A long-term ecstasy-related change in visual perception

Rationale The present study provides the first evidence of the long-term consequences of ecstasy use on visual processes thought to reflect serotonergic functions in the occipital lobe. Methylenedioxymethamphetamine (“ecstasy”) is known to cause lasting changes to the serotonin system in animals, and convergent evidence suggests that similar changes occur in human ecstasy users. Other research suggests that serotonin may be involved in lateral inhibition between orientation sensitive neurons in the occipital lobe, and that disruption to the serotonin system causes an increase in the magnitude of the tilt aftereffect illusion that is known depend on those neurons. Objectives The aim of the present study was to determine if ecstasy users have detectable changes in occipital lobe behavioural functioning, as revealed by the tilt aftereffect illusion. Materials and methods Thirty ecstasy users and 34 non-drug using controls were compared on the magnitude of the tilt aftereffect illusion following adaptation to stimuli oriented at 15 and 40° from vertical. Results Ecstasy users who had not used amphetamines for 115 days or more had a larger average tilt aftereffect than non-drug using controls after adaptation to 40° stimuli but not after adaptation to 15° stimuli. Additionally, there was no difference between non-drug using controls and ecstasy users who had used amphetamines within the last 61 days at either adaptation angle. Conclusions The results were consistent with the proposal that ecstasy-related damage to the serotonin system causes behavioural changes on tests of visual perception processes that are thought to reflect serotonergic functions in the occipital lobe. An erratum to this article can be found at     

Changing nurses' pain assessment practice: a collaborative research utilization approach*

It is not uncommon for a decade to pass between the time a research problem is identified and the time that research-based solutions are translated into standards for care This quasi-experimental study demonstrated the effectiveness of a collaborative research utilization model directed towards the transfer of specific research-based knowledge (pain assessment) into practice for the purpose of helping to solve pain management problems At the same time, nurses who participated in the model significantly improved their competency in research utilization and their attitudes towards research when compared to a control group who did not participate in the model     

Epilepsy: from consensus to daily practice

Most clinicians would accept that epilepsy treatment should begin with monotherapy, and in the majority of cases this is the preferred drug maintenance option. The clinical choice of one antiepileptic drug (AED) over another should be based on firm evidence of efficacy and tolerability as evaluated in comparative monotherapy studies and pharmacokinetics. This paper presents the findings of evidence-based reviews of AED monotherapy in patients newly diagnosed with epilepsy. The main study was conducted in the United Kingdom and investigated the clinical evidence supporting AEDs used as first-line monotherapy. In this paper the general treatment recommendations will focus on valproate, one of the mainstay drugs used in the fight against epilepsy. Finally, with these recommendations in mind, the principles behind AED drug selection in clinical practice will be discussed. Factors for consideration that impact on AED decision-making include: seizure and syndrome diagnosis, AED tolerability profiles, patient characteristics and pharmacokinetic/pharmacodynamic AED interactions.     

Efficacy and tolerability of levetiracetam during 1-year follow-up in patients with refractory epilepsy.

PROBLEM: Levetiracetam (LEV) is a new antiepileptic drug shown to be effective for the treatment of partial seizures in pivotal clinical trials. We investigated the long-term efficacy and tolerability of LEV as add-on therapy, regardless of seizure type, especially in persons who would not be eligible for clinical trials due to factors such as mental retardation and concomitant psychiatric disorders. METHODS: Ninety-eight patients participated and were followed for 1 year. Demographic data, seizure frequency, and side effects were recorded at baseline and during the 1-year follow-up. The first 35 patients were given LEV at a starting dose of 500 mg b.i.d. with weekly increments of 1000 mg (fast titration). The other patients were given LEV with a starting dose of 250 mg b.i.d. with weekly increments of 250 mg (slow titration). RESULTS: Fourteen patients were completely seizure free after titration to effective dose and 57 were responders with >50% seizure reduction for the first year. In the group with generalized seizures, 1 out of 19 became seizure free, but 8 patients had >50% decrease. Average dose at 1 year was 1900 mg (+/-900). Seventeen of 38 discontinuations were due to adverse effects and 21 were due to lack of efficacy. With fast titration, 15 out of 35 (43%) experienced tiredness during the first 12 weeks, and with slower titration 20 of 63 (32%) experienced tiredness. The difference was not statistically significant.Four out of the five patients who discontinued due to behavioral adverse events (mainly irritability) previously had behavioral problems and/or mental retardation. One patient discontinued due to psychosis. CONCLUSIONS: Levetiracetam appears to be well tolerated in patients with severe epilepsy and shows efficacy in a long-term follow-up. Behavioral adverse events were noted in a small number of patients and occurred mainly in patients who had a history of behavioral disturbance or were mentally retarded. These data from an open population are consistent with the findings of clinical trials.     

Issues influencing development of the Canadian Cardiovascular Information Network

The 1995 Consensus Conference of the Canadian Cardiovascular Society on "Indications for and Access to Revascularization" recommended that Canadian centres with invasive cardiovascular facilities should participate in a national observational database that monitors the selection of patients, as well as evaluate outcomes. The Canadian Cardiovascular Society, the Heart and Stroke Foundation of Canada, and Health Canada with IBM as a partner, initiated a process to identify factors influencing the development of the Canadian Cardiovascular Information Network. IBM's "Business Discovery Methodology" was adapted for health care. Structured interviews with representatives of health organizations, cardiovascular databases and research institutes were conducted across Canada, followed by a workshop to identify goals, issues and challenges. Participants identified goals for a cardiovascular database (eg, evidence-based decision-making), project related issues (eg, respecting the integrity of existing databases) and health care related issues (eg, cardiac waiting lists). Challenges included initial mistrust between representatives of provincial cardiovascular databases and national agencies, and a lack of sustained funding. A Project Team was formed to address 'cardiac waiting lists'. Analysis of Alberta and Ontario data identified differences in definitions, such as when the waiting time for bypass surgery began, that impeded detailed comparisons. Development of a centralized national database was not feasible at this time for political, technical and financial reasons. However, provincial cardiovascular database representatives agreed to work together and to share aggregate data and analyses. A first step toward developing a national surveillance system for cardiovascular services will be achieving consensus about standardizing data definitions. This process will require sustained funding.