bluuebunny/crossref_metadata_2025 huggingface dataset:
Les leçons de l'arrêt «Melkunie». (Cour de Justice des Communautés Européennes, 6 juin 1984)
Authors: Seynave René Lucien
Published: February 2018

By its Judgment in the Melkunie case, the Court of Justice confirms its caselaw laid down in «Cassis de Dijon» holding that any measure taken to prevent the import of goods legally produced in a Member State would constitute a measure having an equivalent effect to a quantitative restriction (prohibited by Article 30 of the Treaty of Rome).

Nevertheless, if there is no harmonisation of laws as provided for under Article 100, the Member States may rely upon Article 36 in order to enact health standards based on national microbiological criteria. However, if these measures are taken for the health protection of humans, and failing any other efficient means, they must be necessary, taken in good faith and technically well founded. They may take into account particular national consumer habits but they must remain subject to judicial review (National and European).
Les premières interventions d'Henri Bouley à l’Académie de Médecine : sur l'utilité des sétons
Authors: Jacquet Jean
Published: February 2018

First interventions of H. Bouley in the french academy of medicine about efficacy of setons

A main and long controversy was in the French Academy of Medicine in 1855, after a communication of Bouvier. Malgaigne found that too many surgeons employed too many setons without sure efficacy. He asked to know when they were useful and when they were useless. H. Bouley just elected and U. Leblanc spoke about the domestic animals. But, the most frequent subject of discussion was the ancient authors, specially Hippocrate, proving these texts were still in the medical actuality.
Enquête sérologique sur la fréquence en France des anticorps anti-K 88, anti-K 99, anti-987 P, anti-F 41 d’Escherichia coli chez les truies
Authors: Renault Lucien , Le Bourhis Elizabeth
Published: February 2018

Devant les difficultés d'isolement des souches d’Escherichia coli, pourvues d'antigènes d’attachement différents des K88, les auteurs présentent les résultats d'une enquête sérologique concernant 200 truies environ, de 13 élevages différents.

41,8 % des truies possèdent des anticorps anti-K 88, 59,5 % anti-K 99, 78 % anti-987 P et 62,5 % anti-F 41, dont 87,5 % vis-à-vis de plusieurs pili.

Après discussion sur l’importance respective de ces anticorps et de leur répartition à l'intérieur d'un même élevage et pour un même animal, les auteurs concluent sur la preuve de l'existence en France de souches entérotoxinogènes pourvues de nouveaux pili et sur l'intérêt de leur incorporation dans les vaccins destinés à lutter contre la colibacillose des porcelets nouveau-nés.
La maladie de Teschen-Talfan en France
Authors: Métianu Tibérius
Published: February 2018

Etude critique sur l'historique, l'évolution, les manifestations de la maladie de Teschen et la maladie de Talfan, en France et dans le monde. Description détaillée de la morphologie, de la composition, du pouvoir pathogène, de la sérologie du virus, ainsi que des manifestations cliniques, de l'histopathologie et de l'épizootologie de ces deux maladies. Introduction du nom de «la maladie de Teschen-Talfan» dans la nouvelle classification, pour définir les formes cliniques et épizootologiques intermédiaires, entre la maladie de Teschen et la maladie de Talfan.
Electrophorèse des protéines et lipoprotéines sériques chez des chèvres laitières. Modification avec l’état d'entretien
Authors: Fiocre B. , Jeziorny F. , Groulade Paul
Published: February 2018

Electrophoretic patterns of proteins and lipoproteins coming from sera of milch goats

Variations in relationship with the state of maintenance

The study is related to 45 alpin strain goats, two to six years old. Modifications are seen onto animals with parasitic disorders and bad condition of maintenance. They show a level of albumin associated with an elevation of gamma globulin. Pregnancy and abortion doesnt plays any role.
A propos d’un cas de toxico-pathologie chez des souris de laboratoire
Authors: Maurin-Blanchet Henri
Published: February 2018

La pathologie, chez l’animal de laboratoire, s’exprime souvent de manière originale.

L’auteur relate un incident survenu au sein d’une imité animale d’élevage de souris de laboratoire.

De nombreux cas de mortalité sont constatés chez des souris de sexe mâle appartenant à la lignée consanguine CBA ; les animaux malades, surtout des mâles, présentent une paralysie du train postérieur. Par précaution, les souris de cette lignée ont été sacrifiées.

Parallèlement à une recherche d’éventuels agents infectieux, cause de l’épizootie, une enquête portant sur les circonstances de l’incident montre que, par erreur, des animaux ont été préalablement euthanasiés dans le local à l’aide de vapeurs de chloroforme, produit hautement toxique, pour le sexe mâle de la souche en question. Les autres lignées de souris n’ont pas été affectées. Les lésions histologiques ont confirmé l’origine toxique de l’affection, dont la gravité est directement liée au génotype de la souche concernée.
Multiplication des Salmonella dans la viande hachée. Conclusions générales
Authors: Catsaras Marc , Grébot D.
Published: February 2018

Les résultats d’une large expérimentation portant sur l’inoculation de Salmonella (typhimurium , enteritidis, paratyphi B, senftenberg) dans des échantillons sélectionnés de viande hachée de bovin, sont analysés dans leur ensemble.

La multiplication des Salmonella à +6°C est mise en évidence.

