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Njeh M, Helmick R, Alshaikh E, Marcano K, Alexander A, Osborn E, Jadcherla SR. The Irritable Infant in the Neonatal Intensive Care Unit: Risk Factors and Biomarkers of Gastroesophageal Reflux Disease. J Pediatr 2024; 264:113760. [PMID: 37777170 DOI: 10.1016/j.jpeds.2023.113760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES To determine risk factors for arching/irritability in high-risk infants and examine the significance of comorbidity and gastroesophageal reflux (GER) characteristics. STUDY DESIGN Retrospective analysis of 24-hour pH-impedance studies of symptomatic infants in a neonatal intensive care unit (ICU) (n = 516, 30.1 ± 4.5 weeks of gestation, evaluated at 41.7 ± 3.2 weeks postmenstrual age) was conducted. Comparisons were made between infants with >72 vs ≤72 arching/irritability events per day. We characterized risk factors for arching/irritability along with clinical, pH-impedance, and outcome correlates. RESULTS Of 39 973 arching/irritability events and 42 155 GER events, the averages per day were 77.6 ± 41.0 and 81.7 ± 48.2, respectively. Acid reflux and impedance bolus characteristics were not significantly different between infants with >72 and ≤72 arching/irritability events (P ≥ .05). The odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for postmenstrual age and weight at evaluation were significant for risk factors of preterm birth (2.3 [1.2-4.4]), moderate or severe neuropathology (2.0 [1.1-3.6]), and presence of oral feeding at testing (1.57 [1.07-2.30]). CONCLUSIONS Acid GER disease is unlikely the primary cause of arching/irritability and empiric treatment should not be used when arching/irritability is present. Prematurity and neurologic impairment may be more likely the cause of the arching/irritability. Arching/irritability may not be a concern in orally fed infants.
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Affiliation(s)
- Minna Njeh
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Roseanna Helmick
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Enas Alshaikh
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Kailyn Marcano
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Alexis Alexander
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Erika Osborn
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Division of Neonatology and Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Sudarshan R Jadcherla
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Division of Neonatology and Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH; Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.
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Viswanathan S, Osborn E, Jadcherla S. Predictive ability of postnatal growth failure for adverse feeding-related outcomes in preterm infants: an exploratory study comparing Fenton with INTERGROWTH-21st preterm growth charts. J Matern Fetal Neonatal Med 2022; 35:5470-5477. [PMID: 33573451 DOI: 10.1080/14767058.2021.1882986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Postnatal growth failure (PGF) can impact the short- and long-term health outcomes in preterm infants. However, PGF rates vary according to the way it is defined and the growth chart used to monitor the postnatal growth. Fenton-2013 growth charts which suggest following intrauterine fetal growth compared to INTERGROWTH-21st, one specifically constructed for monitoring preterm extrauterine growth. OBJECTIVE Exploratory study to determine the PGF definition at first per oral (PO) that is most predictive of adverse oral feeding-related outcomes in preterm infants. METHODS Prospectively collected data of preterm infants 24-32 weeks gestation, who were started on cue-based oral feeds at ≤34 weeks gestation were reviewed. Anthropometric data at first PO (weight, length, and head circumference) were compared according to Fenton and INTERGROWTH-21st growth charts. PGF was defined either as <10th percentile, Z-score change (ZSC) of ≥-1.5 from birth, or ZSC of ≥-2.0. Top-quartile (Q4) of feeding-related outcomes (days from first PO to full PO, post-menstrual age at full PO, days from first PO to discharge, and length of hospital stay) was considered as adverse outcome. RESULTS Of the 125 infants included, the median birth gestation and weight were 29.4 weeks and 1235 g, respectively. Incidence of appropriate, small, and large for gestational age was similar at birth by both growth charts. ZSC -1.5 for weight by Fenton was significantly higher at first PO vs. INTERGROWTH-21st (p=.02), while percentile <10th and ZSC -2.0 rates were similar. The PGF definition based on individual anthropometrics at first PO that has the best area under the curve (AUC) for adverse feeding-related outcomes was used to create a combined PGF definition for each growth chart. The AUC for the combined PGF for the Fenton and INTERGROWTH-21st was similar (p>.05) and both have moderate sensitivity and negative predictive value, but have low specificity, positive predictive value, and positive likelihood ratio for adverse feeding-related outcomes. CONCLUSIONS The tested definitions of PGF at first PO have only small to moderate predictive ability for adverse feeding-related outcomes in preterm infants.
