HIV medicine: drug side effects and interactions.

The drugs used in HIV medicine often have toxic side effects; additionally, the risk of drug interactions is high because of the frequent necessity to prescribe multiple drugs. This article covers common or important drug side effects and interactions.     

US ad uses lure of prompt treatment to entice Canadians needing joint replacement.

A Virginia hospital has used newspaper advertisements to solicit Ontario patients who are waiting for hip- or knee-replacement surgery. The ads promote the medical services of US orthopedic surgeons and call attention to exasperatingly long waiting lists for the same surgery in Canada. "Pain doesn't wait," they state. "Neither should you." The hospital says it has been receiving more than 100 calls a week inquiring about the procedure, which costs $15000 (US).     

美国医疗保健成倍支出，但仍落后于其他国家

国际医疗政策调查显示，美国的医疗体系在可获得性、质量、效率和效果方面，远远落后于其他国家。     

在线医疗平台中推荐热度的中介效应分析

目的 分析在线问诊中推荐热度对医生职称、医院等级的中介效应。方法 通过网络爬虫获取某在线医疗平台问诊数据,采用最优尺度回归,利用中介效应模型分析推荐热度的中介效应。结果 在问诊价格中,不论是否考虑医院科室,推荐热度对医生职称有部分中介效应,推荐热度的中介效应对总效应的贡献率为34.2%和35.6%,对医院等级具有遮掩效应。在线问诊量中,不考虑医院科室时,推荐热度对医生职称有完全中介效应;考虑医院科室时,推荐热度有部分中介作用,贡献率为54.1%;而医院等级对问诊量的影响完全被推荐热度替代。在满意度评价中,推荐热度完全替代了医生职称。结论 医生在医疗服务中努力提高自己的推荐热度,实现医生和患者两者的双赢。     

甲状腺功能亢进的放射性碘治疗——抗甲状腺药物治疗的放射防护持续时间仍不确定

本期BMJ刊登了Walter及其同事的一篇抗甲状腺药物对放射性碘治疗影响的随机对照试验的系统性综述和荟萃分析（见第216页）。放射性碘被认为是使用简便和性价比较好的治疗甲状腺功能亢进（甲亢）的方法。β肾上腺素能受体阻断剂，如普萘洛尔（每日总量80～160mg），通常能在首诊至放射性碘治疗的期间明显减轻患者症状，随后6～8周，直至治疗有效。     

Desloratadine and depression,a drug safety signal based on worldwide spontaneous reporting of side effects

Abstract

Objective: Desloratadine, a third-generation antihistamine, is claimed to cause fewer central nervous system (CNS) adverse drug reactions (ADRs) than antihistamines of the first- and second-generation. While literature is inconclusive regarding the possible CNS effects, symptoms like somnolence and hallucinations are acknowledged ADRs of desloratadine, indeed suggesting some passage of this drug across the blood–brain barrier. Depression is currently not described as an ADR in the approved desloratadine product labelling.

Materials and methods: In a joint signal detection workshop with the Uppsala Monitoring Centre and the Netherlands Pharmacovigilance Centre Lareb, case reports of suspected drug–ADR associations were analysed.

Results: Forty-nine unique case reports of desloratadine associated with depression or depressed mood were detected in the WHO global ADR database. In these reports, the median time to onset of depression was three days. Most patients recovered after withdrawal of desloratadine, and in five patients the symptoms of depression recurred after re-administration of desloratadine.

Conclusion: We hypothesize that desloratadine may enter the CNS and that it hence in rare cases may cause a clinically relevant state of depression, a relation that patients and their treating physicians should be made aware of.     

反应停联合地塞米松治疗多发性骨髓瘤临床观察

目的　观察反应停治疗多发性骨髓瘤 (multiplemyelomaMM)的疗效及不良反应。方法　反应停剂量为15 0 -4 0 0mg d ,地塞米松 2 0 -4 0mg d ,d1-4 ,d9-12 ,d17-2 0。根据M蛋白及骨髓中骨髓瘤细胞的减少情况来判断疗效 ,同时观察血象、肾功能、X线等变化。结果　反应停联合糖皮质激素治疗 9例患者 4例部分缓解 ,2例进步 ,2例无效。总有效率达 66.7%,其中 ,难治性MM有效率达 60 .0 %。大多数患者有轻中度副反应 ,一般能耐受 ,外周血三系大多数无明显下降。结论　反应停联合糖皮质激素治疗多发性骨髓瘤是不良反应轻且有效的方法     

吗啡和芬太尼用于术后镇痛效应与不良反应的临床观察

目的 观察吗啡、芬太尼用于患者自控硬膜外镇痛（PCEA）的镇痛效应及不良反应。方法 择期手术患者110例,ASAⅠ～Ⅱ级,随机分为两组,Ⅰ组（n=55例）选用吗啡10mg（1ml）加2％利多卡因和0．75％布比卡因各20ml加生理盐水59ml;Ⅱ组（n=55例）选用芬太尼0．5mg（10ml）（代替Ⅰ组配方中的吗啡）加生理盐水50ml。以LCP模式（负荷剂量5ml加持续剂量2ml／h加PCA每次0．5ml）进行镇痛。结果 Ⅰ组与Ⅱ组镇痛效果差异无统计学意义（P〉0．05）;Ⅰ组出现恶心、呕吐、尿潴留、皮肤瘙痒等不良反应发生率较Ⅱ组高（P〈0．01）。结论 吗啡较芬太尼的不良反应更多,应谨慎选用。     

光疗的副作用及护理对策

目的探讨蓝光照射治疗新生儿高胆红素血症的副作用。方法回顾100例新生儿高胆红素血症蓝光照射治疗时出现的副作用,并作初步分析。结果副作用常见的有烦躁、哭吵、呕吐、腹泻、发热、血钙降低、贫血等。结论蓝光照射治疗副作用较常见,但多不严重,需注意观察,加强护理,积极防治,一般不影响治疗。     

Nonspecific medication side effects and the nocebo phenomenon

Arthur J. Barsky, MD; Ralph Saintfort, MD; Malcolm P. Rogers, MD; Jonathan F. Borus, MD

JAMA. 2002;287:622-627.

Patients taking active medications frequently experience adverse, nonspecific side effects that are not a direct result of the specific pharmacological action of the drug. Although this phenomenon is common, distressing, and costly, it is rarely studied and poorly understood. The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somatize; and situational and contextual factors. Physicians and other health care personnel can attempt to ameliorate nonspecific side effects to active medications by identifying in advance those patients most at risk for developing them and by using a collaborative relationship with the patient to explain and help the patient to understand and tolerate these bothersome but nonharmful symptoms.