Cocaine dependence is a major public health problem that is characterized by recidivism and a host of medical and psychosocial complications. Although effective pharmacotherapy is available for ...alcohol and heroin dependence none exists currently for cocaine dependence despite two decades of clinical trials primarily involving antidepressant, anti convulsivant and dopaminergic medications. There has been extensive consideration of optimal pharmacological approaches to the treatment of cocaine dependence with consideration of both dopamine antagonists and agonists. Anticonvulsants have been candidates for the treatment of addiction based on the hypothesis that seizure kindling-like mechanisms contribute to addiction.
To evaluate the efficacy and the acceptability of anticonvulsants for cocaine dependence
We searched the Cochrane Drugs and Alcohol Groups specialised register (issue 4, 2007), MEDLINE (1966 - march 2007), EMBASE (1988 - march 2007), CINAHL (1982- to march 2007)
All randomised controlled trials and controlled clinical trials which focus on the use of anticonvulsants medication for cocaine dependence
Two authors independently evaluated the papers, extracted data, rated methodological quality
Fifteen studies (1066 participants) met the inclusion criteria for this review: the anticonvulsants drugs studied were carbamazepine, gabapentin, lamotrigine, phenytoin, tiagabine, topiramate, valproate. No significant differences were found for any of the efficacy measures comparing any anticonvulsants with placebo. Placebo was found to be superior to gabapentin in diminishing the number of dropouts, two studies, 81 participants, Relative Risk (RR) 3.56 (95% CI 1.07 to 11.82) and superior to phenythoin for side effects, two studies, 56 participants RR 2.12 (95% CI 1.08 to 4.17). All the other single comparisons are not statistically significant.
Although caution is needed when assessing results from a limited number of small clinical trials at present there is no current evidence supporting the clinical use of anticonvulsants medications in the treatment of cocaine dependence. Aiming to answer the urgent demand of clinicians, patients, families, and the community as a whole for an adequate treatment for cocaine dependence, we need to improve the primary research in the field of addictions in order to make the best possible use out of a single study and to investigate the efficacy of other pharmacological agent.
Application of vertex and mass constraints in track-based alignment Amoraal, J.; Blouw, J.; Blusk, S. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
06/2013, Letnik:
712
Journal Article
Recenzirano
Odprti dostop
The software alignment of planar tracking detectors using samples of charged particle trajectories may lead to global detector distortions that affect vertex and momentum resolution. We present an ...alignment procedure that constrains such distortions by making use of samples of decay vertices reconstructed from two or more trajectories and putting constraints on their invariant mass. We illustrate the method by using a sample of invariant-mass constrained vertices from D0→K−π+ decays to remove a curvature bias in the LHCb spectrometer.
Catalytic combustion in a structured catalyst was used to test advantages of computational fluid dynamics (CFD) codes with respect to simpler approaches to simulation of actual data and kinetic ...studies. Published experimental data on square channels and segmented monoliths were compared and used as a basis for parametric studies. The relevance of temperature‐dependent transport properties was quantified. A comparison of 2‐D approximations with a full 3‐D model, which predicts a different ignition behavior, shows that the latter is needed to properly describe actual data. The segmentation of the monolith shows some influence on the overall combustion rate. The sensitivity analysis of the importance of chemical kinetics relative to mass transport suggests a need for a better description of surface mechanism, even if the simulated data are not uniquely under chemical control. A parameter‐fitting procedure for kinetic studies based on the detailed 3‐D, segmented CFD model was developed and successfully tested for modeling inhibition by water. Results show that more detailed surface and gas‐phase reactions mechanisms must be included, but only after developing and validating a comparably detailed model of the momentum and heat transport in the actual geometry of the real process.
Methadone maintenance at proper doses is effective in retaining patients in treatment and suppressing heroin use. Questions remain regarding the efficacy of the psychosocial services that are offered ...by most maintenance programs.
To evaluate the effectiveness of any psychosocial plus any agonist maintenance treatment versus any agonist treatment alone in retaining patients in treatment, reducing the use of substances and improving health and social status.
We searched the Cochrane Central Register of Trials (CENTRAL) issue 3, 2003; MEDLINE 1966-2003; EMBASE 1980-2003; PsycINFO 1985-2003; relevant web sites; scan of reference list of relevant articles. There were no language or publication restrictions.
RCTs which focus on any psychosocial plus any agonist compared to any agonist maintenance intervention for opiate dependence. People aged less than 18 and pregnant women were excluded. Psychosocial in combination with antagonist maintenance treatment are excluded too.
The trials were independently assessed for inclusion and methodological quality by the reviewers. Data were extracted independently and double checked.