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Affiliation(s)
- Sreekanth Viswanathan
- Department of Pediatrics, Division of Neonatology, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Erika Osborn
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.,Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sudarshan Jadcherla
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.,Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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Viswanathan S, Batchu S, Osborn E, Jadcherla S. Diagnostic utility of impedance-pH monitoring in infants of diabetic mothers with oral feeding difficulties. J Perinatol 2021; 41:1886-1892. [PMID: 32981928 DOI: 10.1038/s41372-020-00832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/21/2020] [Accepted: 09/17/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the diagnostic utility of impedance-pH monitoring in infants of diabetic mothers (IDM) with oral feeding difficulties. STUDY DESIGN Retrospective review of a consecutive sample of 50 IDM who had impedance-pH monitoring for objective gastroesophageal reflux disease (GERD) diagnosis. Acid reflux index (ARI) ≥ 7 was considered pathological (ARI+). RESULTS Impedance-pH monitoring was performed at 42.1-week postmenstrual age. Twenty infants (40%) with ARI+ compared to 30 with ARI < 7 (ARI-). ARI+ had lower weight at study vs. ARI- (p < 0.05). ARI+ had significantly higher reflux parameters but had similar symptom burden and symptom-association scores vs. ARI-. All ARI+ received proton-pump inhibitors (PPI) vs. 7 (23.3%) in ARI- (p < 0.05), but oral feeding outcomes, gastrostomy rate, growth, and hospital length of stay were similar in both groups. CONCLUSIONS The diagnostic yield of impedance-pH monitoring in IDM is about 40%. However, GERD diagnosis or treatment with PPI did not modify short-term clinical outcomes.
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Affiliation(s)
- Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, FL, USA. .,Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Sahithee Batchu
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Erika Osborn
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sudarshan Jadcherla
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
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Osborn E, Brooks J, O'Brien PMS, Wittkowski A. Suicidality in women with Premenstrual Dysphoric Disorder: a systematic literature review. Arch Womens Ment Health 2021; 24:173-184. [PMID: 32936329 PMCID: PMC7979645 DOI: 10.1007/s00737-020-01054-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022]
Abstract
Previous research has identified how menstruation is an important factor in both attempted and completed suicides for women. The purpose of this review was to outline (a) the risk profile for suicidality in women who were identified to experience Premenstrual Dysphoric Disorder (PMDD), a condition characterized by severe physical and psychological changes that occur during the luteal menstrual phase, and (b) the implications of these findings for clinical practice. A systematic literature review was conducted using five databases to identify any peer-reviewed articles published between 1989 and 2019. Ten papers eligible for inclusion were identified: three pertaining to suicide cognitions, five to suicide attempts and two to both cognitions and attempts. Findings showed that suicidal thoughts, ideation, plans and attempts were strongly associated with experiences of PMDD and that these findings were independent of psychiatric co-morbidities. However, women with PMDD did not present with more severe risk profiles for suicide attempts (in terms of frequency, impulsivity and lethality) or make more frequent attempts during the luteal menstrual phase compared with suicide attempters without PMDD. Women with PMDD should be considered a high risk group for suicidality; thus, identifying and treating symptoms are vital in reducing suicide attempts. Implications for clinical practice are outlined in the discussion.
