Effect of coercive measures on treatment outcome in involuntarily admitted patients in Amsterdam.

Objective: The prevalence of involuntary admissions rose the last forty years in European countries, including the Netherlands. Involuntary admissions result in seclusion, physical restraint and forced medication in approximately 40% of patients. We looked at whether treatment outcomes differ in patients with and without coercive measures. Methods: Using The Health of the Nation Outcome Scales (HoNOS) to measure treatment outcomes, we studied the files of 786 patients admitted involuntarily to an Amsterdam clinic. We applied Generalised Linear Models to determine whether the use, or not, of coercive measures during treatment was associated with a difference in outcomes. Results: 19% of the cohort were secluded in a High Security Room (HSR); 24% were secluded in their own room and/or received forced medication. After adjustment for the influence of diagnosis, disorder severity (initial HoNOS score) and treatment duration, the HSR group had, on average, a HoNOS difference score that was 2.4 points lower than patients without coercive measures (CI -4.0 to -0.8.; p 0.003). In the seclusion in own room group, this score was 2.6 points lower (CI -4.0 to -1.1; p 0.001), corresponding to an effect size of 0.35 and 0.40, respectively. Conclusion: Seclusion, whether or not in combination with forced medication, was applied to two-fifths of patients. The HoNOS scores of the group without coercion improved by nearly two and a half points more on average than those of the two groups with coercion. A causal relationship between coercion and treatment outcome could neither be confirmed nor excluded on the basis of our results.

[Differences in the prevalence of acute involuntary admissions between Apeldoorn, Rotterdam and Amsterdam]. / Prevalentie van acute onvrijwillige opnames in Apeldoorn, Rotterdam en Amsterdam.

BACKGROUND: There are regional differences in the Netherlands in the numbers of emergency compulsory admissions (Inbewaringstelling: IBS). We looked at three 24/7 facilities to investigate the relationships between patient and consultation characteristics on the one hand, and numbers of emergency compulsory admissions on the other, against the background of the level of urbanisation. METHOD: We compared emergency consultations in 18-64 year olds in Apeldoorn, Amsterdam and Rotterdam between 2012 and 2016 in terms of socio-demographic, procedural and clinical characteristics, and in terms of outcome. We used the Severity of Psychiatric Illness Scale (SPI) to determine disorder severity. RESULTS: Apeldoorn had as many consultations per 100,000 inhabitants as the highly urbanised city of Rotterdam. GPs there referred 68% of patients, compared with 25% in Amsterdam and 50% in Rotterdam. In Apeldoorn, 17% of the patients were psychotic, compared with 35% in the other regions. In addition, 66% of the patients there had a low SPI score, compared with 40% in the large cities. Amsterdam and Rotterdam had 3.5 times higher risk of emergency compulsory admissions as Apeldoorn. After adjustment for socio-demographic, procedural and clinical characteristics, this difference with Apeldoorn was 1.5 for Amsterdam and 2.6 for Rotterdam. SPI score and psychotic disorder were found to be the most important predictors of IBS admission. CONCLUSION: Differences in consultation numbers, referral patterns and the location of consultations indicate that there are regional differences in the position of the 24/7 facility in the mental health care system. The numbers of emergency compulsory emissions were related in part to the level of urbanisation and the associated epidemiological differences but probably also to differences in the position of the crisis facility in the mental health care system. Differences in admission numbers were primarily linked to differences in diagnostic characteristics and disorder severity and, to a lesser extent, to referral patterns and socio-demographic characteristics. However, these variables did not explain all the observed inter-regional differences.

From CdSe Nanoplatelets to Quantum Rings by Thermochemical Edge Reconfiguration.

The variation in the shape of colloidal semiconductor nanocrystals (NCs) remains intriguing. This interest goes beyond crystallography as the shape of the NC determines its energy levels and optoelectronic properties. While thermodynamic arguments point to a few or just a single shape(s), terminated by the most stable crystal facets, a remarkable variation in NC shape has been reported for many different compounds. For instance, for the well-studied case of CdSe, close-to-spherical quantum dots, rods, two-dimensional nanoplatelets, and quantum rings have been reported. Here, we report how two-dimensional CdSe nanoplatelets reshape into quantum rings. We monitor the reshaping in real time by combining atomically resolved structural characterization with optical absorption and photoluminescence spectroscopy. We observe that CdSe units leave the vertical sides of the edges and recrystallize on the top and bottom edges of the nanoplatelets, resulting in a thickening of the rims. The formation of a central hole, rendering the shape into a ring, only occurs at a more elevated temperature.

