Journal of Medical Toxicology最新文献

{"title":"A Brief Educational Intervention to Increase ED Initiation of Buprenorphine for Opioid Use Disorder (OUD).","authors":"Utsha G Khatri, Kathleen Lee, Theodore Lin, Joseph L D'Orazio, Mitesh S Patel, Frances S Shofer, Jeanmarie Perrone","doi":"10.1007/s13181-022-00890-7","DOIUrl":"10.1007/s13181-022-00890-7","url":null,"abstract":"<p><strong>Background: </strong>Despite the evidence in support of the use of buprenorphine in the treatment of OUD and increasing ability of emergency medicine (EM) clinicians to prescribe it, emergency department (ED)-initiated buprenorphine is uncommon. Many EM clinicians lack training on how to manage acute opioid withdrawal or initiate treatment with buprenorphine. We developed a brief buprenorphine training program and assessed the impact of the training on subsequent buprenorphine initiation and knowledge retention.</p><p><strong>Methods: </strong>We conducted a pilot randomized control trial enrolling EM clinicians to receive either a 30-min didactic intervention about buprenorphine (standard arm) or the didactic plus weekly messaging and a monetary inducement to administer and report buprenorphine use (enhanced arm). All participants were incentivized to complete baseline, immediate post-didactic, and 90-day knowledge and attitude assessment surveys. Our objective was to achieve first time ED buprenorphine prescribing events in clinicians who had not previously prescribed buprenorphine in the ED and to improve EM-clinician knowledge and perceptions about ED-initiated buprenorphine. We also assessed whether the incentives and reminder messaging in the enhanced arm led to more clinicians administering buprenorphine than those in the standard arm following the training; we measured changes in knowledge of and attitudes toward ED-initiated buprenorphine.</p><p><strong>Results: </strong>Of 104 EM clinicians enrolled, 51 were randomized to the standard arm and 53 to the enhanced arm. Clinical knowledge about buprenorphine improved for all clinicians immediately after the didactic intervention (difference 19.4%, 95% CI 14.4% to 24.5%). In the 90 days following the intervention, one-third (33%) of all participants reported administering buprenorphine for the first time. Clinicians administered buprenorphine more frequently in the enhanced arm compared to the standard arm (40% vs. 26.3%, p = 0.319), but the difference was not statistically significant. The post-session knowledge improvement was not sustained at 90 days in the enhanced (difference 9.6%, 95% CI - 0.37% to 19.5%) or in the standard arm (difference 3.7%, 95% CI - 5.8% to 13.2%). All the participants reported an increased ability to recognize patients with opioid withdrawal at 90 days (enhanced arm difference .55, 95% CI .01-1.09, standard arm difference .85 95% CI .34-1.37).</p><p><strong>Conclusions: </strong>A brief educational intervention targeting EM clinicians can be utilized to achieve first-time prescribing and improve knowledge around buprenorphine and opioid withdrawal. The use of weekly messaging and gain-framed incentivization conferred no additional benefit to the educational intervention alone. In order to further expand evidence-based ED treatment of OUD, focused initiatives that improve clinician competence with buprenorphine should be explored.</p><p><strong>Trial re","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":"18 1","pages":"205-213"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9004452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41986962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biostatistics and Epidemiology for the Toxicologist: Measures of Central Tendency and Variability-Where Is the \"Middle?\" and What Is the \"Spread?\"","authors":"Sanjay Mohan, Mark K Su","doi":"10.1007/s13181-022-00901-7","DOIUrl":"https://doi.org/10.1007/s13181-022-00901-7","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":"18 3","pages":"235-238"},"PeriodicalIF":2.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198153/pdf/13181_2022_Article_901.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10090697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Files of the Medical Toxicology Fellowship at the Oregon Poison Center: Thallotoxicosis.","authors":"Matthew S Correia, Annette M Lopez","doi":"10.1007/s13181-022-00880-9","DOIUrl":"https://doi.org/10.1007/s13181-022-00880-9","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":"18 3","pages":"248-255"},"PeriodicalIF":2.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198136/pdf/13181_2022_Article_880.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9733391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary Research: Application of Non-Invasive Measure of Cytochrome c Oxidase Redox States and Mitochondrial Function in a Porcine Model of Carbon Monoxide Poisoning.","authors":"Alistair Lewis, Rodrigo M Forti, Oladunni Alomaja, Clementina Mesaros, Sarah Piel, John C Greenwood, Fatima M Talebi, Constantine D Mavroudis, Matthew Kelly, Shih-Han Kao, Frances S Shofer, Johannes K Ehinger, Todd J Kilbaugh, Wesley B Baker, David H Jang","doi":"10.1007/s13181-022-00892-5","DOIUrl":"10.1007/s13181-022-00892-5","url":null,"abstract":"<p><strong>Introduction: </strong>Carbon monoxide (CO) is a colorless and odorless gas that is a leading cause of environmental poisoning in the USA with substantial mortality and morbidity. The mechanism of CO poisoning is complex and includes hypoxia, inflammation, and leukocyte sequestration in brain microvessel segments leading to increased reactive oxygen species. Another important pathway is the effects of CO on the mitochondria, specifically at cytochrome c oxidase, also known as Complex IV (CIV). The purpose of this ongoing study is the preliminary development of a porcine model of CO poisoning for investigation of alterations in brain mitochondrial physiology.</p><p><strong>Methods: </strong>Four pigs (10 kg) were divided into two groups: Sham (n = 2) and CO (n = 2). Administration of a dose of CO at 2000 ppm to the CO group over 120 minutes followed by 30 minutes of re-oxygenation at room air. The control group received room air for 150 minutes. Non-invasive optical monitoring was used to measure CIV redox states. Cerebral microdialysis was performed to obtain semi real-time measurements of cerebral metabolic status. At the end of the exposure, fresh brain tissue (cortical and hippocampal) was immediately harvested to measure mitochondrial respiration. Snap frozen cortical tissue was also used for ATP concentrations and western blotting.