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Sample records for actual beta-blocker prescribing

  1. PRACTICE OF PRESCRIBING BETA-BLOCKERS AND ITS COMPLIANCE WITH CLINICAL GUIDELINES ACCORDING TO TWO REGISTERS OF CARDIOVASCULAR DISEASES

    Directory of Open Access Journals (Sweden)

    S. Yu. Martsevich

    2016-01-01

    Full Text Available  Aim. To assess real clinical practice of prescribing beta-blockers (BB and its compliance with updated guidelines, using data from outpatient registers that are carried out in medical institutions of different levels. Material and methods. We analyzed data from two outpatient registries - RECVASA and PROFILE. RECVASA register included patients aged ≥18 years with arterial hypertension (HT, ischemic heart disease (IHD, chronic heart failure (CHF and atrial fibrillation (AF that consulted in 3 outpatient clinics of Ryazan city in 2012-2013 (n=3690. PROFILE register included patients aged ≥18 years with HT, IHD, CHF, AF that consulted in specialized cardiac unit of the State Research Center for Preventive Medicine in 2011-2015 (n=1531. Results. There were differences in the basic characteristics of the registers: in the RECVASA register average age of patients was higher, HT, IHD and CHF were more frequent; PROFILE register included more patients with the history of myocardial infarction. In the RECVASA register 41.5% (n=1533 of patients received BB, and in the PROFILE register – 47.7% (n=731. The most frequently prescribed BB was bisoprolol in all cardiovascular diseases. Conclusion. In a specialized medical institution BB used more often under the conditions where they are necessary. The choice of a specific BB inside the pharmacological group, even in a specialized medical institution does not always correspond to clinical guidelines and evidence-based medicine.

  2. Long-term mortality after acute myocardial infarction in relation to prescribed dosages of a beta-blocker at hospital discharge.

    Science.gov (United States)

    Herlitz, J; Dellborg, M; Karlson, B W; Lindqvist, J; Wedel, H

    2000-12-01

    This study was designed to describe the 5-year mortality rate in relation to the dose of metoprolol prescribed at hospital discharge after hospitalisation for acute myocardial infarction (AMI). All patients discharged alive after being hospitalized for AMI at Sahlgrenska Hospital (covering half of the community of Göteborg, with 500,000 inhabitants) during 1986-1987 (period I) and all patients discharged alive after hospitalization for AMI at Sahlgrenska Hospital and Ostra Hospital (covering the whole area of the community of Göteborg) in 1990-1991 (period II) were included. Overall mortality was retrospectively evaluated over 5 years of follow-up. In all there were 2161 patients who were discharged after AMI. Seventy-three percent of these patients were prescribed a beta-blocker and 59% were prescribed metoprolol. Of the patients prescribed metoprolol, 34% were on 200 mg, 46% on 100 mg, and 20% on 50 mg or less. Information on 5-year mortality was available for 2142 of the 2161 patients (99.1%). The 5-year mortality was 24% among patients prescribed 200 mg, 33% among patients prescribed 100 mg, and 43% among patients prescribed 50 mg (P 100 mg was 0.63 (95% confidence limit 0.48-0.84; P = 0.001). Both patients prescribed high and low doses of metoprolol after AMI appeared to benefit from treatment. There was a trend indicating more benefit when larger doses were prescribed.

  3. Non-selective beta-blockers decrease thrombotic events in patients with heart failure

    NARCIS (Netherlands)

    De Peuter, Olav R.; Souverein, Patrick C.; Klungel, Olaf H.; Lip, Gregory Y.; Buller, Harry R.; De Boer, Anthonius; Kamphuisen, Pieter W.

    2010-01-01

    Background: Beta-blockers are often prescribed to patients with heart failure (HF) without distinctions between types of beta-blockers. The 2002 COMET study showed superiority of carvedilol (a non-selective beta-blocker) over metoprolol (selective beta-blocker) on mortality and cardiovascular events

  4. Beta-blocker therapy is not associated with symptoms of depression and anxiety in patients receiving an implantable cardioverter-defibrillator

    NARCIS (Netherlands)

    M.T. Hoogwegt (Madelein); N. Kupper (Nina); D.A.M.J. Theuns (Dominic); L.J.L.M. Jordaens (Luc); S.S. Pedersen (Susanne)

    2012-01-01

    textabstractBeta-blockers are frequently prescribed to implantable cardioverter-defibrillator (ICD) patients. Beta-blocker therapy has been proposed to induce emotional distress such as depression and anxiety, but a paucity of studies has examined the relationship between beta-blockers and distress.

  5. Beta-blocker therapy is not associated with symptoms of depression and anxiety in patients receiving an implantable cardioverter-defibrillator

    OpenAIRE

    Hoogwegt, Madelein; Kupper, Nina; Theuns, Dominic; Jordaens, Luc; Pedersen, Susanne

    2012-01-01

    textabstractBeta-blockers are frequently prescribed to implantable cardioverter-defibrillator (ICD) patients. Beta-blocker therapy has been proposed to induce emotional distress such as depression and anxiety, but a paucity of studies has examined the relationship between beta-blockers and distress. We investigated the association between beta-blocker therapy, including type and dosage, and symptoms of anxiety and depression in a consecutive cohort of patients receiving an ICD. Between 2003 a...

  6. Beta-blocker therapy is not associated with symptoms of depression and anxiety in patients receiving an implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Hoogwegt, Madelein T; Kupper, Nina; Theuns, Dominic A M J

    2012-01-01

    Beta-blockers are frequently prescribed to implantable cardioverter-defibrillator (ICD) patients. Beta-blocker therapy has been proposed to induce emotional distress such as depression and anxiety, but a paucity of studies has examined the relationship between beta-blockers and distress. We...... investigated the association between beta-blocker therapy, including type and dosage, and symptoms of anxiety and depression in a consecutive cohort of patients receiving an ICD....

  7. Beta-blockers for exams identify students at high risk of psychiatric morbidity

    DEFF Research Database (Denmark)

    Butt, Jawad H.; Dalsgaard, Søren; Torp-Pedersen, Christian

    2017-01-01

    OBJECTIVES: Beta-blockers relieve the autonomic symptoms of exam-related anxiety and may be beneficial in exam-related and performance anxiety, but knowledge on related psychiatric outcomes is unknown. We hypothesized that beta-blocker therapy for exam-related anxiety identifies young students...... at risk of later psychiatric events. METHODS: Using Danish nationwide administrative registries, we studied healthy students aged 14-30 years (1996-2012) with a first-time claimed prescription for a beta-blocker during the exam period (May-June); students who were prescribed a beta-blocker for medical...... reasons were excluded. We matched these students on age, sex, and time of year to healthy and study active controls with no use of beta-blockers. Risk of incident use of antidepressants, incident use of other psychotropic medications, and suicide attempts was examined by cumulative incidence curves...

  8. Myokardinfarkt und Beta-Blocker

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    Stühlinger H-G

    2003-01-01

    Full Text Available Im Rahmen eines akuten koronaren Syndroms (akuter Herzinfarkt, Angina pectoris kommt es, aufgrund eines Ungleichgewichtes zwischen Angebot und Bedarf, zu einem akuten Mangel an Sauerstoff im Herzmuskel. Ursache ist eine reduzierte Sauerstoffzufuhr durch verengte bzw. verschlossene Gefäße. Bis zur Behebung der Ursache vergehen oft mehrere Stunden. In dieser Phase muß - durch Verminderung des Sauerstoffbedarfs im Herzmuskel - eine Verlangsamung der Nekroseentwicklung erreicht werden. Das Ausmaß der Nekrose wird reduziert, somit die für die Langzeitprognose wichtige Linksventrikelfunktion verbessert. Eine Verminderung des Sauerstoffbedarfs erreicht man durch kontrollierte Frequenzsenkung mittels intravenöser Beta-Blockade. In optimaler Weise wird diese Methode durch die Anwendung eines kardioselektiven Beta-Blockers mit kurzer Halbwertszeit durchgeführt. Beta-Blocker haben nicht nur auf die Nekroseentwicklung, sondern auch auf die Inzidenz von Rhythmusstörungen - besonders in der Akutphase - Auswirkungen. Vor allem die mit dieser therapeutischen Maßnahme verbundene Reduktion von Kammerflimmern ist von großer Bedeutung.

  9. Photochemical fate of beta-blockers in NOM enriched waters

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    Wang, Ling; Xu, Haomin; Cooper, William J. [Urban Water Research Center, Department of Civil and Environmental Engineering, University of California, Irvine, Irvine, CA 92697-2175 (United States); Song, Weihua, E-mail: wsong@fudan.edu.cn [Department of Environmental Science and Engineering, Fudan University, Shanghai 200433 (China)

    2012-06-01

    Beta-blockers, prescribed for the treatment of high blood pressure and for long-term use after a heart attack, have been detected in surface and ground waters. This study examines the photochemical fate of three beta-blockers, atenolol, metoprolol, and nadolol. Hydrolysis accounted for minor losses of these beta-blockers in the pH range 4-10. The rate of direct photolysis at pH 7 in a solar simulator varied from 6.1 to 8.9 h{sup -1} at pH 7. However, the addition of a natural organic matter (NOM) isolate enhanced the photochemical loss of all three compounds. Indirect photochemical fate, generally described by reactions with hydroxyl radical ({center_dot}OH) and singlet oxygen ({sup 1}{Delta}O{sub 2}), and, the direct reaction with the triplet excited state, {sup 3}NOM{sup Low-Asterisk }, also varied but collectively appeared to be the major loss factor. Bimolecular reaction rate constants of the three beta-blockers with {sup 1}{Delta}O{sub 2} and {center_dot}OH were measured and accounted for 0.02-0.04% and 7.2-38.9% of their loss, respectively. These data suggest that the {sup 3}NOM{sup Low-Asterisk} contributed 50.6-85.4%. Experiments with various {sup 3}NOM{sup Low-Asterisk} quenchers supported the hypothesis that it was singly the most important reaction. Atenolol was chosen for more detailed investigation, with the photoproducts identified by LC-MS analysis. The results suggested that electron-transfer could be an important mechanism in photochemical fate of beta-blockers in the presence of NOM. - Highlights: Black-Right-Pointing-Pointer Photochemical degradation of beta-blockers in the simulated natural waters. Black-Right-Pointing-Pointer Reactive Oxygen Species play a minor role in the indirect photodegradation. Black-Right-Pointing-Pointer The loss of beta-blockers results from direct reaction with {sup 3}DOM{sup Low-Asterisk }.

  10. Detrimental effects of beta-blockers in COPD - A concern for nonselective beta-blockers

    NARCIS (Netherlands)

    van der Woude, HJ; Zaagsma, J; Postma, DS; Winter, TH; van Hulst, M; Aalbers, R

    2005-01-01

    Introduction: beta-Blockers are known to worsen FEV1 and airway hyperresponsiveness (AHR) in patients with asthma. Both characteristics determine the outcome of COPD, a disease with frequent cardiac comorbidity requiring beta-blocker treatment. Design: A double-blind, placebo-controlled, randomized,

  11. Topical beta-Blockers and Mortality

    NARCIS (Netherlands)

    Muskens, Rogier P. H. M.; Wolfs, Roger C. W.; Wittenian, Jacqueline C. M.; Hofman, Albert; de Jong, Paulus T. V. M.; Stricker, Bruno H. C.; Jansonius, Nomdo M.

    2008-01-01

    Purpose: To study the associations between long-term and short-term use of topical beta-blockers and mortality. Design: Prospective population-based cohort study. Participants: To examine long-term effects, 3842 participants aged 55 years and older were recruited. To examine short-term effects, 484

  12. The use of guideline recommended beta-blocker therapy in primary prevention implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine; Gislason, Gunnar Hilmar; Vinther, Michael

    2017-01-01

    Aims: We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a 'real-life' setting. Methods and results: From the Danish Pacemaker and ICD Registry we identified all 1st-time prim......Aims: We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a 'real-life' setting. Methods and results: From the Danish Pacemaker and ICD Registry we identified all 1st......-time primary prevention ICD and cardiac resynchronization therapy defibrillator (CRT-D) implantations in Denmark from 2007-12 (n = 2935). Use of beta-blocker, type and dose was acquired through the Danish Prescription Registry. According to guideline recommendations, we defined target daily doses as ≥50 mg...... carvedilol and ≥200 mg metoprolol. Prior to implantation 2427 of 2935 (83%) patients received beta-blocker therapy, with 2166 patients (89%) having initiated treatment 3 months or more prior to implantation. The majority of patients was prescribed carvedilol (52%) or metoprolol (41%). Patients on carvedilol...

  13. Comparative effects of three beta blockers (atenolol, metoprolol, and propranolol) on survival after acute myocardial infarction.

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    Gottlieb, S S; McCarter, R J

    2001-04-01

    The beneficial impact of beta blockade after an acute myocardial infarction (AMI) is clear, but beta-adrenergic blockers differ in multiple characteristics, including lipophilicity and selectivity. The impact of these factors on the effects of beta blockade is unknown. We therefore compared the effects of different beta blockers on mortality after AMI. Charts of 201,752 patients with AMI were abstracted by the Cooperative Cardiovascular Project, a quality assurance program sponsored by the Health Care Financing Administration. Of the 69,338 patients prescribed beta blockers, we compared mortality of patients receiving different beta-adrenergic blockers using the Cox proportional-hazards model accounting for multiple factors that might influence survival. The mortality rates of the 2 selective agents, metoprolol and atenolol, were virtually identical (13.5% and 13.4% 2-year mortality, respectively). Compared with metoprolol, patients discharged on propranolol had a slightly increased mortality (15.9% 2-year mortality), which may be related to undetected differences at baseline. Survival with all of the drugs was superior to the 23.9% 2-year mortality seen in patients not receiving beta blockers. Beta blockade overall was associated with a 40% improvement in survival. Although the use of beta blockade after AMI has major prognostic importance, the present study suggests that the specific beta blocker chosen will have little influence on mortality.

  14. Perioperative beta blockers in patients having non-cardiac surgery

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi

    2008-01-01

    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidence...... to assess the use of perioperative beta blockers in patients having non-cardiac surgery....

  15. Use of beta blockers in various clinical states

    Directory of Open Access Journals (Sweden)

    Radović Vesna V.

    2011-01-01

    Full Text Available Introduction. According to the convincing evidence, a decline in mortality rate has been achieved with beta-blockers in patients with an acute myocardial infarction and in post-infarction follow-up. In fact, there has been a clear reduction of sudden coronary death. The necessary condition for the efficiency of beta-blockers is an early use. They are also a medication of choice for angina after an infarction. The objective of this work was to evaluate the use of beta-blockers after a myocardial infarction in various clinical states and to eliminate doubts concerning their prescription. Beta blockers Even in conditions considered contraindications for administration of beta blockers such as old age, diabetes, non-Q-wave myocardial infarction, peripheral vascular disease, arterial disease, heart insufficiency, ventricular arrhythmias, renal disease, chronic obstructive pulmonary disease, asthma and depression, patients benefit from beta blockers when they are given along with a right choice of the medication and a regular follow-up of the patient. Preference is given to cardioselective beta blockers in patients with diabetes or lung disease. Beta-blockers do not cause long-term lipid alterations. Therefore, the matter of clinically significant alterations of lipids or blood glucose levels should not need further consideration as a problem of the treatment of diabetics. Discussion and conclusion. Investigations have proved that the use of beta-blockers reduces the development of cerebrovascular accidents, heart insufficiency and hypertension. Despite strong arguments and numerous recommendations, beta-blockers have not been accepted to a sufficient extent as an integral part of treatment of acute coronary syndrome and related diseases, to the detriment of many lost lives and in spite of favourable pharmaco-economic aspect.

  16. Anxiolytics not acting at the benzodiazepine receptor: beta blockers.

    Science.gov (United States)

    Tyrer, P

    1992-01-01

    1. Although there is clear evidence for many controlled trials in the past 25 years that beta blockers are effective in anxiety disorders clear indications for their use are lacking. 2. The balance of evidence suggests that the mechanism of action of beta-blocking drugs is through peripheral blockade of beta-mediated symptoms. 3. Most evidence to the efficacy of beta-blockers comes from study of their use in generalized anxiety and in acute stress. 4. Because beta-blockers carry no risks of pharmacological dependence they may be preferred to many other anti-anxiety drugs.

  17. Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction

    DEFF Research Database (Denmark)

    Gislason, Gunnar H; Rasmussen, Jeppe Nørgaard; Abildstrøm, Steen Z

    2006-01-01

    AIMS: To study initiation, dosages, and compliance with beta-blockers, angiotensin-converting enzyme (ACE)-inhibitors, and statins in patients after acute myocardial infarction (AMI) and to identify likely targets for improvement. METHODS AND RESULTS: Patients admitted with first AMI between 1995...... and 2002 were identified by linking nationwide administrative registers. A total of 55 315 patients survived 30 days after discharge and were included; 58.3% received beta-blockers, 29.1% ACE-inhibitors, and 33.5% statins. After 1, 3, and 5 years, 78, 64, and 58% of survivors who had started therapy were...... still receiving beta-blockers, 86, 78, and 74% were receiving ACE-inhibitors, and 85, 80, and 82% were receiving statins, respectively. Increased age and female sex were associated with improved compliance. The dosages prescribed were generally 50% or less of the dosages used in clinical trials...

  18. Fracture risk in perimenopausal women treated with beta-blockers

    DEFF Research Database (Denmark)

    Rejnmark, Lars; Vestergaard, Peter; Kassem, Moustapha

    2004-01-01

    beta2-Adrenergic receptors have been identified on human osteoblastic and osteoclastic cells, raising the question of a sympathetic regulation of bone metabolism. We investigated effects of treatment with beta-adrenergic receptor antagonists (beta-blockers) on bone turnover, bone mineral density...... (BMD), and fracture risk. Within the Danish Osteoporosis Prevention Study (DOPS) a population based, comprehensive cohort study of 2016 perimenopausal women, associations between treatment with beta-blockers and bone turnover and BMD were assessed in a cross-sectional design at the start of study....... Moreover, in a nested case-control design, fracture risk during the subsequent 5 years was assessed in relation to treatment with beta-blockers at baseline. Multiple regression- and logistic regression-analyses were performed. Treatment with beta-blockers was associated with a threefold increased fracture...

  19. Beta-blockers in cirrhosis and refractory ascites

    DEFF Research Database (Denmark)

    Kimer, Nina; Feineis, Martin; Møller, Søren

    2015-01-01

    OBJECTIVE: It is currently discussed if beta-blockers exert harmful effects and increase mortality in patients with cirrhosis and refractory ascites. In this study, we provide an overview of the available literature in this field in combination with a retrospective analysis of 61 patients...... trials (9 trials on propranolol, 1 case-control study and 4 retrospective analyses) were identified. One trial suggested an increased mortality in patients treated with beta-blockers and refractory ascites. The results of the remaining trials were inconclusive. No increase in mortality among beta-blocker......-treated patients was found in the present retrospective analysis. CONCLUSIONS: Treatment with beta-blockers may increase mortality in patients with cirrhosis and refractory ascites. However, the current evidence is sparse and high-quality studies are warranted to clarify the matter....

  20. Review of topical beta blockers as treatment for infantile hemangiomas.

    Science.gov (United States)

    Painter, Sally L; Hildebrand, Göran Darius

    2016-01-01

    The treatment of infantile hemangiomas changed from the use of oral corticosteroids to oral propranolol on the serendipitous discovery of propanolol's clinical effectiveness in 2008. Since then, clinicians have begun to use topical beta blockers--in particular, timolol maleate 0.5% gel forming solution--with good effect. Topical beta blockers are now used for lesions with both deep and superficial components and those that are amblyogenic. When initiated in the proliferative phase of the lesion, the effectiveness of the treatment can be seen within days. There is no consensus on dosing, treatment bioavailability, or clinical assessment of lesions, but these are topics for future research.

  1. Heart Rate and Cardiovascular Disease: An Alternative to Beta Blockers

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    Michael Liang

    2009-01-01

    Full Text Available Ivabradine, an If inhibitor, acts primarily on the sinoatrial node and is used to reduce the heart rate with minimal effect on myocardial contractility, blood pressure, and intracardiac conduction. Heart rate reduction is an important aspect of care in patients with chronic stable angina and heart failure. Many patients with coronary artery disease have coexisting asthma or chronic obstructive airway disease, and most of them are unable to tolerate beta blockers. Ivabradine may thus be a useful medicine in therapeutic heart rate management especially in patients who are intolerant of beta-blockers.

  2. Beta-Blocker Therapy Early After Myocardial Infarction

    DEFF Research Database (Denmark)

    Pedersen, Susanne Bendesgaard; Nielsen, Jens Cosedis; Bøtker, Hans Erik

    2016-01-01

    BACKGROUND: Beta-blocker (BB) therapy after myocardial infarction (MI) reduces all-cause mortality. OBJECTIVE: The aim of this study was to investigate BB dosing patterns and compliance following MI. METHODS: Using medical patient files and nationwide databases, we identified 100 patients who were...

  3. Pre-stroke use of beta-blockers does not affect ischaemic stroke severity and outcome

    NARCIS (Netherlands)

    De Raedt, S.; Haentjens, P.; De Smedt, A.; Brouns, R.; Uyttenboogaart, Maarten; Luijckx, G. J.; De Keyser, J.

    2012-01-01

    Background and purpose: It is unclear whether pre-stroke beta-blockers use may influence stroke outcome. This study evaluates the independent effect of pre-stroke use of beta-blockers on ischaemic stroke severity and 3 months functional outcome. Methods: Pre-stroke use of beta-blockers was investiga

  4. Beta blocker therapy is associated with reduced depressive symptoms 12 months post percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Battes, Linda C; Pedersen, Susanne S.; Oemrawsingh, Rohit M

    2012-01-01

    Beta blocker therapy may induce depressive symptoms, although current evidence is conflicting. We examined the association between beta blocker therapy and depressive symptoms in percutaneous coronary intervention (PCI) patients and the extent to which there is a dose-response relationship between...... beta blocker dose and depressive symptoms....

  5. Incidence of medication error associated with the use of beta-blockers in Pakistan.

    Science.gov (United States)

    Nesar, Shagufta; Shoaib, Muhammad Harris; Yousuf, Rabia Ismail; Rahim, Najia; Muhammad, Iyad Naeem

    2014-05-01

    Medication errors (ME) are human errors, which are very frequent in cardiovascular patients and result in patient morbidity and mortality. This study was focused to evaluate the quality of prescriptions and to emphasize the placement of clinical pharmacist in health care team. This study was carried out in different outpatient settings of (in) Karachi, Pakistan. The study period was June 2011 till June 2012. Retrospective data was analyzed for the outpatients' prescription of beta blocker drugs. During the study, prescriptions (n=450) were collected from different outpatient settings of (in) Karachi, Pakistan. Prescription containing beta-blockers were analyzed for the essential elements to be mentioned in prescription. Drug-drug interactions were identified by the Micromedex.2.0 Drug-Reax database and severity of medication error was determined by NCCMERP Index. A total of 1627 medication errors were identified in 450 prescriptions. The most frequent error was not mentioning the patient's weight (95%), followed by missing diagnosis (79.4%) and drug-drug interactions (69.5%). Twenty-two prescriptions were placed in the most severe category I (4.88%). Average number of drugs per prescription was 4.76. Significant difference was observed (χ(2)=52.418, p<0.05) using SPSS 19 for those prescription orders having more than 5 drugs with Beta-blockers. This indicates that the errors in prescription such as drug-drug interactions, wrong dose etc. was significantly increased with the number of drugs per prescription. Results showed that medication errors are very frequent in prescription written in outpatient setting of various hospitals and clinics in Karachi. This shows that the irrational prescribing is a common practice in developing countries. Placement of skilled pharmacist in the health care system is the only solution for avoidance of these medication related problems.

  6. HEART FAILURE, DIABETES, BETA-BLOCKERS AND RISK OF HYPOGLYCEMIA

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    A. A. Aleksandrov

    2008-01-01

    Full Text Available Aim. To evaluate an influence of carvedilol on risk of hypoglycemia in patients with diabetes type 2 (D2 and chronic heart failure (CHF treated with angiotensin converting enzyme (ACE inhibitors.Material and methods. 13 patients (10 men, 3 women; aged 59,8±6,7 y.o. with D2 and CHF caused by ischemic heart disease were included in the study. Before inclusion all patients were treated with ACE inhibitors and various beta-blockers (atenolol, metoprolol, bisoprolol. These beta-blockers were changed for carvedilol. Heart ultrasonography, blood pressure control, glycemia monitoring, HbA1c level determination were performed before, during and after carvedilol therapy.Results. Carvedilol reduces frequency and duration of hypoglycaemia episodes. There were not episodes of severe hypoglycaemia during carvedilol therapy.Conclusion. Carvedilol reduces risk of hypoglycemia when it is used in combination with ACE inhiditors in diabetic patients with CHF.

  7. Beta-blockers and depression in elderly hypertension patients in primary care

    DEFF Research Database (Denmark)

    Ringoir, Lianne; Pedersen, Susanne S.; Widdershoven, Jos W M G

    2014-01-01

    BACKGROUND AND OBJECTIVES: Previous findings regarding a possible association between beta-blocker use and depression are mixed. To our knowledge there have been no studies investigating the association of beta-blockers with depression in primary care hypertension patients without previous...... myocardial infarction. The aim of this study was to determine the relation between lipophilic beta-blocker use and depression in elderly primary care patients with hypertension. METHODS: This was a cross-sectional study in primary care practices located in the South of The Netherlands. Primary care...... score of 0, 1--3, 4--8, 9 or higher). RESULTS: A PHQ-9 score of 0 was more prevalent in non-beta-blocker users versus lipophilic beta-blocker users (46% versus 35%), a PHQ-9 score of 4--8 was less prevalent in non-beta-blocker users as compared with lipophilic beta-blocker users (14% versus 25%). A chi...

