Risultati per: Short Acting Opioid

This study examines the distribution of 10- and 30-year cardiovascular disease risk estimates among US adults.

Introduction
Chronic non-cancer pain presents a global health problem, with a significant increase in opioid prescriptions over recent decades. However, opioid therapy poses risks of adverse events, overdose and non-medical use. As a result, many patients seek to discontinue or reduce their opioid intake. Strategies for opioid tapering often lack efficacy, prompting the investigation of novel approaches like open-label placebo (OLP), that is, the administration of a placebo with full disclosure that it is a placebo. OLP has shown efficacy in chronic non-cancer pain syndromes and has been suggested as a promising candidate for medication tapering. This study aims to assess whether OLPs can enhance the reduction of daily morphine equivalent dose (MED) in chronic non-cancer pain patients and examines its potential in mitigating opioid withdrawal symptoms.

Methods and analysis
This study is designed as a randomised, controlled, single-centre trial. Participants will be randomised into either an OLP group or a control group. The study duration will span six to nine weeks, during which all participants will aim to reduce their opioid intake. Both groups will monitor their opioid intake daily using a diary app and will receive feedback on their progress of reducing opioids. Additionally, participants in the OLP group will receive OLP tablets for the entire study period. During the first week, the OLP group will undergo a one week learning phase using a classical conditioning paradigm, where each opioid intake is paired with a placebo. In the subsequent five weeks, the OLP group will enter a dose-extension phase in which only the first opioid intake of the day is paired with a placebo, and additional placebos can be taken as desired. At the end of the study, qualitative interviews will be conducted with the first 15 participants in the OLP group. The primary outcome measure is daily opioid intake. Secondary outcomes include opioid withdrawal symptoms, pain severity, disability, anxiety, depression, opioid beliefs, intervention expectancy and qualitative data. Statistical analyses will include analysis of covariance and regression models.

Ethics and dissemination
The ethics committee of the Canton of Zurich, Switzerland, approved the study (SNCTP-nr.: SNCTP000005853/BASEC nr.: 2023–02327).
Participants will be compensated with 100 Swiss Francs for their full participation in the study. Participants who will take part in the qualitative interview will be compensated with additional 15 Swiss Francs.

Trial registration number
This study is registered at clinicaltrials.gov: NCT06350786.

Apixaban demonstrates slightly superior efficacy and safety over rivaroxaban and warfarin.

Introduction
Opioids play a pivotal role in being capable of effectively blocking the pain and stress responses triggered by procedures such as surgery and intubation. However, it should not be overlooked that opioids have numerous side effects, such as respiratory depression, postoperative nausea and vomiting. These effects can raise intracranial pressure, posing a life-threatening risk in neurosurgical patients. Opioid-free anaesthesia can prevent or significantly reduce opioid usage. The aim of this study is to investigate the effect of opioid-free anaesthesia on the quality of recovery in patients undergoing supratentorial tumour resection in neurosurgery.

Methods and analysis
This is a single-centre, randomised controlled clinical trial. A total of 170 patients receiving general anaesthesia will be randomised in a 1:1 ratio into two groups, one receiving opioid-free anaesthesia and the other receiving opioid-based anaesthesia. The primary outcome measure is the Quality of Recovery-15 Score on the second day after surgery. The secondary outcomes include the Quality of Recovery Score on the fifth day, the incidence of nausea and vomiting within 48 hours, the NRS Pain Score on the second and fifth days, the sleep quality on the second and fifth days after surgery, and the incidence of chronic pain at 3 months and 6 months after surgery.

Ethics and dissemination
This study received official approval from the Ethics Committee of Beijing Tiantan Hospital, Capital Medical University, on 9 September 2024 (KY2024-219-02). The findings of this study are intended to be disseminated through publications in international peer-reviewed journals, presentations at national and international academic conferences, and broad distribution via online platforms.

Trial registration number
ClincalTrials.gov, NCT06607029 (15 September 2024)

Objectives
To investigate the outcomes of patients with ST-elevation myocardial infarction (STEMI) who were treated with coronary artery bypass grafting (CABG) surgery.

Design
Retrospective nationwide cohort study.

Setting
Patients with STEMI in Finland who were treated with CABG between January 2004 and December 2018.

Participants
1069 patients (mean age: 66.4, 21.4% women).

Primary outcome measure
All-cause mortality (median follow-up 6.4 years) and usage of evidence-based secondary preventive medication early after CABG.

Results
In-hospital mortality among the total cohort was 10.0%, with a significant decrease (p90% of patients and ACE inhibitors/angiotensin II receptor blockers by 70% of patients after discharge from the hospital. The proportion of high-dose statin users increased from 33.1% in 2004–2008 to 63.1% in 2014–2018. ADP inhibitors were used by 29.0% of patients, but the proportion increased during the study.

