The use of opioids and laxatives, and incidence of constipation, in patients requiring neck-of-femur (NOF) surgery: a pilot study.

BACKGROUND AND OBJECTIVE: Constipation is one of the most frequent adverse drug reactions occurring in hospital inpatients. There is no evidence base for the use of laxatives in orthopaedic patients on opioids. The aim of the study was to determine the current nature of opioid and laxative prescribing, and the incidence of constipation in patients who require emergency neck-of-femur (NOF) surgery. METHODS: Patients admitted to the Royal Liverpool Hospital for emergency surgery for fractured NOF over an 8-week period in 2007 were included in the study. All opioid and laxative prescribing was recorded, alongside the incidence of constipation, nutritional status and mobility. RESULTS: During the study period, 46 patients were eligible for inclusion. All patients received opioid analgesics. Constipation occurred in 33 patients (71.7%). Prophylactic laxatives were prescribed in 20 (43%) patients, 12 of whom developed constipation. Of the 26 (57%) patients not prescribed prophylaxis, 21 developed constipation (chi(2) = 2.3, P < 0.1 NS). Constipated patients were older (86 years vs. 76 years) (U = 112.5, P < 0.05), and had poorer nutritional status (2/13 vs. 16/33) (chi(2) = 4.28, P < 0.05), than patients without constipation. CONCLUSIONS: This study demonstrates that age and nutritional status are significant factors influencing the occurrence of constipation, though the prophylactic use of laxatives did not alleviate the incidence of constipation. There is a clinical need to develop a robust evidence base surrounding the best management of constipation in this vulnerable group of orthopaedic patients.

Athletes' knowledge and views on OTC medication.

A questionnaire was administered to elite athletes from Australia, Canada, the UK, and the USA representing 10 Olympic sports in order to explore knowledge and understanding of over-the-counter (OTC) medication since the removal of many of these substances from the World Anti-Doping Agency (WADA) Prohibited List, in 2004. Athletes demonstrated limited knowledge and understanding. Around half (50.5 %) knew the penalty incurred following a doping violation involving a banned OTC stimulant. The terms Monitoring Program and Specified Substance List were understood by 43.3 % and 67.5 % of respondents, respectively. Overall, the status of substances in relation to the Prohibited List was correctly identified in just 35.1 % of cases. As a whole, athletes were of the opinion that OTC stimulants posed a risk to health, were performance enhancing and that their use was against the spirit of sport. They were undecided as to whether these drugs should be returned to the Prohibited List. Elite athletes require targeted education programmes that will enable them to make informed decisions on the potential of OTC medications for therapeutic or performance enhancing purposes.

Water-soluble precursors of beef flavour: I. Effect of diet and breed.

The effects of diet and breed on the concentration of water-soluble flavour precursors, namely sugars, free amino acids, ribonucleotides, creatinine, carnosine and creatine, were studied in beef longissimus lumborum muscle. Diet had a significant effect on the concentration of free amino acids, with animals fed on grass silage having higher free amino acid levels than animals fed on a concentrate diet, whereas animals fed concentrates had a higher total reducing sugar content. Differences between a beef breed (Aberdeen Angus×Holstein-Friesian) and a dairy breed (Holstein-Friesian) were generally small.

Water-soluble precursors of beef flavour. Part II: Effect of post-mortem conditioning.

Changes in glycolytic metabolites, nucleotide degradation products, free amino acids and other amino compounds were monitored in beef muscle (M. longissimus lumborum), stored for 21days at 4°C, in order to evaluate how post-mortem conditioning may affect flavour formation in beef. The major effects observed in sugar-related substances were the dephosphorylation of the phosphates of glucose, fructose and mannose, to yield their free sugars, as well as the breakdown of inosine 5'-monophosphate, to give a sixfold increase in ribose. Total reducing sugars increased by only 15% during conditioning, while glycogen levels remained unchanged from 2days post-slaughter. Free amino acids increased during conditioning, particularly between days 7 and 14. Phenylalanine, methionine, lysine, leucine and isoleucine were the amino acids showing the greatest increase with conditioning time, with methionine, in particular, showing a sevenfold increase during the conditioning period. The effects of these precursor changes on cooked beef flavour are discussed.

Adverse drug reactions in hospital in-patients: a pilot study.

