ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Of the 62 million common colds requiring medical attention in the United States each year, more than 80% affect school-aged children. Controlled clinical trials have demonstrated the effectiveness of zinc gluconate glycine lozenges (Cold-Eeze) in reducing cold duration. The objective of this study was to determine the effectiveness of zinc gluconate glycine lozenges in reducing the duration and severity of colds in school-aged subjects and to identify the benefits of prophylactic administration of zinc gluconate glycine lozenges in reducing the occurrence of colds. The medical charts of subjects enrolled at Utah's Heritage Center before and after the introduction of zinc gluconate glycine lozenges (between January 1998 and August 2001) were reviewed to identify those who experienced cold signs or symptoms. Two or more prespecified signs or symptoms on the same day identified a cold and, along with patient or medical staff reports and use of cold medications, were used to determine cold start and resolution dates. Results from subjects who did or did not take study treatment were compared statistically to determine the prophylactic effects of lozenge use. Effects of zinc gluconate glycine lozenges on the need for antibiotic therapy were also analyzed. The review encompassed 496 records. Treatment with zinc gluconate glycine lozenges significantly decreased cold duration (7.5 versus 9.0 days for nonuse;P< 0.0001). Prophylaxis also significantly reduced the median number of colds per year (0.0 versus 1.3;P< 0.001) and concomitant antibiotic use to manage colds (4.1% versus 36.2%;P< 0.0001). Therapy with zinc gluconate glycine lozenges significantly reduced cold duration and antibiotic use in school-aged subjects. Prophylactic administration also significantly decreased cold frequency.

ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

An open-label, multicenter, dose-titration study evaluated 2556 patients with stage I or II essential hypertension (untreated or previously treated with one antihypertensive agent) to assess the effect of a chronotherapeutic formulation of verapamil (Verelan PM) designed to provide maximum plasma concentrations in the midmorning hours. After starting with 200 mg/d at bedtime, the dose of Verelan PM was titrated to a maximum of 400 mg/d at 4-week intervals to achieve a target blood pressure (BP) <140/90 mm Hg using morning BP measurements. In 85.3% of patients, a diastolic blood pressure (DBP) response to less than 90 mm Hg or a 10–mm Hg decline from baseline DBP was achieved. The systolic BP response (<140 mm Hg or 10% decline from baseline) was attained in 76.9% of patients. Blood pressure was controlled in 62.6% of patients with Verelan PM monotherapy. Upward titration of Verelan PM from 200 to 400 mg nearly doubled the DBP response rate (45.8% to 85.3%). This chronotherapeutic formulation of verapamil was well tolerated in this community trial.

ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The goal of this study was to ascertain why patients are maintained on conventional antipsychotics and whether the risks/benefits and alternative treatments with novel antipsychotics are discussed with these patients. We reviewed the charts of 117 outpatients maintained on conventional antipsychotics at three New York hospitals: Hutchings Psychiatric Center (HPC), Syracuse Veterans Affairs Medical Center (SVA), and the Continuing Day Treatment Program (CDT). The major reasons for maintaining patients on conventional antipsychotics were good response (50%), patient choice (45%), and physician choice (36%). Despite the high incidence of tardive dyskinesia at all three hospitals (range: 12%–50%), physicians often did not discuss the risks/benefits of continuing conventional antipsychotics with the patients. The treating psychiatrist discussed alternative treatments with 37% of patients at SVA, 58% at HPC, and 68% at CDT (P= 0.066,df= 2, Pearson &khgr;2test). For patients who are receiving any antipsychotic therapy, discussions about the risks/benefits of treatments are integral for optimal treatment and medicolegal purposes.

ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Coronary and peripheral intervention requires intraprocedural anticoagulation to prevent intraluminal thrombosis. Traditionally, unfractionated heparin (UFH) is administered during the procedure to achieve activated clotting time (ACT) of 300 to 400 seconds. When the intravenous IIb/IIIa antagonists are also used, the recommended ACT is 250 to 300 seconds because higher anticoagulation (ACT, 300–400 seconds) is accompanied by an unacceptable bleeding complication rate without added benefits. Because low molecular weight heparin has a more predictable anticoagulant effect and a higher anti–factor Xa/anti–factor IIa ratio, allows better bioavailability, is resistant to inhibition by activated platelets, and does not require routine monitoring using ACT, its use for intraprocedural anticoagulation (instead of UFH) has been an area of increasing interest. The safety and efficacy of coadministration of low molecular weight heparin with IIb/IIIa antagonists have not been adequately evaluated. We report a study of prospective evaluation of the safety and efficacy of combined use of intravenous enoxaparin and intravenous eptifibatide during nonemergent coronary and peripheral vascular intervention in 93 consecutive procedures performed on 56 patients. The procedural success rate was 99% (92/93 procedures), the acute clinical success rate was 98% (54/55 patients), the major bleeding complication rate was 2% (1/56 patients), and the vascular complication rate was 0.0%. In conclusion, the use of intravenous enoxaparin in conjunction with intravenous eptifibatide during nonemergent coronary and peripheral vascular intervention is safe and effective and eliminates the need for routine measurement of ACT during the procedure.

ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A population pharmacokinetic (PK) study was designed to estimate the PK parameters of digoxin among a selected group of Egyptian pediatric patients (n = 30) with mean age ± SD and body weight ± SD of 8.88 ± 3.01 years and 23.9 ± 5.8 kg, respectively. All patients had heart failure and were maintained on digoxin given orally. Nonlinear mixed effect modeling software version 5 (NONMEM Project Group, San Francisco, CA) and one-compartment modeling were used for fitting the data. A one-trough steady-state plasma concentration level of digoxin was used in the analysis. The population mean estimates for clearance (CL/f) and volume of distribution (V/f), in which f represents oral bioavailability, were 8.61 L/h and 450 L, respectively. Because of the limited number of samples per patient, regression analysis could not detect a correlation between patient covariates and estimated PK parameters. The analysis did not converge to obtain good parameter estimates. At least two samples per patient should be used to improve the PK estimation and allow better analysis of the relation between the potential covariates and estimated PK parameters.

ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Emergency department (ED)–based observation units are becoming increasingly used for the assessment and treatment of patients who may not require inpatient management or monitoring. This is a retrospective study of 5714 patients seen in an ED observation unit from October 16, 1996 through July 12, 2000. Of the 5714 patients seen in the observation unit, 4191 were discharged and 1314 were admitted. The average length of stay was 14.92 hours. The largest group of patients seen in the observation unit was those with chest pain (almost 26%). Patients suffering abdominal pain/colic represented the second largest group (almost 16%). Pediatric patients had the shortest stay, averaging only 11.2 hours, although adult and geriatric patients averaged 15.1 hours and 15.4 hours, respectfully. The ED-based observation unit can be of great value to patient care. Although not a substitute for an inpatient unit, it is meant to be a convenient location from which to observe patients who exhibit questionable admitting criteria.

ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The role of estrogen in the treatment of depression is reviewed. The relation is examined in studies of perimenopausal and postmenopausal women with depressed mood, in studies of depressive disorders, and in studies of estrogen as an adjunct to antidepressant medication. The literature has many methodologic shortcomings, including combining women of various ages, failure to confirm life stage, the use of different types of estrogens, the inclusion of women with a range of mood disturbances, and the enrollment of women with concurrent psychiatric illness. There are few controlled evaluations of the use of estrogen to supplement ongoing antidepressant treatment. Estrogen alone seems to be beneficial for improving mood in perimenopausal and postmenopausal women. Estrogen is superior to placebo for reproductive-related mood disorders, including postpartum depression and mild depressive disorders during perimenopause. Replication is necessary, especially in moderate to severe levels of major depression. Estrogen may augment antidepressant treatment. Assessment and treatment implications are discussed.

ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetic people have cardiovascular disease (CVD) risk factors comparable to those of nondiabetics who have had a myocardial infarction or stroke. Physiologic changes in diabetic hypertensive people include endothelial dysfunction, altered platelet activity, and microalbuminuria, all of which may increase coronary heart disease risk. Hyperglycemia and dyslipidemia have been shown to effect physiologic changes in the vasculature; therefore, establishing normoglycemia, reducing cholesterol levels, and controlling blood pressure are the primary and initial goals in the management of diabetic hypertensive patients. The atherosclerotic risk is greatest in poorly controlled patients, possibly because of associated hypercholesterolemia and hypertriglyceridemia. Aggressive management of risk factors such as hypertension, dyslipidemia, and platelet dysfunction in diabetics has been shown to reduce morbidity and mortality in prospective randomized controlled clinical trials. In this article we review the impact of diabetes mellitus on cardiovascular morbidity and mortality.

ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Obesity is a recognized risk factor for cardiovascular disease. Because the prevalence of obesity is rising in industrialized as well as developing nations, it is important to understand the mechanisms by which obesity targets the vascular system. A metabolic syndrome of insulin resistance is provoked by obesity, and this results in the dysregulation of a number of adipocyte-derived factors, which favors atherosclerosis. This review focuses on how products of the adipocyte, including free fatty acids and “adipo”-cytokines, may mediate the effect of obesity on insulin resistance and atherosclerosis.

ISSN:1075-2765    

出版商:OVID    

年代:2002

数据来源: OVID