scholarly journals Overview of Tertiary Addictions Services response to Opioid dependence during the COVID-19 Pandemic

2021 ◽  
pp. 1-14
Author(s):  
K Hennigan ◽  
E Corrigan ◽  
N Killeen ◽  
E Keenan ◽  
M Scully
Keyword(s):  
At Risk ◽  
Opioid Dependence ◽  
Medication Management ◽  
Health Problems ◽  
Healthcare Staff ◽  
Addiction Services ◽  
Patients At Risk ◽  
Guidance Documents ◽  
High Level ◽  
Opioid Users

Abstract The emergence of the COVID-19 pandemic has presented the addiction services with an unprecedented set of challenges. Opioid users are particularly vulnerable because of their high level of pre-existing health problems and lifestyle factors. In order to minimise their risks to self and to others in the current Covid-19 crisis, the service has sought to urgently identify vulnerable individuals, and induct them into OST treatment promptly. Additionally, several guidelines have been created and regularly updated by the HSE for any healthcare staff working with opioid users. These include guidance documents, to facilitate prompt induction of patients onto the OST programme, the prescribing of naloxone to all patients at risk of overdose, eConsultation, medication management for those in self-isolation, and the delivery of injecting equipment. The guidance documents and resources will provide a template for a new way of working for the sector during these challenging times and into the future.

scholarly journals RESISTANCE CONFERRING MUTATIONS IN SARS-CoV-2 DELTA FOLLOWING SOTROVIMAB INFUSION

2021 ◽  
Author(s):  
Rebecca J Rockett ◽  
Kerri Basile ◽  
Susan Maddocks ◽  
Winkie Fong ◽  
Jessica E Agius ◽  
...  
Keyword(s):  
At Risk ◽  
Rapid Development ◽  
Severe Disease ◽  
Gene Mutations ◽  
Regulatory Agencies ◽  
Spike Gene ◽  
Treatment And Prevention ◽  
Patients At Risk ◽  
High Level

Several Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) neutralising monoclonal antibodies (mAbs) have received emergency use authorisation by regulatory agencies for treatment and prevention of Coronavirus Disease 2019 (COVID-19), including in patients at risk for progression to severe disease. Here we report the persistence of viable SARS-CoV-2 in patients treated with sotrovimab and the rapid development of spike gene mutations that have been shown to confer high level resistance to sotrovimab in vitro. We highlight the need for SARS-CoV-2 genomic surveillance in at risk individuals to inform stewardship of mAbs use and prevent potential treatment failures.

Changes in Mental Status

2004 ◽  
Vol 94 (2) ◽  
pp. 118-125
Author(s):  
Alicia J. Curtin
Keyword(s):  
At Risk ◽  
Mental Status ◽  
Clinical Assessment ◽  
Older Patients ◽  
Medical Condition ◽  
Hospital Setting ◽  
Common Symptom ◽  
Patients At Risk ◽  
Hospitalized Patient ◽  
High Level

Change in mental status is a common symptom in the older, hospitalized patient. Often referred to as delirium, it may be the first indication of a serious medical condition. If delirium is not identified and treated promptly, it may lead to severe complications. The podiatric physician can prevent many cases of delirium by maintaining a high level of suspicion, performing a thorough clinical assessment, and identifying older patients at risk in the hospital setting. (J Am Podiatr Med Assoc 94(2): 118-125, 2004)

scholarly journals Preventing Medication Errors in Ambulatory Care: The Importance of Establishing Regimen Concordance

2007 ◽  
Vol 93 (3) ◽  
pp. 20-28
Author(s):  
Dean Schillinger ◽  
Eddie Machtinger ◽  
Frances Wang ◽  
Maytrella Rodriguez ◽  
Andrew Bindman
Keyword(s):  
At Risk ◽  
Repeated Measures ◽  
Odds Ratio ◽  
Oral Anticoagulants ◽  
Medication Management ◽  
International Normalized Ratio ◽  
Effective Care ◽  
Hemorrhagic Events ◽  
Patients At Risk ◽  
Risk For Thrombosis

ABSTRACT Objective: Miscommunication between patients and providers can have serious consequences—especially where medications are concerned. Because oral anticoagulants are associated with preventable adverse events at disproportionately high rates, we used the model of anticoagulant care to examine the extent to which regimen discordance between patient and provider contributes to unsafe medication management. Methods: We performed a study among 220 long-term users of warfarin in an anticoagulation clinic to characterize the importance of two medication assessment components. We measured (1) adherence to warfarin by asking patients to report any missed doses during the prior 30 days, and (2) concordance between patients’ and providers’ reports of prescribed warfarin regimens. We categorized patients as having complete adherence if they missed no doses and regimen concordance if there was patient-provider agreement in the total weekly dosage. We examined the independent relationships between (a) adherence and anticoagulant outcomes, and (b) concordance and anticoagulant outcomes. We characterized anticoagulant outcomes as unsafe if international normalized ratio (INR) values either were < 2.0 (at risk for thrombosis) or > 4.0 (at risk for hemorrhage) over 90 days, using repeated measures analysis. Results: One hundred fifty-five patients (70.5 percent) reported no missed warfarin doses during the prior 30 days. In multivariate models, poor adherence was associated with under-anticoagulation (adjusted odds ratio [AOR] = 2.33; 95% confidence interval [CI] = 1.56–3.45; P < 0.001), but not with over-anticoagulation (AOR = 1.36; 95% CI = 0.69–2.66; P = 0.38). One hundred ten patients (50 percent) reported warfarin regimens that were discordant with respect to the clinicians’ report. Among adherent patients, discordance was associated with both under-anticoagulation (AOR = 1.67; 95% CI = 1.00–2.78; P = 0.05) and over-anticoagulation (AOR = 3.44; 95% CI = 1.32–9.09; P = 0.01). There was no relationship between patients’ reports of adherence and concordance (odds ratio [OR] = 1.14 95% CI = 0.64–2.04; P = 0.66). Conclusion: Discordance between clinicians and patients regarding warfarin regimens is unsettlingly common and places patients at risk for thromboembolic and hemorrhagic events. To promote safe and effective care, clinicians should sequentially determine adherence (missed doses) and regimen concordance during routine medication assessments. Systems need to be developed to ensure patient-provider concordance in medication regimens.

1678: Identifying Patients at Risk for Benign Versus Life Shortening Postoperative Prostate-Specific Antigen Failure

2005 ◽  
Vol 173 (4S) ◽  
pp. 455-455
Author(s):  
Anthony V. D’Amico ◽  
Ming-Hui Chen ◽  
Kimberly A. Roehl ◽  
William J. Catalona
Keyword(s):  
At Risk ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Patients At Risk
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