Administration of Naloxone in a Home or Community Setting: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines
Notice bibliographique
Résumé
Opioid overdose can induce acute respiratory and central nervous system depression that may lead to death. Recently the numbers of opioid-related deaths or hospitalizations have increased in Canada and there is an ongoing opioid crisis., There were 3,023 and 4,588 apparent opioid-related deaths that occurred in 2016 and 2018 respectively. The rate of apparent opioid-related deaths was 7.9 per 100,000 population in 2016 nationally. This rate can be as high as 20.7 deaths and 14.4 deaths per 100,000 population in British Columbia and Alberta respectively in 2016. Synthetic opioids that are extremely potent, such as fentanyl, are used more prevalently than non-synthetic opioids.Naloxone, a medication that temporarily blocks the effects of opioids, has been advocated for a wider use in the communities. Naloxone works by competing for opioid receptors with opioids and remains active in the body for 20 to 90 minutes, shorter than most opioids. Without opioids, naloxone has little pharmacologic activity. Data from non-comparative studies suggest that naloxone use in a home or community setting for opioid overdose is associated with a low mortality rate.In Canada, take-home naloxone kits are available at most pharmacies without a prescription and are free in some provinces., A 2018 CADTH Environment Scan report identified that there are two to three doses of 0.4 mg or 1 mg naloxone in the naloxone kits in Canadian provinces. The formulations of naloxone available in the kits include naloxone nasal spray in Ontario or naloxone intramuscular injection in other provinces. Both take less than five minutes to take effect. In a 2017 CADTH report that evaluated different formulations of naloxone available in take-home naloxone kits, two randomized controlled trials (RCTs) were identified and compared intramuscular naloxone with naloxone administered intranasally using an atomization device. Higher proportions of patients receiving intramuscular naloxone achieved adequate response than those receiving intranasal naloxone. However, comparative evidence to support the use of take-home naloxone kits in pre-hospital settings may be limited. A 2014 CADTH Rapid Response report did not identify any primary studies or reviews on the effectiveness of naloxone administration in a home or community setting compared with naloxone use by health professionals. Since the release of the 2014 CADTH report, the use of naloxone in home and community settings has been evaluated in several studies or reviewed because of the ongoing opioid crisis and the potential benefits of naloxone use in such settings.– This report aims to update the previous CADTH review on the clinical effectiveness and cost-effectiveness of the administration of naloxone in a home or community setting, as well as to identify evidence-based guidelines for its use.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,006 |
| Bibliométrie | 0,008 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,003 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».