Conclusions
Contemporary in-hospital and long-term outcomes of CABG-treated patients with STEMI are acceptable. In-hospital mortality has decreased, and the usage of secondary prevention medications after CABG procedures has increased in recent years.

Aim
This study aims to identify factors that influence the role of community pharmacy teams in preventing prescription and over-the-counter (OTC) opioid misuse.

Design
Qualitative design using interviews; thematic analysis was used to generate themes mapped to the Capability, Opportunity and Motivation Behaviour (COM-B) model.

Setting
Community pharmacies in North East England.

Participants
28 community pharmacy staff including 16 pharmacists, 1 pharmacy assistant, 10 dispensers and 1 pharmacy technician.

Results
Factors related to the capability component include communication skills, ability to identify service users who misuse OTC opioids, and education and training. Factors in the opportunity component include staff and funding, tools for identification and referral of service users at risk of opioid misuse, and relationship with other healthcare professionals. For the motivation component, attitude towards role, attitude of pharmacist or pharmacy manager, perception about commissioners and commissioned services, and attitude towards service users were identified.

Conclusion
This study identified factors that could influence community pharmacists’ roles in opioid misuse. A critical factor influencing community pharmacy teams preventing opioid misuse is access to a single system to record the use of both OTC and prescription opioids. This would enable teams to identify service users misusing or at risk of misusing opioids, while supporting staff education and training and regulatory compliance. Future research should focus on developing interventions using these identified factors to enhance community pharmacists’ roles in opioid misuse prevention.

Aim
This study aims to identify factors that influence the role of community pharmacy teams in preventing prescription and over-the-counter (OTC) opioid misuse.

Design
Qualitative design using interviews; thematic analysis was used to generate themes mapped to the Capability, Opportunity and Motivation Behaviour (COM-B) model.

Setting
Community pharmacies in North East England.

Participants
28 community pharmacy staff including 16 pharmacists, 1 pharmacy assistant, 10 dispensers and 1 pharmacy technician.

Results
Factors related to the capability component include communication skills, ability to identify service users who misuse OTC opioids, and education and training. Factors in the opportunity component include staff and funding, tools for identification and referral of service users at risk of opioid misuse, and relationship with other healthcare professionals. For the motivation component, attitude towards role, attitude of pharmacist or pharmacy manager, perception about commissioners and commissioned services, and attitude towards service users were identified.

Conclusion
This study identified factors that could influence community pharmacists’ roles in opioid misuse. A critical factor influencing community pharmacy teams preventing opioid misuse is access to a single system to record the use of both OTC and prescription opioids. This would enable teams to identify service users misusing or at risk of misusing opioids, while supporting staff education and training and regulatory compliance. Future research should focus on developing interventions using these identified factors to enhance community pharmacists’ roles in opioid misuse prevention.

This study uses electronic medical record data to compare 48-week viral load outcomes after starting long-acting antiretroviral therapy among people in the US with HIV with or without viremia from January 2021 through September 2024.

The US Food and Drug Administration (FDA) recently approved the rapid-acting human insulin analog insulin-aspart-szjj, marketed as Merilog, as a biosimilar to insulin aspart (Novolog).

Introduction
The HOLA study is a 12-month randomised, hybrid implementation-effectiveness, phase IV, double-arm, open-label, multicentric study including virologically suppressed people living with HIV (PWH). HOLA, which started in September 2023, evaluates acceptability, appropriateness, feasibility and satisfaction of out-of-hospital administration of cabotegravir and rilpivirine long-acting (CAB+RPV LA).

Methods
A total of 110 PWH who are already under treatment with CAB+RPV LA or switch their antiretroviral therapy to CAB+RPV LA will be recruited from two main hospitals in Barcelona (Germans Trias I Pujol and Vall d’Hebrón) and Costa del Sol Hospital, in Marbella. The patients will be randomised 1:1 into a hospital group (administration of CAB+RPV LA in the hospital) and the outpatient group (out-of-hospital administration), including community or primary care centres. The main objectives of the study are to compare the acceptability at month 12 of the administration of CAB+RPV LA in and out-of-hospital centres from the perspective of patients, and assess and compare the safety and tolerability of CAB+RPV LA. The study takes place at nine clinical units in Catalonia and Andalusia (three tertiary hospitals (recruiting centres), one community centre, one sexually transmitted infection clinic and four primary care centres).