BACKGROUND: About 6.5% of admissions to hospital are related to an adverse drug reaction (ADR). There are no recent large studies, which explore the burden of ADRs on hospital in-patients. The aim of this pilot study was to assess the feasibility of, and establish the methodology for, conducting a large prospective study to fully assess the impact of ADRs on in-patients and the National Health Service (NHS). METHODS: Patients admitted to five wards in a university hospital over a 2-week period were assessed for ADRs through a daily ward visit by a pharmacist. Suspected ADRs were analysed for causality, severity and avoidability using appropriate scales. RESULTS: Twenty-four of 125 patients (19.2%, 95% CI 12-26%) were categorized as having suffered one or more ADRs. A total of 27 ADRs were identified. Patients with ADRs spent longer in hospital than those without ADRs. Causality assessment showed that 17 (63%) ADRs were possibly drug-related, whereas 10 (37%) were classified as probably or definitely related to the drug. Almost two-thirds of reactions were potentially avoidable. Intervention was required in all ADRs and reactions indirectly contributed to the death of two patients. CONCLUSIONS: Almost one-fifth of patients suffered an ADR as an inpatient. Methodology tested using this pilot will enable the design of a larger study, involving over 3000 patients, which will allow the ADR burden and vulnerable patient groups, to be more accurately characterized. This study will aid the development of interventions to reduce the impact of ADRs in hospital in-patients.

A study of the management of erectile dysfunction in general practice.

BACKGROUND AND OBJECTIVES: The Department of Health issued guidelines for the NHS treatment of erectile dysfunction (ED) with phosphodiesterase type 5 inhibitors (PDE 5 inhibitors) in 1999. There has been an increasing trend in the prescribing of PDE 5 inhibitors within Bebington and West Wirral Primary Care Trust (PCT) over the 3-year period from February 2001 to January 2004. The objective of the study was to investigate implementation of Government guidelines on prescribing of PDE 5 inhibitors for ED and the cost of prescribing outside these guidelines. METHODS: Practice data were collected for all patients prescribed a PDE 5 inhibitor in 16 surgeries within Bebington and West Wirral Primary Care Trust, from November 2002 to December 2003. The data were evaluated with respect to adherence to UK Government guidelines. Analysis was made on the cost to the PCT with respect to treatment provided outside the guidelines. RESULTS AND DISCUSSION: Prescribing for 78% of patients was within Government guidelines. With respect to frequency of prescribing, 89% of patients in the PCT received less than or equal to the recommended frequency of one tablet per week. The percentage range for practices was 67-100%. The cost to the PCT for PDE 5 inhibitor treatment provided outside the guidelines was 19,060 pounds sterling over the period of study. CONCLUSION: Prescribers generally follow Government guidelines, however, stricter adherence to guidelines could result in more efficient use of National Health Service resources.

A comparison of the aroma volatiles and fatty acid compositions of grilled beef muscle from Aberdeen Angus and Holstein-Friesian steers fed diets based on silage or concentrates.

This paper compares the volatile compound and fatty acid compositions of grilled beef from Aberdeen Angus and Holstein-Friesian steers slaughtered at 14 months, each breed fed from 6 months on either cereal-based concentrates or grass silage. Linoleic acid levels were higher in the muscle of concentrates-fed animals, which in the cooked meat resulted in increased levels of several compounds formed from linoleic acid decomposition. Levels of α-linolenic acid, and hence some volatile compounds derived from this fatty acid, were higher in the meat from the silage-fed steers. 1-Octen-3-ol, hexanal, 2-pentylfuran, trimethylamine, cis- and trans-2-octene and 4,5-dimethyl-2-pentyl-3-oxazoline were over 3 times higher in the steaks from the concentrates-fed steers, while grass-derived 1-phytene was present at much higher levels in the beef from the silage-fed steers. Only slight effects of breed were observed.

Over-the-counter drug use amongst athletes and non-athletes.

