IMPACT OF BEAUVERIA BASSIANA ON THE COTTONWOOD BORER, PLECTRODERA SCALATOR (COLEOPTERA: CERAMBYCIDAE), IN A COMMERCIAL COTTONWOOD NURSERY.

1989 ◽  
Vol 24 (2) ◽  
pp. 186-190 ◽  
Author(s):  
B. T. Forschler ◽  
G. L. Nordin
Keyword(s):  
Beauveria Bassiana ◽  
Populus Deltoides ◽  
Adult Population ◽  
Control Treatment ◽  
High Dose ◽  
Flight Period ◽  
Treatment Area ◽  
Larval Population ◽  
The Mean ◽  
The Impact

A commercial Beauveria bassiana (Balsamo) Vuillemin conidial formulation, AGB 6178, was applied as a soil drench against the cottonwood borer, Plectrodera scalator (F.), in a commercial eastern cottonwood, Populus deltoides, nursery. Doses of 0, 2 × 109, 2 × 1010 and 1 × 1011 conidia/m2 were applied in June 1986. The adult population was monitored throughout its flight period (June–August) for B. bassiana infection. Greater than 60% of the adults collected in the treatment area post-treatment were infected with B. bassiana. The impact of the fungal application on the larval population was assessed 8 months later by the removal and dissection of the treated rootstocks. Though no differences were detected in the number of second-year larvae recovered, the mean number of first-year larvae found at the high dose (1 × 1011 CFU's/m2) was significantly less (LSD, alpha 0.05) than the mean number of larvae found in the control treatment (0 CFU's/m2), 5.0 and 9.4 larvae/10 rootstocks, respectively.

The underrepresentation of female participants in studies assessing the impact of high-dose exercise on cardiovascular outcomes: a scoping review

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Pallikadavath ◽  
R Patel ◽  
CL Kemp ◽  
M Hafejee ◽  
N Peckham ◽  
...  
Keyword(s):  
Scoping Review ◽  
High Volume ◽  
Cardiovascular Outcomes ◽  
High Dose ◽  
Funding Sources ◽  
Review Protocol ◽  
The Mean ◽  
The Impact ◽  
Over Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular adaptations as a result of exercise conducted at high-intensity and high-volume are often termed the ‘Athlete’s heart’. Studies have shown that these cardiovascular adaptations vary between sexes. It is important that both sexes are well represented in this literature. However, many studies assessing the impact of high-dose exercise on cardiovascular outcomes under-recruit female participants. Purpose This scoping review aimed to evaluate the representation of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and demonstrate how this has changed over time. Methods The scoping review protocol as outlined by Arksey and O’Malley was used. OVID and EMBASE databases were searched and studies independently reviewed by two reviewers. Studies must have investigated the effects of high-dose exercise on cardiovascular outcomes. To assess how the recruitment of females has changed over time, two methods were used. One, the median study date was used to categorise studies into two groups. Two, studies were divided into deciles to form ten equal groups over the study period. Mean percentage of female recruitment and percentage of studies that failed to include females were calculated. Results Overall, 250 studies were included. Over half the studies (50.8%, n = 127) did not include female participants. Only 3.2% (n = 8) did not include male participants. Overall, mean percentage recruitment was 18.2%. The mean percentage of recruitment was 14.5% before 2011 and 21.8% after 2011. The most recent decile of studies demonstrated the highest mean percentage of female recruitment (29.3%) and lowest number of studies that did not include female participants (26.9%). Conclusion Female participants are significantly underrepresented in studies assessing cardiovascular outcomes caused by high-dose exercise. The most recent studies show that female recruitment may be improving, however, this still falls significantly short for equal representation. Risk factors, progression and management of cardiovascular diseases vary between sexes, hence, translating findings from male dominated data is not appropriate. Future investigators should aim to establish barriers and strategies to optimise fair recruitment. Mean percentage females recruited per study (%) Percentage studies that do not include women (%) Overall (n = 250) 18.2 50.8 (n = 127) Studies before 2011 (n = 121) 14.5 59.5 (n = 72) Studies after 2011 (n = 129) 21.8 42.6 (n = 55) Table 1: Female recruitment characteristics. The year 2011 (median study year) was chosen as this divides all included studies into two equal groups.

