Epidural Morphine for Relief of Postpartum, Postsurgical Pain

Epidural morphine for the relief of postpartum, postsurgical pain has been used as the analgesic of choice at the Medical Center at the University of California in San Francisco, California, since 1980. Maternal benefits observed by nursing staff include prolonged pain relief, uninterrupted bonding, early ambulation, improved respiratory ventilation, reduced sedation, and overall early recovery. Because the analgesic effects of epidural morphine last about 24 hours, nurses must provide close observations and assessments of potential side effects such as respiratory depression, pruritis, nausea/vomiting, and urinary retention.     

The Effects of Inhalation of Organic Chemical Air Contaminants on Murine Lung Host Defenses

The Effects of Inhalation of Organic Chemical Air Contaminantson Murine Lung Host Defenses. ARANYI, C., O'SHEA, W. J., GRAHAM,J. A., AND MILLER, F. J. (1986). Fundam. Appl. Toxicol. 6,713–720.The potential health hazards of exposure to threshold limitvalue (TLV) concentrations of acetaldehyde, acrolein, propyleneoxide, chloroform, methyl chloroform, carbon tetrachioride,allyl chloride, methylene chloride, ethylene trichloride, perchloroethylene,benzene, phenol, monochlorobenzene, and benzyl chloride, compoundswhich may be present in the ambient or work room atmospherewere investigated. The effects of single and multiple 3-hr inhalationexposures were evaluated in mice by monitoring changes in theirsusceptibility to experimentally induced streptococcus aerosolinfection and pulmonary bactericidal activity to inhaled Klebsiellapneumoniae. When significant changes in these parameters werefound, further exposures were performed at reduced vapor concentrationsuntil the no-measurable-effect level was reached. Multiple exposureson 5 consecutive days were then performed at this concentration.Significant increases in susceptibility to respiratory streptococcusinfection were observed after single 3-hr exposure to TLV concentrationsof methylene chloride, perchloroethylene, and ethylene trichloride.For methylene chloride and perchioroethylene, these exposureconditions also resulted in significantly decreased pulmonarybactericidal activity.     

Towards a Better Understanding of Elderly Migrants

Occupational therapists are currently refining their skills in order to meet the needs of the growing aged population. However, it is necessary to develop even more specialised skills with respect to effective service delivery for those increasing numbers of elderly people whose first language is not English. This paper offers a demographic picture of aged migrants and attempts to describe some of the differences in lifestyle, culture and health beliefs. With this background it is possible to consider ways in which occupational therapists can offer more effective intervention.     

RETROLUMBAR SUBCUTANEOUS EPENDYMOMA AND GIANT BATHING-TRUNK NEVOCELLULAR NEVUS

Background. Subcutaneous ependymomas have been reported rarely in dermatologic reviews and, apparently, were never associated with other cutaneous malformations. Methods. A 60-year-old woman with a retrolumbar subcutaneous ependymoma and a giant bathing-trunk nevocellular nevus submitted to thorough dermatologic and neurologic investigation. The surgical material was extensively analyzed with light and electron microscope. The literature was reviewed. Results. The tumor fits exactly the classical prerequisites of the clinical and pathologic diagnosis. In contrast with the literature, it developed at 53 years, apparently after a trauma, within a congenital giant nevocellular nevus, at the retrolumbar level; it proved unrelated to any spinal cord alteration and so far appeared quite benign. Conclusions. The observation of a retrolumbar subcutaneous ependymoma is reported with detail; this tumor exceptionally recognized by dermatologists must be included in the differential diagnosis of lumps arising in the retro-lumbar-retrosacral area. The most peculiar feature was its development within a giant bathing-trunk nevocellular nevus; such a fascinating association of two neurectodermal defects, as far as known, is presented for the first time.     

The Developmental Toxicity of Triethylene Glycol Dimethyl Ether in Mice1

The Developmental Toxicity of Triethylene Glycol Dimethyl Etherin Mice. GEORGE, J. D., PRICE, C. J., KIMMEL, C. A., AND MARR,M. C. (1987). Fundam. Appl. Toxicol. 9, 173–181. Triethyleneglycol dimethyl ether (triEGdiME) is structurally related toseveral compounds which produce reproductive and developmentaltoxicity, including teratogenicity in laboratory animals. Inthe present study, triEGdiME (0, 250, 500, or 1000 mg/kg/day)was administered by gavage to timed-pregnant CD-I mice duringmajor organogenesis (Gestational Days (gd) 6– 15). Maternalclinical status was monitored daily during treatment. At sacrifice(gd 17), confirmed-pregnant females (26–28 per group)were evaluated for clinical Status and gestational outcome;each live fetus was examined for external, visceral, and skeletalmalformations. No maternal death or morbidity was observed.Clinical signs of toxicity including piloerection were minor.Maternal weight gain during treatment, gestation, and maternalweight gain during gestation corrected for gravid uterine weightwere not affected. Gravid uterine weight decreased in a dose-relatedmanner, indicating compromised pregnancy status. Relative maternalliver weight (% body wt) was significantly increased over controlsat doses 500 and 1000 mg/kg/day. Average fetal body weightper litter was significantly reduced at doses 500 mg/kg/day.The percent age malformed live fetuses per litter (0.3, 0, 0.8,and 11.1%) was significantly increased at 1000 mg/kg/day. Majormalformations affected primarily the development of the neuraltube, cranio facial structures, and the axial skeleton. In summary,oral administration of triEGdiME during major organogenesisproduced only marginal signs of altered maternal status, asevidenced by an increase in maternal liver weight, and causedselective adverse effects upon fetal growth and morphologicaldevelopment at doses 500 mg/kg/day.     