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Affiliation(s)
- E Osborn
- Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J Brooks
- Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - P M S O'Brien
- Emeritus Professor, School of Medicine, Keele University, Staffordshire, UK
| | - A Wittkowski
- Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Prabhakar V, Hasenstab KA, Osborn E, Wei L, Jadcherla SR. Pharyngeal contractile and regulatory characteristics are distinct during nutritive oral stimulus in preterm-born infants: Implications for clinical and research applications. Neurogastroenterol Motil 2019; 31:e13650. [PMID: 31131508 PMCID: PMC6793932 DOI: 10.1111/nmo.13650] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Maturation of pharyngeal swallowing during neonatal oral feeding is unknown. Our objective was to evaluate pharyngeal functioning using high-resolution manometry (HRM) during nutritive oral stimulus and test the hypothesis that pharyngeal contractility and regulation are distinct in preterm-born infants. METHODS High-resolution manometry data during oral milk feeding were analyzed for pharyngeal contractile (PhCI, mm Hg cm s) and regulatory (number and frequency of pharyngeal contractions and bursts, pharyngeal activity-to-quiescence ratio, upper esophageal sphincter nadir pressure) characteristics in 23 preterm (<38 weeks' gestation) and 18 full-term-born infants at term maturation. Mixed linear models and stepwise regression methods were used. RESULTS Despite more oral feeding experiences (P < 0.05), preterm infants (vs full-term), consumed less milk volume (P < 0.001), had lesser pharyngeal contractions within bursts (P = 0.04), lower pharyngeal contraction frequency (P < 0.01), and lower pharyngeal activity (P = 0.03), but higher PhCI per individual contraction (P = 0.01). PhCI is higher for longer PMA (P < 0.05), higher UES nadir pressures (P < 0.05), and lower pharyngeal contraction frequency (P < 0.05). CONCLUSIONS Nutritive oral milk stimulus provoked pharyngeal contractility characteristics is distinct in preterm-born. Despite more oral nutritive experiences, preterm infants had underdeveloped excitatory and inhibitory rhythmic activity. Cranial nerve IX and X effects on sensory-motor responses and feedback (excitation-inhibitory rhythm regulation) remain immature among preterm-born even at full-term maturational status. We speculate the relationship between PhCI and UES regulatory activity contributes to the observed differences in preterm and full-term infants.
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Affiliation(s)
- Varsha Prabhakar
- Innovative Infant Feeding Disorders Research Program, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Kathryn A. Hasenstab
- Innovative Infant Feeding Disorders Research Program, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Erika Osborn
- Innovative Infant Feeding Disorders Research Program, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Sudarshan R. Jadcherla
- Innovative Infant Feeding Disorders Research Program, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,Division of Neonatology, Pediatric Gastroenterology and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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Levy DS, Osborn E, Hasenstab KA, Nawaz S, Jadcherla SR. The Effect of Additives for Reflux or Dysphagia Management on Osmolality in Ready-to-Feed Preterm Formula: Practice Implications. JPEN J Parenter Enteral Nutr 2018; 43:290-297. [PMID: 29992586 DOI: 10.1002/jpen.1418] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/04/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A common osmolality threshold for feedings is to stay <450 mOsm/kg for normal infants. Preterm formulas are frequently modified to improve growth, modify nutrition, and manage gastroesophageal reflux (GER) or dysphagia. Relationships between osmolality and additives to ready-to-feed preterm formulas are unclear. Our aims were to evaluate and compare the effects of caloric density, thickening agent recipes, and supplements to ready-to-feed preterm formula on osmolality. METHODS A freezing point osmometer was used to measure the osmolality of 47 preterm infant formula combinations with varying caloric densities (ready-to-feed 22 and 30 cal/oz), thickening agents (rice vs oatmeal cereal), thickener amounts (0.0, 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 tsp/oz), and combinations of supplements (saline, iron, vitamin D, or multivitamin). Ten samples per combination were tested using a 10-μL pipette. Comparisons were made using analysis of variance and t-tests for group and pair-wise comparisons, respectively. RESULTS A total of 470 osmolality samples were analyzed: (1) raters had high agreement (r = 0.98; P < .001); (2) for every 0.5 tsp/oz of thickener, the osmolality increases by 30 mOsm/kg (P < .001); (3) osmolality was higher with the oatmeal (vs rice) thickening agent (P < .001); and (4) vitamin and electrolyte supplement combinations increase osmolality. CONCLUSIONS Alteration of ready-to-feed preterm formulas may significantly increase osmolality and have unintended consequences. Caution and monitoring should be exercised with modifying ready-to-feed preterm formulas for regurgitation, rumination, GER, dysphagia, feeding intolerance, or emesis. This study supports the concept of achieving volume tolerance before further manipulation of additives.
