Each postoperative analgesic has its own limitations for route of administration, dosage, and potential side effects. Using the oral route for drug administration seems more attractive than other methods but may not be suitable in all postoperative patients. We studied the efficacy and side effect profile of sustained-release, oral morphine compared with standard IM morphine for the treatment of pain after hip replacement surgery. We concluded that use of the oral preparation is a suitable alternative to the IM route in this population undergoing surgery under spinal anesthesia.

BackgroundAlcohol use is an important issue among problem drug users. Although screening and brief intervention (SBI) are effective in reducing problem alcohol use in primary care, no research has examined this issue among problem drug users.ObjectiveThe objective of this study is to determine if a complex intervention including SBI for problem alcohol use among problem drug users is feasible and acceptable in practice. This study also aims to evaluate the effectiveness of the intervention in reducing the proportion of patients with problem alcohol use.MethodsPsychosocial intervention for alcohol use among problem drug users (PINTA) is a pilot feasibility study of a complex intervention comprising SBI for problem alcohol use among problem drug users with cluster randomization at the level of general practice, integrated qualitative process evaluation, and involving general practices in two socioeconomically deprived regions. Practices (N=16) will be eligible to participate if they are registered to prescribe methadone and/or at least 10 patients of the practice are currently receiving addiction treatment. Patient must meet the following inclusion criteria to participate in this study: 18 years of age or older, receiving addiction treatment/care (eg, methadone), or known to be a problem drug user. This study is based on a complex intervention supporting SBI for problem alcohol use among problem drug users (experimental group) compared to an “assessment-only” control group. Control practices will be provided with a delayed intervention after follow-up. Primary outcomes of the study are feasibility and acceptability of the intervention to patients and practitioners. Secondary outcome includes the effectiveness of the intervention on care process (documented rates of SBI) and outcome (proportion of patients with problem alcohol use at the follow-up). A stratified random sampling method will be used to select general practices based on the level of training for providing addiction-related care and geographical area. In this study, general practitioners and practice staff, researchers, and trainers will not be blinded to treatment, but patients and remote randomizers will be unaware of the treatment.ResultsThis study is ongoing and a protocol system is being developed for the study. This study may inform future research among the high-risk population of problem drug users by providing initial indications as to whether psychosocial interventions for problem alcohol use are feasible, acceptable, and also effective among problem drug users attending primary care.ConclusionsThis is the first study to examine the feasibility and acceptability of complex intervention in primary care to enhance alcohol SBI among problem drug users. Results of this study will inform future research among this high-risk population and guide policy and service development locally and internationally.

GPs and receptionists in this sample had mixed views about methadone maintenance which were unchanged by six months experience of the service. The study illustrates important issues in the recruitment and support of general practice in meeting this need.

The risk of falls is common in the aging and Parkinson’s disease (PD) populations. There is limited research on dynamic gait stability, i.e., margin of stability (MOS), in the PD population while turning. The purpose of this exploratory study was to examine the dynamic balance control in individuals with mild to moderate PD and healthy individuals while walking and performing 90° turns utilizing computerized three-dimensional gait analysis. Specifically, we examined the anteroposterior and mediolateral margins of stability and their effect on the dynamic balance during turning in participants. A total of 11 individuals with mild to moderate idiopathic PD and 10 healthy controls (CON) participated in this study. Individuals with PD were tested during the “on phase” of PD medication. The Vicon Nexus camera system, force plates, and Visual3D software were utilized for three-dimensional motion analysis of three right and three left turning trials. A mixed-model ANOVA was used to analyze the primary dependent variables of dynamic balance (p < 0.0028) and the secondary dependent variables of spatiotemporal gait parameters (p < 0.0056). No significant differences in the spatiotemporal parameters or dynamic balance variables were observed between the groups. Gait velocity, center of mass-center of pressure (COM–COP) inclination angle at midstance, and MOS variables showed marginally significant group differences. We found no differences in dynamic balance during gait while performing turns betweenthe healthy elderly and individuals with PD. This finding may be related to the early stage of disease progression in the PD group.

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