Thesis (Ph.D. (Pharmacy)) -- University of Limpopo, 2022 / Antiretroviral (ARV) management in children is considered a challenging process, and patients receiving ARVs remain at risk of medication errors. Recently, there has also been a noticeable increase in Treatment Failure (TF) and the development of drug resistance amongst children on ART. However, ART failure amongst children seems to be an under-recognised issue, and adherence to treatment guidelines is reported to be a challenge among nurses caring for People Living with HIV (PLWHIV). Hence, the aim of this study was to explore the prescribing practices, and to determine the knowledge, understanding, and competence levels of NIMART-trained nurses’ in the management of children on Antiretroviral Therapy (ART) in Public Health Care (PHC) facilities located in a rural district of Limpopo Province. To attain the purpose of the study, the researcher in this study adopted a mixed-method, in an explanatory sequential manner. The quantitative phase adopted a descriptive cross-sectional and retrospective census of medical records to determine whether or not the children on ART were prescribed the correct ARV regimen, dose, strength, dosing frequency and received the correct quantities to last until the next appointment date. Whereas the qualitative phase embraced a total purposive sampling of the NIMART-trained professional nurses to explore their knowledge, understanding and views of ART management in children. The results highlighted that these children under study even though they were prescribed a correct ARV regimen in (n=7045; 96%) of the cases;they were only correctly dosed in (n=7797; 53%); and prescribed the correct strength (n=9539; 77%), with only (n=2748; 36.9%) having received the correct quantity of treatment to last them until the next appointment date. Most nurses even though they rated themselves very knowledgeable and competent in paediatric HIV/AIDS management. This finding was contradicting the results obtained from the medical records, as well as their responses to the given case scenario depicted some level of non-adherence to treatment guidelines as well as a lack of understanding of ARV management. From the findings of this ARV utilisation review and the implementation of the developed ART dosing and dispensing training programme. The study concludes that the nurse's prescribing practice was irrational in this cohort of children, and most prescriptions did not entirely comply with the 2014/15 HIV/AIDs treatment recommendations. Since, this cohort of children was found to be susceptible to medication related errors such as; Drug omissions in ARV regimens; Incorrect dosing & dosing frequencies; as well as incorrectly supplied quantities. From the study findings it is recommended that ARV stewardship programs should be considered in order to develop and establish a core strategy for enhancing quality improvement in the management of HIV-infected children on ART in resource-limited settings, not only to inundate viral suppression and maintain it, but also to help achieve the UNAIDS 95- 95-95 target in children under 15 year / National Research Foundation (NRF)

Introduction: Opioid poisoning has been rapidly increasing in the past decade, and has been driven in large part due to increases in opioid prescribing. This has been accompanied by intervention efforts aimed at preventing and reversing opioid poisoning through naloxone prescription programs. Current literature have not quantified the economic burden of opioid poisoning. Understanding this information can help inform these efforts and bring light to this growing problem. In addition understanding various determinants of increased costs can help to identify the types of populations more likely to have greater costs. Main Objectives: The objectives are 1) to quantify the economic burden of opioid poisoning, 2) to evaluate differences in costs, LOS, and in-hospital mortality depending on opioid type, 3) to identify opioids most likely to result in hospitalization for opioid-related ED visits and 4) to determine differences in the odds of admission to various hospital admission categories with respect to opioid type. Methods: A cost-of-illness approach was used to estimate the economic burden of opioid poisoning. Direct costs and prevalence estimates were obtained from nationally representative databases. Other sources of direct costs were obtained from the literature. Indirect costs were measured using the human capital method. Differences in costs, LOS, and in-hospital mortality were measured through generalized linear models using the National Inpatient Sample in 2009 from the Healthcare Cost and Utilization Project. The Drug Abuse Warning Network database was used to evaluate opioids most likely to result in hospitalization and to evaluate the likelihood of different opioids to cause admission into different types of hospital settings. Results: Opioid poisoning resulted in an economic burden approximately $20.4 billion dollars in 2009. Productivity losses were associated with 89% of this total. Direct medical costs were associated with $2.2 billion. Methadone was associated with the greatest inpatient costs and LOS, while heroin was associated with a greater likelihood of in-patient mortality compared to prescription opioids. Heroin, methadone, and morphine were associated with the greatest odds of hospitalization. Among admitted patients, methadone, morphine, and fentanyl were each associated with the greatest odds of ICU admission compared with other opioids. Conclusions: Opioid poisoning results in a significant economic burden to society. Costs, length of stay, in-patient mortality and the odds of hospitalization and admission type depend on the type of opioid involved. The results from this study can be used to inform policy efforts in providing interventions to reduce opioid poisoning and help focus efforts on populations at highest risk for increased costs.

