Toxicity and adverse effects of herbal complementary therapy

As with any therapy, herbal preparations have the potential to do harm as well as good. Nurses must be aware of the risks and benefits of herbal remedies, when used either separately or in combination with conventional medicine. They need to encourage patients to understand the possible effects of the herbal preparations that they may choose to use.     

Physician acquisition of cancer pain management knowledge

Insufficient physician education in cancer pain management (CPM) is one of the major factors contributing to inadequate pain relief of cancer patients throughout the world. A survey of all physicians in direct patient care in Duluth, MN, (N = 243) was conducted to determine where they learned about CPM and how they would like to further their knowledge. Responses from 150 physicians (62%) have been analyzed, especially focusing on physician age and specialty. Statistically significant differences (p less than 0.001) document that residency training programs have been including CPM in their curricula since 1978 and that medical schools have not. Additional significant sources of CPM have been consultations with expert physicians, conferences and the literature. When asked how they would like to learn more about CPM, 84% of all physicians indicated that local conferences would be most effective. Physicians in various specialties indicated their differing preferences, too. This study suggests that improvements in CPM can occur through these mechanisms.     

Pharmacists' knowledge and attitudes toward herbal medicine

OBJECTIVE: The use and sales of herbal medications have increased dramatically over the past several years. Pharmacists are in an ideal position to educate patients about herbal medicines. This study was intended to determine the knowledge and attitudes of pharmacists regarding herbal medications. METHODS: A survey was distributed to pharmacists at several state and regional meetings in Virginia and North Carolina between August and October 1998. The survey evaluated demographic data, attitudinal scales, and a 15-item herbal medicine knowledge test. Pharmacists immediately returned the surveys to the distributor on completion. RESULTS: Of the 217 surveys distributed, 164 met the inclusion criteria for further evaluation. Of the pharmacists surveyed, 68.0% practiced in a community pharmacy, 45.1% had previous continuing education on herbal medications, and 73.6% sold herbal medications in their practice settings. The average score on the herbal knowledge test was 6.3 (maximum score of 15). Pharmacists with previous continuing education scored significantly higher than those without prior continuing education (p < 0.001). Of the 15 questions, the five that pharmacists were most likely to answer correctly assessed the uses of herbal medications. Additionally, pharmacists with prior continuing education or with access to herbal medication information at their practice site were more likely to agree that providing information about herbal medication is a pharmacist's professional responsibility (p = 0.02 and p = 0.01, respectively). CONCLUSIONS: The findings from this study demonstrate that pharmacists were more likely to answer correctly about the uses of herbal medications than about drug interactions, adverse drug effects, and precautions of herbal medications. Additionally, pharmacists with previous continuing education on herbal medications were more knowledgeable about these products. With the increasing use of herbal medications, there is a greater need for pharmacy training programs in this area.     

Antibiotic adverse reactions and drug interactions

When contemplating antibiotic use, intensivists must consider possible beneficial and harmful drug interactions. After antibiotics are instituted, adverse reactions must be anticipated. Acute illness, comorbidities, and concurrent medications affect the presentation and management of antibiotic-related adverse events. Intensivists should use the fewest possible antibiotics, carefully choosing agents that maximize antimicrobial activity and minimize potential drug interactions and adverse reactions.     

中药不良反应原因分析与预防

目的 为临床合理使用中药,避免和减少不良反应(ADR)发生,提供参考.方法 分析其原因,提出合理辨证使用中药.结果 医生的用药不当、病人对中药治疗的不依从性及药物本身均可造成中药ADR.结论 中药ADR是客观存在的,临床使用方法 得当,中药ADR是可以减少和避免的.     

Toxicity and drug interactions associated with herbal products: ephedra and St. John's Wort

Health care providers are being increasingly confronted with the use of herbal medications by their patients. It is imperative that patients be questioned regarding herbal preparation use and that health care providers become familiar with these agents. Research into the active components and mechanisms of action of various herbals is ongoing [350]. Long-range studies need to be performed to follow patients for efficacy or toxicity in chronic use [351,352]. Adverse reactions to herbal remedies should be reported to the FDA MedWatch at http://www.fda.gov/medwatch. As withany therapeutic agent, risk of use must always be weighed against potential benefits.     

Antihypertensive drug therapy: adverse effects and drug interactions

The number of classes of antihypertensive drugs has been growing. The options of choice of the drugs now are so great that it seems not to be difficult to reduce blood pressure effectively. Newly developed classes have been shown to provide beneficial effects in variety of hypertension-related processes. However, each drug shows significant differences in adverse effects, incidental properties and interactions with non-antihypertensive drugs. To improve quality of life, compliance with medication, and beneficial effects on pathophysiological and cardiovascular risk conditions of patients, we should be well acquainted with adverse effects and possible disadvantages produced by antihypertensive drugs in particular situations.     

Physician assisted suicide: knowledge and views of fifth-year medical students in Germany

Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More than a third of the students viewed PAS in certain situations to be ethically acceptable whereas a smaller proportion thought that it should be legal. Compared with German physicians the medical students taking part in this study were less opposed to PAS. The majority perceived the undergraduate training concerning ethical aspect of assisted death as deficient.     

Physician knowledge and appropriate utilization of computed tomographic colonography in colorectal cancer screening

Goals  

To assess physician understanding of computed tomographic colonography (CTC) in colorectal cancer (CRC) screening guidelines in a pilot study.     

Our knowledge of drug interactions with oral contraceptives

In the introduction the author points out the importance, mechanism and consequence of interactions between oral contraceptives and other drugs. The interactions between certain drugs with different pharmacological action and the contraceptive tablets which decrease or increase the contraceptive effect as well as the drugs whose effect may be influenced by the contraceptive tablets have been discussed. Cases in which only a few data refer to, or no clinical proof supports interaction, are also mentioned. According to interactions observed until present in women taking Anteovin, the recommended measures to be taken in these cases have been described. Finally it has been emphasized that the knowledge of interactions between drugs is just as important in family planning counselling as is when prescribing other drug treatments.     

Physician volume and obstetric outcome.

Although much has been written regarding regionalization of obstetric services and inferences made about centralization of labor and delivery, little data exist that specifically address the volume-outcome relationship for obstetrics. The purpose of this study was to determine the relationship between physician volume and perinatal outcome as measured by neonatal and perinatal mortality. A sample of 210,547 births to Missouri residents from 1984 to 1987 was studied using multivariate logistic regression with perinatal death and neonatal death as outcomes. No relationship was found between physician volume and outcome.