Misuse and dependence of dimenhydrinate: A mixed studies systematic review.

BACKGROUND: Dimenhydrinate (DMH) is an antihistamine used to treat nausea and vomiting. Although widely available in pharmacies as an over the counter medication, there have been reports of potential DMH tolerance and dependence and a possible euphoric potential accompanying heavy use (>100 mg/day). Despite the potential for misuse, there is a gap in the literature concerning patterns, characteristics, and potential mechanisms of DMH misuse. AIMS: This review aimed to synthesize evidence on the pharmacology, clinical effects, and management of DMH misuse and dependence to inform clinical decision making and relevant drug policy. METHODS: We conducted a systematic review in accordance with the PRISMA guidelines and using Cochrane collaboration methods. We searched seven databases from their inception through July 2019. To be included in the review, studies needed to measure or focus on one or more dimensions of morbidity or mortality related to the misuse of DMH. Quantitative, qualitative and mixed-method studies were included in order to capture the breadth of possible studies. Studies were excluded if they did not fit into the conceptual framework of the study of if they focused primarily on the misuse of other substances. A narrative synthesis of study findings was pursued given the limited capacity for a quantitative meta-analysis. FINDINGS: We identified 24 studies, which described a range of neuropsychiatric sequelae related to DMH consumption, including seizures, psychosis, depression, intoxication (resembling anticholinergic syndrome) and withdrawal. The sedative and euphoric properties, readily available nature, and low cost of DMH appear to facilitate DMH dependence, which were more commonly reported among individuals who had concurrent psychiatric disorders, displaying symptoms such as low motivation, poor concentration, and delirium. The overall quality of studies identified by this review was low-largely because the majority of studies were case reports or review articles, with few intervention or cohort studies. CONCLUSIONS: There is some evidence to suggest the existence of DMH-related syndromes involving intoxication, withdrawal, and dependence, more commonly among long-term, heavy DMH consumers. However, higher quality studies are needed to confirm preliminary findings that there may be a biological basis for such syndromes.

"Undressing" distress among cancer patients living in urban, regional, and remote locations in Western Australia.

PURPOSE: People diagnosed with cancer from rural and remote locations may experience heightened distress because of distance from cancer treatment and support services. We examined whether remoteness and other factors are associated with psychosocial distress and explored commonly reported problems among cancer patients in Western Australia (WA). METHODS: In a cross-sectional study, cancer patients newly referred to a Cancer Council WA Cancer Support Coordinator (CSC) were screened and assessed using the Distress Thermometer (DT) and Problem List (PL) and a standardized form, respectively. The index of remoteness was the Australian Standard Geographical Classification. The association between remoteness, demographic variables, and the frequency of problems endorsed on the PL was analyzed using bivariate analyses and a generalized linear mixed model (GLMM) regression. RESULTS: Of 1032 patients referred to a CSC, 466 were screened (45.2 %) with complete data available for 441 patients. Patients from remote areas reported fewer problems than patients from urban and regional locations. Increasing remoteness was not associated with higher distress (r = -0.04, p = 0.43). Concerns reported differed by remoteness category and included worry, sadness, fears, finances, transportation, and physical symptoms. More emotional problems were independently associated with higher distress (ß = 0.47, p < 0.001), explaining 17.31 % of the variance. CONCLUSIONS: There is no evidence that increasing remoteness is associated with higher distress. Emotional concerns and physical problems appear to be prevalent among cancer patients irrespective of urban or rural location. Specific concerns detected by distress screening, particularly emotional concerns, may warrant further assessment and targeted referrals.

Symmetry of hind limb mechanics in orthopedically normal trotting Labrador Retrievers.

OBJECTIVE: To evaluate symmetry of the hind limbs in orthopedically normal trotting dogs. Animals-19 orthopedically normal Labrador Retrievers with no history of lameness. PROCEDURES: Retroreflective markers were applied to the hind limb joints, and a 4-camera kinematic system captured positional data at 200 Hz in tandem with force platform data collection while the dogs trotted. Morphometric data were combined with kinematic and force data in an inverse dynamics method to calculate net joint moments and powers at the joints as well as total support moment for each limb. Dogs were identified as right or left dominant when their total support moment was > 10% asymmetric between sides. RESULTS: 10 of the 19 dogs were mechanically dominant in the right hind limb as determined by their total support moments. One dog was left dominant, and the remaining 8 were symmetric. Right-dominant dogs had larger net joint moments at the right hip, tarsal, and metatarsophalangeal joints and a smaller moment at the right stifle joint, compared with values for the left hind limb. The 1 left-dominant dog had the exact opposite findings. Hip and stifle joint moments and powers varied between limbs of the right-dominant and left-dominant groups in the timing of their transition from negative to positive, and power amplitudes varied at the hip, tarsal, and metatarsophalangeal joints but not the stifle joint. CONCLUSIONS AND CLINICAL RELEVANCE: Sound trotting dogs can have asymmetries in limb and joint mechanics. These natural mechanical asymmetries should be taken into account when considering models to evaluate stresses at joints and when considering surgery for cruciate ligament rupture.