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of both HCP and those using PIEDs, and that careful consideration is given to the various factors that may act as a barrier to effective implementation.
Providing credible evidence-based resources to support HCPs' knowledge development is important. Evidence-based and theory informed interventions are needed to equip HCPs with knowledge that can aid culturally sensitive interactions and effective engagement with people who use PIEDs. Reflecting on our study findings, it is important that the development of interventions should include the voices of both HCP and those using PIEDs, and that careful consideration is given to the various factors that may act as a barrier to effective implementation.Historically, the poppy plant has had multiple uses including as a food product and with medical uses in pain relief; today it is most commonly known as the plant from which heroin is derived. The United Nations international drug control regime currently only allows legal poppy production for medical use in 19 countries. Although Mexico is the third largest illegal poppy producer in the world, no Latin American country is currently allowed to legally produce poppies. Meanwhile, the United States and Canada are experiencing an overdose crisis due in large part to the adulteration and substitution of heroin with fentanyl and its analogues, while the price of opium gum has dropped 80% in the last two years in poppy producing areas of Mexico. The prohibition of opium has wide ranging health and development impacts that bring up a moral imperative regarding the safe supply of diverse opium-based products -including opium gum and heroin- that urgently need to be explored and addressed. Opium gum can be used orally or smoked, reducing riskier modes of administration and possible fatal overdoses. This article discusses the political and legal possibilities of safely supplying opium gum and manually extracted heroin from Mexico to Canada as a public health, harm reduction and development policy.
"Big Events" are major disruptions to physical, political, and economic environments that can influence vulnerability to drug-related harms. We reviewed the impacts of Big Events with relevance to the COVID-19 pandemic on drug-related risk and harms and access to drug treatment and harm reduction services.
We conducted a rapid review of quantitative, qualitative, and mixed methods literature relating to the following Big Events respiratory infection pandemics, natural disasters, financial crises, and heroin shortages. Included studies reported data on changes to risks, harms, and/or service provisioning for people who use illicit drugs (other than cannabis) in the context of these Big Events. Searches were conducted in PubMed in May 2020, and two reviewers screened studies for inclusion. Peer-reviewed studies published in English or French were included. We used a narrative synthesis approach and mapped risk pathways identified in the literature.
No studies reporting on respiratory infection pandemics wnt, and mental health care.
Current evidence reveals numerous risk pathways and service impacts emanating from Big Events. Risk pathway maps derived from this literature provide groundwork for future research and policy analyses, including in the context of the COVID-19 pandemic. In light of the findings, we recommend responding to the pandemic with legislative and financial support for the flexible delivery of harm reduction services, opioid agonist treatment, and mental health care.
Performance status is an important prognostic tool in cancer. In oncology, the Eastern Cooperative Oncology Group (ECOG) measure is commonly used. Patient-reported functional status (PRFS) is an emerging method that allows patients to provide an estimate of their function; however, there is limited information about its prognostic significance. The aim of this study was to compare the predictive validity of functional status as reported by patients and physicians in relation to the observed survival after a new cancer diagnosis.
This was a retrospective, population-based study using observational data of newly diagnosed patients in Ontario, Canada. We included patients who had both PRFS and ECOG recorded on the same day during an outpatient cancer clinic visit between March 2013 and March 2018. The dataset was randomly divided into 60% training and 40% validation cohorts. One-year survival was estimated by modelling clinical characteristics with PRFS, with ECOG, and alone.
In total, 13045 patients met the inclusion criteria. Covariates were similar at baseline for both training and validation datasets. PRFS and ECOG scores were statistically significant predictors of overall survival. Higher PRFS and ECOG scores were both associated with inferior survival, hazard ratio = 1.71 (P < 0.0001) and hazard ratio = 1.90 (P < 0.0001), respectively. Tirzepatide in vitro Models that included either PRFS or ECOG scores outperformed the model with clinical characteristics only. C statistics were 0.836, 0.839 and 0.811, respectively.
PRFS adds to survival modelling and is equally predictive as the ECOG scale. PRFS may be used instead of ECOG in clinical or research settings for survival estimation.
PRFS adds to survival modelling and is equally predictive as the ECOG scale. PRFS may be used instead of ECOG in clinical or research settings for survival estimation.
Until now, there are lack of established clinical factors allowing management of chronic heart failure (CHF) patients being at risk of cardiac cachexia (CC). The changes in soluble protein ST2 (sST2) concentrations suggest a valuable and prognostic usefulness of this biomarker in monitoring patients with CHF, especially those who potentially are prompt to develop CC. The aim of this study was to assess the potential role of sST2 in male patients with CHF under cachexia condition.
91 male patients were selected to the study group and underwent meticulous screening according to recent clinical guidelines in order to CHF and CC detection. Additionally all patients underwent assessment of body composition and sST2 testing. Patients were followed-up for 60 months. Plasma sST2 concentration was significantly increased in cachectic compared with non-cachectic patients (median 27.40ng/mL and 20.62ng/mL; p<0.001), however, in this group the EF% was reduced (mean 34±13.5% and 41±14.5%; p=0.029). Correlations between sST2 and CRP (R=0.