Issues for sustainability of non‐government organisations in the alcohol and other drugs sector

Introduction and Aims. The study aimed to identify issues for sustainability of non‐government organisations in the alcohol and other drugs sector (AODS) in Australia within the current neoliberal context. Design and Methods. Six key‐informant group consultations were conducted in Sydney, Melbourne, Darwin (Australia). Participants were professionals working in the AODS from non‐government AOD organisations, government departments, philanthropic organisations and academic institutions (n = 40). Qualitative data were collected according to a discussion guide. Results. Issues related to problems with workforce capacity, independence, governance and funding. Factors contributing to these issues related to the competitive tendering funding model, for example: accountability requirements and tied funding. Discussion and Conclusions. Issues identified by the AODS were mostly similar to those identified by the broader non‐government organisations sector. There is much to learn from outside the AODS. Strategies to improve sustainability will include workforce development, improving governance and developing relationships within the sector and with government. These require a commitment to innovation and will entail movement of resources from service provision in the short term to organisational development for the long term.[Spooner C, Dadich A. Issues for sustainability of non‐government organisations in the alcohol and other drugs sector. Drug Alcohol Rev 2009]     

Predictors and consequences of incarceration among a sample of young Thai methamphetamine users

Introduction and Aims. Our study examined the incidence of arrest and incarceration, investigated predictors of incarceration and explored the persistence of depression, alcohol use and drug use after incarceration among young methamphetamine users from Thailand. Design and Methods. Participants were aged 18–25 years old and were a part of a 12 month randomised social network trial that aimed to reduce sexual risk and methamphetamine use. Estimates of the incidence of arrest and incarceration over 12 months were calculated. A matched case–control study (n = 73 cases; n = 223 controls) was performed to examine incarceration risk factors using conditional logistic regression. Persistence of drug‐risk behaviours were explored after incarceration. Results. Study participants (n = 950) were 72% male, with a median age of 19 years and a median of 9 years of schooling. Frequent drug and alcohol use were reported at baseline. In total, 35% of the sample reported ever having been arrested and 22% reported ever having been incarcerated at baseline. During the 12 month follow up, 16% of the sample was arrested. In univariate analyses, risk factors for incarceration included frequent drug and alcohol use, being less educated, and a history of arrest and incarceration. A high prevalence of drug and alcohol use and involvement in the drug economy persisted after arrest. Discussion and Conclusions. The study indicates a high prevalence of recidivism among this young sample, with continued involvement in drug‐risk behaviours after incarceration. Appropriate interventions are needed to address root causes of arrest, largely related to substance use.[Sherman SG, Sutcliffe CG, Srirojn B, German D, Thomson N, Aramrattana A, Celentano DD. Predictors and consequences of incarceration among a sample of young Thai methamphetamine users. Drug Alcohol Rev 2010]     

Development and evaluation of a survey tool to explore patients' perceptions of their prescribed drugs and their need for drug information

Objective — To explore the effect of providing information about their prescribed drugs on patients' perceptions and use of the drugs. Method — A survey tool was administered to 501 general medical patients in their own homes during a trial to reduce discrepancies between supplies of hospital prescribed drugs and those received in the community following hospital discharge. The patient sample was randomly recruited into two cohorts: 264 in the intervention group (given information regarding drugs prescribed on discharge from hospital to take to their community pharmacy) and 237 in the comparison group. Responses to the survey were explored to assess any effects on patients of providing such information. Setting — Domiciliary visits to general medical patients in East London. Key findings — The survey tool was subjected to factor analysis and reliability testing. Principal components analysis (PCA) was used to extract five factors that described an intrinsic desire for information, perceived impact of the illness, perceived utility of medicines, anxiety about illness and worry about changes to medicines. Internal consistency was good, ranging from 0.8 to 0.91 (Cronbach's coefficient alpha). Interconstruct relationships between the scales, patient demographics and the two cohorts were explored. The findings indicated that the degree of patient empowerment is related to two constructs: “intrinsic desire for information” and “worry about changes to medicines.” Patients who expressed a low degree of worry about changes and a high desire for information about their drugs seemed less worried and more empowered when given additional information. Conversely, those who expressed worries about changes in their medicines and did not want information about their medicines (were happy knowing little) seemed more worried and less empowered when given additional information about those changes. Conclusion — Further exploration of relationships between patient perceptions and information provision is needed to influence appropriately the development of pharmaceutical care between hospital and community.