Evaluating networked drug checking services in Toronto, Ontario: study protocol and rationale.

BACKGROUND: The increasing incidence of fatal opioid overdose is a public health crisis in Canada. Given growing consensus that this crisis is related to the presence of highly potent opioid adulterants (e.g., fentanyl) in the unregulated drug supply, drug checking services (DCS) have emerged as part of a comprehensive approach to overdose prevention. In Canada's largest city, Toronto, a network of DCS launched in 2019 to prevent overdose and overdose-related risk behaviors. This network employs mass spectrometry technologies, with intake sites co-located with supervised consumption services (SCS) at three frontline harm reduction agencies. The protocol and rationale for assessing the impact of this multi-site DCS network in Toronto is described herein. The aims of this study are to (1) evaluate the impact of DCS access on changes in and factors influencing overdose and related risk behaviors, (2) investigate the perceived capacity of DCS to prevent overdose, and (3) identify composition (qualitative and quantitative) trends in Toronto's unregulated drug supply. METHODS: We will use a parallel-mixed-methods design with complementary data sources (including data from chemical analysis of drug samples, quantitative intake and post-test surveys, SCS, coroners, paramedic services, and qualitative interviews), followed by a meta-inference process wherein results from analyses are synthesized. RESULTS: Whereas most DCS globally target "recreational drug users," in Toronto, this networked DCS will primarily target marginalized people who use drugs accessing frontline services, many of whom use drugs regularly and by injection. This evolution in the application of DCS poses important questions that have not yet been explored, including optimal service delivery models and technologies, as well as unique barriers for this population. Increasing information on the unregulated drug supply may modify the risk environment for this population of people who use drugs. CONCLUSIONS: This study addresses evidence gaps on the emerging continuum of overdose prevention responses and will generate critical evidence on a novel approach to reducing the ongoing high incidence of drug-related morbidity and mortality in Canada and elsewhere.

Outcome with surgical treatment of canine soft tissue sarcoma in the region of the ischiatic tuberosity: A veterinary society of surgical oncology retrospective study.

The aim of this study was to determine the outcome of dogs with soft tissue sarcoma (STS) within the region of the ischiatic tuberosity (ITSTS) treated surgically. This was a multi-institutional retrospective study. Fifty-two dogs met the inclusion criteria, which were: histologically confirmed STS in the region of the IT treated with surgical resection between March 1st, 2009 and March 1st, 2021 with a minimum follow-up time of 6 months. Data collected included patient signalment, preoperative diagnostics, surgical intent/method, surgical complications, histopathology, margins, outcome and cause of death. Statistical analyses were performed to determine significant factors in the treatment and prognosis of ITSTS. Overall survival time (OST) and disease progression were negatively associated with tumour grade, while recurrence was positively associated with grade and incomplete margins. Of the 52 included dogs, there were 24 grade I, 20 grade II and 7 grade III tumours. Forty dogs had reported histopathologic margins of which 26 were reported to be complete and 14 were incomplete. OST and progression-free survival was not reached for tumours graded as I or II and was 255 and 268 days respectively, for grade III. Median time to recurrence was not reached for tumours excised with complete margins and was 398 days for those with incomplete margins. The surgical complication rate was 25%. ITSTS was not found to be a unique clinical entity in dogs as tumour behavior, treatment recommendations, and prognosis were similar to STS in other locations, with overall outcome and prognosis influenced by histologic grade and margins. While surgical complications were common, none resulted in significant morbidity or mortality.

Factors affecting completion of a 28-day inpatient substance abuse treatment programme at the University Hospital of the West Indies.

This study investigated factors leading to premature discharge from the residential substance abuse treatment programme at the University Hospital of the West Indies (UHWI). Two hundred and twenty-four patients, mean age 36 +/- 9.75 and age range of 16-66 years were studied The patients, 87.5% men, were admitted to the programme over the period July 1999 to June 2002. Sources of data, including a routine patient-monitoring form and patients' medical records, were reviewed. Data analysis, performed using the Statistical Package for Social Sciences (SPSS), included frequencies, cross-tabulations and analyses of variance (ANOYA). Crack cocaine was the drug of impact for 60% of patients, alcohol for 17% and marijuana for 8%. Treatment ended prematurely for 22.8% of persons whose reasons for leaving included signing out against medical advice or self-discharge (27.4%), absconding (19.6%), fighting (9.8%), drug use (5.9%) and other rule breaking, including sexual acting out (15.7%). Premature discharge was uninfluenced by gender, age, marital status, schooling, employment status or geographical location. There were significantly more premature discharges in persons admitted primarily for crack dependence versus those admitted primarily for alcoholism (p < 0.05). There were also significantly more premature discharges in persons with 0-10 years of using their most problematic substance when compared with 21-30 years of use (p < 0.05) but not when compared with 11-20 years or over 30 years of use (p > 0.05). The influence of duration of substance use requires further elucidation.