Background – An increase in opioid prescribing has led to an increase in opioid overdoses.1,2 No study has estimated the incremental costs subsequent to an opioid overdose event in prescription opioid users, or the prevalence and costs of overdose events in family members of prescription opioid users and in overdose victims with no identifiable source of prescription opioid. The latter group will be referred to as “others”. Objectives – The first objective of this study was to estimate the prevalence of opioid overdoses in aforementioned groups. The second objective was to estimate the incremental costs and resource utilization associated with opioid overdoses in these groups. Methods – This study is a retrospective analysis using claims data from SelectHealth, a not-for-profit health insurance organization in Utah and southern Idaho. We estimated the prevalence of opioid overdoses in the sample population, as well as in each group, by year. For the cost estimation we collapsed family members and others into one category – “non-medical users”. To estimate costs we used an incremental cost approach whereby we used propensity scores to match cases (patients who suffered from an opioid overdose) to appropriate controls (patients who did not suffer from an opioid overdose) and estimated the direct medical costs incurred in each group in the year following an overdose. Generalized Linear Models were used to estimate incremental costs and resource utilization. Sensitivity analyses were conducted to measure the robustness of the estimates. Results – The prevalence of opioid overdoses increased by 84.8% in prescription opioid users (from 55.6 per 100,000 in 2011 to 102.8 per 100,000 in 2014), increased by 37.9% in family members of prescription opioid users (from 5.9 per 100,000 in 2011 to 8.2 per 100,000 in 2014) and increased by 179.9% in others (from 8.2 per 100,000 in 2011 to 23.1 per 100,000 in 2014). The prevalence of opioid overdoses in acute users increased by 14.7% (from 43.8 per 100,000 in 2011 to 50.3 per 100,000 in 2014) as compared to 165.9% in chronic users (from 187.0 per 100,000 in 2011 to 497.3 per 100,000 in 2014). The incremental direct medical costs per patient per year were estimated to be $65,277 (p-value<0.05) in prescription opioid users who suffered from an overdose and $41,102 (p-value<0.05) in non-medical users who suffered from an overdose. Overdose-specific costs were estimated to be $12,111 for prescription opioid users and $11,070 in non-users. Conclusions – Our study found that the prevalence of opioid overdoses increased steadily from 2011 to 2014 in the sample population. The prevalence of overdoses was much higher in chronic opioid users as compared to acute users. Differences between overdose-specific costs and total incremental costs may suggest that overdoses are associated with substantial costs in addition to costs for the initial treatment of the overdose. While the cost to payers due to overdoses in prescription opioid users is substantial, payers also incur costs from diversion of opioids.