Engineering a Robust Flat Band in III-V Semiconductor Heterostructures.

Electron states in semiconductor materials can be modified by quantum confinement. Adding to semiconductor heterostructures the concept of lateral geometry offers the possibility to further tailor the electronic band structure with the creation of unique flat bands. Using block copolymer lithography, we describe the design, fabrication, and characterization of multiorbital bands in a honeycomb In0.53Ga0.47As/InP heterostructure quantum well with a lattice constant of 21 nm. Thanks to an optimized surface quality, scanning tunnelling spectroscopy reveals the existence of a strong resonance localized between the lattice sites, signature of a p-orbital flat band. Together with theoretical computations, the impact of the nanopatterning imperfections on the band structure is examined. We show that the flat band is protected against the lateral and vertical disorder, making this industry-standard system particularly attractive for the study of exotic phases of matter.

Photobiomodulation therapy reduces postoperative pain after third molar extractions: A randomized clinical trial.

BACKGROUND: To assess the efficacy of PBMT on reducing postoperative pain scores in patients submitted to third molar extractions. MATERIAL AND METHODS: A randomized controlled trial (ReBEC:RBR-94BCKZ) was designed according to the SPIRIT and followed the CONSORT. Patients were randomly allocated according to control or PBMT groups. PBMT consisted of the application of GaAlAs laser (808nm;50mW) applied in six points (1.23 min;11 J/cm2) after extraction. Pain scores were assessed using the Visual Analogue Scale (VAS) in millimeters evaluated after 6 (T6), 24 (T24), and 48 (T48) hours. The Wilcoxon Mann-Whitney test was used to check for possible associations between VAS scores and treatment groups. RESULTS: A total of 101 third molar extractions were performed in 44 patients. The mean age was 28 years old(SD±11.54). Comparing control and intervention, PBMT group showed a significant effect on the reduction of postoperative pain at T6(mean VAS=0.9; C.I:0.63-1.16) compared to control (mean VAS=2.5;C.I:2.1-2.88)(p<0.001). The same statistically significant effect on the reduction of postoperative pain was observed at T24 (PBMT mean VAS=0.72;C.I:0.51-0.93; control mean VAS=2.86;C.I:2.40-3.31;p<0.001) and T48 (PBMT mean VAS=0.64;C.I:0.36-0.92; control mean VAS=2.86;C.I:2.37-3.34;p<0.001). CONCLUSIONS: PBMT significantly reduce the postoperative pain scores when assessed 6, 24, and 48 hours after third molar extractions.

[Suspects with mentally confused behaviour in an Amsterdam police cell; better cooperation between psychiatrist and public prosecutor]. / Verdachten met verward gedrag in Amsterdamse politiecel; betere samenwerking tussen psychiater en officier van justitie.

BACKGROUND: Over the past decade, shocking incidents have driven a debate about how to handle persons exhibiting mentally confused behaviour who commit crimes. In response, Amsterdam launched a pilot project in 2017 to improve collaboration between the judicial system and mental health services at police stations to achieve a more appropriate rapport between criminal justice and care. AIM: To describe the pilot project and it's initial results. METHOD: We describe the establishment of the pilot project, as well as the results of an initial evaluation of the characteristics of the incoming persons and the handling of the arrests. In a separate experiment we evaluated how information about the results of a psychiatric consultation affected decisions about the handling of cases by the public prosecutor's department. RESULTS: While respecting legal constraints, it proved possible to exchange information between the public prosecutor's department and the mental health care system. In one-third of the cases, the public prosecutor adapted the decision about the handling of the case after being informed about the psychiatrist's assessment. Four-fifths of the incoming persons were male and only one-third lived in Amsterdam. One-third had a psychotic disorder and more than one-third a substance-related disorder. Compulsory admissions were ordered for 15% of the suspects who were assessed. After assessment, both treatment and penalties were ordered for one-third. CONCLUSION: The professionals involved thought the new approach was positive. However, it is still too early to draw any conclusions about the effects. The unusual profile of the cohort makes it clear that the police, the judicial system, the mental health care system and municipal organisations are faced with a complex challenge in their efforts to reduce the number of incidents with confused suspects on the long term. Further research is required in order to determine the social and psychiatric characteristics that predict recurring contacts with the police.

