scholarly journals Risks and uncertainties about gabapentinoids

2021 ◽  
pp. 1-14
Author(s):  
Natalia Alzueta ◽  
◽  
Patricia García-González ◽  
Irati Irigoyen ◽  
Keyword(s):  
Respiratory Depression ◽  
Prescription Database ◽  
Low Back ◽  
Electronic Prescription ◽  
Peripheral Neuropathic Pain ◽  
The Public ◽  
Off Label ◽  
Pubmed Search ◽  
The Central Nervous System ◽  
Potential Risks

INTRODUCTION The use of gabapentinoids has increased in the recent years. Approved indications include epilepsy, peripheral neuropathic pain, diabetic neuropathy, postherpetic neuralgia and anxiety disorder. However, these drugs are widely prescribed off-label for indications such as low back pain, fibromyalgia, migraine or restless legs syndrome. Side effects associated with these drugs are common, highlighting the risk of respiratory depression when combined with other drugs that depress the central nervous system, suicidal ideation, abuse and addiction. OBJETIVE To review the evidence available on the uses of gabapentinoids (epilepsy excluded) and its associated risks. METHODS A search in Tripdatabase and Dynamed was conducted for clinical practice guidelines. In addition, a PubMed search was performed including systematic reviews, clinical trials and observational studies in order to analyze the evidence available on these drugs for their different indications. Data about the use of gabapentinoids in Navarre were obtained from the electronic prescription database of the public health system of Navarre -Osasunbidea (SNS-O). CONCLUSIONS Off-label use of gabapentinoids is not recommended due to the lack of consistent evidence available and its potential risks (sedation, dizziness or respiratory depression). Some recommendations are provided for a safe prescription of gabapentinoids.

scholarly journals Adapting harm reduction services during COVID-19: lessons from the supervised injecting facilities in Australia

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Amanda Roxburgh ◽  
Marianne Jauncey ◽  
Carolyn Day ◽  
Mark Bartlett ◽  
Shelley Cogger ◽  
...  
Keyword(s):  
Service Provision ◽  
People Who Inject Drugs ◽  
Health Service Provision ◽  
Loss Of Life ◽  
The Public ◽  
Individual Health ◽  
The North ◽  
Client Group ◽  
Supervised Injecting Facilities ◽  
Potential Risks

AbstractThe COVID-19 crisis has had profound impacts on health service provision, particularly those providing client facing services. Supervised injecting facilities and drug consumption rooms across the world have been particularly challenged during the pandemic, as have their client group—people who consume drugs. Several services across Europe and North America closed due to difficulties complying with physical distancing requirements. In contrast, the two supervised injecting facilities in Australia (the Uniting Medically Supervised Injecting Centre—MSIC—in Sydney and the North Richmond Community Health Medically Supervised Injecting Room—MSIR—in Melbourne) remained open (as at the time of writing—December 2020). Both services have implemented a comprehensive range of strategies to continue providing safer injecting spaces as well as communicating crucial health information and facilitating access to ancillary services (such as accommodation) and drug treatment for their clients. This paper documents these strategies and the challenges both services are facing during the pandemic. Remaining open poses potential risks relating to COVID-19 transmission for both staff and clients. However, given the harms associated with closing these services, which include the potential loss of life from injecting in unsafe/unsupervised environments, the public and individual health benefits of remaining open are greater. Both services are deemed ‘essential health services’, and their continued operation has important benefits for people who inject drugs in Sydney and Melbourne.

Vitamin and mineral supplement exposures: cases reported to Australia’s largest Poisons Information Centre, 2014-15 to 2018-19

2021 ◽  
pp. 1-15
Author(s):  
Usha Luckock ◽  
Joanna Harnett ◽  
Rose Cairns
Keyword(s):  
New South ◽  
High Strength ◽  
Mineral Supplement ◽  
Information Centre ◽  
The Public ◽  
Mineral Supplements ◽  
South Wales ◽  
Unit Dose ◽  
Potential Risks ◽  
Poisons Information

