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Preventive Veterinary Medicine Nov 2018Overuse of antimicrobials in both humans and animals is recognized as one of the main drivers of Antimicrobial Resistance (AMR); and the optimisation of their use has... (Review)
Review
BACKGROUND
Overuse of antimicrobials in both humans and animals is recognized as one of the main drivers of Antimicrobial Resistance (AMR); and the optimisation of their use has been advocated as a key strategy for dealing with AMR. The measurement of antimicrobial use is vital for the design, monitoring and evaluation of such strategies. This systematic review describes and compares methods and measurements used to quantify antimicrobial use in pigs in order to inform efforts to standardize measurement.
METHODS
The peer-reviewed literature was systematically searched using four online databases: MEDLINE, ScienceDirect, Scopus and Web of Science. Eligibility criteria for inclusion in the review included: articles published in English, involving pigs of any age and types of production, providing quantitative data on antimicrobial use, containing a clear description of the methodology, and having moderate to high rank in the quality assessment.
RESULTS
Of 2,362 abstracts reviewed, a total of 25 studies were included based on the eligibility criteria. All studies were published between 2001 and 2017. Twenty of the studies were conducted in eight European countries. Twelve studies estimated antimicrobial use and eight studies were primarily methodological papers comparing different methods or variables, or developing new methods. The two main sources of antimicrobial use data were farm surveys and national sales data. A large variety of units of measurement was found. In this review, the ten measurements identified were categorized into four groups: 1) antimicrobials use measured by milligrams of active substance per animal weight; 2) antimicrobials use measured by daily dose per weight at treatment; 3) antimicrobial use measured by daily dose per treatment period; and 4) antimicrobials use measured by daily dose per period at risk of treatment.
CONCLUSION
There is no global standardized measurement of antimicrobial use in pigs. Given the importance of monitoring the use antimicrobials, we recommend that at a minimum, all countries should develop macro-level monitoring using national sales data and report use by milligram of active ingredients per Population Correcting Unit. Monitoring in specific animal species requires the development of systems to capture prescription at national or farm level. Findings from monitoring antimicrobial use may help to guide effective interventions for optimising use of antimicrobials, as recommended by the WHO Global Action Plan on AMR.
Topics: Animal Husbandry; Animals; Anti-Infective Agents; Swine
PubMed: 30389002
DOI: 10.1016/j.prevetmed.2018.09.016 -
American Journal of Preventive Medicine May 2022Increases in opioid prescribing contributed to the opioid epidemic in the U.S. Subsequent efforts to promote safer use of opioids for treating pain included augmenting...
INTRODUCTION
Increases in opioid prescribing contributed to the opioid epidemic in the U.S. Subsequent efforts to promote safer use of opioids for treating pain included augmenting prescription drug monitoring programs and prescribing guidelines. The purpose of this study is to characterize the distribution of opioids dispensed in the U.S. by specialty.
METHODS
Data from the IQVIA National Prescription Audit were analyzed (in 2019). Prescriptions were standardized to morphine milligram equivalents using the 2018 Centers for Disease Control and Prevention conversion file. The annual number of prescriptions and total dose (morphine milligram equivalents) of opioids dispensed, overall and by specialty (provider type or physician specialty), were calculated for 2012-2017.
RESULTS
The number of prescriptions for opioids dispensed declined by 26.6% overall from 2012 to 2017. However, the number of prescriptions dispensed increased for pain medicine (8.8%) and advanced practice providers (nurse practitioners: 34.8%, physician assistants: 5.4%). Similarly, total morphine milligram equivalents for opioids dispensed declined by 28.6% from 2012 to 2017. Despite an increase in the number of prescriptions, total morphine milligram equivalents of opioids dispensed declined by nearly 20% in pain medicine. Higher total morphine milligram equivalents of dispensed opioids were observed in 2017 than in 2012 for advanced practice providers (nurse practitioners: 19.1%, physician assistants: 1.8%), although a decline in morphine milligram equivalents was observed from 2016 to 2017.
CONCLUSIONS
During a period in which prescribing interventions were expanded, opioid prescribing declined overall, although not uniformly by specialty.
