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Biomedical subjects

A Foy

Publications and source records attributed to A Foy.

At least 19 recordsLinked to original sources
PubMed2006

Clinical use of a shortened alcohol withdrawal scale in a general hospital.

BACKGROUND: Multi-item scales for monitoring alcohol withdrawal reactions have been used since the 1970s, and since 1985 we have used a modified version of the Clinical Institute Withdrawal Assessment (CIWA) in our general hospitals. This study was conducted to determine whether a shorter version of the scale would prove easier to use without loss of accuracy. METHODS: A simultaneous 'crossover' clinical audit using two hospitals. The shortened scale was developed from the existing one, and had 10 items as opposed to the previous 18. The patients were followed throughout their course and the incidences of complication, the frequency of sedation, the delay in initiating monitoring and the ease of use were recorded. RESULTS: There were 106 patients managed with the old scale and 96 with the new. The rate of complication was not different, being 16% in patients managed using the old scale and 14.5% using the new scale; the rates of sedation were 49 and 48%, respectively. Patients managed with the new scale had a shorter course with a median duration of 27.6 h compared with 40 h. The time from admission to first recording of a score was 5.4 h for the new scale and 4.8 h for the old, which is not a significant difference. Both scores were used according to instructions, but staff reported that the shortened scale was easier to use. CONCLUSIONS: We conclude that a shortened form of the CIWA alcohol withdrawal scale works as well as the original and is simple to use.

Adult↗
PubMed2001

Cost-effectiveness of screening swab or urine specimens for Chlamydia trachomatis from young Canadian women in Ontario.

BACKGROUND: Undetected and untreated Chlamydia trachomatis infections can result in a significant health burden. Diagnostic testing refers to tests performed on patients with symptoms, whereas screening refers to testing specimens in asymptomatic patients. The goal of diagnostic testing and screening programs are early identification of infections to prevent upper tract infection and transmission to other partners. GOAL: To compare the costs and outcomes of alternative diagnostic testing and screening programs for women ages 15 to 24 years in the province of Ontario, Canada. STUDY DESIGN: Using outcome probabilities from the literature and a consensus group, together with the costs from insurance billing, a decision analytic model was constructed to determine the baseline risk of C trachomatis and related sequelae. Seven diagnostic testing and screening programs were compared over a 10-year period. The programs compared included the use of nucleic acid amplification assays collected from urine or endocervical swab specimens. RESULTS: Largely because of lower sensitivity the urine-based testing or screening programs were dominated by the swab-based programs. The move from swab-based testing to a swab-based screening program for high-risk women costs $1873 per case of C trachomatis averted. Expanding the program further to include all women in Ontario between 15 and 24 years of age is considerably more costly at $5990 per case averted. CONCLUSIONS: It is more costly and more effective to screen and treat high-risk women ages 15 to 24 years for C trachomatis than to perform only swab-based diagnostic testing on symptomatic women. Expanding the screening program to include all women ages 15 to 24 years is considerably more expensive and only moderately more effective than screening only high-risk women.

Adolescent↗
PubMed2001

Citalopram-induced bradycardia and presyncope.

OBJECTIVE: To report a case of symptomatic bradycardia and hypotension that resulted from the therapeutic use of citalopram and to review any previous reports in the literature, from the manufacturer, and the Australian Drug Reaction Advisory Committee (ADRAC). CASE SUMMARY: A 60-year-old white woman who had been taking citalopram 20 mg/d for two weeks presented to the hospital with a heart rate of 39 beats/min, mild hypotension (systolic BP 105 mm Hg), and a normal electrocardiogram (QTc < 440 msec), following a presyncopal episode. The patient was admitted for cardiac monitoring, and citalopram was discontinued. The bradycardia and hypotension resolved in the 48-hour period following cessation of citalopram. No other medical or pharmacologic cause was found for the adverse drug reaction. DISCUSSION: Bradycardia has been reported rarely with citalopram in therapeutic doses, but this is the first detailed case with a dose of only 20 mg. The manufacturer reports bradycardia as an infrequent adverse effect (0.1-1%) of citalopram. There have been no reports to ADRAC or to the manufacturer in postmarketing surveillance. There is a case report of asymptomatic bradycardia in a patient whose dose was increased to 40 mg. In the case reported here, there was no QTc prolongation consistent with previous reports. The sinus bradycardia reported more often with therapeutic doses would appear to be distinct to QT abnormalities seen with citalopram overdose. CONCLUSIONS: Citalopram should be used with care in the elderly and in persons with a history of heart disease. Heart rate and blood pressure should be monitored in the first week of therapy and when doses are modified.

Blood Pressure↗
PubMed1998

An open trial of naltrexone for opiate dependence.

