as much as they impact processes common among these distinct conditions. We also found evidence that cannabis may be a viable alternative to opioids for those with these conditions and experiencing pain.

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