Topics: Analgesics, Opioid; Drug Prescriptions; Humans; Morphine; Pain; Practice Patterns, Physicians'; Prescription Drug Monitoring Programs
PubMed: 35151524
DOI: 10.1016/j.amepre.2021.10.022 -
Journal of the American College of... Apr 1994In severe catabolic states, such as burn injury, sepsis and accidental injury, a state of marked insulin resistance is encountered. Insulin resistance is also present... (Clinical Trial)
Clinical Trial Randomized Controlled Trial Review
In severe catabolic states, such as burn injury, sepsis and accidental injury, a state of marked insulin resistance is encountered. Insulin resistance is also present after elective surgical treatment, more pronounced with increasingly greater magnitude of operation performed. Results of recent animal experiments have shown that even short periods of food deprivation, reducing carbohydrate reserves, alter responses to stress. This notion resulted in our questioning the rationale of carbohydrate depletion associated with overnight preoperative fasting. Twelve patients undergoing elective open cholecystectomy were randomly given no infusion (control group) or 5 milligrams per kilogram per minute of glucose infusion (glucose group) during preoperative overnight fasting. Insulin sensitivity (M value, milligram per kilogram per minute) was determined using the hyperinsulinemic normoglycemic clamp (plasma insulin level, 65 microunits per milliliter and blood glucose level, 4.5 millimoles per liter) before and the first postoperative day. Preoperative insulin sensitivity was similar in the two groups. Postoperatively, M values decreased by 55 +/- 3 percent (control group) and by 32 +/- 4 percent (glucose group) (p < 0.01). Plasma levels of insulin, c-peptide, glucagon, growth hormone, catecholamines and cortisol in connection with clamps were similar in both groups preoperatively and postoperatively. The present results indicate that active preoperative carbohydrate preservation may improve postoperative metabolism because postoperative occurrence of insulin resistance was reduced with preoperative glucose infusion.
Topics: Animals; Blood Glucose; Carbohydrate Metabolism; Carbohydrates; Cholecystectomy; Disease Models, Animal; Elective Surgical Procedures; Fasting; Glucose; Humans; Informed Consent; Infusions, Parenteral; Insulin Resistance; Postoperative Complications; Preoperative Care; Random Allocation
PubMed: 8149032
DOI: No ID Found -
Pain Medicine (Malden, Mass.) May 2021To provide clinical data for the conversion of Schedule II opioids to buprenorphine buccal film and to demonstrate sustained analgesia and a reduction in morphine...
OBJECTIVE
To provide clinical data for the conversion of Schedule II opioids to buprenorphine buccal film and to demonstrate sustained analgesia and a reduction in morphine milligram equivalents after conversion.
DESIGN
Retrospective review of electronic medical records.
SETTING
Group clinical practice providing outpatient chronic pain management care in Winston-Salem, North Carolina.
SUBJECTS
Patients who received opioids for chronic pain between January 1, 2016, and June 30, 2019, were selected for chart review if they were converted to buprenorphine buccal film from a Schedule II opioid.
METHODS
Patients who met inclusion criteria were stratified into subgroups on the basis of preconversion morphine milligram equivalents, whether they remained on opioids for breakthrough pain postconversion, and pre- and postconversion numerical rating scale pain scores. Outcomes of interest included the differences between pre- and postconversion numerical rating scale pain scores and daily morphine milligram equivalents for each subgroup.
RESULTS
Of 157 patients reviewed, 87.9% were successfully converted to buprenorphine buccal film. Overall, numerical rating scale pain scores were stable after conversion. Statistically significant reductions were demonstrated in the <90 daily morphine milligram equivalent subgroup. Postconversion daily morphine milligram equivalents decreased by 85.4% from baseline. Change in daily morphine milligram equivalents is representative of patients who remained on breakthrough pain medication.
CONCLUSIONS
Results demonstrate continued analgesia after conversion to buprenorphine buccal film despite reductions in daily morphine milligram equivalents. Most patients were able to convert directly from their long-acting opioid to buprenorphine buccal film and stabilized without the use of concomitant opioids for breakthrough pain. Aggressive titration strategies were associated with greater success.
Topics: Analgesics, Opioid; Buprenorphine; Chronic Pain; Humans; Pain Management; Retrospective Studies
PubMed: 32914182
DOI: 10.1093/pm/pnaa226 -
Science (New York, N.Y.) May 2017Nanostructured materials have shown extraordinary promise for electrochemical energy storage but are usually limited to electrodes with rather low mass loading (~1...
Nanostructured materials have shown extraordinary promise for electrochemical energy storage but are usually limited to electrodes with rather low mass loading (~1 milligram per square centimeter) because of the increasing ion diffusion limitations in thicker electrodes. We report the design of a three-dimensional (3D) holey-graphene/niobia (NbO) composite for ultrahigh-rate energy storage at practical levels of mass loading (>10 milligrams per square centimeter). The highly interconnected graphene network in the 3D architecture provides excellent electron transport properties, and its hierarchical porous structure facilitates rapid ion transport. By systematically tailoring the porosity in the holey graphene backbone, charge transport in the composite architecture is optimized to deliver high areal capacity and high-rate capability at high mass loading, which represents a critical step forward toward practical applications.
PubMed: 28495745
DOI: 10.1126/science.aam5852 -
Electrophoresis Dec 2007Protein N-glycosylation is a post-translational modification which plays numerous crucial physiological roles. The N-glycan pattern varies depending on the species...
Protein N-glycosylation is a post-translational modification which plays numerous crucial physiological roles. The N-glycan pattern varies depending on the species organs, tissues and even cell types and their respective physiological states. Obtaining enough starting material from a particular cell type or tissue for N-glycan purification by conventional methods can, in certain cases, be very difficult. Previously, a sensitive technique, the "in-gel release method" that allows the determination of N-glycans attached to a protein isolated by SDS-PAGE, has been developed in this and other laboratories. Here, we describe the adaptation of this method to obtain information on the N-glycome from minute amounts of tissue. The starting material, ranging from less than a milligram to a few milligrams of fresh tissue, is directly ground in Laemmli sample buffer and subject briefly to discontinuous Tris-glycine-SDS-PAGE. The Coomassie-stained band containing the majority of the proteins is subject to the "in-gel release method". The developed technique was used to analyze N-glycan patterns of different samples from Caenorhabditis elegans, Drosophila melanogaster, Spodoptera frugiperda, Trichoplusia ni, Nicotiana benthamiana, Arabidopsis thaliana, and Mus musculus. Furthermore, the technique was used to determine the effects of transient small-scale RNAi-mediated knock-down of a glycosylation-related gene in Drosophila Schneider 2 cell line.
Topics: Animals; Arabidopsis; Caenorhabditis; Carbohydrate Sequence; Cell Culture Techniques; Cell Extracts; Drosophila; Electrophoresis, Polyacrylamide Gel; Glycomics; Glycosylation; Mice; Microchemistry; Oligosaccharides; Sensitivity and Specificity; Species Specificity; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Spodoptera; Tissue Extracts; Nicotiana
PubMed: 18041037
DOI: 10.1002/elps.200700098 -
Annals of Emergency Medicine Nov 1986In this study of ibuprofen overdose, symptoms developed in 19% of patients (24 of 126)--in 7% of children (6 of 88) and in 47% of adults (18 of 38). Central nervous...
In this study of ibuprofen overdose, symptoms developed in 19% of patients (24 of 126)--in 7% of children (6 of 88) and in 47% of adults (18 of 38). Central nervous system depression, seizures, gastrointestinal disturbances, bradycardia, hypotension, apnea, abnormal renal functions, hematuria, nystagmus, and blurred vision were observed. No patients became symptomatic more than four hours after ingestion. There was no significant difference (P greater than .05) between symptomatic and asymptomatic adult groups in either total milligrams or milligram-per-kilogram amounts ingested by history. Pediatric patients who became symptomatic had a mean ingestion by history of 440 mg/kg; those who remained asymptomatic had a mean ingestion by history of 114 mg/kg (P less than .001). No patients ingesting less than 99 mg/kg by history developed any symptoms. Two children had seizures or apnea and one died. Ibuprofen occasionally may cause serious toxicity in overdose.
Topics: Adolescent; Adult; Apnea; Central Nervous System; Child, Preschool; Dose-Response Relationship, Drug; Half-Life; Humans; Ibuprofen; Infant; Poison Control Centers; Seizures
PubMed: 3777588
DOI: 10.1016/s0196-0644(86)80617-5 -
Journal of Clinical Laboratory Analysis 1998We have established a procedure for the production of milligrams of free PSA (fPSA) from LNCaP cells derived from a human carcinoma of the prostate. By growing LNCaP...
We have established a procedure for the production of milligrams of free PSA (fPSA) from LNCaP cells derived from a human carcinoma of the prostate. By growing LNCaP cells in a serum-free medium in the presence of a synthetic androgen (R1881) and taking advantage of the special design of the Micro-mouse Hollow Fiber Bioreactor, relatively pure fPSA could be obtained. We found that columns containing either Sephacryl S-100 or S-200 could be used to remove the small amount of bovine serum albumin (BSA) and PSA-alpha 1-antichymotrypsin complex (PSA-ACT) from the preparation. More than 90% of the PSA from LNCaP cell cultures are fPSA. Like fPSA from seminal plasma, two fractions of fPSA differing in protease activity can be separated by DEAE-Sepharose chromatography. Based on the band pattern exhibited on the Western blot following sodium dodecyl sulfate-polyacrylamide electrophoresis separation, fPSA from LNCaP contains more inactive PSA isoforms. This was confirmed by chromatofocusing: the isoelectric point (pl) of the major PSA isoforms from the LNCaP cell culture were higher (6.8 and 6.6) than that (6.4 and 6.1) of fPSA from seminal fluid. We conclude that the LNCaP cell culture is a reliable source for obtaining large quantities of pure fPSA both for the preparation of assay calibrators and controls and for studying the difference in fPSA between benign prostate disease and prostate cancer.
