Selective digestive decontamination and empirical antimicrobial therapy of late–onset ventilator–associated pneumonia in trauma patients

ObjectiveTo assess the appropriateness of empirical antimicrobial therapy in trauma patients treated with selective digestive decontamination (SDD) who developed ventilator-associated pneumonia (VAP).MethodsRetrospective study comparing 199 trauma patients receiving SDD and 99 non-trauma patients not receiving SDD hospitalized in a polyvalent intensive care unit (ICU) of a university hospital.ResultsEarly-onset VAP were recorded in 76 (35%) patients. Late-onset VAP occurred in 86 (72%) trauma patients receiving SDD and 56 (56%) non-trauma patients not receiving SDD (P = 0.02). The empirical antimicrobial therapy was appropriate in 108 (91%) trauma patients receiving SDD and 82 (83%) non-trauma patients not receiving SDD (P = 0.1). In the patients who developed late-onset VAP, the empirical antimicrobial therapy was appropriate in 77 (90%) trauma patients receiving SDD and 49 (88%) non-trauma patients not receiving SDD (P = 0.9). De-escalation was performed in 52 (44%) trauma patients receiving SDD and 37 (37%) non-trauma patients not receiving SDD (P = 0.4). Recurrences were observed in 26 (22%) trauma patients receiving SDD and 18 (18%) non-trauma patients not receiving SDD (P = 0.6). These episodes were due to easy-to-treat pathogens in 75 (63%) trauma patients and 33 (33%) non-trauma patients (P = 0.01).ConclusionsSDD is not associated with a rise in the rate of inappropriateness of the empirical antimicrobial therapy in trauma patients developing late-onset VAP.     

Clinical Outcomes Associated With the Use of Anticoagulant and Antiplatelet Agents in Patients Undergoing Treatment for Infective Endocarditis: A Pilot Study

PurposeThe use of antithrombotic therapy may increase morbidity and mortality in patients with infective endocarditis (IE). This study evaluated the use of oral anticoagulant and antiplatelet agents on the development of embolic complications and bleeding episodes within 30 days of IE diagnosis.MethodsThis pilot study was a retrospective medical record review of patients receiving treatment for IE between July 1, 2012, and July 31, 2017. The 2 study arms were patients receiving long-term anticoagulant/antiplatelet therapy versus patients not receiving therapy at the time of IE. Patients were eligible for inclusion if they had definite IE per modified Duke criteria and received at least 48 h of antibiotic therapy. The primary and secondary outcomes evaluated the incidence of embolic phenomenon and bleeding events in each group, respectively.FindingsOf 129 patients with IE, 34 met the eligibility criteria, with 20 patients on receiving anticoagulant/antiplatelet therapy and 14 patients not receiving anticoagulant/antiplatelet therapy. The median age was 63 years, with 50% male patients. Staphylococcus aureus was the infecting pathogen in 41% of patients. Embolic events occurred in 30% of patients receiving anticoagulant/antiplatelet therapy versus 7.1% of those not receiving therapy. No patients in the anticoagulant/antiplatelet therapy arm experienced a bleeding event, whereas 7.1% of those in the comparator arm did.ImplicationsThis retrospective pilot study indicates that patients with IE receiving anticoagulant/antiplatelet agents may be at an increased risk for embolic episodes versus those who are not. Larger, prospective studies are necessary to find a definitive correlation.     

Suppression of Grating Lobe Artifacts in Ultrasound Images Formed from Diverging Transmitting Beams by Modulation of Receiving Beams

In linear array transducers, owing to regular spacing of the array elements, grating lobes exist in transmission and reception. In ultrasonic imaging involving the use of diverging (unfocused) transmitting beams and steered receiving beams by linear transducer arrays, aperture apodization and spatial combination of steered receiving beams from multiple transmissions are not sufficient to suppress receive-grating lobe artifacts. To further suppress receive-grating lobe artifacts in reconstructed B-mode images, we propose a technique of modulating the receiving beams by a factor that is governed by the envelope of a corresponding signal, which is formed by filtering the receiving beam with a zero-phase low-pass filter with a cut-off frequency that is determined by the receiving beam steering angle. This technique suppressed receive-grating lobe artifacts without significant loss in spatial resolution in offline reconstructed B-mode images from simulation, phantom and in vivo imaging of the carotid artery. In a simulation of point scatterers, a relative reduction in grating lobe artifacts of 40 dB was realized in images from diverging beam scanning.     

