摘要:

Until recently, control of influenza has focused on increasing the use of the inactivated influenza vaccine and, in some countries, encouraging the appropriate use of the antiviral drugs amantadine and rimantadine. Now that a new class of antiviral drugs, the neuraminidase inhibitors, has been approved for use in many countries, and a live attenuated vaccine is on the horizon, novel opportunities have arisen for the prevention and treatment of influenza. The clinical effectiveness of these innovations has not been fully determined in many patient populations, particularly in managed-care environments; clinical and economic impacts are similarly considered in making decisions regarding access to new technologies in most healthcare delivery systems. However, it is possible to use available information to speculate on how these technologies might be used, while the relative clinical and cost consequences of these innovations are further clarified.Intreatment, the neuraminidase inhibitors have been shown to significantly reduce the duration of influenza-related illness and usage of antibacterial drugs. As the clinical benefits and cost effectiveness of new drugs are documented, utilisation of these agents is likely to extend from those with underlying risk conditions to previously healthy individuals. Forprevention, the new live attenuated vaccines will be increasingly used in children. Inactivated vaccines will continue to be used mainly for the elderly and adults with underlying health conditions. There will also be a limited role for the antiviral drugs in prophylaxis seasonally, but more extensive use is likely in families and in the workplace for short periods after exposure. Relative differences in clinical effectiveness, patient preference and cost will inform managed-care organisations on whether to promote or restrict the use of these interventions in various patient populations.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

ObjectiveTo describe the use of computer technology to enhance our ability to identify and notify providers of potential drug therapy problems using a mail intervention monitoring programme.SettingPharmacy benefit management company.InterventionUse of clinical software systems and professional support to help physicians and pharmacists eliminate drug therapy problems using a drug therapy problem notification service. The service begins with an automated clinical screening system. Pharmacists then review the potential problems for relevance. After a potential problem is identified, the system generates letters to physicians and pharmacists. The letters describe the problem and explain its significance, provide recommended alternatives and supporting references, and give a patient prescription profile. Key enhancements to the system included:use of a commercially available personal computer database program;client-server connections to large data sources;creation of sophisticated computer screening criteria;on-screen patient drug therapy problem review;system loading of patient, physician and pharmacy information;automated follow-up; andcriteria modification based on therapy changes.Main outcome measures and resultsFrom January 1998 through July 1999, the service notified physicians and pharmacists of 100 894 potential problems for 49 892 patients. Over 60% of the interventions resulted in a change of drug therapy. Without this system it took over 3 months to mail letters. The turnaround time now takes less than 15 days. Pharmacists can now review 14 times as many potential problems in the same amount of time as taken previously.ConclusionA combination of end-user programme development and information services department support considerably reduced the time required to identify, and notify providers about, potential drug problems compared with our previous system.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

ObjectiveTo use the System of Objectified Judgement Analysis (SOJA) method for the rational selection ofHelicobacter pylorieradication therapies for formulary inclusion.DesignDrug selection for the eradication therapy ofH. pyloriis made by means of the SOJA method. In this formulary decision-making model, selection criteria for a given class of drugs are prospectively defined and weighted by a panel of experts. The following criteria (relative weight) were used: variability of pharmacokinetics; drug interactions; resistance to antibacterials; efficacy; general adverse effects; complexity of the regimen; acquisition cost and clinical documentation. Only published studies with at least 30 evaluable patients were considered, at least 3 studies had to be available per treatment regimen and efficacy had to be assessed on an intent-to-treat basis.Main outcome measures and resultsThe regimens containing clarithromycin and an imidazole antibacterial in combination with omeprazole or ranitidine bismutrex showed the highest scores for eradication ofH. pylori. The combinations amoxicillin/ clarithromycin and omeprazole or lansoprazole showed slightly lower eradication rates and were more costly. The eradication rates obtained with 2-drug regimens were low, resulting in a low overall SOJA score. No quadruple regimens could be included, as none of the regimens fulfilled the inclusion criteria. This was also true for the classical triple therapy with bismuth/metronidazole/tetracycline.ConclusionThe present score is specific for the Netherlands, as Dutch acquisition costs and data on resistance were used. In other countries, with different degrees of imidazole and clarithromycin resistance, other regimens may be more appropriate. The SOJA score will be regularly updated through the internet to include relevant new studies or new successful eradication regimens. The interactive program offers groups of physicians the opportunity to discuss the optimalH. pylorieradication regimen, based on their weighting of the criteria.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Hypertension and diabetes mellitus are significant and independent risk factors for cardiovascular disease.Antihypertensive therapy reduces cerebrovascular and cardiovascular morbidity and mortality in patients with hypertension. Tight blood pressure (BP) control [target diastolic BP (DBP) ≤80mm Hg] reduced the incidence of major cardiovascular events by 51% compared with less tight control (DBP ≤90mm Hg) in patients with diabetes mellitus in the Hypertension Optimal Treatment (HOT) study. Similarly, in the UK Prospective Diabetes Study (UKPDS), tight BP control [mean systolic BP (SBP)/DBP = 144/82mm Hg] with captopril or atenolol reduced diabetes mellitus-related morbidity and mortality by 24% compared with less tight control (mean SBP/DBP = 154/87mm Hg). Importantly, the frequency of microvascular disease (including retinopathy) was reduced by 37% among those randomised to tight BP control in the UKPDS.In the diabetic subgroup in the Heart Outcomes Prevention Evaluation (HOPE) study, there was a 25% reduction in the composite end-point of death due to cardiovascular causes, or myocardial infarction or stroke during 5 years of treatment with ramipril 10 mg/day relative to placebo.Lisinopril is an ACE inhibitor indicated for use in hypertension, heart failure and post-myocardial infarction. As an antihypertensive agent the drug is effective and generally well tolerated in patients with type 1 or 2 diabetes mellitus and in those with early or overt nephropathy.In the Swedish Treatment of Old People (STOP) Hypertension 2 trial, there was no difference in the relative risk of cardiovascular death between those assigned to ACE inhibitors (lisinopril or enalapril), calcium channel blockers (felodipine or isradipine) or ‘conventional’ antihypertensive therapy (thiazide diuretics or β blockers); treatment effects did not differ significantly between diabetic and nondiabetic patients (10.9% of the 6614 patients had diabetes mellitus). Importantly, lower frequencies of nonfatal or fatal myocardial infarction [relative risk (RR) 0.77; 95% confidence interval (CI) 0.61 to 0.96] and congestive heart failure (RR 0.78; CI 0.83 to 0.97) were detected during 4 years' treatment with lisinopril or enalapril than felodipine or isradipine in this study.Lisinopril reduced albumin excretion rates in patients with type 1 or 2 diabetes mellitus. In the 2-year EURODIAB Controlled Trial of Lisinopril in IDDM (EUCLID) study, albumin excretion rates decreased by 49.7% relative to placebo in normotensive patients with type 1 diabetes mellitus and microalbuminuria during treatment with lisinopril 10 to 20 mg/day. Progression of retinopathy was attenuated in normotensive patients with type 1 diabetes mellitus during treatment with lisinopril in this study.In conclusion, lisinopril, like other ACE inhibitors should be considered a first-line agent for reducing BP and attenuating nephropathy in patients with type 1 or 2 diabetes mellitus.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS