Changing understanding,perceptions, pain relief of and preference for generic medicines with patient education: An experimental intervention study

BackgroundGeneric medicines have been associated with less perceived efficacy and more side effects compared to brand name drugs. Educational interventions to improve individuals’ negative perceptions of generic medicines show contradictory effects.ObjectiveThis study investigated whether an interventional video that informs about the approval process of releasing medicines has better effects on outcomes related to perceptions and effectiveness of generic medicines in participants with headaches, in comparison with another interventional video that addresses bioequivalence between brand name and generic drugs or a control video.MethodsParticipants with frequent tension headaches were randomized to one of three groups (one of two interventional videos or the control video). One of the interventional videos explained the process of approval of generic medicines (n = 34), the other one explained the bioequivalence between brand name and generic drugs (n = 35). The control video informed participants about the epidemiology and etiology of headaches (n = 34). After watching the video, participants treated their next two consecutive episodes of headache with a brand name and a generic analgesic in randomized order.Main outcome measuresSelf-report measures of understanding and perceptions of and preference for medicines, pain severity and side effects.ResultsLinear mixed models showed that both interventional videos improved participants’ understanding of generic medicines. The generic drug approval process video enhanced the perceived effectiveness, safety and quality of generic drugs. The bioequivalence video positively influenced the preference for generic drugs. The brand name and generic drug were equally effective in relieving pain in participants who watched either the generic drug approval process or the bioequivalence video.ConclusionsInformation about both, approving a switch from brand name medicines to generic counterparts and bioequivalence, can be important and should be addressed in future educational interventions.     

硫酸吗啡缓释片联合普瑞巴林治疗癌性神经病性疼痛的疗效及对患者疼痛缓解的影响

目的分析硫酸吗啡缓释片联合普瑞巴林治疗癌性神经病性疼痛的疗效及对患者疼痛缓解的影响。方法102例癌性神经病性疼痛患者,根据随机数字表法分为对照组及观察组,各51例。对照组采用硫酸吗啡缓释片治疗,观察组在对照组基础上联合普瑞巴林治疗。对比两组患者的治疗效果、疼痛程度、睡眠质量和不良反应发生情况。结果观察组治疗总有效率92.16%高于对照组的76.47%,差异具有统计学意义(P<0.05)。治疗后,两组患者的视觉模拟评分法(VAS)评分均较本组治疗前降低,且观察组降低程度优于对照组,差异均具有统计学意义(P<0.05)。两组患者的睡眠干扰(SLPD)、睡眠量(SLPQ)、睡眠充足度(SLPA)、综合睡眠障碍指数(9-items)评分均较本组治疗前改善,且观察组改善程度优于对照组,差异均具有统计学意义(P<0.05)。观察组不良反应发生率9.80%低于对照组的25.49%,差异具有统计学意义(P<0.05)。结论硫酸吗啡缓释片联合普瑞巴林治疗癌性神经病性疼痛的疗效显著,能有效缓解患者的疼痛情况,提高睡眠质量,降低不良反应发生率,安全性较高,值得应用。     

The utility of a computerised clinical decision support system intervention in home medicines review: A mixed-methods process evaluation