[Social isolation, source of income and healthcare consumption for psychiatric patients with and without severe mental illness]. / Sociaal isolement en ggz-gebruik bij patiënten met een ernstige psychische aandoening.

BACKGROUND: The more severe the psychiatric illness the more patients are dependent on social support and informal care. However, research showed that patients with severe mental illness (smi) have smaller networks than healthy controls.
AIM: To examine the relationship between network size and perceived social support on the one hand and healthcare consumption on the other.
METHOD: A group of 252 patients who got a crisis consultation in Amsterdam, was divided into patients with and without smi on the basis of two years of observation. Mental healthcare consumption was then measured over a period of three years. Bi- and multivariate analyses were used to determine which variables predict levels of mental healthcare consumption.
RESULTS: Both patient groups did not show any change in level of care consumption during the three follow-up years. In both smi patients and other patients, mental healthcare consumption increased with smaller network size (or 0,85; 95% ci 0,75-0,96). Patients with smi showed a more than threefold higher care consumption compared to non-smi patients (or 3.19; 95% ci 1.82-5.61) independent of network size and living situation.
CONCLUSION: smi patients live in conditions that undermine self-reliance: they have a small social network, they often live alone and they usually depend on welfare benefits. They also consume considerably more care than patients with milder disorders and this level of consumption did not decline during the three years of follow-up. A development of new social interventions will be needed to make this patient group more self-reliant and less dependent on care.

Triangular nanoperforation and band engineering of InGaAs quantum wells: a lithographic route toward Dirac cones in III-V semiconductors.

The design of two-dimensional periodic structures at the nanoscale has renewed attention for band structure engineering. Here, we investigate the nanoperforation of InGaAs quantum wells epitaxially grown on InP substrates using high-resolution e-beam lithography and highly plasma based dry etching. We report on the fabrication of a honeycomb structure with an effective lattice constant down to 23 nm by realising triangular antidot lattice with an ultimate periodicity of 40 nm in a 10 nm thick InGaAs quantum well on a p-type InP. The quality of the honeycomb structures is discussed in detail, and calculations show the possibility to measure Dirac physics in these type of samples. Based on the statistical analysis of the fluctuations in pore size and periodicity, calculations of the band structure are performed to assess the robustness of the Dirac cones with respect to distortions of the honeycomb lattice.

Diagnosing the Internal Architecture of Zeolite Ferrierite.

Large crystals of zeolite ferrierite (FER) are important model systems for spatially resolved catalysis and diffusion studies, though there is considerable variation in crystal habit depending on the chemical composition and employed synthesis conditions. A synergistic combination of techniques has been applied, including single crystal X-ray diffraction, high-temperature in situ confocal fluorescence microscopy, fluorescent probe molecules, wide-field microscopy and atomic force microscopy to unravel the internal architecture of three distinct FER zeolites. Pyrolyzed template species can be used as markers for the 8-membered ring direction as they are trapped in the terraced roof of the FER crystals. This happens as the materials grow in a layer-by-layer, defect-free manner normal to the large crystal surface, and leads to a facile method to diagnose the pore system orientation, which avoids tedious single crystal X-ray diffraction experiments.

[Intensive follow-on care does not prevent a repeat compulsory admission; a prospective cohort study with a 5-year follow-up]. / Intensieve nazorg voorkomt BOPZ-heropname niet.

OBJECTIVE: To explore the relationship between psychiatric care consumption after a compulsory admission and the probability of a repeat compulsory admission. DESIGN: Prospective cohort study with a 5-year follow-up. METHOD: Mental health care consumption was registered for 460 patients admitted compulsorily under the Dutch Psychiatric Care (Compulsory Admissions) Act by the Amsterdam Emergency Psychiatry service between 15 September 2004 and 14 September 2006, with socio-demographic and clinical data as independent variables. RESULTS: There was no repeat compulsory admission in 63% of the cohort. The odds ratio for repeat compulsory admission only decreased in the fourth year (odds ratio (OR) 0.64; 95% CI 0.45-0.92). Repeat compulsory admission was associated with high treatment continuity (χ2 p ≤ 0.001) and a high level of care consumption during the follow-up period (χ2 p ≤ 0.001). Compulsory admission was predicted on the basis of: high care consumption in the five years prior to inclusion (OR 2.61; 1.44-4.73), aged younger than 35 years at outset (OR 1.65; 1.08-2.52), living alone at the time of inclusion (OR 1.68; 1.22-2.33), and a history of compulsory admission (OR 1.56; 1.03-2.35). CONCLUSION: Two-thirds of the patients were not re-admitted compulsorily. The probability of a repeat admission of this kind fell only after four years. Patients who underwent a repeat compulsory admission proved to be the ones who had been treated most intensively, yet this intense treatment did not prevent a higher probability of readmission. When not taking the quality and nature of care and social integration of patients into account, attempts to reduce treatment dropout on the one hand and more intense treatments on the other may not have an effect on reducing the probability of a repeat compulsory admission.

