Opium tincture (OT) is widely used for opioid substitution treatment (OST) in Iran.

To determine if OT is a safe and effective medication for OST.

Opium Trial was a multicenter, double‐blind, noninferiority randomized controlled trial, with 204 participants with opioid dependence in Iran. Participants were then randomized to OT or methadone arms with an allocation ratio of 1:1 and were followed for 12 weeks. The primary outcome was retention in treatment, compared between the two groups using both intention-To-Treat (ITT) and Per-Protocol (PP) analyses.

A total of 70 participants (IT: 68.6%, PP: 69.3%) in methadone arm and 61 participants (ITT: 59.8%, PP: 60.4%) in OT arm remained in the treatment. The relative retention rate was 1.15 (0.97, 1.36) in both analyses in favour of methadone. A total of 46 out of 152 (30.3%) participants in OT arm and 83 out of 168 (49.4%) participants in methadone arm reported opioid use outside the treatment. The difference in these two proportions (OT - methadone) was 19%: (10%, 28%) in favour of OT. The proportion of patients with adverse events were not different between the two arms (P = 0.06). There was no serious AE in OT arm.

Opium tincture is a clinically effective and safe medication, but this study could not conclude if it was as equally effective as methadone in retaining participants in treatment, but it showed that OT was superior to methadone in reducing opioid use outside the treatment.

No significant relationships.

Violent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs.

We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms.

Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = −2.85, p = 0.005).

These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

Interdisciplinary academic teams perform better when competent in teamwork; however, there is a lack of best practices of how to introduce and facilitate the development of effective learning and functioning within these teams in academic environments.

To close this gap, we tailored, implemented, and evaluated team science training in the year-long Engineering Innovation in Health (EIH) program at the University of Washington (UW), a project-based course in which engineering students across several disciplines partner with health professionals to develop technical solutions to clinical and translational health challenges. EIH faculty from the UW College of Engineering and the Institute of Translational Health Sciences’ (ITHS) Team Science Core codeveloped and delivered team science training sessions and evaluated their impact with biannual surveys. A student cohort was surveyed prior to the implementation of the team science trainings, which served as a baseline.

Survey responses were compared within and between both cohorts (approximately 55 students each Fall Quarter and 30 students each Spring Quarter). Statistically significant improvements in measures of self-efficacy and interpersonal team climate (i.e., psychological safety) were observed within and between teams.

Tailored team science training provided to student-professional teams resulted in measurable improvements in self-efficacy and interpersonal climate both of which are crucial for teamwork and intellectual risk taking. Future research is needed to determine long-term impacts of course participation on individual and team outcomes (e.g., patents, start-ups). Additionally, adaptability of this model to clinical and translational research teams in alternate formats and settings should be tested.

Suicide is one of the major health problems today. The few available health economic studies have focussed on suicides. However suicide attempts, which are much more frequent, have been disregarded.

We made use of available data of the WHO-Euro-Multicentre study. During the year 2003, N=201 persons committing a suicide attempt in Basel could be accessed for health economic investigations. Due to the care structure in our region we started with the direct costs of inpatient treatment at the university (psychiatric) hospitals, which provide a wide majority of care for the people of the area, especially in emergency cases like suicide. Outpatient treatment was only calculated, if it was performed by these hospitals. This analysis included the overhead of the hospitals (staff etc.) was well as the costs provides for special services, consultation and liaison services, transports and emergency actions.

We assume that the direct costs make up only part of the total costs. For example the loss of working ability, health costs for family members, caregivers and friends affected are not included in our analyses. Against our assumption, we could not find major differences regarding the underling diagnoses. However, elderly suicide attempts were more costly. There were also gender differences. Further details will be discussed.

The data show, that suicide attempts are expensive. Health care planers should take these data into account when discussing and deciding investments in suicide preventions.

Difficulties in controlling symptoms such as pain, breathlessness or delirium in palliative care patients, may require sedation as therapeutic strategy.

To study the drugs administered to patients under Palliative Care Sedation (PCS) and its possible side effects.

Our retrospective study included 40 oncological patients with mean age of 69+14.12 years old, under PCS.

Morphine 0.35mg/kg/day, administered to 22,5% (9) patients, caused reduction of systolic blood pressure in 23.61%, diastolic blood pressure in 27.08%, heart rate in 6.09%, body temperature in 2.59%, respiratory rate in 18.26%. Morphine 0.35mg/kg/day associated with midazolam 0.42mg/kg/day, given to 35%(14) patients, caused reduction of systolic blood pressure in 24.63%, diastolic blood pressure in 27.58%, heart rate in 1.56%, body temperature in 1.58%, respiratory rate in 27.66%. The association of chlorpromazine 0.62mg/kg/day to morphine 0.35mg/kg/day and midazolam 0.42mg/kg/day administered to 42,5% (17) patients, also caused reduction of systolic blood pressure in 22.38%, diastolic blood pressure 20.00%, body temperature 1.79%, respiratory rate 22.00%, but the heart rate increased in 15.88%. The variations of vital signs were obtained by records registered right before the palliative care sedation had initiated and the values recorded in patients’ last day of life. The sedation period was 2,40+0,23days.

The association of neuroleptics could conduct to extrapyramidal motor agitation, in this case of deeply sedated patients it could be signed by the incresase of the heart rate. Considering the short period of time between the beginning of sedation and the patients’ death; and that palliative sedation should not include the hastening of patients’ death, we suggest a better drug association criteria.

The sedation could consist in a therapeutic strategy in advanced cancer conditions.

To study the drugs administered to patients under Palliative Care Sedation (PCS) audits effects on vital signs.

Our retrospective study included 101 oncological patients with mean age of 66.5 ± 13.4 years old and mean weight of 48.5 ± 3.36 kg, under PCS. The data were analysed applying the test of Wilcoxon.

The drugs administered to these patients under PCS were morphine 55 mg/kg/day associated to midazolam 52.5 mg/kg/day (Morph/Midazo) or the association of morphine 55 mg/kg/day, midazolam 52.5 mg/kg/day and neuroleptics such as chlorpromazine 54.5 mg/kg/day or haloperidol 13.25 mg/kg/day (Morph/Midazo/Neurol). The values of vital signs of these patients when the sedation was initiated were: systolic blood pressure 116.55 ± 16.98 mmHg, diastolic bloodpressure73.17 ± 10.55 mmHg, heart rate 83.41 ± 16.25bpm, respiratory rate 19.39 ± 3.97 rpm and body temperature 35.91 ± 0.57 °C. No significant differences between these groups were observed. Vital signs measures were collected 48 hours before the patient's death. Significant reduction in systolic blood pressure 77.5 mmHg, diastolic blood pressure 43.3 mmHg were observed in the group (Morph/Benzo/Neurol). The Wilcoxon test for independent samples to a significance level of 5% we obtain a P-value of 0.01. The sedation period was 2.56 ± 0.23 days.

Neuroleptic, a central nervous system (CNS) depressant drug, when associated to other two depressants (morphine/midazolam), conducted to the patient's vital signs reduction.

Considering the short period of time between the beginning of sedation and the patients’ death; and that palliative sedation should not include the hastening of patients’ death, we suggest a better drug association criteria.

The authors have not supplied their declaration of competing interest.