Comparison of the efficacy and tolerability of Prinivil and Procardia XL in black and white hypertensive patients.

The efficacy and tolerability of Prinivil and Procardia XL were compared in 135 (67 black, 68 white) patients with mild to moderate uncomplicated essential hypertension. The goal of therapy was to achieve and maintain a supine diastolic blood pressure (SDBP) of > 90 mmHg or a decrease in SDBP > or = 10 mmHg. Patients received Prinivil 10 to 40 mg once daily or Procardia XL 30 to 120 mg once daily during a titration period of 2 to 8 weeks to achieve the goal blood pressure before a 4-week maintenance period. The mean baseline supine systolic/diastolic blood pressures were 151/97 mmHg in patients receiving Prinivil and 153/99 mmHg in patients receiving Procardia XL. Ninety-one percent of patients receiving Prinivil and 95% of those receiving Procardia XL achieved SDBP control at the end of titration therapy. At the end of the maintenance treatment period, 79% of patients receiving Prinivil and 80% of those receiving Procardia XL had SDBP control. Mean decreases in SDBP from baseline were comparable for both treatment groups. At the end of the titration period, mean decreases were 9.6 mmHg in patients receiving Prinivil and 11.3 mmHg in patients receiving Procardia XL; at the end of the maintenance period, mean decreases were 10.8 mmHg and 12.1 mmHg, respectively. There were no differences in treatment responses in either the black or white hypertensive subgroups. Thus both drugs were equally effective in black and white patients with mild to moderate essential hypertension. Both drugs were generally well tolerated, but the number of adverse experiences requiring discontinuation of therapy was significantly higher (P = 0.03) in patients receiving Procardia XL.     

Disseminated cryptococcosis in a patient taking tocilizumab for Castleman's disease

Infections occur more frequently in patients receiving biologics. However, cryptococcal infection is uncommon in patients receiving tocilizumab, an interleukin-6 inhibitor, in contrast to patients receiving tumor necrosis factor-α inhibitors. In this report, we describe a case of disseminated cryptococcosis in a 55-year-old man who was receiving tocilizumab every 2 weeks along with daily prednisolone and cyclosporine for Castleman's disease. He initially developed cellulitis on both upper limbs, and his condition worsened despite antibacterial therapy. Chest X-ray scanning and computed tomography demonstrated bilateral pulmonary infiltration. Cryptococcus neoformans was detected in blood, skin, and sputum cultures. He was diagnosed with disseminated cryptococcosis, and successfully treated with liposomal amphotericin B for a week followed by oral fluconazole for 11 months. The findings of this study indicate that cryptococcosis should be considered during the differential diagnosis of infection in patients receiving tocilizumab, especially in the presence of other risk factors for infections or a short tocilizumab dosing interval.     

Comparison of temsirolimus pharmacokinetics in patients with renal cell carcinoma not receiving dialysis and those receiving hemodialysis: A case series