La recherche des Salmonella dans 10 g, 1 g et 0,1 g conduit à chiffrer les résultats faussement négatifs à 7,01 % des cas (68 tubes sur 960). Les conséquences sur la doctrine de recherche des Salmonella sont analysées. Le cas des toxi-infections alimentaires est envisagé.
Problèmes du développement. Point de vue de la Banque Mondiale
Authors: Crosnier Jacques
Published: February 2018

World development problems the viewpoint of the world bank.

The World Bank is playing a vital role in world development to help resume the economic growth of developing countries. After a recession period which hit all the regions, but in various degrees, the World Bank provides assistance for foreign capital input and restructuration of their economy. But only a long-term development plan can provide the necessary economic growth. Africa, interalia, because of its slow economic recovery, will receive loans for structural adjustment and for key sectors such as agriculture, population and nutrition, and training. One of the key problem to be solved is the external debt of the developing countries which reaches one trillion dollars. So far, the World Bank has financed 1,850 projects amounting 115.4 billions dollars which requires the lending amounts of about 17 billions dollars each year and 500 man/years annually for projects supervision.
Apport de la cytologie au diagnostic, au pronostic et au suivi thérapeutique du mastocytome chez le chien
Authors: Legrand J. J. , Carlier Bertrand , Parodi André-Laurent
Published: February 2018

Les auteurs décrivent leur expérience de l’examen cytologique du produit d’aspiration par aiguille fine de dix-sept mastocytomes du Chien. L’utilisation de la coloration de May-Grünwald-Giemsa rapide (Diff-Quick) a toujours permis d’identifier les mastocytomes et de les distinguer des autres tumeurs cutanées. La coloration de Papanicolaou a permis de classer ces tumeurs en trois grades, identiques à ceux définis par Patnaïk par examen histologique. Dans deux cas, les examens cytologiques ont permis d’objectiver la réponse thérapeutique au traitement par la L-Asparaginase.
Apport des nouvelles biotechniques à la production des vaccins vétérinaires
Authors: Desmettre Ph.
Published: February 2018

Les biotechniques récemment développées : recombinaison génétique, synthèse peptidique, fournissent de nouvelles opportunités pour la préparation des vaccins vétérinaires destinés à la prévention des infections virales ou bactériennes et des infestations parasitaires.

Qu’il s’agisse de la préparation de vaccins «vivants », de vaccins «inactivés » ou de vaccins de «sous-unités ou purifiés », la recombinaison génétique fournit l’opportunité de produire par biosynthèse des antigènes vaccinants dont l’obtention est actuellement encore hypothéquée par leur rareté, les difficultés et coûts de leur extraction et de leur purification et les contraintes de sécurité biologique liées à leur production.

La synthèse peptidique en permettant de reproduire certains des déterminants portés par les antigènes vaccinants fournit une autre alternative pour la préparation de vaccins.

Associés à de nouveaux modes d’administration qui pourraient contribuer à accroître leur efficacité en même temps qu’à simplifier les programmes de vaccination, les vaccins du futur représenteront un nouveau progrès dans la prévention et l’éradication des maladies infectieuses et parasitaires vétérinaires.
Actinobacillose (Shigellose) du poulain. Importance de l'affection
Authors: Vaissaire Josée , Laugier Claire , Baroux Daniel , Plateau Éric , Laroche Micheline , Mirial Ginette , Coconnier M. H. , Hardy J. , Guery P.
Published: February 2018

Les auteurs décrivent 34 foyers d’Actinobacillose (Shigellose) équine étudiés pendant plus de trois ans sur des chevaux de différentes régions de France. Cette affection est due à Actinobacillus equuli mais on peut rencontrer Actinobacillus suis. Les formes classiques sont soit l’avortement chez les juments soit la septicémie et la mort chez le poulain nouveau-né avec néphrites et arthrites. Les poulains qui n’ont pas tété le colostrum sont les plus sensibles.
Modèles animaux et études des effets de la micro-435 gravité. I. Intérêt ; des modèles
Authors: Milhaud Claude
Published: February 2018

Animal models and study of microgravity effects 1. Model interest.

Mastering problems of space physiology implies the use of animal models as substitutes of man for ethical and methodological reasons as well as for operational availability.

Limits of animal models defined, arguments supporting the use of rat and primates are developped.
Relation entre les notes de plats servis en restauration collective et la notation Norecoin correspondante (étude statistique)
Authors: Catsaras Marc , Dessaint F.
Published: February 2018

Relation between the notes of dishes served in collective restauration and the norecoin notation

statistical study

The 126 quaterly Norecoin notes from 9 groups of restaurants were examined statistically in relation with the percentages of no conform cooked dishes and not satisfactory other dishes. The correlation observed permitted to build a model which explained 86 % of variations of Norecoin note.
Recherche des résidus des substances à activité hormonale dans les animaux et les viandes fraîches
Authors: Willemart Jean-Pierre , Bouffault Jean-Claude , Egron L.
Published: February 2018

Research of residues of hormonal activity substances in animals and fresh meat.

The controls conditions for residues of substances having an hormonal activity in animals and carcasses are indicated by the EEC Council Directives 85/358 and 86/469 and by the EEC Commission Decision 87/410.

The last text :

— Indicates the homologation conditions for the control technics and interpretation of analysis results.

— Gives a list of 48 substances to be controlled.

