Appropriate reductions in compliance among well-controlled hypertensive patients

Physicians have traditionally viewed partial compliance with medications as a concern only in hypertensive patients whose blood pressure (BP) is poorly controlled. However, partial compliance also occurs in patients whose BP: has become normal on medications; in them, reduced compliance may, indicate that they have been prescribed more medication than they need. During enrollment for a study of medication reduction in hypertensive patients, we identified 118 male veterans who were eligible for the, study because their diastolic BP had been less than 95 mmHg for more than 6 months. Fifty-nine of these patients (50.0%) agreed to participate in the study, of whom 71% successfully reduced or stopped (“stepped down”) one or more of their antihypertensive drugs over a 1-year period. The 59 patients who' did not enroll continued to receive routine care for hypertension in the clinic without intensive efforts at stepdown. Nevertheless, 24% o of these patients reduced or stopped at least one medication over the same time period. In the year prior to the study, 29 of the 118 eligible patients (24.6%) had obtained less than 80% of their medications, measured by pharmacy refill records. Compliance in obtaining antihypertensive medications prior to the study was lower among eligible patients who stepped down mediations during the study year (90.4% ± 18.7%) than in those who did not (1p2.1% ± 26.1%, p =0.006). After adjustment for other predictors of stepdown (number of medications, duration of clinic enrollment, and pre-reduction systolic BP), each 10% increase in compliance among all eligible patients was associated with a reduction in the odds ratio for successful stepdown of 0.8 (95% CI 0.5–1.0, p = 0.01). We conclude that many well-controlled hypertensives appropriately obtain less medications than they are prescribed. Such patients should be considered for reduction of antihypertensive drugs.     

Willingness to accept risk in the treatment of rheumatic disease.

STUDY OBJECTIVE--The aim was to assess patients willingness to accept mortal risk in the drug treatment of chronic rheumatic disease. DESIGN--A non-random sample of consecutive patients were interviewed with a standardised survey instrument. SETTING--The study took place in the Royal National Hospital for Rheumatic Diseases, Bath, UK. PATIENTS--100 consecutive in- and out-patients aged 65 or less were interviewed, 50 with rheumatoid arthritis and 50 with ankylosing spondylitis. Mean age was 48 years with mean disease duration of 14 years. The rheumatoid arthritis group was mainly female (84%), v 26% in the ankylosing spondylitis group. MEASUREMENTS AND MAIN RESULTS--Risk preferences were elicited using the method of standard gamble in the context of a hypothetical new drug. Patients indicated the maximum percentage probability of mortality they regarded as acceptable to achieve four different levels of benefit: total cure (20.7%), relief of pain (16.9%), relief of stiffness (13.1%), return to normal functioning (14.5%). Rheumatoid arthritis patients displayed a higher (p less than 0.05) willingness to accept risk than ankylosing spondylitis patients for all gambles except relief of stiffness. Analysis of variance indicated that willingness to accept risk decreases with the duration of disease and increases with reductions in self assessed health status. CONCLUSIONS--Evaluative methods such as standard gamble can elicit useful risk-benefit preference data from patients to assist those who manage clinical risks.     

Pain in ankylosing spondylitis- the impact of the weather

The majority of patients suffering from rheumatic diseases relate their symptoms to the weather. So far, patients with ankylosing spondylitis have not been evaluted with respect to weather-sensitivity. In the present study the impact of weather conditions on pain was investigated in patients with ankylosing spondylitis. A group of 158 patients (125 male, 33 female, aged 53 +/- 5 yrs) suffering from ankylosing spondylitis for 22 +/- 8 yrs, who presented for a spa treatment at the Gasteiner Heilstollen, were interviewed by the examining physician about their individual experiences as to the influence of certain weather conditions on pain intensity: which weather conditions are the worst? Seventy-three percent of the patients claimed that their symptoms are influenced by the weather. Forty-one patients suffer most before a change to cold and humid (25 pat.) or to humid weather (16 pat.). Forty patients feel the worst pain during cold and humid (26 pat.) or during humid (14 pat.) weather. All changes of the weather (changes to both warm as well as cold) cause a deterioration in 23 patients. Eleven patients have most severe pain before (6 pat.) or during (5 pat.) cold weather. One patient claimed warm and dry weather aggravate his symptoms. The data show that in ankylosing spondylitis the share of weather-sensitive patients is similar to other rheumatic diseases. The results confirm the clinical impact of the issue.     

