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Medication Changes (medication + change)
Selected AbstractsRe-awakenings?: A discourse analysis of the recovery from schizophrenia after medication changeINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 2 2001Trudy Rudge ABSTRACT This paper explores the construction of recovery from schizophrenia after medication change through the analysis of people living with schizophrenia. The study is framed by a discourse analysis which assumes that the language used to discuss schizophrenia and its treatment by medication is imbued with the power relations of mental health. The analysis uses research literature, pharmaceutical literature and previous studies of schizophrenia as the discursive background that frames how recovery can be talked about. The discussion highlights how the discourses of medical science construct recovery as a linear event that silences the embodiment of schizophrenia. People with schizophrenia refuse this construction, through finding a ,niche' for themselves. In conclusion, the paper suggests how such analysis opens up for exploration of the silencing of ,insanity', and establishes a beginning dialogue with people who live with the continuing presence of schizophrenia. [source] The Effect of Three-Tier Formulary Adoption on Medication Continuation and Spending among Elderly RetireesHEALTH SERVICES RESEARCH, Issue 5 2007Haiden A. Huskamp Objective. To assess the effect of three-tier formulary adoption on medication continuation and spending among elderly members of retiree health plans. Data Sources. Pharmacy claims and enrollment data on elderly members of four retiree plans that adopted a three-tier formulary over the period July 1999 through December 2002 and two comparison plans that maintained a two-tier formulary during this period. Study Design. We used a quasi-experimental design to compare the experience of enrollees in intervention and comparison plans. We used propensity score methods to match intervention and comparison users of each drug class and plan. We estimated repeated measures regression models for each class/plan combination for medication continuation and monthly plan, enrollee, and total spending. We estimated logit models of the probability of nonpersistent use, medication discontinuation, and medication changes. Data Collection/Extraction Methods. We used pharmacy claims to create person-level drug utilization and spending files for the year before and year after three-tier adoption. Principal Findings. Three-tier formulary adoption resulted in shifting of costs from plan to enrollee, with relatively small effects on medication continuation. Although implementation had little effect on continuation on average, a small minority of patients were more likely to have gaps in use and discontinue use relative to comparison patients. Conclusions. Moderate cost sharing increases from three-tier formulary adoption had little effect on medication continuation among elderly enrolled in retiree health plans with relatively generous drug coverage. [source] Warfarin-induced allergic interstitial nephritis and leucocytoclastic vasculitisINTERNAL MEDICINE JOURNAL, Issue 4 2008K. G. Kapoor Abstract Warfarin sodium has been associated with leucocytoclastic vasculitis and has once been associated with allergic interstitial nephritis. Hypersensitivity to warfarin sodium simultaneously resulting in allergic interstitial nephritis and leucocytoclastic vasculitis has not yet been previously reported. We present a 48-year-old man who was on warfarin sodium for 2 months and presented with acute renal failure and reddish purplish macules on his hypogastric regions and lower extremities bilaterally. Kidney biopsy showed allergic interstitial nephritis and punch skin biopsy showed leucocytoclastic vasculitis. Both biopsies also showed high eosinophil count, highly suggestive of a drug-induced reaction. After a negative comprehensive work-up and the absence of other recent medication changes, our patient was determined to have allergic interstitial nephritis and leucocytoclastic vasculitis secondary to warfarin sodium. [source] The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitusJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2001James E. Stewart Abstract Background, aims: This study was designed to explore the effect of periodontal therapy on glycemic control in persons with type 2 diabetes mellitus (DM). Methods: 36 patients with type 2 DM (treatment group) received therapy for adult periodontitis during an 18-month period. A 36-person control group was randomly selected from the same population of persons with type 2 DM who did not receive periodontal treatment. Results: These groups were well matched for most of the parameters investigated. During the nine-month observation period, there was a 6.7% improvement in glycemic control in the control group when compared to a 17.1% improvement in the treatment group, a statistically significant difference. Several parameters that could confound or moderate this glycemic control were explored. These included the treatment of non-dental infections, weight and medication changes. No moderating effect was associated with any of these variables. However, there were too few subjects in the study to have the statistical power necessary to