BackgroundUse of high-risk medications is common and associated with adverse effects in older adults, including those living with dementia. A Computerised Clinical Decision Support System (CCDSS) called G-MEDSS© (Goal-directed Medication Review Electronic Decision Support System) contains tools that identify medications with anticholinergic and sedative effects and align older adult's health and medication goals of care with medication management strategies.ObjectivesTo describe the utility of a CCDSS called G-MEDSS in Home Medicines Review (HMR) by an accredited clinical pharmacist (ACP) using a mixed-methods process evaluation method.MethodsA mixed-methods process evaluation was conducted as part of a nation-wide cluster-randomised clinical trial evaluating the effectiveness of implementing G-MEDSS in HMR. Data were collected from ACPs and HMR recipients (the patient) using a feedback survey (ACPs and HMR recipients) and one-on-one telephone interviews (HMR recipients). Quantitative and qualitative data were combined at the start of analysis. Content analysis of the qualitative data was conducted, and emerging categories were linked to quantitative data.ResultsFeedback surveys were completed by eight ACPs and 26 HMR recipients; 11 HMR recipients completed one-on-one telephone interviews. Overall, ACPs and HMR recipients who received the intervention reported a positive attitude towards the utility of G-MEDSS in HMR. ACPs reported that G-MEDSS enhanced their ability to make evidence-based recommendations about anticholinergic and sedative medications, and to better align HMR recommendations with HMR recipients’ goals of care. However, ACPs described that it was difficult to obtain goals of care from HMR recipients. HMR recipients gave mixed reports about the ACPs consultations: some HMR recipients reported that they were engaged in discussions about their views on medications, whilst other participants reported that discussions about their concerns towards medications and goals was limited.ConclusionsThis study suggests that a CCDSS, such as G-MEDSS, demonstrates good utility to assist ACPs to identify and assess anticholinergic and sedative medications. Given the mixed feedback from the ACPs on the different components of the G-MEDSS, further refinement of these tools and their use in combination in practice may be needed.     

度洛西汀与硫酸吗啡联合治疗癌痛的临床观察

目的：对比观察度洛西汀与硫酸吗啡缓释片与单用硫酸吗啡治疗癌痛的疗效与安全性，为肿瘤疼痛管理提供参考。方法：180例中重度癌痛患者被纳入这项随机、开放、为期12周的临床研究。研究对象均分入单药治疗组（硫酸吗啡缓释片，100～200mg／d）和合并治疗组（同等剂量的硫酸吗啡缓释片＋度洛西汀，前2周30mg／d，2周后60mg／d）。分别在基线及治疗后第4、8及12周进行随访与评估。用Short—FormMcGillPainQuestionnaire（SF—MPQ）和the10-pointvisualanalogscale（VAS）行疼痛评估。焦虑抑郁症状采用汉密尔顿焦虑与抑郁量表评估。采用治疗时出现的不良事件量表与脱落率评估耐受性。结果：单药治疗组与合并治疗组脱落率相似（第4周8．9）AUS10．0％，第8周15．6％VS17．8％及第12周23．3％YJS25．6%，均P〉0．05）。虽然便秘、出汗和心悸的不良反应频数合并治疗组较高，但差异未达统计学意义。在第4、12周VAS评分减分值合并治疗组显著高于单药治疗组[（3．3±0．9）US（2．1±0．6）；（6．4±0．8）US（4．5±0．5），均P〈0．01]。虽然SF—MPQ总分减分值两组间无统计学差异，但在疼痛情感维度方面，于治疗后第8、12周，合并治疗组减分值显著高于单药治疗组（4．2±1．3）US（2．3±1．0）；（6．8±2．9）VS（4．6±1．7），均P〈0．01]。结论：合用度洛西汀与硫酸吗啡缓释片治疗癌痛的疗效优于单用硫酸吗啡治疗，且耐受性好。     

Impact of a mobile-app assisted self-management educational intervention on the scores of asthma control test (ACT) questionnaire among young asthmatic patients

BackgroundMobile phone apps have reached almost all sectors of everyday modern human life, including health promotion and patient education intervention. Regarding asthma self-management programs, apps are considered to be a potential learning medium for patients with asthma, especially young patients, due to their effectiveness in improving patients’ knowledge and, consequently, the level of asthma control.ObjectiveThe aim of this study was to evaluate the effectiveness of the AsmaDroid® mobile app, as compared with conventional educational methods, as a self-management educational intervention tool for improving asthma control among young patients.MethodsTo determine the app's effectiveness, the study involved 140 participants from various backgrounds and applied a quasi-experimental method using a two-group pretest and posttest with a control group design. Specifically, the treatment groups received the AsmaDroid® app as a learning medium, while the control groups used conventional methods (e.g., books, posters, videos, and social media). Before and after a 4-week intervention period, all the participants of both groups were asked to complete the Asthma Control Test (ACT) questionnaire.ResultsThe results of this study revealed a significant difference of +1.4 (p < 0.0001) in the pretest and posttest scores of the ACT questionnaire from the intervention group, while no difference was found in the control group.ConclusionsTherefore, this study concluded that mobile app-assisted self-management educational intervention significantly improved the scores of the ACT questionnaire among young asthmatic patients.     