scholarly journals OR30-01 Real-World Minimed™ 670G System Use and Glycemic Outcomes of Pediatric and Adult Individuals Living with Type 1 Diabetes (T1D) in the United States

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Robert Alan Vigersky ◽  
Michael Stone ◽  
Pratik Agrawal ◽  
Alex Zhong ◽  
Kevin Velado ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Real World ◽  
Adult Population ◽  
Age Groups ◽  
The United States ◽  
System Use ◽  
System Data ◽  
The Mean ◽  
The Impact ◽  
The U.S

Abstract Introduction: The MiniMed™ 670G system was FDA-approved in 2016 for adults and adolescents ≥14yrs, and in 2018 for children ages 7-13yrs with T1D. Since then, use of the system has grown to over 180,000 people in the U.S. The glycemic control benefits of real-world MiniMed™ 670G system Auto Mode use in the U.S. were assessed. Methods: System data (aggregated five-minute instances of sensor glucose [SG]) uploaded from March 2017 to July 2019 by individuals (N=118,737) with T1D and ≥7yrs of age who enabled Auto Mode were analyzed to determine the mean % of overall time spent <54mg/dL/<70mg/dL (TBR); between 70-180mg/dL (TIR); and >180mg/dL/>250mg/dL (TAR). The impact of Auto Mode was further assessed in a sub-group of individuals (N=51,254) with, at least, 7 days of SG data for both Auto Mode turned ON and turned OFF. The % of TIR, TBR and TAR, and the associated glucose management indicator (GMI) were evaluated for the overall OFF (2,524,570 days) and ON (6,308,806 days) periods, and across different age groups. Results: System data TIR was 71.3%; TBR was 0.4% and 1.9%, respectively; and TAR was 26.8% and 6.2%, respectively. User-wise data of Auto Mode OFF versus ON showed a mean of 70.3% of the time spent in Auto Mode, that TIR increased from 60.9% to 69.9%; and that both TBR and TAR decreased. For those 7-13yrs (N=1,417), TIR increased from 48.7% to 61.5%; TBR increased from 0.5% to 0.6% and from 2.0% to 2.2%, respectively; and TAR decreased from 49.3% to 36.3% and from 20.5% to 13.0%, respectively. For those 14-21yrs (N=4,194), TIR increased from 51.0% to 61.5%; TBR decreased from 0.7% to 0.6% and from 2.3% to 2.0%, respectively; and TAR decreased from 46.7% to 36.5% and from 18.5% to 12.5%, respectively. For those ≥22yrs (N=45,643), TIR increased from 62.2% to 70.9%; TBR decreased from 0.7% to 0.5% and from 2.6% to 1.9%, respectively; and TAR decreased from 35.2% to 27.3% and from 9.9% to 6.3%, respectively. The mean GMI decreased by 0.23% (overall), 0.48% (7-13yrs), 0.35% (14-21yrs), and 0.22% (≥22yrs), respectively, with Auto Mode ON versus OFF. Discussion: In over 6 million days of real-world MiniMed™ 670G system Auto Mode use in the U.S., TIR of a large pediatric and adult population with T1D improved by 9% compared to when Auto Mode was OFF, which was comparable to or exceeded the TIR observed in the smaller pivotal trials. These results further support outcomes of the pivotal trials and increased glycemic control with system use.

scholarly journals Height of Male Prisoners in Santiago de Chile during the Nitrate Era: The Penalty of being Unskilled, Illiterate, Illegitimate and Mapuche