Wen Er Ya Jane. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 130-134). / Table of contents --- p.ii / List of tables --- p.iv / List of figures --- p.vi / Abstract --- p.vii / Glossary of abbreviations --- p.ix / Acknowledgments --- p.x / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- DEFINITIONS AND CLASSIFICATIONS...............................Error! Bookmark not defined / Chapter 1.1.1 --- Classification of drug-related problems --- p.2 / Chapter 1.1.2 --- Adverse drug reactions (ADRs) --- p.2 / Chapter 1.1.3 --- Drug interactions (DI) --- p.7 / Chapter 1.1.4 --- Therapeutic failures (TF) --- p.8 / Chapter 1.1.5 --- Non-compliance --- p.10 / Chapter 1.1.6 --- Drug overdoses (DO) or drug poisonings --- p.11 / Chapter 1.1.7 --- Drug-related hospitalizations (DRH) --- p.12 / Chapter 1.1.8 --- Other relevant definitions --- p.13 / Chapter 1.2 --- LITERATURE REVIEW --- p.16 / Chapter 1.2.1 --- Adverse drug reactions --- p.16 / Chapter 1.2.2 --- Hospital admission due to ADRs --- p.18 / Chapter 1.2.3 --- Drug-related hospitalizations (DRH) --- p.22 / Chapter 1.2.4 --- Discussion --- p.24 / Chapter 1.3 --- PURPOSE OF THIS STUDY --- p.27 / Chapter CHAPTER 2 --- METHODS --- p.30 / Chapter 2.1 --- BACKGROUND --- p.30 / Chapter 2.2 --- DATA COLLECTION --- p.31 / Chapter 2.2.1 --- The patients --- p.31 / Chapter 2.2.2 --- The drug history --- p.31 / Chapter 2.2.3 --- Patients knowledge of drugs they were taking --- p.33 / Chapter 2.2.4 --- Compliance --- p.33 / Chapter 2.2.5 --- Previous episodes of adverse drug reactions --- p.34 / Chapter 2.2.6 --- Diagnosis and outcome --- p.34 / Chapter 2.2.7 --- Laboratory Results --- p.34 / Chapter 2.2.8 --- Demographic characteristics of the patients --- p.35 / Chapter 2.2.9 --- The data sheet --- p.36 / Chapter 2.3. --- CASE REVIEW (REASSESSMENT) --- p.41 / Chapter 2.4 --- CODING OF DATA --- p.41 / Chapter 2.4.1 --- Coding of general data except diagnoses and drugs --- p.41 / Chapter 2.4.2 --- Coding of diagnoses --- p.42 / Chapter 2.4.3 --- Coding of drugs --- p.42 / Chapter 2.5 --- STATISTICAL ANALYSIS --- p.42 / Chapter CHAPTER 3 --- RESULTS --- p.43 / Chapter 3.1 --- THE PATIENTS --- p.43 / Chapter 3.1.1 --- Age and sex distributions --- p.43 / Chapter 3.1.2 --- Patients' ADL and living environments --- p.47 / Chapter 3.1.3 --- Baseline liver and renal function tests --- p.50 / Chapter 3.1.4 --- Diagnoses --- p.52 / Chapter 3.2 --- DRUG USE PRIOR TO ADMISSION --- p.54 / Chapter 3.2.1 --- Overview --- p.54 / Chapter 3.2.2 --- Consumption patterns for the prescribed drugs --- p.61 / Chapter 3.2.3 --- Sources and durations for the prescribed drugs --- p.69 / Chapter 3.2.4 --- Consumption patterns for self-medications --- p.71 / Chapter 3.2.5 --- Source and duration of the self-medications --- p.73 / Chapter 3.2.6 --- Drug overdose patterns --- p.75 / Chapter 3.3 --- PATIENTS' KNOWLEDGE OF THE EFFECTS AND SIDE-EFFECTS OF DRUGS --- p.74 / Chapter 3.3.1 --- Overview --- p.74 / Chapter 3.3.2 --- Patients' knowledge of the effects of their prescribed drugs --- p.74 / Chapter 3.3.3 --- Patients' knowledge of the side-effects of their prescribed drugs --- p.77 / Chapter 3.4 --- COMPLIANCE --- p.79 / Chapter 3.5 --- DRUG-RELATED HOSPITALIZATIONS (DRH) --- p.82 / Chapter 3.5.1 --- Overview --- p.82 / Chapter 3.5.2 --- Adverse drug reactions (ADRs) --- p.84 / Chapter 3.5.3 --- Outcome of ADRs --- p.98 / Chapter 3.5.4 --- "Therapeutic failures (Non-compliance, Inappropriate dose reduction)" --- p.100 / Chapter 3.5.5 --- Drug overdoses --- p.104 / Chapter CHAPTER 4 --- DISCUSSION --- p.106 / Chapter 4.1 --- ABOUT THE PATIENTS --- p.106 / Chapter 4.2 --- DISEASE PATTERNS AND DRUG CONSUMPTION PATTERNS --- p.107 / Chapter 4.2.1 --- Diagnoses on admission --- p.107 / Chapter 4.2.2 --- Drug consumption patterns --- p.109 / Chapter 4.2.3 --- About the sources and durations of the prescribed drugs --- p.112 / Chapter 4.2.4 --- About the self-medications --- p.113 / Chapter 4.3 --- ABOUT PATIENTS' KNOWLEDGE OF THE DRUGS --- p.114 / Chapter 4.4 --- ABOUT COMPLIANCE --- p.116 / Chapter 4.5 --- ABOUT ADRS AND DRUGS INTERACTIONS --- p.118 / Chapter 4.5.1 --- The incidence of ADRs --- p.118 / Chapter 4.5.2 --- The patterns of ADRs --- p.119 / Chapter 4.5.3 --- The drugs and ADRs --- p.119 / Chapter 4.5.4 --- Self-medications and ADRs --- p.121 / Chapter 4.5.5 --- The risk factors for ADRs --- p.122 / Chapter 4.5.6 --- Drug interactions --- p.125 / Chapter 4.6 --- ABOUT THERAPEUTIC FAILURES --- p.126 / Chapter 4.7 --- ABOUT DRUG OVERDOSES --- p.127 / Chapter 4.8 --- CONCLUSIONS --- p.128 / BIBLIOGRAPHY --- p.130

