Background
Practices related to the handling of controlled substances (CS) in Ontario hospices have not been previously published and therefore, are unknown.
Objective
The objective of this study was ...to determine current practices, and policies, standard operating procedures (SOPs) and guidelines related to handling and disposal of CS at hospices across Ontario.
Setting
This study was a cross-sectional survey of hospices in Ontario.
Method
A list of all hospices in Ontario, 39 in total, was obtained from Hospice and Palliative Care Ontario. The Director at each hospice was contacted to request contact information on the person most likely to be knowledgeable about handling procedures related to CS. All participants who provided consent were asked to complete a telephone survey composed of 32 questions: 20 multiple-choice and 12 open-ended. Of the 20 multiple-choice, eight requested demographics of the hospice, nine were related to disposal and documentation practices.
Main outcome measure
Demographic information, disposal practices and patterns of care were summarized and presented as frequencies or means. Responses to open-ended questions were analyzed qualitatively to identify themes related to the handling and disposal of controlled substances in hospices.
Results
Twelve hospices (12/39; 31%) participated in the survey, 25 did not, and two were ineligible. Two (2/12, 17%) hospices served both pediatric and adult patients while 10 (83%) served adults only; 100% indicated that 76–100% of their patients were on CS at time of death. Eight (67%) had a policy for controlled substances handling, two had policy and SOPs and two had no policies, guidelines or SOPs. Qualitative analysis indicated variability in procedures for obtaining CS (patient’s own supply, other patient’s supply, hospice associated pharmacy), storage and dispensation of CS (location, secure lock, dispensing by staff or family), documentation (dispensing records, double signature, tracking returns and disposal), and disposal of CS (return to pharmacy, disposal at hospice, return to families).
Conclusion
Although most of the hospices have a policy, guideline or SOP on the handling of CS, there is considerable variation in practice of dispensing CS to patients, documentation and disposal of CS, which may provide an avenue for inappropriate use, abuse or diversion of CS.
•Direct dual Z-scheme TiO-WO3-CeO2 heterostructured nanocomposite successfully synthesized by co-precipitation route.•The nanocomposite TiO-WO3-CeO2 showed boosted photocatalytic activity towards ...different pollutants.•Systematic investigations confirmed the superior charge separation by direct dual Z-scheme.•Enhanced antibacterial activity of nanocomposite against various pathogenic bacterial strain.•The higher super-capacitive behaviour of nanocomposite.
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Direct dual Z-scheme heterostructured nanocomposite TiO2-WO3-CeO2 (NC) and pristine metal oxides nanostructures (NSs) were fabricated using a facile co-precipitation route. XRD, FTIR, and Raman data have confirmed the formation of NSs and NC. FESEM images showed quasi-mesoporous morphology of as-grown nanocomposite. EDX analysis confirmed the existence of titanium (Ti), cerium (Ce), and tungsten (W) in grown NC. The energy bandgap of NC was narrow 2.45 eV as compared to NSs. The higher electrical conductivity and lower recombination rate of NC were observed in IV and PL analysis. The photodegradation efficiency of NC was recorded 99.8% after 60 min under sunlight radiation against methylene blue (MB), which was significantly higher than NSs. NC catalyst has shown excellent photodegradation against other organic pollutants and has superior recyclability up to 7th cycle toward MB dye with a ~ 6% deficit in photodegradation efficiency. The antimicrobial activity results indicated the higher inhibition ability of NC against E. coli, K. pneumoniae, S. aureus, P. Vulgaris, and P. aeruginosa with maximum inhibition zone diameter 25, 29, 26, 28, and 27 mm, respectively. The electrochemical tests including CV, EIS, and GCD exhibited the superior capacitive behaviour of NC. These results demonstrate that grown NC is an efficient material for electrochemical devices, water purification, and biomedical applications.
Dual metal doping is a state-of-the-art technique for improving the electrocatalytic characteristics for oxygen evolution reaction (OER) and enhancement of the antibacterial activity of the material. ...Series of rare earth dual metal-doped Pr2O3 electrocatalysts (Pr2CeMO3, M = Sm, Yb, Er) were successfully fabricated by employing sol-gel treatment. The antimicrobial and electrochemical applications of grown products were studied along with physical properties using advanced techniques such as FESEM, EDX, XRD, FTIR, IV, CV, LSV, EIS, and ECSA. The prepared products retain the monoclinic Pr2O3 structure with the successful doping of rare-earth elements. From the FESEM analysis, grown products have the grainy conglomerate shape, icy monoclinic boxes, irregular lamellar shaped, and well-crystallized grains with the plate-like morphology. EDX has confirmed the presence of metal elements Pr, Ce, Sm, Yb, and Er in grown samples. The electrochemical measurements exhibited the enhancement by dual-doping, and Pr2CeSmO3 has an extraordinarily low overpotential of 189 mV to reach 10 mAcm−2 density and lower Tafel slope (75 mV/dec) for oxygen evolution reaction (OER) in 1.0 M KOH electrolyte. Furthermore, the electrocatalytic efficiency of Pr2CeSmO3 electrocatalyst for OER is extremely long-lasting for (>16 h). The antibacterial test showed that all grown single and dual-doped nanostructures have good antibacterial performance, but Pr2CeSmO3 exhibits strong inhibition activity towards E. coli, K. pneumoniae, S. aureus, and P. vulgaris bacterial strains with maximum inhibition zone diameter 30, 32, 35, and 31 mm, respectively. This low-cost method for the production of rare earth dual metal-doped materials holds a lot of potential for making efficient catalysts, electrochemical energy-conversion devices, and economical antibacterial agents.