</p><p><strong>Results: </strong>While a preliminary ongoing study, animals in the CO group showed possible early decreases in brain mitochondrial respiration, citrate synthase density, CIV redox changes measured with optics, and an increase in the lactate-to-pyruvate ratio.</p><p><strong>Conclusions: </strong>There is a possible observable phenotype highlighting the important role of mitochondrial function in the injury of CO poisoning.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":"18 3","pages":"214-222"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198167/pdf/13181_2022_Article_892.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9733907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Case Files of the Medical Toxicology Fellowship at the Oregon Poison Center: Thallotoxicosis","authors":"M. Correia, A. Lopez","doi":"10.1007/s13181-022-00894-3","DOIUrl":"https://doi.org/10.1007/s13181-022-00894-3","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":"18 1","pages":"356 - 356"},"PeriodicalIF":2.9,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46891463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on Aspirin Toxicity: Interpreting Effects of Sodium Bicarbonate and Activated Charcoal.","authors":"Joshua Bloom,&nbsp;Mary Ann Howland,&nbsp;Emily T Cohen","doi":"10.1007/s13181-022-00883-6","DOIUrl":"https://doi.org/10.1007/s13181-022-00883-6","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":"18 2","pages":"172-173"},"PeriodicalIF":2.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8938565/pdf/13181_2022_Article_883.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9227980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Opening Doors to Training Medical Toxicology Fellows from All Residency Backgrounds.","authors":"Louise Kao,&nbsp;Michele Burns,&nbsp;Christine Murphy,&nbsp;Evan Schwarz","doi":"10.1007/s13181-022-00882-7","DOIUrl":"https://doi.org/10.1007/s13181-022-00882-7","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"180"},"PeriodicalIF":2.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8938526/pdf/13181_2022_Article_882.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39898343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACMT Position Statement: Interpretation of Urine Opiate and Opioid Tests.","authors":"Andrew Stolbach,&nbsp;Nicholas Connors,&nbsp;Lewis Nelson,&nbsp;Ken Kulig","doi":"10.1007/s13181-021-00864-1","DOIUrl":"https://doi.org/10.1007/s13181-021-00864-1","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":"18 2","pages":"176-179"},"PeriodicalIF":2.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8938527/pdf/13181_2021_Article_864.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9225738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Echocardiographic Findings in Estimating Survival Probability of Intensive Care Unit Admitted Aluminum Phosphide Poisoned Patients.","authors":"Fatma M Elgazzar,&nbsp;Mohamed A Shama,&nbsp;Osama Shoeib,&nbsp;Amal S A F Hafez","doi":"10.1007/s13181-021-00868-x","DOIUrl":"https://doi.org/10.1007/s13181-021-00868-x","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiotoxicity represents the primary cause of death in acute aluminum phosphide (AlP) poisoning. Prompt supportive care can improve patient survival. This study assessed the role of echocardiography in estimating the survival probability of AlP-poisoned patients admitted to the intensive care unit.</p><p><strong>Methods: </strong>A prospective cohort study of symptomatic acute AlP poisoned patients was conducted between September 2019 and December 2020. Patients were subjected to history taking, clinical examination, To be included, patient evaluation needed to include electrocardiographic (ECG) and echocardiographic studies. The statistical analysis assessed the association between patient survival and relevant factors. Survival analysis was performed using the Kaplan-Meier survival curve and Cox proportional hazard regression.</p><p><strong>Results: </strong>A total of 90 patients met inclusion criteria. Electrocardiographic abnormalities were detected in 38.1% of survivors and 82.6% of non-survivors (p < 0.001). Survivors had a higher mean left ventricle ejection fraction (LVEF) (50.86 ± 6.30% vs. 26.52 ± 7.64%, respectively, p < 0.001) and a lower percentage of global LV hypokinesia (4.8% vs. 94.2%, p < 0.001). The mean survival time was higher among patients with LVEF ≥ 50% than those with LVEF = 41-49% and ≤ 40% (p = 0.014 and 0.001, respectively). The hazard of death was 4.42 and 5.40 times greater in patients with LVEF ≤ 40% or with global LV hypokinesia, respectively. Regression revealed that the global LV hypokinesia, ECG abnormalities, and decreased LVEF and oxygen saturation were significantly associated with the risk of death (hazard ratios: 4.382, 3.348, 0.957, and 0.971, respectively).</p><p><strong>Conclusions: </strong>Echocardiography represents a valuable diagnostic tool to assess cardiac function in acute AlP poisoning. Both LVEF and global LV hypokinesia significantly impact the survival of AlP-poisoned patients. Echocardiography was superior to ECG changes in terms of accuracy for the prediction of mortality.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":"18 2","pages":"128-138"},"PeriodicalIF":2.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8938530/pdf/13181_2021_Article_868.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9579840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a Plant Identification Application Using Digital Images of Toxic Plants.","authors":"Sarah Mahonski,&nbsp;Emma Furlano,&nbsp;William Chiang","doi":"10.1007/s13181-022-00877-4","DOIUrl":"https://doi.org/10.1007/s13181-022-00877-4","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":"18 2","pages":"159-162"},"PeriodicalIF":2.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8938528/pdf/13181_2022_Article_877.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9280641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}