The searching process resulted in the identification of 77 different studies: 12 studies met the inclusion criteria. These studies considered 8 different psychosocial interventions and 1 pharmacological treatment: Methadone Maintenance (MMT). The results show additional benefit in adding any psychosocial treatment to standard methadone maintenance treatment in relation to the use of heroin during the treatment RR 0.69 (95% CI 0.53-0.91); no statistically significant additional benefit was shown in terms of retention in treatment RR 0.94 (95% CI 0.85-1.02); and results at follow-up RR 0.90 (95% CI 0.76-1.07).
The present evidence suggests that adding any psychosocial support to Standard MMT significantly improves the non-use of heroin during treatment. Retention in treatment and results at follow-up are also improved, although this findings did not achieve statistical significance. Insufficient evidence is available on other possible relevant outcomes such as Psychiatric symptoms/psychological distress, Quality of life. Limitations to this review are imposed by the heterogeneity of the trials both in the interventions and the assessment of outcomes. Results of studies were sometimes in disagreement and because of lack of detailed information no meta analysis could be performed to analyse the results related to the outcomes more often reported as positive results in the single studies. Duration of the studies was also too short to analyse other relevant outcomes such as mortality. In order to study the possible added value of any psychosocial treatment over an already effective treatment such as standard MMT, only big multi-site studies could be considered which define experimental interventions and outcomes in the most standardized way as possible.
Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a majority of patients relapse to heroin use, and relapses are a substantial problem in the ...rehabilitation of dependent heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychological symptoms rather than physiological symptoms associated with the withdrawal syndrome.
To evaluate the effectiveness of any psychosocial plus any pharmacological interventions versus any pharmacological alone for opioid detoxification, in helping patients to complete the treatment, reduce the use of substances and improve health and social status.
We searched the Cochrane Central Register of Trials (CENTRAL) issue 3, 2003; MEDLINE 1966-2003; EMBASE 1980-2003; PsycINFO 1985-2003; relevant web sites; scan of reference list of relevant articles. There were no language or publication restrictions.
Randomised controlled trials which focus on any psychosocial associated with any pharmacological intervention aimed at opioid detoxification. People less than 18 years of age and pregnant women were excluded.
The trials were independently assessed for inclusion and methodological quality by three reviewers. Data were extracted independently and double checked.
The searching process resulted in the identification of 77 different studies: 8 studies met inclusion criteria. These studies considered 5 different psychosocial interventions and 2 substitution detoxification treatments: Methadone and Buprenorphine. The results show promising benefit from adding any psychosocial treatment to any substitution detoxification treatment in terms of completion of treatment RR 1.68 (95% CI 1.11-2.55), results at follow-up RR 2.43 (95% CI 1.61-3.66), and compliance RR 0.48 (95% CI 0.38-0.59). In respect of the use of heroin during the treatment, the differences were not statistically significant but favoured the combined treatments.
Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment, results at follow-up and compliance. Although a treatment, like detoxification, that exclusively attenuates the severity of opiate withdrawal symptoms can be at best partially effective for a chronic relapsing disorder like opiate dependence, this type of treatment is an essential step prior to longer-term drug-free treatment and it is desirable to develop adjunct psychosocial approaches that might make detoxification more effective. Limitations to this review are imposed by the heterogeneity of the assessment of outcomes. Because of lack of detailed information no meta analysis could be performed to analyse the results related to several outcomes.
Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a majority of patients relapse to heroin use, and relapses are a substantial problem in the ...rehabilitation of heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychological rather than physiological symptoms associated with the withdrawal syndrome.
To evaluate the effectiveness of any psychosocial plus any pharmacological interventions versus any pharmacological alone for opioid detoxification, in helping patients to complete the treatment, reduce the use of substances and improve health and social status.
We searched the Cochrane Drugs and Alcohol Group trials register (June 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 6, 2011), PUBMED (1996 to June 2011); EMBASE (January 1980 to June 2011); CINAHL (January 2003 to June 2008); PsycINFO (1985 to April 2003) and reference list of articles.
Randomised controlled trials and controlled clinical trial which focus on any psychosocial associated with any pharmacological intervention aimed at opioid detoxification. People less than 18 years of age and pregnant women were excluded.
Two authors independently assessed trials quality and extracted data.
Eleven studies, 1592 participants, fulfilled the criteria of inclusion and were included in the review. The studies considered five different psychosocial interventions and two pharmacological treatments (methadone and buprenorphine). Compared to any pharmacological treatment alone, the association of any psychosocial with any pharmacological was shown to significantly reduce dropouts RR 0.71 (95% CI 0.59 to 0.85), use of opiate during the treatment, RR 0.82 (95% CI 0.71 to 0.93), at follow up RR 0.66 (95% IC 0.53 to 0.82) and clinical absences during the treatment RR 0.48 (95%CI 0.38 to 0.59). Moreover, with the evidence currently available, there are no data supporting a single psychosocial approach.
Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment, use of opiate, participants abstinent at follow-up and clinical attendance. The evidence produced by this review is limited due to the small number of participants included in the studies, the heterogeneity of the assessment or the lack of detailed outcome information that prevented the possibility of cumulative analysis for several outcomes. Nevertheless it seems desirable to develop adjunct psychosocial approaches that might make detoxification more effective.
Opioid antagonists for alcohol dependence Rösner, Susanne; Hackl-Herrwerth, Andrea; Leucht, Stefan ...
Cochrane database of systematic reviews,
12/2010
12
Journal Article
Recenzirano
Odprti dostop
Alcohol dependence belongs to the globally leading health risk factors. Therapeutic success of psychosocial programs for relapse prevention is moderate and could be increased by an adjuvant treatment ...with the opioid antagonists naltrexone and nalmefene.
To determine the effectiveness and tolerability of opioid antagonists in the treatment of alcohol dependence.
We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL in January 2010 and inquired manufacturers and researchers for unpublished trials.
All double-blind randomised controlled trials (RCTs) which compare the effects of naltrexone or nalmefene with placebo or active control on drinking-related outcomes.
Two authors independently extracted outcome data. Trial quality was assessed by one author and cross-checked by a second author.
Based on a total of 50 RCTs with 7793 patients, naltrexone reduced the risk of heavy drinking to 83% of the risk in the placebo group RR 0.83 (95% CI 0.76 to 0.90) and decreased drinking days by about 4%, MD -3.89 (95% CI -5.75 to -2.04). Significant effects were also demonstrated for the secondary outcomes of the review including heavy drinking days, MD - 3.25 (95% CI -5.51 to -0.99), consumed amount of alcohol, MD - 10.83 (95% CI -19.69 to -1.97) and gamma-glutamyltransferase, MD - 10.37 (95% CI -18.99 to -1.75), while effects on return to any drinking, RR 0.96 (95 CI 0.92 to 1.00) missed statistical significance. Side effects of naltrexone were mainly gastrointestinal problems (e.g. nausea: RD 0.10; 95% CI 0.07 to 0.13) and sedative effects (e.g. daytime sleepiness: RD 0.09; 95% CI 0.05 to 0.14). Based on a limited study sample, effects of injectable naltrexone and nalmefene missed statistical significance. Effects of industry-sponsored studies, RR 0.90 (95% CI 0.78 to 1.05) did not significantly differ from those of non-profit funded trials, RR 0.84 (95% CI 0.77 to 0.91) and the linear regression test did not indicate publication bias (P = 0.765).
Naltrexone appears to be an effective and safe strategy in alcoholism treatment. Even though the sizes of treatment effects might appear moderate in their magnitudes, these should be valued against the background of the relapsing nature of alcoholism and the limited therapeutic options currently available for its treatment.
Abstract The issue of chronicity and frailty is shaped in the current health care environment as an increase in the complexity of pz–users referred to Rehabilitation Cardiology. Advances in medical ...care and improvements in general living conditions have led to an explosion of chronic diseases and the spread of a new figure of the caregiver, in which several diseases coexist. For this reason, over the past 20 years, the need for care, in the R.C. has increased significantly precisely bc of the increase in multiple comorbidities of pz hospitalized for cardiologic events. This need translates into increased care complexity, which therefore requires the need to experiment with new organizational models capable of ensuring a systemic approach to taking care of the person. In this scenario, the PN of care is developed, an innovative method capable of going beyond the therapeutic project, centering the process from operator–centered to pz–centered. The essential aspect of this organizational model is the practitioner‘s full acceptance of his or her responsibilities from admission to discharge of the pz. From August 2023 to November 2023, 228 consecutive pz were admitted to the RC. The PN organizational model was applied to all in pz admitted during the period under observation. During admission to the ward, the charge nurse, in full sharing with the pz, carried out data collection and planned care activities; in order to create guidance for colleagues who collaborated with the charge nurse in the care plan, the nurse implemented the drafting of the care process. Finally, in order to provide assurance of continuity of care and to ensure a safer and smoother return home or transfer to another facility for the pz and family members, the nurse, thanks to the PN, also planned the discharge, having personally followed the patient throughout the entire hospitalization. In order to assess the quality of care provided, a satisfaction questionnaire was administered to all in pz admitted during the period under observation. The mean age of the observed pz is 68.7 aa, 79% of pz observed had previous hospitalizations in other hospitals,no pz had any experience with PN, 98% of observed pz noted improved care with referral nurse intake,2% of pz did not complete the questionnaire.In our brief experience, the PN organizational proved to be an effective and comprehensive method, contributed to improving the quality of care provided in our OU and improved the satisfaction of staff.
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