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Selected AbstractsIncreased patient co-payments and changes in PBS-subsidised prescription medicines dispensed in Western AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2009Anna Hynd Abstract Objective: To determine whether a 24% increase in patient co-payments in January 2005 and two related co-payment changes for medicines subsidised under the Australian Pharmaceutical Benefits Scheme (PBS) were associated with changes in dispensings in Western Australia (WA). Method: We analysed aggregate monthly prescription counts and defined daily dose per 1,000 population per day (DDD/1,000/day) for atypical antipsychotics, combination asthma medicines, HmgCoA reductase inhibitors (statins) and proton-pump inhibitors (PPIs). Trends pre and post the co-payment increase in January 2005 were compared. Results: In three of the four categories examined, prescription counts were significantly lower following the increase in co-payment thresholds. Compared with dispensings prior to the co-payment increase, prescriptions fell by 8% for combination asthma medicines (p<0.001), 9% for PPIs (p<0.001) and 5% for statins (p<0.001). Following the rise in co-payments, DDD/1,000/day decreased for all four categories. Decreases in dispensings to concessional beneficiaries were between 4% and 5% larger than for general beneficiary patients. Conclusions and Implications: The reduction in the both prescription counts and DDD/1,000/day observed for combination asthma medicines, PPIs and statins, which all remained above co-payment thresholds, suggests the increase in PBS co-payments has affected utilisation of these subsidised medicines. The results indicate that increases in patient contributions particularly impact on concessional patients' ability to afford prescription medicines. [source] Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Kaytan V. Amrute Abstract Aims A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point fixation is also reviewed. Methods After proper vaginal dissection, a specially fashioned "H" shaped polypropylene mesh is positioned and fixed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior fixation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t -test, with Sigma Stat®. Results Seventy-six patients (79%) were available with a mean follow-up time of 30.7,±, 1.7 months and mean age of 69.3,±,11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, defined as an occasional leak. For those with preoperative incontinence (n,=,36), average pad use per day decreased significantly from 2.1,±,0.4 to 0.8,±,0.2 (P,<,0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9,±,0.3 on a scale of 1 (least satisfied) to 10 (most satisfied). Conclusions Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and efficacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: Description of the method and preliminary dataNEUROUROLOGY AND URODYNAMICS, Issue 4 2005Michele Spinelli Pudendal nerve stimulation has beneficial effects on numerous pelvic floor function impairments such as urinary and/or fecal incontinence, retention, and constipation. In preceding literature the implant technique required a fairly complex and invasive surgery, although recent advances with percutaneous placement of the lead through an introducer have made the procedure much less invasive. We performed staged procedure similar to that of sacral neuromodulation (SNM) to place tined lead near the pudendal nerve, using neurophysiological guidance that allowed accurate pudendal nerve stimulation through either perineal or posterior approach. We have named this approach chronic pudendal nerve stimulation (CPNS). Methods Fifteen neurogenic patients (eight male, seven female) with symptoms of urge incontinence due to neurogenic overactive bladder underwent CPNS. All patients had complete neurophysiological and urodynamic evaluation at baseline and follow-up and were asked to complete voiding and bowel diary for 7 days. Results During screening, average number of incontinent episodes per day decreased from 7,±,3.3 to 2.6,±,3.3 (P,<,0.02, paired t -test). Eight patients became continent, two improved by more than 88% (from 9 to 1 daily incontinence episode) and two patients reduced the number of incontinence episodes by 50%. The implantable pulse generator (IPG) was subsequently implanted in those 12 patients. Three patients without improvement did not continue to second stage. In implanted patients with 6 months follow-up, urodynamic evaluation showed an objective improvement in the maximum cystometric capacity which increased from 153.3,±,49.9 to 331.4,±,110.7 ml (P,<,0.01, paired t -test). The maximum pressure decreased from 66,±,24.3 to 36.8,±,35.9 cmH2O (P,=,0.059, paired t -test). Eight patients reported significant improvement in bowel function. Conclusion Chronic pundedal nerve stimulation is feasible. Neurophysiological guidance is mandatory to place the lead near the pudendal nerve either using perineal or posterior approach. Further studies must be carried out to identify the best stimulation parameters and to verify the long term results. Neurourol. Urodynam. 