Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Thesis (Master of Science) -- University of Texas Southwestern Medical Center at Dallas, 2006. / Not embargoed. Vita. Bibliography: 125-132.

abstract: Fibromyalgia (FM) is a chronic musculoskeletal disorder characterized by widespread pain, fatigue, and a variety of other comorbid physiological and psychological characteristics, including a deficit of positive affect. Recently, the focus of research on the pathophysiology of FM has considered the role of a number of genomic variants. In the current manuscript, case-control analyses did not support the hypothesis that FM patients would differ from other chronic pain groups in catechol-O-methyltransferase (COMT) and mu-opioid receptor (OPRM1) genotype. However, evidence is provided in support of the hypothesis that functional single nucleotide polymorphisms on the COMT and OPRM1 genes would be associated with risk and resilience, respectively, in a dual processing model of pain-related positive affective regulation in FM. Forty-six female patients with a physician-confirmed diagnosis of FM completed an electronic diary that included once-daily assessments of positive affect and soft tissue pain. Multilevel modeling yielded a significant gene X environment interaction, such that individuals with met/met genotype on COMT experienced a greater decline in positive affect as daily pain increased than did either val/met or val/val individuals. A gene X environment interaction for OPRM1 also emerged, indicating that individuals with at least one asp allele were more resilient to elevations in daily pain than those homozygous for the asn allele. In sum, the findings offer researchers ample reason to further investigate the contribution of the catecholamine and opioid systems, and their associated genomic variants, to the still poorly understood experience of FM. / Dissertation/Thesis / Ph.D. Psychology 2011

PURPOSE: Develop and evaluate a chart review tool (CRT) to improve the safety and effectiveness of prescribing controlled substances in a primary care setting. METHODS: A Controlled Substance Review Committee, consisting of volunteer primary care physicians and a clinical pharmacist, developed a CRT to assess compliance with a primary care clinic’s controlled substance prescribing policy and effectiveness of therapy. The CRT was based on existing clinic policies and American Pain Society/American Academy of Pain Medicine clinical guidelines for opioid prescribing. Every month, committee physicians used the CRT to review medical records of patients prescribed controlled substances chronically. The CRT tracked factors from the previous 6 months, including morphine equivalent dose (MED) prescribed, indication for treatment, documentation of treatment effectiveness, the Opioid Risk Tool score (ORT score), results from urine drug testing (UDT) and patient violations of the clinic’s controlled substance policy. These findings are used to provide the treating physician constructive, non-punitive feedback. We also assessed if the use of the CRT resulted in change in MED prescribed. RESULTS: Ninety-nine patient charts from 14 different physicians were reviewed over 1 year. Eighty-eight of these patients were receiving opioids for chronic pain, with an average dose in MED 72.6 mg/day (SD 89). Twenty-nine percent of charts had documentation that the controlled substance was improving the patient’s quality of life or decreasing their pain. Sixty percent of patients had at least one violation of the clinic’s controlled substance treatment agreement in the prior 6 months, and half of the violations were due to missed appointments with specialists to help manage pain. Patients were more likely to have a violation of controlled substance policy in the past 6 months if they were prescribed both a benzodiazepine (BZD) and an opioid (p=0.04), had a documented treatment agreement (p=0.002), or were high risk per ORT score (p=0.001). The mean dose of opioids, for the 88 patients who were prescribed opioids, decreased 2.6 mg/day MED from time of chart review until the end of study (mean duration 6.3 months), compared to a 6.9 mg/day MED increase that occurred from 12 months prior to chart review to the time of chart review (p=0.01). CONCLUSION: Development and implementation of a CRT in an urban primary care clinic provided helpful insight on prescribing practices, and has promise to improve quality of opioid prescribing. The most common violation of the clinic policy was missed appointments with specialists, and patients prescribed both BZD and an opioid or were high risk per ORT were most likely to have violations. Documentation of effectiveness of therapy was lacking.