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Background: Caffeine is added to dietary supplements to increase energy and suppress appetite. Many people take dietary supplements for weight loss. Patients may be unaware that supplements can contain caffeine, even if caffeine is not listed as an ingredient. Commonly used herbal dietary supplement ingredients, such as guarana, are natural sources of caffeine. Objective: To describe a case of possible caffeine-induced seizure in a patient taking an over-the-counter weight loss supplement. Case Report: A previously healthy 38-year-old female experienced blurring of vision and a new onset grand mal seizure. The patient had a two-month history of taking the dietary supplement, Zantrex - 3™. Zantrex - 3™ is advertised as a weight loss supplement which may provide rapid weight loss and extreme energy in one “power packed pill.” Conclusions/Summary: After discontinuation of Zantrex - 3™, the patient experienced no further seizure activity. Outpatient follow up at 2 and 6 weeks was noncontributory with follow up MRI and EEG both within normal limits.

Virtually every mental health problem carries stigma, but suicide appears to run so counter to our accumulative, achievement-oriented society, that it poses even greater threat of stigma. While suicide is inherently troubling in that it opposes the fundamental human instinct for self-preservation, the tendency to stigmatize and reject individuals affected by suicide appears to be counterproductive and excessive. Hence, the purpose of this three-manuscript dissertation is to gain a more nuanced understanding of suicide attitudes from an exploratory and terror management theory perspective. More specifically, this dissertation attempts to answer three general questions: (1) how do suicide attitudes differ from other stigmatized deaths – namely, unintentional opioid overdose, (2) does death anxiety and baseline self-esteem impact attitudes toward suicide, and (3) can the effects of death anxiety on suicide attitudes be reversed by temporarily boosting self-esteem? To address the first question, Study 1 compares suicide attitudes to attitudes toward opioid overdose death – another type of stigmatized death that has emerged as a major public health issue in the U.S. in recent years. Study 2 addresses the second question by examining the effect of mortality salience on attitudes toward suicide and by investigating whether participants’ baseline self-esteem will moderate this effect, in keeping with the theory’s claim that self-esteem buffers against death anxiety. Building on the theoretical assumptions of the second study, Study 3 tests whether the effects of death anxiety on suicide attitudes can be reversed by temporarily bolstering the participant’s self-esteem using experimental manipulation. In other words, can cultural worldview validation and self-esteem enhancement inhibit the awareness of personal death and promote prosocial attitudes and behavior? All three proposed studies used quantitative research strategies to examine the research questions detailed above. Study 1 used a traditional questionnaire method to explore and compare attitudes toward suicide and drug overdose death; whereas Study 2 and 3 employed an experimental design to test the MS hypothesis on suicide attitudes. Participants were recruited online using an inexpensive crowdsourcing service called Amazon MTurk. Findings from these studies could have important implications for how we understand the psychological underpinnings of suicide stigma and contribute to the growing body of evidence of the role of existential mortality concerns in hostile attitudes and discriminatory behavior. Not only are we confronted with death reminders in our everyday lives, the topic of suicide is inherently a reminder of death – making the problem of death anxiety even more relevant and unavoidable. These findings could expand our understanding of how cultural worldview and self-esteem are relevant to mitigating death anxiety, and the relationship between death anxiety and suicide.

