Association between Disability,Cognition, Fatigue,EQ-5D-3L Domains,and Utilities Estimated with Different Western European Value Sets in Patients with Multiple Sclerosis

Objectives

To assess the association between fatigue, cognition, domains of the EuroQol five-dimensional questionnaire (EQ-5D-3L), disability, and utilities estimated with several Western European value sets in patients with multiple sclerosis (MS).

Group leader and participant perceptions of Balancing Everyday Life,a group-based lifestyle intervention for mental health service users

Abstract

Background: There exist few recovery and occupation-based interventions for mental health service users. Balancing Everyday Life (BEL) is a new occupation-based lifestyle intervention that was created to fill this need.

Aim: To gain group leaders’ and participants’ perspectives of the BEL intervention content and format, including factors that helped, hindered, and could be improved.

Methods: A constructivist grounded theory method guided data collection and analysis. Interviews took place with 12 BEL group leaders and 19 BEL participants from out-patient psychiatry settings and community-based day centers in Sweden.

Results: BEL’s structure and content were appreciated, yet flexibility was desired to adapt to participant needs. BEL could act as a bridge, helping participants connect with others, and to a more engaged and balanced everyday life. Facilitating factors included a person-focused (versus illness-focused) approach, physical and emotional environments, and connection. Barriers included room resources. More sessions were desired for the intervention.

Conclusion: Group leaders and participants experienced BEL as a useful tool to instigate meaningful change and connection in the participants’ lives. The combination of a positive person-focused approach and group support was appreciated. These results could inform future research, evaluation, and development of occupation-focused lifestyle interventions for mental health service users.     

Adverse events related to the new psychoactive substance 3-fluorophenmetrazine – results from the Swedish STRIDA project

Background: New psychoactive substances (NPS) are often poorly pharmacologically documented and the production is unregulated, implying high risks for toxic side effects. This report from the STRIDA project describes analytically confirmed non-fatal intoxications involving the phenmetrazine analogue 3-fluorophenmetrazine (3-FPM).

Study design and methods: Observational case series of patients with suspected acute NPS exposure requiring hospital care. Blood and urine samples were collected from patients presenting in emergency departments (ED) or intensive care units (ICU), after consultation with the Swedish Poisons Information Centre (PIC). Laboratory analysis was performed by multi-component liquid chromatography–mass spectrometry. Clinical data were collected during PIC consultations and retrieved from medical records.

Results: From November 2014 to October 2015, eight cases were registered as 3-FPM or “phenmetrazine” intoxications at the PIC after consultation. During the same period, analysis of STRIDA project samples confirmed 3-FPM use in a total of 19 patients (84% men) aged 22–54 (median 30) years. 3-FPM was detected in 15 out of 19 serum (2.7–1416?ng/mL) and in 14 out of 14 urine (1.0–6857?μg/mmol creatinine) samples. All patients were also tested positive for other psychoactive substances, with benzodiazepines being most common (57% of the cases). Ten patients were monitored in the ED for <4?h, while six needed ICU monitoring of which five were graded as severe intoxications (Poisoning Severity Score 3). Prominent clinical signs were tachycardia (47%), depressed consciousness (42%), agitation/anxiety (37%), delirium (37%), dilated pupils (26%), and seizures (16%). All patients survived.

Conclusion: In 19 patients testing positive for 3-FPM, a high incidence of severe clinical features was demonstrated. However, as all patients had also used other psychoactive substances, it was difficult to identify a unique toxidrome for 3-FPM. The results further showed that many 3-FPM intoxications would have been missed, if relying solely on information from PIC consultations. These results emphasize the importance of performing bioanalytical investigation in cases of suspected NPS intoxication.