Chronic opioid exposure in utero places the infant at risk of Neonatal Abstinence Syndrome (NAS), a clinical diagnosis of neurological, autonomic, and/or gastrointestinal withdrawal symptoms from opioid abstinence at birth. The prevalence of NAS is rising concurrently with the recent epidemic of opioid misuse among the general population in the United States, including pregnant women. Opioid misusing women typically receive methadone or buprenorphine as a treatment throughout pregnancy. However, the opioid misuse during pregnancy is associated with higher obstetric complications and a higher incidence of NAS in infants, at times requiring pharmacological intervention. The exact consequences to the human development from opioid exposure in utero remain unclear. Animal studies suggest that the fetal impacts of opioid exposure may differ from the consequences for an adult who uses opioids. Furthermore, there may be neurodevelopmental alterations in myelin physiology, dendritic length in the brain, and neurotransmitter systems when a child is exposed to opioids in utero. Clinical studies highlight associations between perinatal opioid exposure and gene mutation variants, cranial abnormalities on imaging, and a high prevalence of ocular and visual comorbidities. Ocular and visual comorbidities are of particular interest, because they may be treatable when detected early. The current literature about NAS infants and ocular and visual comorbidities is limited by the retrospective and small case-control study designs employed by the majority of the research groups. The proposed study design is a prospective study comparing groups of opioid exposed and non-opioid exposed infants born at Boston Medical Center in Boston, Massachusetts. The ocular and visual comorbidities detected in each group will be quantified, while analyzing the relationship and the relative risk attributable to the infant’s and mother’s demographics. The social context of opioid misuse may complicate the interpretation of the data; however, the design anticipates sufficient recruitment and generalizability as it is conducted at a safety net hospital. Ultimately, the goal of this proposal is to reduce the risk to the fetus with perinatal opioid exposure and build the knowledge base about ocular comorbidities in NAS infants so that optimal and comprehensive care can be provided in the future.

BACKGROUND: Guidelines recommend long-term treatment for opioid use disorder including the use of buprenorphine; however, little is known about patients in long-term treatment. OBJECTIVE: Examine the prevalence and patient characteristics associated with long-term treatment retention (≥1 year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine. Study Design: This is a 12-year retrospective cohort study of adults on buprenorphine in OBOT in a large urban safety-net primary care practice. METHODS: The primary outcome was retention in OBOT for ≥1 continuous year. Patients who re-enrolled multiple times in the program contributed repeated observations. Potential predictors of ≥1 year retention assessed were: age, race/ethnicity, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1 year OBOT retention were identified using generalized estimating equation logistic regression models. The different reasons for clinic disengagement by retention status (i.e. ≥1 year vs. <1 year) were also described. RESULTS: OBOT treatment periods (n=1605) among 1237 patients were assessed. Almost half, 44.7% (717/1605), of all treatment periods were ≥1 year and a majority, 53.7% (664/1237), of patients had at least one ≥ 1 year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10 year increase [1.05, 1.34]) were associated with greater odds of ≥1 year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]), compared to white, were associated with lower odds of ≥1 year retention. Relapse to substance use appeared to be a less common reason for disengagement for the ≥1 year (23.3%) compared to the <1 year (40.1%) treatment periods. CONCLUSIONS: Over half of patients were successfully retained in Office Based Opioid Treatment with buprenorphine for ≥1 year. However, significant disparities in one-year treatment retention were seen, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C. / 2018-11-09T00:00:00Z