The objective of this study was to conduct a pilot study of naltrexone in opiate-dependent patients in order to determine the sample size for a double-blind controlled trial, to identify possible confounders and to obtain experience with the drug's side effects and acceptability to patients. Opiate-dependent patients presenting to a public hospital for treatment for their dependence were invited to participate. Patients with major organic illness, another Axis I diagnosis, or who were pregnant were excluded. Naltrexone was prescribed at a dose of 50 mg daily for 6 months. Data were collected on drug use, social stability, physical and mental health before during and after the treatment programme. Patients were seen weekly for 6 months then monthly for a further 6 months. Forty-four patients were enrolled, but three stopped naltrexone early because of possible side effects. Of the remainder, 32 were followed for at least 12 months. Eight (25%) ceased opiate use from the start, and another two were no longer using at the end of 12 months giving an abstinence rate of 31% at 12 months. Retention in treatment was 34%. Of the abstinent patients however, only two took naltrexone for the whole 6 months. Naltrexone was well tolerated and associated with a significant abstinence rate, but most patients do not feel they need to take the drug for 6 months. A double-blind controlled trial would be justified.

Journal Article↗
PubMed1997

The course of alcohol withdrawal in a general hospital.

We conducted an observational study of 539 episodes of alcohol withdrawal in a general hospital, to determine the natural history, the incidences of seizures, hallucinations and delirium, and the risk factors for these events. The reaction began soon after arrival, at a median time of 5 h, and resolved at a median time of 22 h. Patients with a blood alcohol level of zero were in withdrawal on arrival, and only four patients had reactions lasting 120 h or longer. Complications were observed in 113 patients (21%) during the admission. Seizures occurred on arrival, hallucinations usually in the first 24 h and delirium in the first 48 h. No mortality was associated with alcohol withdrawal itself, but complications did extend length of stay by a median of 4 days, with delirium contributing most to the increase. Patients over 70 years of age or admitted with seizures had an increased risk of complication, but the greatest risk was associated with a delay in assessment of > 24 h. We conclude that in general hospitals, the alcohol withdrawal reaction becomes established very early, and detection and monitoring of patients within the first 24 h is the most important element in management.

Adult↗
PubMed1995

The incidence of alcohol-related problems and the risk of alcohol withdrawal in a general hospital population.

A survey was carried out using the Canterbury Alcohol Screening Test (CAST) and clinical criteria for risk of alcohol withdrawal of 2000 randomly selected hospital in-patients in order to determine the prevalence of alcohol-related problems, the work-load for a specialist alcohol withdrawal service and the target group for early intervention. Patients at risk of alcohol withdrawal were followed prospectively.The major findings were: 14.3% of patients had a positive CAST and 8% were at risk of alcohol withdrawal; the prevalence of positive clinical criteria was greatest in men under the age of 30 years (OR 3.6) and very low (OR 0.34) in women over 60 years. In addition, patients who were too sick or refused to complete the questionnaire had high rates of being at risk for alcohol withdrawal. The prevalence of CAST positivity was greatest in men under the age of 40 years (OR 3.7) and lowest in women over 70 years (OR 0.2). It is concluded that 15-20% of in-patients have alcohol problems and 8% are at risk of withdrawal; questionnaires will produce underestimates of the order of 25%; and female in-patients over the age of 60 years are extremely unlikely to have problems with alcohol.

Journal Article↗
PubMed1995

Barbiturate withdrawal--a nomogram for supplementary dosing after the phenobarbitone loading technique.

A case of a woman who presented with a multiple drug overdose and then subsequently had a withdrawal syndrome complicated by seizures and delirium highlights the seriousness of the barbiturate withdrawal syndrome. The patient had a short elimination half-life for phenobarbitone and required supplementary phenobarbitone doses to prevent and treat these complications. We have devised a nomogram which in conjunction with serum levels allows a rapid determination of whether and how much supplementary doses are required during barbiturate withdrawal.

Journal Article↗
PubMed1995

Benzodiazepine use as a cause of cognitive impairment in elderly hospital inpatients.

BACKGROUND: Benzodiazepine drugs are used very frequently by the elderly and have been associated with a number of untoward events in them. In an earlier publication, we showed that there was an association between benzodiazepine use and episodes of confusion in hospital. The purpose of this study was to examine that association in more detail by studying only patients with intact cognitive function on admission and by taking into consideration a range of demographic, drug use, and clinical confounders. METHODS: A prospective cohort study was carried out of inpatients who had normal cognitive function on admission to hospital. The subjects were 418 hospital inpatients who had a normal result of a Mini-Mental State Examination (MMSE) performed within 24 hours of admission. They were aged 59-88 years. A clinical history and detailed drug use history were taken on admission and then the patients were followed prospectively for 10 days or until discharge, whichever was sooner. The MMSE was repeated every 2 days and all significant clinical events and episodes of delirium noted. RESULTS: 10.8% (95% Confidence Interval [CI]: 7.8-13.8%) of patients developed cognitive impairment (as indicated by a decrease in the MMSE). Factors that were statistically significantly related to the development of cognitive impairment included admission diagnoses of cancer or central nervous system (CNS) disease, alcohol consumption > 40 gms/day, hypoxia, and presence of benzodiazepines in the urine on admission. After adjusting for age, alcohol consumption, and admission diagnoses, those who reported taking benzodiazepines in daily doses equivalent to 5 mg or more of diazepam were at significantly higher risk of cognitive impairment than those who had not taken benzodiazepines (adjusted odds ratio = 3.5; 95% CI: 1.4-8.8). Twenty-one (5.0%, 95% CI: 2.9-7.1%) patients developed delirium as defined by the DSM-IIIR criteria. Age and hypoxia were statistically significantly related to the development of delirium. Due to the small number of cases of delirium, the power of the study to detect significant associations was low. CONCLUSIONS: Elderly hospital inpatients who have intact cognitive function on admission to hospital have a low risk of developing cognitive impairment and delirium during their hospital stay. In this population, however, benzodiazepine use accounted for 29% of cases of cognitive impairment which did occur. The data also suggest that dehydration, urinary retention, and an admission diagnosis of CNS disease may be important risk factors for delirium.

