尼可地尔联合曲美他嗪治疗冠心病心绞痛的临床效果及对患者血管内皮功能及MMP-2、MMP-9水平的影响

目的 探讨尼可地尔联合曲美他嗪治疗冠心病心绞痛的临床效果及对患者血管内皮功能及MMP-2、MMP-9水平的影响.方法 择取2015年7月至2020年12月我院收治的94例冠心病心绞痛患者作为研究对象,按照治疗方案将其分为观察组(47例,常规治疗+尼可地尔+曲美他嗪)和对照组(47例,常规治疗+曲美他嗪).比较两组的治疗...     

血府逐瘀汤加减辅助曲美他嗪治疗冠心病心绞痛的临床效果及对患者心绞痛症状、心功能及血清学指标的影响

目的 探讨血府逐瘀汤加减辅助曲美他嗪治疗冠心病心绞痛的临床效果及对患者心绞痛症状、心功能及血清学指标的影响。方法 选择2018年10月至2020年10月我院收治的100例冠心病心绞痛患者为研究对象,根据治疗方式将其分为对照组（50例,曲美他嗪治疗）和观察组（50例,血府逐瘀汤加减辅助曲美他嗪治疗）。比较两组的临床疗效、心绞痛症状、心功能、血清学指标以及生活质量。结果 观察组的治疗总有效率高于对照组,差异有统计学意义（P<0.05）。治疗前,两组患者的心绞痛发作次数、发作持续时间、VAS评分比较,差异无统计学意义（P>0.05）;治疗后,两组患者的心绞痛发作次数均减少,发作持续时间均缩短,VAS评分均降低,且观察组优于对照组,差异具有统计学意义（P<0.05）。治疗前,两组患者的LVEF、SV、J-Td比较,差异无统计学意义（P>0.05）;治疗后,两组患者的LVEF、SV均升高,J-Td均降低,且观察组优于对照组,差异具有统计学意义（P<0.05）。治疗前,两组患者的TG、hs-CRP、IL-6、VCAM-1水平比较,差异无统计学意义（P>0.05）...     

A comparison of HIV risk behaviors between early and late initiators of injection drug use in Houston,Texas

Abstract

Background: Injecting drug use accounts for 10% of new HIV cases worldwide. Younger injecting drug users are more likely to engage in HIV risk behaviors. Objectives: To assess the association between the age at initiation of injecting drugs and HIV risk behaviors. Methods: Houston data from the National HIV Behavioral Surveillance System were analyzed. The primary exposure variable was the self-reported age at injecting drug initiation. This study assessed whether individuals who initiated injecting drugs before and after the age of 21 differ by selected socio-demographic characteristics and high risk behaviors. Results: Black race and lower education level were shown to be the only statistically significant factors with those self-reported to initiate injecting drugs before turning 21. The group initiating use before the age of 21 was found to be more likely to share needles. Conclusions: This study highlights that race and education are positively associated with younger injecting drug initiation and younger injectors tend to engage in HIV risk behaviors such as needle sharing.     

Epoetin alfa and darbepoetin alfa for the treatment of chemotherapy-related anemia in cancer patients in Sweden: Comparative analysis of drug utilization, costs, and hematologic response

A retrospective chart review was performed at 3 Swedish hospitals to evaluate the utilization, outcomes, and cost of using epoetin alfa or darbepoetin alfa to treat cancer patients with chemotherapy-related anemia. Data on dosage, duration of treatment, hematologic response, red blood cell transfusions, and healthcare resource consumption were collected and analyzed at various time points following the initiation of drug therapy. A significantly faster hematologic response and increase in hemoglobin were observed in patients treated with epoetin alfa. Dosages used in clinical practice appeared to be lower than those recommended by Swedish treatment guidelines. There were no significant differences in resource utilization or healthcare costs between the 2 treatment groups. By day 112, the mean treatment cost per patient, in Swedish kronors (SEK), was SEK74,701 (~US$9800 or E8300) with epoetin alfa and SEK85,285 (~US$11,000 or E9500) with darbepoetin alfa. Drug acquisition and administration accounted for 81 % and 67% of the total cost of epoetin alfa and darbepoetin alfa therapy, respectively; the remainder of the total cost was for hospitalization and transfusions.     

