14 research outputs found
Treatment of Early Parkinson's Disease
Treatment of early Parkinson's disease with either selegiline (Eldepryl), a dopamine agonist (pramipexole [Mirapex], ropinirole [Requip], or bromocriptine [Parlodel]), or the combination of levodopa and carbidopa (Sinemet) or levodopa and cabidopa with entacapone (Stalevo) improves symptoms and quality of life, but all medication regimens are associated with significant side effects (Table 1). There is no compelling evidence favoring a medication option, so treatment should be individualized. [Strength of recommendation: A, based on systematic reviews of randomized controlled trials (RCTs)
Comparison of chronic systolic heart failure guideline adherence for two ambulatory clinics
Guidelines have been published for management of
chronic systolic heart failure to reduce patient
morbidity and mortality.
Objective: A quality review of the heart failure
medical therapy for a community family medicine
residency program clinic and a multidisciplinary
heart failure specialty clinic was performed to
compare adherence to ACC/AHA heart failure
guidelines, with regard to medications and in
titrating to recommended target doses.
Methods: The study was a retrospective chart
review and data collected included name and dose
of any ACEI, beta-blocker, ARB, or other medication
addressed in the guidelines.
Results: Specialty clinic patients had significantly
lower systolic blood pressures and ejection
fractions. Significantly more patients were
prescribed beta-blockers in the specialty clinic
population (98% vs 80%, p<0.05). Both patient
populations had very low rates of reaching target
beta-blocker doses (15% vs 21%, p=0.27). More
patients in the family medicine clinic reached target
doses of ACEI (64% vs 49%, p<0.05) and ARBs
(67% vs 35%, p<0.05).
Conclusions: This study revealed the vast majority
of patients in either a community family medicine
residency program or heart failure specialty clinic
were prescribed ACEI or ARB, and beta-blockers.
However, achieving target doses should continue to
be an important goal for practitioners.Se han publicado guías para el manejo del fallo
cardiaco sistólico crónico para reducir la
morbilidad y mortalidad de los pacientes.
Objetivo: Se realizó una revisión de la calidad del
tratamiento del fallo cardíaco en un programa de
residencia en una clínica de medicina familiar y en
una clínica multidisciplinaria especializada en fallo
cardiaco para comparar el cumplimiento de las
guías de fallo cardiaco ACC/AHA en relación a la
medicación y en la reducción de dosis hacia las
dosis recomendadas.
Métodos: El estudio fue una revisión retrospectiva
de historiales y una recogida de datos que incluyó
nombre y dosis de cualquier IECA, betabloqueante,
ARA u otra medicación mencionada en las guías.
Resultados: La clínica especializada tuvo presiones
sistólicas y fracciones de eyección
significativamente más bajas. Se prescribió
betabloqueantes significativamente a más pacientes
en la clínica especializada (98% vs 80%, p<0.05).
Ambos grupos de pacientes tuvieron tasa muy bajas
de alcanzar los valores objetivo de dosis de
betabloqueantes (15% vs 21%, p=0.27). Más
pacientes en la clínica de medicina familiar
alcanzaron las dosis objetivo de IECA (64% vs
49%, p<0.05) y ARA (67% vs 35%, p<0.05).
Conclusiones: Este estudio revela que la gran
mayoría de pacientes, tanto en un programa de
medicina familiar y comunitaria como en una
clínica especializada en fallo cardiaco tenían
prescritos IECA o ARA y betabloquenates. Sin
embargo, alcanzar las dosis objetivo debería
continuar a ser una meta para los facultativos
Improving Anticoagulation Therapy Using Point-of-Care Testing and a Standardized Protocol
PURPOSE Many patients in primary care require anticoagulation with warfarin for the prevention of venous and systemic embolism. Achieving the goal international normalized ratio (INR) with warfarin is challenging. The purpose of this quality improvement initiative was to increase the proportion of patients taking warfarin with an INR value within the goal range
Glycemic Control in Medical Inpatients with Type 2 Diabetes Mellitus Receiving Sliding Scale Insulin Regimens versus Routine Diabetes Medications: A Multicenter Randomized Controlled Trial
PURPOSE Hospitalized patients with type 2 diabetes mellitus traditionally receive insulin on a sliding-scale regimen, but the benefits of this approach are unclear. The purpose of this study was to compare the effects of the sliding scale insulin regimen with those of routine diabetes medications on hyperglycemia, hypoglycemia and length of hospitalization in diabetic patients hospitalized for other conditions. METHODS This was a multicenter, randomized controlled trial conducted in family medicine inpatient services. One hundred fifty-three patients with type 2 diabetes mellitus hospitalized for other conditions were randomized to receive routine diabetes medications (control) or the combination of a standard sliding-scale insulin regimen and routine diabetes medications (intervention). The outcome measures included frequency of hyperglycemia and hypoglycemia (glycemic events), and length of hospitalization. RESULTS No differences were identified between treatment groups in the frequency of glycemic events. In the intervention group, 33.3% of patients developed hyperglycemia compared to 34.6% in the control group (P = .87). Six patients developed hypoglycemia in the intervention group, compared with 7 in the control group (P = .83). There was no difference in length of hospitalization (P = .86). Regardless of treatment assignment, patients receiving intermediate-acting insulin (OR, 2.8; 95% CI, 1.2–6.5), those with blood glucose values greater than 250 mg/dL at baseline (OR, 6.3; 95% CI, 2.3 – 17.2) and those receiving corticosteroids (OR, 9.1; 95% CI, 3.1 – 27.0) were more likely to have glycemic events. CONCLUSIONS The use of the sliding scale insulin regimen in combination with routine diabetes medications does not affect the rate of hyperglycemia, hypoglycemia or length of hospitalization in patients with type 2 diabetes mellitus hospitalized for other conditions
