Improving treatment adherence and longitudinal outcomes in patients with a serious mental illness by using telemedicine

A psycho-educational programme was developed using the health belief model and the individual s cognitive model of the disorder and treatment. The participants were 51 rural inpatients admitted to a tertiary psychiatric centre. Twenty-four inpatients (13 men, 11 women) were discharged using discharge planning by videoconference involving the general practitioner, case manager and a family member. Patients then received six sessions of the psycho-educational programme. A control group of 27 inpatients (16 men, 11 women) were discharged with conventional discharge summaries to general practitioners and case managers and did not receive the psycho-educational programme. More patients in the control group than in the telemedicine group were readmitted to hospital over a 12-month period. Significantly more patients in the control group reported medication side-effects than those in the telemedicine group. Patients in the telemedicine group reported greater treatment adherence and compliance than those in the control group. When compared with the control group, the telemedicine group reported significantly more satisfaction with their treatment and discharge planning.     

Pharmacological characterisation of the beta-adrenoceptor expressed by human lung mast cells

This study investigated whether human vascular smooth muscle cell proliferation induced by native low-density lipoprotein (LDL) is affected by green tea catechins. Furthermore, the effects of native LDL on extracellular signal-regulated kinase (ERK) 1/2 activity were determined. Cell proliferation stimulated by native LDL was concentration-dependently inhibited by epigallocatechin, epigallocatechin-3-gallate, green tea polyphenon, and the nonspecific antioxidant N-acetylcysteine (P<0.05). Combined treatment of green tea polyphenon and N-acetylcysteine markedly potentiated the effect of each drug on vascular smooth muscle cell proliferation. ERK1/2 activity was only partly inhibited by green tea catechins alone or in combination with N-acetylcysteine (P<0.05). These data suggest that green tea constituents inhibit proliferation of human vascular smooth muscle cells exposed to high levels of native LDL. Green tea constituents and antioxidants may exert vascular protection by inhibiting human vascular smooth muscle cell growth associated with hypercholesterolemia.     

Design,synthesis, and SAR of tachykinin antagonists: modulation of balance in NK(1)/NK(2) receptor antagonist activity

Through optimization of compounds based on the dual NK(1)/NK(2) antagonist ZD6021, it was found that alteration of two key regions could modulate the balance of NK(1) and NK(2) potency. Substitution of the 2-naphthalene position in analogues of ZD6021 resulted in increased NK(1) potency and thus afforded NK(1) preferential antagonists. Alterations of the piperidine region could then increase NK(2) potency to restore dual NK(1)/NK(2) selectivity. Through these efforts, three novel receptor antagonists from a single chemically related series were identified; two are dual NK(1)/NK(2) antagonists, and the third is an NK(1) preferential antagonist. In this paper, the factors affecting the balance of NK(1) and NK(2) selectivity in this series are discussed and the in vitro and in vivo properties of the novel antagonists are described.     

Formulations of antibiotics for children in primary care: effects on compliance and efficacy

This review article is designed for pediatricians as well as primary care physicians in the outpatient setting as a clinical guide to antibiotic selection. It emphasizes variables related to compliance as well as efficacy. The aim is to give recommendations as to the choice of antibiotics, depending on factors such as taste, cost, efficacy, and compliance. Common bacterial pathogens causing infections in children are reviewed, along with their susceptibility patterns to antimicrobial agents. Emerging mechanisms of resistance, particularly the increasing resistance of pneumococci to beta-lactam antibiotics, are discussed because of their importance to antibiotic selection. Previously published studies that have examined the treatment of common outpatient infections in children, such as otitis media, streptococcal tonsillopharyngitis, and sinusitis, are summarized. Adverse reactions associated with antibiotics, second in importance only to efficacy, are reviewed. Finally, compliance issues, which include palatability, cost, duration of therapy, and administration frequency, are analyzed using recently published information related to each of these issues. The efficacy of the commonly used antibiotics for urinary tract infections, pneumonia, and streptococcal pharyngitis does not vary significantly; however, for otitis media and sinusitis, some studies have shown that treatment efficacy with the antibiotic does not vary significantly from that with placebo. Likewise, adverse reactions rarely provide a basis for antibiotic selection, since virtually all antibiotics are generally well tolerated. The final factor, compliance, is a major issue in determining both first- and second-line therapy of common outpatient infections in children. Although cost is not a factor in compliance in countries such as the UK where no copayment is required for pediatric drugs, it is of major importance in the US. This is followed by palatability, administration duration and finally administration frequency. As a group, cephalosporins are generally the best tasting but are relatively more expensive than macrolides. Antibiotics that can be given for 5 days, and just once or twice daily, are preferred by most parents and physicians. Since final assessment of antibiotic choice is likely to vary considerably among healthcare personnel, decisions must be made on an individual basis.