Overdose and addiction are two medical complications of cocaine abuse. To date, there is no FDA approved pharmacotherapy specific for cocaine abuse. Cocaine hydrolases (CocHs) have been extensively investigated for its potential in anti-cocaine therapy. Previous studies have demonstrated that CocHs efficiently hydrolyze cocaine to generate biologically inactive metabolites both in vivo and in vitro. However, it has not been studied whether there is gender difference in the therapy using CocHs. In addition, the effectiveness of CocHs is unknown for treating cocaine toxicity when alcohol is co-administered. The main purpose of this dissertation is to characterize and evaluate efficient CocHs for cocaine overdose and cocaine addiction treatment. In the first set of studies, the effectiveness of human serum albumin-fused CocH1 were studied in male and female rats. The pharmacokinetic profiles, as well as the pharmacodynamic effects of CocH1-HSA were compared in male and female rats. The obtained data clearly demonstrated that CocH1-HSA was equally effective in both genders. The second set of studies investigated the efficiency of Fc-fused CocH5 in reversing cocaine toxicity in rats receiving simultaneous administration of cocaine and alcohol. Results showed that CocH5-Fc rapidly hydrolyzed cocaine and cocaine’s toxic metabolites in rats, and demonstrated that CocH5-Fc was efficient in treating cocaine toxicity when alcohol was simultaneously administered. In later studies to investigate the effects of CocH5-Fc for the treatment of cocaine addiction, a mathematical model was developed and validated to predict the effects of CocH5-Fc on the disposition of cocaine in rat blood and brain. This model adequately described the effects of CocH5-Fc in accelerating the elimination of cocaine and its toxic metabolites in both rat blood and brain. In conclusion, the studies within the current dissertation demonstrate the clinical potential of CocHs for the treatment of both cocaine overdose and cocaine addiction.

No description available.

Traumatic brain injury (TBI) is considered the “signature injury” for United States Veterans who deployed in support of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) since 2001. Veterans with TBI may be at higher risk for subsequent intentional and unintentional injuries due to cognitive and executive function impairments from the injury and co-occurring psychiatric conditions. This dissertation evaluated the association between TBI and attempted suicide, motor vehicle accidents, and opioid overdose, in a large cohort of United States OEF/OIF/OND Veterans aged 18 to 40 who received care in the Veterans Health Administration (VHA). These studies utilized data from the VHA electronic medical records collected between April 2007 and September 2012. Study 1 evaluated the association between TBI and attempted suicide. Veterans with TBI had approximately a 4-fold increased risk of attempted suicide compared to those without, adjusting for demographics (adjusted hazard ratio (aHR): 3.73, 95% CI = 3.07, 4.53). The mediation analyses suggested that the psychiatric conditions substantially attenuated the impact of TBI on attempted suicide (aHR: 1.25 (95% CI = 1.05, 1.48). Study 2 evaluated the association between TBI and motor vehicle accidents. Veterans with TBI had a 56% increased risk of motor vehicle accident compared to those without, adjusting for demographics (aHR: 1.58, 95% CI = 1.27, 1.97). However, the mediation analyses attenuated this association (aHR: 1.17, 95% CI = 0.96, 1.43). Study 3 evaluated the association between TBI and opioid overdose among OEF/OIF/OND Veterans receiving long-term opioid treatment for non-cancer, chronic pain. Veterans with TBI had 2-fold increased risk for opioid overdose compared to those without, adjusting for demographics (aHR: 2.00, 95% CI = 1.26, 3.16). Nevertheless, the mediation analyses suggested that psychiatric conditions attenuated the impact of TBI on opioid overdose (aHR: 1.38, 95% CI = 0.94, 2.01). In conclusion, these studies add to the literature about risk of intentional and unintentional injuries among Veterans with TBI. Additionally, it highlights that Veterans with TBI and at least one co-morbid psychiatric condition are a particularly vulnerable group with the highest risk for injuries.