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Affiliation(s)
- Deborah S Levy
- Speech and Language Pathology, Health and Communication Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Erika Osborn
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kathryn A Hasenstab
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Saira Nawaz
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sudarshan R Jadcherla
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Divisions of Neonatology, Pediatric Gastroenterology, and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Abstract
The author recounts an incident of cheating by two first-year medical students, and how it was handled. One of the students, George, had waited until the last minute to write what he called a "stupid" paper that was required as the final examination in a health policy course. His classmate Ellen offered to write the paper for him, and other students also offered to help; no one pointed out that this would be unethical. After some hesitation, George was persuaded to accept Ellen's offer, and he turned in the paper as his own. The course director deduced the deception, and when the students were confronted, they immediately admitted what they had done, blamed only themselves, and said they had been "foolish." Subsequent events showed that the faculty saw the incident as a clear-cut case of cheating, whereas many students felt that George and Ellen's transgression was trivial when compared with plagiarizing a research paper or falsifying lab results on a patient's chart. Also, the faculty chose a more severe and long-lasting punishment, one that many students did not agree with. The author believes that the faculty's refusal to give George and Ellen a clean slate after a reasonable time reflected a lack of forgiveness that is antithetical to the compassionate, forgiving role of physician-healer that medical education promotes. She concludes by explaining how this incident illustrates complex generational and cultural differences in moral reasoning and the selection of punishment, and the great emphasis that medical education places on knowing the facts rather than working creatively with ideas.
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Affiliation(s)
- E Osborn
- Palo Alto Medical Foundation, California 94301, USA.
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Sakheim GA, Osborn E. Severe vs. nonsevere firesetters revisited. Child Welfare 1999; 78:411-434. [PMID: 10418114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The study reported here compares a group of 75 severe firesetters with a group of 105 nonfiresetters and minor firesetters along 32 variables that have been positively correlated with juvenile firesetting behavior. A chisquare analysis of the data revealed that the frequencies observed in the 75 "severe" cases differ significantly from those in the "nonsevere" group. A prediction equation was derived from the 14 most salient variables. This equation can be used to differentiate severe/high-risk from minor/low-risk firesetters 95% of the time.
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Affiliation(s)
- G A Sakheim
- Westchester County Department of Social Services, Westchester County Family Court, NY, USA
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Osborn E. Organizational skills: half the battle. Home Healthc Nurse 1997; 15:53-4. [PMID: 9052085 DOI: 10.1097/00004045-199701000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- E Osborn
- Mercy Home Care, Phoenix, Arizona, USA
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Osborn E. Forward projection of HIV prevalence. S Afr Med J 1990; 78:373. [PMID: 2396159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Bertolucci PH, Mattas SL, Santos VD, Osborn E. [Auditory agnosia, pure word deafness, Wernicke's aphasia without alexia: clinical and conceptual aspects]. Rev Paul Med 1988; 106:35-41. [PMID: 3238262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Osborn E, Grey C, Reznikoff M. Psychosocial adjustment, modality choice, and outcome in naltrexone versus methadone treatment. Am J Drug Alcohol Abuse 1986; 12:383-8. [PMID: 3826024 DOI: 10.3109/00952998609016877] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Thirty naltrexone and 30 methadone patients in outpatient opiate addiction treatment were compared on pretreatment psychosocial adjustment and on short-term outcome in terms of drug abuse and retention. Also, the relationship between pretreatment psychosocial adjustment and outcome for the total sample was assessed. The naltrexone and methadone groups were generally not significantly different in pretreatment psychosocial adjustment. The two groups differed significantly in retention, but not in drug abuse outcome. Pretreatment drug abuse was significantly related to drug abuse outcome. No aspect of pretreatment psychosocial functioning was related to retention outcome. Treatment and research implications are discussed.
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Abstract
Thirty naltrexone and 30 methadone patients in outpatient opiate addiction treatment were compared on pretreatment somatization, stress, and family support. Also, the relationship between these pretreatment variables and outcome in terms of drug abuse and retention was examined. In the methadone group, drug abuse was correlated significantly with somatization, stress, and family support. In the naltrexone group, retention was correlated significantly with somatization and stress. Treatment and research considerations were discussed.
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Abstract
We determined the relative potencies of penicillin G, carbenicillin, oxacillin, cephalothin, cephaloridine, gentamicin, kanamycin, neomycin, vancomycin, and bacitracin after their addition to three commercially available 0.5% hydroxypropyl methylcellulose artificial tear solutions in plastic squeeze bottles. We found no significant loss of antibiotic activity at room temperature over a period of seven days for all antibiotics except penicillin G, cephalothin, and cephaloridine. Three of the antibiotics were insoluble in one or more of the artificial tear solutions.
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