复方利多卡因乳膏用于缓解手术患者浅静脉套管针输液疼痛的临床观察

目的观察应用复方利多卡因乳膏缓解浅静脉套管针输液所致疼痛的可行性。方法选择168例于手术室内采用套管针浅静脉输液并于术中使用含静脉刺激性药物的患者,随机分为2组:观察组(n=84)应用复方利多卡因乳膏涂敷套管针输液的浅静脉上皮肤区域;对照组(n=84)只在浅静脉输液疼痛发生时采取如安慰、热敷、翻转针柄、减慢输液速度等综合处理措施,通过线性视觉模拟标尺评分法进行输液部位疼痛评定。结果观察组输液部位疼痛的发生率及程度显著低于对照组(P<0.01)。结论应用复方利多卡因乳膏外敷输液部位可有效缓解手术患者套管针输液所致的疼痛,适当的麻醉干预可提高医疗舒适性。     

Intrathecal administration of a gap junction decoupler, an inhibitor of Na-K-2Cl cotransporter 1, or a GABAA receptor agonist attenuates mechanical pain hypersensitivity induced by REM sleep deprivation in the rat

We studied the hypothesis that some of the spinal mechanisms that are involved in neuropathic hypersensitivity play a role in hypersensitivity induced by REM sleep deprivation (REMSD). Rats with a chronic intrathecal (i.t.) catheter had REMSD of 48 h duration that induced hypersensitivity to mechanical stimulation. After REMSD, the animals were treated i.t. with carbenoxolone (a gap junction decoupler), bumetanide (a blocker of Na⁺-K⁺-2Cl⁻ cotransporter 1 or NKCC1), muscimol (a GABA_A receptor agonist), or pretreated intraperitoneally with minocycline (an inhibitor of microglia activation). Previously, all these treatments attenuated neuropathic hypersensitivity. Following REMSD, carbenoxolone, bumetanide and muscimol had a strong antihypersensitivity effect, whereas pretreatment with minocycline failed to prevent development of hypersensitivity. The results suggest that among spinal pain facilitatory mechanisms that are common to REMSD and neuropathy are NKCC1 blocker- and gap junction decoupler-reversible mechanisms. Moreover, there is a net pain inhibitory effect by spinal administration of an exogenous GABA_A receptor agonist following REMSD as shown earlier in neuropathy. In contrast, activation of spinal microglia may not be as important for the development of hypersensitivity induced by REMSD as following nerve injury.     

Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes

Introduction: We have previously reported sub optimal use of hypnotics in geriatric institutions. In the present study we examined the intervention by a pharmacist on the prescribing and administration of hypnotics in nursing homes. Thus a follow up study was performed in 5 nursing homes included in the previous study.Method: In the period between the two surveys the pharmacist provided drug information on the rational use of hypnotics, both written and verbal, to the staff of the institutions. Data on the administration of hypnotics was obtained from the Cardex system in the institutions. Data were compared to a control group in other nursing homes, where no intervention was carried out.Results: Although the population was older in 2000 than in 1995, the proportion of patients using hypnotics (24%) was similar. Use of benzodiazepines was reduced from 81% to 40%, use of long acting benzodiazepines was reduced from 62% to 22%, and use of shortacting hypnotics (zopiclone, zolpidem) increased from 9% to 53%. Furthermore, hypnotics administered before 9 p.m. were reduced from 40% to 14%, and the time of administration showed less variation than before. In the control population we also observed the use of short acting hypnotics in favour of benzodiazepines, similar to the results in the 5 institutions. However, in this population a significantly higher proportion of patients used hypnotics, used more than 1 hypnotic and the hypnotics were administered earlier in the evening.Conclusion: The results demonstrate an important effect of written and verbal drug information provided by a pharmacist to improve the prescribing and administration on the use of hypnotics in nursing homes.