Background: Intravenous temsirolimus, an inhibitor of the mammalian target of rapamycin (mTOR), is approved for the treatment of advanced renal cell carcinoma (RCC). Sirolimus, the principal metabolite of temsirolimus in humans, also exhibits mTOR inhibitory activity.Objective: The purpose of this study was to compare the pharmacokinetics of temsirolimus and its metabolite, sirolimus, among patients with RCC not receiving dialysis and those receiving hemodialysis.Methods: This was a single-center, unblinded, single-dose study. Patients with histologically confirmed metastatic RCC were eligible. A single 25-mg dose of temsirolimus was administered as a 30-minute intravenous infusion during the first round of chemotherapy. Blood samples were drawn at 0 (predose), 0.5 (end of infusion), 1.5, 2.5, 5.5, 24, 72, and 144 hours after infusion. In patients receiving hemodialysis, an additional blood sample was drawn 1 hour after each treatment to compare pre- and postconcentration. Temsirolimus concentrations were assayed in blood using HPLC coupled to mass spectrometry. Pharmacokinetic parameters (C_max, T_max, t_½, AUC_0-∞, total body clearance, volume of distribution at steady state, AUC ratio [the ratio of sirolimus to temsirolimus AUCs], and AUC sum [the algebraic sum of temsirolimus and sirolimus AUCs]) were calculated and analyzed statistically.Results: In total, 13 consecutive patients (11 men and 2 women; 11 not receiving dialysis and 2 receiving hemodialysis) were included. No patient refused to participate in the study. Of those not receiving dialysis, the median age was 54 years (range, 36–77 years), and of those receiving hemodialysis, the median age was 60.5 years (60–61 years). There were no significant between-group differences in the pharmacokinetic parameters of temsirolimus and sirolimus. Moreover, in patients receiving hemodialy-sis, blood drug concentrations assessed immediately before hemodialysis were similar to those assayed 1 hour after the treatment.Conclusion: This study found that after single-dose administration of 25 mg of temsirolimus as a 30-minute intravenous infusion, neither temsirolimus nor sirolimus concentrations were significantly affected in these patients with RCC receiving hemodi-alysis compared with those not receiving dialysis.     

Metoclopramide for preventing pneumonia in critically ill patients receiving enteral tube feeding: a randomized controlled trial

OBJECTIVE: To determine whether metoclopramide prevents nosocomial pneumonia in intensive care unit (ICU) patients receiving enteral feeding by a nasogastric tube. DESIGN: Prospective, randomized, controlled trial. SETTING: ICU of a university hospital. PATIENTS: A total of 305 consecutive patients requiring placement of a nasogastric tube for >24 hrs. INTERVENTIONS: Patients were randomized to receive either 10 mg of metoclopramide or placebo at 8-hr intervals through the nasogastric tube. MEASUREMENTS AND MAIN RESULTS: A total of 174 patients received placebo and 131 received metoclopramide. Baseline characteristics in the two treatment groups were comparable. Of the 305 patients, 46 developed nosocomial pneumonia, which was 24 patients (13.7%) in the placebo group and 22 (16.8%) in the metoclopramide group (p > .05). Patients in the placebo group developed pneumonia earlier than patients receiving metoclopramide (4.46+/-1.72 days [mean +/- SD[rsqb] after ICU admission compared with 5.95+/-1.78 days; p = .006). Subgroup analysis showed that metoclopramide did not reduce the frequency rate of pneumonia in patients with tracheal intubation (19 [25.3%] of 75 patients receiving metoclopramide vs. 21 [21.2%] of 99 patients receiving placebo) or those receiving mechanical ventilation (17 [25.6%] of 58 patients receiving metoclopramide vs. 20 [29.3%] of 78 patients receiving placebo). The mortality rate also did not differ in the two treatments groups (56% in the metoclopramide group vs. 53% in the placebo group; p > .05). CONCLUSIONS: Although metoclopramide delayed the development of nosocomial pneumonia, it did not decrease its frequency rate and had no effect on the mortality rate in critically ill patients receiving nasogastric enteral feeding.     