Clinical Pharmacists as Educators in Family Medicine Residency Programs: A CERA Study of Program Directors
BACKGROUND AND OBJECTIVES: The clinical pharmacist’s role within family medicine residency programs (FMRPs) is well established. However, there is limited information regarding perceptions of program directors (PDs) about clinical pharmacy educators. The study objectives were (1) to estimate the prevalence of clinical pharmacists within FMRPs and (2) to determine barriers and motivations for incorporation of clinical pharmacists as educators. METHODS: The Council of Academic Family Medicine Educational Research Alliance (CERA) distributed an electronic survey to PDs. Questions addressed formalized pharmacotherapy education, clinical pharmacists in educator roles, and barriers and benefits of clinical pharmacists in FMRPs. RESULTS: The overall response rate was 50% (224/451). Seventy- six percent (170/224) of the responding PDs reported that clinical pharmacists provide pharmacotherapy education in their FMRPs, and 57% (97/170) consider clinical pharmacists as faculty members. In programs with clinical pharmacists, 72% (83/116) of PDs reported having a systematic approach for teaching pharmacotherapy versus 22% (21/95) in programs without. In programs without clinical pharmacists, the top barrier to incorporation was limited ability to bill for clinical services 48% (43/89) versus 29% (32/112) in programs with clinical pharmacists. In both programs with and without clinical pharmacists, the top benefit of having clinical pharmacists was providing a collaborative approach to pharmacotherapy education for residents (35% and 36%, respectively). CONCLUSIONS: Less than half of FMRPs incorporate clinical pharmacists as faculty members. Despite providing collaborative approaches to pharmacotherapy education, their limited ability to bill for services is a major barrier
Formation of a primary care pharmacist practice-based research network
Purpose. The results of a survey conducted to characterize participating practice sites, patient populations, and collaborative physician-pharmacist services provided through an emerging practice-based research network (PBRN) in the primary care setting are presented. Methods. A targeted sample of faculty pharmacist investigators practicing in primary care settings were selected for participation in this PBRN based on several factors, including past research activities, their interest in soliciting additional clinics within their state to participate in a research network, the potential for regional collaboration, geographic location, and the patient population served. A baseline survey to characterize the PBRN was distributed to members of the PBRN in June 2006. Data were analyzed using descriptive statistics. Results. A total of 81 pharmacists in 48 practice sites were recruited to join the PBRN. Most practice sites were located within family medicine residency programs, and the majority were affiliated with a community hospital or health system. Half of participating practices had 300-599 ambulatory care visits per week. Pharmacists in the PBRN spent their time performing direct patient management and had collaborative practice agreements with physicians. Patient revenue was used to cover pharmacist salaries in about one fifth of the practice sites. Pharmacists in the PBRN reported participation in diverse educational activities, such as point-of-care resident education and curbside consultation in the clinic hallways or their office. Conclusion. Eighty-one pharmacists from 48 primary care practice sites in 11 states were recruited to join a PBRN. These pharmacists provided descriptive data regarding their practice site, characteristics of patients served, and clinical services provided as a first step in collaborative research efforts. Copyright © 2007, American Society of Health-System Pharmacists, Inc. All rights reserved
Premenstrual Syndrome (PMS) and the Myth of the Irrational Female
King’s chapter begins by describing the historical context of ‘premenstrual’ symptoms, which were first formally described in 1931. She then questions the prioritization of mood-based symptoms in the diagnostic criteria for Premenstrual Syndrome (PMS). King argues that population studies suggest that mood-based symptoms are not the most common nor most disruptive of menstrual changes. She then proposes that the trend of ‘psychologizing’ premenstrual symptoms is influenced by the sexist historical assumption of ‘the myth of the irrational female’—the idea that women, due to their reproductive biology, are pathologically emotional and thus have a reduced capacity for reason. The author concludes by calling for a more integrated and rigorous approach to PMS definitions and research to support people who experience cyclical symptoms, without unintentionally pathologizing the menstrual cycle or stigmatizing an entire gender