ABSTRACT
Objective To investigate the effect of transfer service utilization in increased methadone dosage after missed dose of participants in methadone maintenance treatment (MMT).Methods We selected 9 MMT clinics in Guangdong Province and collected the data from the web-based system of MMT management. All the participants who had utilized the transfer service from January 2008 to December 2016 were included in our study. We explored multilevel Logistic regression analysis to explore the associated factors of changing methadone dosage after missed dosage of transfer participants.Results A total of 197 patients were included in the study for a total of 840 person-time transfer services. Of these, 119 (14.26%) had increased-dose after transfer. The patients whose (1) dose of methadone was less than 60 ml/d during the transfer period (OR=2.88, 95%CI:1.85-4.50, P<0.001), (2)had longer transfer period (OR=1.02, 95%CI: 1.01-1.03, P<0.001), and (3) fewer cumulative transfertimes (OR=0.97, 95%CI:0.95-0.99, P=0.004) were more likely to increase the methadone dosage after the missed.Conclusions The characteristic of transfer service utilization could result in the increasing methadone dosage after missed doses in transfer participants. This finding suggest MMT clinic should strengthen the supervision of transfer patients, especially those who failed to return on time after transfer. The doctors in MMT should carefully consider the dose adjustment requirements from patients and improve the efficacy of methadone maintenance treatment.
ABSTRACT
Objective To investigate the effects of application and clinical value of the epinephrine with graduate increased dosage by the modality equation G=(K+2n-1)mg/3 min(K=1,2,n=1,2,3……,G≤0.2 mg/kg)and aminophylline and sheng-mai injection with uniform method at the same time rapidly combination on cardiopulmonary resuscitation (CPR).MethodsThree hundred and twenty-eight cases with sudden cardiac-arrest (CA) were randomly divided into 3 groups：112 cases with the standard-dose epinephrine group (SDE control group);106 cases with the first-dosage epinephrine for K=1 mg in the equation G=(K+2n-1)mg/3min (K=1,2,n=1,2,3……,G≤0.2 mg/kg,group (equation 1 group) and 110 cases with the first-dosage epinephrine for K=2mg(epuation 2 group).Patients'electrocardiogram and mean arterial pressure(MAP)and the heart rate(HR)and the time of recovery of spontaneous circulation (ROSC)were monitored,and the resuscitation effect were evaluated.ResultsTo compare the equation 2 group and equation 1 group with the SDE control group,the ROSC rate,the survival rate,the 24-hour survival rate and the scoring by Glasgow coma scale were all significantly elevated(P＜0.01)：but the average time from initial stage applied with the epinephrine in the CPR to ROSC in the equation 2 group and equation 1 group was much shorten significantly than that in the SDE control group(P＜0.01).To compare the equation 2 group and equation 1 group with the SDE control group：the average dose of the epinephrine was much reduced from initial stage applied with the epinephrine on CPR to ROSC(P＜0.05),but the cycle summation of apphcation epinephrine by mainline from the CPR initial stage to ROSC in the equation 2 group and equation 1 group was much significantly decreased than that in the SDE control group(P＜0.01).ConclusionsThe method of the epinephrine with graduate increased dosage by the equation G=(K+2n-1) mg/3min(K=1,2,n=1,2,3……,C≤0.2mg/kg)and aminophylline and sheng-mai injection with uniform method at the same time rapidly combination on CPR has better effects on increasing significandy the success rate of CPR,the survival rate,the time activity of success and shortening significantly time of the ROSC,improving brain and nervous system function.It can be new and effective method to increasing the success rate of resuscitation on the CPR.