AIM: Many over-the-counter (OTC) drugs used in the symptomatic relief of upper respiratory tract (URT) conditions are banned by sports governing bodies. It would appear therefore that athletes are being penalised for practising conventional pharmacological methods in the management of common ailments. The aim was to identify any differences between athletes and non-athletes and amongst athletic groups, with respect to the prevalence of URT conditions and the use of OTC drugs to treat such conditions. METHODS: Questionnaires were distributed at domestic and international athletics meetings and at university lectures and tutorials. Respondents (n=401) represented both track and field athletes (n=199) and non-athletes (n=202). RESULTS: No differences were found between athletes and non-athletes and between elite and non-elite athletes in terms of the frequency of episodes of URT conditions reported in the previous year. A higher proportion of elite, as opposed to non-elite athletes did not take OTC medicines (p=0.028) and of those that did take OTC medicines a higher proportion of elite athletes (68%) as opposed to non-elite (32%) took those not containing sympathomimetics, banned by the International Olympic Committee (IOC). Athletes were found to have greater knowledge of IOC banned OTC drugs (p=0.002) and within this group, elite athletes were most knowledgeable (p=0.0003). Although most respondents (81%) believed that OTC drugs should not be prohibited in sport, athletes made up the greatest proportion in support of prohibition (23.5% as opposed to 14.4% of non-athletes) with elite as opposed to non-elite most in favour (p=0.0181). CONCLUSION: These results suggest that URT conditions are no more prevalent between athletes and non-athletes or between endurance and power athletes. Athletes competing at the highest level tended to avoid OTC medicines or those containing IOC banned drugs and were most knowledgeable in terms of banned OTC drugs and most in favour of their prohibition suggesting that the control mechanisms in place are only reaching elite athletes.

Physiological, subjective and performance effects of pseudoephedrine and phenylpropanolamine during endurance running exercise.

The aim of the study was to assess the effect of maximal therapeutic dosing of sympathomimetic amines found in over-the-counter (OTC) decongestant preparations on endurance running. Following familiarisation and a graded exercise test to determine maximal oxygen uptake (VO2 max), trained male runners (n = 8) completed four exercise sessions each separated by a minimum of one week. Each session was comprised of 20 min of sub-maximal treadmill running (70 % VO2 max) followed by a 5,000-m time trial on the treadmill under drug, placebo or control conditions. Drugs were administered in their commercial format over the 36-hour period prior to testing in the manufacturer's recommended maximal doses (i. e. 25 mg of phenylpropanolamine and 60 mg of pseudoephedrine four times daily). During sub-maximal endurance running no statistical differences were observed in heart rate, VO2, minute ventilation, respiratory exchange ratio, blood lactate, glucose or non-esterified fatty acids (NEFA) or ratings of perceived exertion with respect to the treatment administered. Similarly there were no statistical differences according to the condition during the 5,000-m running time trial, in terms of heart rate, ratings of perceived exertion, time of completion and pre and post exercise blood lactate, glucose or NEFA. The results indicate that in maximal, multiple therapeutic doses both pseudoephedrine or phenylpropanolamine as present in common OTC decongestant formulations do not affect, nor possess any ergogenic properties with regard to, endurance running.

Modelling the effect of fatty acids in odour development of cooked meat in vitro: part I-sensory perception.

We have investigated the contribution of muscle components to the development of cooked meat odour in an aqueous model system using trained taste panels. Reaction mixtures were prepared with oleic, linoleic and linolenic acids with or without cysteine and ribose in a buffer with or without ferrous sulphate. Odour profiles were assessed and triangular tests were used to determine the ability of panellists to discriminate between mixtures. The presence of sugar and amino acid was highly detectable by panellists independently of the fatty acid considered (P<0.001). However, the presence of C18:3 made differences more obvious between mixtures than the presence of C18:1 or C18:2. 'Meaty' notes were only associated with cysteine and ribose. 'Fishy' notes were only apparent in C18:3 mixtures with or without sugar and amino acid, although the presence of cysteine and ribose decreased the perception. The addition of Fe(++), a pro-oxidant present in the muscle, produced a reduction in the score of the attributes although the pattern was the same as when Fe was not used in the mixtures. Only 'fishy' notes that were exclusively perceived in C18:3 mixtures showed a higher score in the presence of iron. Iron also produced a better discrimination in C18:3 mixtures, which were closely related to 'grassy' notes in the presence of cysteine and ribose.

Sensory and chemical investigations on the effect of oven cooking on warmed-over flavour development in chicken meat.