Complications associated with the treatment of fractures of the dentate portion of the mandible in paediatric patients: a systematic review.

This study aimed to answer the following question: What is the best treatment option for fractures of the dentate portion of the mandible in paediatric patients when considering the occurrence of postoperative complications? A systematic literature review was done using the PubMed, Scopus, and Cochrane Library databases, and 1186 articles on the topic were found. Twelve of these articles were included in the final review after the full texts had been read. A sample of 178 paediatric patients was obtained. In the six cases in which treatment was surgery with titanium plate fixation, there were no postoperative complications, whereas in the 141 cases in which treatment was surgery with biodegradable plates, there were 12 postoperative complications, and in the 31 cases in which treatment was non-surgical, there were three postoperative complications. A connection between the best treatment and the number of postoperative complications in fractures of the dentate portion of the mandible in paediatric patients could not be established; however, the occurrence of postoperative complications was low for both surgical and non-surgical treatments.

Autogenous non-vascularized bone graft in segmental mandibular reconstruction: a systematic review.

The restoration of mandibular bone defects with non-vascularized bone grafts depends on the diagnosis, anatomical site, extent of the defect, and the patient's age, as well as the surgeon's experience. The aim of this study was to perform a systematic literature review on mandibular reconstruction for segmental mandibular bone defects using non-vascularized bone grafts to answer the following question: Is there scientific evidence to support the use of this technique? The initial literature search in PubMed, Scopus, and Cochrane databases identified 862 articles. Of these, 25 were included in the final review. These articles encompassed 926 procedures with non-vascularized bone grafts; 76.1% were from the iliac crest. Benign tumours were the major cause of these defects (56.8%), and 44.7% of defects were located in the lateral mandibular area. Although this technique showed a high occurrence of complications (290 in 873 patients, some with more than one complication), these did not account for treatment failure. The restoration of bone defects due to malignant tumours treated with radiation therapy had lower success rates, and these appear to be a contraindication for the technique. Although standardized randomized controlled clinical studies are needed to obtain better clinical evidence for treatment choices in general, the use of non-vascularized bone grafts for mandibular reconstruction showed an 87.6% success rate in this review.

Avian influenza in Australia: a summary of 5 years of wild bird surveillance.

BACKGROUND: Avian influenza viruses (AIVs) are found worldwide in numerous bird species, causing significant disease in gallinaceous poultry and occasionally other species. Surveillance of wild bird reservoirs provides an opportunity to add to the understanding of the epidemiology of AIVs. METHODS: This study examined key findings from the National Avian Influenza Wild Bird Surveillance Program over a 5-year period (July 2007-June 2012), the main source of information on AIVs circulating in Australia. RESULTS: The overall proportion of birds that tested positive for influenza A via PCR was 1.9 ± 0.1%, with evidence of widespread exposure of Australian wild birds to most low pathogenic avian influenza (LPAI) subtypes (H1-13, H16). LPAI H5 subtypes were found to be dominant and widespread during this 5-year period. CONCLUSION: Given Australia's isolation, both geographically and ecologically, it is important for Australia not to assume that the epidemiology of AIV from other geographic regions applies here. Despite all previous highly pathogenic avian influenza outbreaks in Australian poultry being attributed to H7 subtypes, widespread detection of H5 subtypes in wild birds may represent an ongoing risk to the Australian poultry industry.

Are long-term psychiatric patients causing more crisis consultations outside office hours in mental health care?

