A search for socio‐economic influences in behaviour and attitudes to medicines available for self‐medication and NHS prescription

□ Variations in medicines purchased for pain relief and dyspepsia in areas with contrasting socio‐economic characteristics mirror morbidity and mortality data for the localities □ A higher overall use of medicines, both purchased and prescribed, was found in the more socially “deprived” area □ Purchasers of medicines in the “deprived” area were more frequent users of these medicines □ Purchasers of medicines in the “deprived” area were more likely to be taking concurrent prescribed medication.     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

Concordance in Muslim patients in primary care

□ The study examined the perceptions of Muslim patients and general practitioners (GPs) about ways in which the Muslim faith may influence medicine concordance □ Fifty Muslim patients (100 per cent response) and 18 general practitioners (53 per cent response) were surveyed using self‐completion questionnaires in order to determine attitudes towards dietary requirements and medicines □ A large proportion of the Muslim patients sampled stated that they would stop taking a medicine if they found out that it was not halaal □ Pharmaceutical manufacturers also need to be sensitive towards the requirements of Muslim patients □ In specific cases, doctors should seek guidance from Islamic leaders as to the correct interpretation of Islamic law with regard to the use of medicines considered haraam     

中西药联合治疗慢性心力衰竭的临床分析

目的对应用中西药联合的治疗方法治疗慢性心力衰竭的疗效加以分析。方法随机将100心力衰竭患者分为两组,分别给予西药治疗(西药组)和中西药联合治疗(联合组),每组患者50例,分析两组的治疗效果及药物副作用发生率。结果西药组经治疗后总有效率约为80.00%;而联合组总有效率约为96.00%。两组比较。联合组明显优于西药组(P<0.05)。且两组患者在药物副作用发生率方面未见明显差异,P<0.05。结论中西药联合的治疗方法较单纯西药治疗可明显提高治疗效果,且不增加药物副作用发生率。     

Identification of the pharmaceutical needs of patients with heart failure

□ An extensive evidence‐base exists to support the treatment of heart failure □ A systematic identification of the pharmaceutical care of heart failure patients is needed to develop a model of pharmaceutical care □ Pharmaceutical care issues may be identified from a number of sources □ Care issues may be based on evidence or accepted “best practice”     

Does social environment affect arthritis patients' ability to remain on methotrexate treatment?

□ Drug toxicity is still a major limiting factor for methotrexate treatment continuation □ Treatment discontinuation within 12 months of start of methotrexate in this UK cohort was 20% (SE 2%) □ The monitoring of tolerance to methotrexate has implications for the dispensing of the drug in primary care □ Although social circumstances may have a role in arthritis patients' psychosocial health status, continuation rates of methotrexate in “affluent” and “deprived” patients were similar at the end of the first and second years of treatment □ The reasons for lower socio‐economic groups being discontinued on lower methotrexate doses warrant further study     

Rapid Narcotic Detoxification in Chronic Pain Patients Treated with Auricular Electroacupuncture and Naloxone

Severe withdrawal signs which accompany the detoxification of narcotic addicts from opiate drugs are also a serious problem for chronic pain patients taking high levels of analgesic medications. A rapid narcotic detoxification procedure utilizing auricular electroacupuncture was applied to 14 chronic pain patients to be withdrawn from their opiate medications. All patients were first switched to oral methadone. They were then given bilateral electrical stimulation to needles inserted in the “lung” and “shen men” acupuncture points on the ear, followed by periodic intravenous injections of low doses of naloxone. Twelve of the patients, 85.7%, were completely withdrawn from narcotic medications within 2-7 days, and they experienced no to minimal side effects. These results are explained by the relationship of electroacupuncture to the release of endorphins.     

A pilot project on the impact of a community pharmacy programme providing advice to women initiating HRT therapy

□ The pilot study evaluated the outcome of a pharmacy‐based initiative for women starting or having recently started HRT □ At the end of the study over twice as many women in the control group had stopped taking HRT than in the intervention group □ Kupperman menopausal index scores used to indicate control of menopausal symptoms had improved significantly more in the intervention group compared with the control group □ Intervention group patients were more knowledgeable of the benefits of HRT, and of osteoporosis risk factors and preventive measures □ The control group expressed significantly more concerns about HRT at the end of the study compared with the intervention group     