  8. "Oral ascorbic acid in combination with beta blockers in prevention of atrial fibrillation after Coronary Artery Bypass Graft "

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    Mousavi M

    2007-04-01

    Full Text Available Background: Adrenergic beta antagonists are not sufficient to prevent atrial fibrillation after coronary artery bypass graft (CABG. This study was designed to evaluate the effect of ascorbic acid as an adjunct to beta-blockers in prevention of post-CABG atrial fibrillation Methods: Patients who were more than 50 years old and scheduled to undergo CABG were included if they were treated with beta-blockers at least 1 week before surgery. Patients with previous history of atrial fibrillation, AV block, heart rate <50 /min, end-stage renal disease, severe pulmonary or liver disease and those who were taking digoxin or class I and III anti-arrhythmics or had pacemakers were not included. Ascorbic acid group were prescribed 2 gm of ascorbic acid, the night before the surgery, and 1 gm twice daily for 5 days after surgery. Beta blockers continued in both group after surgery. Telemetry monitoring was performed in ICU and Holter monitoring was performed for 4 days. Results: Fifty patients completed the study as ascorbic acid and 50 as control group. The population was 60.19 ± 7.14 years old and 67% were male. The incidence of postoperative atrial fibrillation was 4% in the ascorbic acid group and 26% in control group (odds ratio=0.119, 95% confidence interval: 0.025 to 0.558, P=0.002 Conclusion: Ascorbic acid is well-tolerated, relatively safe and seems effective. Therefore it can be prescribed as an adjunct to beta-blockers for prophylaxis of post-CABG atrial fibrillation.

  9. BETA-BLOCKERS IN THE TREATMENT OF ARTERIAL HYPERTENSION: EVIDENCE BASED DATA AND REAL PRACTICE

    Directory of Open Access Journals (Sweden)

    M. V. Leonova

    2012-01-01

    Full Text Available Data of the largest meta-analyzes of beta-blockers use in arterial hypertension is presented. The role of beta-blockers among other basic groups of antihypertensive drugs (thiazide diuretics, calcium channel blockers, ACE inhibitors is evaluated. Special considerations of beta-blockers use in hypertensive patients with diabetes mellitus and chronic heart failure are discussed. Special attention is paid to bisoprolol.

  10. BETA-BLOCKERS IN THE TREATMENT OF ARTERIAL HYPERTENSION: EVIDENCE BASED DATA AND REAL PRACTICE

    Directory of Open Access Journals (Sweden)

    M. V. Leonova

    2015-12-01

    Full Text Available Data of the largest meta-analyzes of beta-blockers use in arterial hypertension is presented. The role of beta-blockers among other basic groups of antihypertensive drugs (thiazide diuretics, calcium channel blockers, ACE inhibitors is evaluated. Special considerations of beta-blockers use in hypertensive patients with diabetes mellitus and chronic heart failure are discussed. Special attention is paid to bisoprolol.

  11. Banding ligation versus beta-blockers for primary prevention in oesophageal varices in adults

    DEFF Research Database (Denmark)

    Gluud, Lise Lotte; Krag, Aleksander

    2012-01-01

    Non-selective beta-blockers are used as a first-line treatment for primary prevention in patients with medium- to high-risk oesophageal varices. The effect of non-selective beta-blockers on mortality is debated and many patients experience adverse events. Trials on banding ligation versus non......-selective beta-blockers for patients with oesophageal varices and no history of bleeding have reached equivocal results....

  12. Prognosis in heart failure and the value of {beta}-blockers are altered by the use of antidepressants and depend on the type of antidepressants used

    DEFF Research Database (Denmark)

    Fosbøl, Emil Loldrup; Gislason, Gunnar H; Poulsen, Henrik Enghusen

    2009-01-01

    to cardiovascular causes (median follow-up, 1.9 years; 5, 95% fractiles, 0.04 to 7.06 years). Use of beta-blockers was associated with decreased risk of cardiovascular death (hazard ratio [HR], 0.77; 95% CI, 0.75 to 0.79). Antidepressants were prescribed to 19 411 patients, and both TCA and SSRI were associated...... with increased risk of overall and cardiovascular death (TCA: HR, 1.33; CI, 1.26 to 1.40; and HR, 1.25; CI, 1.17 to 1.32; SSRI: HR, 1.37; CI, 1.34 to 1.40; and HR, 1.34; CI, 1.30 to 1.38, respectively). Coadministration of SSRI and beta-blockers was associated with a higher risk of overall and cardiovascular...... death compared with coadministration of beta-blockers and TCA (P for interaction beta-blockers was associated with increased risk of overall death and cardiovascular death...

  13. A review on the putative association between beta-blockers and depression

    NARCIS (Netherlands)

    Verbeek, D.E.; van Riezen, J.; de Boer, R.A.; van Melle, J.P.; de Jonge, P.

    2011-01-01

    Several kinds of systematic studies have been conducted verifying the putative association between beta-blockers and depressive symptoms. However, many of these studies had important limitations in their design. In most of the studies, no effect of beta-blockers on depressive symptoms was seen. Beca

  14. Discontinuation of beta-blockers and the risk of myocardial infarction in the elderly.

    NARCIS (Netherlands)

    Teichert, M.; Smet, P.A.G.M. de; Hofman, A.; Witteman, J.C.; Stricker, B.H.C.

    2007-01-01

    BACKGROUND: It has been shown that the abrupt cessation of treatment with beta-adrenoceptor antagonists (beta-blockers) increases the risk of myocardial infarction in patients with hypertension. As beta-blockers differ in their pharmacokinetic and pharmacodynamic properties, this risk of discontinua

  15. Banding ligation versus beta-blockers as primary prophylaxis in esophageal varices

    DEFF Research Database (Denmark)

    Gluud, Lise L; Klingenberg, Sarah; Nikolova, Dimitrinka

    2007-01-01

    To compare banding ligation versus beta-blockers as primary prophylaxis in patients with esophageal varices and no previous bleeding.......To compare banding ligation versus beta-blockers as primary prophylaxis in patients with esophageal varices and no previous bleeding....

  16. Beta-blocker use and clinical outcomes after primary vascular surgery

    DEFF Research Database (Denmark)

    Høgh, A.; Lindholt, J.S.; Nielsen, Henrik

    2013-01-01

    To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.......To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction....

  17. Beta-blockers and depression after myocardial infarction - A multicenter prospective study

    NARCIS (Netherlands)

    van Melle, Joost P.; Verbeek, Danielle E. P.; van den Berg, Maarten P.; Ormel, Johan; van der Linde, Marcel R.; de Jonge, Peter

    2006-01-01

    OBJECTIVES The purpose of this research was to explore the prospective relationship between the use of beta-blockers and depression in myocardial infarction (MI) patients. BACKGROUND Beta-blocker use has been reported to be associated with the development of depression, but the methodological qualit

  18. [Elderly heart failure patients and the role of beta-blocker therapy

    NARCIS (Netherlands)

    Middeljans-Tijssen, C.W.; Jansen, R.W.M.M.

    2006-01-01

    In this article different aspects of chronic heart failure in old age are described. We mainly focus on the place of beta-blocker therapy in chronic heart failure. Beta-blockers are recommended for the treatment of stable chronic heart failure with left ventricular systolic dysfunction. There is add

  19. Impact of Beta-Blockers on Nonhead Injured Trauma Patients.

    Science.gov (United States)

    Hendrick, Leah E; Schroeppel, Thomas J; Sharpe, John P; Alsbrook, Diana; Magnotti, Louis J; Weinberg, Jordan A; Johnson, Benjamin P; Lewis, Richard H; Clement, L Paige; Croce, Martin A; Fabian, Timothy C

    2016-07-01

    Catecholamine surge after traumatic injury may lead to dysautonomia with increased morbidity. Small retrospective studies have shown potential benefit of beta-blockers (BB) in trauma patients with and without traumatic brain injury (TBI). This study evaluates a large multiply injured cohort without TBI that received BB. Patients were identified from the trauma registry from January 1, 2003 to December 31, 2011. Patients who received >1 dose of BB were compared to controls. Patients with TBI, length of stay (LOS) ratio (OR) 0.952; confidence interval (CI) 0.620-1.461]. In conclusion, in this largest study to date, patients receiving BB were older, more severely injured, and had a higher mortality. Unlike TBI patients, multivariable regression showed no benefit from BB in this population.

  20. Poor tolerance of beta-blockers by elderly patients with heart failure

    Directory of Open Access Journals (Sweden)

    Satoshi Yanagisawa

    2010-11-01

    Full Text Available Satoshi Yanagisawa, Noriyuki Suzuki, Toshikazu TanakaDepartment of Cardiology, Okazaki City Hospital, Aichi, JapanAbstract: Despite the well-understood importance of beta-blocker therapy in heart failure, it is sometimes not possible to use beta-blockers in elderly patients due to poor tolerance. In this report, we describe the case of an 83-year-old patient with severe systolic heart failure complicated by aortic valve stenosis and atrial fibrillation. A simple therapeutic approach involving discontinuation of beta-blockers remarkably alleviated the symptoms such as left ventricular ejection fraction, and improved the chest radiography and laboratory findings; further, atrial fibrillation converted to sinus rhythm. It is important to carefully administer beta-blocker therapy to elderly patients with heart failure, especially after considering cardiac output.Keywords: elderly, octogenarians, beta-blockers, heart failure

  1. Not All Beta-Blockers Are Equal in the Management of Long QT Syndrome Types 1 and 2

    NARCIS (Netherlands)

    Chockalingam, Priya; Crotti, Lia; Girardengo, Giulia; Johnson, Jonathan N.; Harris, Katy M.; van der Heijden, Jeroen F.; Hauer, Richard N. W.; Beckmann, Britt M.; Spazzolini, Carla; Rordorf, Roberto; Rydberg, Annika; Clur, Sally-Ann B.; Fischer, Markus; van den Heuvel, Freek; Kaeaeb, Stefan; Blom, Nico A.; Ackerman, Michael J.; Schwartz, Peter J.; Wilde, Arthur A. M.

    2012-01-01

    Objectives The purpose of this study was to compare the efficacy of beta-blockers in congenital long QT syndrome (LQTS). Background Beta-blockers are the mainstay in managing LQTS. Studies comparing the efficacy of commonly used beta-blockers are lacking, and clinicians generally assume they are equ

  2. Predictors of switching from beta-blockers to other anti-hypertensive drugs: a review of records of 19,177 Chinese patients seen in public primary care clinics in the New Territory East, Hong Kong

    Directory of Open Access Journals (Sweden)

    Wong Martin CS

    2011-07-01

    Full Text Available Abstract Background Beta-blocker drugs are commonly used in family practice and studies showed that they were the most popularly prescribed medications among all antihypertensive agents. This study aimed to identify the factors associated with medication switching from a beta-blocker to another antihypertensive drug among Chinese patients. Methods We used a validated database which consisted of the demographic and clinical information of all Chinese patients prescribed a beta-blocker from any public, family practice clinics between 01 Jan 2004 to 30 June 2007 in one large Territory of Hong Kong. The proportion of patients switched from beta-blockers to another antihypertensive agent 180 days within their first prescription was studied, and the factors associated with medication switching were evaluated by using multivariate regression analyses. Results From 19,177 eligible subjects with a mean age of 59.1 years, 763 (4.0% were switched from their beta-blockers within 180 days of commencing therapy. A binary logistic regression model used medication switching as the outcome variable and controlled for age, gender, socioeconomic status, clinic setting (general out-patient clinics, family medicine specialist clinic or staff clinics, district of residence, visit type (new vs. follow-up attendance, the number of concomitant co-morbidities, and the calendar year of prescription. It was found that older patients (age 50-59 years: adjusted odds ratio [AOR] 1.38, 95% C.I. 1.12-1.70; p = 0.002; age 60-69 years: AOR 1.63 95% C.I. 1.30-2.04, p Conclusions Closer monitoring of the medication taking behavior among the older patients and the new clinic visitors prescribed a beta-blocker is warranted. Future studies should evaluate the reasons of drug switching.

  3. Beta blockers, norepinephrine, and cancer: an epidemiological viewpoint

    Directory of Open Access Journals (Sweden)

    Fitzgerald PJ

    2012-06-01

    Full Text Available Paul J FitzgeraldThe Zanvyl Krieger Mind/Brain Institute, Solomon H Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USAAbstract: There is growing evidence that the neurotransmitter norepinephrine (NE and its sister molecule epinephrine (EPI (adrenaline affect some types of cancer. Several recent epidemiological studies have shown that chronic use of beta blocking drugs (which antagonize NE/EPI receptors results in lower recurrence, progression, or mortality of breast cancer and malignant melanoma. Preclinical studies have shown that manipulation of the levels or receptors of NE and EPI with drugs affects experimentally induced cancers. Psychological stress may play an etiological role in some cases of cancer (which has been shown epidemiologically, and this could be partly mediated by NE and EPI released by the sympathetic nervous system as part of the body’s “fight or flight” response. A less well-appreciated phenomenon is that the genetic tone of NE/EPI may play a role in cancer. NE and EPI may affect cancer by interacting with molecular pathways already implicated in abnormal cellular replication, such as the P38/MAPK pathway, or via oxidative stress. NE/EPI-based drugs other than beta blockers also may prevent or treat various types of cancer, as may cholinesterase inhibitors that inhibit the sympathetic nervous system, which could be tested epidemiologically.Keywords: clonidine, guanfacine, aspirin, acetylcholine, epinephrine, adrenaline, sympathetic nervous system, parasympathetic nervous system, inflammation

  4. Beta blockers and the sensitivity of the thallium treadmill test

    Energy Technology Data Exchange (ETDEWEB)

    Martin, G.J.; Henkin, R.E.; Scanlon, P.J.

    1987-09-01

    The effect beta blockers (BB) may have on the sensitivity of the thallium treadmill test (Th-TMT) is controversial. The purpose of this study was to test the hypothesis that BB decrease the sensitivity of the Th-TMT. Two hundred three patients over a two-year period were identified who satisfied the following criteria. All had symptom-limited upright treadmill exercise tests with stress and redistribution thallium imaging, as well as coronary angiography within two months of the Th-TMT. Of 58 patients with CAD not on BB, 52 had an abnormal Th-TMT scan (sensitivity 90 percent). In comparison, the sensitivity of the Th-TMT scan in the 88 patients with CAD receiving BB was 76 percent (p less than 0.05). We conclude that BB may significantly decrease the sensitivity of the Th-TMT. Physicians should fully appreciate the higher false negative rate (24 vs 10 percent) for patients on BB and consider cautious withdrawal prior to diagnostic studies.

  5. THE CHOICE OF DRUG FROM THE STANDPOINT OF EVIDENCE-BASED MEDICINE: CASE STUDY OF BETA-BLOCKERS

    Directory of Open Access Journals (Sweden)

    S. Yu. Martsevich

    2010-01-01

    Full Text Available Basic principles of beta-blockers choice strategy are presented. Attention is focused on the facts concerning the evidence base for effects of various beta-blockers on the outcomes of cardiovascular diseases. Beta-blocker indications and safety of their long-term use are considered from this point of view. Convincing data about beta-blocker impact on the prognosis of cardiovascular disease should be the reason for any beta-blocker choice, as well as choice of their doses which were tested in large randomized trials.

  6. Heart rate distribution and predictors of resting heart rate after initiation of beta-blocker treatment in patients with coronary artery disease: REsults of Sympathetic Evaluation And Research of China(RESEARCH) study

    Institute of Scientific and Technical Information of China (English)

    ZHAO Ying-xin; LI Yue-ping; GAO Fei; MA Han-ying; WANG Zhi-jian; HAN Hong-ya; SHEN Hua

    2013-01-01

    Background The importance of heart rate as secondary prevention strategies for patients with coronary artery disease (CAD) is emphasized by multiple guidelines.However,limited information is available on the heart rate distribution and the change patterns of resting heart rate when initiating beta-blocker therapy among Chinese patients with CAD.Methods The REsults of Sympathetic Evaluation And Research of China (RESEARCH) study is a multi-centre,prospective,observational study involving 147 centers in 23 cities across China.All eligible beta-blocker naive patients were prescribed with metroprolol succinate.Initial dosage and target heart rate were selected at the discretion of their physicians in charge according to their usual institutional practice.The heart rate distribution and the change patterns of resting heart rate after initiation of beta-blocker therapy were observed.Results The majority of patients (63.6%) were prescribed with 47.5 mg metroprolol succinate.At baseline,there were only 17.4% of patients whose heart rate was less than 70 beats per minute,and the proportion reached 42.5% and 79.1%,one month and two months after initiation of beta-blockers,respectively.Multivariate linear regression analysis showed that baseline heart rate (B=0.900,SE=0.006,t=141.787,P<0.0001) and the dosage (B=-0.007,SE=0.002,t=-3.242,P=0.001) were independent predictors of resting heart rate 2 months after beta-blocker therapy.Conclusions Resting heart rate is not optimally controlled in a broadly representative cohort of Chinese outpatients with CAD even after initiation of β-blocker therapy,and baseline heart rate and the dosage of beta-blocker are both independent predictors of resting heart rate after β-blocker therapy.

  7. Can non-selective beta-blockers prevent hepatocellular carcinoma in patients with cirrhosis?

    DEFF Research Database (Denmark)

    Thiele, Maja; Wiest, Reiner; Gluud, Lise Lotte

    2013-01-01

    Hepatocellular carcinoma is the main liver-related cause of death in patients with compensated cirrhosis. The early phases are asymptomatic and the prognosis is poor, which makes prevention essential. We propose that non-selective beta-blockers decrease the incidence and growth of hepatocellular...... carcinoma via a reduction of the inflammatory load from the gut to the liver and inhibition of angiogenesis. Due to their effect on the portal pressure, non-selective beta-blockers are used for prevention of esophageal variceal bleeding. Recently, non-hemodynamic effects of beta-blockers have received...... reduce hepatic inflammation. Blockage of β-adrenoceptors also decrease angiogenesis by inhibition of vascular endothelial growth factors. Because gut-derived inflammation and neo-angiogenesis are important in hepatic carcinogenesis, non-selective beta-blockers can potentially reduce the development...

  8. Beta-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Shilane, David; Go, Alan S

    2014-01-01

    BACKGROUND: The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI). OBJECTIVES: The purpose of this study was to assess the association of beta-blockers with outcomes among...... patients with new-onset CHD. METHODS: We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time......-varying Cox regression models to determine the hazard ratio (HR) associated with beta-blocker treatment and used treatment-by-covariate interaction tests (pint) to determine whether the association differed for patients with or without a recent MI. RESULTS: A total of 26,793 patients were included, 19...

  9. Comparison of the clinical outcome of different beta-blockers in heart failure patients

    DEFF Research Database (Denmark)

    Bølling, Rasmus; Scheller, Nikolai Madrid; Køber, Lars

    2014-01-01

    AIM: To compare survival on different beta-blockers in heart failure. METHODS AND RESULTS: We identified all Danish patients ≥35 years of age who were hospitalized with a first admission for heart failure and who initiated treatment with a beta-blocker within 60 days of discharge. The study period....... In an unadjusted model carvedilol was associated with a lower mortality [hazard ratio (HR) 0.737, 0.714-0.761] compared with metoprolol (reference) while bisoprolol was not associated with an increased mortality (HR 1.020, 0.973-1.069). In a model adjusted for possible confounders and stratified according to beta-blocker...... receiving high-dose carvedilol (≥50 mg daily) showed significantly lower all-cause mortality risk and hospitalization risk, compared with other beta-blockers....

  10. Effect of different beta blockers on penile vascular velocities in hypertensive males

    OpenAIRE

    Samer Malak Botros; Ahmed Mohamed Hussein; Ahmed Shawky Elserafy

    2015-01-01

    Background: Beta blockers are very commonly used as antihypertensive medications in young active individuals. This class has been accused of erectile dysfunction in patients taking them. Problems with erectile function can raise a concern in the treatment of hypertension and may influence the choice of treatment regimens and decisions to discontinue drugs. Aim: The aim was to assess the effect of different beta blockers: nebivolol, atenolol, bisoprolol, and carvedilol on the penile arteria...

  11. Non-selective beta-blockers may reduce risk of hepatocellular carcinoma

    DEFF Research Database (Denmark)

    Thiele, Maja; Albillos, Agustín; Abazi, Rozeta

    2015-01-01

    BACKGROUND & AIMS: Non-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB...... HCC-related mortality (RD -0.011; 95% CI -0.040 to 0.017). CONCLUSIONS: Non-selective beta-blockers may prevent HCC in patients with cirrhosis....

  12. Beta-blocker use and COPD mortality: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Etminan Mahyar

    2012-09-01

    Full Text Available Abstract Background Despite the benefits of beta-blockers in patients with established or sub-clinical coronary artery disease, their use in patients with chronic obstructive pulmonary disease (COPD has been controversial. Currently, no systematic review has examined the impact of beta-blockers on mortality in COPD. Methods We systematically searched electronic bibliographic databases including MEDLINE, EMBASE and Cochrane Library for clinical studies that examine the association between beta-blocker use and all cause mortality in patients with COPD. Risk ratios across studies were pooled using random effects models to estimate a pooled relative risk across studies. Publication bias was assessed using a funnel plot. Results Our search identified nine retrospective cohort studies that met the study inclusion criteria. The pooled relative risk of COPD related mortality secondary to beta-blocker use was 0.69 (95% CI: 0.62-0.78; I2=82%. Conclusion The results of this review are consistent with a protective effect of beta-blockers with respect to all cause mortality. Due to the observational nature of the included studies, the possibility of confounding that may have affected these results cannot be excluded. The hypothesis that beta blocker therapy might be of benefit in COPD needs to be evaluated in randomised controlled trials.

  13. Beta-blockers: friend or foe in asthma?

    Directory of Open Access Journals (Sweden)

    Arboe B

    2013-07-01

    induce acute bronchoconstriction, and, not least, may have beneficial effects on airway inflammation and airway hyperresponsiveness in some patients with asthma. Further studies addressing the potential role of β-blocker therapy for asthma are clearly needed, but careful selection of the target population is warranted.Keywords: asthma, beta-blockers, lung function, airway responsiveness

  14. Ischaemic heart disease: how well are the risk profiles modulated by current beta blockers?

    Science.gov (United States)

    Leren, P

    1993-01-01

    In acute myocardial infarction, intravenous beta blocker therapy has been tested in about 30 controlled, randomized trials. Of these, the ISIS-1 using atenolol and the MIAMI trial using metoprolol are the most important. In a total of 26,437 patients, total deaths were reduced by 62 during day 1 and by 64 during the first week, i.e. 97% of the lives were saved during the first day of beta blocker treatment. In post-myocardial infarction, oral beta blocker maintenance treatment has been used in about 35,000 survivors in placebo-controlled trials. Of these, the timolol, metoprolol and propranolol (BHAT) trials are the most important. In the timolol trial lasting for 33 months, total death, total cardiac death and re-infarction rate were significantly reduced. In the metoprolol study lasting for 3 months, total and cardiac mortality were reduced, and in the BHAT study lasting for 25 months fatal and non-fatal re-infarction combined was significantly reduced. Primary prevention of coronary heart disease has been the intention in hypertension trials. Despite the fact that beta blockers are potent agents against elevated blood pressure, a well-established coronary risk factor, no controlled trial with a placebo or untreated control group has shown a definite preventive effect on coronary heart disease. The reason for this apparent paradox is not known, but many speculations have been aired that the lack of effect might be due to adverse metabolic effects of most beta blockers.

  15. USE OF BETA-BLOCKERS IN THE PERIOPERATIVE PERIOD: HOW STRONG ARE THE EVIDENCES?

    Directory of Open Access Journals (Sweden)

    V. V. Samoylenko

    2013-01-01

    Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

  16. USE OF BETA-BLOCKERS IN THE PERIOPERATIVE PERIOD: HOW STRONG ARE THE EVIDENCES?

    Directory of Open Access Journals (Sweden)

    V. V. Samoylenko

    2015-09-01

    Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

  17. Use of statins and beta-blockers after acute myocardial infarction according to income and education

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe Nørgaard; Gislason, Gunnar H; Rasmussen, Søren

    2007-01-01

    OBJECTIVE: To study the initiation of and long-term refill persistency with statins and beta-blockers after acute myocardial infarction (AMI) according to income and education. DESIGN AND SETTING: Linkage of individuals through national registers of hospitalisations, drug dispensation, income...... and education. PARTICIPANTS: 30 078 patients aged 30-74 years surviving first hospitalisation for AMI in Denmark between 1995 and 2001. MAIN OUTCOME MEASURES: Initiation of statin or beta-blocker treatment (out-patient claim of prescriptions within 6 months of discharge) and refill persistency (first break.......66-0.82) and medium (HR 0.82; 95% CI 0.74-0.92) income compared with low income, whereas there was a trend in the opposite direction concerning a break in beta-blocker treatment. There was no gradient in re-initiation of treatment. CONCLUSION: Patients with low compared with high income less frequently initiated...

  18. Effects of beta-blockers on heart failure with preserved ejection fraction: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Feng Liu

    Full Text Available BACKGROUND: Effects of beta-blockers on the prognosis of the heart failure patients with preserved ejection fraction (HFpEF remain controversial. The aim of this meta-analysis was to determine the impact of beta-blockers on mortality and hospitalization in the patients with HFpEF. METHODS: A search of MEDLINE, EMBASE, and the Cochrane Library databases from 2005 to June 2013 was conducted. Clinical studies reporting outcomes of mortality and/or hospitalization for patients with HFpEF (EF ≥ 40%, being assigned to beta-blockers treatment and non-beta-blockers control group were included. RESULTS: A total of 12 clinical studies (2 randomized controlled trials and 10 observational studies involving 21,206 HFpEF patients were included for this meta-analysis. The pooled analysis demonstrated that beta-blocker exposure was associated with a 9% reduction in relative risk for all-cause mortality in patients with HFpEF (95% CI: 0.87 - 0.95; P < 0.001. Whereas, the all-cause hospitalization, HF hospitalization and composite outcomes (mortality and hospitalization were not affected by this treatment (P=0.26, P=0.97, and P=0.88 respectively. CONCLUSIONS: The beta-blockers treatment for the patients with HFpEF was associated with a lower risk of all-cause mortality, but not with a lower risk of hospitalization. These finding were mainly obtained from observational studies, and further investigations are needed to make an assertion.