Aged↗
PubMed1994

Quality assurance in the management of alcohol withdrawal in a general hospital.

We have shown previously that a standardized protocol is effective in the management of alcohol withdrawal in a general hospital. In this study a Quality Assurance (QA) approach was used to determine whether all patients at risk were detected and treated correctly in time. A total of 500 episodes were monitored, 82% of patients at risk were identified, and 89% of patients were seen within 24 h (median 4 h). The protocol was followed correctly in 86% of cases but was inappropriately applied in 7.2%. Medication was given in 242 cases, on 93% of occasions according to guidelines. In all, 11.8% of episodes became complicated by seizure, hallucinations or confusion and two patients had terminal respiratory failure which worsened after sedation. A standardized protocol for alcohol withdrawal can be used in a general hospital with high rates of detection of at risk patients, a high rate of compliance with treatment guidelines and a low rate of complications.

Adolescent↗
PubMed1991

Detoxification: the basis of current practice.

With chronic use of a psychoactive drug the central nervous system undergoes a series of changes. These changes vary both in nature and in extent with each drug, but in general, they alter the responsiveness of the nervous system to the drug so as to reduce the perceived clinical effect, and also alter the innate responsiveness of the affected neurons to various stimuli. With cessation of drug use the nervous system undergoes a natural healing which consists of a restoration of normal responsiveness, but this process takes some time during which the patient's responses are abnormal and they are vulnerable to a variety of stressors. Detoxification is the safe negotiation of this period.

Journal Article↗
PubMed1991

Drug withdrawal: a selective review.

This review will concentrate on the contributions medical science, in particular pharmacology and electrophysiology, have made to the understanding of withdrawal states and so will look mostly at the first element in withdrawal. Behavioural and emotional issues will be dealt with in the section on management.

Journal Article↗
PubMed1990

Plasma noradrenaline, platelet alpha 2-adrenoceptors, and functional scores during ethanol withdrawal.

Plasma noradrenaline and platelet alpha 2-adrenoceptor density (sites/cell using 3H-rauwolscine with and without phentolamine) were correlated with withdrawal score in 23 hospitalized patients undergoing ethanol withdrawal. Control groups for plasma noradrenaline were 25 patients admitted to hospital for elective gastroscopy and 12 laboratory workers accustomed to venipuncture. Controls for platelet alpha 2-adrenoceptor measurements were a separate group of 31 normal subjects with a mean age close to that of the patients' withdrawing from ethanol. Plasma noradrenaline was significantly higher in the patients undergoing ethanol withdrawal than in patients admitted to hospital for elective endoscopy. Twelve laboratory controls had plasma noradrenaline levels significantly lower than either patient group. A significant though poor statistical correlation existed between ethanol withdrawal score and simultaneously determined plasma noradrenaline level. Platelet alpha 2-adrenoceptor sites/cell were reduced in ethanol withdrawal compared with the normal controls. Platelet alpha 2-adrenoceptor sites/cell increased over the first 24 hr of ethanol withdrawal but remained significantly lower than control values. The change in platelet adrenoceptors was accompanied by a fall in mean plasma noradrenaline. Thus, the stress of hospital admission itself is associated with an increase in plasma noradrenaline, but ethanol withdrawal enhances this increase, which is accompanied by and probably causes a reduction in platelet alpha 2-adrenoceptor numbers. These changes begin to return towards normal within 24 hr as the withdrawal reaction subsides.

Adult↗
PubMed1989

A prospective clinical audit of methadone maintenance therapy at the Royal Newcastle Hospital.

In a prospective study of 63 admissions to a methadone maintenance programme in a public hospital, 13 admissions were for less than two weeks. Of the remaining 50 such admissions, 35 admissions were terminated because of absenteeism, drug abuse, violence or drug-dealing. Twelve patients did not take intravenously administered drugs during the time that they were receiving methadone, but in 25 of the 50 admissions that lasted for more than two weeks, such drugs were abused at least fortnightly. Eight patients achieved a stable state without drugs that lasted at least three months. No improvements were note in patients' social situations, relationships, health or criminal activity, but compliant patients did improve their employment status. A significant minority of patients has benefited from methadone maintenance therapy, but most patients have continued their drug abuse and drug-related life-styles.

Adolescent↗