2020 ◽  
Vol 17 (17) ◽  
pp. 6261
Author(s):  
Manuel Llorca-Jaña ◽  
Javier Rivas ◽  
Damian Clarke ◽  
Diego Barría Traverso
Keyword(s):  
Adult Population ◽  
Physical Growth ◽  
Height Distribution ◽  
Santiago De Chile ◽  
Northern European ◽  
The Mean ◽  
Male Inmates ◽  
University Degree ◽  
The Impact ◽  
Male Prisoners

This article contributes to the study of inequality in the biological welfare of Chile’s adult population during the nitrate era, ca. 1880s–1930s, and in particular focuses on the impact of socioeconomic variables on height, making use of a sample of over 20,000 male inmates of the capital’s main jail. It shows that inmates with a university degree were taller than the rest; that those born legitimate were taller in adulthood; that those (Chilean born) whose surnames were Northern European were also taller than the rest, and in particular than those with Mapuche background; and that those able to read and write were also taller than illiterate inmates. Conditional regression analysis, examining both correlates at the mean and correlates across the height distribution, supports these findings. We show that there was more height inequality in the population according to socioeconomic status and human capital than previously thought, while also confirming the importance of socioeconomic influences during childhood on physical growth.

Results of the Largest Study on Post-Transplant-Lymphoproliferations (PTLDs) of the Central Nervous System (CNS) in the Rituximab Era: A Surprising Overrepresentation of Kidney Transplantations, Key Importance of Methotrexate (Mtx), Cytarabine (AraC) and Radiotherapy (RX) for Long Term Survival and Low Impact of Rituximab (R)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3614-3614 ◽  
Author(s):  
Sylvain Choquet ◽  
Stefan Oertel ◽  
Ioannis Anagnostopoulos ◽  
Hanno Riess ◽  
Madalina Uzunov ◽  
...  
Keyword(s):  
Overall Survival ◽  
University Hospital ◽  
High Dose ◽  
Solid Organ ◽  
Cns Involvement ◽  
Term Survival ◽  
Long Term Survival ◽  
The Mean ◽  
The Impact

Abstract Background: PTLD is a rare and severe complication of solid organ and hematopoetic stem cell transplantation and CNS localizations are well known to be associated with an unfavourable outcome. Published data on PTLD with CNS involvement (CNS-PTLDs) are nearly inexistent and the impact of rituximab is unknown. Methods: We performed a retrospective analysis on CNS-PTLDs in two centres, the Pitié salpêtrière university hospital in Paris, France, and the Charité university hospital in Berlin, Germany, in order to have an homogeneous way to handle these diseases and to avoid biases of large national registers. PTLDs with extra-CNS localization were excluded. While attitudes for diagnosis, staging and initial immunosuppression diminution were identical, one centre largely used intravenous (iv) rituximab and radiotherapy while the other preferred high dose chemotherapy. The Pitié Salpêtrière series of 72 PTLD patients without CNS involvement served as a control population to identify specific disease characteristics of primary CNS-PTLD. Results: 24 patients with CNS-PTLD (median age 55y) have been analyzed and compared to the non-CNS PTLD group (table I). The mean follow-up of patients alive is 5 years. Primary CNS-PTLD are clearly of late onset (mean 1366 days after transplantation) with only 3/24 patients diagnosed within the first year after transplantation. There was a significant overrepresentation of renal allografts in the CNS-PTLD group as compared to PTLDs without CNS involvement, (75% vs 29%). Primary CNS-PTLDs were always of B-cell phenotype and tumors were EBV positive in 88% of cases. Treatment of primary CNS-PTLDs consisted of chemotherapy (CT) alone with high dose (HD) Mtx and/or HD AraC in 8 cases, intrathecal (it) Mtx only in 1 case and it single agent rituximab in 1 case. Rituximab has been used in combination with CT in 2 cases. Radiotherapy (RX) was used at a mean dose of 30 Gy in combination with CT in 6 patients, and in combination with rituximab in 6 patients. The overall survival of patients suffering from primary CNS-PTLD was 180 days, but some patients obtained sustained complete remissions (CR) and 11 survived more than one year [395d – 3965d]. Eight patients are alive at the time of analysis, 9 died of PTLD progression and 2 by early sepsis. The mean DFS is 1456 days. Among the 13 patients obtaining a CR, only one relapsed 6 years after his first PTLD diagnosis in an extra CNS form. Five patients died, 3 by sudden death (d60, d408, d671), one by cerebral toxoplasmosis (d703) and one by sepsis (d91). Among patients with long term survival, 5 have been treated with CT alone, 3 by RX +/− R and 3 with combined CT-RX. The role of rituximab in primary CNS-PTLD is still unclear, as only 4/9 patients treated with rituximab achieved survival, all the more so since it as been always used but once in association. Concusion: Primary CNS-PTLD is a specific entity inside the PTLD family, with a high representation of kidney grafts and EBV positive tumors. As in immunocompetent patients, long survival is possible, especially with HD CT with or without RX. The impact of rituximab seems to be reduced. CNS-PTLD Non CNS PTLD n 24 72 Age (years) 55 47 Sex ratio (M/F) 12/12 49/72 Delay from transplantation 1366 days 830 Kidney transplantation 75% (18/24) 29% Monomorphic/polymorphic 86% (19/22) 68% B phenotype 100% (24/24) 90% EBV positive (tumor) 88% (21/24) 71% ECOG > 2 33% (7/21) 14% (18/70) Overall survival 180 days 372 days Table1: comparison between primary CNS-PTLD and non CNS-PTLD