The forecast of the cost of such controls is considerably high, in order of one milliard of francs per year for french cattle flock.
Effect of fentanyl buccal tablet on pain-related anxiety: A 4-week open-label study among opioid-tolerant patients with chronic and breakthrough pain
Authors: Webster, MD Lynn R. , Messina, PharmD John , Xie, PhD Fang , Nalamachu, MD Srinivas
Published: February 2018

Objective: To evaluate the effect of fentanyl buccal tablet (FBT) on pain-related anxiety in opioid-tolerant patients with chronic pain and breakthrough pain (BTP).Design: This study consisted of a screening visit, open-label titration period, and 4-week open-label treatment period.Setting: Thirty-one US study centers.Patients: Opioid-tolerant adults with chronic, persistent pain experiencing 1-4 BTP episodes per day at baseline. Two hundred eighteen patients were enrolled in this study; 180 completed the titration period; and 169 completed the treatment period.Intervention: Patients were treated with FBT (100-800 g) for BTP episodes for 4 weeks while continuing their around-the-clock opioid regimens.Main outcome measures: Change from baseline in the Pain Anxiety Symptoms Scale (PASS) total score at the final visit.Results: Based on a mean baseline PASS total score of 82.6, study patients had a high level of anxiety; 92 patients (42 percent) had a history of anxiety disorders. The change from baseline in PASS total score was not statistically significant (mean change, −1.6; p = 0.322). Numerical improvements were reported in some secondary measures (eg, Beck Depression Inventory total score [mean change, −1.1; p = 0.038]) and categorical measures (eg, Pain Flare Treatment Satisfaction, Patient Assessment of Function, and Clinician Assessment of Patient Function ratings). FBT was generally well tolerated, with no serious adverse events related to study drug.Conclusions: Four weeks of treatment with FBT did not reduce anxiety to a clinically meaningful extent, although improvement was reported in several secondary measures of functioning. Further research is needed to assess the impact of treatment for BTP on anxiety symptoms in opioid-tolerant patients with BTP.
Who should regulate the practice of medicine?
Authors: Egan, MD, JD Erin A.
Published: February 2018

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With the withdrawal of COX-2 inhibitors, opioids are an obvious alternative choice for pain
Authors: Hutchison, PharmD Rob
Published: February 2018

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A comparison of rapid (opioid) detoxification with clonidine-assisted detoxification for heroin-dependent persons
Authors: Arnold-Reed, PhD Diane E. , Hulse, PhD Gary K.
Published: February 2018

This study compares two methods of detoxification available to heroin users in Western Australia: clonidine-assisted detoxification (CD) or clonidine-naloxonepre-cipitated withdrawal under sedation (rapid opioid detox-ification [ROD]). Oral naltrexone was made available to all participants following detoxification. Eighty heroin-dependent persons were randomly assigned to either ROD or CD. Most undertaking ROD commenced and completed this treatment. Less than one-third undertaking CD completed this treatment. There was no significant difference in those treated by CD or ROD in subjective assessment of degree or duration of pain, severity of withdrawal and craving, nor was there an increase in the withdrawal sequelae after treatment. Induction of oral naltrexone following ROD was greater, but oral naltrexone compliance levels and abstinence from heroin four weeks following detoxification were similar between ROD and CD groups. The level of patient satisfaction between the two treatments was also similar. The authors discuss why ROD is considered more effective than CD.
Pain Medicine and Management: Just the Facts
Authors: Fanciullo, MD, MS Gilbert J.
Published: February 2018

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Congratulations on the new journal
Authors: Mahon, PhD, FAAN Mimi
Published: February 2018

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The effect of tramadol or clonidine added to intraperitoneal bupivacaine on postoperative pain in total abdominal hysterectomy
Authors: Memis, MD Dilek , Turan, MD Alparslan , Karamanlioglu, MD Beyhan , Tükenmez, MD Baris , Pamukçu, MD Zafer
Published: February 2018

Recent studies suggest that intraperitoneal application of local anesthetics is useful in abdominal surgery. Tramadol and clonidine have specific effects on peripheral nerves when used alone. We aimed to evaluate the effects of intraperitoneal application of bupivacaine and the combinations of bupivacaine plus tramadol and bupivacaine plus clonidine on postoperative pain in total abdominal hysterectomy.After standard anesthetic procedure during closure of the abdomen, Group 1 (n = 20) was given 20 mL bupivacaine 0.5 percent, Group 2 (n = 20) was given 20 mL bupivacaine 0.5 percent plus 100 mg tramadol, and Group 3 (n = 20) was given 20 mL bupivacaine 0.5 percent plus 1 μg per kg clonidine, all into the peritoneal cavity. Postoperative pain was evaluated with the visual analog scale (VAS) at 30 minutes, and two, four, six, 12, and 24 hours after extubation. While patients were supine and seated, mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) values were noted. When VAS scores were 4 to 7, 0.5 mg per kg of meperidine was given intramuscularly (IM); above 7, 1 mg per kg of meperidine was given IM; and when VAS scores were 2 to 4, 500 mg acetaminophen was given orally. For evaluating quality of analgesia, rescue analgesic dose, analgesia time, and side effects were noted.The groups were similar in respect to SpO2; however, when Group 1 was compared to Groups 2 and 3 at 30 minutes, and two, four, and six hours, MAP and HR measurements were found to be significantly higher (p < 0.05). VAS values in sitting and supine positions at 30 minutes and two hours were significantly lower in Group 2 (p < 0.05) when compared to Group 1. VAS values for Group 3 at 30 minutes, and two and four hours in the supine position, and at 30 minutes and two hours in the sitting position, were found to be significantly lower than those in Group 1 (p < 0.05). There were no significant differences between Groups 2 and 3.The mean dosage of meperidine used was 76.7 ± 10.5 mg in Group 1, 63.9 ± 8.4 mg in Group 2, and 70 ± 5.2 mg in Group 3. When Group 1 was compared to Group 2, there were significant differences found (p < 0.05). First analgesic requirement time was found to be 30 (range, 30 to 30) minutes in Group 1, 120 (range, 30 to 240) minutes in Group 2, and 110 (range, 30 to 240) minutes in Group 3. There were significant differences found when Groups 2 and 3 were compared to Group 1 (p < 0.05).We concluded that the combinations of bupivacaine plus tramadol and bupivacaine plus clonidine administered intraperitoneally in total abdominal hysterectomy operations provide more effective analgesia than bupivacaine alone during the early postoperative period.
PUMP TAMPERING POSSIBLE BY PATIENTS IN OPIOID ADMINISTRATION
Authors: DeVito, Jr. Richard A.
Published: February 2018