石杉碱甲微乳型巴布剂经督脉给药对早老性痴呆患者的临床疗效

目的探讨石杉碱甲微乳型巴布剂经督脉给药对早老性痴呆患者的临床疗效。方法将早老性痴呆患者70例随机分成亚门、大椎、至阳、命门、胸口5组治疗组、阳性对照组及空白对照组,每组10例。所有患者在进行试验前2周及治疗中停服一切改善脑功能的药物,2周后治疗组贴敷石杉碱甲微乳型巴布剂于督脉穴位（亚门、大椎、至阳、命门）及胸口部位。阳性对照组口服石杉碱甲片2个月,每天服用2次,空白对照组采用空白巴布剂贴敷于胸口部位,巴布剂均贴2个月,每3d更换,2个月后撕去巴布剂,停用石杉碱甲片,进行简易智力状态（MMSE）、生活功能量表（ADL）评定,并抽取血样,用改良的黄嘌呤氧化酶法测定血清中超氧化物歧化酶（SOD）活性,比较各组在治疗2个月后的临床疗效差异。结果亚门、大椎、至阳、命门组的MMSE和ADL数值明显优于胸口对照组与阳性对照组;SOD活性明显高于胸口对照组与阳性对照组。结论石杉碱甲微乳型巴布剂贴敷于督脉穴位对早老性痴呆患者记忆改善效果明显优于胸口部位和阳性对照组,这与传统中医药学“督脉通于脑”理论相符。     

129例消化性溃疡患者不同时间服用泮托拉唑钠肠溶胶囊的疗效观察

目的观察泮托拉唑钠肠溶胶囊不同时间给药对治疗消化性溃疡的疗效影响。方法将医院确诊为消化性溃疡的129例患者,用泮托拉唑钠肠溶胶囊治疗,每次40 mg,Qd,疗程均为5周,按服药时间不同分为观察组(晚上固定时间服药)与对照组(白天不固定时间服药),对比两组给药后的疗效和副作用。结果观察组疗效优于对照组,且不良反应少,差异有统计学意义(P<0.05)。结论用泮托拉唑钠肠溶胶囊治疗消化性溃疡,晚上固定时间服药比白天不固定时间服药疗效更好,副作用更少。     

四种植物药参与干预老年人心脑血管危险因素的疗效观察

目的　观察四种植物药物参与干预高血压病、高脂血症、高粘血症对老年人心脑血管终点事件发生率的影响,以及药物的副作用。方法　回顾性分析 1995年至 2 0 0 0年住院的资料完整的老年病人 10 2名,同时患有高血压病、高脂血症和高粘血症,在常规治疗基础上,应用植物药治疗者(治疗组)5 2例,未用者(对照组)5 0例,观察两组 5年间心脑血管终点事件发生率的差别。结果　治疗组发生缺血性心脑血管终点事件比对照组明显减少( P <0 0 5 ),脑出血发生率无明显差别( P >0 0 5 )。观察到的副作用主要有过敏性休克、皮疹、发热、消化道症状等。结论　应用植物药参与干预老年人心脑血管疾病危险因素,缺血性心脑血管终点事件发病率明显减少;而且药物不同,副作用的发生率也不同。     

Supplying emergency hormonal contraception through patient group direction: a qualitative study of the views of pharmacists

□ Pharmacists have been supplying emergency hormonal contraception via patient group direction in two health action zone areas since late 1999 and early 2000 □ This paper presents qualitative interview data on participating pharmacists' views of the service □ Pharmacists were in general extremely positive about supplying EHC via patient group direction in the pharmacy, citing the chief benefits to users as including greatly improved access at no financial cost □ Participants also noted that the scheme also enhanced the professional standing of community pharmacy and demonstrated its worth as a sexual health resource □ There were concerns about use of EHC as a “regular” form of contraception and that widened availability might increase the number of episodes of unprotected sexual intercourse and consequently, sexually transmitted infections     

Compliance,concordance and the revolving door of care: caring for elderly people with mental health problems

□ The project involved community pharmacists receiving specialised training, becoming integrated into the community mental health teams and providing pharmaceutical care when making joint domiciliary visits with the key workers. □ Community pharmacists, psychiatrists and key workers all wanted the project to develop into a service and had similar views about the general benefits of the study. However, they had contrasting expectations of the project, based on their own perspectives on compliance, concordance and models of care □ The key workers valued the provision of monitored dosage systems for patients with confusion or memory problems. But the pharmacists felt that they were being expected to organise compliance aids; they recognised that it was their role to assess complaince and that other measures could be taken before organising an MDS □ The psychiatrists stated that involuntary non‐compliance with medication, arising from confusion, memory and physical problems, was a major issue and the project had made improvements in this area; they wanted to keep patients in the community and particularly valued reductions in morbidity, relapses and the “revolving door of care”     

The 2013 American College of Cardiology/American Heart Association guidelines for the treatment of dyslipidemia: mind the gaps!

The ACC/AHA lipid guidelines need to be reconsidered before full implementation. A new cardiovascular disease (CVD) risk estimation, preferably based in interventional multiethnic studies, will be ideal. Specific LDL-C targets may also be necessary because there are data pointing out that they are useful and pragmatic. The risk/benefit ratio should be a key issue because medicine is all about this concept (Hippocrates 460 – c. 370 BC: “first do not harm”; and then in the Hippocratic Oath: “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous”).