General derivation of the ideal intravenous drug input required to achieve and maintain a constant plasma drug concentration. Theoretical application to lignocaine therapy

Summary A constant plasma drug concentration can be achieved and maintained by the intravenous administration of an initial bolus loading dose in conjunction with a constant rate and an exponential intravenous drug infusion. The drug input required to achieve a constant plasma drug concentration is derived without making any assumptions about the nature of drug distribution within the body or elimination from the body.     

The missing link: Incorporating behaviour change theories in overdose education and naloxone distribution programs

Current rates of opioid-related mortality have been increasing globally. An effective harm reduction program consists of overdose education and naloxone distribution (OEND) programs. Incorporating both education and naloxone administration, OENDs have been reported to improve knowledge, self-efficacy and have resulted in multiple overdose reversals. Similarly effective has been the incorporation of Behaviour Change Theories within harm reduction programs. Although limited, literature that does exist surrounding this intersection, explains how theories such as social cognitive theory and the transtheoretical model have proven to reduce harms relating to injection drug use. Engaging with participants at multiple levels while using a context-dependent and iterative approach have been documented strengths of behaviour change theories with respect to minimizing substance use behaviours. This commentary argues for the potential benefit, incorporating behaviour change theories in OENDs has in reducing opioid-related overdoses.     

高血压合并糖尿病患者行系统健康教育的效果评价

目的探讨高血压合并糖尿病患者健康教育的方法和效果。方法选择高血压合并糖尿病患者80例,分为对照组和研究组各40例,对照组采用常规健康教育的方法,研究组在常规健康教育的基础上,由护士实施系统健康教育。对比两组在用药、饮食、运动方面的依从性,和空腹血糖、餐后2h血糖、血压、三酰甘油控制达标效果。结果研究组治疗效果优于对照组,在空腹血糖、餐后2h血糖、血压、三酰甘油控制方面明显好于对照组。结论应用系统健康教育能提高高血压合并糖尿病患者的依从性,有效控制空腹血糖、餐后2h血糖、血压、三酰甘油。提高高血压合并糖尿病患者的生活质量。     

A change in behaviour: getting the balance right for research and policy

Behaviour change interventions offer clinical pharmacists many opportunities to optimise the use of medicines. ‘MINDSPACE’ is a framework used by a Government-affiliated organisation in the United Kingdom to communicate an approach to changing behaviour through policy. The Theoretical Domains Framework (TDF) organises constructs of psychological theories that are most relevant to behaviour change into 14 domains. Both frameworks offer a way of identifying what drives a change in behaviour, providing a target for an intervention. This article aims to compare and contrast MINDSPACE and the TDF, and serves to inform pharmacy practitioners about the potential strengths and weaknesses of using either framework in a clinical pharmacy context. It appears that neither framework can deliver evidence-based interventions that can be developed and implemented with the pace demanded by policy and practice-based settings. A collaborative approach would ensure timely development of acceptable behaviour change interventions that are grounded in evidence.     

Smoking and diabetes: readiness for change and provider advice.

Smoking is a serious health risk, particularly for people with diabetes. This study was designed to examine important aspects of smoking in a large group of individuals with diabetes. A survey was mailed to 2,056 individuals with diabetes. The variables examined were the stages of change for smoking, prevalence of quitting advice given by health care providers, and the patterns of readiness for change. The majority (57.8%) of current smokers were in the precontemplation stage. Comparisons on the stage of change indicated that more individuals with Type 2 diabetes have quit while there are more current smokers among those with Type 1 diabetes. Comparisons on current smokers indicated no differences on stage of change across the Type 1 and Type 2 groups, across three subgroups of individuals with Type 2 diabetes, or across duration of diabetes. Those who reported that they were given cessation advice were further along in the stages of change. These results suggest that the majority of individuals with diabetes who smoke are in the precontemplation stage of change and provider advice is important in moving smokers toward change. The current findings underscore the importance of assessing stage of change and providing stage-matched interventions when working with smokers with diabetes.     

小儿麻醉维持中使用七氟醚与丙泊酚的效果观察及对脑氧代谢影响

目的:观察七氟醚与丙泊酚在小儿麻醉维持中的临床疗效,并分析两者对脑氧代谢的影响。方法:选取遂宁市中心医院2014年1月至2016年1月收治的542例需接受手术治疗的患儿,按随机数字表法分为对照组和观察组,观察并比较患儿麻醉维持不同时间段的血流动力学情况、脑氧代谢指标以及镇痛效果。结果:两组t_1时刻的平均动脉压(MAP)、血流变学(HR)指标均明显高于t_2、t_3、t_4时刻,差异有统计学意义(P<0.05),但组间比较则差异无统计学意义(P>0.05);观察组t_1时刻的脑动脉血氧含量差(Da-jvo_2)、脑氧代谢率(CERO_2)较对照组高,但t_2、t_3、t_4时刻较对照组低,差异有统计学意义(P<0.05);观察组的镇痛有效率为90.4%,对照组为65.2%,观察组明显高于对照组,差异有统计学意义(P<0.05)。结论:在小儿麻醉维持中应用七氟醚与丙泊酚均有较好疗效,但七氟醚的麻醉效果较丙泊酚强,且具有更好镇痛效果,可更大程度降低患儿脑氧代谢。     

Preventing type 2 diabetes in high risk patients: an overview of lifestyle and pharmacological measures