ABSTRACT Vitamin and mineral supplements (VMS) are widely available and commonly used. Little is known about patterns of poisoning exposures to VMS in the Australian population. We performed a retrospective study of calls to the New South Wales Poisons Information Centre (NSWPIC), July 2014-June 2019. NSWPIC is Australia’s largest PIC, taking approximately 100,000 calls/year (50% of Australian poisoning calls) from healthcare professionals and members of the public. We conducted additional analyses on iron exposures due to their high risk of acute toxicity. There were 10 944 VMS exposures reported to NSWPIC during the study period, increasing 9.6% per annum over a five year period (95%CI, 7.2 – 12.1%). Toddlers (1-4 years) accounted for 41.5% (4546) of cases. Agents most commonly involved were multivitamins (n=3610), Vitamin D (n=2080), iron (n=1533), and magnesium (n=804). In 17.7% (1934) of cases the call originated from hospital or the patient was referred to hospital by NSWPIC. Iron exposures increased by 14.0% per year (95%CI, 9.5 – 18.5%), and most were associated with high strength products (>45 mg elemental iron per unit dose, n=1036). Iron exposures were hospitalised in 38% of cases (n=583). We conclude that vitamin and mineral supplement exposures are increasing in Australia. Although most exposures can be managed at home, many required hospitalisation. Iron exposures are increasing and had higher rates of hospitalisation than other agents. Vitamin and mineral supplements are often considered safe and without the potential for adverse effects, highlighting the importance of public education into the potential risks of misuse of these products.

Risks to the Public

2021 ◽  
Vol 46 (2) ◽  
pp. 11-15
Author(s):  
Peter G. Neumann
Keyword(s):  
Computer Systems ◽  
Strong Sense ◽  
Risk Awareness ◽  
Short Term ◽  
The Public ◽  
The Past ◽  
The Media ◽  
Potential Risks ◽  
Security And Reliability

Mini-editorial (PGN) 2020 was a crazy year, with all kinds of risks on display. As usual, many of the lessons noted in past issues of SEN and RISKS have been largely ignored, and failures continue to mirror events from the past that have long been discussed here. Issues such as safety, security, and reliability always seem to need more foresight than they receive. Y2K con- tinues to hit somewhere each New Year's Day, when short- term remediations that demanded periodic upgrading have been forgotten. (I suppose old COBOL code will still ex- ist in year 2100, when there may be ambiguities relating to dates that could be 21xx or 20xx (although 19xx is unlikely), and the narrow windowing xes will fail even more dramati- cally.) Election integrity continues to be a real concern, where we are caught in the crosshairs between computer systems and networks that are not meaningfully trustworthy or au- ditable, and the nontechnological risks are still pervasive from unbalanced redistricting, creative dysinformation, poli- tics, Citzens United, and foreign interference. We need non- partisan scrutiny and defense against would-be subverters to overcome potential attacks and inadvertent mistakes. In pres- ence of potential risks in every part of the process, a strong sense of risk-awareness is required by voters, election officials, and the media (both proactively and remedially, as needed).

Conclusion: What academia can contribute to refugee policy

2018 ◽  
Vol 56 (1) ◽  
pp. 146-151 ◽  
Author(s):  
Idean Salehyan
Keyword(s):  
Academic Research ◽  
Forced Migration ◽  
Humanitarian Assistance ◽  
Future Research ◽  
Security Risks ◽  
Individual Level ◽  
The Public ◽  
Level Data ◽  
Potential Risks

This conclusion to the special issue highlights the role of scholars in advancing the public discussion about forced migration. As countries around the world are adopting increasing restrictions on the entry of refugees, academic research can help to dispel some of the myths and apprehensions regarding the risks that forced migration entails. While refugees may be linked to conflict and violence in limited circumstances, the research generally demonstrates that robust international cooperation to manage refugee settlements, provide adequate humanitarian assistance, and integrate refugees into host communities, among other policies, can help to mitigate potential risks. Directions for future research and analysis are also discussed. Forced migration scholars should endeavor to collect more individual-level data; seek to understand factors that exacerbate or reduce security risks associated with cross-border militancy; conduct research on the long-term integration of refugees; and seek to understand the causes and consequences of resettlement and repatriation policies.

scholarly journals Identification of Bacillus Anthracis, Brucella Spp., and Coxiella Burnetii DNA Signatures From Bushmeat

2021 ◽  
Author(s):  
Robab Katani ◽  
Megan Schilling ◽  
Beatus Lyimo ◽  
Ernest Eblate ◽  
Andimile Martin ◽  
...  
Keyword(s):  
Bacillus Anthracis ◽  
Coxiella Burnetii ◽  
Wildlife Diseases ◽  
Middle Income ◽  
The Public ◽  
Middle Income Countries ◽  
Close Proximity ◽  
Disease Risks ◽  
Potential Risks ◽  
Dry Seasons