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A Physician’s Guide to Pain and Symptom Management in Cancer Patients.
Authors: Burton, MD Allen W.
Published: February 2018

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In pain or drug-seeking? Resident continuity clinic, chronic nonmalignant pain, and addiction
Authors: Weaver, MD Michael
Published: February 2018

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Opiate replacement therapy at time of release from incarceration: Project MOD, a pilot program
Authors: McKenzie, MPH Michelle , Macalino, PhD Grace , McClung, BS Clair , Shield, BS David C. , Rich, MD, MPH Josiah D.
Published: February 2018

Approximately 7 million people in the United States are in jail, in prison, or on probation or parole, many as a result of drug-related offenses. Individuals who use opiates account for a significant minority of this population. Methadone maintenance treatment (MMT) of opiate addiction is highly effective in reducing drug use, drugrelated criminal activity, and risk of human immunodeficiency virus transmission. Recently released inmates are at particularly high risk for overdose and disease transmission. Project MOD (Managing Opioid Dependency) provides services to eliminate logistical and financial barriers to MMT entry immediately on release from incarceration. Such programs provide a promising opportunity to facilitate reentry into the community, combat disease transmission, and reduce recidivism.
Taking back your turf: Understanding the role of law in medical decision making in opioid management (Part II—Putting legal/regulatory materials to work for you)
Authors: Bolen, JD Jennifer
Published: February 2018

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Opioids: The role in headache pharmacotherapy
Authors: Hutchison, PharmD Rob
Published: February 2018

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Opioid contract use is associated with physician training level and practice specialty
Authors: Touchet, MD Bryan Keith , Yates, MD William Robert , Coon, EdD Kim Annette
Published: February 2018

Opioid contracts are widely used to manage opioid prescribing in the treatment of pain conditions, but they are not well studied. A notable gap in our knowledge of opioid contracts involves the factors that determine their use. As an initial inquiry, this study evaluated the responses of a Web-based survey of trainees and faculty in an academic medical training context to determine correlates of opioid contract use.All paid faculty, third- and fourth-year medical students, and residents in The University of Oklahoma College of Medicine were invited via email to participate in a Web-based survey of their attitudes and prescribing practices related to controlled prescription drugs. Respondents composing a subgroup of those who replied to the survey were identified by their prescription of opioids and by their designation that pain was the most likely diagnosis for which they would prescribe a controlled drug. Chi-square analysis was used to determine any correlation between contract use and respondents’ demographic variables and categorical survey responses. Analysis of variance was used to determine any correlation between contract use and survey responses that involved continuous variables. Our results showed that opioid contract use was significantly associated with resident status, primary care specialty, participant estimation of alcohol and illicit drug abuse by patients, and the participant’s assessment of the risks in general of prescribing controlled drugs. A majority of contract users reported that the use of this tool increased their sense of mastery and comfort with prescribing controlled drugs.The factors associated with opioid contract use found in this study suggest there are significant prescriber-specific determinants of the use of the tool, including training level, medical specialty, and risk appraisals. Opioid contracts’ effects on mastery and comfort of the physician with prescribing opioids suggest that they may play an important role in facilitating appropriate pain management with opioids. Further study is needed to elucidate environmental and patient-specific factors that may influence opioid contract use.
Factors associated with willingness to participate in a heroin prescription program among injection drug users
Authors: Miller, MSc Cari L. , Strathdee, PhD Steffanie A. , Kerr, PhD Thomas , Small, MA Will , Li, MSc Kathy , Wood, PhD Evan
Published: February 2018

Randomized controlled trials of prescription heroin have shown success in reducing drug-related harm among chronic opiate injection drug users (IDUs) in several European nations. We sought to explore willingness to participate in a heroin trial among a well-characterized North American cohort of IDUs, and therefore performed analyses of factors associated with willingness to participate in a prescription heroin trial among IDUs enrolled in the Vancouver Injecting Drug Users Study (VIDUS). Of 410 current heroin injectors followed between May and November 2002, injecting heroin frequently (more than once daily) [odds ratio (OR) 1.33; 95 percent confidence interval (CI) 1.06 to 1.69] and being enrolled in methadone maintenance therapy (MMT; OR 1.33, 95 percent CI 1.06 to 1.69) were associated with willingness to participate in a trial. In subanalyses, statistical associations with willingness to participate in a trial among current MMT users were frequent injection of heroin (OR 2.12, CI 1.16 to 3.88) and speedballs (OR 2.57, CI 1.02 to 6.48), frequent crack cocaine use (OR 1.84, CI 1.11 to 3.06), lending of syringes (OR 3.22, CI 1.08 to 9.65), and requiring help to inject (OR 1.83, CI 1.01 to 3.33). Among IDUs, willingness to enroll in a heroin prescription program was associated with highintensity heroin injection and high-risk behaviors and was particularly prevalent among individuals who have been unable to significantly reduce their injection drug use on MMT alone. These findings indicate that a clinical trial of prescribed heroin should be able to enroll an appropriate sample of drug users and properly assess the treatment potential of prescribed opiate pharmacotherapy.
Handbook of Pain Relief in Older Adults: An Evidence-Based Approach
Authors: Barkin, PharmD, MBA, FCP, DAPPM Robert L.
Published: February 2018

