What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies.

Guidelines now discourage opioid analgesics for chronic noncancer pain because the benefits frequently do not outweigh the harms. We aimed to determine the proportion of patients with chronic noncancer pain who are prescribed an opioid, the types prescribed and factors associated with prescribing. Database searches were conducted from inception to 29 October 2018 without language restrictions. We included observational studies of adults with chronic noncancer pain measuring opioid prescribing. Opioids were categorized as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing (e.g. sampling year, geographic region as per World Health Organization). The overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Of the 42 studies (5,059,098 participants) identified, the majority (n = 28) were from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic noncancer pain prescribed opioids was 30.7% (95% CI 28.7% to 32.7%, n = 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95% CI 16.0-21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95% CI 7.2-9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined that opioid prescribing was associated with year of sampling (more prescribing in recent years) (P = 0.014) and not geographic region (P = 0.056). Opioid prescribing for patients with chronic noncancer pain is common and has increased over time.

Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial.

PURPOSE: To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand. METHOD: A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30-50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5 mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES). RESULTS: There was a statistically significant difference observed between the two groups in terms of FIM score (F = 5.09, p = 0.03) and MFES (F = 3.52, p = 0.007) but no difference was observed in terms of PPA scores (F = 0.96, p = 0.36). CONCLUSIONS: Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants. IMPLICATIONS FOR REHABILITATION: Vibration training (VT) may assist in reducing the risk of falling among at risk older people. Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people. Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

In-depth performance analysis of an EEG based neonatal seizure detection algorithm.

OBJECTIVE: To describe a novel neurophysiology based performance analysis of automated seizure detection algorithms for neonatal EEG to characterize features of detected and non-detected seizures and causes of false detections to identify areas for algorithmic improvement. METHODS: EEGs of 20 term neonates were recorded (10 seizure, 10 non-seizure). Seizures were annotated by an expert and characterized using a novel set of 10 criteria. ANSeR seizure detection algorithm (SDA) seizure annotations were compared to the expert to derive detected and non-detected seizures at three SDA sensitivity thresholds. Differences in seizure characteristics between groups were compared using univariate and multivariate analysis. False detections were characterized. RESULTS: The expert detected 421 seizures. The SDA at thresholds 0.4, 0.5, 0.6 detected 60%, 54% and 45% of seizures. At all thresholds, multivariate analyses demonstrated that the odds of detecting seizure increased with 4 criteria: seizure amplitude, duration, rhythmicity and number of EEG channels involved at seizure peak. Major causes of false detections included respiration and sweat artefacts or a highly rhythmic background, often during intermediate sleep. CONCLUSION: This rigorous analysis allows estimation of how key seizure features are exploited by SDAs. SIGNIFICANCE: This study resulted in a beta version of ANSeR with significantly improved performance.

Adherence to a Mediterranean diet and Alzheimer's disease risk in an Australian population.

The Mediterranean diet (MeDi), due to its correlation with a low morbidity and mortality for many chronic diseases, has been widely recognised as a healthy eating model. We aimed to investigate, in a cross-sectional study, the association between adherence to a MeDi and risk for Alzheimer's disease (AD) and mild cognitive impairment (MCI) in a large, elderly, Australian cohort. Subjects in the Australian Imaging, Biomarkers and Lifestyle Study of Ageing cohort (723 healthy controls (HC), 98 MCI and 149 AD participants) completed the Cancer Council of Victoria Food Frequency Questionnaire. Adherence to the MeDi (0- to 9-point scale with higher scores indicating higher adherence) was the main predictor of AD and MCI status in multinominal logistic regression models that were adjusted for cohort age, sex, country of birth, education, apolipoprotein E genotype, total caloric intake, current smoking status, body mass index, history of diabetes, hypertension, angina, heart attack and stroke. There was a significant difference in adherence to the MeDi between HC and AD subjects (P < 0.001), and in adherence between HC and MCI subjects (P < 0.05). MeDi is associated with change in Mini-Mental State Examination score over an 18-month time period (P < 0.05) in HCs. We conclude that in this Australian cohort, AD and MCI participants had a lower adherence to the MeDi than HC participants.

Spectinomycin in gonorrhoea.