  19. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Ph Gabriel Steg

    Full Text Available BACKGROUND: Heart rate (HR is an emerging risk factor in coronary artery disease (CAD. However, there is little contemporary data regarding HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice. The goal of the present analysis was to describe HR in such patients, overall and in relation to beta-blocker use, and to describe the determinants of HR. METHODS AND FINDINGS: CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis of >50%, or chest pain associated with proven myocardial ischemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. Most of the 33,177 patients included in this analysis were men (77.5%. Mean (SD age was 64.2 (10.5 years, HR by pulse was 68.3 (10.6 bpm, and by electrocardiogram was 67.2 (11.4 bpm. Overall, 44.0% had HR ≥ 70 bpm. Beta-blockers were used in 75.1% of patients and another 14.4% had intolerance or contraindications to beta-blocker therapy. Among 24,910 patients on beta-blockers, 41.1% had HR ≥ 70 bpm. HR ≥ 70 bpm was independently associated with higher prevalence and severity of angina, more frequent evidence of myocardial ischemia, and lack of use of HR-lowering agents. CONCLUSIONS: Despite a high rate of use of beta-blockers, stable CAD patients often have resting HR ≥ 70 bpm, which was associated with an overall worse health status, more frequent angina and ischemia. Further HR lowering is possible in many patients with CAD. Whether it will improve symptoms and outcomes is being tested.

  20. Transport of beta-blockers and calcium antagonists by diffusion in cat myocardium

    DEFF Research Database (Denmark)

    Haunsø, Stig; Sejrsen, Per; Svendsen, Jesper Hastrup

    1991-01-01

    Beta-blockers and calcium antagonists have been claimed to possess cardioprotective properties. This study addresses the question of whether a significant amount of these drugs will reach the cardiac myocytes during no-flow ischemia, where solute transport depends solely on diffusion. In anesthet......Beta-blockers and calcium antagonists have been claimed to possess cardioprotective properties. This study addresses the question of whether a significant amount of these drugs will reach the cardiac myocytes during no-flow ischemia, where solute transport depends solely on diffusion...

  1. Actual and prescribed energy and protein intakes for very low birth weight infants: An observational study

    Science.gov (United States)

    Allevato, Anthony J.

    Objectives: To determine (1) whether prescribed and delivered energy and protein intakes during the first two weeks of life met Ziegler's estimated requirements for Very Low Birth Weight (VLBW) infants, (2) if actual energy during the first week of life correlated with time to regain birth weight and reach full enteral nutrition (EN) defined as 100 kcal/kg/day, (3) if growth velocity from time to reach full EN to 36 weeks' postmenstrual age (PMA) met Ziegler's estimated fetal growth velocity (16 g/kg/day), and (4) growth outcomes at 36 weeks' PMA. Study design: Observational study of feeding, early nutrition and early growth of 40 VLBW infants protein (89% [3.1 g/kg/day]) were significantly less than theoretical estimated requirements. Delivered intakes were 15% less than prescribed because of numerous interruptions in delivery and medical complications. During the second week, the delivered intakes of energy (90% [86 kcal/kg/day]) and protein (102% [3.5 g/kg/day]) improved although the differences between prescribed and delivered were consistently 15%. Energy but not protein intake during the first week was significantly related to time to reach full EN. Neither energy nor protein intake significantly correlated with days to return to birth weight. The average growth velocity from the age that full EN was attained to 36 weeks' PMA (15 g/kg/day) was significantly less than the theoretical estimated fetal growth velocity (16 g/kg/day) (pintakes were consistently less than 15% of the prescribed intakes. Growth velocity between the age when full EN was achieved and 36 weeks' PMA was 6.7% lower than Ziegler's estimate. One-third to one-half of the infants have EUGR at 36 weeks' PMA.

  2. Evaluation of risk of falls and orthostatic hypotension in older, long-term topical beta-blocker users

    NARCIS (Netherlands)

    W.D. Ramdas (Wishal); N. van der Velde (Nathalie); T.J.M. van der Cammen (Tischa); R.C.W. Wolfs (Roger)

    2009-01-01

    textabstractBackground: Falls are a serious problem in the elderly, and have recently been described as cardiovascular-mediated side effects of beta-blocker eye drops. Therefore, we investigated the possible association between the long-term use of beta-blockers, prostaglandins and their combination

  3. SAFETY AND EFFICACY OF BETA-BLOCKERS IN THE TREATMENT OF STABLE ANGINA-PECTORIS

    NARCIS (Netherlands)

    DEMUINCK, ED; LIE, KI

    1990-01-01

    In stable exercise-induced angina pectoris, beta-blockers exert their beneficial effects mainly through a reduction in heart rate, blood pressure, and contractility. Additional beneficial effects are an improvement in myocardial oxygen supply through a redistribution of coronary flow, a lengthening

  4. Chronic beta-blocker treatment in patients with advanced heart failure - Effects on neurohormones

    NARCIS (Netherlands)

    Teisman, ACH; van Veldhuisen, DJ; Boomsma, F; de Kam, PJ; Pinto, YM; de Zeeuw, D; van Gilst, WH

    2000-01-01

    Background: To date, the use of beta-blockers in treating patients with chronic heart failure gains support, this since several large clinical trials reported reduced mortality after chronic beta-blockade. Part of these beneficial effects may result from inhibition of deleterious neurohormone activa

  5. Treatment with beta-blockers in nurse-led heart failure clinics

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Schou, Morten; Videbaek, Lars

    2007-01-01

    BACKGROUND: Beta-blockers (BBs) are a cornerstone in the treatment of chronic heart failure (HF), but several surveys have documented that many patients are not offered treatment or are not titrated to target doses. In part to address this problem, specialized, nurse-led HF clinics have been...

  6. Playing with Performance: The Use and Abuse of Beta-Blockers in the Performing Arts

    Science.gov (United States)

    Patston, Tim; Loughlan, Terence

    2014-01-01

    This article discusses the use of beta-blockers by performing artists, the reasons why they are taken, and the potential associated risks. We argue that there are high levels of usage within sectors of the professional performing arts community and that there may be high levels of risk in using these medications, particularly without medical…

  7. Lack of effect of beta-blocker on flat dose response to thiazide in hypertension: efficacy of low dose thiazide combined with beta-blocker.

    OpenAIRE

    1983-01-01

    Increasing the dose of a thiazide diuretic used alone in patients with essential hypertension has little further effect on blood pressure but increases the deleterious metabolic consequences of the diuretic. The effect of a beta-blocker on this flat dose response is not known. In two randomised crossover studies the effect of 12.5 mg, 25 mg, and 50 mg hydrochlorothiazide combined with 400 mg acebutolol was assessed. The mean fall in supine blood pressure was about 15% and was the same whateve...

  8. Atrial fibrillation pharmacotherapy after hospital discharge between 1995 and 2004: a shift towards beta-blockers

    DEFF Research Database (Denmark)

    Hansen, Morten Lock; Gadsbøll, Niels; Gislason, Gunnar H;

    2008-01-01

    AIMS: To study evolvement in pharmacotherapy of atrial fibrillation from 1995 to 2004. METHODS AND RESULTS: All Danish patients were discharged following first-time atrial fibrillation and their pharmacotherapy was identified by individual-level-linkage of nationwide registers of hospitalization ...... and drug dispensing from pharmacies. A total of 108 791 patients survived 30 days after discharge and were included. In 1995-1996, 7.4% of the patients received beta-blockers, increasing to 44.3% in 2003-2004. The corresponding figures for amiodarone were 2.9 and 5.4%. In contrast, use...... has changed towards increased beta-blocker use with a coincident decrease in the use of other rate-limiting drugs and sotalol. Treatment with amiodarone or class 1C antiarrhythmics remained very low. Oral anticoagulant therapy increased considerably, but women and elderly were apparently undertreated....

  9. Practical guidelines for treatment with beta-blockers and nitrates in patients with acute myocardial infarction

    OpenAIRE

    Simoons, Maarten; Serruys, Patrick; Fioretti, Paolo; Brand, Marcel; Hugenholtz, Paul

    1983-01-01

    textabstractTreatment of a patient with myocardial infarction might include opiates and sedatives to reduce pain and anxiety, heparin, antiarrhythmic drugs, diuretics which aim at improvement of myocardial function and drugs which might reduce the ischemic area at risk and thus mortality such as beta-blockers, vasodilators and possibly calcium antagonists. Obviously a selection of these and other therapeutic agents should be made for each individual patient. Guidelines for such a selection ar...

  10. Application of Beta Blockers in the Treatment of Heart Failure%β-受体阻滞剂在心力衰竭治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    唐荣华

    2014-01-01

    在对心力衰竭治疗过程中β受体阻滞剂为基本的药物。然而,在临床上怎样才能正确的应用β受体阻滞剂是对临床医生造成困扰的一个问题。优势在于心力衰竭指南能够依据循证医学证据为临床治疗提供大的治疗方向。劣势在于怎样根据患者的具体情况实施有针对性的治疗方案,这是一个非常棘手的问题。因而,临床医生对指南正确理解,同时以指南为依据结合患者临床实际情况,对β受体阻滞剂的使用情况进行有针对性的应用,这样能够使药物发挥更好的临床效果。%In the treatment of heart failure of beta blockers in the process of basic drugs.However,in clinical on how to correctly use of beta blockers is a problem caused problems for clinicians.Advantage of heart failure guidelines can according to evidence based medicine treatment direction for the clinical treatment of.The disadvantage is that how to according to the specific circumstances of patients implement targeted treatment programs,this is a very difficult problem.Thus,clinicians to guide correct understanding,at the same time to guide as the basis and combining with the actual situation of patients,the use of beta blockers for targeted applications,such clinical effects can make medicines work better.

  11. Effect of beta-blocker therapy on functional status in patients with heart failure--a meta-analysis

    DEFF Research Database (Denmark)

    Abdulla, Jawdat; Køber, Lars; Christensen, Erik

    2005-01-01

    BACKGROUND: The results of randomised control trials (RCTs) evaluating the effect of beta-blockers on functional status in patients with chronic heart failure are conflicting. AIM: To perform a systematic review and meta-analysis of RCTs evaluating the effect of beta-blockers on New York Heart...... Association (NYHA) classification and exercise tolerance in chronic heart failure. METHODS AND RESULTS: We selected 28 RCTs evaluating beta-blocker versus placebo in addition to ACE inhibitor therapy. Combined results of 23 RCTs showed that beta-blockers improved NYHA class by at least one class with odds...... ratio (OR) 1.80 (1.33-2.43) pbeta-blockers had no significant effect...

  12. Mortality and Reinfarction among Patients Using Different Beta-Blockers for Secondary Prevention after a Myocardial Infarction

    DEFF Research Database (Denmark)

    Andersen, Søren Skøtt; Hansen, Morten Lock; Gislason, Gunnar H

    2009-01-01

    Objectives: To study differences in the clinical efficacy of various brands of beta-blocker in secondary prevention after a myocardial infarction (MI). Methods: All patients hospitalized with a first MI between 1995 and 2002 who were still alive 30 days after discharge and had had at least one...... prescription for a beta-blocker filled were identified by individual-level linkage of nationwide registries of hospitalizations and drugs dispensed from pharmacies. A total of 32,259 MI patients were included in the study. Multivariable Cox proportional hazard models were used to analyze the risks of death...... and recurrent MI related to treatment with different beta-blockers. Results: The risks for death and recurrent MI were similar in patients using different beta-blockers, except that mortality from all causes among patients with a prescription for sotalol was higher. Subgroup analyses of high-risk patients...

  13. [Physiotherapy in correction of proatherogenic shifts in long-term administration of beta-blockers and thiazide diuretics].

    Science.gov (United States)

    Razumov, A N; Kniazeva, T A; Badtieva, V A

    2002-01-01

    A physiotherapeutic complex (laser therapy, dry carbon dioxide and iodine-bromine baths) addition to a course treatment with beta-blockers and thiazide diuretics produced positive changes in the levels of triglicerides, total cholesterol, beta- and alpha-cholesterol, lipid peroxidation in patients with proatherogenic shifts in the lipid spectrum and lipid peroxidation system secondary to long-term therapy with beta-blockers and thiazide diuretics, and therefore can be used for partial correction and prevention of the above shifts.

  14. Beta Blockers Suppress Dextrose-Induced Endoplasmic Reticulum Stress, Oxidative Stress, and Apoptosis in Human Coronary Artery Endothelial Cells.

    Science.gov (United States)

    Haas, Michael J; Kurban, William; Shah, Harshit; Onstead-Haas, Luisa; Mooradian, Arshag D

    Beta blockers are known to have favorable effects on endothelial function partly because of their capacity to reduce oxidative stress. To determine whether beta blockers can also prevent dextrose-induced endoplasmic reticulum (ER) stress in addition to their antioxidative effects, human coronary artery endothelial cells and hepatocyte-derived HepG2 cells were treated with 27.5 mM dextrose for 24 hours in the presence of carvedilol (a lipophilic beta blockers with alpha blocking activity), propranolol (a lipophilic nonselective beta blockers), and atenolol (a water-soluble selective beta blockers), and ER stress, oxidative, stress and cell death were measured. ER stress was measured using the placental alkaline phosphatase assay and Western blot analysis of glucose regulated protein 78, c-Jun-N-terminal kinase (JNK), phospho-JNK, eukaryotic initiating factor 2α (eIF2α), and phospho-eIF2α and measurement of X-box binding protein 1 (XBP1) mRNA splicing using reverse transcriptase-polymerase chain reaction. Superoxide (SO) generation was measured using the superoxide-reactive probe 2-methyl-6-(4-methoxyphenyl)-3,7-dihydroimidazo[1,2-A]pyrazin-3-one hydrochloride (MCLA) chemiluminescence. Cell viability was measured by propidium iodide staining method. The ER stress, SO production, and cell death induced by 27.5 mM dextrose were inhibited by all 3 beta blockers tested. The antioxidative and ER stress reducing effects of beta blockers were also observed in HepG2 cells. The salutary effects of beta blockers on endothelial cells in reducing both ER stress and oxidative stress may contribute to the cardioprotective effects of these agents.

  15. Ozonation of reverse osmosis concentrate: kinetics and efficiency of beta blocker oxidation.

    Science.gov (United States)

    Benner, Jessica; Salhi, Elisabeth; Ternes, Thomas; von Gunten, Urs

    2008-06-01

    Reverse osmosis (RO) concentrate samples were obtained from a RO-membrane system that uses effluents of wastewater treatment plants (WWTP) as feed water for the production of drinking water. A number of different pharmaceuticals (e.g. antibiotics, contrast media, beta blockers) were found in the WWTP effluent as well as in the RO-concentrate. Overall, a concentration factor (feed:concentrate) of approximately 3-4 was measured. Beta blockers (acebutolol, atenolol, bisoprolol, celiprolol, metoprolol, propranolol, timolol) were found in the range of low ng/L to low microg/L. Because metoprolol and propranolol are classified as potentially toxic to aquatic organisms and all beta blocker molecules have moieties, which are reactive towards ozone (amine groups, activated aromatic rings), it was tested whether ozonation can be applied for their mitigation. Rate constants for the reaction of acebutolol, atenolol, metoprolol and propranolol with ozone and OH radicals were determined. At pH 7 acebutolol, atenolol and metoprolol react with ozone with an apparent second-order rate constant k(O)(3) of about 2,000 M(-1)s(-1), whereas propranolol reacts with approximately 10(5)M(-1)s(-1). The rate constants for the reaction of the selected compounds with OH radicals were determined to be 0.5-1.0 x 10(10)M(-1)s(-1). Experiments with RO concentrate showed that an ozone dose of only 5mg/L resulted in a quantitative removal of propranolol in 0.8s and 10mg O(3)/L oxidized 70% of metoprolol in only 1.2s. Tests with chlorinated and non-chlorinated WWTP effluent showed an increase of ozone stability but a decrease of hydroxyl radical exposure in the samples after chlorination. This may shift the oxidation processes towards direct ozone reactions and favor the degradation of compounds with high k(O)(3).

  16. Leukocyte redistribution: effects of beta blockers in patients with chronic heart failure.

    Directory of Open Access Journals (Sweden)

    Stephan von Haehling

    Full Text Available BACKGROUND: Overproduction of pro-inflammatory cytokines is a well established factor in the progression of chronic heart failure (CHF. Changes in cellular immunity have not been widely studied, and the impact of standard medication is uncertain. Here we investigate whether a leukocyte redistribution occurs in CHF and whether this effect is influenced by beta-blocker therapy. METHODOLOGY: We prospectively studied 75 patients with systolic CHF (age: 68+/-11 years, left ventricular ejection fraction 32+/-11%, New York Heart Association class 2.5+/-0.7 and 20 age-matched healthy control subjects (age: 63+/-10 years. We measured the response of cells to endotoxin exposure in vitro, analysed subsets of lymphocytes using flow cytometry, and assessed plasma levels of the pro-inflammatory markers interleukin 1, 6, tumor necrosis factor-alpha, and soluble tumor necrosis factor receptors 1 and 2. PRINCIPAL FINDINGS: While no differences in the number of leukocytes were noted between patients with CHF and healthy controls, we detected relative lymphopenia in patients with CHF (p<0.001 vs. control, mostly driven by reductions in T helper cells and B cells (both p<0.05. The number of neutrophils was increased (p<0.01. These effects were pronounced in patients who were beta-blocker naïve (32% of all patients with CHF. Increased plasma levels of soluble tumor necrosis receptor-1 correlated with the relative number of lymphocyte subsets. CONCLUSIONS: In patients with CHF, we detected a redistribution of leukocyte subsets, i.e. an increase in neutrophils with relative lymphopenia. These effects were pronounced in patients who were beta-blocker naïve. The underlying mechanism remains to be elucidated.

  17. [Treatment of arrhythmia in coronary patients and hypertensives with beta blockers and Depasan retard].

    Science.gov (United States)

    Kandziora, J

    1981-05-14

    In the ambulatory of an internal specialist a number of patients suffering from angina pectoris or hypertonia together with arrhythmic troubles received an initial treatment with beta-blockers over a period of 21 days. In cases in which arrhythmia persisted after this initial period the treatment was continued for another 21 days with the addition of Depasan retard in function of a second medicament. This combined treatment in form of an open study was extended to a total number of 50 patients presenting ventricular extrasystolia in 45 cases and in 5 cases absolute arrhythmia in addition to the main disease. Treatment with Depasan retard showed good or satisfactory results in 39 out of 45 patients suffering from ventricular extrasystoles, whilst no effect could be obtained in the 5 cases with absolute arrhythmia. No signs of incompatibility or unwanted interactions were observed in the course of this open study. Based on these results it can be concluded that Depasan retard should be recommended in those cases where on account of persistent arrhythmical troubles and especially extrasystoles, during a treatment with beta-blockers in patients suffering from angina pectoris or hypertonia, and additional treatment with anti-arrhythmical medicaments appears to be indicated.

  18. Treatment with oral beta-blockers during pregnancy complicated by maternal heart disease increases the risk of fetal growth restriction

    DEFF Research Database (Denmark)

    Ersbøll, A S; Hedegaard, M; Søndergaard, L

    2014-01-01

    OBJECTIVE: To investigate the effect on fetal growth of treatment with oral beta-blockers during pregnancy in women with congenital or acquired heart disease. DESIGN: Historical matched cohort study. SETTING: Centre for Pregnant Women with Heart Disease, Copenhagen University Hospital, Denmark....... POPULATION: A cohort of 175 women with heart disease, grouped according to beta-blocker treatment, and a cohort of 627 women from the overall population matched on seven birthweight-determining factors. METHODS: Differences between groups were tested by simple descriptive statistics and assessed using...... standard hypothesis tests. Associations were estimated by correlational analysis and multivariable regression. MAIN OUTCOME MEASURE: Proportion of infants born small for gestational age (SGA). RESULTS: More of the infants exposed to beta-blockers were SGA compared with non-exposed infants (29.4 versus 15...

  19. The effects of beta-blockers on dobutamine-atropine stress echocardiography: early protocol versus standard protocol

    Directory of Open Access Journals (Sweden)

    Weitzel Luis H

    2006-07-01

    Full Text Available Abstract Background To study the effects of Beta-blockers during Dobutamine Stress Echocardiography (DSE comparing the hemodynamic benefits of an early administration of atropine in patients taking or not Beta-blockers. Methods One hundred and twenty-one patients were submitted to dobutamine stress echocardiography for the investigation of myocardial ischemia. The administration of atropine was randomized into two groups: A or B (early protocol when atropine was administered at 10 and 20 mcg/kg/min of dobutamine, respectively and C (standard protocol with atropine at 40 mcg/kg/min of dobutamine. Analysis of the effects of Beta-blockers was done regarding the behavior pattern of heart rate and blood pressure, test time, number of conclusive and inconclusive (negative sub-maximum test results, total doses of atropine and dobutamine, and general complications. Results Beta-blocked patients who received early atropine (Group A&B had a significantly lower double product (p = 0.008, a higher mean test time (p = 0.010 and required a higher dose of atropine (p = 0.0005 when compared to the patients in this group who were not Beta-blocked. The same findings occurred in the standard protocol (Group C, however the early administration of atropine reduced test time both in the presence and absence of this therapy (p = 0.0001. The patients with Beta-blockers in Group A&B had a lower rate of inconclusive tests (26% compared to those in Group C (40%. Complications were similar in both groups. Conclusion The chronotropic response during dobutamine stress echocardiography was significantly reduced with the use of Beta-blockers. The early administration of atropine optimized the hemodynamic response, reduced test time in patients with or without Beta-blockers and reduced the number of inconclusive tests in the early protocol.

  20. ACT-ONE - ACTION at last on cancer cachexia by adapting a novel action beta-blocker.

    Science.gov (United States)

    Lainscak, Mitja; Laviano, Alessandro

    2016-09-01

    Novel action beta-blockers combine many different pharmacological effects. The espindolol exhibits effects through β and central 5-HT1α receptors to demonstrate pro-anabolic, anti-catabolic, and appetite-stimulating actions. In the ACT-ONE trial, espindolol reversed weight loss and improved handgrip strength in patients with cachexia due to non-small cell lung cancer or colorectal cancer. With this trial, another frontier of cachexia management is in sight. Nonetheless, more efficacy and safety data is needed before new therapeutic indications for novel action beta-blockers can be endorsed.

  1. Effectiveness of beta-blocker therapy in daily practice patients with advanced chronic heart failure; is there an effect-modification by age?

    NARCIS (Netherlands)

    Dobre, D.; deJongste, M.J.L.; Lucas, C.; Cleuren, G.; van Veldhuisen, D.J.; Ranchor, A.V.; Haaijer-Ruskamp, F.

    2007-01-01

    Aims The effects of beta-blockers in daily practice patients with advanced chronic heart failure (CHF) and a broad range of ejection fraction (EF) are not well established. We aimed to assess, first, the association between beta-blocker prescription at discharge and mortality in a cohort of patients

  2. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning.

    Science.gov (United States)

    Engebretsen, Kristin M; Kaczmarek, Kathleen M; Morgan, Jenifer; Holger, Joel S

    2011-04-01

    INTRODUCTION. High-dose insulin therapy, along with glucose supplementation, has emerged as an effective treatment for severe beta-blocker and calcium channel-blocker poisoning. We review the experimental data and clinical experience that suggests high-dose insulin is superior to conventional therapies for these poisonings. PRESENTATION AND GENERAL MANAGEMENT. Hypotension, bradycardia, decreased systemic vascular resistance (SVR), and cardiogenic shock are characteristic features of beta-blocker and calcium-channel blocker poisoning. Initial treatment is primarily supportive and includes saline fluid resuscitation which is essential to correct vasodilation and low cardiac filling pressures. Conventional therapies such as atropine, glucagon and calcium often fail to improve hemodynamic status in severely poisoned patients. Catecholamines can increase blood pressure and heart rate, but they also increase SVR which may result in decreases in cardiac output and perfusion of vascular beds. The increased myocardial oxygen demand that results from catecholamines and vasopressors may be deleterious in the setting of hypotension and decreased coronary perfusion. METHODS. The Medline, Embase, Toxnet, and Google Scholar databases were searched for the years 1975-2010 using the terms: high-dose insulin, hyperinsulinemia-euglycemia, beta-blocker, calcium-channel blocker, toxicology, poisoning, antidote, toxin-induced cardiovascular shock, and overdose. In addition, a manual search of the Abstracts of the North American Congress of Clinical Toxicology and the Congress of the European Association of Poisons Centres and Clinical Toxicologists published in Clinical Toxicology for the years 1996-2010 was undertaken. These searches identified 485 articles of which 72 were considered relevant. MECHANISMS OF HIGH-DOSE INSULIN BENEFIT. There are three main mechanisms of benefit: increased inotropy, increased intracellular glucose transport, and vascular dilatation. EFFICACY OF HIGH

  3. Removal of beta-blockers from aqueous media by adsorption onto graphene oxide

    Energy Technology Data Exchange (ETDEWEB)

    Kyzas, George Z. [Laboratory of Polymer Chemistry and Technology, Department of Chemistry, Aristotle University of Thessaloniki, GR-541 24 Thessaloniki (Greece); Koltsakidou, Anastasia [Laboratory of Environmental Pollution Control, Department of Chemistry, Aristotle University of Thessaloniki, GR–541 24 Thessaloniki (Greece); Nanaki, Stavroula G.; Bikiaris, Dimitrios N. [Laboratory of Polymer Chemistry and Technology, Department of Chemistry, Aristotle University of Thessaloniki, GR-541 24 Thessaloniki (Greece); Lambropoulou, Dimitra A., E-mail: dlambro@chem.auth.gr [Laboratory of Environmental Pollution Control, Department of Chemistry, Aristotle University of Thessaloniki, GR–541 24 Thessaloniki (Greece)

    2015-12-15

    The aim of the present study is the evaluation of graphene oxide (GhO) as adsorbent material for the removal of beta-blockers (pharmaceutical compounds) in aqueous solutions. The composition and morphology of prepared materials were characterized by scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR). Atenolol (ATL) and propranolol (PRO) were used as model drug molecules and their behavior were investigated in terms of GhO dosage, contact time, temperature and pH. Adsorption mechanisms were proposed and the pH-effect curves after adsorption were discussed. The kinetic behavior of GhO-drugs system was analyzed after fitting to pseudo-first and -second order equations. The adsorption equilibrium data were fitted to Langmuir, Freundlich and Langmuir–Freundlich model calculating the maximum adsorption capacity (67 and 116 mg/g for PRO and ATL (25 °C), respectively). The temperature effect on adsorption was tested carrying out the equilibrium adsorption experiments at three different temperatures (25, 45, 65 °C). Then, the thermodynamic parameters of enthalpy, free energy and entropy were calculated. Finally, the desorption of drugs from GhO was evaluated by using both aqueous eluants (pH 2–10) and organic solvents. - Highlights: • Removal of beta-blockers by graphene oxide (GhO) from aqueous samples • Detailed adsorbent characterization and adsorption studies • Kinetic studies are performed and adsorption isotherms are determined and modeled. • GhO was proved to be an effective adsorbent for removal of atenolol and propranolol.