Single-center experience of using high definition (Hi-Def) imaging during neurointervention treatment of intracranial aneurysms using flow diverters

2020 ◽  
Vol 12 (9) ◽  
pp. 897-901
Author(s):  
Swetadri Vasan Setlur Nagesh ◽  
Kunal Vakharia ◽  
Muhammad Waqas ◽  
Stephan A Munich ◽  
Daniel R Bednarek ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Detector System ◽  
Large Field ◽  
Medical Systems ◽  
High Definition ◽  
Treatment Area ◽  
X Ray ◽  
The Mean ◽  
The Impact ◽  
Flow Diverters

BackgroundA new dual resolution imaging x-ray detector system (Canon Medical Systems Corporation, Tochigi, Japan) has a standard resolution 194 µm pixel conventional flat-panel detector (FPD) mode and a high-resolution 76 µm high-definition (Hi-Def) mode in a single unit. The Hi-Def mode enhances the visualization of the intravascular devices.ObjectiveWe report the clinical experience and physician evaluation of this new detector system with Hi-Def mode for the treatment of intracranial aneurysms using a Pipeline embolization device (PED).MethodsDuring intervention at our institute, under large field of view (FOV) regular resolution FPD mode imaging, the catheter systems and devices were first guided to the proximity of the treatment area. Final placement and deployment of the PED was performed under Hi-Def mode guidance. A post-procedure 9-question physician survey was conducted to qualitatively assess the impact of Hi-Def mode visualization on physicians’ intraoperative decision-making. One-sample t-test was performed on the responses from the survey. Dose values reported by the x-ray unit were also recorded.ResultsTwenty-five cases were included in our study. The survey results indicated that, for each of the nine questions, the physicians in all cases indicated that the Hi-Def mode improved visualization compared with the FPD mode. For the 25 cases, the mean cumulative entrance air kerma was 2.35 Gy, the mean dose area product (DAP) was 173.71 Gy.cm2, and the mean x-ray exposure time was 39.30 min.ConclusionsThe Hi-Def mode improves visualization of flow diverters and may help in achieving more accurate placement and deployment of devices.