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a common disease that is associated with an increased risk of vascular complications. The incidence of T2DM is also increasing. It follows that T2DM prevention is important. METHODS: Relevant articles (review articles, randomised studies and large cohort and case-control studies) were identified through a Medline search (up to March 2005). RESULTS: The first trials on T2DM prevention were based on lifestyle intervention. The results of these studies were impressive since they demonstrated that even a small reduction in weight could significantly reduce the incidence of T2DM. However, the main disadvantage of lifestyle measures is that they are difficult to achieve and sustain. Therefore, pharmacological interventions have also been evaluated. The results of trials using metformin, orlistat, nateglinide, acarbose, thiazolidinediones, hormone replacement therapy, statins or fibrates are either encouraging or require more extensive evaluation. In addition, studies using antihypertensive drugs (mainly angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists) showed that these drugs could also reduce the progression to T2DM in high risk individuals. CONCLUSIONS: T2DM has major quality of life and cost implications. Therefore, more research is needed to establish safe and cost effective ways to prevent this modern epidemic.     

Type 2 diabetes in China: partnerships in education and research to evaluate new antidiabetic treatments

There are 40 million people with diabetes in China, and the projected increase in the rates of obesity and premature cardiovascular disease is alarming. Most patients prefer to combine traditional Chinese medicine with Western medicine, but there is little or no information about the risks and benefits of this approach. Traditional Chinese medicine identifies three patterns of 'depletion-thirst' syndrome and therapy is aimed at reversing the deficiency in yin and qi, using a combination of products tailored to the symptoms and clinical features of individual patients. In Western medicine a number of new oral and injectable antidiabetic therapies are likely to enter routine clinical practice over the next 5 years, for example long-acting GLP-1 analogues, DPP-IV inhibitors and dual PPAR-alpha, PPAR-gamma agonists. To make best use of these agents in China and to promote diabetes education and health service development, there is a need for improved communication and collaboration between universities and hospitals both inside and outside China; and Western pharmacologists and clinicians need a better understanding of traditional Chinese medicine. There are several examples of institutional cooperation that should further diabetes research in China, for example the Beijing Chaoyang Diabetes Hospital linked with Imperial College, London, and the University of Nottingham, which has a new campus in Ningbo, south of Shanghai.     

Increased nitric oxide activity compensates for increased oxidative stress to maintain endothelial function in rat aorta in early type 1 diabetes

Hyperglycaemia and oxidative stress are known to acutely cause endothelial dysfunction in vitro, but in the initial stages of diabetes, endothelium-dependent relaxation is preserved. The aim of this study was to investigate how endothelium-dependent relaxation is maintained in the early stages of type 1 diabetes. Diabetes was induced in Sprague–Dawley rats with a single injection of streptozotocin (48?mg/kg, i.v.), and after 6?weeks, endothelium-dependent and endothelium-independent relaxations were examined in the thoracic aorta in vitro. Lucigenin-enhanced chemiluminescence was used to measure superoxide generation from the aorta. Diabetes increased superoxide generation by the aorta (2,180?±?363 vs 986?±?163?AU/mg dry tissue weight). Acetylcholine (ACh)-induced relaxation was similar in aortae from control (pEC₅₀ 7.36?±?0.09, R _max 95?±?3?%) and diabetic rats (pEC₅₀ 7.33?±?0.10, R _max 88?±?5?%). The ACh-induced relaxation was abolished by the combined presence of the nitric oxide synthase inhibitor N-nitro-l-arginine (L-NNA, 100?μM) and an inhibitor of soluble guanylate cyclase, 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ, 10?μM) in control rats, but under the same conditions, the diabetic aortic rings showed significant relaxation to ACh (pEC₅₀ 6.75?±?0.15, R _max 25?±?4?%, p?<?0.05). In diabetic aortae, the addition of haemoglobin, which inactivates nitric oxide, to L-NNA + ODQ abolished the response to ACh. The addition of the potassium channel blockers, apamin and TRAM-34, to L-NNA + ODQ also abolished the relaxation response to ACh. Diabetes significantly elevated plasma total nitrite/nitrate and increased expression of endothelial nitric oxide synthase (eNOS) and calmodulin in aortae. These data indicate that after 6?weeks of diabetes, despite increased oxidant stress, endothelium-dependent relaxation is maintained due to the increased eNOS expression resulting in increased NO synthesis. In diabetic arteries, NO acts both through and independently of cGMP pathways to cause relaxation.     

看图对话教育模式与传统健康教育模式对糖尿病患者中的效果分析

目的探讨两种不同糖尿病健康教育模式在糖尿病患者中的应用及效果。方法将136例糖尿病患者随机分为观察组和对照组各68例,观察组由通过统一培训后的糖尿病专科护士采用看图对话互动式健康教育方式,对照组采用传统式教育方式,通过问卷调查,比较教育前及教育1年后两组糖尿病患者的糖尿病知识掌握程度及自护行为的变化。结果两组糖尿病患者教育前糖尿病知识测评及自护行为量表评分差异无统计学意义(P>0.05),教育后观察组患者对糖尿病知识的掌握程度、自律运动、饮食控制、血糖监测率均显著优于对照组,差异有统计学意义(P<0.01)。结论与传统的以医疗为中心的被动式教育模式相比,以患者为中心的看图对话互动式教育模式,能使患者主动参与决策过程,提高了患者对糖尿病知识的掌握程度及治疗依从性,改善其自护行为,提高了患者的生活质量,因此有必要在糖尿患者群中进行推广。