  4. Beta-Blockers and Outcome in Heart Failure and Atrial Fibrillation A Meta-Analysis : a meta-analysis

    NARCIS (Netherlands)

    Rienstra, Michiel; Damman, Kevin; Mulder, Bart A.; Van Gelder, Isabelle C.; McMurray, John J. V.; Van Veldhuisen, Dirk J.

    2013-01-01

    Objectives The purpose of this study was to analyze the effect of beta blockade on outcome in patients with heart failure (HF) and atrial fibrillation (AF). Background Beta-blockers are widely used in patients with HF and AF. Recommendation in current HF guidelines, however, is based on populations

  5. Is heart rate reduction more important than target dose in chronic heart failure therapy with a beta-blocker?

    Institute of Scientific and Technical Information of China (English)

    Yong-Fang Guo; Yi An

    2011-01-01

    1 IntroductionBeta-adrenoceptor blocking agents (beta-blockers) are now well established as cornerstone therapy in patients with systolic chronic heart failure (CHF).[1] Clinical data have overwhelmingly proven the beneficial effects of beta-blocker therapy in terms of improving patient prognosis,decreasing requirements for hospitalization,and postponing disease progression.[2-4] However,it remains unclear what the optimal efficacious and safe dose for an individual patient with CHF is,and whether this can simply be inferred from the target dose for each beta-blocking agent as used in the major clinical trials.Beta-blockers are a heterogeneous class of drugs,and due to the polymorphisms of beta-adrenoceptor gene expression,there is marked individual variation in responsiveness to specific agents.[5] If pharmacodynamic markers of responsiveness to beta-blockade (such as heart rate (HR) reduction) are more important than the achievement of a target dose,could they become another potential therapeutic target in beta-blocker therapy? We provide a discussion of the question in this article.

  6. The period between beta-blocker use and physical activity changes training heart rate behavior

    Directory of Open Access Journals (Sweden)

    Naiane Ferraz Bandeira Alves

    2009-12-01

    Full Text Available The Brazilian Society of Cardiology (SBC proposes that hypertensive subjects who use beta-blockers and practice physical exercises must have their training heart rate (HR corrected due to the negative chronotropic effect of this drug. Nevertheless, if the physical activity is performed outside of plasmatic half-life, correction may not be necessary. This study investigated the exercise chronotropic response both inside and outside the beta-blocker plasmatic half-life. Nine subjects in use of atenolol or propranolol, and six controls, carried out three walking sessions in three days according to different schedules: EX2 (two hours after drug administration, at the plasmatic peak; EX11 (eleven hours after drug administration, at the end of plasmatic half-life; and EX23 (twenty-three hours after drug administration, outside the plasmatic half-life. The walking sessions were performed on an ergometric treadmill and HR was monitored by a heart rate monitor. During the exercises, mean HRs were 97.2, 108.4 and 109 for EX2, EX11 and EX23, respectively, with the value for EX2 statistically lower than the others (p0.05. The study concludes that the attenuation of the positive chronotropic response which occurs during exercise in subjects using beta-blockers, is less evident when the exercise is performed outside the plasmatic half-life of the drug.A Sociedade Brasileira de Cardiologia (SBC propõe que os hipertensos que utilizam beta-bloqueadores e praticam exercícios físicos devem ter sua frequência cardíaca de treinamento (HR corrigida devido ao efeito cronotrópico negativo desse fármaco. Contudo, se a atividade física é realizada fora da meia-vida plasmática do fármaco, a correção pode não ser necessária. Este estudo investigou a resposta cronotrópica ao exercício dentro e fora da meia-vida plasmática do beta-bloqueador. Nove indivíduos que usavam atenolol ou propranolol e seis controles, efetuaram três sessões de caminhada em tr

  7. Removal of beta-blockers from aqueous media by adsorption onto graphene oxide.

    Science.gov (United States)

    Kyzas, George Z; Koltsakidou, Anastasia; Nanaki, Stavroula G; Bikiaris, Dimitrios N; Lambropoulou, Dimitra A

    2015-12-15

    The aim of the present study is the evaluation of graphene oxide (GhO) as adsorbent material for the removal of beta-blockers (pharmaceutical compounds) in aqueous solutions. The composition and morphology of prepared materials were characterized by scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR). Atenolol (ATL) and propranolol (PRO) were used as model drug molecules and their behavior were investigated in terms of GhO dosage, contact time, temperature and pH. Adsorption mechanisms were proposed and the pH-effect curves after adsorption were discussed. The kinetic behavior of GhO-drugs system was analyzed after fitting to pseudo-first and -second order equations. The adsorption equilibrium data were fitted to Langmuir, Freundlich and Langmuir-Freundlich model calculating the maximum adsorption capacity (67 and 116 mg/g for PRO and ATL (25 °C), respectively). The temperature effect on adsorption was tested carrying out the equilibrium adsorption experiments at three different temperatures (25, 45, 65 °C). Then, the thermodynamic parameters of enthalpy, free energy and entropy were calculated. Finally, the desorption of drugs from GhO was evaluated by using both aqueous eluants (pH2-10) and organic solvents.

  8. A comparative ex vivo drug permeation study of beta-blockers through porcine buccal mucosa.

    Science.gov (United States)

    Amores, Sonia; Lauroba, Jacinto; Calpena, Ana; Colom, Helena; Gimeno, Alvaro; Domenech, José

    2014-07-01

    Apparent permeability coefficients (kp) of a series of beta-blockers: acebutolol, atenolol, labetalol, metoprolol, oxprenolol and propranolol, through porcine buccal mucosa were determined. The aim of the study was to determine the permeation parameters (apparent permeability coefficient, kp; flux, J; and lag time, TL) as a measure of the intrinsic permeability of porcine buccal mucosa to these drugs, in order to predict the efficacy of their possible administration through human buccal mucosa. A positive linear correlation was observed between the apparent permeability coefficient, kpand the partition coefficient, P. Oxprenolol and propranolol are the drugs that presented the highest values of kp: 0.3231×10(2) cm/h and 0.5666×10(2) cm/h, respectively. Multiple linear regression (MLR) using least square estimation was performed on the data set with logkpas dependent variable and the descriptors as predictor variables. The potential systemic capacity after a buccal administration was predicted by estimating the plasma concentrations at steady-stated (Css). Considering the entire process of permeation ex vivo, propranolol and oxprenolol would seem to be the best candidates for administration through the buccal mucosa.

  9. Management of Agitation Following Aneurysmal Subarachnoid Hemorrhage: Is There a Role for Beta-Blockers?

    Directory of Open Access Journals (Sweden)

    Fayaz Ibrahim

    2012-01-01

    Full Text Available Introduction. Stroke is a leading cause of mortality and morbidity in the United States. About 20% of the stroke is hemorrhagic and about 50% of these is due to aneurysmal subarachnoid hemorrhage. A troublesome neuropsychiatric complication of subarachnoid hemorrhage is agitation/aggression. Case Presentation. A 45-year-old man with no prior psychiatric history, sustained subarachnoid hemorrhage. After initial stabilization for 2 days, he underwent craniotomy and clipping of anterior cerebral communicating artery aneurysm. Treatment was continued with labetalol, nimodipine, and levetiracetam. Beginning postoperative day 4, patient developed episodes of confusion and agitation/aggression. Switching of Levetiracetam to valproate did not show any improvement. Psychiatry team tried to manage him with intense nursing intervention and different medications like olanzapine, valproate, lorazepam, and haloperidol. However, patient continued to be agitated and aggressive. Switching from labetalol to metoprolol resulted in dramatic improvement within 3 days. Discussion. Antipsychotics and benzodiazepines are often not sufficiently effective in the control of agitation/aggression in patients with traumatic brain injury and similar conditions. Our case report and the literature review including a cochrane review suggests that beta-blockers may be helpful in this situation.

  10. Dose dependent effect of statins on postoperative atrial fibrillation after cardiac surgery among patients treated with beta blockers

    Directory of Open Access Journals (Sweden)

    Kelly Rosemary F

    2009-11-01

    Full Text Available Abstract Background Previous studies on the effects of Statins in preventing atrial fibrillation (AF after cardiac surgery have shown conflicting results. Whether statins prevent AF in patients treated with postoperative beta blockers and whether the statin-effect is dose related are unknown. Methods We retrospectively studied 1936 consecutive patients who underwent coronary artery bypass graft (CABG (n = 1493 or valve surgery (n = 443 at the Minneapolis Veterans Affairs Medical Center. All patients were in sinus rhythm before the surgery. Postoperative beta blockers were administered routinely (92% within 24 hours postoperatively. Results Mean age was 66+10 years and 68% of the patients were taking Statins. Postoperative AF occurred in 588 (30% patients and led to longer length of stay in the intensive care unit versus those without AF (5.1+7.6 days versus 2.5+2.3 days, p 20 mg daily had a 36% reduction in the risk of postoperative AF (OR 0.64, 95% CI 0.43 to 0.6; p = 0.03 in comparison to those taking lower dosages. Conclusion Among cardiac surgery patients treated with postoperative beta blockers Statin treatment reduces the incidence of postoperative AF when used at higher dosages

  11. Efficacy of beta-blocker therapy in symptomatic athletes with exercise-induced intra-ventricular gradients

    Directory of Open Access Journals (Sweden)

    Cotrim Carlos

    2010-09-01

    Full Text Available Abstract Background Upright exercise stress echocardiography (SE induces significant intraventricular gradient (IVG and systolic anterior motion (SAM in a large proportion of symptomatic athletes, who may therefore benefit from a negative inotropic therapy. The purpose of the present study was to assess the effect of chronic oral β blocker therapy on the occurrence of exercise-induced IVG and mitral valve SAM, in symptomatic athletes. Methods We enrolled 35 symptomatic athletes (age = 23 ± 11 years with IVG (>30 mmHg during SE off therapy. All repeated SE on chronic oral beta-blocker therapy (atenolol up to 50 mg, bisoprolol up to 10 mg, or metoprolol up to 100 mg daily according to physician-driven choice. Results On therapy, there was during SE a reduction in IVG (35 off vs 17 on beta blocker, p Conclusions In athletes with positive screening on medical evaluation for sports practice and IVG on exertion, treatment with oral beta blockers improved symptoms in the large majority of patients. Symptomatic benefit was mirrored by objective evidence of improvement of echocardiographic signs of obstruction (IVG and SAM and reduction of ischemia-like electrocardiographic changes.

  12. Nationwide trends in the prescription of beta-blockers and angiotensin-converting enzyme inhibitors after myocardial infarction in Denmark, 1995-2002

    DEFF Research Database (Denmark)

    Gislason, Gunnar H; Abildstrom, Steen Z; Rasmussen, Jeppe N

    2005-01-01

    pharmacies within 30 d from discharge was obtained from the National Patient Registry and the Danish Registry of Medicinal Product Statistics. RESULTS: Beta-blocker use increased from 38.1% of patients in 1995 to 67.9% in 2002 (OR = 3.85, CI: 3.58-4.13). Women, elderly patients and patients taking loop......OBJECTIVES: To study the use of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors after acute myocardial infarction (AMI) in Denmark from 1995 to 2002. DESIGN: Information about patients with first AMI aged > or = 30 years and the dispensing of beta-blockers and ACE inhibitors from......-diuretics received ACE inhibitors less frequently, but patients not taking loop-diuretics had the greatest increase. CONCLUSIONS: Beta-blocker use increased markedly post-AMI from 1995 to 2002, whereas ACE inhibitor use increased modestly. The results suggested undertreatment of women, elderly patients and people...

  13. Meta-analysis of randomized controlled trials on magnesium in addition to beta-blocker for prevention of postoperative atrial arrhythmias after coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Wu Xiaosan

    2013-01-01

    Full Text Available Abstract Background Atrial arrhythmia (AA is the most common complication after coronary artery bypass grafting (CABG. Only beta-blockers and amiodarone have been convincingly shown to decrease its incidence. The effectiveness of magnesium on this complication is still controversial. This meta-analysis was performed to evaluate the effect of magnesium as a sole or adjuvant agent in addition to beta-blocker on suppressing postoperative AA after CABG. Methods We searched the PubMed, Medline, ISI Web of Knowledge, Cochrane library databases and online clinical trial database up to May 2012. We used random effects model when there was significant heterogeneity between trials and fixed effects model when heterogeneity was negligible. Results Five randomized controlled trials were identified, enrolling a total of 1251 patients. The combination of magnesium and beta-blocker did not significantly decrease the incidence of postoperative AA after CABG versus beta-blocker alone (odds ratio (OR 1.12, 95% confidence interval (CI 0.86-1.47, P = 0.40. Magnesium in addition to beta-blocker did not significantly affect LOS (weighted mean difference −0.14 days of stay, 95% CI −0.58 to 0.29, P = 0.24 or the overall mortality (OR 0.59, 95% CI 0.08-4.56, P = 0.62. However the risk of postoperative adverse events was higher in the combination of magnesium and beta-blocker group than beta-blocker alone (OR 2.80, 95% CI 1.66-4.71, P = 0.0001. Conclusions This meta-analysis offers the more definitive evidence against the prophylactic administration of intravenous magnesium for prevention of AA after CABG when beta-blockers are routinely administered, and shows an association with more adverse events in those people who received magnesium.

  14. Impact of an acute coronary syndrome pathway in achieving target heart rate and utilization of evidence-based doses of beta-blockers.

    Science.gov (United States)

    Irani, Farzan; Herial, Nabeel; Colyer, William R

    2012-11-01

    Beta-blockers remain a cornerstone of therapy in the management of acute coronary syndrome (ACS). The 2007 American College of Cardiology/American Heart Association unstable angina/non-ST elevation myocardial infarction guideline revisions recommend a target heart rate (HR) of 50-60 beats per minute (bpm). Despite improved trends toward utilization of beta-blockers therapy, beta-blockers continue to be underdosed. Guideline-based tools have been shown to improve adherence to evidence-based therapy in patients with ACS. Implementation of a standardized ACS pathway would lead to titration of beta-blockers to recommended dosages with improved HRs in eligible patients. The ACS clinical protocol was implemented at the University of Toledo Medical Center in May 2007. A retrospective study of 516 patients admitted during a comparable 6-month period, before and after the institution of the protocol, was conducted. The preprotocol and protocol group included 237 and 279 patients, respectively. Patient information extracted from the medical records included age, gender, HR on admission, blood pressure on admission, duration of hospital stay, preadmission use of beta-blocker, type of beta-blocker and dosage, discharge beta-blocker and dosage, peak troponin levels, and therapeutic intervention. A target HR of less than 60 bpm was achieved in 19% of the protocol group, as compared with 6% in the preprotocol group (P metoprolol in the protocol group was noted to be significantly higher (118 vs. 80 mg/d; P < 0.001). The institution of an ACS clinical pathway led to utilization of beta-blockers in significantly higher dosages, resulting in improved HR control and increased attainment of target HR.

  15. A Review of the External Validity of Clinical Trials with Beta-Blockers in Heart Failure

    Science.gov (United States)

    Iyngkaran, Pupalan; Toukhsati, Samia R.; Thomas, Merlin C.; Jelinek, Michael V.; Hare, David L.; Horowitz, John D.

    2016-01-01

    BACKGROUND Beta-blockers (BBs) are the mainstay prognostic medication for all stages of chronic heart failure (CHF). There are many classes of BBs, each of which has varying levels of evidence to support its efficacy in CHF. However, most CHF patients have one or more comorbid conditions such as diabetes, renal impairment, and/or atrial fibrillation. Patient enrollment to randomized controlled trials (RCTs) often excludes those with certain comorbidities, particularly if the symptoms are severe. Consequently, the extent to which evidence drawn from RCTs is generalizable to CHF patients has not been well described. Clinical guidelines also underrepresent this point by providing generic advice for all patients. The aim of this review is to examine the evidence to support the use of BBs in CHF patients with common comorbid conditions. METHODS We searched MEDLINE, PubMed, and the reference lists of reviews for RCTs, post hoc analyses, systematic reviews, and meta-analyses that report on use of BBs in CHF along with patient demographics and comorbidities. RESULTS In total, 38 studies from 28 RCTs were identified, which provided data on six BBs against placebo or head to head with another BB agent in ischemic and nonischemic cardiomyopathies. Several studies explored BBs in older patients. Female patients and non-Caucasian race were underrepresented in trials. End points were cardiovascular hospitalization and mortality. Comorbid diabetes, renal impairment, or atrial fibrillation was detailed; however, no reference to disease spectrum or management goals as a focus could be seen in any of the studies. In this sense, enrollment may have limited more severe grades of these comorbidities. CONCLUSIONS RCTs provide authoritative information for a spectrum of CHF presentations that support guidelines. RCTs may provide inadequate information for more heterogeneous CHF patient cohorts. Greater Phase IV research may be needed to fill this gap and inform guidelines for a more

  16. Pathophysiological targets for beta-blocker therapy in congestive heart failure.

    Science.gov (United States)

    Just, H

    1996-04-01

    The treatment of congestive heart failure has seen considerable changes: while treatment with diuretics, digitalis glycosides and vasodilators has remained the mainstay of therapy, recently neurohumeral inhibition has been developed as an important principle: ACE-inhibitors have been shown to significantly improve quality of life and exercise performance and to substantially reduce mortality. Beta-blockers have been employed with increasing success mainly in congestive heart failure due to dilated idiopathic cardiomyopathy, in which a significant improvement in symptoms and life expectancy has been demonstrated. However, the precise mechanisms by which beta-blockade improves congestive heart failure remain to be elucidated. In addition to direct sympathoadrenal inhibition, reduction of heart rate may also play a major role in the therapeutic efficacy of beta-blockade in congestive heart failure. In the normal human heart increase in heart rate is accompanied by an increase in myocardial contractile performance (Bowditch-Treppe phenomenon). In chronic heart failure the myocardium undergoes a phenotype change which includes alterations of the activity of enzymes regulating calcium homoeostasis. The sarcoplasmic reticulum calcium ATPase (SERCA) is depressed both in function, as well as in expression. At the same time the sarcolemmal sodium-calcium exchanger is increased both in function and in expression. The result is a characteristic change in calcium homoeostasis with decreased diastolic uptake of calcium into the sarcoplasmic reticulum with subsequently reduced calcium release during the next systole, resulting in reduced contractile performance. At the same time increased capacity of the sodium-calcium exchanger extrudes intracellular calcium ions to the extra-cellular space, thereby rendering these ions unavailable for the contractile cycle. A result of these, seemingly specific, phenotype changes is an alteration of the force/frequency relationship. Instead of

  17. The influence of radiation sterilisation on some {beta}-blockers in the solid state

    Energy Technology Data Exchange (ETDEWEB)

    Marciniec, B. [Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Gruwaldzka Str., 60-780 Poznan (Poland); Ogrodowczyk, M., E-mail: mogrodo@ump.edu.pl [Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Gruwaldzka Str., 60-780 Poznan (Poland); Czajka, B.; Hofman, M. [Department of Cooridinational Chemistry, A. Mickiewicz University, Grunwaldzka 6, 60-780 Poznan (Poland)

    2011-02-20

    Research highlights: {yields} Six {beta}-blockers (acebutolol, alprenolol, atenolol, metoprolol, pindolol, propranolol) in solid phase were exposed to the ionising radiation by e-beam in doses from 25 to 400 kGy. {yields} To establish the effects of irradiation on their physico-chemical properties, the compounds were then analysed by DSC, SEM, XRD and FT-IR. {yields} For alprenolol, propranolol and metoprolol linear relations were found between the irradiation dose and the decrease in the melting point (r = 0.9446-0.9864). {yields} No changes were observed in the FT-IR spectra and in the SEM images of the compounds studied. - Abstract: Six derivatives of aryloxyalkylaminopropanol of known {beta}-adrenolytic activity (acebutolol, alprenolol, atenolol, metoprolol, pindolol, propranolol) in solid phase were exposed to the ionising radiation generated by e-beam of high-energy electrons from an accelerator ({approx}10 MeV) in doses from 25 to 400 kGy. To establish the effects of irradiation on their physico-chemical properties, the compounds were then analysed by differential scanning calorimetry (DSC), scanning electron microscope (SEM), X-ray diffraction (XRD) and FT-IR spectrometry. The standard sterilisation dose (25 kGy) was found to cause no changes in only one derivative - acebutolol, whereas in the other derivatives the irradiation caused colour changes, differences in X-ray diffraction patterns and in the character of DSC curves, including a decrease in the melting point. For each derivative one clear peak corresponding to the process of melting was observed and its position shifted towards lower temperatures with increasing dose of irradiation. For all compounds studied the value of the shift was between 0.1 and 1.0 {sup o}C. For alprenolol, propranolol and metoprolol linear relations were found between the irradiation dose and the decrease in the melting point, described by the correlation coefficient (between 0.9446 and 0.9864). No changes were observed in

  18. Withholding or Continuing Beta-Blocker Treatment Before Dipyridamole Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease? a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Babak Fallahi

    2013-01-01

    Full Text Available Although it has been shown that acute beta-blocker administration may reduce the presence or severity of myocardial perfusion defects with dipyridamole stress, little information is available about the potential effect of chronic beta-blocker treatment on the sensitivity of dipyridamole myocardial perfusion imaging (DMPI.Methods As a randomized clinical trial, one hundred twenty patients (103 male and 17 female with angiographically confirmed CAD who were on long-term beta blocker therapy ([greater than or equal to]3 months enrolled in a randomized clinical trial study. The patients were allocated into two groups: Group A (n=60 in whom the beta-blocker agent was discontinued for 72h before DMPI and Group B (n=60 without discontinuation of beta-blockers prior to DMPI.ResultsNo significant difference was noted between the groups concerning age, sex, type of the injected radiotracer and number of involved coronary vessels. The mean rank of total perfusion scores for whole myocardium (irrespective of reversibility or irreversibility in group B was not significantly different from that of group A, (65.75 vs. 55.25, P=0.096. Regarding the only irreversible perfusion defects, the mean rank of perfusion score in group B was higher than that of group A for whole myocardium (72 vs. 49, P=0.0001; however, no difference was noted between two groups for only reversible perfusion defects (61.0 vs. 60.0, P=0.898. The overall sensitivity of DMPI for the diagnosis of CAD in group A (91.7% was not statistically different from group B (90%.ConclusionBeta-blocker withholding before DMPI did not generally affect the sensitivity of the test for the diagnostic purposes in our study. Thus, beta-blocker withdrawal for just the purpose of diagnostic imaging is not mandatory particularly when medication discontinuation may cause the patients to face increased risk of heart events.

  19. Beta-blocker therapy in patients with left ventricular systolic dysfunction and chronic obstructive lung disease in an ambulatory care setting

    Directory of Open Access Journals (Sweden)

    Billups SJ

    2009-12-01

    Full Text Available Objective: To evaluate beta blocker persistence six months after beta-blocker initiation or dose titration in heart failure (HF patients with COPD compared to those without COPD. Secondary objectives included comparison of beta-blocker dose achieved, changes in left ventricular ejection fraction (LVEF and incidence of hospitalizations or emergency department (ED visits during follow-up.Methods: We conducted a matched, retrospective, cohort study including 86 patients with COPD plus concomitant HF (LVEF ≤40% and 137 patients with HF alone. All patients were followed in an outpatient HF clinic. Eligible patients had a documented LVEF ≤40% and were initiated or titrated on a beta-blocker in the HF clinic. Patients were matched based on LVEF (categorized as ≤ 20% or 21-40%, gender, and age (> or ≤70 years. The primary outcome was beta blocker persistence at 6 months. Secondary outcomes were dose achieved, LVEF, and incidence of hospitalizations or ED visits. Results: There were no differences between the COPD and non-COPD groups in beta-blocker persistence at six-month follow-up (94.2% vs. 93.4% respectively, adjusted p=0.842. The proportion of patients who achieved a daily metoprolol dose equivalent of at least 100 mg was similar between the groups (adjusted p=0.188. The percent of patients with at least one ED visit or hospitalization in the six-month post-titration period was substantial but similar between the groups (53.5% and 48.2% for COPD and non-COPD patients, respectively, adjusted p=0.169. Conclusion: Our results support the use of beta-blockers in the population of heart failure patients with COPD and without reactive airway disease.

  20. Beneficial effects of beta-blockers on left ventricular function and cellular energy reserve in patients with heart failure.