Submitted by Socorro Pontes (socorrop@ufersa.edu.br) on 2017-06-21T13:36:52Z No. of bitstreams: 1 TalytaLN_TESE.pdf: 1505855 bytes, checksum: f450d9b1a9eb7f3e1dc8fddf45518523 (MD5) / Approved for entry into archive by Vanessa Christiane (referencia@ufersa.edu.br) on 2017-06-22T11:39:09Z (GMT) No. of bitstreams: 1 TalytaLN_TESE.pdf: 1505855 bytes, checksum: f450d9b1a9eb7f3e1dc8fddf45518523 (MD5) / Approved for entry into archive by Vanessa Christiane (referencia@ufersa.edu.br) on 2017-06-22T11:41:55Z (GMT) No. of bitstreams: 1 TalytaLN_TESE.pdf: 1505855 bytes, checksum: f450d9b1a9eb7f3e1dc8fddf45518523 (MD5) / Made available in DSpace on 2017-06-22T11:42:26Z (GMT). No. of bitstreams: 1 TalytaLN_TESE.pdf: 1505855 bytes, checksum: f450d9b1a9eb7f3e1dc8fddf45518523 (MD5) Previous issue date: 2017-04-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Tramadol is an atypical opioid analgesic widely used in humans and in the routine of the small animal clinic. Due to the lack of studies that determine its pharmacokinetic and pharmacodynamic characteristics, its use in production animals is restricted. The objective of this research was to evaluate the clinical, familial and bioavailability effects of tramadol in goats. The study was divided into two phases: the first one evaluated the clinical effects of tramadol at doses of 2 and 4 mg / kg intravenously; In the second stage, the bioavailability and pharmacokinetic parameters of tramadol and O-desmethyltramadol were evaluated after intravenous and intramuscular administration at a dose of 4 mg / kg. Opioid has been shown to be safe and effective in the control of orchiectomy pain and should be given every 6 and 8 hours at doses of 2 and 4 mg / kg. The intramuscular opioid has bioavailability of 62%. The data from this research provide information on tramadol and its metabolites, and serve as the basis for future studies involving the drug and the plasm / O tramadol é um analgésico opioide atípico amplamente utilizado em humanos e na rotina da clínica de pequenos animais. Devido ausência de estudos que determinam as características farmacocinéticas e farmacodinâmicas, sua utilização em animais de produção é restrita. Objetivou-se com esta pesquisa avaliar os efeitos clínicos, farmacocinética e biodisponibilidade do tramadol em caprinos. O estudo foi dividido em duas fases: na primeira, realizou-se avaliação dos efeitos clínicos do tramadol nas doses de 2 e 4 mg/kg intravenoso em caprinos submetidos a orquiectomia e na segunda etapa, realizou-se avaliação da biodisponibilidade e dos parâmetros farmacocinéticos do tramadol e O-desmetiltramadol após administração intravenosa e intramuscular em caprinos, na dose de 4 mg/kg. O opioide mostrou-se seguro e eficaz no controle da dor da orquiectomia, devendo ser administrado a cada 6 e 8 horas, nas doses de 2 e 4 mg/kg. O opioide intramuscular tem biodisponibilidade de 62%. Os dados desta pesquisa fornecem informações relevantes a respeito do tramadol e seus metabólitos e servem de base para estudos futuros envolvendo o fármaco e a matriz biológica / 2017-06-21

This triptych consists of three pointillist-style portraits of myself, a close friend and my mother, each assembled out of the specific pills we take. While we each appear “healthy” at first glance, a closer examination raises questions about society’s collective dependence on prescription drugs – a microcosm of the much larger tragedy of opioid abuse that is destroying many American families. In addition to the portraits is an animation, “Oxycodone Lungs,” comprised of individual Oxy pills, reflecting my personal experience with this wildly addictive opiate during an emergency room visit to relieve extreme chest pain from pericarditis. Creating each portrait required me to inventory the specific medicines taken by the subject, capture high-resolution images of each pill, then transfer the images to Adobe Illustrator to be used as individual design elements. In total, these three digital portraits required the use of over 10,000 elements. Beyond the rendering of each “pill face” I added critical context in the background, listing the pill name and a quote from each subject as to why she is taking it. I also added a subtle, almost transparent, layer of pill bottles to provide more texture to each portrait. For the “Oxycodone Lungs,” I created and duplicated two 2-D pills in Adobe Illustrator to form the trachea, lobes and bronchioles. To capture a realistic rendering, I added animation so that the lungs appear to be breathing. Three artists have provided valuable inspiration for my thesis project. Vik Muniz is a Brazilian multimedia artist who uses unusual everyday items to create art that is accessible and meaningful to all viewers. Yayoi Kusama’s work with polka dots creates a sense of movement and depth through scale and repetition. Lastly, I was inspired by Yung Jake’s innovative, accurate images that he creates solely out of emojis.

