Moving Towards Common Data Elements and Core Outcome Measures in Frailty Research.

With aging populations around the world, frailty is becoming more prevalent increasing the need for health systems and social systems to deliver optimal evidence based care. However, in spite of the growing number of frailty publications, high-quality evidence for decision making is often lacking. Inadequate descriptions of the populations enrolled including frailty severity and frailty conceptualization, lack of use of validated frailty assessment tools, utilization of different frailty instruments between studies, and variation in reported outcomes impairs the ability to interpret, generalize and implement the research findings. The utilization of common data elements (CDEs) and core outcome measures (COMs) in clinical trials is increasingly being adopted to address such concerns. To catalyze the development and use of CDEs and COMs for future frailty studies, the Canadian Frailty Network (www.cfn-nce.ca; CFN), a not-for-profit pan-Canadian nationally-funded research network, convened an international group of experts to examine the issue and plan the path forward. The meeting was structured to allow for an examination of current frailty evidence, ability to learn from other COMs and CDEs initiatives, discussions about specific considerations for frailty COMs and CDEs and finally the identification of the necessary steps for a COMs and CDEs consensus initiative going forward. It was agreed at the onset of the meeting that a statement based on the meeting would be published and herein we report the statement.

Changes in regional brain glucose metabolism measured with positron emission tomography after paroxetine treatment of major depression.

OBJECTIVE: Depression is commonly associated with frontal hypometabolic activity accompanied by hypermetabolism in certain limbic regions. It is unclear whether successful antidepressant treatments reverse these abnormalities or create new resting levels of metabolism. The aim of the present study was to assess the effects of successful paroxetine treatment on regional glucose metabolism in patients with major depression. METHOD: Positron emission tomography with [(18)F]fluorodeoxyglucose was performed on 13 male patients before and after 6 weeks of paroxetine therapy. Resting state scans were also acquired under similar conditions in 24 healthy male subjects for comparison. RESULTS: After successful paroxetine therapy, increased glucose metabolism occurred in dorsolateral, ventrolateral, and medial aspects of the prefrontal cortex (left greater than right), parietal cortex, and dorsal anterior cingulate. Areas of decreased metabolism were noted in both anterior and posterior insular regions (left) as well as right hippocampal and parahippocampal regions. In comparison to metabolism levels in a group of healthy volunteers, the increase in prefrontal metabolic activity represented a normalization of previously reduced metabolic activity, whereas the reduction in pregenual anterior cingulate activity represented a decrease from previously elevated metabolic levels. CONCLUSIONS: These results provide further support for a dysfunction in cortical-limbic circuitry in depression, which is at least partly reversed after successful paroxetine treatment.

The lived experiences of adult female victims of child abuse.

The purpose of this study was to investigate the lived experiences of female victims of domestic violence who also identified themselves as victims of physical abuse as children. There have been numerous studies of identifying perpetrators of violence as having a history of experienced violence in the family of origin. However, few studies address the victims/survivors of domestic violence and the historical significance of abuse in the family of origin. It is estimated that greater than 50% of the victims of domestic violence were also victims of abuse as a child. The research design partially followed the qualitative ethnonursing methodology. This pilot project consisted of seven females between the ages of 37 and 58. These women were members of a long-standing support group for battered women. The Pitts-Williams Inventory was used to obtain data. The instrument contained six major research questions, with sub questions. Data analysis was done by identifying major themes that emerged. Eight themes were identified. The majority of the women identified their mother as the perpetrator. They described a continuous cluster of violence, which included several different forms of violence being used consistently in order to maintain control and foster isolations. This type of violence continued in throughout their childhood and adult life.

Harm reduction: roads less travelled to the holy grail.