    Science.gov (United States)

    Spoladore, Roberto; Fragasso, Gabriele; Perseghin, Gianluca; De Cobelli, Francesco; Esposito, Antonio; Maranta, Francesco; Calori, Giliola; Locatelli, Massimo; Lattuada, Guido; Scifo, Paola; Del Maschio, Alessandro; Margonato, Alberto

    2013-08-01

    Beta-blockers have been shown to improve left ventricular (LV) function in patients with heart failure. The aim of this study is to non-invasively assess, by means of in vivo 31P-magnetic resonance spectroscopy (31P-MRS), the effects of beta-blockers on LV cardiac phosphocreatine and adenosine triphosphate (PCr/ATP) ratio in patients with heart failure. Ten heart failure patients on full medical therapy were beta-blocked by either carvedilol or bisoprolol. Before and after 3 months of treatment, exercise testing, 2D echocardiography, MRS, New York Heart Association (NYHA) class, ejection fraction (EF), maximal rate-pressure product and exercise metabolic equivalent system (METS) were evaluated. Relative concentrations of PCr and ATP were determined by cardiac 31P-MRS. After beta-blockade, NYHA class decreased (from 2.2 ± 0.54 to 1.9 ± 0.52, P = 0.05), whereas EF (from 33 ± 7 to 44 ± 6%, P = 0.0009) and METS (from 6.74 ± 2.12 to 8.03 ± 2.39, P = 0.01) increased. Accordingly, the mean cardiac PCr/ATP ratio increased by 33% (from 1.48 ± 0.22 to 1.81 ± 0.48, P = 0.03). Beta-blockade-induced symptomatic and functional improvement in patients with heart failure is associated to increased PCr/ATP ratio, indicating preservation of myocardial high-energy phosphate levels.

  1. How should we manage heart failure developing in patients already treated with angiotensin-converting enzyme inhibitors and beta-blockers for hypertension, diabetes or coronary disease?

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Segura, Julian; Ruilope, Luis M

    2010-01-01

    An increasing number of patients in the community are being treated with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and beta-blockers for hypertension, coronary disease or diabetic renal and vascular complications. Some of these patients will develop heart...... failure despite such treatment. Based on data from hypertension trials it can be estimated that approximately 5% of treated patients will develop heart failure over 5 years. It is unclear whether patients developing heart failure on and off ACE-inhibitors or beta-blockers, respectively, at the time...... of heart failure diagnosis have similar prognosis.Treatment options for patients developing heart failure while already treated with ACE inhibitors/ARBs and beta-blockers are very limited if current heart failure guidelines are followed. In this review possible strategies are outlined and important areas...

  2. Impact of wastewater treatment plants on receiving surface waters and a tentative risk evaluation: the case of estrogens and beta blockers.

    Science.gov (United States)

    Gabet-Giraud, V; Miège, C; Jacquet, R; Coquery, M

    2014-02-01

    Five estrogenic hormones (unconjugated + conjugated fractions) and 10 beta blockers were analyzed in three wastewater treatment plant (WWTP) effluents and receiving river waters in the area of Lyon, France. In the different samples, only two estrogens were quantified: estrone and estriol. Some beta blockers, such as atenolol, acebutolol, and sotalol, were almost always quantified, but others, e.g., betaxolol, nadolol, and oxprenolol were rarely quantified. Concentrations measured in river waters were in the nanogram per liter range for estrogens and between 0.3 and 210 ng/L for beta blockers depending on the substance and the distance from the WWTP outfall. The impact of the WWTP on the receiving rivers was studied and showed a clear increase in concentrations near the WWTP outfall. For estrogens, the persistence in surface waters was not evaluated given the low concentrations levels (around 1 ng/L). For beta blockers, concentrations measured downstream of the WWTP outfall were up to 16 times higher than those measured upstream. Also, the persistence of metoprolol, nadolol, and propranolol was noted even 2 km downstream of the WWTP outfall. The comparison of beta blocker fingerprints in the samples collected in effluent and in the river also showed the impact of WWTP outfall on surface waters. Finally, a tentative environmental risk evaluation was performed on 15 sites by calculating the ratio of receiving water concentrations to predicted non-effect concentrations (PNEC). For estrogens, a total PNEC of 5 ng/L was considered and these substances were not linked to any potential environmental risk (only one site showed an environmental risk ratio above 1). Unfortunately, few PNECs are available and risk evaluation was only possible for 4 of the 10 beta blockers studied: acebutolol, atenolol, metoprolol, and propranolol. Only propranolol presented a ratio near or above 1, showing a possible environmental risk for 4 receiving waters out of 15.

  3. How should we manage heart failure developing in patients already treated with angiotensin-converting enzyme inhibitors and beta-blockers for hypertension, diabetes or coronary disease?

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Segura, Julian; Ruilope, Luis M

    2010-01-01

    An increasing number of patients in the community are being treated with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and beta-blockers for hypertension, coronary disease or diabetic renal and vascular complications. Some of these patients will develop heart...... failure despite such treatment. Based on data from hypertension trials it can be estimated that approximately 5% of treated patients will develop heart failure over 5 years. It is unclear whether patients developing heart failure on and off ACE-inhibitors or beta-blockers, respectively, at the time...

  4. Cost-effectiveness analysis of beta-blockers vs endoscopic surveillance in patients with cirrhosis and small varices

    Science.gov (United States)

    Di Pascoli, Lorenza; Buja, Alessandra; Bolognesi, Massimo; Montagnese, Sara; Gatta, Angelo; Gregori, Dario; Merkel, Carlo

    2014-01-01

    AIM: To evaluate the most cost-effectiveness strategy for preventing variceal growth and bleeding in patients with cirrhosis and small esophageal varices. METHODS: A stochastic analysis based on decision trees was performed to compare the cost-effectiveness of beta-blockers therapy starting from a diagnosis of small varices (Strategy 1) with that of endoscopic surveillance followed by beta-blockers treatment when large varices are demonstrated (Strategy 2), for preventing variceal growth, bleeding and death in patients with cirrhosis and small esophageal varices. The basic nodes of the tree were gastrointestinal endoscopy, inpatient admission and treatment for bleeding, as required. All estimates were performed using a Monte Carlo microsimulation technique, consisting in simulating observations from known probability distributions depicted in the model. Eight-hundred-thousand simulations were performed to obtain the final estimates. All estimates were then subjected to Monte Carlo Probabilistic sensitivity analysis, to assess the impact of the variability of such estimates on the outcome distributions. RESULTS: The event rate (considered as progression of varices or bleeding or death) in Strategy 1 [24.09% (95%CI: 14.89%-33.29%)] was significantly lower than in Strategy 2 [60.00% (95%CI: 48.91%-71.08%)]. The mean cost (up to the first event) associated with Strategy 1 [823 £ (95%CI: 106 £-2036 £)] was not significantly different from that of Strategy 2 [799 £ (95%CI: 0 £-3498 £)]. The cost-effectiveness ratio with respect to this endpoint was equal to 50.26 £ (95%CI: -504.37 £-604.89 £) per event avoided over the four-year follow-up. When bleeding episodes/deaths in subjects whose varices had grown were included, the mean cost associated with Strategy 1 was 1028 £ (95%CI: 122 £-2581 £), while 1699 £ (95%CI: 171 £-4674 £) in Strategy 2. CONCLUSION: Beta-blocker therapy turn out to be more effective and less expensive than endoscopic surveillance for

  5. [Role of the sympathetic nervous system in vasovagal syncope and rationale for beta-blockers and norepinephrine transporter inhibitors].

    Science.gov (United States)

    Márquez, Manlio F; Gómez-Flores, Jorge Rafael; González-Hermosillo, Jesús A; Ruíz-Siller, Teresita de Jesús; Cárdenas, Manuel

    2016-12-29

    Vasovagal or neurocardiogenic syncope is a common clinical situation and, as with other entities associated with orthostatic intolerance, the underlying condition is a dysfunction of the autonomic nervous system. This article reviews various aspects of vasovagal syncope, including its relationship with orthostatic intolerance and the role of the autonomic nervous system in it. A brief history of the problem is given, as well as a description of how the names and associated concepts have evolved. The response of the sympathetic system to orthostatic stress, the physiology of the baroreflex system and the neurohumoral changes that occur with standing are analyzed. Evidence is presented of the involvement of the autonomic nervous system, including studies of heart rate variability, microneurography, cardiac innervation, and molecular genetic studies. Finally, we describe different studies on the use of beta-blockers and norepinephrine transporter inhibitors (sibutramine, reboxetine) and the rationality of their use to prevent this type of syncope.

  6. Polypharmacy in chronic heart failure : practical issues regarding the use of angiotensin-converting enzyme inhibitors, beta-blockers and other drugs

    NARCIS (Netherlands)

    de Boer, RA; van Veldhuisen, DJ

    2002-01-01

    Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are the cornerstone for treatment of patients with chronic heart failure (CHF), and are usually combined with diuretics, with or without digoxin. With the development of new, additional treatments, the problem of polypharmacy becomes r

  7. beta-blocker Therapy is Not Associated with Reductions in Angina or Cardiovascular Events After Coronary Artery Bypass Graft Surgery : Insights from the IMAGINE Trial

    NARCIS (Netherlands)

    Booij, Harmen G.; Damman, Kevin; Warnica, J. Wayne; Rouleau, Jean L.; van Gilst, Wiek H.; Westenbrink, B. Daan

    2015-01-01

    To evaluate whether beta-blockers were associated with a reduction in cardiovascular events or angina after Coronary Artery Bypass Graft (CABG) surgery, in otherwise stable low-risk patients during a mid-term follow-up. We performed a post-hoc analysis of the IMAGINE (Ischemia Management with Accupr

  8. Nationwide trends in the prescription of beta-blockers and angiotensin-converting enzyme inhibitors after myocardial infarction in Denmark, 1995-2002

    DEFF Research Database (Denmark)

    Gislason, Gunnar H; Abildstrom, Steen Z; Rasmussen, Jeppe Nørgaard

    2005-01-01

    OBJECTIVES: To study the use of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors after acute myocardial infarction (AMI) in Denmark from 1995 to 2002. DESIGN: Information about patients with first AMI aged > or = 30 years and the dispensing of beta-blockers and ACE inhibitors from...... pharmacies within 30 d from discharge was obtained from the National Patient Registry and the Danish Registry of Medicinal Product Statistics. RESULTS: Beta-blocker use increased from 38.1% of patients in 1995 to 67.9% in 2002 (OR = 3.85, CI: 3.58-4.13). Women, elderly patients and patients taking loop......-diuretics and antidiabetic drugs received beta-blockers less frequently, but patients taking loop-diuretics or antidiabetic drugs had the greatest increase. ACE inhibitor use increased from 24.5 to 35.5% (OR = 1.86, CI: 1.72-2.01). Women, patients aged or = 80 years and patients not taking loop...

  9. Treatment with non-selective beta blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure

    DEFF Research Database (Denmark)

    Mookerjee, Rajeshwar P; Pavesi, Marco; Thomsen, Karen Louise

    2016-01-01

    BACKGROUND AND AIMS: Non-selective beta-blockers (NSBBs) have been shown to have deleterious outcomes in patients with refractory ascites, alcoholic hepatitis and spontaneous bacterial peritonitis leading many physicians to stop the drug in these cases. Acute on chronic liver failure (ACLF...

  10. Photocatalytic degradation kinetics and mechanism of environmental pharmaceuticals in aqueous suspension of TiO{sub 2}: A case of {beta}-blockers

    Energy Technology Data Exchange (ETDEWEB)

    Yang Hai [State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Resources Utilization and Protection, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Kehua Street, Tianhe District, Guangzhou 510640 (China); Graduate School of Chinese Academy of Sciences, Beijing 100049 (China); An Taicheng, E-mail: antc99@gig.ac.cn [State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Resources Utilization and Protection, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Kehua Street, Tianhe District, Guangzhou 510640 (China); Li Guiying [State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Resources Utilization and Protection, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Kehua Street, Tianhe District, Guangzhou 510640 (China); Song Weihua; Cooper, William J. [Urban Water Research Center, Department of Civil and Environmental Engineering, University of California, Irvine, CA 92697-2175 (United States); Luo Haiying [State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Resources Utilization and Protection, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Kehua Street, Tianhe District, Guangzhou 510640 (China); Graduate School of Chinese Academy of Sciences, Beijing 100049 (China); Guangzhou Product Quality Supervision and Testing Institute, National Centre for Quality Supervision and Testing of Processed Food (Guangzhou), Guangzhou 510110 (China); Guo Xindong [Guangzhou Product Quality Supervision and Testing Institute, National Centre for Quality Supervision and Testing of Processed Food (Guangzhou), Guangzhou 510110 (China)

    2010-07-15

    This study investigated the photocatalytic degradation of three {beta}-blockers in TiO{sub 2} suspensions. The disappearance of the compounds followed pseudo-first-order kinetics according to the Langmuir-Hinshelwood model and the rate constants were 0.075, 0.072 and 0.182 min{sup -1} for atenolol, metoprolol and propranolol, respectively. After 240 min irradiation, the reaction intermediates were completely mineralized to CO{sub 2} and the nitrogen was predominantly as NH{sub 4}{sup +}. The influence of initial pH and {beta}-blocker concentration on the kinetics was also studied. From adsorption studies it appears that the photocatalytic degradation occurred mainly on the surface of TiO{sub 2}. Further studies indicated that surface reaction with {center_dot}OH radical was principally responsible for the degradation of these three {beta}-blockers. The major degradation intermediates were identified by HPLC/MS analysis. Cleavage of the side chain and the addition of the hydroxyl group to the parent compounds were found to be the two main degradation pathways for all three {beta}-blockers.

  11. Reseaech progress on the application of beta blockers in cancer%β受体阻滞剂在癌症中应用的研究进展

    Institute of Scientific and Technical Information of China (English)

    房晶雪; 程刚

    2015-01-01

    Beta blockers were the first-line drugs for the treatment of hypertension. In recent years,studies had shown that beta blockers was benefit for the survival of cancer patients,but there is a controversial. This article reviewed the uses of beta blockers in cancer in preclinical studies and clinical researches over the last three years, in order to study the role of beta blockers in cancer.%β受体阻滞剂是治疗高血压的一线药物. 近年研究表明,β受体阻滞剂的使用对癌症患者的生存有益,但存在一定的争议性. 本文回顾了近3年来β受体阻滞剂在癌症中应用的临床前研究和临床研究进展,为更好地研究β受体阻滞剂在癌症中的作用提供帮助.

  12. The Influence of Molecular Structure Modifications on Vibrational Properties of Some Beta Blockers: A Combined Raman and DFT Study

    Directory of Open Access Journals (Sweden)

    A. Farcaș

    2016-01-01

    Full Text Available We report results of a systematic Raman, SERS, and DFT study on four beta blocking molecules: Atenolol, Metoprolol, Propranolol, and, for the first time reported in the literature, Bisoprolol. The choice of these molecules was motivated by the structural similarities between Atenolol, Bisoprolol, and Metoprolol on one hand and by their differences relative to Propranolol. The density functional theory (DFT approach, using the B3LYP method at the 6-311+G(d,p level of theory, has been employed for geometry optimization and vibration bands assignments. The obtained results highlight the major role played by the central aromatic ring whose vibrations dominate the Raman spectra in all compounds. While the phenyl group vibrations dominate the Raman spectrum in the case of Atenolol, Bisoprolol, and Metoprolol, the spectrum of Propranolol presents high intensity vibrations of the naphthyl group. SERS performed on gold and silver colloids, at various pH conditions, revealed a higher sensitivity for Propranolol detection. The pH dependence of the spectrum indicates that the studied beta blockers attach themselves to the metal nanoparticles in a protonated form. The molecular adsorption geometry on metal nanoparticles surface has been evaluated by using the experimental SER spectra and the quantum chemical calculations.

  13. Effect of placebo groups on blood pressure in hypertension: a meta-analysis of beta-blocker trials.

    Science.gov (United States)

    Wilhelm, Marcel; Winkler, Alexander; Rief, Winfried; Doering, Bettina K

    2016-12-01

    Hypertension is often treated pharmacologically. Since there is evidence that the cardiovascular system is sensitive to placebo mechanisms, our aim was to conduct an effect size analysis of placebo groups in double-blinded randomized controlled parallel-group drug trials using beta-blockers to treat hypertensive patients. A comprehensive literature search via PubMed, PsycINFO, PSYNDEX, PQDT OPEN, OpenGREY, ISI Web of Knowledge, and the WHO International Clinical Trials Registry Platform provided the basis of our meta-analysis. Effect sizes were estimated using a random-effects model based on 23 studies covering a total of 11,067 participants. Main outcomes were systolic blood pressure (sBP) and diastolic blood pressure (dBP). Blood pressure was lowered in placebo groups with significant and robust effect sizes (Hedges' g). The estimates for sBP (-0.27, P < .001) and dBP (-0.49, P < .001) can be interpreted as small to moderate. The placebo response accounted for 34% of the drug response for sBP and 47% of the drug response for dBP. Our moderator analyses indicated that a higher study quality and more study site visits were marginally associated with a higher placebo response. In light of these strong placebo responses, placebo mechanisms need to be considered in order to improve antihypertensive treatment.

  14. [Comparative pharmacoclinical study of 2 beta-blockers: atenolol and betaxolol in slight-to-moderate arterial hypertension].

    Science.gov (United States)

    Herpin, D; Boutaud, P; Ciber, M A; Amiel, A; Demange, J

    1987-11-01

    Sixteen patients with mild to moderate hypertension were randomized to receive either atenolol 100 mg a day (group A: 2 females, 6 males, mean age 42.3 years) or betaxolol 20 mg a day (group B: 8 males, mean age 49.3 years), both drugs given once daily for one month with a wash out on the 5th day. Pretreatment blood pressure was significantly higher in group B than in group A: this disparity, linked with randomization, hampered the comparison of the antihypertensive efficacy of both drugs but not the comparison of their pharmacodynamics. The maximal effect on resting supine blood pressure occurred later with betaxolol (4th day) than with atenolol (1st day), while the effect on peak exercise-blood pressure and heart rate was rapidly maximal (1st day) for both beta-blockers. The duration of the antihypertensive action at rest seemed to be nearly similar, while the effects of betaxolol on exercising heart rate and blood pressure were more prolonged than those of atenolol: on the wash out day, plasma atenolol and betaxolol levels fell in a same way but the increase in peak systolic blood pressure was more marked in group A than in group B, so that the positive correlation we found between the plasma drug levels and the percentage of peak systolic blood pressure reduction, was much closer with atenolol (p less than 0.001) than with betaxolol (p less than 0.05).

  15. Use of thallium-201 myocardial scintigraphy for the prediction of the response to {beta}-blocker therapy in patients with dilated cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Hara, Yuji; Hamada, Mareomi; Ohtsuka, Tomoaki; Ogimoto, Akiyoshi; Saeki, Hideyuki; Suzuki, Jun; Matsunaka, Tsuyoshi; Nakata, Shigeru; Shigematsu, Yuji [Ehime Univ., Shigenobu (Japan). School of Medicine

    2002-12-01

    This study was performed to evaluate whether thallium-201 myocardial scintigraphy (Tl-201) and iodine-123-metaiodobenzylguanidine (MIBG) myocardial scintigraphy could predit the usefulness of {beta}-blocker therapy in patients with dilated cardiomyopathy (DCM). Tl-201 and MIBG were performed in 47 patients before {beta}-blocker therapy. Patients were classified into group A, if their cardiac function improved, and group B, whose function remained unchanged Two types of extent score (ES) by Tl-201 were proposed to quantitate myocardial damage, mean-2SD (ES-2) and mean -3SD (ES-3). The ES difference between ES-2 and ES-3 was calculated, and according to ES and ES difference, DCM cases were classified into 3 groups: mild-defect type (mild-type), moderate-defect type (moderate-type) and severe-defect type (severe-type). The heart-to-mediastinum (H/M) MIBG uptake ratio was evaluated, and the percent washout ratio of myocardial MIBG was obtained from these data. Group A comprised 18 mild-type, 14 moderate-type and 1 severe-type cases, and group B comprised 5 mild-type, 4 moderate-type and 5 severe-type cases. A significant relation was observed between the defect type on Tl-201 and the response to {beta}-blocker therapy (p=0.0090). Both H/M MIBG uptake ratios and washout ratio were not significantly different in the 2 groups. Tl-201 may be useful for predicting the response to {beta}-blocker therapy in patients with DCM. (author)

  16. Efficacy and Tolerability of Travoprost 0.004%/Timolol 0.5% Fixed-Dose Combination for the Treatment of Primary Open-Angle Glaucoma or Ocular Hypertension Inadequately Controlled with Beta-Blocker Monotherapy

    Science.gov (United States)

    Park, Ki Ho; Hubatsch, Douglas A.; Erichev, Valeriy; Paczka, Jose A.; Roberts, Timothy V.

    2017-01-01

    Objective. To evaluate the efficacy and tolerability of travoprost 0.004%/timolol 0.5% fixed-dose combination (TTFC) in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) inadequately controlled on beta-blocker monotherapy. Methods. In this phase IV, open-label study, 156 patients on beta-blocker monotherapy with mean intraocular pressure (IOP) between 18 and 32 mmHg were randomized (no washout period) to receive TTFC for 8 weeks (TTFC group) or to continue beta-blocker monotherapy for 4 weeks followed by TTFC for the remaining 4 weeks (beta-blocker group). Results. The mean IOP (±standard deviation) at baseline in the TTFC and beta-blocker groups was 22.5 ± 2.5 mmHg and 22.2 ± 2.3 mmHg, respectively, and at weeks 4 and 8, was 16.7 ± 3.1 mmHg and 16.1 ± 3.1 mmHg, respectively, in TTFC group and 21.1 ± 3.1 mmHg and 16.1 ± 2.8 mmHg, respectively, in the beta-blocker group. There was a significant least squares mean difference between TTFC and beta-blocker in 8 a.m. IOP at week 4 (−4.6 mmHg; one-sided 95% confidence interval [−inf, −3.9]; p < 0.0001 [primary endpoint]); the upper bound of the 95% confidence interval was within the prespecified limit (<0). Both treatments were well tolerated. Conclusion. Superior IOP control was achieved with TTFC in patients with OAG or OHT previously uncontrolled with beta-blockers. No new safety findings were identified. This trial is registered with ClinicalTrials.gov NCT02003391. PMID:28239491

  17. Beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, nitrate-hydralazine, diuretics, aldosterone antagonist, ivabradine, devices and digoxin (BANDAID(2) ): an evidence-based mnemonic for the treatment of systolic heart failure.

    Science.gov (United States)

    Chia, N; Fulcher, J; Keech, A

    2016-06-01

    Heart failure causes significant morbidity and mortality, with recognised underutilisation rates of guideline-based therapies. Our aim was to review current evidence for heart failure treatments and derive a mnemonic summarising best practice, which might assist physicians in patient care. Treatments were identified for review from multinational society guidelines and recent randomised trials, with a primary aim of examining their effects in systolic heart failure patients on mortality, hospitalisation rates and symptoms. Secondary aims were to consider other clinical benefits. MEDLINE and EMBASE were searched using a structured keyword strategy and the retrieved articles were evaluated methodically to produce an optimised reference list for each treatment. We devised the mnemonic BANDAID (2) , standing for beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, nitrate-hydralazine (or potentially neprilysin inhibitor), diuretics, aldosterone antagonist, ivabradine, devices (automatic implantable cardioverter defibrillator, cardiac resynchronisation therapy or both) and digoxin as a representation of treatments with strong evidence for their use in systolic heart failure. Treatment with omega-3 fatty acids, statins or anti-thrombotic therapies has limited benefits in a general heart failure population. Adoption of this mnemonic for current evidence-based treatments for heart failure may help improve prescribing rates and patient outcomes in this debilitating, high mortality condition.

  18. A self-controlled case series to assess the effectiveness of beta blockers for heart failure in reducing hospitalisations in the elderly

    Directory of Open Access Journals (Sweden)

    Pratt Nicole L

    2011-07-01

    Full Text Available Abstract Background To determine the suitability of using the self-controlled case series design to assess improvements in health outcomes using the effectiveness of beta blockers for heart failure in reducing hospitalisations as the example. Methods The Australian Government Department of Veterans' Affairs administrative claims database was used to undertake a self-controlled case-series in elderly patients aged 65 years or over to compare the risk of a heart failure hospitalisation during periods of being exposed and unexposed to a beta blocker. Two studies, the first using a one year period and the second using a four year period were undertaken to determine if the estimates varied due to changes in severity of heart failure over time. Results In the one year period, 3,450 patients and in the four year period, 12, 682 patients had at least one hospitalisation for heart failure. The one year period showed a non-significant decrease in hospitalisations for heart failure 4-8 months after starting beta-blockers, (RR, 0.76; 95% CI (0.57-1.02 and a significant decrease in the 8-12 months post-initiation of a beta blocker for heart failure (RR, 0.62; 95% CI (0.39, 0.99. For the four year study there was an increased risk of hospitalisation less than eight months post-initiation and significant but smaller decrease in the 8-12 month window (RR, 0.90; 95% CI (0.82, 0.98. Conclusions The results of the one year observation period are similar to those observed in randomised clinical trials indicating that the self-controlled case-series method can be successfully applied to assess health outcomes. However, the result appears sensitive to the study periods used and further research to understand the appropriate applications of this method in pharmacoepidemiology is still required. The results also illustrate the benefits of extending beta blocker utilisation to the older age group of heart failure patients in which their use is common but the evidence is

  19. Patient medication adherence and physician prescribing among congestive heart failure patients of Yemen

    Directory of Open Access Journals (Sweden)

    K M Alakhali

    2013-01-01

    Full Text Available Congestive heart failure has been associated with high morbidity and mortality requiring hospitalisation and is further complicated by noncompliance and under prescriptions. We aim to determine medication adherence and percentage deviation among Asians population in general and Yemenis in particular. A cross-sectional, prospective observational study with purposive sampling was conducted at two cardiac outpatient centers in 70 congestive heart failure patients for a period of 3 months. An Arabic translated Morisky 4 item scale assessed the adherence of patients. Deviation in prescribing was determined by chart review. All 70 patients had mean age of 56.6΁16 years. Morisky 4 item scale predicted low adherence (n=33; 47.1% and overall nonadherencerate (n=38; 54.2% was slightly higher than adherence. Percentage nonadherence versus adherence was high with diuretics (53 vs. 46% and, digoxin (40 vs. 29%. The adherence percentage of angiotensin receptor blockers (9% and beta blockers (8% was low. Diuretics were the most prescribed drugs (n=69; 99%, followed by angiotensin converting enzyme inhibitors (n=51; 73%, cardiac glycoside (n=48; 69%, few patients were on angiotensin receptor blockers (n=8; 11% and (n=9; 13% beta blockers. The maximum prescribing rate deviation was seen with angiotensin receptor blockers (−89% and beta blockers (−87% followed by nitrates (−77%. Digoxin (−31% and angiotensin converting enzymes (−27% deviated comparatively less. Prescribing as well as utilisation rates generally were low resulting in nonachievement of therapeutic goals which could be resolved using multimodel approach.