Descriptive sensory profiling was carried out to evaluate the effect of oven-cooking temperature (160, 170, 180, 190 °C) on warmed-over flavour (WOF) development in cooked, chill-stored (at 4 °C for 0, 1, 2 and 4 days) and reheated chicken patties, derived from M. pectoralis major. In addition, gas chromatography-mass spectrometry (GC-MS) was carried out on a representative sub-set (160, 180, 190(o)C, stored at 4 °C for 0, 1, 4 days) of the meat samples used in sensory profiling. The effects of cooking and WOF in the sensory and chemical data were analysed using multivariate ANOVA-Partial Least Squares Regression (APLSR). Descriptive profiling indicated that WOF development was described by an increase of 'rancid' and 'sulphur/rubber' sensory notes and a concurrent decrease of chicken 'meaty' characteristics. Increasing cooking temperature resulted in meat samples with a more 'roasted', 'toasted' and 'bitter' sensory nature. Moreover, the 'roasted' character of the meat samples was also related to WOF development. Analysis of the volatile compounds from the chicken patties showed a rapid development of lipid oxidation derived compounds with chill-storage. Such compounds most likely contributed to the 'rancid' aspect of WOF development. Moreover, changes in sulphur-containing compounds were also related to WOF development and were proposed as additional participants in the lipid oxidation reactions. The sensory effects of these compounds were mainly described by the 'sulphur/rubber' note associated with WOF development. Overall, cooking temperature was found to increase the formation of Maillard-derived compounds, however, these did not appear to inhibit WOF development in the chicken patties.

A comparison of headspace entrainment on Tenax with solid phase microextraction for the analysis of the aroma volatiles of cooked beef.

Headspace solid phase microextraction (SPME), using a Carboxen-polydimethylsiloxane fiber, was compared with headspace entrainment on Tenax TA, as a means of examining the aroma constituents of cooked beef. Extracts were analyzed using gas chromatography-mass spectrometry. Headspace entrainment on Tenax extracted higher amounts of most volatiles, particularly low-boiling compounds. However, polar volatiles, such as hydroxyfuranones and hydroxyketones, were present at higher levels in the SPME extracts. Some components were present only in the SPME extracts, including norfuraneol, furaneol, and cyclotene, which are key Maillard reaction intermediates.

Flavor-protein binding: disulfide interchange reactions between ovalbumin and volatile disulfides.

The irreversible binding of selected sulfur-containing flavor compounds to proteins was investigated in aqueous solutions containing ovalbumin and a mixture of disulfides (diethyl, dipropyl, dibutyl, diallyl, and 2-furfuryl methyl) using solid-phase micro-extraction (SPME). In systems which had not been heated, the recovery of disulfides from the headspace above the protein at the native pH (6.7) was similar to that from an aqueous blank. However, significant losses were observed when the pH of the solution was increased to 8.0. When the protein was denatured by heating, much greater losses were observed and some free thiols were produced. In similar heat-denatured systems at pH 2.0, no losses of disulfides were observed. Disulfides containing allyl or furfuryl groups were more reactive than saturated alkyl disulfides. Interchange reactions between protein sulfhydryl groups and the disulfides are believed to be responsible for the loss of the disulfides.

Heterocyclic volatiles formed by heating cysteine or hydrogen sulfide with 4-hydroxy-5-methyl-3(2H)-furanone at pH 6.5.

The reaction of 4-hydroxy-5-methyl-3(2H)-furanone (HMF) with cysteine or hydrogen sulfide at pH 6.5 for 60 min at 140 degrees C produced complex mixtures of volatile compounds, the majority of these containing either sulfur or nitrogen. Of the 68 compounds detected, 63 were identified, some tentatively, by GC-MS. Among the identified compounds were thiophenes (10), thiophenones (6), thienothiophenes (5), thiazoles (5), trithiolanes (4), pyrazines (6), and oxazoles (4). More compounds were produced in the reaction of HMF with cysteine (63) than were formed in the reaction with hydrogen sulfide (33). In both systems, thiophenones were major reaction products, accounting for 25-36% of the total volatiles formed. Possible reasons for the differences in the composition of the two systems are discussed. The contributions of these reactions, and their products, to the flavor of heated foods are considered.

Attitudes and knowledge of hospital pharmacists to adverse drug reaction reporting.

AIMS: To investigate the attitudes of UK hospital pharmacists towards, and their understanding, of adverse drug reaction (ADR) reporting. METHODS: A postal questionnaire survey of 600 randomly selected hospital pharmacists was conducted. RESULTS: The response rate was 53.7% (n = 322). A total of 217 Yellow Cards had been submitted to the CSM/MCA by 78 (25.6%) of those responding. Half of those responding felt that ADR reporting should be compulsory and over three-quarters felt it was a professional obligation. However, almost half were unclear as to what should be reported, while the time available in clinical practice and time taken to complete forms were deemed to be major deterrents to reporting. Pharmacists were not dissuaded from reporting by the need to consult a medical colleague or by the absence of a fee. Education and training had a significant influence on pharmacists' participation in the Yellow Card Scheme. CONCLUSIONS: Pharmacists have a reasonable knowledge and are supportive of the Yellow Card spontaneous ADR reporting scheme. However, education and training will be important in maintaining and increasing ADR reports from pharmacists.