In recent years, a number of countries have embraced harm reduction as their principal philosophical stance and policy platform on alcohol and other drug-related problems. Harm reduction, while argued by some as not being a new concept, has dramatically changed the overall orientation of many health and human service approaches. We argue that as a result many important considerations have been overlooked. This paper explores the merits of harm reduction and examines the limitations and potential pitfalls that may exist in its application in the real world. For instance, where do we position non-drug-use? Such questions are raised in light of the impression perpetuated by some leading practitioners in this field that harm reduction is a global panacea for alcohol and drug problems. Without exploring all possible paths, progress toward our holy grail of minimising the harms and maximising the potential benefits of drug use will be hampered. An integrated model is discussed, which we believe provides an opportunity for wider acceptance and ownership by alcohol and drug stakeholders, politicians and the community.

Problematic behavior of drug-dependent patients in the general hospital. A clinical and administrative approach to management.

Drug-dependent patients in general hospitals behave in ways that are difficult for medical and surgical staff to manage. Common problems include drug-seeking, states of intoxication and withdrawal, poor compliance, and behavior that is disruptive or dangerous to others. The authors describe an approach to these problematic behaviors based upon early recognition, a clinical perspective, and administrative action. Institutional initiatives are needed to overcome the practical and conceptual obstacles to effective management of these patients.

Amphetamine- and morphine-induced feeding: evidence for involvement of reward mechanisms.

The present study examined the possibility that the increased feeding found following central and peripheral administrations of low doses of d-amphetamine (AMP) and morphine (MOR) may involve central reward mechanisms. In order to examine this possibility, the effects of these drugs on food selection and intake of foods that varied in palatability and nutritive content were determined. In addition, the importance of the nucleus accumbens (ACB), a critical structure for AMP and MOR reward, in these effects was determined. Results indicated that MOR increased the intake of preferred food regardless of nutritive content. In contrast, AMP was most effective at increasing the intake of preferred foods which contained carbohydrates. These effects were observed following systematic or intra-ACB administration of low doses of MOR and AMP. Together these findings implicate reward mechanisms in the expression of MOR- and AMP-induced feeding. It is further suggested that the feeding effects of MOR and AMP can be differentiated in paradigms where animals have a choice of several foods which may vary in palatability and/or nutritive content. The relevance of the present findings for our understanding of which elements of food and feeding behavior are coupled with ACB reward signals is also discussed.

Effects of d- and l-amphetamine on food intake: evidence for a dopaminergic substrate.

The present experiment examined the effects of d- and l-amphetamine on the intake of sugar, sweetened rat chow and unsweetened rat chow in free feeding rats. Rats were injected IP with 4 doses of d- or l-amphetamine (0.0, 0.125, 0.50 and 2.00 mg/kg). Regardless of drug condition, animals were found to prefer sugar over sweetened or unsweetened chow. d-Amphetamine significantly increased food intake at 0.125 and 0.50 mg/kg doses but not at 2.00 mg/kg. l-Amphetamine had no significant effects at any dose. Further, d-amphetamine significantly increased sugar intake but not sweetened or unsweetened chow. Since d- and l-amphetamine are equipotent at releasing noradrenaline, while d-amphetamine is 2 to 5 times more potent at releasing dopamine, the results suggest that d-amphetamine-induced feeding is associated with activation of a dopaminergic substrate.

Feeding induced by ventricular bromocriptine and amphetamine: a possible excitatory role for dopamine in eating behavior.

The effects of intracerebroventricular (ICV) administration of the dopamine (DA) agonists, bromocriptine and d-amphetamine, on feeding and feeding-associated behaviors were examined. Male Wistar rats were injected ICV with 80-micrograms bromocriptine or its vehicle or with 10-micrograms d-amphetamine or saline. For 2 hr, the activity, duration of individual grooming, eating, and drinking bouts, and the amount of food and water consumed were recorded. Bromocriptine and amphetamine significantly increased the amount the animals ate and meal duration, but did not significantly affect the other observed behaviors (grooming, drinking, activity, or number of meals). The findings are interpreted as being consistent with the anhedonia hypothesis (Wise, 1982), in which DA is involved with the reinforcing components of external stimuli (i.e., food).