Evaluation of drug therapy and risk factors in diabetic hypertensives: a study of the quality of care provided in diabetic clinics in Bahrain

OBJECTIVE: To evaluate control of blood pressure (BP) and diabetes and the associated risk factors in diabetic hypertensives treated by diabetic clinic primary care physicians. METHODS: A retrospective analysis of the medical records of diabetic hypertensives from six primary care diabetic clinics in Bahrain. RESULTS: The recommended BP target <130/<85 mmHg and of glycosylated haemoglobin (HbA1C) <7% were achieved in 7.5% and 14.5%, respectively. Most of the patients with uncontrolled BP and HbA(1C) were at high cardiovascular risk. More patients were on antihypertensive monotherapy than on combination therapy (60.6% vs. 36.7%; P<0.0001). The recommended two- and three-antihypertensive drug combinations were less often prescribed. In high-risk patients glycaemic control achieved was poor: antidiabetic combination therapy vs. monotherapy did not significantly differ. Inappropriate prescribing practices, such as the use of immediate-release nifedipine monotherapy, use of sulphonylurea instead of metformin in obese patients, and a trend towards prescribing of glyburide rather than a gliclazide in the elderly, were observed. Lipid-lowering (13.5%) and antiplatelet (12.8%) drugs were infrequently prescribed. CONCLUSIONS: Hypertension and diabetes in patients treated at the primary care diabetic clinics were inadequately controlled. In several instances, mono- and combination antihypertensives prescribed were irrational. Lipid-lowering and platelet aggregation inhibition strategies have received little attention. Intensive antihypertensive and antidiabetic complementary combination therapy should be encouraged. Continuous professional education of diabetic clinic physicians and expert-supervised diabetic clinics are desirable.     

Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study

Summary.  Background:  Venous thrombosis is one of the leading causes of maternal morbidity and mortality. Objective:  In the MEGA study, we evaluated pregnancy and the postpartum period as risk factors for venous thrombosis in 285 patients and 857 control subjects. Patients/methods:  Between March 1999 and September 2004, consecutive patients with a first episode of venous thrombosis were included from six anticoagulation clinics. Partners of patients and a random digit dialing group were included as control subjects. Participants completed a questionnaire and DNA was collected. Results:  The risk of venous thrombosis was 5-fold (OR, 4.6; 95% CI, 2.7–7.8) increased during pregnancy and 60-fold (OR, 60.1; 95% CI, 26.5–135.9) increased during the first 3 months after delivery compared with non-pregnant women. A 14-fold increased risk of deep venous thrombosis of the leg was found compared with a 6-fold increased risk of pulmonary embolism. The risk was highest in the third trimester of pregnancy (OR, 8.8; 95% CI, 4.5–17.3) and during the first 6 weeks after delivery (OR, 84.0; 95% CI, 31.7–222.6). The risk of pregnancy-associated venous thrombosis was 52-fold increased in factor V Leiden carriers (OR, 52.2; 95% CI, 12.4–219.5) and 31-fold increased in carriers of the prothrombin 20210A mutation (OR, 30.7; 95% CI, 4.6–203.6) compared with non-pregnant women without the mutation. Conclusion:  We found an increased risk of venous thrombosis during pregnancy and the postpartum period, with an especially high risk during the first 6 weeks postpartum. The risk of pregnancy-associated venous thrombosis was highly increased in carriers of factor V Leiden or the prothrombin 20210A mutation.     

