Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department.

OBJECTIVES: To examine the use of buprenorphine for the treatment of opioid withdrawal (OW) in an emergency department (ED) setting. METHODS: The medical records of all adult patients who presented to the study ED during a 10 week period for OW were abstracted. Subjects were categorized as receiving buprenorphine, symptomatic treatment or no pharmacologic treatment for their OW. The three groups were compared by patient and service characteristics, withdrawal symptoms and outcomes. RESULTS: Of the 11,019 patients who presented to the ED during the 10 week study period, 158 (1.4%) were eligible. Subjects were more likely to receive buprenorphine (56%) compared to symptomatic treatment only (26%) or no pharmacologic treatment (18%). Subjects who received buprenorphine were more likely to have a history of suicide ideation (34% versus 12% p<0.05) compared to subjects who received symptomatic treatment(s) and were less likely to present with a gastrointestinal complaint (9% versus 25% p<0.05). Subjects who received buprenorphine were less likely to return to the same ED within 30 days for a drug-related visit (8%) compared to those who received symptomatic treatment (17%) (p<0.05). CONCLUSIONS: Buprenorphine was a common treatment for OW in this ED without any documented adverse outcomes. Given that it did not result in an increase in drug-related return ED visits and its proven efficacy in other settings, a prospective evaluation of its potential value to ED patients who present with OW is warranted.

Comparison of two concentrations of amphotericin B bladder irrigation in the treatment of funguria in patients with indwelling urinary catheters.

The efficacy of amphotericin B bladder irrigation at two concentrations was studied. Patients with funguria (> or =15,000 colony-forming units of yeast per milliliter of urine), an indwelling urinary catheter, and a physician order for amphotericin B continuous bladder irrigation were randomly assigned to receive 10 or 50 mg of amphotericin B per liter of sterile water as a continuous irrigation for 72 hours at the rate of 42 mL/hr. Before the bladder irrigation began, the indwelling catheter was changed to a three-way catheter. Repeat urine cultures were performed 24 hours after the irrigation was discontinued. A total of 28 patients were enrolled from November 1993 to May 1995. The rate of eradication of the infection was 100% in the 50-mg/L group and 67% in the 10-mg/ L group. Subject enrollment was stopped prematurely because all the treatment failures occurred in the 10-mg/L group. Dose was the only variable significantly associated with outcome. Bladder irrigation with amphotericin B was more effective when the drug concentration was 50 mg/L rather than 10 mg/L.

The influence of storage conditions on film characteristics of Ektaspeed plus and Ultra-speed films.

BACKGROUND: Dental professionals were reluctant to accept Ektaspeed (Eastman Kodak Co.) intraoral film despite its X-radiation dose-sparing advantages for patients. One reason may have been Ektaspeed film's known sensitivity to long-term storage as compared with that of Ultra-speed film (Eastman Kodak Co.). In 1995, Kodak replaced Ektaspeed with Ektaspeed Plus, claiming it had better resolution and higher stability than Ektaspeed, as well as equal exposure radiation. The authors compared film response to storage condition and time for Ultra-speed and Ektaspeed Plus films. METHODS: The authors stored 10 boxes of newly produced Ultra-speed and Ektaspeed Plus film in five locations. They conducted 23 image trials over a 26-month period, exposing each film with an aluminum step-wedge under controlled conditions. After processing the film, they measured density to calculate the film's base + fog and contrast index values. RESULTS: The authors found significant differences in film type (P = .0002), processing status (P < .0001), storage location (P < .0001) and month of storage (P < .0001). They also found a film-type-by-location interaction (P < .0001) but did not find a film-type-by-processing interaction (P = .3271). Regression lines suggested that the optical density of base + fog levels rose more steeply for Ultra-speed film than they did for Ektaspeed Plus film. A significant association of decreasing contrast with increasing months of storage was seen with Ultra-speed film (P < .0001). There was a small increase in base + fog levels resulting from the use of used solutions over the course of the study. CONCLUSIONS: Ektaspeed Plus film compared favorably with Ultra-speed film under all conditions. CLINICAL IMPLICATIONS: The authors recommend the use of Ektaspeed Plus film for intraoral imaging, as its performance is comparable to that of Ultra-speed film while requiring half the X-radiation exposure to patients. Clinicians must ensure that the correct safelights and processing solutions are used before switching to the new film.