SIMULATION MODEL FOR THE POPULATION DYNAMICS OF THE CARROT WEEVIL, LISTRONOTUS OREGONENSIS (LECONTE) (COLEOPTERA: CURCULIONIDAE)

1991 ◽  
Vol 123 (1) ◽  
pp. 63-76 ◽  
Author(s):  
D.X. Zhao ◽  
G. Boivin ◽  
R.K. Stewart
Keyword(s):  
Population Dynamics ◽  
Simulation Model ◽  
Mortality Rates ◽  
Egg Parasitoid ◽  
Adult Density ◽  
Larval Population ◽  
Listronotus Oregonensis ◽  
The Mean ◽  
Carrot Weevil ◽  
The Impact

AbstractA simulation model was developed for the population dynamics of a carrot weevil, Listronotus oregonensis (LeConte), population on muck-grown carrots. The model includes mortality rates of eggs, larvae, and pupae for different sowing dates of carrots. It also incorporates the overwintered adult density, the temperature-dependent growth rates of the above-mentioned life stages, the age-, temperature-, and phenology-dependent oviposition rates, and the impact of an egg parasitoid, Anaphes sordidatus (Girault), on egg mortality rates. Model output was evaluated by comparing simulated results with observed results on the seasonal totals and time of population peaks of the egg and larval populations. The mean percentage differences between the simulated and observed seasonal egg totals were 3.1 ± 0.66 (SE) in 1987 and 1988, and 4.2 ± 0.05 in 1989. They were not statistically different. The mean percentage differences between the simulated and observed seasonal larval totals were 10 ± 3.33 in 1987 and 1988 and 29.8 ± 0.66 in 1989. Independent data sets (i.e. field data in 1989) showed a significant increase in the simulation error of the larval population. Sensitivity analysis indicated that A. sordidatus had a large influence on the population dynamics of L. oregonensis.

scholarly journals A Multidisciplinary Diagnostic Approach Reveals a Higher Prevalence of Indolent Systemic Mastocytosis: 15-Years’ Experience of the GISM Network

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6380
Author(s):  
Roberta Zanotti ◽  
Massimiliano Bonifacio ◽  
Cecilia Isolan ◽  
Ilaria Tanasi ◽  
Lara Crosera ◽  
...  
Keyword(s):  
Systemic Mastocytosis ◽  
Adult Population ◽  
Young Patients ◽  
Fragility Fractures ◽  
Veneto Region ◽  
Epidemiology Data ◽  
The Mean ◽  
Cutaneous Mastocytosis ◽  
The Impact ◽  
Indolent Systemic Mastocytosis

Systemic mastocytosis (SM) and other adult clonal mast cell disorders (CMD) are often underestimated, and their epidemiology data are scarce. We aimed at evaluating the impact of the activity of the Interdisciplinary Group for Study of Mastocytosis (GISM) of Verona on the prevalence and incidence of CMD. We examined the data of 502 adult patients diagnosed with CMD and residing in the Veneto Region, consecutively referred to GISM between 2006 and 2020. SM was diagnosed in 431 cases, while 71 patients had cutaneous mastocytosis or other CMD. Indolent SM represented the most frequent SM variant (91.0%), mainly with the characteristics of bone marrow mastocytosis (54.8%). The prevalence of SM in the adult population of the Veneto region and of the Verona province was 10.2 and 17.2/100,000 inhabitants, respectively. The mean incidence of new SM cases in Verona was 1.09/100,000 inhabitants/year. Hymenoptera venom allergy was the main reason (50%) leading to the CMD diagnosis. Osteoporosis, often complicated by fragility fractures, was present in 35% of cases, even in young patients, especially males. Our data show a higher prevalence and incidence of SM than previously reported, confirming that reference centers with multidisciplinary approach are essential for the recognition and early diagnosis of CMD.

scholarly journals Biorational management of okra jassid (Amrasca devastans)

2018 ◽  
Vol 29 (3) ◽  
pp. 205-212
Author(s):  
M Akramuzzaman ◽  
MM Uddin ◽  
KS Islam
Keyword(s):  
Beauveria Bassiana ◽  
Management Strategy ◽  
Control Treatment ◽  
Adult Plant ◽  
Neem Oil ◽  
Comparative Efficacy ◽  
Emamectin Benzoate ◽  
Field Laboratory ◽  
The Mean ◽  
Karanja Oil

