Introduction
Decisions about using psychotropics during pregnancy are complex as risks of untreated illness are balanced against risks of fetal exposure to medication. The objective was to describe ...perinatal psychotropic dispensing patterns in New Zealand.
Methods
Nationwide data from the New Zealand National Maternity Collection between January 1, 2011 and December 31, 2017 identified 399 715 pregnancies. These were linked with dispensing records to determine the proportion of pregnancies during which at least 1 psychotropic was dispensed. Proportions were calculated separately for each class, year, pregnancy period, and across maternal characteristics. The pattern of dispensing (including discontinuations) was also determined for the 25 841 women who were dispensed at least 1 psychotropic drug prior to pregnancy.
Results
From the 399 715 pregnancies in the study cohort, 6.6% were dispensed at least 1 psychotropic during pregnancy. Antidepressants (5.1%) were the most dispensed, followed by hypnotics (1.2%), anxiolytics (0.7%), and antipsychotics (0.7%). From the 25 841 pregnancies during which a psychotropic was dispensed pre‐pregnancy, 91% and 90% discontinued hypnotics and anxiolytics respectively, prior to or during pregnancy. This was followed by lithium (71%), antipsychotics (66%), and antidepressants (66%).
Discussion
Dispensing of psychotropics during pregnancy occurs in approximately 6.6% of pregnancies in New Zealand. Two‐thirds of women (66%) on antidepressants or antipsychotics discontinue dispensing before or during pregnancy. This may have implications for maternal mental health, suggesting there is a need to investigate how healthcare providers and women are making decisions about psychotropic use during pregnancy.
Full text
Available for:
FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract
Objective
To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) diagnosis and treatment program on non-OSA-program trucker medical insurance claim costs.
Methods
...Retrospective cohort analysis; cohorts constructed by matching (randomly, with replacement) Screen-positive Controls (drivers with insurance screened as likely to have OSA, but not yet diagnosed) with Diagnosed drivers (n = 1,516; cases = 1,224, OSA Negatives = 292), on two factors affecting exposure to medical claims: experience level at hire and weeks of job tenure at the Diagnosed driver’s polysomnogram (PSG) date (the “matching date”). All cases received auto-adjusting positive airway pressure (APAP) treatment and were grouped by objective treatment adherence data: any “Positive Adherence” (n = 932) versus “No Adherence” (n = 292). Bootstrap resampling produced a difference-in-differences estimate of aggregate non-OSA-program medical insurance claim cost savings for 100 Diagnosed drivers as compared to 100 Screen-positive Controls before and after the PSG/matching date, over an 18-month period. A two-part multivariate statistical model was used to set exposures and demographics/anthropometrics equal across sub-groups, and to generate a difference-in-differences comparison across periods that identified the effect of OSA treatment on per-member per-month (PMPM) costs of an individual driver, separately from cost differences associated with adherence choice.
Results
Eighteen-month non-OSA-program medical claim costs savings from diagnosing (and treating as required) 100 Screen-positive Controls: $153,042 (95% CI: −$5,352, $330,525). Model-estimated effect of treatment on those adhering to APAP: −$441 PMPM (95% CI: −$861, −$21).
Conclusions
Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs.
Human rabies is a fatal disease, transmitted by saliva of infected animals, and the diagnosis requires a high index of suspicion. Very few cases are reported annually in the United States. We present ...a case of human rabies without a clear exposure history that masqueraded as serotonin syndrome.
Australasia is home to unique and endangered avian species. Drug administration to this group of animal patients for prophylaxis and treatment is challenging from a number of different perspectives. ...A key limitation for optimal drug dosing in birds is the lack of published pharmacokinetic studies to guide dose requirements. The aim of this review was to systematically investigate published literature on pharmacokinetics in penguin species and compare that with the pharmacokinetics of other avian species with a focus on two drugs: enrofloxacin and voriconazole. The review was conducted following PRISMA guidelines. A systematic literature search was performed in Pubmed, Embase, Scopus, and Web of Science databases. A key finding is that penguin pharmacokinetics differs from other avian species, with weight-adjusted AUC and C max values higher than most other avian species (e.g., for enrofloxacin, the AUC in the African penguin is 85.7 μg h/mL, which is more than double the other bird species). Doses for some avian species may be successfully extrapolated from other avian species; however, it appears important to consider factors other than just body weight (e.g., clearance mechanism and drug physicochemical characteristics). Consequently, there is an important need for robust pharmacokinetic data in wildlife species to ensure optimal therapy for this special group of patients. As part of this review, we identify key aspects that should be considered when estimating dose in species for which there is limited pharmacokinetic information available.
Full text
Available for:
IJS, KILJ, NUK, PNG, UL, UM
•Moral disengagement explains how ostensibly good people can do very bad things.•Agreeableness’s influence on moral disengagement is reduced by the introduction of DT traits.•Moral disengagement is ...predicted by younger age, lower Intellect, psychopathy and Machiavellianism.•Unethical consumer attitudes are specifically predicted by younger age, lower Intellect, and greater moral disengagement.•Moral disengagement provides incremental validity to a model using trait measures alone.
Bandura’s theory of moral disengagement explains how otherwise ethical persons can behave immorally. We examined whether a trait model of general personality and the “dark triad” underlay moral disengagement, the relationship these constructs have to unethical consumer attitudes, and whether moral disengagement provided incremental validity in the prediction of antisocial behaviour.
Self-report data were obtained from a community sample of 380 adults via an online survey that administered all measures.
Correlations between unethical consumer attitudes, lower Agreeableness, lower Conscientiousness, higher moral disengagement, higher psychopathy, and higher Machiavellianism were captured by a single factor. When this broad factor was examined using regression, demographic, personality and the dark triad traits all predicted moral disengagement, specific influences being age, education, Intellect, psychopathy, and Machiavellianism. A similar model examining predictors of unethical consumer attitudes again found all blocks contributed to the outcome, with specific influence provided by age, Intellect, and moral disengagement, the latter showing incremental validity as a predictor of unethical consumer attitudes.
Moral disengagement is based on low Agreeableness, Machiavellianism and psychopathic-type traits, but provides incremental validity in predicting antisocial attitudes to a trait model alone. Narcissism is neither related to moral disengagement, nor unethical consumer attitudes.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The purpose of this study was to quantify three-dimensional (3D) stifle kinematics during walking in dogs with complete cranial cruciate ligament insufficiency (CCL-I) treated with a CORA-based ...leveling osteotomy (CBLO).
Four client-owned dogs with unilateral complete CCL-I were prospectively enrolled. Custom digital 3D models of the femora and tibiae were created from pre-and postoperative computed tomographic scans for each dog. Lateral view fluoroscopic images were collected during treadmill walking preoperatively and 6 months after CBLO. Results were generated using a 3D-to-2D image registration process. Pre-and postoperative stifle kinematics (craniocaudal translation, extension angle) were compared to that of the unaffected contralateral (control) stifle. Force plate gait analysis was performed, and symmetry indices (SI) were calculated for peak vertical force (PVF) and vertical impulse (VI).
After CBLO, craniocaudal femorotibial motion was reduced by a median (range) of 43.0 (17.0-52.6) % over the complete gait cycle. Median (range) PVF SI was 0.49 (0.26-0.56) preoperatively and 0.92 (0.86-1.00) postoperatively, and VI SI was 0.44 (0.20-0.48) preoperatively and 0.92 (0.82-0.99) postoperatively.
CBLO mitigated but did not fully resolve abnormal craniocaudal translation; lameness was substantially improved at 6 months.
Background:
The N-methyl-D-aspartate antagonist ketamine has rapid onset antidepressant activity in treatment-resistant depression (TRD).
Aims:
To evaluate mood rating, safety and tolerability data ...from patients with TRD treated with ketamine and the psychoactive control fentanyl, as part of a larger study to explore EEG biomarkers associated with mood response.
Methods:
We evaluated the efficacy and safety of intramuscular racemic ketamine in 25 patients with TRD, using a double-blind active-controlled randomized crossover design. Ketamine doses were 0.5 and 1 mg/kg, and the psychoactive control was fentanyl 50 mcg, given at weekly intervals.
Results/outcomes:
Within 1 h of ketamine dosing, patients reported reduced depression and anxiety ratings, which persisted for up to 7 days. A dose–response profile for ketamine was noted for dissociative side effects, adverse events and changes in blood pressure; however, changes in mood ratings were broadly similar for both ketamine doses. Overall, 14/25 patients (56%) were responders (⩾50% reduction at 24 h compared with baseline) for either ketamine dose for the Hospital Anxiety and Depression Scale (HADS), and 18/25 (72%) were responders for the HADS-anxiety scale. After fentanyl, only 1/25 (HADS-depression) and 3/25 (HADS-anxiety) were responders. Ketamine was generally safe and well tolerated in this population.