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The World Institute of Pain: Advancing research and clinical practice
Authors: Ziegler, PhD, JD Stephen J.
Published: February 2018

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Dextropropoxyphene and the cardiovascular system: About two cases of acute poisoning with cardiac conduction abnormalities
Authors: Staikowsky, MD, PhD Frédérik , Candella, MD Sébastien , Raphael, MD Maurice
Published: February 2018

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Monitoring outcomes during long-term opioid therapy for noncancer pain: Results with the Pain Assessment and Documentation Tool
Authors: Passik, PhD Steven D. , Kirsh, PhD Kenneth L. , Whitcomb, MA Laurie , Schein, PhD, MPH Jeffrey R. , Kaplan, PhD Mitchell A. , Dodd, MSc Sheri L. , Kleinman, PhD Leah , Katz, MD Nathaniel P. , Portenoy, MD Russell K.
Published: February 2018

The increasingly common practice of long-term opioid therapy for chronic noncancer pain must be guided by ongoing assessment of four types of outcomes: pain relief, function, side effects, and drug-related behaviors. Our objective was to gather initial pilot data on the clinical application of a specialized chart note, the Pain Assessment and Documentation Tool (PADT), which was developed and tested with 27 physicians. This pilot test provided the means to collect cross-sectional outcome data on a large sample of opioid-treated chronic pain patients. Each of the physician volunteers (located in a variety of settings across the United States) completed the PADT for a convenience sample of personally treated chronic pain patients who had received at least three months of opioid therapy. Completion of the PADT required a clinical interview, review of the medical chart, and direct clinical observation. Data from the PADTs were collated and analyzed. The results suggested that the majority of patients with chronic pain achieve relatively positive outcomes in the eyes of their prescribing physicians in all four relevant domains with opioid therapy. Analgesia was modest but meaningful, functionality was generally stabilized or improved, and side effects were tolerable. Potentially aberrant behaviors were common but viewed as an indicator of a problem (i.e., addiction or diversion) in only approximately 10 percent of cases. Using the PADT, physician ratings can be developed in four domains. In this sample, outcomes suggested that opioid therapy provided meaningful analgesia.
Problematic terminology for problematic drug use
Authors: Cowan, MD, BSc (Hons), PhD David
Published: February 2018

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A comparison of patient-controlled epidural pethidine vs. nurse-administered epidural pethidine for analgesia after caesarean section
Authors: Lim, MMed Yvonne , Wilson Sally , Katz, MD Steven
Published: February 2018

Patient-controlled epidural analgesia with pethidine for post-caesarean section patients has been shown to be efficacious. However, no studies to date have compared it with intermittent nurse-administered epidural pethidine. The aim of this study was to compare the analgesia efficacy, pethidine requirement, side effects, and nurses’ and patients’ satisfaction with these two techniques in postcaesarean section patients. After obtaining informed patient consent, we recruited 34 patients undergoing elective lower-segment caesarean section. A combined spinal epidural technique was used to provide anesthesia for all patients, and 50 mg pethidine was given epidurally at the end of the operation. Patients were assigned to two groups: group P (n = 17) received patient-controlled epidural analgesia with pethidine (25 mg of five mg/ml solution, lockout of 10 minutes and maximum dose of 150 mg/four hours), and group N (n = 17) received nurseadministered epidural pethidine (bolus of 50 mg and maximum dose of 50 mg/two hours) when required. We collected data at six, 12, 24, 36, and 48 hours following initiation of anesthesia. Visual analogue pain scores (median) were lower in group P than in group N, both on movement and at rest, at six, 12, 24, 36, and 48 hours postoperatively (p < 0.05). Total pethidine consumption (median) and frequency of side effects were similar in both groups. Patients in group P exhibited a trend toward earlier return to activities of daily living and care for the newborn; however, this did not reach statistical significance, and there was no difference in maternal satisfaction between the two groups. Satisfaction scores of nurses caring for patients in group P were higher than for those in group N (median 100 mm, interquartile range [IQR] 90 to 100, vs. median 90 mm, IQR 80 to 90, p < 0.05). Patient-controlled epidural analgesia with pethidine improved patients’ pain scores after caesarean section when compared with intermittent nurse-administered epidural pethidine. Regarding the mode of delivery of postoperative analgesia, we noted a higher satisfaction score among nurses caring for group P than among those caring for group N.
Effect of drug and medical treatment on wide geographic variations in repeated emergency department use by HIV-infected drug users
Authors: Turner, MD, MSEd Barbara J. , Laine, MD, MPH Christine , Kott Alan , Hauck, PhD Walter W.
Published: February 2018

