Trends in Opioid Analgesics Sales to Community Pharmacies and Hospitals in Italy (2000-2010).

Trends in opioid analgesics sales to community pharmacies and hospitals in Italy (2000-2010).

Minerva Anestesiol. 2013 Apr 5;
Caraceni AT, Brunelli C, Rocco P, Minghetti P

Background: Opioid consumption data in Italy have been widely studied. However, only aggregate data can be found in the published literature, and differences are expected by distribution setting (community pharmacies and hospitals). The aim of our paper is to analyse opioids sales trends in Italy in the decade 2000-2010, in an effort to explore such differences. Methods: Quarterly sales data of opioid medicinal products sold by wholesalers to both community pharmacies (retail) and to hospitals (non-retail) during the time period 2000-2010 were supplied by IMS Italy. Data were standardized using the Defined Daily Doses per day per 1000 inhabitants (DDD/1000). Results: Opioid sales have steadily increased during the time period considered going from 1.04 DDD/1000 in 2000 to 4.1 in 2010 (+292%). Nonetheless relevant differences can be found both by distribution setting and drug type. In particular retail sales have increased by 286 % for WHO Step II opioids and by 575% for WHOStep III drugs, while non-retail sales have increased by 48% and 263% respectively. In 2010, fentanyl and buprenorphine transdermal patches and oxycodone are more widely prescribed than morphine, in the retail setting, with fentanyl at large in the first position. In hospitals morphine and fentanyl almost equally share the 75% of the market. Conclusion: Data suggest that morphine is no more the opioid of first choice for severe pain in Italy, at least for outpatients. This is contradicting most international guidelines available in the 2000-2010 decade. HubMed – rehab


Executive functioning in children with unilateral cerebral palsy: protocol for a cross-sectional study.

BMJ Open. 2013; 3(4):
Bodimeade HL, Whittingham K, Lloyd O, Boyd RN

INTRODUCTION: Early brain injury, as found in children with unilateral cerebral palsy (CP), may cause deficits in higher-order cognitive tasks known as executive functions (EF). EF has been conceptualised as comprised of four distinct yet inter-related components: (1) attentional control, (2) cognitive flexibility, (3) goal setting and (4) information processing. The aim of this study was to examine EF in children with unilateral CP and compare their performance with a typically developing reference group (TDC). The potential laterality effects of unilateral CP on EF will be explored, as will the relationship between the cognitive measures of EF, behavioural manifestations of EF, psychological functioning and clinical features of unilateral CP. METHODS AND ANALYSIS: This cross-sectional study aims to recruit a total of 42 children with unilateral CP (21 right unilateral CP and 21 left unilateral CP) and 21 TDC aged between 8 and 16 years. Clinical severity will be described for gross motor function and manual ability. Outcomes for cognitive EF measureswill include subtests from the Wechsler Intelligence Scale for Children-Fourth Edition, Delis-Kaplan Executive Function System, Rey Complex Figure Test and the Test of Everyday Attention for Children. Behavioural manifestations of EF will be assessed using the Behaviour Rating Inventory of Executive Function, Parent and Teacher versions. Psychological functioning will be examined using the Strengths and Difficulties Questionnaire. Between-groups differences will be examined in a series of one-way analyses of covariance and followed up using linear comparisons. An overall composite of cognitive EF measures will be created. Bivariate correlations between the EF composite and psychological measures will be calculated. ETHICS AND DISSEMINATION: This protocol describes a study that, to our knowledge, is the first to examine multiple components of EF using a cohort of children with unilateral CP. Exploration of potential laterality effects of EF among children with a congenital, unilateral brain injury is also novel. Possible relationships between EF and psychological functioning will also be investigated. Ethics have been obtained through the University of Queensland School of Psychology Ethics Committee and the Queensland Children’s Health Services Human Research Ethics Committee. Results will be disseminated in peer reviewed publications and presentations at national and international conferences. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000263998). HubMed – rehab


Role, indications and controversies of levodopa administration in chronic stroke patients.

Eur J Phys Rehabil Med. 2013 Apr 5;
Acler M, Manganotti P

Stroke leaves many patients disabled even after rehabilitative training, representing a major cause of disability. Several approaches to improve outcomes have been attempted in recent years, with only relative benefit. Emerging evidences show a potential role of pharmacological intervention to enhance motor recovery after stroke. Contrasting evidence are coming from experimental and clinical studies, so far, and pharmacological intervention during rehabilitation represents a major controversial in neurorehabilitation. Dopaminergic stimulation appears as one of the most promising way to improve motor recovery. Subject of this paper will be the ratio underlying the clinical use of levodopa in chronic stroke patients, trying to outline the most convincing evidences about a potential role of this drug in rehabilitative strategies. HubMed – rehab