Intra-nucleus accumbens amphetamine: dose-dependent effects on food intake.

The effects of microinjections into the nucleus accumbens (N.ACC.) of 0.0, 2.0 or 8.0 micrograms of (+)-amphetamine sulphate (AMPH) on food intake and running wheel activity were examined. The 2.0 micrograms dose of AMPH produced increased food intake while 8.0 micrograms significantly decreased food intake. No effect was found on running wheel activity with the 2.0 micrograms dose, though 8.0 micrograms significantly increased the number of wheel revolutions with respect to the saline group. Results were interpreted to suggest that the N.ACC. may be an important site in the mediation of the increased food intake noted with low doses of psychomotor stimulants.

Physician acquisition of prescription drug information.

The authors explore how the characteristics of prescription drug information sources influence the perceived usefulness of those sources. Physicians were asked in a survey to assess several prescription drug information sources and source characteristics. Their perceptions were examined statistically to determine whether they vary among physician subgroups (general practitioners versus specialists and younger versus older physicians). The results show that physician subgroups differ not only in their likelihood of using prescription drug information sources, but also in the importance they attribute to the information source characteristics. A situationally derived model of physician prescription drug information acquisition is advanced and a variety of academic and practitioner implications are discussed.

Physician perceptions of prescription drug information.

This study reports the findings of an investigation designed to explore the importance of prescription drug information source characteristics among physicians. Differences were found to exist among the importance ratings both in aggregate, and between, categories of physician specialty and years in practice. Conclusions for pharmaceutical marketers and the implications for future research efforts are discussed.

Dopamine-beta-hydroxylase inhibitors, feeding and locomotor activity: reinstatement of feeding following central norepinephrine.

The effects of two dopamine-beta-hydroxylase (DBH) inhibitors, FLA-63 and fusaric acid (FA) on feeding behaviour and locomotor activity were examined. In Experiment 1 activity was measured over 7 hr in 48 rats treated with FLA-63 (0, 1.25, 2.50, 5.00 mg/kg) or FA (0, 20.0, 40.0, 80.0 mg/kg). While FA produced no significant effect on activity, FLA-63 produced an increase at the highest doses. In Experiment 2 the same doses of the two DBH inhibitors were administered to 48 rats and food intake over 7 hr was measured; both FA and FLA-63 produced decreases in food intake. In a third experiment, rats were stereotaxically implanted with microinjection guide cannulae extending to the ventromedial hypothalamus and, following peripheral treatment with either 5.0 mg/kg FLA-63, 40 mg/kg FA, or their respective vehicles were injected centrally with morphine (5.3 nmoles in 0.5 microliter), norepinephrine (NE; 60 nmoles in 0.5 microliter for the FLA-63 pre-treated group and 30 nmoles in 0.5 microliter for the FA pre-treated group) or saline. Central NE was found to reinstate feeding only in the hr following injection in both groups, while morphine reinstated feeding only in the FA group and only in the third hr following injection. Results support the involvement of hypothalamic NE in feeding.

Anaesthetic emergency service at three hospitals--a decade of change.

The results of a 6-week survey of anaesthetic emergency work completed in 1978 are compared with those from an earlier survey in 1967. Three hospitals sampled, an undergraduate teaching hospital, a district general hospital and a specialized paediatric hospital. At all three hospitals emergency workload increased relative to the population served, with intensive therapy accounting for much of the extra demand. The consequences for the provision of an anaesthetic service are discussed.

Continuous epidural infusion of bupivacaine in labour: a simple method.

Thirty patients were given a constant epidural infusion in labour by gravity feed drip of approximately 10 ml of 0.25% bupivacaine per hr. The infusion proved a simple and reliable method of ensuring adequate analgesia throughout labour. There were no problems of drug toxicity and the incidence of complications and side effects was comparable to a previous series using intermittent 0.5% bupivacaine.