Repeated (≥ two visits) emergency department (ED) visits by HIV-infected (HIV+) drug users in New York State (NYS) vary widely by region and may reflect regional inequities in receipt of needed drug treatment and medical services. The study’s objective was to evaluate receipt of drug treatment and medical care by HIV+ drug users by region and its effect on ED use. For NYS Medicaid-enrolled HIV+ drug users (N = 11,556) in 1996 and 1997, we identified receipt of long-term (≥ six months) drug treatment, HIV care, and a usual source of medical care from claims files. Regions were classified as New York City , downstate suburban, upstate urban, and rural/small city. We examined adjusted associations of these services with ≥ two ED visits in the entire cohort and separately among patients who do and do not receive these three types of services. Repeated ED visits were greatest in rural/small cities (40.7 percent) and least in New York City (24.1 percent; p < 0.001), and receipt of drug treatment was also poorest (p < 0.001) in rural/small cities, whereas receipt of HIV care and usual source of medical care varied less by region. Adjusted odds of ≥ two ED visits was increased for patients in rural/small cities (1.89 [confidence interval, 1.44 to 2.50]) vs. New York City and reduced for patents with long-term drug treatment (0.76 [confidence interval, 0.69 to 0.84]). Among persons receiving long-term drug treatment, observed regional differences in ED use largely disappeared. Regional variations in receipt of long-term drug treatment by HIV+ drug users in one state appear to contribute to large differences in ED utilization.
The ACTION study: A randomized, open-label, multicenter trial comparing once-a-day extended-release morphine sulfate capsules (AVINZA®) to twice-a-day controlled-release oxycodone hydrochloride tablets (OxyContin®) for the treatment of chronic, moderate to severe low back pain
Authors: Rauck, MD Richard L. , Bookbinder, MD Stephen A. , Bunker, MD Timothy R. , Alftine, MD Christopher D. , Ghalie, MD Richard , Negro-Vilar, MD, PhD Andres , De Jong, MD Egbert , Gershon, MD Steven
Published: February 2018

This large, open-label, randomized, parallel-group, multicenter study compared two oral sustained-release opioids (SROs)—AVINZA® (A-MQD), morphine sulfate extended-release capsules given once a day, and OxyContin® (O-ER), oxycodone modified-release tablets given twice a day—in SRO-naive subjects ages 30 to 70 with chronic, moderate to severe low back pain. Of the 392 subjects enrolled and randomized, 266 (132 in the AMQD group and 134 in the O-ER group) completed the opioid dose titration phase and entered an eight-week evaluation phase. During the evaluation phase, A-MQD achieved significantly better pain control than O-ER, as demonstrated by a greater decrease from baseline in pain scores obtained four times daily during weeks one, four, and eight (p = 0.002). The number of breakthrough-pain rescue medication doses adjusted for the number of patient days was significantly lower in the A-MQD group (p < 0.0001). Better pain control with A-MQD was achieved with a significantly lower daily opioid dose than with O-ER (mean 69.9 mg and 91 mg morphine equivalents, respectively; p = 0.0125). Quality of sleep was significantly better with A-MQD for the entire evaluation phase (p = 0.0026). The incidence and severity of elicited opioid side effects were similar in the two groups. This trial demonstrated that once-daily A-MQD provides consistent around-the-clock pain relief in patients with low back pain. In patients who completed opioid dose titration, A-MQD was significantly better than O-ER for reducing pain and improving sleep, while requiring a lower daily opioid dose.
Relative abuse potential of opioid formulations in Canada: A structured field study
Authors: Sellers, MD, PhD, FRCPC Edward M. , Schuller, MSc Reinhard , Romach, MD Myroslava K. , Horbay, PhD G. L. A.
Published: February 2018

Introduction: While prescription opioids can improve quality of life through pain relief, they are susceptible to misuse. This field study characterizes the relative susceptibility and attractiveness of a new analgesic patch, with fentanyl embedded in a matrix material, compared to other opioid dose formulations.Methods: Recreational opioid abusers (N = 42; 31 male, 11 female) from three Canadian sites participated in structured interviews. They were presented with nine products, some of which were hypothetical (fentanyl [F], hydromorphone [H], and oxycodone [O] in each of three formulations: matrix patch [M], reservoir-type gel patch [G], and tablet [T]). The attractiveness and tampering potential of each product was ranked using two 7-point Likert scales (Value of Product and Likelihood to Tamper), an index representing the product of the two scales, a 17-item Opiate Attractiveness Scale (OAS), relative street value, and rank order of overall desirability. Non-parametric analyses were used to compare each product to the FM.Results: The FT, HT, and FM were highly valued and most likely to be tampered with. The products were ranked in decreasing order of desirability as follows: FT > HT > FM > FG > OT > HM > HG > OM > OG. On the OAS, FM was more attractive than all gel-patch products (p < 0.001), and OT was most attractive overall. FM was statistically similar to OT, FT, OM, and HT. Of the 42 subjects, 25 (60 percent) preferred the matrix patch to the gel patch. Of the 17 subjects who preferred the gel patch, 10 (59 percent) were from a region generally unfamiliar with that formulation.Conclusions: Fentanyl is attractive to opioid abusers regardless of formulation. In Canada, a fentanyl matrix patch may be at higher risk for diversion, tampering, and abuse than other transdermal opioid formulations. These findings should be confirmed by epidemiological studies. Comparative risk management programs should be part of the development of any new narcotic delivery system.
The Fourth Circuit Court of Appeals’ decision in United States v. Hurwitz: An important victory for pain management professionals and those living with pain
Authors: Bolen, JD Jennifer
Published: February 2018

