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Comment in:
 
Postcards from the EDge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning.
Carter GL, Clover K, Whyte IM, Dawson AH, D'Este C.
Suicide Prevention Research Unit, Centre for Mental Health Studies, Faculty of Health, University of Newcastle, Newcastle, Australia. gregory.carter@newcastle.edu.au
OBJECTIVE: To determine whether an intervention using postcards (postcards from the EDge project) reduces repetitions of hospital treated deliberate self poisoning. DESIGN: Randomised controlled trial. SETTING: Regional referral service for general hospital treated deliberate self poisoning in Newcastle, Australia. PARTICIPANTS: 772 patients aged over 16 years with deliberate self poisoning. INTERVENTION: Non-obligatory intervention using eight postcards over 12 months along with standard treatment compared with standard treatment alone. MAIN OUTCOME MEASURES: Proportion of patients with one or more repeat episodes of deliberate self poisoning and the number of repeat episodes for deliberate self poisoning per person in 12 months. RESULTS: The proportion of repeaters with deliberate self poisoning in the intervention group did not differ significantly from that in the control group (57/378, 15.1%, 95% confidence interval 11.5% to 18.7% v 68/394, 17.3%, 13.5% to 21.0%: difference between groups -2%, -7% to 3%). In unadjusted analysis the number of repetitions were significantly reduced (incidence risk ratio 0.55, 0.35 to 0.87). CONCLUSION: A postcard intervention reduced repetitions of deliberate self poisoning, although it did not significantly reduce the proportion of individual repeaters.
Publication Types:
PMID: 16183654 [PubMed - indexed for MEDLINE]
Death during patient-controlled analgesia: piritramide overdose and tissue distribution of the drug.
Musshoff F, Padosch SA, Madea B.
Institute of Legal Medicine, University of Bonn, Germany. f.musshoff@uni-bonn.de
We report about a fatality during patient-controlled analgesia (PCA). Piritramide peripheral blood concentration was measured with 0.1 mg/l and exceeded the normal therapeutic range. Therefore, a fatal overdose was considered as the cause of death with respiratory depression as the underlying pathophysiological mechanism. The tissue distribution was studied; highest concentrations of piritramide were measured in kidney, bile and urine. Due to a large volume of distribution a difference in the drug concentration found in heart and peripheral bloods the phenomenon of drug redistribution was observed. Confronted with toxicological results, investigations revealed, that the PCA pump had been changed during a previous servicing from displaying mg/h to ml/h, therefore, the anesthetist had entered "1.5" assuming mg/h, but actually applying 1.5 ml/h (which was therefore equivalent to 2.25 mg/h, given a concentration in the cartridge of 1.5 mg piritramide/ml). In total, 61.5 ml (instead of 61.5 mg) had been infused, equivalent to 92.25 mg piritramide. This case report is a further example that human errors can play a crucial role in the safety of medical equipment. Experts in anesthesia recommended human factors engineering design principles to improve the safety of medical devices.
PMID: 16182973 [PubMed - in process]
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GSH poisoning.
Matteucci MJ, Clark RF.
Division of Medical Toxicology, University of California San Diego Medical Center, San Diego, California.
Publication Types:
PMID: 16183460 [PubMed - in process]
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Intraventricular conduction delay after bupropion overdose.
Curry SC, Kashani JS, Lovecchio F, Holubek W.
Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, Arizona; Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona; Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona.
Bupropion overdose mainly is characterized by tachycardia, agitation, and seizures. The few reports of QRS complex widening after bupropion overdose that have been published in peer-reviewed literature are notable for failure to have confirmed elevated plasma bupropion concentrations or failure to have excluded other causes of QRS widening. We describe two patients in whom bupropion overdose was confirmed with elevated plasma bupropion concentrations and in whom other cardiotoxic ingestions were excluded with comprehensive analytical toxicology testing. Our findings are in keeping with ex vivo studies in which bupropion antagonizes cardiac voltage-gated sodium channels. Bupropion overdose should be considered in the differential diagnosis of unexpected QRS widening.
PMID: 16183450 [PubMed - in process]
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Efficacy of intranasal naloxone as a needleless alternative for treatment of opioid overdose in the prehospital setting.
Barton ED, Colwell CB, Wolfe T, Fosnocht D, Gravitz C, Bryan T, Dunn W, Benson J, Bailey J.
Division of Emergency Medicine, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah.
Prehospital providers are at increased risk for blood-borne exposure and disease due to the nature of their environment. The use if intranasal (i.n.) medications in high-risk populations may limit this risk of exposure. To determine the efficacy of i.n. naloxone in the treatment of suspected opiate overdose patients in the prehospital setting, a prospective, nonrandomized trial of administering i.n. naloxone by paramedics to patients with suspected opiate overdoses over a 6-month period was performed. All adult patients encountered in the prehospital setting as suspected opiate overdose (OD), found down (FD), or with altered mental status (AMS) who met the criteria for naloxone administration were included in the study. i.n. naloxone (2 mg) was administered immediately upon patient contact and before i.v. insertion and administration of i.v. naloxone (2 mg). Patients were then treated by EMS protocol. The main outcome measures were: time of i.n. naloxone administration, time of i.v. naloxone administration, time of appropriate patient response as reported by paramedics. Ninety-five patients received i.n. naloxone and were included in the study. A total of 52 patients responded to naloxone by either i.n. or i.v., with 43 (83%) responding to i.n. naloxone alone. Seven patients (16%) in this group required further doses of i.v. naloxone. In conclusion, i.n. naloxone is a novel alternative method for drug administration in high-risk patients in the prehospital setting with good overall effectiveness. The use of this route is further discussed in relation to efficacy of treatment and minimizing the risk of blood-borne exposures to EMS personnel.
PMID: 16183444 [PubMed - in process]
Comment on:
The choice of antipsychotic drugs for schizophrenia.
Freedman R.
Publication Types:
PMID: 16172204 [PubMed - indexed for MEDLINE]
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