Changing prescribing patterns in an Irish community mental health service.

OBJECTIVES: Medication is an important component of the treatment of many mental illnesses. Very little information is available about the particular medications that are being prescribed by community mental health services and how this has changed over time. We set out to obtain details of psychiatric medications being prescribed by one Irish community mental health service. METHOD: All prescribing by the Cluain Mhuire Community Mental Health Service became electronic during 2004. Using Business Intelligence software, we obtained details of all psychiatric medications prescribed from 2005 to 2016. We compared numbers of prescriptions written in the first 6 years (2005-2010) with the following 6 (2011-2016). RESULTS: Olanzapine was the most commonly prescribed medication throughout but its use declined by one-quarter over the study period. Clozapine, quetiapine, aripiprazole and haloperidol prescribing increased. Prescriptions for mood stabilisers and antidepressants fell by 25%. Sedative prescriptions declined by almost 50%. Absolute numbers of prescriptions written for methylphenidate and pregabalin were small but increased dramatically over the time period. CONCLUSIONS: This community mental health service prescribed less of most psychiatric medications in 2016, than had been the case in 2005. This is despite an increase in the numbers of patients seen over the same period. It is not clear if this pattern is echoed in other services.

How do we compare with best practice? A completed audit of benzodiazepine and z-hypnotic prescribing.

OBJECTIVES: To compare benzodiazepine and z-hypnotic prescribing practices in an inpatient psychiatric unit to best practice standards. METHODS: Medication charts of all inpatients in the psychiatric unit, over a 1-week period, were reviewed. Details of current benzodiazepine and z-hypnotic prescriptions were collected. Information collected included the substance prescribed, duration and administration instructions. Feedback was communicated to medical practitioners through a presentation and email. A re-audit was completed 4 months later. RESULTS: There were increases in total benzodiazepine and z-hypnotic prescribing despite intervention. A reduction of 2 mg occurred in the mean regular dose of benzodiazepine prescribed. Lorazepam was the most prescribed benzodiazepine throughout. In both data sets, at least 50% of regular z-hypnotics and benzodiazepines were initiated before admission. There was an increase of 14% in regular benzodiazepines initiated in hospital exceeding 4 weeks in duration. In neither data collection did regular z-hypnotics initiated in hospital exceed this cut off. A greater number of individuals were in the process of being withdrawn from regular benzodiazepine or z-hypnotic prescriptions in the re-audit. There were minimal improvements in 'as required' prescribing as regards documentation of an indication, time limit and maximum dose. CONCLUSION: The increase in overall prescribing, despite intervention, maybe because these medications continued to be indicated in the acute presentations needing inpatient treatment. The small improvements in 'as required' prescribing patterns suggest that the intervention was limited in effecting change in this area.

An element in intron 1 of the CFTR gene augments intestinal expression in vivo.

The elements controlling the complex developmental and tissue-specific expression of the cystic fibrosis transmembrane conductance regulator (CFTR) gene lie outside the basal promoter region and have not been characterized. We previously identified a tissue-specific DNase I hypersensitive site (DHS) in intron 1 (185 + 10 kb) of the CFTR gene. Here we show that removal of the core element abolishes the activity of this DHS in transient transfection assays of reporter/enhancer gene constructs. We then compared expression from a 310 kb yeast artificial chromosome (YAC) that contains the entire CFTR gene with expression from the same YAC from which the DHS element had been deleted. Stable transfection of a human colon carcinoma cell line showed that transcription from the deleted YAC was reduced by approximately 60%. In transgenic mice, deletion of the intron 1 DHS had no effect on expression in the lung, but reduced expression in the intestine by approximately 60%. Thus, the regulatory element associated with the intron 1 DHS is tissue-specific and is required for normal CFTR expression levels in the intestinal epithelium in vivo.

A shigellosis outbreak traced to commercially distributed shredded lettuce.

In the period August 30-October 7, 1986, 347 persons in adjacent west Texas counties (Ector and Midland) contracted culture-confirmed Shigella sonnei gastroenteritis. A case-control study showed an increased risk of acquiring shigellosis in Ector County with eating at outlets of fast-food Restaurant A, and in Midland County with eating at Restaurant B or C. A second case-control study, of persons who had eaten at Ector County outlets of Restaurant A, showed an increased risk of acquiring shigellosis with eating foods containing shredded lettuce and tomatoes, which were served together (odds ratio = 68.8; 95% confidence interval 8.5-293.1). All implicated restaurants received shredded lettuce produced at one lettuce-shredding plant; two implicated restaurants did not receive tomatoes from the lot delivered to other implicated restaurants. The lettuce-shredding plant distributed shredded lettuce and intact lettuce; restaurants that received only intact lettuce were not involved in the outbreak. Investigation at the lettuce-shredding plant suggested that a food handler might have been the source of contamination and that the method of processing might have allowed cross-contamination to occur. In the laboratory, the outbreak strain of S. sonnei multiplied rapidly on shredded lettuce at 22 C and survived on refrigerated shredded lettuce for at least seven days. This outbreak, one of the largest outbreaks of Shigella infections in the United States in the last decade, indicates that a large, geographically widespread shigellosis outbreak can result from contaminated shredded lettuce that is distributed commercially.

A randomised controlled trial of the effects of screening for ulcer-type dyspepsia.

One hundred and ninety-nine male London office workers with dyspeptic symptoms elicited by a self-administered questionnaire were randomly allocated to intervention and control groups to assess the potential benefits of screening. The members of the intervention group were interviewed and examined, and those men who were considered to have a possible or probable peptic ulcer received a barium meal examination (53%). At the clinical interview the intervention group were advised against both smoking and drinking alcohol. Eighteen months later both groups were recalled for interview and examination and their sickness absence in the intervening period was assessed. The intervention group did not alter their cigarette consumption but did reduce their alcohol intake by an average of 10%. The control group increased their alcohol intake by 20%. Both groups tended to improve symptomatically, and there were no differences in symptoms between the groups at the end of the study. Sickness absence was not affected by the intervention. It is concluded that screening for ulcer-type dyspepsia is not justifiable in male London office workers.

Accumulation of (14)C from exogenous labelled auxin in lateral root primordia of intact pea seedlings (Pisum sativum L.).

When [(14)C]indol-3yl-acetic acid was applied to the apical bud of 5-day old dwarf pea seedlings which possessed unbranched primary roots, a small amount of (14)C was transported into the root system at a velocity of 11-14 mm h(-1). Most of the (14)C which entered the primary root accumulated in the young lateral root primordia, including the smallest detectable (20-30 mm from the primary root tip). In older (8-d old) seedlings in which the primary root bore well-developed lateral roots, (14)C also accumulated in the tertiary root primordia. In contrast, little (14)C was detected in the apical region of the primary root or, in older plants, in the apices of the lateral roots.