A systematic review of psychological interventions for excessive alcohol consumption among people with psychotic disorders.

OBJECTIVE: Excessive alcohol consumption is common among people with psychotic disorders. While there is an extensive literature on the efficacy of psychological treatments for excessive drinking, few studies have examined interventions addressing this issue among people with psychotic disorders. METHOD: Systematic searches in PubMed and PsycINFO were conducted to identify randomized controlled trials comparing manual-guided psychological interventions for excessive alcohol consumption among individuals with psychotic disorders. Of the 429 articles identified, seven met inclusion criteria. Data were extracted from each study regarding study sample characteristics, design, results, clinical significance of alcohol consumption results, and methodological limitations. RESULTS: Assessment interviews, brief motivational interventions, and lengthier cognitive behavior therapy have been associated with reductions in alcohol consumption among people with psychosis. While brief interventions (i.e. 1-2 sessions) were generally as effective as longer duration psychological interventions (i.e. 10 sessions) for reducing alcohol consumption, longer interventions provided additional benefits for depression, functioning, and other alcohol outcomes. CONCLUSION: Excessive alcohol consumption among people with psychotic disorders is responsive to psychological interventions. It is imperative that such approaches are integrated within standard care for people with psychosis.

Attitudes and perceptions towards substances among people with mental disorders: a systematic review.

OBJECTIVE: To develop effective interventions for people with coexisting mental disorders (MD) and substance use, it may be beneficial to understand their attitudes and perceptions of substances. METHOD: A systematic literature search regarding attitudes and perceptions towards tobacco, alcohol or cannabis among people with MD was conducted. Studies' methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Twenty-one papers were included in the review and found to have generally low methodological quality. Papers investigated reasons for substance use, substance use expectancies, substances' perceived effects and reasons for quitting. People with psychotic disorders reported using substances primarily for relaxation and pleasure. Among people with mood disorders, alcohol was used primarily for social motives and tobacco for negative affect reduction. CONCLUSION: For substance use interventions among people with MD to be more effective, it may be necessary to tailor interventions specifically for this population and customize by substance type. Gaps in the literature regarding attitudes and perceptions towards substance use among people with MD were identified, which future research should aim to address. These include designing and conducting methodologically rigorous research, investigating perceived harmfulness and knowledge of substances, and broadening recruitment of participants to include people with MD other than psychosis.

Equipment and instrumentation for ultrasound-assisted lipoplasty.

Ultrasound energy has been applied in many areas of medicine for some time, but ultrasound energy, equipment, and instrumentation for liposuction are new to plastic surgeons. The technique and equipment differ in many ways from suction-assisted lipoplasty and practitioners of ultrasound-assisted lipoplasty must gain a thorough understanding of the physical principles, the equipment, the limits, and the potential problems before using this technique. Basic components of all systems include a generator, connecting cable, vacuum pump, and activation control. Some units also require the use of a skin protection.

Anatomic basis and clinical implications for nasal tip support in open versus closed rhinoplasty.

Successful rhinoplasty depends on nasal tip support and its influence on nasal tip projection. The factors involved in nasal tip support are numerous; however, the role of the anterior septum versus the lower lateral cartilages has been debated in the literature. The purpose of this study was to quantitate, using fresh cadavers, the critical elements for nasal tip support with open versus closed rhinoplasty techniques. Multiple nasal manipulations, including cephalic trim, cephalic trim and interruption of the lower lateral cartilages, dorsal hump resection (1 to 4 mm), submucous resection of the septum, and complete septal removal, were performed using fresh cadaver heads and using both the open and closed rhinoplasty approach. Changes in nasal tip support were recorded. In comparing similar procedures, the mean loss of tip projection for the open approach was 3.43 mm versus 1.98 mm for the closed approach (p < 0.001). There was a significantly larger loss of tip projection in open versus closed procedures for cephalic trim, cephalic trim and interruption of the lower lateral cartilages, and cephalic trim with interruption of the lower lateral cartilages and septum removal (p < 0.001, 0.001, and 0.001, respectively). We attributed the differences between the open and closed approaches to the increases in ligamentous disruption and skin undermining that occur when using the open approach. Septum manipulation in general resulted in larger losses in tip support in both the open and closed approach. We conclude that the open approach for rhinoplasty results in a significantly increased loss of tip projection when compared with the closed technique due to the larger disruption of ligamentous support. Contrary to previous data, septal manipulation resulted in significant losses of tip projection, most likely secondary to lowering the nasal septal angle, and this effect may be more significant in closed rhinoplasty. The apparent clinical implications are that active measures, such as columellar struts and/or suture techniques for adding or maintaining nasal tip support during rhinoplasty, are indicated, especially when using the open approach and when any anterior septal alteration is performed using the open or endonasal approach.

Stability of sterile aqueous epinephrine injections submitted by U.S. hospitals.

The stability of sterile aqueous epinephrine injections stored in hospital pharmacies across the United States was studied. Through a voluntary drug stability program, FDA selected 254 samples of epinephrine injection submitted by hospital pharmacies. The samples were analyzed for strength, identification, d-isomer content, related impurities, pH, total acidity, and physical condition. Of the 254 samples tested, 23 samples did not meet USP requirements for epinephrine strength. Four of these samples were still within their expiration dates and seven had no expiration dates, indicating they were manufactured before 1975. An additional 19 samples did not meet USP requirements for total acidity. Some samples were found to be racemic; it appears that the racemic mixture originates from using d,l-epinephrine as the starting material rather than from racemization during shelf-life. Epinephrine injections obtained from hospital pharmacies appear to be stable within their expiration dates.

Systematic error associated with apparatus 2 of the USP dissolution test III: limitations of calibrators and the USP suitability test.

The calibrator tablets now used in the USP suitability test do not reveal common sources of systematic error associated with Apparatus 2. When the apparatus was operated under conditions near or beyond USP tolerances, changes in the results of the USP calibrators were slight, whereas those of several samples of commercial prednisone tablets were significant. Thus, the USP calibrators and requirements do not guarantee suitability of the equipment for general dissolution testing of drug products.