Topics: Animals; Bioreactors; Blotting, Western; Chromatography, Agarose; Culture Media; Humans; Male; Mice; Prostate-Specific Antigen; Prostatic Neoplasms; Semen; Tumor Cells, Cultured; alpha 1-Antichymotrypsin
PubMed: 9484663
DOI: 10.1002/(SICI)1098-2825(1998)12:1<6::AID-JCLA2>3.0.CO;2-A -
PloS One 2015We developed an efficient, automated 2-step purification protocol for the production of milligram quantities of untagged recombinant rat lactate dehydrogenase A (rLDHA)...
We developed an efficient, automated 2-step purification protocol for the production of milligram quantities of untagged recombinant rat lactate dehydrogenase A (rLDHA) from E. coli, using the ÄKTAxpress™ chromatography system. Cation exchange followed by size exclusion results in average final purity in excess of 93% and yields ~ 14 milligrams per 50 ml of original cell culture in EnPresso B media, in under 8 hrs, including all primary sample processing and column equilibration steps. The protein is highly active and coherent biophysically and a viable alternative to the more problematic human homolog for structural and ligand-binding studies; an apo structure of untagged rLDHA was solved to a resolution 2.29 Å (PDB ID 5ES3). Our automated methodology uses generic commercially available pre-packed columns and simple buffers, and represents a robust standard method for the production of milligram amounts of untagged rLDHA, facilitating a novel fragment screening approach for new inhibitors.
Topics: Animals; Automation, Laboratory; Chromatography, Affinity; Chromatography, Liquid; Crystallography, X-Ray; Culture Media; Escherichia coli; Isoenzymes; L-Lactate Dehydrogenase; Lactate Dehydrogenase 5; Rats; Recombinant Proteins; Surface Plasmon Resonance
PubMed: 26717415
DOI: 10.1371/journal.pone.0146164 -
Surgery Mar 2023Patients prescribed higher opioid dosages are at increased risk of overdose and death without added pain reduction. Increases in opioid prescribing continue to fuel the...
BACKGROUND
Patients prescribed higher opioid dosages are at increased risk of overdose and death without added pain reduction. Increases in opioid prescribing continue to fuel the epidemic. We hypothesized a comprehensive guideline to standardize opioid prescribing would decrease postdischarge dosages for patients experiencing trauma without requiring additional refills.
METHODS
This quasiexperimental study compared opioid prescribing by trauma providers before and after the implementation of a departmental guideline on April 1, 2019, aimed at aligning opioid prescription patterns with Centers for Disease Control and Prevention recommendations. Patients prescribed opioids before implementation were the control group, whereas patients prescribed opioids after were the intervention group. The primary outcome was the proportion of patients receiving ≥50 morphine milligram equivalents per day.
RESULTS
We identified 293 and 280 patients experiencing trauma in the control and intervention groups, respectively. There were no differences between the groups' Injury Severity Score (P = .69) or the frequency of having a procedure performed (P = .80). Total morphine milligram equivalents and maximum morphine milligram equivalents per day were 16% and 25% lower, respectively, in the intervention group compared with the control group (P < .001). The proportion of trauma patients prescribed ≥50 morphine milligram equivalents per day at discharge decreased from 57% to 18% after implementation (P < .001). The proportion of trauma patients prescribed ≥90 morphine milligram equivalents per day also decreased, from 37% to 14% (P < .001). There was no significant increase in the frequency of refill requests (P = .105) or refill prescriptions (P = .099) after discharge.
CONCLUSION
A departmental guideline aimed at optimizing opioid prescription patterns successfully lowers the amount of morphine milligram equivalents prescribed to trauma patients and improves compliance with Centers for Disease Control and Prevention recommendations.
Topics: Humans; Analgesics, Opioid; Patient Discharge; Aftercare; Pain, Postoperative; Practice Patterns, Physicians'; Morphine Derivatives
PubMed: 36371358
DOI: 10.1016/j.surg.2022.07.037