Do seniors get the medicines prescribed for them? Evidence from the 1996-1999 Medicare Current Beneficiary Survey

Using the 1996-1999 Medicare Current Beneficiary Survey, we examine trends in nonacquisition of prescribed medicines among seniors. Each year less than 3 percent of seniors reported not getting the medicines that were prescribed for them, most often for economic reasons, but they also noted reasons relating to their preferences about using medicines. The presence or absence of drug coverage and chronic disease did not appreciably change this percentage, which suggests that a Medicare drug benefit may not greatly increase seniors' acquisition of their prescribed medicines.     

86例强直性脊柱炎患者血清免疫球蛋白的变化探讨

目的探讨强直性脊柱炎（AS）患者免疫球蛋白水平的变化。方法以86例AS患者（疾病组）和80例健康人群（健康对照组）作为研究对象,采用免疫散射比浊法测定其血清中IgA、IgG、IgM的浓度。结果 AS患者血清IgA和Ig G水平显著高于健康对照组（P〈0.05）。免疫球蛋白变化以IgG异常为主,异常率为31.4%（27/86）;IgA异常率为17.4%（15/86）;IgM异常率为5.8%（5/86）。结论血清免疫球蛋白可作为强直性脊柱炎的重要炎症指标。     

协同护理模式对强直性脊柱炎患者自我护理能力和生活质量的影响

目的：探讨协同护理对强直性脊柱炎患者自我护理能力和生活质量的影响。方法：选择强直性脊柱炎患者80例。采用随机数字表法分为试验组40例和对照组40例。试验组实施协同护理模式,对照组实施常规护理。干预后3个月,采用自我护理能力测定置表（ESCA）和生活质量量表（SF-36）比较两组干预效果。结果：干预后,试验组自我护理能力和生活质量得分与对照组相比,差异具有统计学意义（P〈0．05）。结论：应用协同护理模式能够显著提高强直性脊柱炎患者的自我护理能力和生活质量。     

Analysis of education-support groups for patients with rheumatoid arthritis

A controlled study of education-support groups for patients with rheumatoid arthritis showed that participation increased patients' knowledge about their disease (P less than 0.05) and improved some patients' perceptions of the adequacy of their families' attitudes and behavior. The groups had little effect on the patients' ability to cope with arthritis or on their compliance with prescribed treatment. Some participants felt threatened by the thought of meeting another patient with more severe rheumatoid arthritis than their own. This finding suggests that group leaders should facilitate open discussion of such emotional concerns, eg, fear and depression, that admixtures may generate.     

The COPD Italian Lung Information Needs Questionnaire (LINQ): development, preliminary validation, and findings

Chronic obstructive pulmonary disease (COPD) patients have poor knowledge about the disease. Until now, it has not been possible to check the information needs of these patients. The Lung Information Needs Questionnaire (LINQ), however, could fill this particular need. The aims of this study were to identify patient perceptions about COPD, and what information patients need, and to verify whether the questionnaire is comprehensible. Data demonstrate that LINQ is easily understood: 82% answered all questions with "I have properly understood the question". LINQ is quick to apply (approx. 6 min to complete). Sixty-seven per cent of patients had incorrect knowledge about their prognosis. Thirty-six per cent did not know when to call an ambulance. Eight per cent of smokers said that no one had ever told them to stop smoking. Compliance with therapy results was not sufficient. Patients had poor knowledge of the causes of COPD, and they knew little about the whys and wherefores of COPD treatment. LINQ represents a valid means of investigating patients afflicted with COPD and managing pathology control by the doctor and by the patient. LINQ represents a fundamental means of investigating otherwise-unknown COPD issues.     

The COPD Italian Lung Information Needs Questionnaire (LINQ): Development,preliminary validation,and findings

Chronic obstructive pulmonary disease (COPD) patients have poor knowledge about the disease. Until now, it has not been possible to check the information needs of these patients. The Lung Information Needs Questionnaire (LINQ), however, could fill this particular need. The aims of this study were to identify patient perceptions about COPD, and what information patients need, and to verify whether the questionnaire is comprehensible. Data demonstrate that LINQ is easily understood: 82% answered all questions with “I have properly understood the question”. LINQ is quick to apply (approx. 6 min to complete). Sixty-seven per cent of patients had incorrect knowledge about their prognosis. Thirty-six per cent did not know when to call an ambulance. Eight per cent of smokers said that no one had ever told them to stop smoking. Compliance with therapy results was not sufficient. Patients had poor knowledge of the causes of COPD, and they knew little about the whys and wherefores of COPD treatment. LINQ represents a valid means of investigating patients afflicted with COPD and managing pathology control by the doctor and by the patient. LINQ represents a fundamental means of investigating otherwise-unknown COPD issues.     