A model (CMBP) for collaboration between university college and nursing practice to promote research utilization in students' clinical placements: A pilot study

BackgroundA collaborative project was initiated in Norway between a university college and a hospital in order to improve RNs' and nursing students' research utilization in clinical placements. This paper describes the model (CMBP) that was developed, its first application, and evaluation.AimThe evaluation aimed at describing nurses' and students' experiences of the CMBP related to collaboration, facilitation, learning, and impact on nursing care.MethodsThirty-eight students from the second and third year of nursing education, and four nurses answered questionnaires with closed and open ended questions. In addition two of the nurses wrote diaries. Data were subjected to qualitative and quantitative analysis.FindingsAlmost all participants reported that collaboration between nursing college and nursing practice had been beneficial. Most students and all nurses reported about valuable learning, increased understanding of research utilization, and improved quality of nursing care. Both students and RNs recommended the CMBP to be used in all clinical placements to support academic learning and increase research utilization in clinical practice.ConclusionDespite study limitations the findings indicate that the CMBP has a potential to be a useful model for teaching RNs' and students EBP. However, further refinement of the model is needed, followed by a more comprehensive implementation and evaluation.     

Influenza prophylaxis in the long-term care facility: a case-control study of the risk factors for adverse drug reactions to amantadine

Background

Amantadine hydrochloride remains an inexpensive means of influenza A prophylaxis, but it is reported to have a high incidence of adverse drug reactions (ADRs) in residents of long-term care facilities (LTCFs) compared with newer, more expensive drugs.

Objective

This study attempted to determine the effects of poor renal function on the rate of ADRs and any other variables on the tolerability of prophylaxis in this population. This would allow a high-risk subset of LTCF residents to be identified before prophylaxis, thus decreasing the risk for ADRs from amantadine.

Methods

In this retrospective case-control study, a course of standardized low-dose (100-mg/d tablets) amantadine prophylaxis was ordered for all 242 residents of Ten Broeck Commons LTCF in Lake Katrine, New York, without influenza A for 14 days. Chart data of residents who developed ADRs (ADR group) were compared with those of a selected group who did not (control group). Residents’ age, sex, renal function (blood urea nitrogen, serum creatinine, and creatinine clearance), dementia diagnosis, and number and classes of medications were compared.

Results

The ADR group comprised 25 residents (21 women, 4 men; mean [SD] age, 84.8 [8.4] years); the control group, 29 residents (23 women, 6 men; mean [SD] age, 85.7 [7.5] years). The development of ADRs was not associated with differences in age, sex, renal function, or any medical condition, including measured, preexisting mental status changes between the groups. The overall risk for ADRs in the 242 residents was highest between days 8 and 14 of prophylaxis (17 residents [7.0%]) compared with the first 7 days (8 residents [3.3%]). Acute confusion was the most common ADR. All ADRs resolved on cessation of treatment.

Conclusions

No preexisting medical condition was statistically associated with an increased risk for ADRs, but an association with the number of days of prophylaxis was observed. By shortening prophylaxis to 7 days, the ADR risk may be lowered to be commensurate with more expensive medications.     

A literature review to assess the reliability and validity of measures appropriate for use in research to evaluate the efficacy of a brief harm reduction strategy in reducing cannabis use among people with schizophrenia in acute inpatient settings

There is a growing body of evidence looking at the effects of cannabis use on those with schizophrenia with concerning results. This has led to the development of a number of interventions that are intended to improve outcomes for this client group. However, the methodological quality of some dual diagnosis research has been questioned in reviews for using outcome measures that are not tested as reliable and valid in the population for which they are intended for use. This literature review assesses the self-report measures that have been reliability and validity tested in populations of people with schizophrenia who use cannabis and reports on their appropriateness for use in further research studies. An overview of the most appropriate biochemical tests for cannabis is also given.     