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•Ni doped and Co, Cr, Cu co-doped CdO nanobelts synthesized via facile sol-gel approach.•Lower recombination of charge carriers and redshift in energy bandgap of CdO was ...obtained.•Higher sunlight harvesting capability of grown samples for photodegradation of various pollutants.•Enhanced antimicrobial activity against various bacterial strains.•Superior electrochemical capacitive behaviour of grown nanobelts.
In the present work, single Ni-doped and Co, Cr, Cu co-doped CdO nanostructures via sol-gel approach were fabricated. The XRD diffractograms have confirmed the successful doping and co-doping in CdO lattice without any impurity phase generation. FTIR and Raman spectra have further confirmed the metal-oxygen bonding vibration and optical phonon modes related to CdO. FE-SEM images exhibited nanobelt type morphology varied with the type of dopant and EDX evident the presence of dopants along with Cd, and O. PL and IV results exhibited that the charge carrier recombination hinders and electrical conductivity has improved by co-doping. UV–vis absorbance spectra have shown redshift in energy bandgap by co-doping. The CV, EIS, and GCD tests suggested the superior electrochemical capacitive characteristic of co-doped CdO and can serve as efficient electrode materials. The photocatalytic activity results exhibited increased photodegradation performance by co-doping, and the highest was achieved for Ni/Cr co-doped samples. The antimicrobial activity results have shown a higher zone of inhibition against Escherichia coli and Staphylococcus aureus bacterial strains. The narrow energy bandgap, lower recombination, and low charge transfer resistance are responsible for boosting the properties of CdO by co-doping and making it a prospective candidate as effective photocatalysts, antibiotic-resistant agents, and supercapacitor electrode materials.
Objectives
Shame and guilt in polysubstance abusers are still understudied despite their significance in substance use disorders (SUD). The goal of the current study is to develop a better ...understanding of how shame and guilt interact among polysubstance abusers who are receiving residential treatment.
Methods
The sample of two hundred four males with SUD admitted to five rehabilitation centers from two cities in Pakistan participated in this study. For comparison, 215 age-matched healthy individuals were recruited (control). All participants reported their scores on the state shame and guilt scale (SSGS) and demographic form. A cross-sectional study design was adopted.
Results
The group with SUD reported greater activations on SGSS (
r
= 0.79,
p
< 0.001) as compared to healthy (control) individuals (
r
= 0.48,
p
< 0.001). Further, multivariate analysis indicated that people with SUD who were of older age, unemployed, living in a nuclear family system, with a higher level of education, and low income, experienced higher levels of shame and guilt. Multinomial logistic regression analysis revealed that people with SUD in the age group 41–60 years (OR 5.2, 95%CI 2.4–6.8), unemployed (OR 4.4, 95%CI 3.2–4.7), nuclear family system (OR 5.9, 95%CI 4.5–6.4) and low monthly income group (OR 5.4, 95%CI 3.5–5.8) had a significantly high risk of shame and guilt than the control group.
Conclusion
Findings of the current study indicate an association between shame and guilt activation and SUD. These results suggest that polysubstance users may benefit from therapeutic interventions to avoid a generalization of shame and guilt toward their substance use. Reducing shame and guilt should be considered a priority in treating adults with multiple SUD.
The study aimed to determine the efficacy of foot muscle exercises in children with DS having pes planus.OBJECTIVEThe study aimed to determine the efficacy of foot muscle exercises in children with ...DS having pes planus.Forty-seven subjects randomly assigned to foot muscle exercises (study group) or an arch support insole with one-leg balance exercises (control group), thrice weekly intervention for 12-weeks followed by a home program with residual effect assessed after 24-weeks from baseline.METHODSForty-seven subjects randomly assigned to foot muscle exercises (study group) or an arch support insole with one-leg balance exercises (control group), thrice weekly intervention for 12-weeks followed by a home program with residual effect assessed after 24-weeks from baseline.The motor functions were significantly improved in both groups (p = 0.00). A positive residual effect was found in the study group for both parameters. Whilst in the control group it failed to give a positive residual effect for GMFM-88, while PBS yielded positive outcomes. The study group showed significantly better results than the control group in comparison.RESULTSThe motor functions were significantly improved in both groups (p = 0.00). A positive residual effect was found in the study group for both parameters. Whilst in the control group it failed to give a positive residual effect for GMFM-88, while PBS yielded positive outcomes. The study group showed significantly better results than the control group in comparison.The novel finding suggests that the foot muscle exercise has the potential to improve motor functions in children with Down syndrome and it can be used as an alternative therapeutic approach to the conventional method.CONCLUSIONThe novel finding suggests that the foot muscle exercise has the potential to improve motor functions in children with Down syndrome and it can be used as an alternative therapeutic approach to the conventional method.