Ethics and dissemination
The current publication refers to V.3.0 of the protocol, with issue date 14 April 2024, as approved by the Comité de Ética de la Investigación con medicamentos del Hospital Universitari Germans Trias i Pujol (approval number AC-23-042-HGT-CEIM). The clinical trial will be conducted according to the principles of the Declaration of Helsinki, Fortaleza, Brazil, October 2013. This study will be conducted according to Spanish regulations regarding clinical trials (Royal Decree 1090/2015) and biomedical investigations (Organic Law 14/2007 of biomedical investigation and the Royal Decree 1716/2011), and the Clinical Trial Regulation (Regulation EU No 536/2014). Confidentiality requirements will follow the required Data Protection legislation. Enrolment completion in the study is expected by the end of May 2024, with an end of study expected in May 2025. Results emerging from this study will be reported in HIV national and international meetings as well as published in international journals with a high impact factor. If the outcome is deemed positive, we will also develop and propose policy guidelines for the integration of the administration of CAB+RPV LA in alternative outpatient facilities into the standard of care in the HIV care pathway.

Trial registration number
NCT06185452/EUCT number: 2023-503963-41-00.

This Medical News article discusses lawsuits filed by the US Department of Justice against CVS and Walgreens, two of the nation’s largest pharmacies, for their alleged role in exacerbating the opioid crisis by dispensing “massive quantities” of the drugs.

This study uses 2021 data on the percentage of unavailable opioid tests in the US to examine how opioid involvement informs injury death investigations.

Objective
This scoping review aimed to map the content, duration, delivery methods and modes of assessment for paediatric oncology nursing education and training programmes.

Design
Scoping review.

Data sources
Published articles were retrieved from Cumulative Index to Nursing and Allied Health Literature, Dimensions, Embase, PubMed and Scopus. Additional articles were identified from the reference list of the included studies.

Eligibility criteria
Articles that described or reported on a paediatric oncology nursing education and training programme, from any setting, published in English from 2012 to 2022.

Data extraction and synthesis
Two reviewers independently screened the titles, abstracts and full texts. Data were extracted using a standardised data extraction tool. Content analysis using basic coding of data was performed. The findings are presented in figures and tables, and the results are described narratively.

Results
This review included 15 articles. Content identified for paediatric oncology education and training programmes included supportive care, chemotherapy, overview of paediatric oncology, management of venous access devices, oncological emergencies, nursing considerations, infection prevention and control, paediatric cancers, patient and family education, communication, ethical legal considerations, grief and bereavement, and overview of haematological cancers. Didactic methods used included traditional face-to-face and virtual approaches to deliver theoretical and practical content. The duration of the programmes ranged from 2 hours to 6 months. Both qualitative and quantitative methods of assessment were used before, during and after the training.

Conclusion
This review offers valuable insights for the development of paediatric oncology education and training programmes for nurses. It provides comprehensive guidance on key content, duration, delivery methods and modes of assessment. However, there is a need to consider context-specific issues and availability of resources when developing the programmes to ensure relevance and sustainability.

Study registration
Open Science Framework (https://doi.org/10.17605/OSF.IO/X3Q4H).

Introduction
The opioid crisis is a significant burden on adolescent public health in the USA. Medical use of prescription opioids is a pathway via which adolescents transition to opioid misuse, opioid use disorder and overdose. More than half of all opioids prescribed to adolescents are for pain management following surgery. Yet, little is known about the critical period following surgery during which adolescents initiate opioid misuse or the modifiable mechanisms (such as sleep deficiency) contributing to this process. This prospective observational study will broaden our knowledge by examining associations between sleep deficiency and opioid use and misuse following surgery. We will also examine behavioural, psychological, family and social factors linking sleep deficiency with opioid use and misuse.

Methods and analysis
Adolescents (10–19 years) undergoing outpatient orthopaedic surgery, along with one parent, will be recruited from two paediatric hospitals, for a sample of 400 dyads. Adolescents will be assessed at six timepoints. Before surgery, participants will undergo comprehensive multimodal sleep assessments (sleep surveys and actigraphy). Participants will also report on previous substance use, pain intensity and psychosocial, family and social factors. Adolescents will then be closely monitored over the first 14 days following surgery using ecological momentary assessment methods to capture real-time, naturalistic, daily data on sleep, opioid use, pain and psychological factors (including mood, affect and subjective response to opioid use). Opioid use (total number of doses and duration) will be measured with an innovative electronic medication monitoring device following surgery. Follow-up assessments at 3 months, 6 months, 12 months and 24 months will track the development of opioid misuse over time. Our primary outcomes include opioid use during the immediate 14 days following surgery and the presence of opioid misuse at 24 months after surgery. Multilevel mediation models will determine associations between predictor variables and acute postsurgical opioid use. We will apply modern machine learning algorithms to develop and validate models predicting adolescent prescription opioid misuse at 24 months from surgery.

Ethics and dissemination
This study was approved by Advarra’s Center for Institutional Review Board Intelligence (CIRBI) (Protocol 00072049), which serves as the single IRB of record for this multisite study.

This randomized clinical trial evaluates the effectiveness of an intervention combining nicotine replacement with brief behavioral support in reducing cigarette use among adults with opioid dependency in Norway.