Absence of gastrointestinal infections in a cohort of patients with Zollinger-Ellison syndrome and other acid hypersecretors receiving long-term acid suppression with lansoprazole

<p>Abstract</p> <p>Background</p> <p>The relationship between proton pump inhibitor therapy and other acid suppressing medications and the risk of gastrointestinal infections remains controversial.</p> <p>Methods</p> <p>Patients enrolled in a long-term trial of lansoprazole for Zollinger-Ellison syndrome and other acid hypersecretory states had interval histories taken every six months regarding hospitalizations or other intercurrent medical conditions. All medications taken were also reviewed at each visit. In addition, available patients were specifically queried during the study period 2006–2007 regarding the development of any gastrointestinal infections, hospitalizations, and prescriptions for antibiotics.</p> <p>Results</p> <p>Ninety patients were enrolled in our long-term study and 81 were available for review. The median basal gastric pH for the cohort after stabilization on therapy was 2.9 and ranged from 1.1 – 8.4 with a median pentagastrin stimulated gastric pH of 1.60 (range 1.0 – 8.2). No patient developed a clinically significant gastrointestinal infection during the study. The median patient years of follow-up were 6.25 years.</p> <p>Conclusion</p> <p>In a cohort of patients with gastric acid hypersecretion in whom acid secretion status was monitored on lansoprazole, all were free of significant gastrointestinal infections on long-term follow-up.</p> <p>Trial registration</p> <p>NCT00204373</p

Cost effectiveness of support for people starting a new medication for a long term condition through community pharmacies: an economic evaluation of the New Medicine Service (NMS) compared with normal practice

Background: The English community pharmacy New Medicine Service (NMS) significantly increases patient adherence to medicines, compared with normal practice. We examined the cost-effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs. Methods: We developed Markov models for diseases targeted by the NMS (hypertension, type 2 diabetes, chronic obstructive pulmonary disease, asthma and antiplatelet regimens) to assess the impact of patients’ non-adherence. Clinical event probability, treatment pathway, resource-use and costs were extracted from literature and costing tariffs. Incremental costs and outcomes associated with each disease were incorporated additively into a composite probabilistic model and combined with adherence rates and intervention costs from the trial. Costs per extra quality-adjusted-life-year(QALY) were calculated from the perspective of NHS England, using a lifetime horizon. Results: NMS generated a mean of 0.05 (95%CI: 0.00, 0.13) more QALYs per patient, at a mean reduced cost of -£144 (95%CI: -769, 73). The NMS dominates normal practice with probability of 0.78 (ICER: - £3166 per QALY). NMS has a 96.7% probability of cost-effectiveness compared with normal practice at a willingness-to-pay of £20000 per QALY. Sensitivity analysis demonstrated that targeting each disease with NMS has a probability over 0.90 of cost-effectiveness compared with normal practice at a willingness-to-pay of £20000 per QALY. Conclusions: Our study suggests that the New Medicine Service increased patient medicine adherence compared with normal practice, which translated into increased health gain at reduced overall cost

Estrés adulto y problemas conductuales infantiles percibidos por sus progenitores

Objective: Analysing if there are some relations between parenting stress (mothers and fathers) and their perception about child behaviour problems which are evaluated by empirical taxonomies. Method: Twenty-eight children, with their fathers and mothers respectively, participated in the current research. All participants were from the kindergarten of the University of Murcia. Parents filled in the consent, Check Behaviour List 1-1/2-5 of Achenbach and Parenting Stress Index of Abidin (PSI-short form) when the children were between 2-3 years-old. Results: Any results have not been found about the relation of fathers’ reports on CBCL and parenting stress levels with their fatherhood. Nevertheless, the analysis of reporting from mothers has showed that there is a statistically significant relation between stress levels and the perception about behaviour problems in their children. Conclusion: In children upbringing, mothers experience more stress problems than fathers. For this reason, the mothers’ perception of child behaviour is different from fathers. We consider necessary to establish early care programs in children to prevent these problems.Objetivo: Analizar si existen relaciones entre el estrés experimentado por los padres y madres en la crianza de sus hijos, y su percepción de problemas conductuales infantiles evaluados a través de taxonomías empíricas. Método: Participaron 28 niños, sus padres y sus madres. Todos los niños asistían a una Escuela Infantil de Murcia. Los progenitores firmaron el consentimiento informado y cumplimentaron el cuestionario CBCL/ 1½-5 de Achenbach y el cuestionario de Estrés de Abidin (PSI- forma reducida) cuando sus hijos tenían una edad comprendida entre los 2 y 3 años. Resultados: No se obtienen relaciones significativas entre las percepciones de los padres y los niveles de estrés experimentado por el ejercicio de su paternidad. En el caso de las madres si existen relaciones significativas entre los niveles de estrés vivido y su percepción de problemas conductuales en sus hijos. Concretamente el malestar materno y la percepción de niño difícil son las variables de estrés que se relacionan con la percepción de los problemas conductuales. Conclusiones: Las madres experimentan más problemas de estrés que los padres en la crianza de los niños y ello incide en la percepción de problemas conductuales en sus hijos. Se plantea la necesidad de elaborar programas de prevención desde la atención temprana