  20. Patient Medication Adherence and Physician Prescribing among Congestive Heart Failure Patients of Yemen

    Science.gov (United States)

    Alakhali, K. M.; Daniel, P. S; Noohu, A. M.; Sirajudeen, S. A.

    2013-01-01

    Congestive heart failure has been associated with high morbidity and mortality requiring hospitalisation and is further complicated by noncompliance and under prescriptions. We aim to determine medication adherence and percentage deviation among Asians population in general and Yemenis in particular. A cross-sectional, prospective observational study with purposive sampling was conducted at two cardiac outpatient centers in 70 congestive heart failure patients for a period of 3 months. An Arabic translated Morisky 4 item scale assessed the adherence of patients. Deviation in prescribing was determined by chart review. All 70 patients had mean age of 56.6±16 years. Morisky 4 item scale predicted low adherence (n=33; 47.1%) and overall nonadherencerate (n=38; 54.2%) was slightly higher than adherence. Percentage nonadherence versus adherence was high with diuretics (53 vs. 46%) and, digoxin (40 vs. 29%). The adherence percentage of angiotensin receptor blockers (9%) and beta blockers (8%) was low. Diuretics were the most prescribed drugs (n=69; 99%), followed by angiotensin converting enzyme inhibitors (n=51; 73%), cardiac glycoside (n=48; 69%), few patients were on angiotensin receptor blockers (n=8; 11%) and (n=9; 13%) beta blockers. The maximum prescribing rate deviation was seen with angiotensin receptor blockers (−89%) and beta blockers (−87%) followed by nitrates (−77%). Digoxin (−31%) and angiotensin converting enzymes (−27%) deviated comparatively less. Prescribing as well as utilisation rates generally were low resulting in nonachievement of therapeutic goals which could be resolved using multimodel approach. PMID:24403656

  1. Beta-blockers

    DEFF Research Database (Denmark)

    Arboe, Bente; Ulrik, Charlotte Suppli

    2013-01-01

    Recently, β-blockers have been suggested as a potential maintenance treatment option for asthma. The aim of this review is to provide an overview of the current knowledge of the potential benefits and risks of β-blocker therapy for asthma.......Recently, β-blockers have been suggested as a potential maintenance treatment option for asthma. The aim of this review is to provide an overview of the current knowledge of the potential benefits and risks of β-blocker therapy for asthma....

  2. Chronic effects assessment and plasma concentrations of the {beta}-blocker propranolol in fathead minnows (Pimephales promelas)

    Energy Technology Data Exchange (ETDEWEB)

    Giltrow, Emma [Institute for the Environment, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom); Eccles, Paul D. [Institute for the Environment, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom); Biosciences, School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom); Winter, Matthew J.; McCormack, Paul J. [AstraZeneca Safety, Health and Environment, Brixham Environmental Laboratory, Freshwater Quarry, Brixham, Devon TQ5 8BA (United Kingdom); Rand-Weaver, Mariann [Biosciences, School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom); Hutchinson, Thomas H. [Natural Environmental Research Council, Plymouth Marine Laboratory, Prospect Place, The Hoe, Plymouth PL1 3DH (United Kingdom); Sumpter, John P., E-mail: john.sumpter@brunel.ac.uk [Institute for the Environment, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom)

    2009-11-27

    The presence of many human pharmaceuticals in the aquatic environment is now a worldwide concern, yet little is known of the chronic effects that these bioactive substances may be having on aquatic organisms. Propranolol, a non-specific beta adrenoreceptor blocker ({beta}-blocker), is used to treat high blood pressure and heart disease in humans. Propranolol has been found in surface waters worldwide at concentrations ranging from 12 to 590 ng/L. To test the potential for ecologically relevant effects in fish in receiving waters, short-term (21 days) adult reproduction studies were conducted, in which fathead minnows were exposed to nominal concentrations of propranolol hydrochloride [CAS number 318-98-9] ranging from 0.001 to 10 mg/L (measured concentrations typically from 78 to 130%). Exposure of fish to 3.4 mg/L (measured) over 3 days caused 100% mortality or severe toxicity requiring euthanasia. The most sensitive endpoints from the studies were a decrease in hatchability (with regard to the number of days to hatch) and a concentration-related increase in female gonadal somatic index (GSI), giving LOEC{sup hatchability} and LOEC{sup female} {sup GSI} values of 0.1 mg/L. Concentration-related decreases in weights of male fish were also observed, with LOEC{sup m}ale wet weight value of 1.0 mg/L, and the LOEC{sup r}eproduction value was 1.0 mg/L. Collectively, these data do not suggest that propranolol was acting as a reproductive toxin. Plasma concentrations of propranolol in male fish exposed to nominal concentrations of 0.1 and 1.0 mg/L were 0.34 and 15.00 mg/L, respectively, which constitutes 436 and 1546% of measured water concentrations. These compare with predicted concentrations of 0.07 and 0.84 mg/L, and thus to a degree support the use of partition coefficient models for predicting concentrations in plasma in fish. In addition, propranolol plasma concentrations in fish exposed to water concentrations of 0.1 and 1.0 mg/L were greater than the human

  3. Usefulness of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy for predicting the effectiveness of {beta}-blockers in patients with dilated cardiomyopathy from the standpoint of long-term prognosis

    Energy Technology Data Exchange (ETDEWEB)

    Fujimoto, Shinichiro; Inoue, Aritomo; Hisatake, Shinji; Yamashina, Shohei; Yamashina, Hisayo; Nakano, Hajime; Yamazaki, Junichi [Toho University School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Tokyo (Japan)

    2004-10-01

    The usefulness of {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in predicting the effectiveness of {beta}-blocker therapy in dilated cardiomyopathy (DCM) was investigated from the standpoint of long-term prognosis. The subjects were 53 DCM patients in whom {beta}-blockers had been successfully introduced and used for 6 months or longer. When symptoms were stable before the introduction of {beta}-blockers and for up to 1 year thereafter, MIBG myocardial single-photon emission computed tomography was performed and the images analysed to obtain the extent score (EXT), severity score (SEV) and washout rate (WR). At the same time, echocardiography was performed to measure left ventricular ejection fraction (LVEF). Thereafter, patients were placed under observation for an average of 1,314{+-}986 days, with the occurrence of cardiac events as the endpoint. The degree of improvement in WR after introduction of {beta}-blockers was a significant predictor of cardiac events. In fact, none of the patients whose improvement in WR was valued at 10 or higher had cardiac events. Accordingly, using improvement in WR of 10 as the cut-off value, the patients were divided into two groups, ''improved'' and ''unimproved''. There were significant differences between the groups in respect of early EXT, early SEV and WR before the introduction of {beta}-blockers. As regards predictors of WR improvement, multivariate logistic regression analysis demonstrated that early EXT, WR and LVEF were significant predictors. This study shows that, from the standpoint of long-term prognosis, DCM patients who would benefit the most from {beta}-blocker therapy are those with low early EXT and early SEV and high WR before {beta}-blocker introduction regardless of LVEF values. (orig.)

  4. Assessment of response to beta-blockers by expression of βArr2 and RhoA/ROCK2 in antrum mucosa in cirrhotic patients

    DEFF Research Database (Denmark)

    Trebicka, Jonel; von Heydebrand, Matthias; Lehmann, Jennifer

    2016-01-01

    BACKGROUND & AIMS: Non-selective beta-blockers (NSBB) are first choice for prevention of variceal bleeding. But possible deleterious effects in refractory ascites and frequent non-response are clinical drawbacks. Since levels of vasoactive proteins in antrum mucosa reflect vascular dysfunction...... and protein expression of Ras homolog family member A (RhoA), Rho-kinase (ROCK)2, beta-arrestin2 (βArr2), endothelial nitric oxide synthase (eNOS) and the phosphorylation of downstream effectors VASP and moesin were analyzed using PCR and Western blot. Further 21 patients on NSBB were evaluated...

  5. Effect of beta blockers (metoprolol or propranolol) on effect of simvastatin in lowering C-reactive protein in acute myocardial infarction.

    Science.gov (United States)

    Quinaglia e Silva, Jose C; Munhoz, Daniel B; Morato, Tiago N; Gurgel, Augusto; Macedo, Antonio C T; Sever, Peter; Sposito, Andrei C

    2009-02-15

    Recent data indicated that statin therapy may fail to reduce the incidence of coronary events in patients concomitantly using beta blockers. The aim of the present study was to examine whether the concomitant use of beta blockers would modify the anti-inflammatory action of statins. Changes in C-reactive protein (CRP) between days 1 and 5 after myocardial infarction were evaluated in 189 patients treated with simvastatin alone (S), beta blockers alone (B; propranolol or metoprolol), S + B, or neither of these 2 medications (N) in a prospective observational cohort. At baseline, median CRP was lower in the S group (0.40 mg/dl, interquartile range 0.1 to 0.6) than the other groups (B: 0.6 mg/dl, interquartile range 0.4 to 1.6; S + B: 0.5 mg/dl, interquartile range 0.3 to 1.2; and N: 0.6 mg/dl, interquartile range 0.2 to 1.5). By day 5, median CRP was 1.3 mg/dl (interquartile range 0.7 to 2.6), 4.3 (interquartile range 1.6 to 8.8), 4.6 (interquartile range 2.8 to 9.5), and 4.4 (interquartile range 1.9 to 9.9) for the S, B, S + B, and N groups, respectively. After adjusting for log(e) baseline CRP, the difference in log(e) CRP between days 1 and 5 was significantly lower in the S group compared with the B (-0.74 +/- 0.23 [SE], p = 0.001) or S + B group (-0.99 +/- 0.20 [SE], p <0.0001). The significance remained after adjustment for age, gender, and baseline CRP. There was no significant difference in change in CRP between the SB and B groups. In conclusion, the present study confirmed the anti-inflammatory action of statins and showed that concomitant use of beta blockers may significantly attenuate this effect.

  6. Guideline-recommended therapy, including beta-blocker utilization, in patients with chronic heart failure: results from a Canadian community hospital heart function clinic

    Directory of Open Access Journals (Sweden)

    Heffernan M

    2016-06-01

    Full Text Available Michael Heffernan Division of Cardiology, Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada Abstract: A comprehensive analysis of beta-blocker utilization and other guideline-recommended therapies for the treatment of chronic heart failure in a Canadian community hospital heart function clinic has not been undertaken and was, therefore, the focus of this study. The proportion of patients who would be potential candidates for ivabridine and sacubitril–valsartan therapy as a result of fulfilling the criteria for enrollment in either the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT study (left-ventricular ejection fraction [LVEF] >35%, sinus rhythm, New York Heart Association II–IV or the Prospective Comparison of angiotensin receptor-neprilysin inhibitor (ARNI with angiotensin-converting enzyme inhibitor (ACEI to determine impact on global Mortality and Morbidity in Heart Failure (PARADIGM-HF study (LVEF <40%, New York Heart Association II–IV, glomerular filtration rate >30 mL/min, was also assessed. A retrospective cross-sectional analysis was carried out in all 371 patients treated in this community heart function clinic for at least a 12-month period. The patients were elderly (mean age 74±13.3 years and predominately male (61.5% with symptomatic (82.5% moderate left-ventricular dysfunction (LVEF 45.4%±15.6%. A substantial proportion of the patients also had a diagnosis of atrial fibrillation (52.8%. The total use of beta blockers exceeded 87%, while 100% of patients without a documented contraindication or intolerance to a beta blocker received therapy. Adherence to other guideline-recommended pharmacotherapies specifically for heart failure with reduced left ventricular ejection was high: 86.1% of the eligible patients were treated with an ACEI/angiotensin receptor blocker and 61.9% received a mineralcorticoid receptor antagonist. We determined that 13.7% of the complement of this heart

  7. Statin, Calcium Channel Blocker and Beta Blocker Therapy May Decrease the Incidence of Tuberculosis Infection in Elderly Taiwanese Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Mei-Yueh Lee

    2015-05-01

    Full Text Available Background: It is well known that diabetes mellitus impairs immunity and therefore is an independent risk factor for tuberculosis. However, the influence of associated metabolic factors, such as hypertension, dyslipidemia and gout has yet to be confirmed. This study aimed to investigate whether the strong association between tuberculosis and diabetes mellitus is independent from the influence of hypertension and dyslipidemia, and its treatment in elderly Taiwanese patients. Methods: A total of 27,958 patients aged more than 65 years were identified from the National Health Insurance Research Database (NIHRD in 1997 and were followed from 1998 to 2009. The demographic characteristics between the patients with and without diabetes were analyzed using the χ2 test. A total of 13,981 patients with type 2 diabetes were included in this study. Cox proportional hazard regression models were used to determine the independent effects of diabetes on the risk of tuberculosis. Results: After adjusting for age, sex, other co-morbidities and medications, calcium channel blocker, beta blocker and statin users had a lower independent association, with risk ratios of 0.76 (95% CI, 0.58–0.98, 0.72 (95% CI, 0.58–0.91 and 0.76 (95% CI, 0.60–0.97, respectively. Conclusion: Calcium channel blocker, beta blocker and statin therapy may decrease the incidence of tuberculosis infection in elderly Taiwanese patients with type 2 diabetes.

  8. Effects of a beta-blocker on ventricular late potentials in patients with acute anterior myocardial infarction receiving successful thrombolytic therapy.

    Science.gov (United States)

    Evrengul, Harun; Dursunoglu, Dursun; Kayikcioglu, Meral; Can, Levent; Tanriverdi, Halil; Kaftan, Asuman; Kilic, Mustafa

    2004-01-01

    Late potentials (LP) detected on the signal-averaged electrocardiogram (SAECG) predict arrhythmic events after acute myocardial infarction (AMI). It is also well established that successful thrombolytic therapy reduces the incidence of LP. Our aim was to evaluate the effects of a beta-blocker on LP in patients receiving thrombolytic therapy. We studied 40 patients presenting with anteroseptal AMI (metoprolol (5 mg IV on admission followed by 50 mg BID). SAECG recordings were obtained serially using an ART system (40-250 Hz filter, noise infarct related artery patency and LV functions) of the groups. Baseline SAECG findings were also similar between the groups. The incidence of LP significantly decreased after TT in the BB group, however, this change was not observed in patients who did not receive BB (P = 0.012, McNemar test). Beta-blockers reduce the incidence of LPs following thrombolytic therapy in patients with anterior AMI. This might be explained by the possible beneficial effect of BB on the arrhythmogenic substrate.

  9. According to MIAMI and ISIS-I trials, can a general recommendation be given for beta blockers in acute myocardial infarction?

    Science.gov (United States)

    Kjekshus, J K

    1988-05-01

    The goal of early intervention of acute coronary occlusion by beta blockers is to reduce ultimate infarct size and to consequently reduce morbidity and mortality. Until 1986 small early intervention trials suggested that infarct size may be reduced by 25% if treatment was started within 6 to 10 hours after the onset of symptoms. At this time, an average of 80% of the infarct is fully developed. On the basis of previous trials, the reduction of infarct size has been associated with improvement of symptoms, prevention of infarct development, reduced occurrence of arrhythmias and reinfarctions, and earlier discharge from the hospital. Although the trials suggested some benefit in mortality, this issue has not been solved. The MIAMI trial randomized 5778 patients to blind treatment with metoprolol or placebo. ISIS-I randomized 16,027 patients to atenolol with an open label. No titration of the effect on lowering myocardial oxygen requirement was attempted. Both studies included less than 25% of all eligible patients. Exclusions were chiefly due to current beta blocker or calcium blocker treatment. Thus, the results obtained concern only a selected group of patients. In MIAMI only 15% received treatment within 6 hours, while in ISIS 38% were treated within 4 hours. It is therefore likely that in most patients the infarcts were completed before intervention was started. Thus, the two trials did not differentiate between primary and secondary effects on the acute myocardial infarct. Mortality was reduced by 13% (NS) and 15% (p less than 0.04), respectively, in MIAMI and ISIS.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Different effects of calcium antagonist and beta-blocker therapy on left-ventricular diastolic function in ischemic heart disease. A direct comparison of the impact of mibefradil and atenolol

    DEFF Research Database (Denmark)

    Hassager, C; Thygesen, K; Grande, P

    2001-01-01

    OBJECTIVE: To compare the effect of a calcium antagonist and a beta-blocker on left-ventricular diastolic function in patients with ischemic heart disease. METHODS: 138 patients with chronic stable angina pectoris were randomized in a multicenter, double-blind trial to treatment with either...

  11. Do immigrants from Turkey, Pakistan and Yugoslavia receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction compared with Danish-born residents? A register-based follow-up study

    DEFF Research Database (Denmark)

    Hempler, Nana Folmann; Diderichsen, Finn; Larsen, Finn Breinholt

    2010-01-01

    We undertook a study investigating whether immigrants from Turkey, Pakistan and Yugoslavia received adequate medical treatment with beta-blockers and statins after acute myocardial infarction (AMI) when compared with Danish-born residents and explored whether associations between patient origin...

  12. The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital

    NARCIS (Netherlands)

    H.L.P. Hurkmans (Henri); J.B.J. Bussmann (Hans); R.W. Selles (Ruud); E. Benda (Eric); H.J. Stam (Henk); J.A.N. Verhaar (Jan)

    2007-01-01

    textabstractOBJECTIVE: To determine whether patients load the operated leg at a prescribed weight-bearing target load during postoperative recovery. DESIGN: A descriptive prospective study. SETTING: Orthopedic clinic and patients' homes. PARTICIPANTS: Fifty patients who had undergone total hip arthr

  13. Cost-effectiveness analysis of nebivolol and metoprolol in essential hypertension: A pharmacoeconomic comparison of antihypertensive efficacy of beta blockers

    Directory of Open Access Journals (Sweden)

    Rachna S Patel

    2014-01-01

    Full Text Available Objective: To estimate and compare the cost-effectiveness and safety of nebivolol with sustained-release metoprolol in reducing blood pressure by 1 mm of Hg per day in hypertensive patients. Materials and Methods: This was a prospective, randomized, open label, observational analysis of cost-effectiveness, in a questionnaire-based fashion to compare the cost of nebivolol (2.5 mg, 5 mg, 10 mg and sustained released metoprolol succinate (25 mg, 50 mg, 100 mg in hypertensive patients using either of the two drugs. A total of 60 newly detected drug naïve hypertensive patients were considered for the comparison, of which 30 patients were prescribed nebivolol and the other 30 were prescribed metoprolol succinate as per the recommended dosage. Based on the data, statistical analysis was carried out using GraphPad Prism 5 and MS Excel Spreadsheet 2007. Result: The cost of reducing 1 mm of Hg blood pressure per day with nebivolol was 0.60, 0.70, and 1.06 INR, whereas that of metoprolol succinate was 0.93, 1.18, and 1.25 INR at their respective equivalent doses, hence significantly lower with the nebivolol group as compared to the metoprolol group (P < 0.05. Conclusion: This pharmacoeconomic analysis shows that nebivolol is more cost-effective as compared to metoprolol when the cost per reduction in blood pressure per day is considered. This may affect the patients economically during their long-term use of these molecules for the treatment of hypertension.

  14. Time-of-day variation in cardiovascular response to maximal exercise testing in coronary heart disease patients taking a beta-blocker.

    Science.gov (United States)

    Dufour Doiron, Monique; Prud'homme, Denis; Boulay, Pierre

    2007-08-01

    The aim of this study was to investigate the effect of a beta-blocker (atenolol and metoprolol) on exercise heart rate (HR) and rate pressure product (RPP) during a morning and afternoon maximal exercise test (maxET) in patients with coronary heart disease (CHD). Twenty-one CHD patients (59.9 +/- 8.9 years of age) treated with either atenolol or metoprolol participated in this study. All subjects underwent a morning and afternoon symptom-limited maximal exercise test (maxET) 2-3 h and 8-10 h after medication intake. No significant differences in exercise capacity (atenolol: 8.3 +/- 1.9 vs. 8.3 +/- 2.1 metabolic equivalents (METs); metoprolol: 8.8 +/- 2.0 vs. 8.7 +/- 2.0 METs) or rate of perceived exertion (atenolol: 7.4 +/- 1.9 vs. 7.4 +/- 1.7 METs; metoprolol: 7.2 +/- 1.5 vs. 6.8 +/- 0.9 METs) were observed between the 2 maxETs in either group. However, there was a discrepancy in cardiovascular and ischemic responses between morning and afternoon maxET. Subjects treated with atenolol demonstrated better overall control of HR and RPP during the afternoon maxET. The difference between morning and afternoon HRmax (11 +/- 8 vs. 19 +/- 9 beats.min-1; p = 0.05) was significantly higher in the metoprolol group, but did not attain significance for RPP (31 +/- 30 vs. 54 +/- 28 mmHg.beats.min-1.10-2; p = 0.09). Also, nearly one quarter of our subjects who had a normal morning maxET demonstrated an abnormal electrocardiogram response and (or) ischemia when exercise testing was done in the late afternoon. These changes were more prevalent in subjects taking metoprolol. The results of this study suggest that there is considerable time-of-day variation in the cardiovascular response to a maxET in CHD patients treated with a beta-blocker.

  15. Degradation of pharmaceutical beta-blockers by electrochemical advanced oxidation processes using a flow plant with a solar compound parabolic collector.

    Science.gov (United States)

    Isarain-Chávez, Eloy; Rodríguez, Rosa María; Cabot, Pere Lluís; Centellas, Francesc; Arias, Conchita; Garrido, José Antonio; Brillas, Enric

    2011-08-01

    The degradation of the beta-blockers atenolol, metoprolol tartrate and propranolol hydrochloride was studied by electro-Fenton (EF) and solar photoelectro-Fenton (SPEF). Solutions of 10 L of 100 mg L⁻¹ of total organic carbon of each drug in 0.1 M Na₂SO₄ with 0.5 mM Fe²⁺ of pH 3.0 were treated in a recirculation flow plant with an electrochemical reactor coupled with a solar compound parabolic collector. Single Pt/carbon felt (CF) and boron-doped diamond (BDD)/air-diffusion electrode (ADE) cells and combined Pt/ADE-Pt/CF and BDD/ADE-Pt/CF cells were used. SPEF treatments were more potent with the latter cell, yielding 95-97% mineralization with 100% of maximum current efficiency and energy consumptions of about 0.250 kWh g TOC⁻¹. However, the Pt/ADE-Pt/CF cell gave much lower energy consumptions of about 0.080 kWh g TOC⁻¹ with slightly lower mineralization of 88-93%, then being more useful for its possible application at industrial level. The EF method led to a poorer mineralization and was more potent using the combined cells by the additional production of hydroxyl radicals (•OH) from Fenton's reaction from the fast Fe²⁺ regeneration at the CF cathode. Organics were also more rapidly destroyed at BDD than at Pt anode. The decay kinetics of beta-blockers always followed a pseudo first-order reaction, although in SPEF, it was accelerated by the additional production of •OH from the action of UV light of solar irradiation. Aromatic intermediates were also destroyed by hydroxyl radicals. Ultimate carboxylic acids like oxalic and oxamic remained in the treated solutions by EF, but their Fe(III) complexes were photolyzed by solar irradiation in SPEF, thus explaining its higher oxidation power. NO₃⁻ was the predominant inorganic ion lost in EF, whereas the SPEF process favored the production of NH₄⁺ ion and volatile N-derivatives.

  16. Development and validation of a HPLC-UV method for the simultaneous determination of the antipsychotics clozapine, olanzapine and quetiapine, several beta-blockers and their metabolites.

    Science.gov (United States)

    Gracia, Margarete Silva; Köppl, Alexandra; Unholzer, Sandra; Haen, Ekkehard

    2017-03-07

    A simple, accurate and selective column-switching high performance liquid chromatography (HPLC) method was developed and validated for simultaneous quantification of six beta-blockers (metoprolol MET, timolol TIM, bisoprolol BIS, propranolol PRO, carvedilol CAR and nebivolol NEB), three of their metabolites (α-hydroxy metoprolol α-HMET, N-desisopropyl propranolol DIPRO and 4'-hydroxy carvedilol 4-HCAR), three antipsychotics (olanzapine OLA, clozapine CLO and quetiapine QUE) and three of their metabolites (N-desmethyl olanzapine DMOLA, N-desmethyl clozapine DMCLO and N-desalkyl quetiapine DAQUE) in human serum. After pretreatment on a Merck LiChrospher RP-4 ADS column (25 μm) drugs were separated on a Phenomenex Gemini Phenyl Hexyl 110 A column (250 mm x 4.6 mm, 5 μm) using a gradient mixture of acetonitrile and potassium dihydrogen phosphate buffer pH 3.1 (containing 10 % methanol) as a mobile phase at a flow rate of 1ml/min. The total analysis time was 40 min. For detection of the analytes, four different UV wavelengths were used: 215 nm, 226 nm, 242 nm and 299 nm. The method was validated according to the guidelines of the Society of Toxicology and Forensic Chemistry (GTFCh) in terms of selectivity, linearity, accuracy, precision and stability and successfully applied for the analysis of the 15 described analytes in human serum.

  17. Ion-transfer voltammetric determination of the beta-blocker propranolol in a physiological matrix at silicon membrane-based liquid|liquid microinterface arrays.

    Science.gov (United States)

    Collins, Courtney J; Arrigan, Damien W M

    2009-03-15

    In this work, the ion-transfer voltammetric detection of the protonated beta-blocker propranolol in artificial saliva is presented. Cyclic voltammetry, differential pulse voltammetry, and differential pulse stripping voltammetry (DPSV) were employed in the detection of the cationic drug based on ion-transfer voltammetry across arrays of microinterfaces between artificial saliva and an organogel phase. It was found that the artificial saliva matrix decreased the available potential window for ion-transfer voltammetry at this liquid|liquid interface but transfer of protonated propranolol was still achieved. The DPSV method employed a preconditioning step as well as a preconcentration step followed by analytical signal generation based on the back-transfer of the drug across the array of microinterfaces. The DPSV peak current response was linear with drug concentration in the artificial saliva matrix over the concentration range of 0.05-1 microM (i(p) = -8.13 (nA microM(-1))(concentration) + 0.07 (nA), R = 0.9929, n = 7), and the calculated detection limit (3s(b)) was 0.02 microM. These results demonstrate that DPSV at arrays of liquid|liquid microinterfaces is a viable analytical approach for pharmaceutical determinations in biomimetic matrixes.