Endocarditis prophylaxis in a primary care clinic

BACKGROUND. Primary care physicians often make decisions about the use of endocarditis prophylaxis (EP). Compliance with American Heart Association (AHA) recommendations has been found to be poor in hospitalized patients and in a dental school clinic. The purpose of this study was to examine the use of endocarditis prophylaxis in a primary care clinic. METHODS. The problem list of all adult patients seen in a primary care clinic in 1989 was reviewed for diagnoses that might require EP. Eighty-four charts were identified and reviewed. RESULTS. Sixty-five percent of the study patients had documentation in their charts about the need for EP. Mitral valve prolapse was the most frequent diagnosis. The physicians recommended EP for most patients with mitral valve prolapse regardless of whether there was documented mitral insufficiency. Endocarditis prophylaxis was most commonly prescribed for dental procedures. Six patients received prophylaxis for procedures for which the AHA does not recommend prophylaxis. Only 19% of the antibiotic regimens prescribed were entirely consistent with the AHA 1984 guidelines. The most common deviation from the AHA guidelines was continuing oral antibiotics too long. CONCLUSIONS. Compliance with the AHA 1984 recommendations, although better than reported in other settings, was less than optimal in this primary care clinic. Family physicians should consider whether EP is indicated in any patient with cardiac disease. If prophylaxis is indicated, then such a recommendation should be clearly documented in the chart. Family physicians need to be familiar with the 1990 AHA recommendations.     

补肾壮骨方治疗强直性脊柱炎患者100例疗效分析

目的探析补肾壮骨方对强直性脊柱炎患者的临床治疗效果。方法回顾性分析我院100例强直性脊柱炎患者的临床治疗经验,所有患者均用补肾壮骨方治疗,对比治疗前后强直性脊柱炎患者病情的改善情况。结果对比患者治疗前后的腰背酸痛积分和晨僵时间,差异显著,有统计学意义(P<0.05);对比患者治疗前后的血清C-反应蛋白和红细胞升降率,差异显著,有统计学意义(P<0.05)。结论补肾壮骨方对直性脊柱炎患者的治疗有一定的帮助作用,能够缓解患者的疼痛感,高效改善其病情,值得在临床中被广泛推广和应用。     

肿瘤坏死因子拮抗剂（TNF-α）治疗强直性脊柱炎临床不良反应观察

目的：了解接受肿瘤坏死因子拮抗剂治疗强直性脊柱炎临床常见不良反应及少见不良反应。方法：本组选取了50例强直性脊柱炎患者接受肿瘤坏死因子拮抗剂（本组均选用上海中信科健公司产品益赛普）治疗,同时观察不良反应发生率及常见不良反应症状。结果：接受肿瘤坏死因子拮抗剂治疗的50例患者发生首次不良反应的有8例,中长期不良反应5例。结论：生物制剂治疗强直性脊柱炎是安全有效的,但应注意不良反应的发生及处置。     

全髋关节置换术治疗20例强直性脊柱炎的临床效果观察

目的 观察人工全髋关节置换手术治疗20例强直性脊柱炎患者的临床效果.方法 选取某院收治的强直性脊柱炎患者20例,对其进行全髋关节置换术并对患者的临床资料进行回顾性调查研究,总结评价全髋关节置换术治疗强直性脊柱炎的临床效果.结果 患者的髋关节活动度等参数由手术前的平均48°提高到术后的平均160°.其余各项髋关节的活动度参数均有不同程度的改善(与术前相比差异具有统计学意义).对20例患者进行Harris评分,均由术前的平均30.39分提高到术后的93.75分,手术优良率为90.0％.结论 对强直性脊柱炎患者进行全髋关节置换术可显著改善髋关节活动范围,矫正髋关节畸形,改善患者的生活质量,该手术方式是目前治疗强直性脊柱炎的有效方法之一.     

强直性脊柱炎骶骼关节早期改变应用X线、CT、MRI检查技术分析

目的探讨强直性脊柱炎骶骼关节早期改变应用X线、CT、MRI检查意义。方法本组强直性脊柱炎患者43例早期受累骶骼关节采用X线、CT、MRI检查进行回顾性分析。结果 X线检出病变关节25侧,CT检出病变关节61侧,MRI检查病变关节76侧;MRI和CT骶骼关节数检出率显著高于X线,具有统计学差异（P〈0.05）;MRI骶骼关节数检出率显著高于CT,具有统计学差异（P〈0.05）。结论三者结合能够准确反映强直性脊柱炎骶骼关节早期改变,MRI可显示X线和CT检查观察不到的细微病变,且可进行准确分级。     

自身免疫调节法控制强直性脊柱炎病情发展的临床应用

目的 探讨自身免疫调节法控制强直性脊柱炎病情发展的临床应用价值.方法 分析中西结合治疗强制性脊柱炎的理论,采用中西医结合进行基础治疗,结合自身免疫调节法进行辅助治疗.分析患者病情进展的速度及病情的稳定状况,进行观察组与对照组比较.结果 20例患者的病情进展速度及生活治疗状况优于以往的单纯基础治疗.结论 自身免疫调节法对强直性脊柱炎的治疗有一定的临床意义.     