Two-fibre solid-phase microextraction combined with gas chromatography-mass spectrometry for the analysis of volatile aroma compounds in cooked pork.

The volatile aroma compounds in cooked pork were examined using solid-phase microextraction (SPME). Two SPME fibres coated with different stationary phases were used simultaneously to collect aroma compounds from the headspace above the pork. One fibre was coated with 75 microm. Carboxen-polydimethylsiloxane and the other was coated with 50/30 microm divinylbenzene-Carboxen on polydimethylsiloxane. After extraction, the two fibres were desorbed in the injection port of a gas chromatograph sequentially, so that the aroma compounds from both of the fibres could be analysed in one gas chromatogram. This procedure resulted in a chromatogram containing a more complete aroma profile for cooked pork than the chromatograms from either of the fibres on their own. Thirty-six compounds were identified in cooked pork for the first

The contribution of Penicillium aurantiogriseum to the volatile composition and sensory quality of dry fermented sausages.

An atoxygenic, proteolytic and lipolytic strain of Penicillium aurantiogriseum was tested for its ability to accelerate the production of volatile compounds and to improve the sensory properties of dry fermented sausages. The following batches of sausages were prepared: control; superficially inoculated with a spore suspension; added with an intracellular cell free extract; and superficially inoculated and added with the intracellular cell free extract. Higher levels of lipid oxidation products were found in the aroma extracts of sausages without a mould cover. In contrast, branched aldehydes and alcohols presented higher concentrations in superficially inoculated and extract added sausages, while esters only showed higher concentration in the first ones. The sensory analysis showed that sausages prepared with both treatments received the highest scores in all the properties evaluated, which demonstrated both the potential of this mould as producer of volatile compounds and the effectiveness of combining both treatments.

Adverse drug reactions as a cause of admission to an acute medical assessment unit: a pilot study.

BACKGROUND: In this pilot study, we have investigated the frequency of adverse drug reaction (ADR)-related admissions to an acute medical assessment unit. Although ADRs are thought to be responsible for 5% of hospital admissions, there have been no recent studies in the U.K. OBJECTIVE: To pilot such a study for estimating the incidence of ADR-related admissions to an acute medical assessment unit. METHOD: Data were collected for 200 patients including details of concurrent illness, drug usage and reasons for admission. ADRs were assessed for causality using two previously published classification systems. RESULTS: ADRs were responsible for admission in 15 (7.5%) patients, were present in an additional three (1.5%) patients and may have contributed to the deaths of two (1%) patients. Of the 15 ADRs suspected of causing an admission, three were considered to be 'possible' or 'unlikely', with the remaining 12 considered to be 'probable' or 'certain'. The proportion of patients identified in this study with ADR-related admissions is either similar to or larger than that found in comparable studies carried out in other hospitals. Nearly all ADRs were Type A reactions in that they were predictable and therefore potentially preventable. CONCLUSION: This study suggests that the proportion of ADR-related admissions has not decreased in the last decade and, given the increasing numbers of acute medical admissions, the absolute numbers may have actually increased. Furthermore, the nature of drugs causing admissions has not changed substantially over the last 20 years. Strategies to reduce the burden of ADR-related admissions are urgently needed.

Sensory and instrumental analyses of volatiles generated during the extrusion cooking of oat flours.

Three batches of oats were extruded under four combinations of process temperature (150 or 180 degrees C) and process moisture (14. 5 and 18%). Two of the extrudates were evaluated by a sensory panel, and three were analyzed by GC-MS. Maillard reaction products, such as pyrazines, pyrroles, furans, and sulfur-containing compounds, were found in the most severely processed extrudates (high-temperature, low-moisture). These extrudates were also described by the assessors as having toasted cereal attributes. Lipid degradation products, such as alkanals, 2-alkenals, and 2, 4-alkadienals, were found at much higher levels in the extrudates of the oat flour that had been debranned. It contained lower protein and fiber levels than the others and showed increased lipase activity. Extrudates from these samples also had significantly lower levels of Maillard reaction products that correlated, in the sensory analysis, with terms such as stale oil and oatmeal. Linoleic acid was added to a fourth oat flour to simulate the result of increased lipase activity, and GC-MS analysis showed both an increase in lipid degradation products and a decrease in Maillard reaction products.