Randomized pilot trial of eight weeks of bedaquiline (TMC207) treatment for multidrug-resistant tuberculosis: long-term outcome, tolerability, and effect on emergence of drug resistance

The 2-year follow-up results for a randomized placebo-controlled study of 47 patients with multidrug-resistant pulmonary tuberculosis treated with either the new diarylquinoline TMC207, recently renamed bedaquiline, or placebo, added to the first 8 weeks of a background regimen, are presented. Bedaquiline significantly reduced the time to culture conversion over 24 weeks (hazard ratio, 2.253; 95% confidence interval, 1.08 to 4.71; P = 0.031). With the exception of nausea reported in 26% of patients receiving bedaquiline and none receiving placebo, adverse events occurred at similar frequencies in both groups of patients: bilateral hearing impairment, extremity pain, acne, and noncardiac chest pain occurred in 13 and 21%, 17 and 13%, 9 and 17%, and 4 and 17% of patients, respectively, receiving bedaquiline or placebo. Excluding resistance to ethambutol and ethionamide, only one patient receiving bedaquiline acquired resistance to companion drugs, but five patients receiving placebo (4.8% versus 21.7%; P = 0.18) acquired resistance to companion drugs, and resistance to ofloxacin was acquired in four patients receiving placebo and none receiving bedaquiline (0% versus 22%; 0 = 0.066). In all, 23 patients (49%), including 13 receiving placebo (54%) and 10 receiving bedaquiline (44%), discontinued the study prior to its completion, 12 during the first 24 weeks of treatment. Eight subjects were withdrawn for noncompliance or default, and seven withdrew consent, citing the rigorous program of investigations for safety and pharmacokinetic monitoring. Bedaquiline may contribute to the management of multidrug-resistant tuberculosis by effecting more rapid sputum culture negativity and by preventing acquired resistance to companion drugs.     

Medicaid's beta 2-agonist recipients and their treatment by national standards.

OBJECTIVE: To determine whether Connecticut's Medicaid high-dose beta 2-agonists (HDB) users (> 1 canister/mo) are receiving medications according to National Institutes of Health (NIH) asthma guidelines, and to compare healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month. METHODS: All Connecticut Medicaid pharmacy claims from April to December 1998 were examined. Subjects were included if they had an asthma diagnosis and were excluded if they had chronic obstructive pulmonary disease. The percentage of HDB users not receiving long-term-control medication; receiving low doses of a long-term-control medication; and receiving oral, nebulized, or long-acting beta 2-agonists was determined. Healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month was also compared. RESULTS: Of 1599 profiles included, 14% (n = 223) were HDB users. Twenty-five percent of these patients did not receive a long-term-control medication, and 35% received low doses of a long-term-control medication. Claims for oral, nebulized, and long-acting beta 2-agonists were submitted for 4%, 29%, and 22% of HDB users, respectively. More claims for short courses of oral corticosteroids were submitted for HDB users than for patients receiving no more than one canister of a short-acting beta 2-agonist per month (n = 1376) (1.99 +/- 3.60 vs. 0.39 +/- 1.07 mean +/- SD; p < 0.001). HDB users visited their physicians' offices an average of 4.72 +/- 24.08 times per month compared with an average of 2.40 +/- 14.4 office visits per month for patients receiving no more than one canister of a short-acting beta 2-agonist (p = 0.04). CONCLUSIONS: A high proportion of Connecticut's Medicaid HDB users are not receiving medications according to NIH guidelines. HDB users were significantly more likely to receive short courses of oral corticosteroids and required significantly more office visits than patients receiving no more than one canister of a short-acting beta 2-agonist per month. Intervention programs designed to improve adherence to the guidelines will be developed.     

Estimation of free thyroxin with a new thyroxin analog and a porous-glass solid phase

We evaluated a new thyroxin analog-based assay for free thyroxin (FT4) (Corning Medical), finding it technically simple and precise (between-assay CVs of 3.3 and 4.2% for FT4 concentrations of 12 and 25 ng/L, respectively). We measured FT4 in a total of 325 serum samples from euthyroid patients; patients receiving replacement thyroxin; patients receiving estrogens or who were pregnant; hyperthyroid, hypothyroid, and non- thyroidally ill patients; and patients receiving salicylates, phenytoin, or heparin. This assay clearly identified hyper- and hypothyroid patients, and produced similar results in euthyroid patients with above-normal, normal, or low concentration of thyroxin-binding globulin. Results in some non-thyroid-illness patients and patients receiving salicylates or phenytoin were low compared with euthyroid patients receiving no medications, but the diagnostic accuracy of the Corning FT4 assay exceeded that of another analog-based assay (Amersham) in these particular groups. We believe the new Corning analog FT4 assay offers an attractive alternative to other commercial FT4 systems.     