Introduction Seroma formation is the most common complication after modified radical mastectomy (MRM). It leads to increased pain and discomfort, potentially prolonging morbidity and treatment. ...Various treatment modalities are being used to decrease the incidence of seroma formation. The objective of this study was to compare intravenous hydrocortisone injection versus placebo in patients undergoing MRM in terms of frequency of post-operative seroma formation. Methods This randomized, double-blinded, placebo-controlled study was conducted at Surgical Unit-I, Holy Family Hospital, Rawalpindi, Pakistan from January 2021 to December 2021. A total of 152 female patients were randomly assigned to each of the study and placebo groups. Group I patients received 100 mg of hydrocortisone intravenously while group II patients received one ml of 0.9% normal saline intravenously prior to induction of general anesthesia for MRM. The incidence of seroma formation after 10 days of MRM and total drain volume till their removal was measured in all patients. Results The mean age was 48.42±10.15 in Group I, while it was 47.67±10.75 in Group II. Mean drain output till removal was 99.14±31.01 ml in the hydrocortisone group and 177.57±63.37 ml in the placebo group. Forty-eight patients developed seroma (31.58%), of whom nine received intravenous hydrocortisone and 39 received normal saline (P=0.000). Conclusion Intravenous hydrocortisone is effective in terms of frequency of post-operative seroma formation as compared to placebo in patients undergoing MRM.
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•Direct dual Z-scheme Sm2O3-WO3-La2O3 heterostructured nanocomposite successfully prepared via co-precipitation approach.•Boosted photocatalytic activity of Sm2O3-WO3-La2O3 towards ...different dyes pollutant.•Mechanistic insight confirmed the better electron-transfer/separation by direct dual Z-scheme.•Superior super-capacitive and antibacterial behaviour of nanocomposite.•Efficient material for energy storage, water purification, and biomedical applications.
In this study, heterostructured dual Z-scheme Sm2O3-WO3-La2O3 nanocomposite (NC) and bare Sm2O3, WO3, and La2O3 nanostructured (NSs) were prepared using a co-precipitation approach. The comparative electrochemical, photocatalytic, and antimicrobial properties of NC and NSs were studied. The XRD spectrum exhibits the formation of bare NSs and NC having cubic-Sm2O3, monoclinic-WO3, and hexagonal-La2O3 phases. FESEM results showed mesoporous morphology of NC. The higher electrical conductivity 261.33 mho-cm−1 and lower optical energy bandgap 2.55 eV were obtained for NC. The photodegradation tests exhibited that NC photocatalyst has degraded 99% (methylene blue), 96% (Methyl orange), 99% (safranin-O), 48% (p-nitroaniline), and 98% (methyl red) dyes pollutants in 40 min sunlight radiation and showed strong inhibition activity against E. coli, K. pneumoniae, S. aureus, P. Vulgaris, and P. aeruginosa bacterial strains with zones of inhibition (ZOI) 31 mm, 30 mm, 30 mm, 28 mm, and 31 mm, respectively. Electrochemical studies revealed the excellent capacitive characteristics of NC with a specific capacitance 532F/g at a scan rate 5 mV/s, energy density 48.0278 W h Kg−1, and power density 0.3782 KW Kg−1 at 0.006 A/cm2 current density. Furthermore, the present study revealed a novel composition for environmental remediation and energy storage applications.
A substantial portion of drug abuse research has concentrated on people with a single-substance-use disorder (SSUD), but many people abuse more than one drug. Studies have yet to examine how those ...with polysubstance-use disorder (PSUD) differ from those with an SSUD on the risk of relapse, self-evaluative emotions (e.g., shame and guilt), and personality factors (e.g., self-efficacy). Eleven rehab facilities in Lahore city, Pakistan were randomly chosen to provide a sample of 402 males with PSUD. For comparison, 410 age-matched males with SSUD were enlisted using a demographic form with eight questions, the State Shame and Guilt Scale, and the General Self-Efficacy Scale. Mediated moderation analysis was performed using Hayes' process macro. The results demonstrate that shame-proneness is positively associated with relapse rate. Guilt-proneness mediates the relationship between shame-proneness and relapse rate. Self-efficacy buffers the influence of shame-proneness on relapse rate. Although the mediation and moderation effects were found in both study groups, these effects were significantly stronger among people with PSUD than those with SSUD. To be more specific, people with PSUD reported a higher overall score on shame, guilt, and relapse rate. Additionally, people with SSUD indicated a higher score on self-efficacy than those with PSUD. The findings of this study suggest that drug rehab facilities should implement a variety of strategies to raise drug users' levels of self-efficacy, which will help to reduce their risk of relapse.