A contemporary perspective on pharmacy's traditional strengths.

OBJECTIVE: To present a framework for recognizing, appreciating, and applying the specific skills used during the processes of medication order screening and therapy monitoring in daily practice. SUMMARY: The health care system in which the profession of pharmacy serves is undergoing significant change. The profession is continually reacting to this change. Recently these reactions have included a shift in focus from the medication order processing skills all pharmacists possess to such things as medication prescribing, clinical pathway development, and formulary management. Although some of these activities have merit, we believe that the disregard of pharmacy's traditional strengths applied to medication order processing may damage both patient care and the system in which we practice. Renewed focus must be applied to the development of practice models that include the application of unique pharmacist skills (e.g., optimizing drug doses, safety, routes of administration, and compliance) as integral components. Variances in knowledge and training among pharmacists may result in differences in the level of service provided to a given patient. However, all pharmacists are equipped to provide unique professional services at a level that has demonstrable impact on patient care. CONCLUSION: Pharmacists are uniquely skilled in ensuring the safe and effective use of medications. The authors believe that the specific skills applied during the processes of medication order screening and therapy monitoring can and should be incorporated into daily practice. Failure to do so will deprive patients of optimal care and pharmacists of professional satisfaction. We encourage pharmacists to recognize and develop their unique, traditional strengths, and subsequently allow these strengths to provide the health benefits for which they were intended.

Analytical design of iron golf club heads.

This paper describes an analytical method for the design of iron golf club heads. The method divides the club head into the basic shape and the back-weighting. The basic shape, which consists of the club face profile, hosel and club face-hosel blend section, is configured directly from geometric specifications. An adaptive random search optimization algorithm is employed to design the back-weighting to obtain desired mass properties for the club head. The designer has control of the general configuration of the back-weighting through the method of geometric influencing. Several dynamically equivalent iron club heads are presented that were designed using this method.

Does the cycle of rerestoration lead to larger restorations?

The common practice of rerestoring teeth has been termed the "cycle of rerestoration." Some researchers and clinicians have speculated that this cycle results in teeth receiving progressively larger restorations. In this study involving 1,337 decisions to replace existing restorations in posterior teeth, the authors noted that 70 percent of all recommendations resulted in an increased number of restored surfaces. This observed increase in restoration size raises questions about the effects of the rerestoration cycle on the health of a tooth and suggests that practitioners should attempt to avoid premature rerestoration since it could hasten the cycle.

Teaching radiographic localization in dental schools in the United States and Canada.

Although radiographic localization is an essential element of the practices of radiography and radiology, its incorporation into the dental curriculum has not previously been studied. This project surveyed dental schools in the United States and Canada on the relative amount of time that was given to instruction in various localization techniques and instructor opinion of the adequacy of training in localization skills. Ninety-eight percent of all dental schools returned questionnaires. Respondents who felt that teaching time was inadequate had mean rank time scores that were 40% less for total localization instruction and 57% less for teaching anatomic clues of the Buccal Object Rule than those who felt that teaching time was adequate. Because the Buccal Object Rule, cues, and cues represent the definitive dose-reducing approach to radiographic localization and because the Buccal Object Rule is readily applied across a broad range of clinical disciplines and activities, we recommend that this concept be incorporated into the curricula of all dental schools.

Comparing E- and D-speed film: the effects of various storage conditions on fogging.

Despite the reduced radiation exposure documented with E-speed film use, many clinicians still prefer D-speed radiographic film. The authors tested various storage factors and found that E-speed film is more sensitive to these variables than D-speed film.

Multiple recurrence of oral erythema multiforme after secondary herpes simplex: report of case and review of literature.

Reviewed are the causes, diagnosis, and treatment methods of oral erythema multiforme. The relationship between herpes simplex virus and erythema multiforme is discussed, and the role of the dentist in the diagnosis and management is emphasized.