assess these possible moderators of glycemic control. Conclusions: We interpret the data in the study to suggest that periodontal therapy was associated with improved glycemic control in persons with type 2 DM. Zusammenfassung Zielsetzung: Untersuchung der Wirkung parodontaler Therapie auf die Blutzuckerkontrolle bei Patienten mit Typ-2-Diabetes mellitus (DM2). Material und Methoden: 260 Patienten, die am Veteranenhospital in Los Angeles ambulant wegen Diabetes mellitus betreut wurden, wurde eine zahnmedizinische Behandlung empfohlen und angeboten. Von den 92 DM2-Patienten, die dieses Angebot wahrnahmen, wurden 36 Patienten, die an Erwachsenenparodontitis litten, parodontal behandelt: Wurzelglättung, subgingivale Kürettage, Extraktionen (Testgruppe). Von den DM2-Patienten, die keine Parodontalbehandlung durchführen ließen, wurde eine Kontrollgruppe mit 36 Personen gebildet. Die Blutzuckerkontrolle wurde in der Testgruppe vor Therapie und 10 Monate später über den arameter Hämoglobin A1C (HbA1C) bestimmt. In der Kontrollgruppe lagen 8,10 Monate zwischen den HbA1C -Untersuchungszeitpunkten. Ergebnisse: Beide Gruppen entsprachen einander sehr gut für die meisten untersuchten Parameter. Während der Beobachtungszeit von 9 Monaten verbesserte sich die Blutzuckerkontrolle in der Kontrolgruppe um 6.7% und in der Testgruppe um 17.1% (p=0.02). Verschiedene Parameter, die die Kontrolle des Blutzuckerspiegels beeinflussen könnten, wurden untersucht (z.B. nicht-dentale Infektionen, Veränderungen des Körpergewichtes oder der Medikation). Es konnte kein Einfluß dieser Faktoren gefunden werden. Allerdings ist die Stichprobe zu klein, um diese Aussage mit genügender Teststärke treffen zu können. Schlußfolgerungen: Parodontale Therapie der Erwachsenenparodontitis ist mit einer verbesserten Blutzuckerkontrolle bei DM2-Patienten assoziiert. Résumé Cette étude a été réalisée pour examiner les effets du traitement parodontal chez des personnes atteintes de diabète mellitus type 2 (DM). 36 patients atteints de DM type 2 (groupe traitement) furent traités pour une partodontite de l'adulte pendant une période de 18 mois. Un groupe contrôle de 36 personnes fut sélectionnê au hasard à partir de la même population (DM) mais sans recevoir de traitement parodontal. Ces groupes furent comparés entre eux pour la plupart des paramètres examinés. Pendant la période d'observation de 9 mois, il y avait une amélioration de 6.7% du controle de la glycémie dans le groupe contrôle comparéà une amélioration de 17.1% pour le groupe traité, cette différence étant statistiquement significative. Plusieurs paramètres comme le traitement d'infections non dentaires et les changements de poids et de prescription, qui auraient pu moduler le controle de la glycémie ont été explorés. Aucun effect de modulation ne put être associé avec aucune de ces variables. Cependant, il y avait trop peu de sujets inclus dans l'étude pour permettre un pouvoir statistique nécessaire pour préciser ces possibles modulateurs du contróle de la glycémie. Nous interprétons les données de l'étude pour suggérer que le traitement paradontal est associéà une amélioration de la glycémie chez les personnes atteintes de diabéte mellitus type 2. [source] Stimulation Parameters After Vagus Nerve Stimulator ReplacementNEUROMODULATION, Issue 2 2008Douglas Labar MD ABSTRACT Objectives., This study aims to assess tolerability and efficacy of stimulation parameters after vagus nerve stimulator (VNS) pulse generator replacement. Materials and Methods., We carried out an observational, retrospective study, reviewing our experience with VNS generator replacements in 28 epilepsy patients. Results., Seven patients had actual end of battery life (EOBL) (with symptoms), and 21 patients had asymptomatic projected EOBL. When we reprogrammed stimulation parameters postoperatively, 17 of the 28 patients could not tolerate the preoperative baseline current settings, even one year later. There were no differences in pre- vs. postoperative seizure rates between patients who did or did not return to baseline settings. Failure to return to baseline current was not related to previous VNS duration, same- vs. different-battery generator replacements, or antiepileptic medication changes. Conclusions., After VNS generator replacement, patients' common inability to tolerate preoperative current settings does not lead to more seizures. A chronic modification of the vagus nerve system's sensitivity to stimulation changes may be hypothesized. [source] Latest news and product developmentsPRESCRIBER, Issue 5 2008Article first published online: 3 APR 200 Newer antidepressants no better than placebo? A new meta-analysis suggests that newer antidepressants are no superior to placebo in most patients with depression , the exception being those with very severe depression, who can expect a small benefit. Writing in the online-only open access journal PLoS Medicine (5:e45.doi:10.1371/ journal.pmed.0050045), researchers from Hull and the US analysed published and unpublished trials submitted to the Food and Drug Administration in marketing applications for fluoxetine, paroxetine, venlafaxine (Efexor) and nefazodone (no longer available). Using the Hamilton Rating Scale for Depression (HRSD) score as an endpoint, meta-analysis of 35 trials involving 5133 patients and lasting six to