BACKGROUND: As well as an improvement in community services, the de-institutionalization of patients receiving long-term psychiatric care can lead to marginally staffed mental health services, more homelessness, rising admission rates and more people in prison cells. It is assumed that an imbalance between community and hospital care for chronic patients puts pressure on crisis services. AIMS: In this study, the central question is whether patients receiving long-term psychiatric care in Amsterdam do indeed put pressure on the city's emergency mental health services. We compare the pressure exerted by this group with the pressure resulting from the use of these services by all registered patients. METHODS: Data were taken from the client registration systems of three mental health organizations in Amsterdam in the period from 2000 to 2004. Inclusion criteria for long-term psychiatric patients were age above 19 years and uninterrupted receipt of mental health care for a minimum of two successive years. RESULTS: Annually, 6%-8% of all non-long-term patients experienced a crisis outside office hours in the period under investigation; this was 4%-6% for long-term patients. The non-long-term patients accounted for 83% of crisis contacts outside office hours over the entire study period, with long-term patients accounting for 17%. CONCLUSIONS: The assumption that crises are more prevalent in long-term patients in the community seems to be an example of stigmatization rather than an observation based on fact.

[Emergency compulsory admission in crisis situations; the Amsterdam Study of Acute Psychiatry]. / Inbewaringstelling als uitkomst; de Amsterdam Study of Acute Psychiatry.

BACKGROUND: This article presents initial data from the Amsterdam Study of Acute Psychiatry (ASAP) which investigated the factors that play a role in the decision to admit a patient compulsorily to a psychiatric clinic in the Amsterdam area. AIM: To find out how socio-demographic factors, a patient's psychiatric history and pathway to care influence a patient's chance of being served with an emergency compulsory admission order during emergency consultation. METHODS: We conducted a prospective cohort study of 1970 consecutive patients who consecutively came into contact with the Psychiatric Emergency Service Amsterdam (PESA) in the period September 2004 to September 2006. RESULTS: A patient who had been admitted compulsorily once in the previous five years ran an increased risk of compulsorily admission (or 3.9). Referral by the police or by the mental health services also implied a high risk of a compulsorily admission (or 2.2 and or 2.6 respectively). CONCLUSION: A previous compulsorily admission and referral by the police or mental health services were found to be predictors of emergency compulsory admission, irrespective of possible danger to the patient himself and others and irrespective of the patient's lack of motivation for treatment.

Crisis intervention and acute psychiatry in Amsterdam, 20 years of change: a historical comparison of consultations in 1983 and 2004-2005.

AIM: There has been a striking increase in the number of compulsory admission proceedings in the Netherlands since 1992, to such an extent that treatment in Amsterdam's psychiatric clinics is in danger of being dominated by coercive treatment. Our aim was to establish a picture of the changes in emergency psychiatry that have contributed to the increase in the number of acute compulsory admissions. METHODS: A cohort (N = 460) of psychiatric emergency consultations with the city crisis service in 1983 was compared with a similar cohort (N = 436) in 2004-2005. The study focused on the following variables: patient characteristics, crisis-service procedures and consultation outcomes. RESULTS: Compared with 1983, there are now more services involved in crisis support in the public domain for psychiatric patients. The number of patients referred by the police has risen from 29% to 63%. In 1983, all consultations took place where the patients were located; at present, 60% take place at the crisis service premises. The number of psychotic patients in the cohort has increased from 52.0% and 63.3 %. There has been an increase in the proportion of compulsory admissions and a sharp decrease in the proportion of voluntary admissions from 61% to 28% of all admissions. Overall, the percentage of consultations leading to a psychiatric admission has fallen from 42% to 27%. CONCLUSION: The front-line outreach service of 1983 has changed into a specialist psychiatric emergency department with a less pronounced outreach component. Voluntary admissions to psychiatric hospitals have almost disappeared as a feature of the crisis service.

[Changes in crisis intervention and emergency psychiatry, Amsterdam emergency consultations in 1983 and 2005]. / Veranderingen in crisisinterventie en acute psychiatrie; Amsterdamse consulten in 1983 en 2005.

