A case-matched comparison of readmission patterns between primary methamphetamine-using and primary cocaine-using adolescents engaged in inpatient substance-abuse treatment

OBJECTIVE: In the United States and Canada, elevated patterns of methamphetamine-related treatment admissions among youth have triggered questions about appropriate substance-abuse treatment strategies for methamphetamine-using adolescents. This study aimed to provide a comparative examination of the readmission patterns of primary methamphetamine-using and primary cocaine-using adolescents to a cognitive behavioral therapy (CBT)-based alcohol-and-drug inpatient treatment program. METHODS: The current study employed a 5-year medical-chart review of all consecutive admissions to an inpatient, hospital-based substance-abuse treatment program for adolescents in northern British Columbia, Canada. After using a propensity-score-matching approach to construct a case-matched sample (n=202) of primary methamphetamine-using and primary cocaine-using adolescents, we employed a Kaplan-Meier survival analysis technique to test group differences in time-to-readmission. RESULTS: The findings demonstrated that the methamphetamine group did not have a more severe time-to-readmission profile. CONCLUSIONS: General CBT-based treatment-as-usual approaches appear to produce similar long-term readmission outcomes for these two groups of treatment-seeking adolescents.     

Tissue inhibitor of metalloproteinase-1 protects MCF-7 breast cancer cells from paclitaxel-induced apoptosis by decreasing the stability of cyclin B1

Paclitaxel(PTX) is a very effective drug in treating tumors.It disturbs microtubule dynamics and impairs the transition of cells from metaphase to anaphase in mitosis,leading to cell death by apoptosis.However,the effectiveness of PTX in cancer chemotherapy is hampered by drug resistance in some patients.Tissue inhibitor of metalloproteinase-1(TIMP-1) is well known to be capable of inhibiting apoptosis.Elevated tumor tissue TIMP-1 levels have been significantly associated with a poor response to chemotherap...     

Chemotherapy-induced nausea and vomiting in breast cancer patients: a prospective observational study

Despite advances in the prevention and treatment of emesis, nausea and vomiting are still considered by patients to be among the most severe and feared adverse effects of chemotherapy for breast cancer. There is, however, a paucity of prospective data documenting the prevalence and severity of emesis in patients with breast cancer in the era of modern antiemetics.This prospective multicenter study evaluated chemotherapy-induced nausea and vomiting (CINV) in patients with breast cancer. Patients were given a daily diary to record the frequency and severity of nausea and vomiting during the first 5 days following chemotherapy. Data were collected until either the cessation of chemotherapy or the administration of a maximum of 6 cycles of treatment. Data are available from 143 patients who received a total of 766 cycles of chemotherapy. Prevalence rates of any nausea or any vomiting were, respectively, 37% and 13% at 24 hours and 70% and 15% during days 2-5. Severe emesis was reported by fewer than 10% of patients. Risk factors associated with CINV included age younger than 40 years, nausea expectation, not eating before treatment, and low alcohol use. The prevalence of severe CINV for breast cancer was relatively low compared with the prevalence reported in the literature. As a result of the observational design of this study, the results may better reflect the "true" prevalence of nausea and vomiting than do estimates from previously reported randomized controlled trials. Several patient characteristics that predict which patients are at increased risk of developing severe symptoms were identified.     

Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for codeine therapy in the context of cytochrome P450 2D6 (CYP2D6) genotype

Codeine is bioactivated to morphine, a strong opioid agonist, by the hepatic cytochrome P450 2D6 (CYP2D6); hence, the efficacy and safety of codeine as an analgesic are governed by CYP2D6 polymorphisms. Codeine has little therapeutic effect in patients who are CYP2D6 poor metabolizers, whereas the risk of morphine toxicity is higher in ultrarapid metabolizers. The purpose of this guideline (periodically updated at http://www.pharmgkb.org) is to provide information relating to the interpretation of CYP2D6 genotype test results to guide the dosing of codeine.     

Predictors of postoperative movement and resting pain following total knee replacement

This study determined preoperative predictors of movement and resting pain following total knee replacement (TKR). We hypothesized that younger patients with higher preoperative pain intensity, pain sensitivity, trait anxiety, pain catastrophizing, and depression would be more likely to experience higher postoperative movement pain than older patients with lower scores on these variables prior to surgery, and that predictors would be similar for resting pain. Demographics, analgesic intake, anxiety, depression, pain catastrophizing, resting pain, movement pain (ie, during active knee range of motion), and quantitative sensory tests were performed preoperatively on 215 participants scheduled for a unilateral TKR. On postoperative day 2, analgesic intake, resting pain, and movement pain were again assessed. Significant predictors of moderate or severe movement pain were higher preoperative movement pain, von Frey pain intensity, and heat pain threshold. People with severe movement pain preoperatively were 20 times more likely to have severe movement pain postoperatively. When the influence of preoperative movement pain was removed, depression became a predictor. Significant predictors of moderate to severe resting pain were higher preoperative resting pain, depression, and younger age. These results suggest that patients with higher preoperative pain and depression are more likely to have higher pain following TKR, and younger patients may have higher resting pain. Cutaneous pain sensitivity predicted movement pain but not resting pain, suggesting that mechanisms underlying movement pain are different from resting pain. Aggressive management of preoperative pain, pain sensitivity, and depression prior to surgery may facilitate postoperative recovery.     

Usability of Selected Databases for Low-Resource Clinical Decision Support

Background

Smartphones are increasingly important for clinical decision support, but smartphone and Internet use are limited by cost or coverage in many settings. txt2MEDLINE provides access to published medical evidence by text messaging. Previous studies have evaluated this approach, but we found no comparisons with other tools in this format.

Objectives

To compare txt2MEDLINE with other databases for answering clinical queries by text messaging in low-resource settings.

Methods

Using varied formats, we searched txt2MEDLINE and five other search portals (askMEDLINE, Cochrane, DynaMed, PubMed PICO, and UpToDate) to develop optimal strategies for each. We then searched each database again with five benchmark queries, using the customized search-optimization formats. We truncated the results to less than 480 characters each to simulate delivering them to a maximum of three text messages. Clinicians with practice experience in low-resource areas scored the results on a 5-point Likert scale.

Results

Median scores and standard deviations from 17 reviewers were: txt2M2MEDLINE, 3.2±0.82 (control); askMEDLINE, 3.2±0.90 (p = 0.918); Cochrane, 3.8±0.58 (p = 0.073); DynaMed, 3.6±0.65 (p = 0.105); PubMed PICO, 3.6±0.82 (p = 0.005); and UpToDate, 4.0±0.52 (p = 0.002). Our sample size was sufficiently powered to find differences of 1.0 point.

Conclusions

Comparing several possible sources for texting-based clinical-decision-support information, our results did not demonstrate one-point differences in usefulness on a scale of 1 to 5. PubMed PICO and UpToDate were significantly better than txt2MEDLINE, but with relatively small improvements in Likert score (0.4 and 0.8, respectively). In a texting-only setting, txt2MEDLINE is comparable to simulated alternatives based on established reference sources.