A Cohort Comparison of Buprenorphine versus Methadone Treatment for Neonatal Abstinence Syndrome.

OBJECTIVES: To compare the duration of opioid treatment and length of stay among infants treated for neonatal abstinence syndrome (NAS) by using a pilot buprenorphine vs conventional methadone treatment protocol. STUDY DESIGN: This retrospective cohort analysis evaluated infants who received pharmacotherapy for NAS at 6 hospitals in Southwest Ohio from January 2012 through August 2014. A single neonatology provider group used a standardized methadone protocol across all 6 hospitals. However, at one of the sites, infants were managed with a buprenorphine protocol unless they had experienced chronic in utero exposure to methadone. Linear mixed models were used to calculate adjusted mean duration of opioid treatment and length of inpatient hospitalization with 95% CIs in infants treated with oral methadone compared with sublingual buprenorphine. The use of adjunct therapy was examined as a secondary outcome. RESULTS: A total of 201 infants with NAS were treated with either buprenorphine (n = 38) or methadone (n = 163) after intrauterine exposure to short-acting opioids or buprenorphine. Buprenorphine therapy was associated with a shorter course of opioid treatment of 9.4 (CI 7.1-11.7) vs 14.0 (12.6-15.4) days (P < .001) and decreased hospital stay of 16.3 (13.7-18.9) vs 20.7 (19.1-22.2) days (P < .001) compared with methadone therapy. No difference was detected in the use of adjunct therapy (23.7% vs 25.8%, P = .79) between treatment groups. CONCLUSION: The choice of pharmacotherapeutic agent is an important determinant of hospital outcomes in infants with NAS. Sublingual buprenorphine may be superior to methadone for management of NAS in infants with select intrauterine opioid exposures.

Diuretic therapy: implications for nursing practice.

Diuretics relieve fluid overload by increasing the volume of urine passed and decreasing the volume of fluid in the body. The consequent challenges to fluid balance require careful observation if dehydration and therapeutic failure are to be avoided. As fluid is lost, so are electrolytes. The subsequent biochemical changes may have adverse effects on patients, however with careful medication monitoring, most of these effects can be detected and prevented.

Diagnosing the problem: using a tool to identify pre-registration nursing students' mathematical ability.

Mathematical ability is a skill nurses need to safely administer medicines and fluids to patients (Elliott, M., Joyce, J., 2005. Mapping drug calculation skills in an undergraduate nursing curriculum. Nurse Education in Practice 5, 225-229). However some nurses and nursing students lack mathematical proficiency (Hilton, D.E., 1999. Considering academic qualification in mathematics as an entry requirement for a diploma in nursing programme. Nurse Education Today 19, 543-547). A tool was devised to assess the mathematical abilities of nursing students. This was administered to 304 nursing students in one Higher Education Institution (HEI) in Wales, United Kingdom (UK) on entry to a pre-registration undergraduate nursing course. The students completed a diagnostic mathematics test comprising of 25 non-clinical General Certificate of Secondary Education (GCSE) level multiple choice questions with a pass mark set at 72%. The key findings were that only 19% (n=53) of students passed the test. Students appeared to have difficulties with questions involving decimals, SI units, formulae and fractions. The key demographic variable that influenced test scores was previous mathematical qualifications on entry to the course. The tool proved useful in two ways. First, in identifying those students who needed extra tutorial support in mathematics. Second, in identifying those areas of mathematics that presented difficulties for students.

The nursing assessment and management of patients with angina.

Coronary heart disease (CHD) is a growing problem in the UK. Angina is just one way that CHD manifests itself in the patient, thus challenging the approach that healthcare professionals use to manage these patients. With approximately 2-4% of all accident and emergency admissions presenting with chest pain, it is important that nurses, who are often the first healthcare professionals to assess the patient, have the appropriate knowledge and expertise to distinguish the aetiology of the chest pain. With CHD being the main cause for illness and death in the UK, it is inevitable that nurses at some point in their career will need to assess and manage patients with this presentation.

Prevalence of bulimic behaviours and eating attitudes in schoolgirls from Trinidad and Barbados.

We investigated eating attitudes and the prevalence of bulimic disorders in a group of 362 schoolgirls from the islands of Trinidad and Barbados using key questions from the Bulimia Investigatory Test, Edinburgh (BITE) and additional questions for the exploration of eating attitudes and dieting practices. A random sample of 92 girls were interviewed using the DSM-III-R Bulimia Diagnostic Interview. Only three subjects (0.8%) scored over the cut-off point on the BITE. None of the interviewees was diagnosed as having bulimia nervosa. Two hundred and forty-five girls (67.7%) reported being terrified of becoming fat and fat-fear was associated with higher Body Mass Index, dieting and exercising for losing weight. Girls of African origin were found to have a more unusual eating pattern and more concerns about their eating habits. The prevalence of bulimic disorders in Caribbean schoolgirls is still very low, but they are a population at increasing risk since they share the western ideals of slimness and engage in dieting behaviours.