24:305,309, 2005. © 2005 Wiley-Liss, Inc. [source] Five-year follow-up during antipsychotic treatment: efficacy, safety, functional and social outcomeACTA PSYCHIATRICA SCANDINAVICA, Issue 2007E. Lindström Objective:, Explore the long-term course of schizophrenia and related disorders. Method:, Naturalistic study of 225 patients initially treated with risperidone (monotherapy or in combination with other psychotropic drugs) over 5 years. Results:, Stable symptomatology and side effects were observed. Clinician GAF scores were 55,61, but patients' self-ratings were higher. Clinician and patient CGI scores were at the same level. Annual in-patient days decreased but days in sheltered accommodations increased still more. Only 12% of the patients studied or worked full-time. One in four had no social contacts except with staff. Eight patients died during the 5 years. Conclusion:, The findings underline the chronicity and seriousness of psychotic disorders in terms of social outcome and, indirectly, the low quality of life of this group of persons. Patients were generally well aware of their illness and able to sort out symptoms from drug side effects. This opens for more active involvement of patients in monitoring their own treatment. [source] A Double-Blind Comparison of OnabotulinumtoxinA (BOTOX®) and Topiramate (TOPAMAX®) for the Prophylactic Treatment of Chronic Migraine: A Pilot StudyHEADACHE, Issue 10 2009Ninan T. Mathew MD Background., There is a need for effective prophylactic therapy for chronic migraine (CM) that has minimal side effects. Objective., To compare the efficacy and safety of onabotulinumtoxinA (BOTOX®, Allergan, Inc., Irvine, CA) and topiramate (TOPAMAX®, Ortho-McNeil, Titusville, NJ) prophylactic treatment in patients with CM. Methods., In this single-center, double-blind trial, patients with CM received either onabotulinumtoxinA, maximum 200 units (U) at baseline and month 3 (100 U fixed-site and 100 U follow-the-pain), plus an oral placebo, or topiramate, 4-week titration to 100 mg/day with option for additional 4-week titration to 200 mg/day, plus placebo saline injections. OnabotulinumtoxinA or placebo saline injection was administered at baseline and month 3 only, while topiramate oral treatment or oral placebo was continued through the end of the study. The primary endpoint was treatment responder rate assessed using Physician Global Assessment 9-point scale (+4 = clearance of signs and symptoms and ,4 = very marked worsening [about 100% worse]). Secondary endpoints included the change from baseline in the number of headache (HA)/migraine days per month (HA diary), and HA disability measured using Headache Impact Test (HIT-6), HA diary, Migraine Disability Assessment (MIDAS) questionnaire, and Migraine Impact Questionnaire (MIQ). The overall study duration was approximately 10.5 months, which included a 4-week screening period and a 2-week optional final safety visit. Follow-up visits for assessments occurred at months 1, 3, 6, and 9. Adverse events (AEs) were documented. Results., Of 60 patients randomized to treatment (mean age, 36.8 ± 10.3 years; 90% female), 36 completed the study at the end of the 9 months of active treatment (onabotulinumtoxinA, 19/30 [63.3%]; topiramate, 17/30 [56.7%]). In the topiramate group, 7/29 (24.1%) discontinued study because of treatment-related AEs vs 2/26 (7.7%) in the onabotulinumtoxinA group. Between 68% and 83% of patients for both onabotulinumtoxinA and topiramate groups reported at least a slight (25%) improvement in migraine; response to treatment was assessed using Physician Global Assessment at months 1, 3, 6, and 9. Most patients in both groups reported moderate to marked improvements at all time points. No significant between-group differences were observed, except for marked improvement at month 9 (onabotulinumtoxinA, 27.3% vs topiramate, 60.9%, P = .0234, chi-square). In both groups, HA/migraine days decreased and MIDAS and HIT-6 scores improved. Patient-reported quality of life measures assessed using MIQ after treatment with onabotulinumtoxinA paralleled those seen after treatment with topiramate in most respects. At month 9, 40.9% and 42.9% of patients in the onabotulinumtoxinA and topiramate groups, respectively, reported ,50% reduction in HA/migraine days. Forty-one treatment-related AEs were reported in 18 onabotulinumtoxinA-treated patients vs 87 in 25 topiramate-treated patients, and 2.7% of patients in the onabotulinumtoxinA group and 24.1% of patients in the topiramate group reported AEs that required permanent discontinuation of study treatment. Conclusions., OnabotulinumtoxinA and topiramate demonstrated similar efficacy in the prophylactic treatment of CM. Patients receiving onabotulinumtoxinA had fewer AEs and discontinuations. [source] Trends in New Zealand daily temperature and rainfall extremesINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 12 2001M.J. Salinger Abstract Trends in daily temperature and rainfall indices are described for New Zealand. Two periods were examined: 1951,1998, to describe significant trends in temperature and rainfall parameters; and 1930,1998, to ascertain the effects of two main circulation changes that have occurred in the New Zealand region around 1950 and 1976. Indices examined included frequencies of daily maximum and minimum temperatures, above and below specified percentile levels and at those levels, as well as frequencies