An experiment was carried out to appraise the comparative efficacy of some biorationals against okra jassid at the Field Laboratory, Department of Entomology, Bangladesh Agricultural University, Mymensingh during January to June 2016. The experiment was accomplished using three botanical oils (Neem oil@ 2ml/L, Mahogany oil @2ml/L & Karanja oil @2ml/L) and four microbial insecticides (Spinosad @ 1ml/ L, Beauveria bassiana @ 1 g/ L, Buprofezin @ 2ml/L, Emamectin benzoate @ 1g/L) along with control. Among various biorationals the mean number of nymph plant-1 varied significantly (p<0.01, p<0.05) after 1st, 2nd and 3rd spray. After 1st and 2nd spray, Beauveria showed the best results both at 3 DAT (0.00 & 2.33, respectively) while after 3rd spray Mahogany (0.00) performed best at 3 DAT compared to other treatments including control (4.00). In number of adult plant-1 effectiveness was reflected on Neem (0.66) among various biorationals at 3 DAT after 2nd spray. Similarly, at 5 and 7 DAT, the lowest number of adult was observed at Emamectin (1.66, 1.00), respectively. It revealed that Neem and Emamectin had strong efficacy in controlling okra jassid in comparison to their control (7.33, 11.33), respectively. After 3rd spray, the efficacy of different bioratioanls in managing okra jassid was significant (p<0.01). The Buprofezin showed the best performance both at 3 and 5 DAT (0.66 & 1.66, respectively). Similarly, the number of curled leaf plant-1 varied significantly (p<0.05, p<0.01) after both 1st 2nd and 3rd spray than the control. The lowest number of curled leaf plant-1 was observed in Neem (0.66) treated plants at 3 DAT after 2nd spray. This data revealed that the Neem had strong effect on okra jassid management. The number of curled leaf plot-1 also varied significantly (p<0.01) after 2nd and 3rd spray than the control. The highest infestation was always found in control treatment. The results indicated that Beauveria bassiana had strong efficacy in controlling okra jassid followed by Neem oil, Buprofezin and Emamectin benzoate in comparison to control. Therefore, it might be concluded that these biorational insecticides could be used as eco-friendly management strategy for okra jassid and can be incorporated in developing IPM programme for jassid. Progressive Agriculture 29 (3): 205-212, 2018

Intensifying Methotrexate (MTX) Dosage Reduces Treatment Failure in Adults with Burkitt or Burkitt-Like Leukaemia/Lymphoma (BL) Treated with an Adapted BFM Protocol.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2438-2438
Author(s):  
Sudhir Tauro ◽  
Gulnaz Begum ◽  
Grete Fossum Lauritzsen ◽  
Jan Delabie ◽  
Claudia Roberts ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Organ Transplant ◽  
High Dose ◽  
Severe Toxicity ◽  
Disease Relapse ◽  
Transplant Recipients ◽  
The Mean ◽  
Pre Treatment ◽  
The Impact ◽  
Experienced Treatment