Orientador: Valéria Nobre Leal de Souza Oliva / Banca: Paulo Sérgio Patto dos Santos / Banca: Juan Carlos Duque Moreno / Resumo: A utilização da anestesia local peridural tem alcançado grande ênfase nos últimos anos, sobretudo com a utilização de opióides. O presente trabalho teve como objetivo investigar a utilização da ropivacaína isolada ou em associação a diferentes opióides, na anestesia peridural de cadelas submetidas à ovariosalpingohisterectomia (OSH) eletiva. Participaram do estudo duplamente encoberto 32 cadelas sadias, adultas, de diferentes raças, pesando entre seis e 15 kg e pré-medicadas com acepromazina (0,05mg/kg, IM) associada ao midazolam (0,2mg/kg, IM), distribuídas em quatro grupos distintos: Grupo 1: ropivacaína: 0,3 mL/kg; Grupo 2: ropivacaína + morfina (0,1 mg/kg); Grupo 3: ropivacaína + butorfanol (0,1 mg/kg); e Grupo 4: ropivacaína + tramadol (0,5 mg/kg) administrados pela via peridural. Em cada momento experimental foram mensurados: freqüência cardíaca; freqüência respiratória; pressão arterial sistólica; temperatura retal; pressão parcial dos gases sangüíneos (arterial); pH sangüíneo; além da avaliação não-paramétrica do grau de sedação, grau de sangramento e de relaxamento muscular seguindo tabelas de escores. Os dados foram submetidos à ANOVA e comparados pelos testes de Kruskal-Wallis, Friedman, Dunn e Tukey (p< 0,05). Concluiu-se que a utilização da ropivacaína isolada ou associada à morfina, ao butorfanol ou ao tramadol pela via peridural não promoveu depressão cardiorrespiratória ou alterações hemodinâmicas significativas, sendo que a ropivacaína associada ao butorfanol permitiu a realização de OSH em cadelas. / Abstract: The use of epidural local anesthesia has been reaching great emphasis for the last years, overcoat with the opioids using. This research ained the use of ropivacaine with or without association the different opioids, for epidural anesthesia biches submitted the elective ovariosalpingohisterectomy (OSH). 32 bitches tool part is this double-blind study, adult, different breed, weighing between 6 and 15kg and pré-medicated with acepromazine (0.05mg/kg, IM) associated to the midazolam (0.2mg/kg, IM), distributed in for different groups: Group 1: ropivacaine: 0.3 mL/kg; Group 2: ropivacaine + morphine (0.1 mg/kg); Group 3: ropivacaine + butorphanol (0.1 mg/kg); and Group 4: ropivacaine + tramadol (0.5 mg/kg) administered epidural. The following parameters were studied: heart frequency; breathing frequency; systolic arterial pressure; rectal temperature; blood gas partial pressures (arterial); blood pH; besides non-parametric of sedation grade, bleeding grade and muscular relaxation following tables scores. The results were submitted by ANOVA and compared by Kruskal-Wallis, Friedman, Dunn and Tukey test (p< 0.05). It was conclude that the use of only ropivacaine or associated with morphine, with butorphanol or tramadol for the epidural administration didn't promote depression cardiorrespiratory or significant hemodinamycs alterations and the ropivacaine associated to the butorphanol allowed OSH in bitches accomplishment. / Mestre