of these above and below fixed temperature thresholds. Extreme daily rainfall intensity and frequency above the 95th percentile and the length of consecutive dry day sequences were the rainfall indices selected. There were no significant trends in maximum temperature extremes (,hot days') but a significant increase in minimum temperatures was associated with decreases in the frequency of extreme ,cold nights' over the 48-year period. There was a non-significant tendency for an increase in the frequency of maximum temperature extremes in the north and northeast of New Zealand. A decline occurred in frequency of the minimum temperature 5th percentile (,cold nights') of 10,20 days a year in many locations. Trends in rainfall indices show a zonal pattern of response, with the frequency of 1-day 95th percentile extremes decreasing in the north and east, and increasing in the west over the 1951,1996 period. Changes in the frequency of threshold temperatures above 24.9°C (25°C days) and below 0°C (frost days) are strongly linked to atmospheric circulation changes, coupled with regional warming. From 1930,1950 more south to southwest anomalous flow occurred relative to later years. In this period, 25°C days were less frequent in all areas except the northeast, and there was markedly more frost days in all but inland areas of the South Island compared with the 1951,1975 period. There was more airflow from the east and northeast from 1951 to 1975, the frequency of 25°C days increased and frost days decreased in many areas of New Zealand. In the final period examined (1976,1998), more prevalent airflow from the west and southwest was accompanied by more anticyclonic conditions. Days with a temperature of 25°C increased in the northeast only. Frost day frequencies decreased between 5 and 15 days a year in many localities, with little change in the west of the South Island and at higher elevation locations. Copyright © 2001 Royal Meteorological Society [source] Biochemical changes in cut vs. intact lamb's lettuce (Valerianella olitoria) leaves during storageINTERNATIONAL JOURNAL OF FOOD SCIENCE & TECHNOLOGY, Issue 5 2009Antonio Ferrante Summary Consumers are oriented towards fresh-cut vegetables that provide phytonutrients useful for preventing stress-related diseases. The aim of this work was to evaluate the cut operations on the quality changes of lamb's lettuce (Valerianella olitoria L.) cv. Trofy during storage at 4 °C for 8 days. Results showed that chlorophyll and carotenoids reduction was observed after 8 days of storage. In both treatments, total carotenoids after 8 days decreased from 20 to 16 mg g,1 FW. Free and total phenols increased with storage in both treatments. Total phenols were 23% higher in control (32 ,mol g,1 FW) compared to cut leaves (25 ,mol g,1 FW) after 8 days of storage. Anthocyanins increased after 8 days and reached 30 mg 100 g,1 FW without significant difference between treatments. Ascorbic acid (AsA) and dehydroascorbic (DHA) acid increased in cut leaves compared to control. After 1 day AsA concentration was 3 300 nmol g,1 FW in cut leaves, while in control leaves was 1 500 nmol g,1 FW. Analogously AsA + DHA was higher in cut leaves, 4 100 nmol g,1 FW, while in control leaves the mean was 3 000 nmol g,1 FW. After 5 days of storage the values of AsA returned to initial values, while AsA + DHA were lower. [source] An Open Pilot Study Assessing the Benefits of Quetiapine for the Prevention of Migraine Refractory to the Combination of Atenolol, Nortriptyline, and FlunarizinePAIN MEDICINE, Issue 1 2010Abouch V. Krymchantowski MD, FAHS ABSTRACT Background., Migraine is a prevalent neurological disorder. Although prevention is the core of treatment for most, some patients are refractory to standard therapies. Accordingly, the aim of this study was to evaluate the use of Quetiapine (QTP) in the preventive treatment of refractory migraine, defined as previous unresponsiveness to the combination of atenolol, nortriptyline, and flunarizine. Methods., Thirty-four consecutive patients (30 women and 4 men) with migraine (ICHD-II), fewer than 15 days of headache per month, and not overusing symptomatic medications were studied. All participants had failed to the combination of atenolol (60 mg/day), nortriptyline (25 mg/day), and flunarizine (3 mg/day). Failure was defined as <50% reduction in attack frequency after 10 weeks of treatment. After other medications were discontinued, QTP was initiated at a single daily dose of 25 mg, and then titrated to 75 mg. After 10 weeks, headache frequency, consumption of rescue medications, and adverse events were analyzed. Results., Twenty-nine patients completed the study. Three patients withdrew and two were lost to follow-up. Among those who completed, 22 (75.9%; 64.7% of the intention-to-treat population) had greater than 50% headache reduction. The mean frequency of migraine days decreased from 10.2 to 6.2 per month. Use of rescue medications decreased from 2.3 to 1.2 days/week. Adverse events were reported by nine (31%) patients. Conclusions., Although limited by the open design, this study provides pilot data to support the use of QTP in the preventive treatment of refractory migraine. Controlled studies are necessary to confirm these observations. [source] | ||||||||||