Abstract The use of short-duration intensive combination chemotherapy protocols has improved survival in adults with Burkitt/Burkitt-like leukaemia and lymphoma (BL). Systemic methotrexate (MTX) is an integral component of these regimens, but the dosage varies between treatment schedules, and the precise dose required to optimise tumour-kill without causing severe toxicity is not known. In this study of 66 adults with sporadic BL, we have investigated whether the dosing intensity of MTX can influence treatment failure (defined as disease relapse or resistance to treatment, or death due to therapy). There were 49 males and 17 females in the cohort (median age 36 years, range 16–69y), including 9 with HIV disease and 2 organ-transplant recipients. Majority of patients (66%) had St Jude stage III/IV disease. The median increase in serum LDH level relative to normal (adjusted LDH) was 1.4 (range 1–65). Patients were treated with a combination of CNS-directed and systemic chemotherapy comprising of a pre-phase [fractionated (Fr) cyclophosphamide and prednisolone], followed by a possible total of 6 cycles of alternating Fr ifosfamide, dexamethasone, vincristine, cytarabine and etoposide [Cycle A], with Fr cyclophosphamide, dexamethasone, vincristine and adriamycin [Cycle B] as outlined by the German BFM paediatric protocols. Patients received a 24h intravenous infusion of MTX on d1 of each cycle of treatment. Based on the mean MTX dose administered per cycle, patients were stratified into three dosage groups: low (<1gm/m2, n=4), intermediate (1–1.5g/m2, n=24) or high (>1.5–3g/m2, n=34). There were 3 toxic deaths, disease was refractory in 8 patients and 9 experienced disease relapse. Durable complete responses following BFM were observed in 46/66 (70%) patients. A significantly lower proportion of patients receiving high-dose MTX (17%) experienced treatment failure compared to 45% and 50% in the intermediate and low-dose groups respectively (Fisher’s Exact p=0.01). Risk stratification on the basis of pre-treatment stage and bulk of disease, adjusted LDH and ECOG score was however unable to identify patients who may benefit from intensifying MTX dosage. These data thus uniquely highlight the impact of MTX dose in influencing outcomes in adult BL as well as the need for novel biological markers to identify patients requiring additional therapeutic strategies.

Assessment of outcomes following high-dose opioid tapering in a Veterans Healthcare System

2018 ◽  
Vol 14 (2) ◽  
pp. 89 ◽  
Author(s):  
Lauren Hundley, PharmD, BCPS ◽  
Shelley Spradley, PharmD, BCPS ◽  
Scott Donelenko, BPharm, CPE
Keyword(s):  
Cancer Pain ◽  
Monitoring Program ◽  
Opioid Analgesics ◽  
Opioid Therapy ◽  
Adverse Outcomes ◽  
High Dose ◽  
Veterans Health ◽  
The Mean ◽  
The Impact

Objective: To assess the impact of tapering of chronic high dose opioid therapy in veterans prompted by the implementation of the Opioid Safety Initiative in 2013. Design: IRB and VA Office of Research and Development-approved retrospective, observational chart review.Setting: North Florida/South Georgia Veterans Health System Patients: Veterans on high dose opioid therapy (≥300 mg of morphine equivalents per day) for chronic non-cancer pain as of 1/1/2012 with an opioid agreement discontinuation note documented in the medical record were included. Veterans treated for cancer pain or under palliative care were excluded.Outcomes: Descriptive outcomes include rate of opioid discontinuation, average duration of tapering, and rate of relapse. Differences before and after discontinuation assessed include healthcare utilization, monitoring via urine drug screens and state prescription drug monitoring program (PDMP) queries, non-opioid analgesics, benzodiazepines, and non-pharmacologic modalities.Results: Forty-three patients were included. The mean duration of therapy was 7.8 years and 81.4 percent were on methadone prior to tapering. Opioids were tapered to discontinuation in 28 patients (65 percent) with long-term abstinence in 71 percent. The mean duration of tapering was 81 days and the median/mode was 30 days. Statistically significant differences after tapering include decreased PDMP queries, increased non-opioid analgesics, decreased benzodiazepine prescriptions, and increased use of mental health services (p < 0.05). There were zero adverse outcomes identified in those tapered and one death in the group who sought non-VA care for continuation.Conclusions: This study suggests that moderate speed tapering in high-risk veterans on chronic high-dose opioid therapy can be achieved, but caution is warranted in ensuring adequate follow-up and monitoring. Clinical pharmacy services may improve tapering outcomes by providing more frequent follow-up, monitoring via state PDMP queries to identify patients who have relapsed, and dispensing naloxone for increased safety.

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