BACKGROUND: Since 1992 The Netherlands has seen a striking increase in the number of compulsory admissions. There is a danger that coercion will become the dominant form of treatment in the Amsterdam clinics. AIM: To build up a picture of the changes in emergency psychiatry which have contributed to the increase in the number of acute compulsory admissions. METHOD: A cohort (n = 460) of consultations conducted by the city crisis service in 1983 was compared with a similar cohort (n = 436) of consultations conducted in 2004-2005 based on the following variables: crisis-service procedures, patient characteristics, diagnosis and consultation outcomes. RESULTS: In 2003-2004 more services were involved with psychiatric patients in acute situations in the public domain than were involved in 1983. The number of patients referred by the police almost doubled, rising from 29.3 to 62.7%. In 1983 all consultations took place where the patients were located; in 2004-2005 60% took place at the premises of the crisis service. The number of psychotic patients in the cohort rose from 52 to 63.3%. There was a rise in the number of compulsory admissions (from 16.7 to 20%) and a sharp decline in voluntary admissions (from 25.7 to 7.6%). The total number of admissions following a consultation decreased from 42 to 28%. CONCLUSIONS: The front-line outreach service of 1983 has been transformed into a specialist psychiatric emergency department with only a modest outreach component. Voluntary admissions via the consultation service have almost ceased. Further research is needed into the characteristics of the consultations and into the variables that play a role in the use of compulsion in emergency psychiatry.

Marginal adaptation and microleakage of five root-end filling materials: an in vitro study.

AIM: Endodontic surgery consists of several procedures which involve the endodontic space or the root canal and is performed as an alternative to unsuccessful outcomes or complications following endodontic treatments. The aim of the study was to evaluate the sealing ability of five root-end filling materials. METHODS: Fifty human single rooted teeth were treated endodontically; roots were resected at 3 mm from the apex, and root end cavities were prepared with ultrasonic tips. Root ends were filled with one of the following materials: silver amalgam (control group); mineral trioxide aggregate; white Portland cement; Vitremer; and Fuji Ortho. Apical sealing was evaluated by evaluating microleakage of 50% silver nitrate solution. The apical portion of the roots was sectioned to obtain 1-mm thick transversal slices, and epoxy resin replicas of these apical slices were produced. A scanning electron microscope (SEM) was used for analyses. The Kruskal-Wallis test and a multiple comparisons test were used for statistical data analysis. RESULTS: Results showed microleakage and variable adaptation gaps on the interface between dentin and root-end filling material in all specimens. CONCLUSION: All the studied materials exhibited some degree of apical microleakage and marginal gaps. No correlation was found between data obtained from analyses of apical sealing and marginal adaptation.

Characterization of Epstein-Barr virus-infected B cells in patients with posttransplantation lymphoproliferative disease: disappearance after rituximab therapy does not predict clinical response.

Post-transplantation lymphoproliferative disease (PTLD) is associated with Epstein-Barr virus (EBV). Quantitative and qualitative differences in EBV in peripheral blood mononuclear cells (PBMCs) of PTLD patients and healthy controls were characterized. A quantitative competitive polymerase chain reaction (QC-PCR) technique confirmed previous reports that EBV load in PBMCs is increased in patients with PTLD in comparison with healthy seropositive controls (18 539 vs 335 per 10(6) PBMCs, P =.0002). The average frequency of EBV-infected cells was also increased (271 vs 9 per 10(6) PBMCs, P =.008). The distribution in numbers of viral genome copies per cell was assessed by means of QC-PCR at dilutions of PBMCs. There was no difference between PTLD patients and healthy controls. Similarly, no differences in the patterns of viral gene expression were detected between patients and controls. Finally, the impact of therapy on viral load was analyzed. Patients with a past history of PTLD who were disease-free (after chemotherapy or withdrawal of immunosuppression) at the time of testing showed viral loads that overlapped with those of healthy seropositive controls. Patients treated with rituximab showed an almost immediate and dramatic decline in viral loads. This decline occurred even in patients whose PTLD progressed during therapy. These results suggest that the increased EBV load in PBMCs of PTLD patients can be accounted for by an increase in the number of infected B cells in the blood. However, in terms of viral copy number per cell and pattern of viral gene expression, these B cells are similar to those found in healthy controls. Disappearance of viral load with rituximab therapy confirms the localization of viral genomes in PBMCs to B cells. However, the lack of relationship between the change in viral load and clinical response highlights the difference between EBV-infected PBMCs and neoplastic cells in PTLD.

Current status of food animal antidotes.

The availability of antidotes in veterinary medicine has been an issue for more than a decade. Antidotes are available for food animals through extralabel use, regulatory discretion, and compounding. There is little economic incentive for pharmaceutical companies to pursue approval of antidotes and other drug products that have a small market. In addition, human food safety concerns must be addressed when approving antidotes for use in food animals. This article provides a brief history of antidote availability, current mechanisms for procuring food animal antidotes, and availability of specific antidotes for use in food animals.