Tissue Edema, Fluid Balance, and Patient Outcomes in Severe Sepsis: An Organ Systems Review.

Severe sepsis and septic shock remain among the deadliest diseases managed in the intensive care unit. Fluid resuscitation has been a mainstay of early treatment, but the deleterious effects of excessive fluid administration leading to tissue edema are becoming clearer. A positive fluid balance at 72 hours is associated with significantly increased mortality, yet ongoing fluid administration beyond a durable increase in cardiac output is common.

Randomized controlled trial of osmotic-release methylphenidate with cognitive-behavioral therapy in adolescents with attention-deficit/hyperactivity disorder and substance use disorders.

Objective: To evaluate the efficacy and safety of osmotic-release methylphenidate (OROS-MPH) compared with placebo for attention-deficit/hyperactivity disorder (ADHD), and the impact on substance treatment outcomes in adolescents concurrently receiving cognitive-behavioral therapy (CBT) for substance use disorders (SUD).

Method: This was a 16-week, randomized, controlled, multi-site trial of OROS-MPH + CBT versus placebo + CBT in 303 adolescents (aged 13 through 18 years) meeting DSM-IV diagnostic criteria for ADHD and SUD. Primary outcome measures included the following: for ADHD, clinician-administered ADHD Rating Scale (ADHD-RS), adolescent informant; for substance use, adolescent-reported days of use in the past 28 days.

Randomized multi-site trial of the Job Seekers' Workshop in patients with substance use disorders.

Background: Unemployment is associated with negative outcomes both during and after drug abuse treatment. Interventions designed to increase rates of employment may also improve drug abuse treatment outcomes. The purpose of this multi-site clinical trial was to evaluate the Job Seekers' Workshop (JSW), a three session, manualized program designed to train patients in the skills needed to find and secure a job.

Implementing an adapted version of the job seekers' workshop in a residential program for patients with substance use disorders.

Objectives: To evaluate the feasibility and effectiveness of adapting the Job Seekers' Workshop (JSW) to a residential setting within a Massachusetts-based substance use disorder treatment agency.

Methods: Implementation of the adapted JSW consisted of a continual sequence of three weekly sessions that focused on job interview rehearsals, practice completing job applications, and identification of job leads. Data were compiled on the employment rates of the 188 patients discharged from the residential treatment program during July - December 2006 (baseline participants, n = 95) and January - June 2007 (JSW intervention participants, n = 93).

Methods of recruiting adolescents with psychiatric and substance use disorders for a clinical trial.

Background: The present article reports on recruiting strategies in a 16-week, multi-site trial of osmotic-release methylphenidate combined with cognitive-behavioral therapy in adolescents with co-occurring attention deficit hyperactivity disorder and substance use disorder.

Methods: A multifaceted recruiting strategy was employed that targeted multiple referral sources, used incentives, involved numerous staff members, emphasized the therapeutic alliance during prescreening, and utilized data to modify strategies based on results. Overall, 303 adolescents were randomized from 1,333 total referrals across 11 participating sites.

A "community-friendly" version of integrated group therapy for patients with bipolar disorder and substance dependence: a randomized controlled trial.

Background: Integrated group therapy, a new treatment for patients with bipolar disorder and substance use disorder, has previously been found to be efficacious in reducing substance use, but its length (20 sessions) and need for highly trained therapists may limit its adoption in substance use disorder community treatment programs. This paper compares a briefer (12 session) version of integrated group therapy, led by substance use disorder counselors without previous cognitive-behavioral training or bipolar disorder experience, to group drug counseling.

Methods: Sixty-one patients with bipolar disorder and substance dependence, taking mood stabilizers, were randomized to 12 sessions of integrated group therapy (n=31) or group drug counseling (n=30).

Depression precipitated by alcohol use in patients with co-occurring bipolar and substance use disorders.

Objective: Bipolar disorder and substance use disorder frequently co-occur. However, little is known about the near-term effects of substance use on bipolar disorder. Thus, the present study tests whether alcohol use precipitates depression among patients with co-occurring bipolar disorder and substance use disorder.

Personality, problem solving, and adolescent substance use.

The major aim of this study was to examine the role of social problem solving in the relationship between personality and substance use in adolescents. Although a number of studies have identified a relationship between personality and substance use, the precise mechanism by which this occurs is not clear. We hypothesized that problem-solving skills could be one such mechanism.