  18. Use of iodine-123 metaiodobenzylguanidine myocardial imaging to predict the effectiveness of {beta}-blocker therapy in patients with dilated cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Fukuoka, Shuji [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Hayashida, Kohei [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Hirose, Yoshiaki [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Shimotsu, Yoriko [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Ishida, Yoshio [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Kakuchi, Hiroyuki [Department of Internal Medicine, National Cardiovascular Center, Osaka (Japan); Eto, Tanenao [First Department of Internal Medicine, Miyazaki Medical College, Miyazaki (Japan)

    1997-05-01

    We studied 13 patients with dilated cardiomyopathy (DCM) and seven normal subjects. We obtained myocardial SPET images 15 min and 4 h after administration of {sup 123}I-MIBG (111 MBq). Studies were performed in the patients with DCM before and 1 and 3 months after the administration of metoprolol and in the normal subjects. We calculated the regional {sup 123}I-MIBG washout rate (r-WR) in the SPET image, and the global {sup 123}I-MIBG washout rate (g-WR) and heart-mediastinum activity ratio (H/M) using the anterior planar image. We classified patients into those showing a {>=}5% increase in LV ejection fraction (LVEF) at 3 months compared with LVEF values before the treatment (group I, n=7) and those showing a <5% increase in LVEF (group II, n=6). In normal subjects, the r-WR values in each of the anterior, lateral, septal and inferior segments were significantly lower than those in groups I and II. These values were 18%{+-}9%, 18%{+-}15%, 20%{+-}12% and 21%{+-}15%, respectively. This study demonstrated that with regional assessment {sup 123}I-MIBG SPET imaging can be used to predict the functional improvement of LVEF at 1 month of {beta}-blocker therapy in patients with DCM. (orig./VHE). With 4 figs., 1 tab.

  19. Simultaneous determination of the beta-blocker atenolol and several complementary antihypertensive agents in pharmaceutical formulations and urine by capillary zone electrophoresis.

    Science.gov (United States)

    Maguregui, M I; Jiménez, R M; Alonso, R M

    1998-10-01

    A simple capillary zone electrophoresis method is developed for the quantitation of the beta-blocker atenolol and the complementary antihypertensive agents bendroflumethiazide, amiloride, and hydrochlorothiazide in human urine samples. The electrophoretic separation is performed using a 78-cm x 75-micron-i.d. (70-cm effective length) fused-silica capillary. A borate buffer (pH 9) is used as running electrolyte. The sample is hydrostatically introduced for 20 s, and the running voltage is 25 kV at the injector end of the capillary. The analysis of urine samples requires the optimization of solid-phase extraction methods, achieving recoveries > or = 61% for all the drugs and good separation from the urine matrix. The method is successfully applied to the determination of these compounds in pharmaceutical formulations and in urine samples collected after the intake of Neatenol Diu (100 mg atenolol-5 mg bendroflumethiazide) and Kalten (50 mg atenolol-25 mg hydrochlorothiazide-2.5 mg amiloride). The method is validated in terms of reproducibility, linearity, and accuracy.

  20. Myocardial scintigraphy using iodine-123 15-(p-Iodophenyl)-3-R, S-methylpentadecanoic acid predicts the response to beta-blocker therapy in patients with dilated cardiomyopathy but does not reflect therapeutic effect

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Keiichiro; Tahara, Minoru; Torii, Hiroyuki; Akimoto, Masaki [Kagoshima City Medical Association Hopital (Japan); Kihara, Koichi; Tei, Chuwa

    2000-05-01

    Myocardial fatty acid metabolism is disturbed in patients with idiopathic dilated cardiomyopathy. Myocardial scintigraphy using iodine-123 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP) was used to assess the response to {beta}-blocker therapy in 19 patients with dilated cardiomyopathy. BMIPP myocardial scintigraphy was performed before and 6 months after initiating {beta}-blocker therapy with metoprolol. Cardiac BMIPP uptake was assessed as the total defect score (TDS) and heart-to-mediastinum activity (H/M) ratio. Patients were classified retrospectively as responders with an improvement of at least one functional class (New York Heart Association) or an increase in ejection fraction of {>=}0.10 at 6 months, or as nonresponders meeting neither criterion. Responders had a significantly better pretreatment TDS (p<0.005) and H/M ratio (p<0.0001) than nonresponders. TDS exhibited no significant changes over 6 months in either group (responders: 13.2{+-}3.7 vs 12.5{+-}3.3; nonresponders: 20.8{+-}6.5 vs 20.5{+-}3.0). Responders showed no significant changes in H/M ratio (2.47{+-}0.28 vs 2.43{+-}0.42); paradoxically, nonresponders showed a significant increase from 1.82{+-}0.11 to 2.10{+-}0.19 (p<0.05), suggesting that {beta}-blocker therapy protected the myocardial fatty acid metabolism even in the absence of clinical improvement. BMIPP myocardial scintigraphy provides a prediction of response to {beta}-blocker treatment, but does not reflect the therapeutic effect in responders at 6 months. (author)

  1. Electronic Prescribing

    Science.gov (United States)

    ... Do you prescribe electronically?” For more information about electronic prescribing, call 1-800-MEDICARE (1-800-633- ... TTY users should call 1-877-486-2048 . Electronic eRx Prescribing I went to the pharmacy, and ...

  2. The Role of Beta Blockers in the Treatment of Hypertension%β受体阻滞剂在高血压治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    袁雯婷

    2016-01-01

    高血压是一种常见的危害性极高的慢性疾病。β受体阻滞剂是能选择性地与β肾上腺素受体结合、从而拮抗神经递质和儿茶酚胺对β受体的激动作用的一种药物类型。肾上腺素受体分布于大部分交感神经节后纤维所支配的效应器细胞膜上,其受体分为3种类型,即β1受体、β2受体和β3受体。β1受体主要分布于心肌,可激动引起心率和心肌收缩力增加;β2受体存在于支气管和血管平滑肌,可激动引起支气管扩张、血管舒张、内脏平滑肌松弛等;β3受体主要存在于脂肪细胞上,可激动引起脂肪分解。β受体阻滞剂能够减少心肌的耗氧量,降低心肌收缩力,治疗高血压的效果比较好,利于患者血压的控制,对保障患者远期生存质量有积极的影响,非常值得在临床上推广和普及。%Hypertension is a common chronic disease highly damaging. Beta blockers can selectively bind to beta adrener-gic receptor, a type of drug to antagonize and catecholamine neurotransmitter of beta receptor agonist. Effector cell mem-brane distribution of adrenergic receptors in most sympathetic postganglionic fibers dominated on the receptor divided into 3 types, namely, beta 1 receptor, beta 2 receptor and beta 3 receptor. Beta 1 receptor mainly distributed in myocardium, can be excited by the heart rate and cardiac contractility increased; beta 2 receptor exists in bronchial and vascular smooth muscle, can be excited by bronchiectasis, vasodilation, visceral smooth muscle relaxation; beta 3 the receptor exists mainly in fat cells, can be excited to cause fat decomposition. Beta blockers can reduce myocardial oxygen consumption, decreased myocardial contractility, antihypertensive effect is good, beneficial to patients with blood Pressure control, to ensure the long-term survival quality of patients have a positive impact, it is worth to be popularized in clinical practice.

  3. The beta2 adrenergic receptor Gln27Glu polymorphism affects insulin resistance in patients with heart failure: possible modulation by choice of beta blocker.

    Science.gov (United States)

    Vardeny, Orly; Detry, Michelle A; Moran, John J M; Johnson, Maryl R; Sweitzer, Nancy K

    2008-12-01

    Insulin resistance is prevalent in heart failure (HF) patients, and beta2 adrenergic receptors (beta2-AR) are involved in glucose homeostasis. We hypothesized that beta2-AR Gln27Glu and Arg16Gly polymorphisms affect insulin resistance in HF patients, and we explored if effects of beta2-AR polymorphisms on glucose handling are modified by choice of beta blocker. We studied 30 nondiabetic adults with HF and a history of systolic dysfunction; 15 were receiving metoprolol succinate, and 15 were receiving carvedilol. We measured fasting glucose, insulin, and insulin resistance, and we determined beta2-AR genotypes at codons 27 and 16. The cohort was insulin resistant with a mean HOMA-IR score of 3.4 (95% CI, 2.3 to 4.5; normal value, 1.0). Patients with the Glu27Glu genotype exhibited higher insulin and HOMA-IR compared to individuals carrying a Gln allele (P = 0.019). Patients taking carvedilol demonstrated lower insulin resistance if also carrying a wild-type allele at codon 27 (fasting insulin, 9.8 +/- 10.5 versus 20.5 +/- 2.1 for variant, P = 0.072; HOMA-IR, 2.4 +/- 2.7 versus 5.1 +/- 0.6, P = 0.074); those on metoprolol succinate had high insulin resistance irrespective of genotype. The beta2-AR Glu27Glu genotype may be associated with higher insulin concentrations and insulin resistance in patients with HF. Future studies are needed to confirm whether treatment with carvedilol may be associated with decreased insulin and insulin resistance in beta2-AR codon 27 Gln carriers.

  4. Electro-Fenton and photoelectro-Fenton degradations of the drug beta-blocker propranolol using a Pt anode: Identification and evolution of oxidation products

    Energy Technology Data Exchange (ETDEWEB)

    Isarain-Chavez, Eloy; Cabot, Pere Lluis; Centellas, Francesc; Rodriguez, Rosa Maria; Arias, Conchita; Garrido, Jose Antonio [Laboratori d' Electroquimica dels Materials i del Medi Ambient, Departament de Quimica Fisica, Facultat de Quimica, Universitat de Barcelona, Marti i Franques 1-11, 08028 Barcelona (Spain); Brillas, Enric, E-mail: brillas@ub.edu [Laboratori d' Electroquimica dels Materials i del Medi Ambient, Departament de Quimica Fisica, Facultat de Quimica, Universitat de Barcelona, Marti i Franques 1-11, 08028 Barcelona (Spain)

    2011-01-30

    The beta-blocker propranolol hydrochloride has been degraded by electrochemical advanced oxidation processes like electro-Fenton (EF) and photoelectro-Fenton (PEF) using a single cell with a Pt anode and an air diffusion cathode (ADE) for H{sub 2}O{sub 2} electrogeneration and a combined system containing the above Pt/ADE pair coupled in parallel to a Pt/carbon-felt (CF) cell. Organics are mainly oxidized with hydroxyl radical ({center_dot}OH) formed from Fenton's reaction between added Fe{sup 2+} and electrogenerated H{sub 2}O{sub 2}. The PEF treatment in Pt/ADE-Pt/CF system yields almost total mineralization because {center_dot}OH production is enhanced by Fe{sup 2+} regeneration from Fe{sup 3+} reduction at the CF cathode and Fe(III) complexes with generated carboxylic acids are rapidly photodecarboxylated under UVA irradiation. Lower mineralization degree is found for PEF in Pt/ADE cell due to the little influence of UVA light on Fe{sup 2+} regeneration. The homologous EF processes are much less potent as a result of the persistence of Fe(III)-carboxylate complexes. Aromatic intermediates such as 1-naphthol, 1,4-naphthoquinone and phthalic acid and generated carboxylic acids such as pyruvic, glycolic, malonic, maleic, oxamic, oxalic and formic are identified. While chloride ion remains stable, NH{sub 4}{sup +} and NO{sub 3}{sup -} ions are released to the medium. A reaction sequence for propranolol hydrochloride mineralization is proposed.

  5. Degradation of the beta-blocker propranolol by electrochemical advanced oxidation processes based on Fenton's reaction chemistry using a boron-doped diamond anode

    Energy Technology Data Exchange (ETDEWEB)

    Isarain-Chavez, Eloy; Rodriguez, Rosa Maria; Garrido, Jose Antonio; Arias, Conchita; Centellas, Francesc; Cabot, Pere Lluis [Laboratori d' Electroquimica dels Materials i del Medi Ambient, Departament de Quimica Fisica, Facultat de Quimica, Universitat de Barcelona, Marti i Franques 1-11, 08028 Barcelona (Spain); Brillas, Enric, E-mail: brillas@ub.ed [Laboratori d' Electroquimica dels Materials i del Medi Ambient, Departament de Quimica Fisica, Facultat de Quimica, Universitat de Barcelona, Marti i Franques 1-11, 08028 Barcelona (Spain)

    2010-12-15

    The electro-Fenton (EF) and photoelectro-Fenton (PEF) degradation of solutions of the beta-blocker propranolol hydrochloride with 0.5 mmol dm{sup -3} Fe{sup 2+} at pH 3.0 has been studied using a single cell with a boron-doped diamond (BDD) anode and an air diffusion cathode (ADE) for H{sub 2}O{sub 2} electrogeneration and a combined cell containing the above BDD/ADE pair coupled in parallel to a Pt/carbon felt (CF) cell. This naphthalene derivative can be mineralized by both methods with a BDD anode. Almost overall mineralization is attained for the PEF treatments, more rapidly with the combined system due to the generation of higher amounts of hydroxyl radical from Fenton's reaction by the continuous Fe{sup 2+} regeneration at the CF cathode, accelerating the oxidation of organics to Fe(III)-carboxylate complexes that are more quickly photolyzed by UVA light. The homologous EF processes are less potent giving partial mineralization. The effect of current density, pH and Fe{sup 2+} and drug concentrations on the oxidation power of PEF process in combined cell is examined. Propranolol decay follows a pseudo first-order reaction in most cases. Aromatic intermediates such as 1-naphthol and phthalic acid and generated carboxylic acids such as maleic, formic, oxalic and oxamic are detected and quantified by high-performance liquid chromatography. The chloride ions present in the starting solution are slowly oxidized at the BDD anode. In PEF treatments, all initial N of propranolol is completely transformed into inorganic ions, with predominance of NH{sub 4}{sup +} over NO{sub 3}{sup -} ion.

  6. Rapid method for the determination of tranquilizers and a beta-blocker in porcine and bovine kidney by liquid chromatography with tandem mass spectrometry

    Energy Technology Data Exchange (ETDEWEB)

    Mitrowska, Kamila [National Veterinary Research Institute, Department of Pharmacology and Toxicology, al. Partyzantow 57, 24-100 Pulawy (Poland)], E-mail: kamitro@piwet.pulawy.pl; Posyniak, Andrzej; Zmudzki, Jan [National Veterinary Research Institute, Department of Pharmacology and Toxicology, al. Partyzantow 57, 24-100 Pulawy (Poland)

    2009-04-01

    A fast and simple liquid chromatography with tandem mass spectrometry method for detection and confirmation of tranquilizers (chlorpromazine, propionylpromazine, acepromazine, triflupromazine, promazine, azaperone and its metabolite, azaperol) and beta-blocker (carazolol) in porcine and bovine kidney has been presented. The method relies on the extraction with acetonitrile followed by centrifugation. After evaporation of acetonitrile, the residue was reconstituted in a mobile phase and filtrated. The separation of analytes was performed on a C18 column using a mobile phase of acetonitrile and ammonium formate buffer (0.05 M, pH 4.5) with gradient elution. The electrospray ionization was used to obtain the protonated molecules [M+H]{sup +} and two product ions were monitored for each compound. For quantification deutered internal standards were used. The whole method has been validated according to the European Union requirements. Specificity, decision limit (CC{alpha}), detection capability (CC{beta}), trueness and precision were determined. The results showed good trueness ranged from 73.2% to 110.6% with a good R.S.D., less than 13.0% under within-laboratory reproducibility conditions. The calculated critical concentrations of CC{alpha} for phenothiazines were between 5.8 and 6.6 {mu}g kg{sup -1} while for azaperone CC{alpha} was 105.5 {mu}g kg{sup -1} and for azaperol was 121.4 {mu}g kg{sup -1}. CC{alpha} for carazolol was 16.7 {mu}g kg{sup -1} in bovine and 21.9 {mu}g kg{sup -1} in porcine kidney. CC{beta} for phenothiazines were between 6.3 and 7.6 {mu}g kg{sup -1}, for azaperone was 119.0 {mu}g kg{sup -1} and for azaperol was 140.0 {mu}g kg{sup -1}. For carazolol in bovine kidney CC{beta} was 18.6 {mu}g kg{sup -1} whereas in porcine kidney was 24.4 {mu}g kg{sup -1}.

  7. β受体阻滞剂治疗慢性心力衰竭30例临床分析%The efficacy of beta blocker treatment in thirty chronic heart failure patients

    Institute of Scientific and Technical Information of China (English)

    胡光春

    2016-01-01

    目的:观察在常规药物治疗基础上加用β受体阻滞剂治疗慢性心力衰竭的临床疗效。方法选择30例心力衰竭患者以滴定法的治疗策略使用β受体阻滞剂,并以心脏超声检查和6 min步行距离来客观评价临床症状和心功能改善情况。结果为期2年的治疗后观察患者临床症状好转、心脏缩小和心功能改善(P<0.01)。结论针对社区或基层的慢性心力衰竭患者应尽早积极使用β受体阻滞剂,以达到改善症状和心功能的目的。%ObjectiveTo evaluate the effect of additional beta blocker on the standard therapy for chronic heart failure. MethodsBeta blocker metoprolol was titrated in thirty patients with chronic heart failure. Echocardiogram and six-minute walking distance were used for the evaluation of clinical symptoms and cardiac function.ResultsTwo-year follow up showed improved symptoms,decreased left ventricular diameter and increased left ventricular ejection fraction. ConclusionEarly use of beta blocker is essential for the clinical improvement for chronic heart failure in district hospital.

  8. Different effects of calcium antagonist and beta-blocker therapy on left-ventricular diastolic function in ischemic heart disease. A direct comparison of the impact of mibefradil and atenolol

    DEFF Research Database (Denmark)

    Hassager, C; Thygesen, K; Grande, P;

    2001-01-01

    OBJECTIVE: To compare the effect of a calcium antagonist and a beta-blocker on left-ventricular diastolic function in patients with ischemic heart disease. METHODS: 138 patients with chronic stable angina pectoris were randomized in a multicenter, double-blind trial to treatment with either...... mibefradil or atenolol for 6 weeks (50 mg once daily for 2 weeks followed by 100 mg once daily for 4 weeks). The ratio between early (E) and late (A) diastolic mitral flow velocities (E/A), the E wave deceleration time (DT) and the left ventricular isovolumetric relaxation time (IRT) were measured by Doppler...

  9. Rationalising prescribing

    DEFF Research Database (Denmark)

    Wadmann, Sarah; Bang, Lia Evi

    2015-01-01

    with chronic care management in Denmark. We demonstrate how attempts to rationalise prescribing by informing GPs about drug effects, adverse effects and price do not satisfy GPs' knowledge needs. We argue that, for GPs, 'rational' prescribing cannot be understood in separation from the processes that enable...... of GPs as a need for practice-relevant knowledge and argue that industry sales representatives are granted opportunity to access general practice because they understand this need of GPs....

  10. β受体阻滞剂在慢性心力衰竭中的应用现状%Status in Clinical Settings of Beta-Blocker Treatment in Patients with Chronic Heart Failure

    Institute of Scientific and Technical Information of China (English)

    王勤

    2011-01-01

    β受体阻滞剂在慢性心力衰竭治疗中的优势已被多项大型临床试验证实.近10年来,β受体阻滞剂被广泛应用于慢性心力衰竭的临床治疗,但是大量的流行病学资料显示:其使用率在欧洲及我国均较低,并且存在地区性差异,同时使用剂量与指南的推荐剂量存在明显差距.现就β受体阻滞剂的临床应用现状做一综述.%The advantages of beta-blockers in the treatment for chronic heart failure ( CHF) have been largely confirmed by clinical trials over the last lO years. However, a large body of epidemiological data shows that the use of beta-blockers in Europe and China was relatively low , there were regional variations in the use of beta-blocken, and the dosages were significantly different compared to the dosage recommended in European guidelines. This article reviews the use of, and the clinical status of β-blockers.

  11. Use of beta-blockers in chronic obstructive pulmonary disease%β受体阻滞剂在慢性阻塞性肺疾病患者中的应用

    Institute of Scientific and Technical Information of China (English)

    曾葭; 白冲

    2010-01-01

    β肾上腺素能受体阻滞剂禁止使用于支气管哮喘和慢性阻塞性肺疾病患者.近年研究发现,使用心脏选择性β受体阻滞剂治疗慢性阻塞性肺疾病和肺源性心脏病,长期治疗可降低死亡率,提高患者生活质量.本文就β受体阻滞剂在慢性阻塞性肺疾病患者中的应用作一综述.%Beta-blockers were contraindicated in bronchial asthma and chronic obstructive pulmonary disease (COPD). Recent studies show that chronic administration of cardioselective betablockers in patients with COPD or pulmonary heart disease can improve mortality and quality of life. This paper reviewed the application of beta-blockers on patients with COPD.

  12. The Basic Mechanism of Beta-blocker in Chronic Heart Failure%β受体阻断剂在慢性心衰中作用的基础机制

    Institute of Scientific and Technical Information of China (English)

    刘伟

    2011-01-01

    心力衰竭是很多心血管疾病的最终阶段,也是常见的致死原因之一.心力衰竭时起代偿作用的交感神经系统的持续兴奋是导致心力衰竭恶化的一个重要原因.近年来,众多临床试验证实β受体阻断剂类药物对心力衰竭有良好的治疗作用,β受体阻断剂能通过慢性抑制交感神经的兴奋,改善心力衰竭患者心功能,从而减少患者病死率,增加生存率.%Heart failure is the final phase for many cardiovascular diseases , one of the common fatal causes as well. One important reason of heart failure deterioration is the sustained excitement of sympathetic nervous system which is a compensatory mechanism in heart failure. In recent years,evidence has been accumulated on the beneficial actions of beta-blockers in patients with heart failure. The effect of beta-blocker in chronic inhibition of sympathetic nervous system can improve cardiac function of heart failure patients , reduce mortality and increase survival rates.

  13. PRESCRIBING PATTERN OF ANTIHYPERTENSIVES IN INDIVIDUALS WITH HYPERTENSION ALONE AND WITH COEXISTING DIABETES MELLITUS – A COMPARATIVE STUDY

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    J. Keerthi Sagar*, S. Narendranath, H.S. Somashekar, S.R. Reshma, Susheela Somappa Halemani and Prabhakar Adake

    2012-06-01

    Full Text Available Objective: Analysis of prescribing pattern of antihypertensives in patients with hypertension alone and with coexisting diabetes mellitus. Materials and Methods: A cross sectional study was conducted in an outpatient and inpatient department of general medicine at JJM Medical College hospital for a period of 3 months (July 2011 to September 2011. Prescriptions of the patients were collected and relevant data was entered in the preformed proforma and analyzed.Results: A total of 210 prescriptions were analyzed using chi square test. Out of which 126 prescriptions were of patients with hypertension alone which contain calcium channel blockers (30%, beta blockers (26%, angiotensin receptor blockers (15%, angiotensin converting enzyme inhibitors (4% and fixed dose combinations of angiotensin receptor blockers with hydrochlorothiazide (11% and combination of amlodipine with hydro-chlorothiazide (2.5%.84 Prescriptions of hypertension with coexisting diabetes mellitus had calcium channel blockers (24%, angiotensin converting enzyme inhibitors (19%, angiotensin receptor blockers (13%, beta blockers (13%, and fixed dose combinations of angiotensin receptor blockers with hydrochlorothiazide (18% and combination of amlodipine with hydrochlorothiazide (6%.[χ2=17.01, p=o.oo4] Conclusion- The present study shows that angiotensin converting enzyme inhibitors because of its beneficial effects which are well known are more commonly prescribed drugs in individuals with hypertension with coexisting diabetes mellitus. Calcium channel blockers and newly introduced angiotensin receptor blockers alone or in combination with hydrochlorothiazide are preferred drugs in both the study groups. Beta blockers are less preferred in patients of hypertension with coexisting diabetes mellitus for obvious reasons.

  14. Progress in use of beta-blockers for cardiovascular diseases%β受体阻滞剂在心血管疾病中的应用进展

    Institute of Scientific and Technical Information of China (English)

    冯庆芝

    2005-01-01

    β受体阻滞剂(beta-blocker)过去多作为抗心律失常药应用于临床,近年来其应用范围逐渐扩大,现已应用于抗高血压、纠正心肌缺血、改善心功能,品种及剂型也日新月异,其作用机制是多方面的,至今尚未完全清楚,不同制剂作用机制亦有差别,其核心作用是预防儿茶酚胺的心脏毒性作用。

  15. The classification , clinical usage and its progress of beta-blocker%β-受体阻滞药的分类、临床应用及其进展

    Institute of Scientific and Technical Information of China (English)

    刘万车; 方立梅; 胡少红; 谷雨; 张冬梅; 刑春阳

    2009-01-01

    The application of beta-blocker is unfailing for more than forty years, furthermore its indica-tion is magnified continually, which make it play very important role in the treatment of caxdiovascular diseases. In order to master the elassfication , clinical application and the recent research better, we write this overview by summarizeing articles at home and abroad.%β-受体阻滞药的应用40多年来久用不衰,而且适应证不断拓宽,使其在心血管疾病的治疗中起着十分重要的作用,为更好地掌握其分类、临床应用及其进展,本文结合国内外文献作一综述.