Patterns of drug abuse in persons referred to the drug rehabilitation unit in Barbados - abstract

The problem of drug abuse in Barbados has undergone dramatic change in the last twenty years. To the tradition of alcohol use, cannabis was first introduced in the 1970s and cocaine in the mid-1980s. The aim of this study was to examine the patterns of drug use in persons referred to the Drug Rehabilitation Unit with particular reference to referral practices and demographic factors. Data on demographics, sources of referral, and reported drugs of abuse over a ten-month period were obtained from the assessment book of the Unit and augmented from case notes. A total of 197 cses were analysed, consisting of 182 males and only 15 females. The mean age was 31 years with a range of 14 to 69 years. The subjects were representative of the general population in terms of their parish of residence. The ward of the Pschiatric Hospital accounted for most of the referrals (53.6 percent), with self referrals (16.2 percent) coming second. Polydrug abuse was the most common finding (34 percent), followed in rank order by abuse of cannabis, alcohol and cocaine. The most common form of polydrug abuse was a combnation of alcohol, cannabis and cocaine (67 percent). When the pattern of abuse was examined with respect to age, use of cannabis was the most common in the adolescents (71.1 percent), declining to 3.8 percent in the over 44-year old age group. Conversely, alcohol abuse was most common in the more than 44 year-old age group (69.2 percent) with only 2.6 percent in the 16-21 year-old age group. The greatest use of cocaine, either alone or in combination with other drugs, occurred in the 27 - 32 year-old age group. There is cause for concern about the use of cannabis in the adolescent, and the possible introduction of cocaine at this age, resulting in further use during the productive years of adulthood. Polydrug use is also widespread, and this form of abuse is known to have more serious consequences. The necessity to facilitate the treatment and rehabilitation of female drug abusers, and the need for community - based surveys are also recognised. (AU)

Profile of young offenders attending the child guidance clinic in Barbados

There is concern and debate in the Barbadian society about the apparent increase in offences committed by the adolescent age group. This study seeks to identify some of the factors that may be associated with offences committed by adolescents in Barbados. All new referrals from the Probation Department to the Child Guidance Clinic, over an eighteen-month period, were examined for demographic factors, the nature of their offences and their psychiatric morbidity. The results showed that there may be an increase in the number of female offenders, an association with single mother families and, in boys, with previous behavioural problems at school. The offence of 'wandering' was the most common recorded for both sexes (53.6 percent); conduct disorder was the most common diagnosis made in boys (59.3 percent) and the diagnosis of depression was made in the majority of females (60.0 percent). The study highlights the need for further delineation of these factors in all offenders, so that risk factors may be identified and prevention initiated (AU)

Management of post-operative urinary tract fistula - abstract

This paper presents nine patients with urinary tract fistula repair done over a two-year period. All followed gynaecological/obstetrical trauma. Five patients suffered uretero-vaginal fistula; four patients vesico-vaginal fistula. The diagnosis was made by inspection of the introitus followed by an intravenous urogram, and a cytoscopy preceding the repair. A simple two-layer closure of the vesico-vaginal fistula and non-refluxing reimplementation of the proximal ureter in ureter-vaginal fistula was performed. A Foley catheter (bulb not inflated) is tied in for 12 days after the vesico-vaginal fistula repair and seven days after ureteric implantation. Antibacterial therapy is provided during the period with the in-dwelling catheter. Operation was done at three weeks after the injury rather than the conventional three months; this approach is psychologically kinder and technically no more difficult. Six women healed without complications; two healed after further simple intervention. One patient died after a flap interposition reoperation; post-mortem examination did not reveal the cause of death. Although we should prevent fistulae rather than attempt their repair, this is not always possible in the presence of fibrosis that follows severe recurrent pelvic sepsis (AU)

Management of post-operative urinary tract fistula - abstract

Urinary fistula is a tragedy. We present 8 patients, 33 to 49 yrs. of age, without malignancy, seen over a 16-month period, who had post-operative urinary tract fistulae. The antecedent surgery was gynaecological/obstetrical in each case. In 6 patients, the fistulae followed abdominal hysterectomy, and in 2, it followed caesarean section. The diagnosis was made by simple clinical inspection of the introitus to confirm urinary leakage; this occurred 2 to 8 days after surgery. Intravenous urograms were done to identify ureteric damage specifically, and provide information on the integrity of the upper tracts. Four women had vesico-vaginal fistulae, 3 had ureterico-vaginal fistulae and one had both bladder and ureteric damage. The urinary tract fistulae were repaired at three weeks rather than at 3 months, the conventional time for repair. We used a z-layer repair for the vesico-vaginal fistula (longitudinal vaginal and transverse vesical), using 20 or 30 chromic catgut. Ureteric damage was managed by a non-refluxing reimplantation procedure. The Foley balloon was not inflated, and the catheter was carefully observed to ensure free drainage. Five healed without complication; one ureterico-vaginal fistula developed abdominal leakage due to a blocked catheter, which healed after catheter change: 1 vesico-vaginal repair leaked when the catheter was removed at 14 days post-operatively, recatherisation for three weeks was successful; and in one patient, the procedure failed. In this last patient, the fistula recurred after her first repair; she remained dry for 6 weeks after a further attempt but then the fistula recurred (AU)