Focus on alcohol & drug abuse: ensuring validity in urine drug testing.

Methods for urine drug testing have been available for several decades. These procedures are useful in assessing and identifying substance use in treatment programs, research programs, law enforcement, the workplace, and schools. Despite widespread adoption of such techniques, limited knowledge exists regarding their valid use and interpretation among many who frequently perform these tests.

Is this urine really negative? A systematic review of tampering methods in urine drug screening and testing.

Adulterants and urine substitutes that are designed to defeat drug tests are readily available and can be easily researched or purchased over the Internet. Utilizing Google, PsychInfo, and Medline, we searched the Internet and psychiatric and medical literature to identify a comprehensive list of products, compounds, and methods of urine tampering, as well as data on their efficacy. These products, compounds, and methods are described, and literature on their effectiveness in masking drug use is reviewed.

Group therapy for substance use disorders: what do we know?

Although group therapy is the most prevalent treatment modality for substance use disorders, an up-to-date review of treatment outcome literature does not exist. A search of the literature yielded 24 treatment outcome studies comparing group therapy to other treatment conditions. These studies fell into one of six research design categories: (1) group therapy versus no group therapy; (2) group therapy versus individual therapy; (3) group therapy plus individual therapy versus group therapy alone; (4) group therapy plus individual therapy versus individual therapy alone; (5) group therapy versus another group therapy with different content or theoretical orientation; and (6) more group therapy versus less group therapy.

Effect of dopamine on gonadotropin-releasing hormone-induced gonadotropin secretion in postmenopausal women.

Five healthy women who had previously undergone spontaneous menopause and had not received exogenous estrogens were studied with infusions of synthetic GnRH and dopamine to ascertain the site of dopaminergic modulation of pituitary gonadotropin secretion. Infusion of dopamine at 4 micrograms/kg . min for 5 h induced a significant decrease in circulating LH concentrations, but not those of FSH.

Production rates of androgens and oestrogens in post-menopausal women.

The production rate (PR) values of delta 4-androstenedione (A), testosterone (T), oestrone (E1) and oestradiol (E2) have been determined in a large group of post-menopausal women following constant infusions of radiolabelled hormones and radioimmunoassay of endogenous steroid concentration. The mean +/- SE age was 64 +/- 2 yr, ranging from 46 to 91 yr and the mean +/- SE weight was 144 +/- 4 lb. When the PR values were related to age by linear regression analysis no significant correlation could be found for PRA, PRT or PRE1 and the age of the subjects.

Effect of peripheral sex steroid metabolism on pituitary gonadotropin reserve of women with hypothalamic amenorrhea.

Women with hypothalamic amenorrhea without evidence of pituitary tumor were studied to ascertain (1) whether affected patients have altered pituitary sensitivities and reserves to a constant gonadotropin-releasing hormone (GnRH) infusion and (2) whether altered sex steroid metabolism contributed to altered pituitary synthesis or secretion of gonadotropin. Women with hypothalamic amenorrhea displayed abnormal gonadotropin reserves without altered pituitary sensitivity to GnRH. Those altered reserves may have reflected, abnormally low estradiol levels, which directly or indirectly affected, pituitary gonadotropin synthesis.

Characterization of a small molecular size urinary immunoreactive human chorionic gonadotropin (hCG)-like substance produced by normal placenta and by hCG-secreting neoplasms.

Urine obtained from normal pregnant women as well as from patients with hCG-secreting tumors frequently contains native hCG and free hCG subunits when separated on Sephadex G-100. In addition, a small amount of an immunoreactive, hCG-like, low molecular weight substance is usually observed in those chromatograms and represents less than 1% of the total immunoreactive hCG present. Two patients with widely metastatic hCG-secreting tumors excreted disproportionately large quantities of that low molecular weight substance, and that observation raised the possibility that this substance was a secretory and not a degradative product of the hCG molecule.

Metabolic clearance rates of androgens and oestrogens in ageing women.

Using the constant infusion technique we have measured the metabolic clearance rates (MCR) for delta 4-androstenedione (A), testosterone (T), oestrone (E1) and oestradiol (E2) in a large group of post-menopausal women. Their mean +/- SE age was 64.5 +/- 1.