Administration of sedatives and level of sedation: comparative evaluation via the Sedation-Agitation Scale and the Bispectral Index.

OBJECTIVES: To compare levels of sedation in patients receiving continuous intravenous infusions of sedative/hypnotic or narcotic agents with levels in patients not receiving infusions and to compare subjective (Sedation-Agitation Scale) and objective (Bispectral Index) evaluations of sedation. METHODS: Patients receiving mechanical ventilation in a medical intensive care unit were evaluated prospectively. Level of sedation was assessed with the Sedation-Agitation Scale (range 1-7, unarousable to dangerous agitation) and the Bispectral Index (range 0-100, flat line to awake waveform) recorded before and after stimulation. Patients were classified as receiving continuous infusions if an infusion had been administered within 24 hours preceding assessment. RESULTS: Nineteen patients were evaluated on 80 occasions. Scores on the Sedation-Agitation Scale ranged from 1 to 5 (mean 2.6 and median 2) and correlated highly with values for the Bispectral Index (R2 = 0.48 before and 0.44 after stimulation, P < .001). Patients receiving continuous infusions were more deeply sedated than were patients receiving boluses or no medication (mean [SD] scores, Sedation-Agitation Scale: 2.1 [1.2] vs 3.3 [1.0], P < .001; Bispectral Index before stimulation: 63 [24] vs 86 [13], P < .001). Patients receiving continuous infusions were more likely to have a score of 2 or less on the Sedation-Agitation Scale (32/44 vs 8/35, P < .001). CONCLUSION: Objective and subjective assessments of sedation are highly correlated. Use of continuous infusions is associated with deeper levels of sedation, and patients receiving continuous infusions are more likely to be oversedated. Sedation therapy should be guided by subjective or objective assessment.     

Induction of arterial hypertension in normal and adrenalectomized rats given cortisone acetate

1. Marked hypertension was induced in adrenalectomized rats on a sodium-restricted intake by the administration of cortisone acetate; on a similar regimen, adrenalectomized rats receiving DCA failed to become hypertensive. 2. The incorporation of a liberal amount of sodium in the diet of adrenalectomized rats receiving cortisone acetate resulted in a lesser degree of hypertension; whereas on a similar regimen, DCA-injected animals became strikingly hypertensive, as has been previously reported. 3. The presence of hypertension in the cortisone acetate-treated rats was not associated with histological evidence of renal damage or serum electrolyte disturbance, such as was observed in hypertensive animals receiving DCA. 4. The hypertension in sodium-restricted normal rats receiving cortisone acetate was less striking than in similarly treated adrenalectomized animals. On a liberal sodium intake similar degrees of hypertension were noted in both intact and adrenalectomized groups. 5. To approximate the loss of weight which occurred in cortisone acetate-injected rats, it was necessary to curtail the food intake of partially fasted control groups to 50 to 75 per cent of the amount consumed by the animals receiving the steroid. 6. The serum cholesterol levels of the cortisone acetate-injected rats were consistently and strikingly elevated as contrasted with normal, partially fasted, or DCA-treated animals.     