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Prescription opioid abuse among drug-involved street-based sex workers
Authors: Surratt, PhD Hilary L. , Inciardi, PhD James A. , Kurtz, PhD Steven P.q
Published: February 2018

National population surveys and individual studies over the past decade have documented the escalating abuse of a variety of prescription medications, particularly prescription opioids. Although surveillance data provide important information for estimating the prevalence of prescription opioid abuse in the general population, studies documenting the patterns of prescription drug abuse among chronic street-drug-using populations are extremely rare. This paper examines the abuse of prescription opioids among drug-involved street-based sex workers in Miami, Florida. The data for this study were drawn from an ongoing HIV intervention trial initiated in 2001, designed to test the relative effectiveness of two alternative HIV prevention protocols for this population. Participants in the study were recruited through traditional targeted sampling strategies, and complete data are available on 588 street-based sex workers. In terms of prescription drug abuse, 12.2 percent of the sample reported using at least one opioid analgesic in the past 90 days without having a legitimate prescription. Logistic regression analyses were conducted to examine the associations between prescription opioid abuse and its predictors. In the multivariate model, factors positively associated with prescription opioid abuse included: Caucasian race (OR = 2.53; 95 percent CI 1.30 to 4.91), current powder cocaine use (OR = 2.28; 95 percent CI 1.28 to 4.08), current heroin use (OR = 2.08; 95 percent CI 1.10 to 3.92), 90-day physical abuse/victimization (OR = 2.07; 95 percent CI 1.18 to 3.61), and shorter sex-work involvement (OR = 1.98; 95 percent CI 1.13 to 3.48). In contrast, daily crack smoking was negatively associated with prescription opioid abuse (OR = 0.61; 95 percent CI 0.33 to 1.10). This study provides some of the first empirical evidence to indicate that prescription opioid abuse is emerging in a heretofore unstudied community of marginalized drug-using sex workers. In addition, data on this population’s mechanisms of access to prescription opioids clearly suggest that there is an active black market for these drugs. These findings warrant intensive study to determine the relative contribution of each mechanism of diversion to the illicit market.
Roadblock on the health IT superhighway: E-prescribing and the controlled substances act
Authors: Lapane, PhD Kate L. , Quilliam, PhD Brian J. , Dore, PharmD David D.
Published: February 2018

Electronic prescribing technology enables healthcare providers access to more complete information regarding patient’s medication history including prescriptions written by other healthcare providers. President Bush has put forth the goal of electronic health records for most Americans by 2014. Yet, regulatory roadblocks may be preventing further progress toward achieving these goals. The Drug Enforcement Agency (DEA) must modify the Controlled Substances Act (CSA) to keep pace with technology. It is time to move from discussions and hearings to piloting e-prescribing of controlled substances.
Physician-related barriers to cancer pain management with opioid analgesics: A systematic review
Authors: Jacobsen, MS, MPH Ramune , Sjøgren, MD, DMS Per , Møldrup, PhD Claus , Christrup, PhD Lona
Published: February 2018

Objective: The purpose of this review is to summarize the results of studies on physician-related barriers to cancer pain management with opioid analgesics.Methods: A literature search was conducted in PUBMED, using a combined text word and MeSH heading search strategy. Those articles whose full texts were not available in PUBMED were retrieved from the electronic databases of specific journals.Results: Sixty-five relevant articles, published in the period from 1986 to 2006, were identified. Physicians’ barriers to cancer pain management were studied in questionnaire surveys and in the reviews of drug prescribing documents. The results of the articles found were analyzed with respect to (a) knowledge, beliefs, concerns, problems endorsed or acknowledged by physicians treating cancer pain, (b) physicians’ skills in pain assessment, and (c) adequacy of opioid prescription.Conclusions: This review revealed mostly general and common physician-related barriers to cancer pain management: concerns about side effects to opioids, prescription of not efficient doses of opioids, and very poor prescription for the treatment of side effects from opioids. In the future, the evaluation of the influence of cultural-social-economical background, as well as the differences between the various specialists involved in the care of patients with cancer, should be explored to better understand physicians’ barriers and more effectively address them in interventional and educational programs.
Tactics of the physician-controlled counter—detail and the imminent risk of not changing pharma’s detail relationship with physicians
Authors: Kale, MD, JD, MS Scott A. , Barkin, PharmD, MBA Robert L.
Published: February 2018

The traditional relationship between physicians and drug companies is imperiled because the perceived clinical value of the sales detail is found to be increasingly barren of clinical relevancy by physicians. There is an urgent need to train physicians to more effectively mine and refine the data offered by pharma for the benefit of present and future patients. The ability of doctors to use medicines for chronic disease states such as chronic pain, diabetes, hyperlipedemias, depression would be vastly improved if doctors were in possession of clinically relevant data that pharma has, but does not share with clinicians. Doctors must take control of the detail to extract this vital clinical information.
Attributes and behaviors associated with opioid seeking in the emergency department
Authors: Chan, MD Lisa , Winegard, MPH Billie
Published: February 2018

Objective: Determine if the attributes and behaviors anecdotally thought to be indicative of drug seeking have statistical association with opioid seeking.Methods: Data on variables thought to be indicative of drug seeking were retrospectively extracted and compared between two patient groups seen in the Emergency Department between July 1, 2006 and December 31, 2006. Group 1 was considered to have true physical pain, and Group 2 was thought to be seeking opioids.Results: Seven variables were found to have statistical associations with opioid seeking. There was no chart documentation on absence or presence of six variables.Conclusions: Significant associations were found between several variables and opioid seeking. A prospective study should be performed so that all variables of interest can be thoroughly studied and a predictive model can be developed to differentiate patients with real pain from drug seekers.
The safety and tolerability of the fentanyl HCl iontophoretic transdermal system: An alternative to currently available analgesic modalities
Authors: Eberhart, MD Leopold
Published: February 2018

Background and objective: The patient-controlled fentanyl HCl iontophoretic transdermal system (ITS) is an analgesic modality approved for the management of acute postoperative pain. The fentanyl ITS uses a generally imperceptible electrical field to drive fentanyl across the skin and into the bloodstream. Unlike intravenous patient-controlled analgesia (PCA), fentanyl ITS is needle free and preprogrammed, eliminating the risks of needlestick injury and programming errors. Its efficacy, safety, and tolerability were assessed in several clinical trials, and this article presents the integrated safety and tolerability of fentanyl ITS using data pooled from these studies.Methods: Data were pooled from three placebocontrolled trials and one active-controlled trial (fentanyl ITS vs intravenous PCA morphine) in which patients 18 years or older were admitted to the postanesthesia care unit after major abdominal, orthopedic, or thoracic surgery.Results: This analysis of safety and tolerability data revealed common treatment-related adverse events: nausea, vomiting, headache, and erythema. No clinically relevant respiratory depression was observed. No significant differences were observed between elderly patients (≥65 years of age) and patients <65 years of age.Conclusion: The fentanyl ITS addresses certain safety issues of existing modalities while providing comparable pain relief, making it an attractive option for postoperative pain management.
An evaluation of the predictive validity of the Pain Medication Questionnaire with a heterogeneous group of patients with chronic pain
Authors: Dowling, MS Leah S. , Gatchel, PhD Robert J. , Adams, PhD Laura L. , Stowell, PhD Anna W. , Bernstein, MS, PhD Dana
Published: February 2018

The Pain Medication Questionnaire (PMQ), initially developed by Adams et al. (J Pain Symptom Manage. 2004; 27: 440-459), is a 26-item self-report assessment to screen for opioid-medication misuse. The PMQ has demonstrated good reliability and validity, and was predictive of early termination from treatment and identified patients who demonstrated maximal benefit from interdisciplinary treatment (Holmes et al. Pain Pract. 2006; 6: 74-88). This study was designed to further evaluate the validity of the PMQ by exploring whether the initial PMQ score would accurately predict the development of aberrant opioid-medication use behaviors relative to specific behavioral indices (ie, request for early refills, use of a medication agreement) and a physician rating of medication misuse behaviors. Patients were grouped according to the initial score on the PMQ based on the median score of 25. Patients with higher PMQ (H-PMQ) scores reported greater levels of perceived disability and decreased physical and mental functioning. Similar to earlier studies, total scores on the PMQ were moderately correlated with initial measures of physical and psychosocial functioning, and observed problematic medication use behaviors observed by physicians during evaluation. Furthermore, excessively high PMQ scores (≥30) were significantly associated with the need to use a medication agreement or requests for early refills. Five patients were identified from the H-PMQ group who demonstrated problematic opioid-medication use that fell outside of the realm of just early refill requests. Thus, although a PMQ total score ≥25 is indicative of problematic use, a score ≥30 suggests that a patient should be closely monitored when prescribed an opioid medication. Overall, this study again demonstrated that a patient’s self-report is significantly correlated with problematic behaviors observed by physicians. Therefore, when utilized in a busy clinic setting, the PMQ will aide in the identification of specific problematic behaviors and beliefs at the outset of treatment that may hinder successful treatment of a patient’s pain condition.
Remifentanil versus remifentanil with paracervical block on plasma remifentanil concentrations and pulmonary function tests for transvaginal ultrasound-guided oocyte retrieval
Authors: Gunaydin, MD, PhD Berrin , Ozulgen, MD I. Kivilcim , Ozturk, MD Ertan , Tekgul, MD Zeki T. , Kaya, MD Kadir
Published: February 2018

Study objective: The aim of this study is to compare plasma remifentanil concentrations and pulmonary function tests in subjects receiving remifentanil infusion (RI) versus RI with paracervical block (PCB) during transvaginal ultrasound-guided oocyte retrieval (TUGOR).Design: Prospective, randomized.Setting: Assisted Conception Unit.Patients: Forty American Society of Anesthesiologists I subjects requiring TUGOR.Intervention: After ovarian hyperstimulation, subjects were randomly allocated into two groups to receive either RI (Group RI, n = 20) or RI with PCB (Group RI + PCB, n = 20).Measurements: Heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), end tidal carbon dioxide (ETCO2) tension, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and amount of remifentanil used were collected. Plasma remifentanil concentrations were calculated with STANPUMP software.Main results: HR, MAP, ETCO2, SpO2, FEV1, and FVC did not differ between the groups. Total amount of remifentanil used were 486 ± 1.81 μg and 321 ± 0.87 μg in groups RI and RI + PCB, respectively, (p < 0.05). In Group RI, plasma remifentanil concentrations were 4.7 ng mL−1 and 4.2 ng mL−1 during the second transvaginal puncture, and at the end of TUGOR, respectively, whereas corresponding plasma remifentanil concentrations were 3.1 ng mL−1 and 2.6 ng mL−1in Group RI + PCB (p < 0.05).Conclusion: Both anesthesia regimens provided satisfactory analgesia without affecting FEV1 and FVC, but significantly higher plasma remifentanil concentrations were calculated when only RI was used as an anesthetic technique.