10 research outputs found
Skuteczno艣膰 po艂膮czenia ezetymibu/simwastatyny w dawkach 10/40 mg w por贸wnaniu z podw贸jn膮 dawk膮 statyny u pacjent贸w hospitalizowanych z powodu ostrego incydentu wie艅cowego: badanie INFORCE
Wst臋p: Celem pracy by艂o zbadanie skuteczno艣ci i bezpieczeñstwa stosowania skojarzonego
preparatu ezetymibu/simwastatyny (Eze/Simva) w dawce 10/40 mg w por贸wnaniu z podw贸jn膮
dawk膮 statyny, kt贸re w艂膮czano przy wypisie ze szpitala u pacjent贸w przyjmuj膮cych dotychczas
statyny, a u kt贸rych powodem hospitalizacji by艂a diagnostyka epizodu wie艅cowego.
Metody: By艂o to otwarte wieloo艣rodkowe badanie IV fazy, z randomizacj膮, prowadzone
w uk艂adzie r贸wnoleg艂ym z grup膮 kontroln膮, do kt贸rego zakwalifikowano 424 pacjent贸w
(w wieku ≥ 18 lat) hospitalizowanych z powodu ostrego epizodu wie艅cowego. Pacjenci przyjmowali
wcze艣niej statyny (przez ≥ 6 tygodni) w sta艂ej dawce, kt贸rej warto艣膰 mo偶na by艂o
podwoi膰 zgodnie z zaleceniami producenta preparatu. W momencie wypisu ze szpitala pacjent
贸w dzielono na grupy pod wzglêdem dawki/si艂y dzia艂ania statyny (du偶a, 艣rednia, ma艂a)
i przydzielano losowo w stosunku 1:1 do grupy, kt贸ra przyjmowa艂a nast臋pnie podwojon膮 dawk臋
tego preparatu (n = 211) lub preparat Eze/Simva w dawce 10/40 mg (n = 213) przez 12 tygodni.
Pierwszorz臋dow膮 zmienn膮 okre艣laj膮c膮 skuteczno艣膰 zastosowanego leczenia by艂o st臋偶enie frakcji
cholesterolu o ma艂ej g臋sto艣ci (LDL-C) wyra偶one w warto艣ciach bezwzgl臋dnych [mmol/l]
w momencie zako艅czenia badania. Wyniki: 艢rednie warto艣ci st臋偶enia cholesterolu frakcji LDL w punkcie wyj艣ciowym wynosi艂y
2,48 mmol/l w grupie Eze/Simva i 2,31 mmol/l w grupie leczonej tylko statyn膮. W momencie
zakoñczenia badania warto艣ci najmniejszych kwadrat贸w st臋偶enie LDL-C wynios艂y odpowiednio
1,74 mmol/l w grupie Eze/Simva i 2,22 mmol/l w grupie leczonej statyn膮; r贸偶nica pomi臋dzy grupami osi膮gn臋艂a warto艣膰 znamienn膮 statystycznie, rz臋du -0,49 mmol/l (p ≤ 0,001).
Przyjmowanie skojarzonego preparatu Eze/Simva powodowa艂o tak偶e znamienne zmniejszenie
st臋偶enia cholesterolu ca艂kowitego (–0,49 mmol/l), cholesterolu frakcji lipoprotein innych ni¿ te
o du偶ej g臋sto艣ci [(nie-HDL); –0,53 mmol/l] oraz apolipoproteiny B (–0,14 mmol/l) w por贸wnaniu
z przyjmowaniem podw贸jnej dawki statyny (p £ 0,001 dla wszystkich por贸wnywanych
wartoœci). Oba protoko艂y leczenia mia艂y zbli偶ony wp艂yw na st臋偶enia trigliceryd贸w, bia艂ka
C-reaktywnego i cholesterolu frakcji lipoprotein o du偶ej g臋sto艣ci (HDL, high-density protein);
por贸wnania pomi臋dzy grupami przynios艂y warto艣ci nieznamienne (p ≥ 0,160). U istotnie
wi臋kszej liczby pacjent贸w przyjmuj膮cych Eze/Simva st臋偶enie cholesterolu frakcji LDL spad艂o
do poni偶ej 2,5 mmol/l (< 100 mg/dl; 86% pacjent贸w leczonych Eze/Simva vs. 72% os贸b
leczonych podw贸jn膮 dawk膮 statyny), do poni偶ej 2,0 mmol/l (< 77 mg/dl; 70% vs. 42%) oraz do
poni偶ej 1,8 mmol/l mmol/l (< 70 mg/dl; 60% vs. 13%) w por贸wnaniu z grup膮 otrzymuj膮c膮
sam膮 statyn臋 (p ≤ 0,001 dla wszystkich por贸wnywanych warto艣ci). Po艂膮czenie preparat贸w
Eze/Simva by艂o og贸lnie dobrze tolerowane, a jego profil bezpiecze艅stwa by艂 zbli偶ony do profilu
samej statyny. Nie stwierdzono r贸偶nic pomi臋dzy grupami pod wzgl臋dem cz臋sto艣ci wyst臋powania
zwy偶ki aktywno艣ci aminotransferaz w膮trobowych do warto艣ci r贸wnej przynajmniej
3-krotno艣ci g贸rnej granicy przedzia艂u wartoœci prawid艂owych (ULN) ani zwy偶ki aktywno艣ci
kinazy kreatynowej do warto艣ci r贸wnej przynajmniej 10-krotno艣ci ULN.