Musculoskeletal Safety Outcomes of Patients Receiving Daptomycin with HMG-CoA Reductase Inhibitors

Daptomycin, a cyclic lipopeptide antibiotic, and 3-hydroxy-3-methylglutaryl–coenzyme A (HMG-CoA) reductase inhibitors (statins) are commonly administered in the inpatient setting and are associated with creatine phosphokinase (CPK) elevations, myalgias, and muscle weakness. Safety data for coadministration of daptomycin with statins are limited. To determine the safety of coadministration of daptomycin with statin therapy, a multicenter, retrospective, observational study was performed at 13 institutions in the Southeastern United States. Forty-nine adult patients receiving statins concurrently with daptomycin were compared with 171 patients receiving daptomycin without statin therapy. Detailed information, including treatment indication and duration, infecting pathogen, baseline and subsequent CPK levels, and presence of myalgias or muscle complaints, was collected. Myalgias were noted in 3/49 (6.1%) patients receiving combination therapy compared with 5/171 (2.9%) of patients receiving daptomycin alone (P = 0.38). CPK elevations of >1,000 U/liter occurred in 5/49 (10.2%) patients receiving combination therapy compared to 9/171 (5.3%) patients receiving daptomycin alone (P = 0.32). Two of five patients experiencing CPK elevations of >1,000 U/liter in the combination group had symptoms of myopathy. Three patients (6.1%) discontinued therapy due to CPK elevations with concurrent myalgias in the combination group versus 6 patients (3.5%) in the daptomycin-alone group (P = 0.42). CPK levels and myalgias reversed upon discontinuation of daptomycin therapy. Overall musculoskeletal toxicity was numerically higher in the combination group but this result was not statistically significant. Further prospective study is warranted in a larger population.     

The antiemetic activity of high-dose alizapride and high-dose metoclopramide in patients receiving cancer chemotherapy: a prospective, randomized, double-blind trial

Alizapride is a new substituted benzamide with suggested superior antiemetic efficacy to and fewer side effects than metoclopramide. High-dose alizapride (4 mg/kg X five doses) was compared with high-dose metoclopramide (2 mg/kg X five doses) in a prospective, randomized, double-blind trial in 62 evaluable patients undergoing strongly emetic cancer chemotherapy. Patients receiving metoclopramide experienced significantly fewer vomiting episodes than patients receiving alizapride (median of three episodes vs. eight episodes; P less than 0.001). Metoclopramide was more effective in decreasing the volume of emesis than was alizapride (median of 100 ml vs. 360 ml; P less than 0.02). Seventy-two percent of the patients receiving alizapride and 57% of those receiving metoclopramide experienced side effects. High-dose metoclopramide is an effective antiemetic in patients receiving cancer chemotherapy. Alizapride is less effective and has more side effects than metoclopramide. We do not recommend the further use of alizapride.     

The meanings and implications of receiving care

Scand J Caring Sci; 2011; 25; 235–242
The meanings and implications of receiving care The aim of this study was to gain an understanding of the concept of receiving care, from the perspective of the general public, nursing students and graduate nurses. The need for, and acceptance of care can occur at many different times during a human life and is sometimes necessary for survival. Experiences of receiving care are often retained as a tacit and subconscious awareness and knowledge. It is reasonable to expect that perceptions of receiving care can differ depending on different situation and experiences. Data were gathered by a questionnaire containing an open‐ended question, which were presented to and answered by the general public, nursing students and graduate nurses. Content analysis was used to analyse the question posed. Having analysed the data, one main theme could be identified; being of value despite any potential disadvantages which include both edifying and not very edifying aspects. This study demonstrates that if one is in need of receiving care, there are not many choices available. Those requiring care must accept the situation and be prepared to leave themselves in the hands of caregivers. Receiving care highlights the human mode of being, which includes experiences of being exposed, which in turn motivates a seeking for valued and appreciated mutual interactions within the caring process. Within current nursing practice, our findings confirm the necessity of nurses to be fully aware of the importance of mutuality when giving care to patients. It is essential that modern nursing education continuously review the many complex aspects involved in the giving of, and receiving care.     

