A Retrospective Audit to Evaluate the Effect of the Change in Midazolam Concentration From 10 Mg/5 Ml to 5 Mg/5 Ml Ampoules on Midazolam Doses Given to Sedation Patients Following the Rapid Response Report (RRR).

A retrospective audit to evaluate the effect of the change in midazolam concentration from 10 mg/5 ml to 5 mg/5 ml ampoules on midazolam doses given to sedation patients following the rapid response report (RRR).

SAAD Dig. 2013 Jan; 29: 40-5
Kaka S, Taneja P

The technique of intravenous sedation with a benzodiazepine is a well documented and successful method for reducing fear and anxiety in many patients who regard dental treatment as challenging and potentially painful. One of the most important factors to achieving a well sedated patient is ensuring the dose of the drug given is titrated to the individual patient. Five years ago, a Rapid Response Report issued by the National Patient Safety Agency changed the concentration of midazolam within a 5 ml ampoule from 10 mg/5 ml to 5 mg/5 ml. A retrospective audit of 300 patients undergoing oral surgery treatment under intravenous midazolam sedation at Birmingham Dental Hospital was carried out over a 6-month period to assess whether this difference in midazolam concentration had any influence on the average dose of midazolam given to these patients.The midazolam doses given by five clinicians were audited both before and after the concentration change.the mean midazolam dose that was administered by three clinicians decreased following the change in concentration. In addition, the number of patients given greater than 5 mg midazolam following the change decreased with all five clinicians.The change in midazolam concentration from 10 mg/5 ml to 5 mg/5 ml ampoules has resulted in the overall average dose of midazolam given by five clinicians at Birmingham Dental Hospital to decrease. HubMed – drug

Experts: despite time constraints, motivational interviewing techniques can have lasting impact on drinkers, drug abusers.

ED Manag. 2013 Apr; 25(4): 44-6

Researchers have found that the Brief Negotiation Interview (BNI), a tool developed at Yale School of Medicine in New Haven, CT, can curb harmful drinking in patients when the tool is used with these patients in the emergency setting. Further, by using the same motivational interviewing techniques employed in the tool, experts say providers can help patients curb other harmful behaviors as well. The BNI consists of a series of questions that take about seven minutes to discuss with patients. The tool prompts patients to come up with their own reasons for changing harmful behaviors. To implement the BNI, emergency providers need training and constant reinforcement. Ideally, experts say the motivational interviewing techniques employed in the BNI need to become routine to have a lasting impact on patient care. HubMed – drug

ED-based protocols speed care to sickle cell patients, reduce repeat ED visits, and discharge admitted patients earlier.

ED Manag. 2013 Apr; 25(4): 37-40

Patients with sickle cell disease commonly experience episodes of extreme pain that prompt them to seek care in the ED. However, emergency providers sometimes mistake these patients as drug-seekers, delaying effective pain relief and often resulting in under-treatment that can prolong suffering and result in repeat visits. Experts recommend development of specialized sickle cell protocols that fast-track patients toward the care they need, and give patients some control over how much pain medication they need. Experts say ED-based sickle cell protocols can improve patient and provider satisfaction while also reducing repeat ED visits as well as length-of-stay when patients need to be admitted. New research suggests that ED use spikes as sickle patients reach adulthood. Experts say ED providers can play a role in helping these patients transition into effective primary care settings. HubMed – drug

Radiosensitization of Glioblastoma Cell Lines by the Dual PI3K and mTOR Inhibitor NVP-BEZ235 Depends on Drug-Irradiation Schedule.

Transl Oncol. 2013 Apr; 6(2): 169-79
Kuger S, Graus D, Brendtke R, Günther N, Katzer A, Lutyj P, Polat B, Chatterjee M, Sukhorukov VL, Flentje M, Djuzenova CS

Previous studies have shown that the dual phosphatidylinositide 3-kinase/mammalian target of rapamycin (PI3K/mTOR) inhibitor NVP-BEZ235 radiosensitizes tumor cells if added shortly before ionizing radiation (IR) and kept in culture medium thereafter. The present study explores the impact of inhibitor and IR schedule on the radiosensitizing ability of NVP-BEZ235 in four human glioblastoma cell lines. Two different drug-IR treatment schedules were compared. In schedule I, cells were treated with NVP-BEZ235 for 24 hours before IR and the drug was removed before IR. In schedule II, the cells were exposed to NVP-BEZ235 1 hour before, during, and up to 48 hours after IR. The cellular response was analyzed by colony counts, expression of marker proteins of the PI3K/AKT/mTOR pathway, cell cycle, and DNA damage. We found that under schedule I, NVP-BEZ235 did not radiosensitize cells, which were mostly arrested in G1 phase during IR exposure. In addition, the drug-pretreated and irradiated cells exhibited less DNA damage but increased expressions of phospho-AKT and phospho-mTOR, compared to controls. In contrast, NVP-BEZ235 strongly enhanced the radiosensitivity of cells treated according to schedule II. Possible reasons of radiosensitization by NVP-BEZ235 under schedule II might be the protracted DNA repair, prolonged G2/M arrest, and, to some extent, apoptosis. In addition, the PI3K pathway was downregulated by the NVP-BEZ235 at the time of irradiation under schedule II, as contrasted with its activation in schedule I. We found that, depending on the drug-IR schedule, the NVP-BEZ235 can act either as a strong radiosensitizer or as a cytostatic agent in glioblastoma cells. HubMed – drug

Acupuncture in Alcohol and Drug Rehabilitation – How Acupuncture aids in Alcohol and drug rehabilitation.