BMJ open
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To examine the population-wide overdose risk emerging from the prescription of methadone and buprenorphine for opioid substitution treatment in England and Wales. ⋯ Our analysis of the relative safety of buprenorphine and methadone for opioid substitution treatment reveals that buprenorphine is six times safer than methadone with regard to overdose risk among the general population. Clinicians should be aware of the increased risk of prescribing methadone, and tighter regulations are needed to prevent its diversion.
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Observational Study
Acute myocardial infarction or acute myocarditis? Discharge registry-based study of likelihood and associated features in hospitalised patients.
To evaluate the likelihood of and patient features associated with acute myocardial infarction (AMI) versus acute myocarditis in different population segments. ⋯ Acute myocarditis is more common than AMI in hospitalised patients aged 18-29 years, but the risk of AMI increases exponentially thereafter. Hypercholesterolaemia, diabetes and hypertension predict AMI regardless of age and gender.
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Randomized Controlled Trial Comparative Study
Extra Physiotherapy in Critical Care (EPICC) Trial Protocol: a randomised controlled trial of intensive versus standard physical rehabilitation therapy in the critically ill.
Patients discharged from Critical Care suffer from excessive longer term morbidity and mortality. Physical and mental health measures of quality of life show a marked and immediate fall after admission to Critical Care with some recovery over time. However, physical function is still significantly reduced at 6 months. The National Institute for Health and Care Excellence clinical guideline on rehabilitation after critical illness, identified the need for high-quality randomised controlled trials to determine the most effective rehabilitation strategy for critically ill patients at risk of critical illness-associated physical morbidity. In response to this, we will conduct a randomised controlled trial, comparing physiotherapy aimed at early and intensive patient mobilisation with routine care. We hypothesise that this intervention will improve physical outcomes and the mental health and functional well-being of survivors of critical illness. ⋯ The trial has ethical approval from Newcastle and North Tyneside 2 Research Ethics Committee (11/NE/0206). There is a Trial Oversight Committee including an independent chair. The results of the study will be submitted for publication in peer-reviewed journals and presented at national and international scientific meetings.
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The sudden growth of e-cigarettes over the last decade has forced advocates and critics scrambling to bolster support for their respective sides. Bridging the divide in geographic barriers, social networking sites were an ideal meeting place for international activist communities, affording them the ability to organise events and discuss new topics in real time. This study examines how e-cigarettes are addressed in GLOBALink, an online international tobacco control community. We seek to discover if the pattern of activity in e-cigarette discussions changes over time. We are also interested in understanding the characteristics of sentiment toward e-cigarettes in discussion topics between countries with different network characteristics. ⋯ E-cigarettes are a polarising topic that can be seen in how countries appear to discuss related topics with others who share the same opinions. More work is needed to help communities stay informed of current research, and diffuse objective information. Network and sentiment analyses offer a strong combination of methodologies that can help support such efforts.
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Reduced pulmonary function is an important predictor of environment-related pulmonary diseases; however, evidence of an association between exposures to various metals from all possible routes and altered pulmonary function is limited. We aimed to investigate the association of various metals in urine with pulmonary function, restrictive lung disease (RLD) and obstructive lung disease (OLD) risks in the general Chinese population. ⋯ These results suggest that multiple urinary metals are associated with altered pulmonary function, and RLD and OLD prevalences.