Wnioski: W populacji pacjent贸w leczonych wcze艣niej statyn膮, kt贸rych hospitalizowano w celu
diagnostyki incydentu wieñcowego, leczenie skojarzonym preparatem Eze/Simva w dawce
10/40 mg przez 12 tygodni powoduje wi臋ksz膮 normalizacj臋 lipemii ni偶 podwojenie dawki
przyjmowanej wczeœniej statyny, z zachowaniem zbli偶onego profilu bezpiecze艅stwa
Sensitivity to Adp and Prostacyclin of Platelets from Patients with Hyperlipoprotein-Aemia
Current approaches to obesity management in UK Primary Care : the Counterweight Programme
Background/Aims Primary care is expected to develop strategies to manage obese patients as part of coronary heart disease and diabetes national service frameworks. Little is known about current management practices for obesity in this setting. The aim of this study is to examine current approaches to obesity management in UK primary care and to identify potential gaps in care.
Method A total of 141 general practitioners (GPs) and 66 practice nurses (PNs) from 40 primary care practices participated in structured interviews to examine clinician self-reported approaches to obesity management. Medical records were also reviewed for 100 randomly selected obese patients from each practice [body mass index (BMI) greater than or equal to30 kg m(-2), n = 4000] to review rates of diet counselling, dietetic or obesity centre referrals, and use of anti-obesity medication. Computerized medical records for the total practice population (n = 206 341, 18-75 years) were searched to examine the proportion of patients with a weight/BMI ever recorded.
Results Eighty-three per cent of GPs and 97% of PNs reported that they would raise weight as an issue with obese patients (P < 0.01). Few GPs (15%) reported spending up to 10 min in a consultation discussing weight-related issues, compared with PNs (76%; P < 0.001). Over 18 months, practice-based diet counselling (20%), dietetic (4%) and obesity centre (1%) referrals, and any anti-obesity medication (2%) were recorded. BMI was recorded for 64.2% of patients and apparent prevalence of obesity was less than expected.
Conclusion Obesity is under-recognized in primary care even in these 40 practices with an interest in weight management. Weight management appears to be based on brief opportunistic intervention undertaken mainly by PNs. While clinicians report the use of external sources of support, few patients are referred, with practice-based counselling being the most common intervention
Engaging patients, clinicians and health funders in weight management: the Counterweight Programme
Background. The Counterweight Programme provides an evidence based and effective approach for weight management in routine primary care. Uptake of the programme has been variable for practices and patients. Aim. To explore key barriers and facilitators of practice and patient engagement in the Counterweight Programme and to describe key strategies used to address barriers in the wider implementation of this weight management programme in UK primary care. Methods. All seven weight management advisers participated in a focus group. In-depth interviews were conducted with purposeful samples of GPs (n = 7) and practice nurses (n = 15) from 11 practices out of the 65 participating in the programme. A total of 37 patients participated through a mixture of in-depth interviews (n = 18) and three focus groups. Interviews and focus groups were analysed for key themes that emerged. Results. Engagement of practice staff was influenced by clinicians’ beliefs and attitudes, factors relating to the way the programme was initiated and implemented, the programme content and organizational/contextual factors. Patient engagement was influenced by practice endorsement of the programme, clear understanding of programme goals, structured proactive follow-up and perception of positive outcomes. Conclusions. Having a clear understanding of programme goals and expectations, enhancing self-efficacy in weight management and providing proactive follow-up is important for engaging both practices and patients. The widespread integration of weight management programmes into routine primary care is likely to require supportive public policy