Abstract Meat from wildlife species (bushmeat) represents a major source of dietary protein in low- and middle-income countries where humans and wildlife live in close proximity. Despite the occurrence of zoonotic pathogens in wildlife, their prevalence in bushmeat remains unknown. To assess the risk of exposure to major pathogens in bushmeat, a total of 3,784 samples were collected from three major regions in Tanzania during both rainy and dry seasons, both fresh and processed and screened by real-time PCR for the presence of DNA signatures of Bacillus anthracis, Brucella spp and Coxiella burnetii (Coxiella). The analysis identified DNA signatures of B. anthracis (0.48%), Brucella (0.9%), and Coxiella (0.66%) in a total of 77 samples. Highest prevalence rates of B. anthracis, Brucella, and Coxiella were observed in wildebeest, dik-dik, and impala, respectively. Fresh samples, those collected during the rainy season, and samples from Selous or the Serengeti had a greater relative risk of being positive. Microbiome characterization identified Firmicutes and Proteobacteria as the most abundant phyla. The results highlight and define potential risks of exposure to endemic wildlife diseases from bushmeat and the need for future investigations to address the public health and emerging infectious disease risks associated with bushmeat harvesting, trade, and consumption.

scholarly journals Intramedullary spinal cysticercosis simulating a conus medullaris tumor: case report

2006 ◽  
Vol 64 (1) ◽  
pp. 149-152 ◽  
Author(s):  
José Fernando Guedes-Corrêa ◽  
Ricardo Caratta Macedo ◽  
Rafael Pereira Vaitsman ◽  
Jorge Gomes de Mattos ◽  
Jovita Marques Agra
Keyword(s):  
Spinal Cord ◽  
Daily Living ◽  
Conus Medullaris ◽  
Acute Onset ◽  
Pathological Examination ◽  
Low Back ◽  
The Central Nervous System ◽  
Intradural Extramedullary ◽  
Magnetic Resonance Imaging Mri

Cysticercosis is an endemic condition in many developing countries. Although it is the most common parasitic disease of the central nervous system, cysticercal involvement of the spinal cord is rare. It may occur as intradural extramedullary, intramedullary, intramedullary associated with intradural-extramedullary or as the vertebral presentation. We report the case of a 53-year-old woman who presented with low back pain of acute onset and no other symptoms. Magnetic resonance imaging (MRI) showed an intramedullary cyst of the conus medullaris region which, at pathological examination, was diagnosed as a cysticercal cyst. She refused anticysticercal agents and steroids postoperatively. After an eight-year follow-up, the patient performs the activities of her daily living with no difficulties, and annual spinal MRIs show no residual signs of the disease. Clinical, pathofisiological, diagnostic and therapeutic aspects of spinal cord intramedullary cysticercosis are discussed.

scholarly journals Off-label prescribing of quetiapine in HMP Elmley, a Category B remand prison: a re-audit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S85-S85
Author(s):  
Nosa Igbinomwanhia ◽  
Kathleen McCurdy
Keyword(s):  
Mental Health ◽  
Royal College ◽  
Health Assessment ◽  
List Type ◽  
Physical And Mental Health ◽  
Off Label ◽  
The Past ◽  
Number Of Patients ◽  
Prescribing Practice ◽  
Potential Risks