Lavender Aromatherapy as a Nurse-Driven Intervention for Preoperative Anxiety

ObjectiveTo explore potential clinical applications, based on evidence and a nurse-driven test of change, of using lavender aromatherapy for preoperative anxiety as an intervention complementary to standard preoperative care.DesignA pre- versus postaromatherapy comparison using a visual analog scale (VAS).SettingThe preoperative department at a level 2 trauma hospital with 544 beds.ParticipantsForty-four surgical patients, including 29 female participants and 15 male participants.Intervention/MeasurementsParticipants reported their anxiety on a VAS before receiving a lavender aromatherapy inhaler. Anxiety scores were measured again after receiving the lavender aromatherapy and shortly before participants left the preoperative area for surgery. A pre–post comparison of the two VAS anxiety measurements before and after receiving the lavender aromatherapy was completed, analyzed, and is discussed.ResultsMean anxiety scores were calculated for the pre- and postaromatherapy groups. Forty-eight percent of female participants (n = 29) reported a decrease in their anxiety after receiving preoperative lavender aromatherapy. Female participants reported higher preoperative anxiety scores and a larger decrease in their mean anxiety scores after receiving lavender aromatherapy when compared to male participants.ConclusionThe use of a nurse-driven complementary intervention in the preoperative area was associated with a decrease in mean anxiety scores among female patients about to undergo elective surgery. However, cause and effect cannot be determined because of a lack of a control group and randomization. Opportunities exist with support from seasoned staff for nurses to incorporate safe, evidence-based complementary interventions into the current standard of care for preoperative anxiety.     

Sildenafil citrate (Viagra) is effective and well tolerated for treating erectile dysfunction of psychogenic or mixed aetiology

Sildenafil citrate (Viagra) has been shown to be an effective treatment for erectile dysfunction (ED) of organic aetiology. This study assessed the efficacy and tolerability of sildenafil for treating ED of psychogenic and mixed psychogenic/organic aetiology. Men with ED of psychogenic and mixed aetiology were randomised in a double-blind, fixed-dose study to placebo (n = 95) or sildenafil 10 mg (n = 90), 25 mg (n = 85), or 50 mg (n = 81) once daily for 28 days. Efficacy was evaluated with two global efficacy questions, a patient log of erectile activity, a sexual function questionnaire and a partner questionnaire. Patients receiving sildenafil had significantly more grade 3 (hard enough for penetration) or grade 4 (fully hard) erections per week than patients receiving placebo, and a greater proportion of patients receiving sildenafil reported that treatment had improved their erections (p < 0.001). Results of the sexual function questionnaire demonstrated significant improvement for patients with ED receiving sildenafil compared with patients receiving placebo for frequency, hardness and duration of erections (p < 0.01), and for enjoyment of sexual intercourse and satisfaction with sex life (p < 0.05). The results of the partner questionnaire were consistent with the results reported by patients and showed that treatment with sildenafil was associated with significant improvement in the partners' own sex lives (p < 0.001). Adverse events were mostly mild to moderate in nature. The commonest adverse events were headache, dyspepsia, flushing, myalgia, arthralgia and flu syndrome. Discontinuations due to treatment-related adverse events were few, ranging from 1.1% to 6.2% for patients receiving different doses of sildenafil and 4.2% for patients receiving placebo. Sildenafil is an effective and well-tolerated treatment for ED of psychogenic or mixed aetiology with once-daily dosing.     

Gambling problems and health functioning in individuals receiving disability

Purpose. This study evaluated the rates and correlates of disordered gambling, with a focus on gambling behavior among participants receiving disability.

Method. The sample consisted of 723 patients seeking free or reduced-cost dental care. Participants completed the South Oaks Gambling Screen (SOGS), Short Form-12 Health Survey, Second Edition (SF-12v2), and questions assessing demographic characteristics and frequency and intensity of current gambling behaviors.

Results. Results indicate a significantly higher prevalence of disordered gambling among participants receiving disability (26%) than in the remainder of the sample (14%; p < 0.001). Of the 135 individuals receiving disability, disordered gambling was associated with decreased physical and mental health functioning.

Conclusions. These data indicate that individuals receiving disability have high rates of disordered gambling, and gambling behavior in this population is associated with poorer health functioning. Results suggest that disordered gamblers who receive disability have an increased need for interventions to reduce gambling and associated problems.