People with Borderline Personality Disorder (PBPD) have been historically excluded from Assertive Community Treatment (ACT) teams. The ‘gold standard’ ACT service model in community psychiatry aims to serve people with serious mental illness (SMI), typically diagnosed with psychotic and mood disorders. For various clinical, administrative, and model innovation reasons, PBPD are notably present on ACT teams, presenting unique clinical challenges; yet clinician perspectives and experiences are little known. Qualitative study using semi-structured interviews and thematic analysis on experiences and perspectives of clinicians from a well-established ACT team in an academic setting that transitioned to a Flexible ACT team in Toronto, Canada. Clinicians reported working with PBPD presents unique training, skills, clinical, team, system, and personal level challenges Five main themes included: (1) Lack of specific training among clinicians in serving people with BPD; (2) Diverse views of suitability of ACT for PBPD; (3) Specific challenges for clinicians working with PBPD on ACT; (4) Positive aspects of using ACT to serve PBPD; (5) Potential adaptive changes to ACT teams working with PBPD. Conclusion: Having PBPD on ACT teams is a little acknowledged and less known area of ACT and has significant impact on ACT services. Further attention to training and skill building, service adaptation, and research that improve care and therapeutic relationships with PBPD on ACT are warranted. Having PBPD on ACT teams is a little acknowledged and less known area of ACT and has significant impact on ACT services. Further attention to training and skill building, service adaptation, and research that improve care and therapeutic relationships with PBPD on ACT are warranted.
Hypotension, or low mean arterial blood pressure (MAP), has been associated with adverse outcomes in perioperative patients. A primary goal of treating hypotension during surgery is to preserve vital organ perfusion by maintaining intravascular volume and the use of vasoactive medications, including phenylephrine (PE), to support MAP. Phenylephrine, a vasoconstrictor with α1-adrenergic agonist activity, acts on resistance arterioles and veins to increase vascular resistance and reduce venous capacitance, thereby increasing MAP. It predominantly acts on skeletal muscle resistance arterioles, but concerns have been raised about its potential negative impact on brain and revascularized muscle flap perfusion. We conducted an in vivo animal study using translational rodent models. Measuring microvascular blood flow (laser Doppler) and partial pressure of oxygen (PO2) (phosphorescence quenching of oxygen) in rats (total N = 48), we sought to test the hypothesis that PE produces differential effects on brain, skeletal muscle, and skeletal muscle flap perfusion. Treatment of hypotension with PE increased MAP, brain microvascular blood flow, and brain tissue PO2, at the expense of reduced skeletal muscle microvascular blood flow. Escalating doses of PE reduced skeletal muscle microvascular blood flow without reducing tissue PO2. Tissue blood flow and PO2 were severely reduced in skeletal muscle free flaps at baseline, without any further reduction after exposure to escalating doses of PE. Elevation of the hypoxic cellular protein hypoxia-inducible factor 1α (HIF-1α) in muscle free flaps provided evidence of severe tissue hypoxia in viable muscle flap tissue. These data may inform the optimal use of PE to restore MAP to ensure optimal brain tissue perfusion. Use of tissue oximetry may ensure the adequacy of tissue perfusion in perioperative patients.
Designer benzodiazepines (DBZDs) are a class of new psychoactive substances (NPS) designed as legal alternatives to prescription BZDs. Bromazolam has been the most prevalent DBZD detected on the recreational market around the world; however, a new DBZD, ethylbromazolam (8-bromo-1-ethyl-6-phenyl-4 H-[1,2,4]triazolo[4,3-a][1,4]benzodiazepine; also known as bromoethylazolam) has recently emerged. In this study, the emergence of ethylbromazolam in Canada, the UK, and Australia is reported based on analysis of samples from drug checking services and in Germany based on analysis of samples seized by customs and mail services. Since November 2024, ethylbromazolam has been increasingly detected with a concurrent decrease in bromazolam detections, suggesting that its emergence is likely in response to the international control of bromazolam on 3rd December 2024. Additionally, increased detections of other DBZDs, including desalkylgidazepam (bromonordiazepam) and clobromazolam (phenazolam) have been recently observed. The in vitro α1β2γ2 GABAA receptor activity of ethylbromazolam was determined using an automated patch clamp assay. Ethylbromazolam was found to have similar in vitro GABAA receptor activity as bromazolam (EC50 of 10.1 nM and 15.2 nM, respectively), indicating comparable pharmacological activity and potential for harm. The market should continue to be monitored closely as it continues to evolve in response to the control of bromazolam.
Although the Woven EndoBridge (WEB) device is increasingly used for the treatment of wide-neck intracranial aneurysms, including in the acute rupture setting, comparative evidence assessing the impact of rupture status remains limited. This study compared angiographic, safety, and clinical outcomes between ruptured and unruptured intracranial aneurysms treated with WEB. We conducted a retrospective analysis of prospectively collected data from the multicenter cohort registry WorldWideWEB, including consecutive adult patients with intracranial aneurysms treated with the WEB. Patients were stratified into groups of ruptured and unruptured aneurysms. Propensity score matching was used to balance baseline characteristics between both groups. Retreatment rate was the primary outcome. Secondary outcomes included mRS, safety events (thromboembolic complications) and angiographic outcomes (periprocedurally and last follow-up). Among 1,220 patients, 342 (28.0
Considering growing food insecurity and diet-related inequalities, Canada has introduced a national school food program (SFP). International studies have shown the benefits of SFPs for student diets, but their potential to reduce differences in dietary intake and diet quality (dietary inequalities) has not been studied. This study examines the associations of existing SFPs with dietary intake and inequalities among elementary students in Canada. Data from 1442 grade 4–6 students (9–12 years of age) from 26 schools in underserved communities reported foods and beverages consumed in the past 24 h and whether these were provided as part of an SFP, brought from home, or obtained elsewhere. Inequalities in dietary intake (vegetables and fruit, milk and alternatives, free sugars, sodium) and overall diet quality of students who accessed vs. did not access SFPs were quantified using Gini coefficients. Students who accessed SFPs (n = 181) reported consuming more vegetables and fruit, more milk and alternatives, and diets of better quality, compared to their peers who did not access SFPs (n = 1261). These differences were especially pronounced among students from less affluent households. Lower inequalities in the consumption of vegetables and fruit (difference in Gini coefficients = 0.072, 95