Rivastigmine in the treatment of alcohol-induced persisting dementia.

A case of Alcohol-Induced Persisting Dementia (AIPD) in a 62-year-old man is presented. His progress on treatment with the acetylcholinesterase inhibitor, rivastigmine, is followed. The significant improvement observed suggests that AIPD may be a new indication for this class of drug.

Factors affecting completion of a 28-day inpatient substance abuse treatment programme at the University Hospital of the West Indies / Factores que afectan la terminación del programa de 28 días de tratamiento por abuso de sustancias de los pacientes de ingreso en el Hospital Universitario de West Indies

This study investigated factors leading to premature discharge from the residential substance abuse treatment programme at the University Hospital of the West Indies (UHWI). Two hundred and twenty-four patients, mean age 36 # 9.75 and age range of 16-66 years were studied. The patients, 87.5% men, were admitted to the programme over the period July 1999 to June 2002. Sources of data, including a routine patient-monitoring form and patients' medical records, were reviewed. Data analysis, performed using the Statistical Package for Social Sciences (SPSS), included frequencies, cross-tabulations and analyses of variance (ANOVA). Crack cocaine was the drug of impact for 60% of patients, alcohol for 17% and marijuana for 8%. Treatment ended prematurely for 22.8% of persons whose reasons for leaving included signing out against medical advice or self-discharge (27.4%), absconding (19.6%), fighting (9.8%), drug use (5.9%) and other rule breaking, including sexual acting out (15.7%). Premature discharge was uninfluenced by gender, age, marital status, schooling, employment status or geographical location. There were significantly more premature discharges in persons admitted primarily for crack dependence versus those admitted primarily for alcoholism (p < 0.05). There were also significantly more premature discharges in persons with 0-10 years of using their most problematic substance when compared with 21-30 years of use (p < 0.05) but not when compared with 11-20 years or over 30 years of use (p > 0.05). The influence of duration of substance use requires further elucidation.

Este estudio investigó los factores que llevan a dar de alta prematuramente del programa residencial de tratamiento por abuso de sustancia, en el Hospital Universitario de West Indies (HUWI). Se estudiaron doscientos veinticuatro pacientes, de edad promedio 36 +/- 9.75 y rango de edad 16-66 años. Los pacientes, 87.5% hombres, ingresaron al programa en el periodo de julio 1999 a junio 2002. Se revisaron las fuentes de los datos - incluyendo un formulario de rutina para el monitoreo de los pacientes, y las historias clínicas. El análisis de datos, realizado mediante el Paquete Estadístico para la Ciencias Sociales (SPSS), incluyó frecuencias, tabulaciones cruzadas y análisis de varianza (ANOVA). La cocaína crack fue la droga de impacto en el 60% de los pacientes, el alcohol en el 17%, y la marihuana en el 8%. El tratamiento terminó prematuramente para 22.8% de las personas cuyas razones para abandonarlo incluyeron firmar su renuncia a la asistencia médica o darse de alta a sí mismos (27.4%), fugas (19.6%), peleas (9.8%), uso de drogas (5.9%), y otras violaciones de las reglas, incluyendo conductas sexuales inadecuadas (15.7%). El alta prematura no se produjo por influencias de género, edad, estado civil, escolaridad, empleo o localidad geográfica. Se produjeron significativamente más altas prematuras en personas ingresadas al programa fundamentalmente por dependencia del crack, en comparación con aquellas que entraron fundamentalmente por alcoholismo (p < 0.05). Hubo también significativamente más altas prematuras en personas con 0-10 años de uso de su sustancia más problemática en comparación con aquellas con 21-30 años de uso (p < 0.05), pero no en comparación con 11-20 años o más de 30 años de uso (p > 0.05). La influencia de la duración del uso de la sustancia requiere elucidación posterior.