American journal of therapeutics最新文献

Background: Flumazenil is a competitive benzodiazepine (BZD) antagonist most used for treating delirium in BZD overdoses. Since its introduction, many have expressed concerns about its safety secondary to the risk of inducing BZD withdrawal and refractory seizures.

Study question: What is the incidence of adverse drug events after the administration of flumazenil in patients with suspected iatrogenic BZD delirium?

Study design: This is a retrospective cross-sectional study of patients from a single center from 2010 to 2013. Patients experiencing delirium after receiving BZDs in the hospital were included if they had a bedside toxicology consult and were administered flumazenil. Patients were excluded if they were given BZDs for ethanol withdrawal or if they did not have mental status documentation before and after flumazenil administration. Descriptive statistics were calculated.

Measures and outcomes: The primary outcome was the incidence of adverse drug events after flumazenil administration. The secondary outcome was the efficacy of flumazenil determined by the patient's mental status.

Results: A total of 501 patient records were reviewed, and 206 patients were included in the final analysis. Of those patients, 172 (83.5%) experienced an objective improvement in their mental status within 1 hour after flumazenil administration. A total of 5 patients experienced adverse events (2.4%), 95% confidence interval (0.78, 5.54). Of these, 3 patients experienced minor agitation or restlessness without pharmacologic intervention. Two patients experienced moderate agitation or restlessness that resolved with haloperidol or physostigmine administration. No patients had a reported seizure, 95% confidence interval (0.0, 1.77).

Conclusions: Flumazenil seems to be a safe and effective intervention for the reversal of delirium secondary to iatrogenic BZD administration.

Background: Public and medical interest in the use of cannabis has increased in Israel and the world over recent years.

Study question: The aim of the study was to assess the attitudes of medical students from the Faculty of Health Sciences of Ben-Gurion University of the Negev on the use of medical cannabis.

Study design: This is a cross-sectional study using a self-administered questionnaire completed by medical students from Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Measures and outcomes: Attitudes and knowledge toward the use of medical cannabis were evaluated.

Results: A total of 243 medical students participated in the study. Of these, 111 (46.1%) were from preclinical years. The mean age was 27.31 ± 3.07, and 138 (57.3%) were female students. Most students (N = 193, 79.4%) agreed to a great degree or to a very great degree that there was a role for cannabis for medical purposes. Most students thought that medical cannabis should be recommended for use by pain specialists (N = 231, 95.1%), by oncologists (N = 208, 85.6%), and by psychiatrists (N = 192, 79%). A little more than half of the participants (N = 127, 52.5%) would agree to be licensed, as future physicians, to prescribe medical cannabis. A logistic regression analysis found that the students strongly agreed with legalization of medical cannabis and students who strongly agreed that medical cannabis should be in the health basket predicted a very strong agreement about its use (OR = 2.623, P ≤ 0.002, and OR = 3.285, P ≤ 0.001, respectively).

Conclusions: Most medical students support the use of medical cannabis for medical purposes and are in favor of its legalization. As physicians of the future, it is important to assess the attitudes of medical students on medical cannabis.