AimsThis was a re-audit of off-label prescribing of quetiapine in order to identify the number of patients on off-label quetiapine in HMP Elmley, to monitor compliance by the Mental Health Inreach Team (MHIRT) psychiatrists with the Royal College of Psychiatrists guideline on off-license prescribing, to compare findings with the baseline audit and to identify areas for improvement.MethodAll patients on quetiapine in HMP Elmley were identified and their electronic patient record was reviewed against the standards outlined in the Royal College of Psychiatrists “Use of licensed medicines for unlicensed applications in psychiatric practice (2nd edition).ResultThere were 60 residents on off-license quetiapine prescription in HMP Elmley.Of this number, four had their prescription initiated by a general practitioner, either while in prison or in the community. Two residents were on quetiapine first prescribed while they were on admission in hospital. 5 patients had been initiated by the MHIRT psychiatrists. 38 residents were commenced off-license quetiapine by another psychiatrist, either while they were in the community or in another prison. In 17 patients, electronic records were inadequate to determine who had prescribed the quetiapine.The number of inmates prescribed off-label quetiapine in HMP Elmley had dropped from 82 to 60 in the 1 year since the initial audit. Of these figures, prescriptions initiated by the MHIRT psychiatrists, had dropped from 28.1% (23/82) to 8.3% (5/60).For those prescribed quetiapine by the HMP Elmley psychiatrists, notes were audited against the RCPsych guidelines: Licensed medication was considered first in 80.0%Risks and benefits were considered and documented in 80.0%The benefits and potential risks were explained to patient in 80.0%There was documentation of informed consent in 80.0%Quetiapine was started at a low dose and monitored in 100%No residents required withdrawal of medication due to ineffectiveness or adverse effects.Baseline physical health assessment was performed in 80.0%, though all had an ECG done.ConclusionOver the past year there has been an improvement in off-label antipsychotic prescribing practice within the MHIRT.However, the number of off-label antipsychotic prescriptions still remains high throughout the prison. There should be continued effort at minimizing off-label prescribing within the MHIRT, monitored by auditing. However, work needs to be done jointly with other prescribers, such as GP colleagues, in order to avoid unnecessary prescriptions and to monitor regularly the physical and mental health of those on off-label quetiapine.

scholarly journals Upgrade the Saudi Arabian Procurement System Delivery Method

2015 ◽  
Vol 7 (1) ◽  
pp. 146
Author(s):  
Ahmed Alofi ◽  
Yasir Alhammadi ◽  
Dean Kashiwagi ◽  
Kenneth Sullivan
Keyword(s):  
Saudi Arabia ◽  
Construction Projects ◽  
Public Procurement ◽  
Saudi Arabian ◽  
The Public ◽  
Public Projects ◽  
Potential Risks ◽  
Low Performance ◽  
And Performance ◽  
Procurement System

Saudi Arabia has had many issues in delivering mega construction projects, such as delays, high costs, and low customer satisfaction. Some studies show that around 70% of public projects in Saudi Arabia are delayed. One factor that might be causing these performance issues is the traditional low bid contracting system in Saudi Arabia, or the Saudi procurement system. In Saudi Arabia, owners select contractors based only upon the lowest price. This paper researched ways to modify the current Saudi procurement system and show quick and simple modifications that can be done to improve the low performance. This research proposes that by adding the clarification phase from the Performance Information Procurement System (PIPS) to the Saudi traditional procurement process could greatly improve construction performance. The clarification phase requires the selected contractor to submit a project scope, detailed and milestone schedule, potential risks that they do not control, and performance measurement before a contract is awarded. The PIPS system is one of the most successful systems around the world, which shows success rate of 98% in six different countries with risk and cost reduction up to 30%. The clarification phase has been identified as the most important step in the PIPS to ensuring a successful project. This paper conducted a survey among construction professionals in Saudi Arabia, including 157 engineers, 33 consultants 9 owners, 5 vendors, 13 academics, and 28 architects, in order to develop the public procurement system in Saudi Arabia. The participants work in government sectors with an interest in the Saudi Arabian procurement system. The survey confirmed that professionals in the Saudi construction industry believe that the procurement system should be changed and that the inclusion of the clarification phase to the procurement system is a way to improve the procurement system.

Reprogenetic Technologies Between Private Choice and Public Good

2019 ◽  
pp. 212-227
Author(s):  
Maartje Schermer
Keyword(s):  
Public Good ◽  
Societal Perspective ◽  
Social Conditions ◽  
Individual Choice ◽  
Checks And Balances ◽  
The Public ◽  
Side Constraints ◽  
Genetic Technologies ◽  
Bioethical Debate ◽  
Potential Risks

Much of the bioethical debate on reproductive and genetic technologies has focused on the potential risks and benefits for individuals. This chapter shifts the focus from the individualistic level towards a societal perspective. It explores how emerging reprogenetic technologies can both thwart and promote the flourishing of communities, and argues that these technologies can contribute to the public good only when certain social conditions and side-constraints are in place—which can sometimes entail influencing or even limiting individual choice. The chapter gives an account of how we should understand ‘the public good’ in this context, including values such as tolerance, inclusion, and solidarity. It explores how reprogenetic technologies can affect the public good, for better or worse. Finally it addresses the forms of governance—regulations, institutional checks and balances—we might deploy with regard to these technologies to ensure they contribute to both individual and collective flourishing.

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