eight weeks showed that mean HRSD score improved by 9.6 points with drug treatment and 7.8 with placebo. The authors say the difference of 1.8 was statistically significant but below the criterion for clinical significance (3.0) set by NICE in its clinical guideline on depression. A review of the study by the NHS Knowledge Service (www.nhs.uk) points out that it omits trials published after the drugs were licensed (1999) and those not sponsored by the pharmaceutical industry. It did not include any patients with severe depression and only one trial in patients with moderate depression. An earlier US study of data submitted to the FDA (N Eng J Med 2008;358:25260) showed that published trials of antidepressants were more likely to be positive (37/38) than unpublished ones (3/25). Further, FDA analysts concluded that 51 per cent of trials (published and unpublished) demonstrated positive findings compared with 94 per cent of those that were published. Audit reveals variations in hospital psoriasis care There are unacceptably large variations in the quality of care for patients with psoriasis in UK hospitals, a report by the British Association of Dermatologists and the Royal College of Physicians reveals. The audit of 100 hospital units found that 39 per cent restricted access to biological therapies because of cost, and over one-third of pharmacies could not supply ,specials' such as topical coal tar preparations. More positively, the units are adequately resourced to provide timely communication with GPs. RCGP responds to Public Accounts Committee The Royal College of General Practitioners has agreed with the Commons Public Accounts Committee that drug package labelling should include the cost of the medication. The suggestion was made by the Committee in its report Prescribing Costs in Primary Care. While recognising the importance of generic prescribing, the RCGP cautions against frequent medication switches because it may unsettle patients. ,Any changes must be carried out for sound clinical reasons with good communication between GPs and their patients,' it adds. Statins for patients with kidney disease? Statins reduce cardiovascular risk in people with chronic kidney disease, a new study suggests, but their effects on renal function remain unclear (BMJ 2008; published online doi: 10.1136/bmj. 39472.580984.AE). The meta-analysis of 50 trials involving a total of 30 144 patients found that statins reduced lipids and cardiovascular events regardless of the severity of kidney disease. However, all-cause mortality was unaffected and, although proteinuria improved slightly, there was no change in the rate of decline of glomerular filtration rate. An accompanying editorial (BMJ 2008; published online doi:10.1136/ bmj.39483.665139.80) suggests that the indications for statin therapy to reduce cardiovascular risk in patients with chronic kidney disease should be the same as for those with normal renal function. New NICE guidance New clinical guidelines from NICE (see New from NICE, pages 14,15) include the diagnosis and management of irritable bowel syndrome in adults in primary care, the care and management of osteoarthritis in adults, and the diagnosis and treatment of prostate cancer. In a public health guideline on smoking cessation services, NICE endorses the use of nicotine replacement patches for 12,17 year olds. Suspect additives in children's medicines The Food Commission (www.foodcomm.org.uk) has drawn attention to the presence in children's medicines of food additives it says are linked with hyperactivity. The Commission, a national nonprofit organisation campaigning for ,the right to safe, wholesome food', says that seven common additives (including tartrazine, sodium benzoate and Ponceau 4R) are associated with hyperactivity in susceptible children. Checking the SPCs, it found that 28 of 70 children's medicines , including formulations of paracetamol, ibuprofen, amoxicillin, erythromycin and codeine phosphate throat linctus , contain at least one suspect additive. Digoxin may increase mortality in AF patients An observational study has suggested that digoxin may increase deaths in patients with atrial fibrillation (Heart 2008;94:191,6). The study was a planned subgroup analysis of a trial evaluating anticoagulant therapy in 7329 patients with atrial fibrillation. Of these, 53 per cent were treated with digoxin. Mortality was significantly higher among digoxin users than nonusers (4.22 vs 2.66 per cent per year); myocardial infarction and other vascular deaths (but not stroke, systemic embolic episodes and major bleeding events) were significantly more frequent with digoxin. Poor communications cause readmission Elderly hospital patients are often discharged with inadequate information or arrangements for care, causing almost three-quarters to be readmitted within a week, say investigators from Nottingham (Qual Safety Health Care 2008;17:71,5). Retrospective review of records for 108 consecutive patients aged over 75 found that readmission was related to medication in 38 per cent and, of these, 61 per cent were considered avoidable. Almost two-thirds had no discharge letter or were readmitted before the letter was typed; two-thirds of discharge letters had incomplete documentation of medication changes. Copyright © 2008 Wiley Interface Ltd [source] | ||||||||||