A prospective study of early diagnostic investigations in the diagnosis of ankylosing spondylitis

This study was designed to assess the relative values current of locally available investigations in the early diagnosis of inflammatory sacroiliitis. Consecutive patients attending routine rheumatology clinics in Aberdeen clinically considered by consultant rheumatologists to have inflammatory back disease but with insufficient criteria to firmly establish a diagnosis of ankylosing spondylitis were included. Patients were assessed using a standard questionnaire, clinical examination of spinal movements, plain radiology of the sacroiliac joints, computerised tomographic scanning of the sacroiliac joints and HLA-B27 typing. Patients were systematically followed up using repeated clinical and radiological examination for five years. Plain film evidence of grade 2 radiological sacroiliitis (bilateral or unilateral) was found to be the most reliable predictor for the development of ankylosing spondylitis satisfying the New York criteria at 5 year follow up. CT scanning and HLA-B27 typing were of no added value in this series and the clinical questionnaire lacked specificity. It is concluded that the combination of clinical history, examination and plain film radiology are currently reliable criteria for diagnosing the subsequent development of ankylosing spondylitis satisfying established criteria.     

Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. American Heart Association Women's Heart Disease and Stroke Campaign Task Force

CONTEXT: One of 2 women in the United States dies of heart disease or stroke, yet women are underdiagnosed and undertreated for these diseases and their risk factors. Informed decisions to prevent heart disease and stroke depend on awareness of risk factors and knowledge of behaviors to prevent or detect these diseases. OBJECTIVE: Assess (1) knowledge of risks of heart disease and stroke and (2) perceptions of heart disease and its prevention among women in the United States. DESIGN AND SETTING: Telephone survey conducted in 1997 of US households, including an oversample of African American and Hispanic women. PARTICIPANTS: One thousand respondents 25 years or older; 65.8% white, 13.0% African American, and 12.6% Hispanic. MAIN OUTCOME MEASURES: Knowledge of heart disease and stroke risks, perceptions of heart disease, and knowledge of symptoms and preventive measures. RESULTS: Only 8% of the respondents identified heart disease and stroke as their greatest health concerns; less than 33% identified heart disease as the leading cause of death. More women aged 25 to 44 years identified breast cancer as the leading cause of death than women 65 years or older. Women aged 25 to 44 years indicated they were not well informed about heart disease and stroke. Although 90% of the women reported that they would like to discuss heart disease or risk reduction with their physicians, more than 70% reported that they had not. CONCLUSIONS: Most women do not perceive that heart disease is a substantial health concern and report that they are not well informed about their risk. Age influenced knowledge to a greater extent than ethnicity. Programs directed at young women that address the effects of lifestyle behaviors on long-term health are needed. Better communication between physicians and patients is also warranted.     

血液光量子治疗对强直性脊柱炎患者免疫学指标的影响

目的观察血液光量子治疗(UBIO)对强直性脊柱炎(AS)患者免疫学指标的影响,为临床治疗强直性脊柱炎提供参考依据。方法将首次诊断强直性脊柱炎患者45例随机分为单纯服药组(n=22)和服药+UBIO治疗组(n=23),即2个组均常规服用柳氮磺胺嘧啶片,其中1个组在服药基础上给予血液光量子治疗。检测2个组患者的白细胞(WBC)、抗链球菌O(ASO)、C-反应蛋白(CRP)及血沉(ESR),一些相关急病学免疫球蛋白(IgG、IgA、IgM)、补体成分(C3、C4)。结果 2个组患者在治疗1个月后,白细胞升高,ASO、CRP水平及血沉下降,治疗前后组间比较差异均有显著性(P<0.05),组间比较差异无显著性(P>0.05)。治疗2个月和3个月后,服药+UBIO治疗组的WBC计数高于单纯服药组,ASO、CRP、ESR水平低于单纯服药组,差异有显著性(P<0.05)。治疗2个月后,服药+UBIO组IgG为(8.68±1.10)g/L,IgA为(3.10±0.58)g/L,明显低于单纯服药组〔IgG(9.08±1.11)g/L,IgA(3.78±0.58)g/L〕,差异有显著性(P<0.05);IgM、C3、C4水平组间差异无显著性(P>0.05)。治疗3个月后,服药+UBIO组IgG、IgA、IgM、C3、C4水平明显低于单纯服药组,差异均有显著性(P<0.05)。结论血液光量子治疗方法对改善AS患者的免疫功能有一定作用。