Methods to evaluate perspectives of safety,independence, activity,and participation in older persons using welfare technology. A systematic review

Abstract

Purpose: To conduct a systematic review of existing methods to evaluate the individual aspects of welfare technology from the perspectives of independence, safety, activity, and participation. Furthermore, the study aimed to describe outcomes that have been the focus of previous research to evaluate individual aspects of welfare technology in older persons living in ordinary housing. Materials and methods: A systematic literature review in PubMed, CINAHL Plus, PsycINFO, Scopus, and Web of Science. Studies selected were those that explored the use of assistive and welfare technology devices from older persons’ perspectives, and which considered the concepts of independence, safety, activity and participation, and quality of life. Results: A broad spectrum of instruments was applied in the studies. For independence, three questionnaires were used in the identified studies. For safety, one instrument was used in two versions. To study activity and participation as well as quality of life, several scales were used. Additionally, several studies included qualitative approaches for evaluation, such as interviews, or posed one or more questions regarding the effects of welfare technology. Conclusions: The integration of digital assistive and welfare technology should be based on the needs of older persons, and those needs must be assessed using reliable and relevant instruments. The heterogeneity of the target group, i.e., older persons, together with the fact that assessments must give consideration to identifying goals, obstacles, and risks as well as users’ preferences, implies a person-centred approach.

• Implications for rehabilitation

• The integration of digital assistive and welfare technology should be based on older persons’ needs, and those needs must be assessed using reliable and relevant instruments.

• The heterogeneity of the target group, i.e. older persons, together with the fact that assessments must give consideration to identifying goals, obstacles and risks as well as users’ preferences, implies a person-centred approach.

• The ideal would be one coherent model that explores the use of digital assistive and welfare technology from the individual, economic as well as organisational dimensions. This would cover the different needs and expectations of various stakeholders, including economic and organisational, but also the needs of the older person.

     

Safety,tolerability, and effectiveness of repetitive intravenous dihydroergotamine for refractory chronic migraine with cardiovascular risk factors: A retrospective study

Background

Dihydroergotamine (DHE), like triptans, is contraindicated in patients with ischemic heart disease or coronary vasospasm. Its true safety, tolerability, and efficacy in patients with cardiovascular risk without ischemic heart disease or coronary vasospasm remain unclear.

Objectives

To assess the safety, tolerability, and effectiveness of repetitive intravenous DHE in patients with cardiovascular risk factors.

Methods

A single-center, retrospective cohort study was conducted at the Jefferson Headache Center inpatient unit for refractory chronic migraine patients treated with our intravenous DHE protocol between January 1, 2019, and October 15, 2019. We evaluated tolerability and effectiveness outcomes based on atherosclerotic cardiovascular disease 10-year calculated risk scores, stratified into low (<5.0%) and elevated (≥5.0%) risk. Data were presented in mean ± standard deviation or median (25th percentile, 75th percentile) if non-normally distributed.

Results

Among 347 patients (median age of 46 [36, 57], female n = 278 [80.1%]), who received inpatient intravenous DHE, 227 patients (age 53 [45, 60], female 81.1%) had calculable risk scores, 64 (28.2%) had elevated risk, and 38 (16.7%) had cardiology consultations. There were no clinically significant electrocardiogram abnormalities or cardiovascular adverse events. The median hospital length of stay was 6 (5, 7) days. Compared to the low-risk group, those with elevated risk had higher nausea (31.3% vs. 14.1%, p = 0.008), but similar initial DHE dose (0.5 [0.25, 0.5] vs. 0.5 [0.25, 0.5], p = 0.009), lower final DHE dose (0.75 [0.5, 1] vs. 1 [0.75, 1] p < 0.001), and lower pain reduction after admission (−3.8 [2.1, 6] vs. −5 [3, 7] p = 0.037).

Conclusion

Patients receiving intravenous DHE by the Jefferson Headache Center inpatient headache protocol had significantly reduced pain severity at discharge. No clinically significant cardiac or electrocardiogram abnormalities were detected in patients with elevated (or low) atherosclerotic cardiovascular disease risk. Repetitive intravenous DHE used by our protocol was safe in refractory chronic migraine patients.     

A postmarketing,open-label study to evaluate the tolerability and effectiveness of replacing standard-formulation doxazosin with doxazosin in the gastrointestinal therapeutic system formulation in adult patients with hypertension

BACKGROUND: The antihypertensive doxazosin works to decrease perivascular muscular tone, causing vasodilatation and hence a decrease in peripheral vascular resistance. To prevent the sharp decrease in blood pressure (BP), syncope, and other postural effects that may occur at the beginning of therapy with this drug, the dose must be adjusted. A new formulation, doxazosin gastrointestinal therapeutic system (GITS), allows slow release of the active agent so therapeutic serum levels are reached within 24 hours, rendering dose adjustment unnecessary and eliminating any first-dose effects. OBJECTIVES: The goals of this study were to evaluate the tolerability and effectiveness of (1) using doxazosin in the standard and new GITS formulations in adult patients with hypertension who either had uncontrolled or newly diagnosed disease, and (2) replacing standard-formulation doxazosin with doxazosin in the GITS formulation. METHODS: This was a postmarketing, open-label, noncomparative, multicenter clinical study covering primary care patients diagnosed with essential uncontrolled arterial hypertension (AHT). Subjects could be patients who were undergoing drug therapy before enrollment or those diagnosed with AHT and/or treated for the disease for the first time on entering the study. The study covered a period of 6 to 9 months, divided into 2 phases. Phase 1 involved a minimum of 3 and maximum of 6 months of treatment with standard-formulation doxazosin. Phase 2 commenced with the changeover from standard-formulation doxazosin to the GITS formulation and lasted 12 weeks. The principal study variables included BP and the development of adverse events (AEs). At every visit, the patients were asked by an investigator whether they had suffered any AEs since the previous contact. RESULTS: Of the total of 4,512 patients initially enrolled, 3537 (78.4%) completed the study. A total of 285 patients were excluded for failing to comply with the inclusion criteria, leaving 4,227 patients for analysis. In most instances, premature withdrawal from the study (16.3% [690/4,227]) was due to loss to follow-up (37.2% [257/690]), followed by the development of AEs (27.8% [192/690]). Fifty-nine percent (2,493/4,226) of patients analyzed were men and 41.0% (1,733/4,226) were women (sex data not recorded for 1 patient), with a mean age of 62.4 years (SD, 10.6). Among the patients participating, 54.8% (2,316/4,227) presented with some type of associated disease. The percentage of patients undergoing monotherapy was 70.7% (2,987/4,227); the remainder (29.3% [1,240/4,227]) underwent a combined-therapy regimen using another antihypertensive drug in conjunction with doxazosin. The mean initial systolic and diastolic BPs were 160 +/- 10.63 mm Hg and 95.26 +/- 7.21 mm Hg, respectively. Reduction in systolic BP was 20.9 mm Hg in phase 1 and 3.8 mm Hg in phase 2. In the case of diastolic BP, the reduction was 13.3 mm Hg in phase 1 and 2.6 mm Hg in phase 2. The percentage of patients with controlled disease was 47.9% (1,891/3,949) by the end of phase 1 and 63.4% (2,242/3,537) by the end of phase 2. A total of 322 (7.6%) patients presented with 343 AEs. 37 (0.9%) of which were deemed severe (0.6% in phase 1 and 0.3% in phase 2). Limitations included the following: (1) the design of this study did not allow comparison of the 2 formulations regarding effectiveness or tolerability: (2) the patients who remained in the study after phase 1 were those less susceptible to toxicity from doxazosin; and (3) it is probable that the nonresponders were more likely to drop out of the study. CONCLUSIONS: Doxazosin in the standard formulation was effective and well tolerated for the purpose of lowering BP. Patients who tolerated the standard formulation also tolerated the switch to the GITS formulation. Finally, this substitution did not negatively impact the effectiveness of treatment of AHT.