Conclusions:
Our findings add to the literature confirming ketamine’s activity against depressive and anxiety symptoms in patients with TRD.
Full text
Available for:
NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
The importance of wildlife health has been critically emphasized by the current global pandemic. Pharmacists play a valuable role in the health care of companion animals and livestock; however, their ...involvement in exotic animal health is largely unexplored.
This project consulted with zoo vets in New Zealand and investigated their practices around prescribing and dispensing of medicines to explore the opportunities for the involvement of pharmacists.
A mixed methods approach was used where data were initially collected through an online survey distributed to 26 veterinarians and animal keepers working in zoos, wildlife parks, and sanctuaries. An optional semistructured interview followed the survey.
The facilities surveyed housed New Zealand native animal species and 85% also housed exotic animals. Veterinarians dispensed 75% of medicines at their animal facility, whereas the remaining 25% were dispensed by veterinary nurses. On average, 5-10 medications were dispensed at each animal facility per day. Common medicines dispensed were antibiotics, pain relievers, and antifungals. Most respondents felt that they could benefit from working alongside pharmacists in veterinary care. Compounding, access to medicines and identification of tailored formulations were identified as areas where collaboration would be valued. Limitations in the knowledge of pharmacists in animal medicine were distinguished as an area enhancement to assist in collaborative relationships.
There are opportunities for the skills of pharmacists to be incorporated into the care of animals in zoos and wildlife parks in New Zealand. Strengthening the pharmacist-veterinarian relationship can enhance the health outcomes of animals in animal facilities through this interprofessional interaction.
Docetaxel, a taxane used in the treatment of solid tumours, exerts pharmacological activity when in its unbound form. We report a sensitive assay to quantify unbound docetaxel after oral ...administration of docetaxel plus encequidar (oDox+E). Unbound drug quantification is important due to its direct correlation with drug-related toxicity and therapeutic efficacy. We improve on the sensitivity of current assay methods and demonstrate the utility of the assay on a novel formulation of oral docetaxel.
Ultrafiltration followed by high-performance liquid chromatography and tandem mass spectrometry (HPLC-MS/MS) was utilized. Long-term stability, precision, accuracy, and recovery experiments were conducted to validate the assay. Additionally, patient samples from a Phase I dose-escalation pharmacokinetic study were analyzed using the developed assay.
The assay method exhibited long-term stability with an observed change between 0.8 and 6.9% after 131 days of storage at -60 °C. Precision and accuracy quality controls met the FDA acceptance criteria. An average recovery of 88% was obtained. Patient sample analysis demonstrated successful implementation of the assay.
A validated sensitive assay was developed with an LLOQ of 0.084 ng/mL using 485 µL of human plasma. The sensitivity of the assay allowed quantification of unbound docetaxel concentrations in an early-phase oDox+E clinical study to compare it against IV docetaxel using pharmacokinetic modelling. Successful development of oDox+E represents an opportunity to replace the current IV docetaxel regimen with an oral regimen with lower cost, decreased side effects, and improve patient quality of life and experience.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background Antiplatelet therapy is a complicating factor in patients with traumatic brain injuries (TBI), as well as those with hemorrhagic cerebrovascular accidents (CVAs). Platelet Function Assay ...(PFA)-100 is a coagulation device that can detect platelet dysfunction caused by aspirin and adenosine diphosphate inhibition. Our retrospective study reviewed the effectiveness of PFA-100 in detecting platelet dysfunction caused by aspirin and clopidogrel and determined its clinical importance. Methods All patients with PFA-100 tests from January 2013 to February 2014 were collected. Diagnoses indicative of a TBI or CVA were chosen for analysis. Patients with a normal PFA-100 indicating no platelet dysfunction but with documented aspirin and/or clopidogrel use were selected. An extensive chart review was performed to determine the relevance to their clinical care. Results A total of 475 patients were evaluated with a PFA-100 from January 2013 to February 2014. PFA-100 detected platelet dysfunction as the result of pre-injury use of antiplatelet agents in TBI and CVA patients with a sensitivity of only 48.6% and a specificity of 74.8%. Had these antiplatelet medications been known during initial workup, these patients would have had a change in management that may have impacted their outcomes. Conclusion Despite its common usage, the PFA-100 is an unreliable tool to assist in the management of TBI and CVA patients. Additional investigation into alternative methods for detecting platelet dysfunction is warranted.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
PDF