Of 104 male and nine female patients with uncomplicated acute gonorrhoea who were treated with spectinomycin (males 2 g., females 4 g.), two patients (one male and one female) were considered to be treatment failures. No conclusions can be drawn from the small numbers of female patients investigated. Of the 104 male patients, 93 were followed for 2 weeks or more, giving a failure rate of 1-1 per cent. The drug was well tolerated. Sensitivity tests were carried out on 44 strains of N. gonorrhoeae; 42 strains were sensitive to 2-5 mug./ml. spectinomycin and all strains were sensitive to 5 mug./ml.

Characterisation of side-chain conformational preferences in a biologically active but unfolded protein.

A combination of experimental NMR 3J alpha beta coupling constant measurements and theoretical predictions from a statistical model for a random coil have been used to characterise the conformations of amino acid side-chains in an unfolded fibronectin binding protein. The statistical model uses the distribution of torsion angles in a data base of native folded protein structures to provide a description of the torsion angle populations of each residue in a random coil. For all but three of the residues studied a close agreement is observed between the experimental 3J alpha beta data and the model predictions (correlation coefficient 0.90; RMSD 0.70 Hz). In these cases the populations about the chi 1 torsion angles in the conformational ensemble defining the fibronectin binding protein are well described by those present in the protein data base. For Phe 69, Asp 92 and Asp 105 however significant deviations are observed between the predictions and experimental data. Each of these side-chains is found to be involved in persistent non-random structural features arising from clustering of hydrophobic groups or interactions between charged side-chains. The analysis demonstrates the detailed insight that can be provided into conformationally disordered states by combining experimental and theoretical approaches.

Electrogenic ion transport in the intestine of the Australian common brushtail possum, Trichosurus vulpecula: indications of novel transport patterns in a marsupial.

In this study, electrogenic ion transport in the intestine of the Australian common brushtail possum, Trichosurus vulpecula was investigated. In the ileum, a Na(+)-dependent, phloridzin- and amiloride-insensitive short-circuit current ( Isc) was present. Mucosal glucose stimulated a further phloridzin-sensitive, dose-dependent increase in Isc. A Na(+)-dependent, ouabain-sensitive Isc was also present in the caecum and colon. In the proximal and distal colon, amiloride (100 micro mol l(-1), mucosal) inhibited this Isc by 81+/-4% and 65+/-3%, respectively and the Ki for amiloride (approximately 1 micro mol l(-1)) was consistent with the inhibition of a classical epithelial Na(+) channel. In the caecum, 50% of the Isc was inhibited by amiloride (100 micro mol l(-1), mucosal). The amiloride-insensitive Isc in the colon was not due to electrogenic Cl(-) secretion, as serosal bumetanide (100 micro mol l(-1)) had no effect on the Isc. Furthermore, the secretagogues forskolin (10 micro mol l(-1)), carbachol (100 micro mol l(-1)) and dibutyryl-cAMP or dibutyryl-cGMP (100 micro mol l(-1)) did not stimulate electrogenic Cl(-) secretion by the colon. These results indicate that the transport properties of the hindgut of the possum differ significantly from those of eutherian mammals and may be associated with different functions of the hindgut of possums when compared to eutherian mammals.

Aldosterone does not regulate amiloride-sensitive Na(+) transport in the colon of the Australian common brushtail possum, Trichosurus vulpecula.

Plasma aldosterone concentrations and the magnitude of amiloride-sensitive Na(+) transport in the proximal and distal colon of newly caught wild possums, and of possums maintained on either low or high Na(+) diets, were determined to evaluate their role in the regulation of salt content of faeces in common brushtail possums. Wild animals had a plasma aldosterone concentration of 439+/-115 pmol l(-1) and high levels of amiloride-sensitive Na(+) transport in both the proximal and distal colon. Animals maintained on a low Na(+) diet for 14 days excreted very little Na(+) in the urine and had an elevated aldosterone concentration (840+/-246 pmol l(-1)), but levels of amiloride-sensitive Na(+) transport in the proximal and distal colon were similar to those in wild animals. Conversely, while provision of a high Na(+) diet (7 days or 14 days) resulted in increased urinary Na(+) excretion and a fall in aldosterone (approximately 250 pmol l(-1)), there was no reduction in the amount of amiloride-sensitive Na(+) transport in either the proximal or distal colon. These data strongly indicate that aldosterone does not regulate amiloride-sensitive Na(+) transport in the colon of possums and that the colon is not involved in the regulation of salt content of the faeces in this species.