  16. β-受体阻滞剂对高血压患者房颤发生的预防作用%Prevention of atrial fibrillation about beta blockers in patients with hypertension

    Institute of Scientific and Technical Information of China (English)

    郜黎伟; 邱林林; 赵宏

    2014-01-01

    Objective To evaluate the role of beta blockers and significance in prevention of atrial fibrillation( AF)in patients with hy-pertension. Methods The levels of PⅠCP and procollagen typeⅢ( PCⅢ)and Transforming growth factor beta 1( TGF -β1)were meas-ured by enzyme linked immunosorbent assay( ELISA)in 128 hypertension patients in the treatment group and 128 controls,24 hours dy-namic electrocardiogram were measured also. Results There are no significant difference abort AF cases occurred in two groups( P ﹥0. 05),serum P Ⅰ CP and PC Ⅲ and TGF - beta 1 level is significantly lower in treatment group than in control group( P < 0. 05). Conclusion Beta blockers reduced AF by blocking autonomic nerve to reverse myocardial fibrosis,and impact in the prevention of AF in patients with hypertension.%目的:研究高血压患者出现心房颤动( AF)前预防使用β-受体阻滞剂的作用及意义。方法:对高血压患者治疗组128例和对照组128例进行24小时动态心电图及实验室检查,并对结果进行分析。结果:AF发生例数两组比较差异无统计学意义( P﹥0.05),治疗组血清PⅠCP、PCⅢ及TGF-β1水平明显低于对照组( P<0.05)。结论:β-受体阻滞剂通过阻断自主神经以逆转心肌纤维化减少AF发生,实现对高血压患者房颤发生的预防作用。

  17. Is residual ischemia related to a worsening of the prognosis of patients treated with beta-blockers after myocardial infarction?; L'ischemie residuelle est-elle de mauvais pronostic chez les patients traites par beta-bloquant apres un infarctus myocardique,

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    Mercenier, C.; Hassan, N.; Grentzinger, A. [Centre Hospitalier Universitaire, 54 - Nancy (France)] [and others

    1999-11-01

    It has been demonstrated that myocardial ischemia, documented by exercise myocardial tomo-scintigraphy (MTS), was related to a worsening of prognosis. Our study was aimed at determining whether this deleterious effect persists in patients treated by beta-blockers, which are strong anti-anginal medications having a proven beneficial effect on prognosis. We have retrospectively included 300 patients (58{+-}11 years) treated by beta-blockers after myocardial infarction and for whom exercise thallium-201 MST had been performed on medical treatment. A myocardial ischemia was observed using MST in 224 patients (74%) and was extended on at least 15 % of the left ventricle in 86 patients (29%). During a follow-up period of 2.5{+-}1.4 years, only 22 patients had a major cardiac event (12 infarctions, 10 cardiac deaths). On Cox analysis of the MST parameters, the patients prognosis was correlated to the extent of necrotic myocardial areas (p < 0.001) but not to exercise ischemia. The annual rates of major events were 2% in the absence of ischemia, 2% when ischemia had a low extent (< 15 % of LV) and 3.5 % only when ischemia had a higher extent. Therefore, residual ischemia, detected after myocardial infarction by exercise MST, does not appear to have a deleterious prognosis effect when the patients are treated by beta-blockers. This might at least partly be related to the protective effect of beta-blockers against fatal cardiac arrhythmias which may be induced by ischemia. (author)

  18. Comparative assessment of the pattern of anti-hypertensive drugs prescribed in medicine and cardiology outpatient department

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    Bhargav Gaikwad

    2016-10-01

    Results :The present study which was conducted for a period of 6 months in the medicine and cardiology OPD showed unequal distribution of the patients in the medicine and cardiology OPD, with 223 patients attended medicine OPD while 434 patients attended cardiology OPD. Amongst the patients attending medicine OPD, majority of the patients (61.88% were stage 1 hypertensive (>140/90mmHg according to JNC VII classification whereas majority (69.38% of those attending cardiology OPD were stage II hypertensive (>160/100. calcium channel blockers (CCB were the most commonly prescribed drug in medicine OPD followed by angiotensin converting enzyme inhibitors (ACEI whereas beta blockers (BB were most commonly prescribed in cardiology OPD followed by ACEI. [Int J Basic Clin Pharmacol 2016; 5(5.000: 1958-1965

  19. ANTIHYPERTENSIVE MEDICATION PRESCRIBING PATTERNS IN A UNIVERSITY TEACHING HOSPITAL IN SOUTH DELHI

    Directory of Open Access Journals (Sweden)

    Fowad Khurshid et al.

    2012-07-01

    Full Text Available Study objective: To investigate the use of antihypertensive drugs in hypertensive patients and to identify whether such pattern of prescription is appropriate in accordance with international guidelines for management of hypertension. Methods: This was a prospective analysis. A prescription based survey among patients with established hypertension was conducted at the Medicine Out-Patient Department of University Teaching Hospital in South Delhi, India. Data were collected from patients’ medical records as well as patients’ interviews.Results: A total of 192 hypertensive patients fulfilled the criteria for inclusion in the study analysis. Combination therapy was used more commonly than monotherapy (54.6% vs 45.4. Among the monotherapy category, the various classes of drugs used were as follows: beta- blockers (28.8%, diuretics (24.1%, calcium channel blockers (21.8%, ACE inhibitors (18.4%, angiotensin II receptor blockers (5.7% and α 1- blocker (1.1%. With respect to overall utilization pattern, diuretics (42.2% were the most frequently prescribed class, beta- blockers (41.2% ranked second followed by calcium channel blockers (39.1%, ACE inhibitors (26.0%, angiotensin II receptor blockers (23.4% and α 1- blocker (9.4%. As for individual medicines, amlodipine (35.4% was the most commonly prescribed antihypertensive drug followed by atenolol (17.8%, ramipril (17.2 % and furosemide (13.0 %. Among the combination therapies, 2- drug treatment was preferred for 75% of the hypertensive patients with CCB and β-blocker being the most frequent drug combination (22.4%.Conclusion: The general pattern of antihypertensive utilization seems to be in accordance with the international guidelines for management of hypertension.

  20. Clinical practice of beta blockers:New ideas and disputes%β受体阻滞剂的临床实践——新视点与争议

    Institute of Scientific and Technical Information of China (English)

    戴闺柱

    2011-01-01

    β受体阻滞剂在心血管疾病(cardiovascular disease,CVD)治疗中得到广泛应用,其药理基础是抑制交感神经活性,预防儿茶酚胺对心脏的毒性,发挥一系列心血管保护作用.但β受体阻滞剂的临床使用还存在诸多争议和不同观念.本文将β受体阻滞剂在高血压、心肌梗死(myocardial infarction,MI)和心力衰竭中的使用涌现的新观点和存在的争议做简要评述.%Beta blockers are wildly used in the treatment of cardiovascular disease.The pharmacology is based on the inhibition of sympathetic activity to prevent heart from the toxicity of catecholamines to protect the cardiovascular.However,there are still many disputes and different ideas about the clinical use of β-blockers.This article will review the new ideas and disputes about β-blockers in the use of hypertension,myocardial infarction and heart failure.

  1. Clinical study on ACEI combined with beta-blocker in the treatment of chronic heart failure%卡托普利联合美托洛尔治疗慢性心力衰竭的临床研究

    Institute of Scientific and Technical Information of China (English)

    殷洪志

    2014-01-01

    目的 观察卡托普利联合美托洛尔对慢性心力衰竭(CHF)的治疗作用,并探讨其作用机制.方法 60例CHF患者分为常规治疗组(A组)和卡托普利+美托洛尔治疗组(B组),观察治疗后左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、基质金属蛋白酶-9(MMP-9)和高敏C反应蛋白(hs-CRP)水平变化.酶联免疫吸附双抗体夹心法(ELISA)检测血清MMP-9表达水平;乳胶增强免疫比浊法检测血清hs-CRP表达水平.结果 B组LVEF及LVEDD[(63.21±6.09)%、(58.42±5.73) mm]的改善显著优于A组[(41.13±3.67)%、(66.24±4.24) mm](t=7.62、6.54,均P<0.01);B组MMP-9和hs-CRP[(1.31±0.24) ng/mL、(6.34±0.58) mg/L]水平显著低于A组[(2.23±0.39) ng/mL、(8.31±0.74) mg/L](t=6.82、7.03,均P<0.01).A和B组的有效率分别为36.7%和73.3%,差异有统计学意义(x2=6.90,P<0.05).结论 卡托普利与美托洛尔联合治疗对CHF患者心功能具有保护作用,抑制MMP-9和hs-CRP的表达可能是其主要的作用机制.%Objective To investigate the effects of ACEI combined with beta-blocker on cardiac function in patients with chronic heart failure (CHF)and explore its action mechanisms.Methods 60 CHF patients were enrolled in this study.The patients were randomly divided into the two groups:conventional treatment group(group A,n =30),ACEI combined with beta-blocker treatment group (group B,n =30).The LVEF,LVEDD,MMP-9,and hsCRP were recorded after treatment.The expression of MMP-9 was measured by ELISA.The level of serum hs-CRP was measured by latex enhanced immunoturbidimetric assay.Results The improvement of LVEF and LVEDD in B group [(63.21 ± 6.09) %,(58.42 ± 5.73)mm] were better than those in A group [(41.13 ± 3.67) %,(66.24 ± 4.24) mm] (t =7.62,6.54,P < 0.01).The expressions of MMP-9 and hs-CRP in group B [(1.31 ± 0.24) ng/ml,(6.34 ± 0.58) mg/L] were significantly lower than those in A group[(2.23 ±0.39) ng/mL,(8.31 ±0.74) mg/L] (t =6.82,7.03,P <0.01).The

  2. Effect of beta blocker in treatment of paroxysmal atrial fibrillation:a meta-analysis%β受体阻滞剂治疗阵发性心房颤动疗效及安全性的Meta分析

    Institute of Scientific and Technical Information of China (English)

    张淑娟; 赵庆彦; 代子玄; 王晓占; 郭宗文; 赵红宜

    2015-01-01

    Objective To assess the efficacy and safety of beta blockers in the treatment of paroxysmal atrial fibrilla-tion.Method From 2001 January to 2014 September, computer retrieval of controlled trials in the Cochrane library, PubMed database, Wanfang Data, Chinese academic periodical full-text database, VIP database ( VIP) , the clinical randomized con-trolled trials of beta blocker therapy in patients with paroxysmal atrial fibrillation ( RCT) were collected, 2 reviewers according to the inclusion and exclusion criteria, extracted the data independently, cross check and evaluate the quality of methodology, use RevMan 5 software to perform the Meta-analysis.Result 26 studies of 3368 cases were included.(1) combined with the application of beta blocker therapy in patients with paroxysmal atrial fibrillation was better than amiodarone (OR=1.97, 95%CI 1.49~2.61, P 0.05), the overall induced gastrointestinal adverse reaction rate was lower than the control group (OR=0.48, 95%CI, 0.35~0.66, P =0.05) and ACEI (OR=0.62, 95%CI 0.37~1.04, P >=0.05) showed no significant difference;the overall adverse reaction induced by arrhythmia rate the treatment group was lower than that of control group (OR=0 .60, 95%CI, 0.46~0.79, P <0.05).Conclusion Beta blockers has good clinical efficacy in the treatment of paroxysmal atrial fibrillation with low incidence rate of adverse reaction.Limited with the quality of the included studies, the evaluation of the treatment of paroxysmal atrial fibrillation efficacy and safety need more high quality randomized controlled double-blind trial.%目的:系统评价β受体阻滞剂治疗阵发性心房颤动的有效性及安全性。方法计算机检索2001年1月—2014年9月Cochrane图书馆临床对照试验数据库、Pubmed、万方数据、中国学术期刊全文数据库、维普数据库( VIP)等,收集β受体阻滞剂治疗阵发性房颤的临床随机对照试验( RCT),由2名评价者按纳入、排除标准独立选择

  3. Analysis of 1 case with intermittent left bundle branch block caused by high doses of beta blocker%大剂量β受体阻滞剂致间歇性左束支传导阻滞1例分析

    Institute of Scientific and Technical Information of China (English)

    王清丽; 金向梅; 张力; 赵激扬

    2014-01-01

    We have treated 1 case with intermittent left bundle branch block caused by high doses of beta blocker.We briefly reported the treatment experience.%在临床治疗了1例大剂量β受体阻滞剂致间歇性左束支传导阻滞的患者,现将体会简要报告。

  4. Observation of topical beta-blocker for superficial infantile hemangioma%局部应用β受体阻滞剂治疗婴儿眼部浅表型血管瘤观察

    Institute of Scientific and Technical Information of China (English)

    吕建美; 林婷婷; 朱利民; 何彦津

    2014-01-01

    目的 评估β受体阻滞剂2%盐酸卡替洛尔滴眼液局部应用治疗婴儿浅表型血管瘤的临床疗效.方法 对2012年5月至2013年9月在天津医科大学眼科医院就诊的8例婴儿浅表型血管瘤患者,应用2%盐酸卡替洛尔滴眼液瘤体外敷,每次外敷时间持续30~60 min,一天2~4次,治疗周期6个月.结果 8例进行上述治疗的患儿中,5例达到病变消退>75%,消退时间为1~6个月不等;2例病变缩小50%~75%,颜色变淡;1例病变无明显改变,病情控制无进展.在治疗及其随访期间均未见明显副反应或病情复发.结论 局部应用β受体阻滞剂2%盐酸卡替洛尔滴眼液治疗婴儿浅表型血管瘤效果显著,副反应小,有望成为浅表型血管瘤或早期血管瘤重要的治疗手段.%Objective To evaluate the clinical curative effect of topical beta-blocker 2% Carteolol Hydrochloride eye drops for superficial Infantile gemangioma.Methods Eight cases of superficial infantile hemangiomas in Tianjin Medical University Eye Hospital between May 2012 to September 2013 were topically applied 2% Carteolol Hydrochloride eye drops for 30-60 minutes twice to quarter a day,six months in all.Results Of all the eight cases,5 achieved completely regression (>75%) of the tumor within 1 to 6 months,2 cases' tumor became significantly smaller (50%-75%)with lighter color and no changes was found in 1 case.No recurrence or remarkable side effects were found during the treatment and follow-up visit.Conclusions Topical applying of beta-blocker 2% Carteolol Hydrochloride eye drops for superficial infantile hemangioma show exciting results without remarkable side effects,and this may become one important mean of treatment for superficial or early stage infantile hemangiomas.

  5. Application Effect of Beta Blockers in the Treatment of Heart Failure%β-受体阻滞剂在心力衰竭治疗中的应用研究

    Institute of Scientific and Technical Information of China (English)

    靳晓慧

    2016-01-01

    目的 评价3种β-受体阻滞剂治疗慢性心力衰竭效果. 方法 整群选取2012年3月—2014年1月该院收治的心力衰竭病例217例为研究对象,按不同治疗方法分为:50例患者应用酒石酸美托洛尔纳入A组,103例应用酒石酸美托洛尔缓释片纳入B组,64例应用富马酸比索洛尔片纳入C组,对比相关指标. 结果 出院后,A、B、C组、合计心率达标率分别为36.0%、30.1%、20.3%、28.6%,高于入院前8.0%、5.8%、6.3%、6.5%,差异具有统计学意义(P<0.05);出院后,A、B、C组平均剂量分别为 (46.3±22.0) mg/d、(57.9±34.4) mg/d、(5.32±3.1) mg/d 高于入院前 (41.4±25.1) mg/d、(39.4±23.1) mg/d、(3.74±2.0) mg/d,差异具有统计学意义(P<0.05). 结论 住院CHF患者β-受体阻滞剂用药率较高,但剂量偏少,心率达标率较低,应尽量遵照指南推荐标准用药.%Objective To evaluate the effects of three kinds of beta blockers in the treatment of chronic heart failure. Methods 217 case of heart failure in the hospital from March 2012 to January 2014 as the research objest,according to the different treatment methods were divided into 50 cases treated with metoprolol tartrate were selected as group A, 103 cases treated by metoprolol tartrate sustained-release tablets were selected as group B, and 64 cases treated by bisoprolol fu-marate tablets were selected as group C. And the values of the relative indicators were compared between the groups. Re-sults The rate of standard-achieving heart rate after discharge was higher than that before admission in group A (36.0% vs 8.0%), group B (30.1%vs 5.8%) and group C (20.3%vs 6.3%) with statistically significant differences (P<0.05). The mean dosage after discharge was much more than that before admission in group A[(46.3±22.0) mg/d vs (41.4±25.1) mg/d], group B[(57.9±34.4) mg/d vs (39.4±23.1) mg/d], and group C[(5.32±3.1) mg/d vs (3.74±2.0) mg/d], the differences were statistically significant (P<0.05). Conclusion

  6. Clinical Experience of Beta Blocker Therapy in Unstable Angina%β受体阻滞剂治疗不稳定型心绞痛的临床体会

    Institute of Scientific and Technical Information of China (English)

    许志茹

    2015-01-01

    目的:针对β受体阻滞剂治疗不稳定型心绞痛的临床体会进行分析。方法选择我院在2013年6月~2014年6月期间,收治的80例不稳定型心绞痛患者,分为对照组和观察组。对照组常规心绞痛治疗,观察组常规治疗+β受体阻滞剂治疗。观察两组患者的临床治疗效果、不良反应、心绞痛发作情况。结果观察组与对照组患者的临床治疗总有效率分别为95.00%、65.00%,P<0.05,具有统计学意义。观察组与对照组患者的不良反应发生率分别为2.50%、15.00%,P<0.05,具有统计学意义。观察组与对照组患者的心绞痛发作次数和持续时间均有显著差异,P<0.05,具有统计学意义。结论在不稳定型心绞痛治疗中,β受体阻滞剂发挥重要作用,可以改善患者临床症状,降低不良反应,提高患者生活质量。%Objective To analysis Beta blockers in the treatment of unstable angina clinical experience. Methods Selected 80 patients with unstable angina treated in June 2013~June 2014, divided into control group and observation group. The control group conventional treatment angina pectoris, observation group conventional treatment+beta blockers. Observed the clinical therapeutic effect of two groups of patients, adverse reactions, angina pectoris attack Situation. Results Observation group and control group in patients with the clinical total effective rate respectively were 95.00%, 65.00%, P<0.05, there was statistical significance. Observation group and control group patients the incidence of adverse reactions were 2.50%, 15.00%, P<0.05, there was statistical significance. Observation group and control group in patients with angina frequency and duration were signiifcantly different, P<0.05, there was statistical signiifcance. Conclusion In the treatment of unstable angina, β-blockers play an important role, can improve the clinical symptoms and reduce adverse reactions and improve the

  7. Study on the influence of beta-blockers on endogenous CO concentration and NOS activity in rat corpus ;cavernosum%β受体阻滞剂对雄性大鼠阴茎组织中内源性一氧化碳浓度及一氧化氮合酶活性影响的研究

    Institute of Scientific and Technical Information of China (English)

    李明; 丁连芹; 张万峰; 王贵平; 杨振涛; 王洪杰

    2016-01-01

    Objective To discuss the impact of beta -blockers on endogenous CO concentration and NOS activity in rat corpus cavernosum .Methods Thirty adult male rats were equally divided into three groups , the first group raised with first generation beta -blocker ( Propranolol ) , the control group raised with regular diet , the third group raised with second generation beta -blocker ( Metoprolol ) .The concentration of CO was measure by modified dual -wavelength spectrophotometry , the NOS activity was measure by improved Griess measurement .Results The concentration of CO and the NOS activity of first generation beta -blocker ( Propranolol ) group were lower than the group raised with regular diet .The concentration of CO and the NOS activity of the group raised with regular die were lower than the group raise with second generation beta -blocker (Metoprolol).The difference between groups were statistically significant (P<0.05).Conclusions The first generation beta-blockers can reduce the concentration of CO and the NOS activity in rat corpus cavernosum , the second generation beta -blockers can increase the concentration of CO and the NOS activity in rat corpus cavernosum .%目的:探讨β受体阻滞剂对雄性大鼠阴茎组织中内源性CO浓度及NOS活性的影响。方法健康雄性大鼠30只,分为三组,第一代β受体阻滞剂(普萘洛尔)饲养组,正常饲养组,第二代β受体阻滞剂(倍他乐克)饲养组,采用改良双波长分光光度法检测大鼠阴茎组织中CO浓度,改良Griess法检测大鼠阴茎组织中NOS活性。结果普萘洛尔饲养组大鼠阴茎组织中内源性CO浓度及NOS活性低于正常饲养组,正常饲养组大鼠阴茎组织中CO浓度及NOS活性低于倍他乐克饲养组,各组间差异具有统计学意义(P均<0.05)。结论第一代β受体阻滞剂可导致成年雄性大鼠阴茎海绵体内源性CO浓度及NOS活性下降,而第二代β受体阻滞剂可增加成年

  8. District nurses prescribing as nurse independent prescribers.

    Science.gov (United States)

    Downer, Frances; Shepherd, Chew Kim

    2010-07-01

    Nurse prescribing has been established in the UK since 1994, however, limited focus has been placed on the experiences of district nurses adopting this additional role. This phenomenological study explores the experiences of district nurses prescribing as nurse independent prescribers across the West of Scotland. A qualitative Heideggarian approach examined the every-day experiences of independent prescribing among district nurses. A purposive sample was used and data collected using audio taped one-to-one informal interviews. The data was analysed thematically using Colaizzi's seven procedural steps. Overall these nurses reported that nurse prescribing was a predominantly positive experience. Participants identified improvements in patient care, job satisfaction, level of autonomy and role development. However, some of the participants indicated that issues such as support, record keeping, confidence and ongoing education are all major influences on prescribing practices.

  9. Pharmacoeconomics of antihypertensive drugs prescribed in a multispecialty hospital in South India

    Directory of Open Access Journals (Sweden)

    P S Dhivya

    2014-01-01

    Full Text Available The main objective of this study is to evaluate the most cost-effective therapy among the different group of antihypertensive prescribed in a multispecialty hospital. According to inclusion and exclusion criteria, 104 hypertensive patients were selected. Participants were interviewed at about the demographic data. Initial clinical assessment of blood pressure (BP and pulse rate were done. They were prescribed monotherapy either with angiotensin receptor blocker (ARB (n = 7 or beta blocker (BB (n = 23 or calcium channel blocker (CCB (n = 9. Angiotensin converting enzyme with BB (n = 27, ARB with CCB (n = 17 and ARB with BB (n = 21 were prescribed in combination therapy. The cost of antihypertensive drugs was calculated using incremental cost for "per mmHg" reduction and cost for "per patient" reaching target BP. The data are analyzed using suitable statistical methods. ARB with BB shows significant reduction in BP. To maintain the targeted BP, BB is found to be cost-effective in both systolic BP (SBP and diastolic BP (DBP as well as in the reduction of "per mmHg" of DBP. In case of reduction of "per mmHg" of SBP ARB is cost-effective. Treatment of hypertension with BBs is cost-effective.

  10. Beta-Blockers: An Abstracted Bibliography.

    Science.gov (United States)

    1989-04-04

    seizure test, perphenazine-liduced catatonia , nicotine-induced tremors effect on motor activity, effect on body temperature, and influence on...chemically induced). All phases of convulsions were blocked in audiogenic seizures. Propranolol delayed the onset of perphenazine catatonia and decreased the

  11. Beta-blockers and heart failure.

    Science.gov (United States)

    Cruickshank, John M

    2010-01-01

    The life-time risk of developing HF is about 20% (40% if hypertension present). With increasing longevity in the developed world the burden of HF (hospitalisation) is set to increase over the next 10-20 years. CAD and hypertension are the two main causes of HF; CAD (and obesity) in the case of systolic HF and hypertension in the case of diastolic HF (mainly in the elderly). BB have become the corner-stone (alongside ACE-inhibitors) in the treatment of systolic HF. Bisoprolol, metoprolol and carvedilol (on an ACE-inhibitor background) have reduced all-cause death by 34-5%. The presence of intrinsic sympathomemetic activity (xamoterol, bucindolol, nebivolol) diminishes efficacy in the treatment of systolic HF. First-line bisoprolol has proved "non-inferior" to first-line enalapril in reducing all-cause death and is probably superior in reducing sudden death. The main mode of action of BB in treating systolic HF is inhibition of chronic beta-1 stimulation-induced myocardial apoptosis/necrosis/inflammation. The combination of pure beta-1 blockade (low-dose bisoprolol) and pure beta-2 blockade (clenbuterol) may prove invaluable in the treatment of end-stage systolic HF (thus avoiding cardiac transplantation). The appropriate treatment of diastolic HF has yet to be determined. Beta-blockade is effective in the prevention of HF i) in the post-MI period and ii) as first-line agents in the treatment of young/middle-aged hypertension and as second-line agents (to first-line diuretics) in the treatment of elderly systolic hypertension. BB are highly effective in reversing LVH in young/middle-aged hypertensives (LVH pre-disposes to HF in young/middle-aged hypertension) and are (bisoprolol) at least as good as ACE-inhibitors. Choice of BB is important as benefit is not a class-effect. ISA (xamoterol, bucindolol, nebivolol) markedly diminishes efficacy. The choice is between bisoprolol, metoprolol succinate and carvedilol for optimal efficacy. Adverse reactions are associated, mainly, with beta-2 blockade and alpha-blockade. Thus non-selective (e.g. propranolol) or modestly beta-1 selective (e.g. metoprolol, atenolol) are associated with metabolic disturbance, bronchospasm, epinephrine/hypertensive interaction (with cigarette-smoking or insulin-induced hypoglycaemia), while the possession of alpha-blocking activity (e.g. carvedilol) is associated with dizziness and postural hypotension. The possession of beta-2 blockade, particularly if combined with alpha-blockade, is associated with an increased occurrence of sexual dysfunction. Lipophilic BB like propranolol and metoprolol appear in high concentrations in human brain tissue and are associated with side-effects such as insomnia, dreams and nightmares.

  12. Antipsychotics, Lithium, Benzodiazepines, Beta-Blockers.

    Science.gov (United States)

    Karper, Laurence P.; And Others

    1994-01-01

    The psychopharmacologic treatment of aggression is a critical component of the treatment of psychiatric patients. The diagnostic assessment of aggressive patients is reviewed and relevant literature is presented to help clinicians select appropriate medication. Side-effects, dosages, and methods of administration are highlighted. (JPS)

  13. Research progress of beta-blockers in the treatment of infantile hemangioma%β-受体阻滞剂治疗婴幼儿血管瘤的研究进展

    Institute of Scientific and Technical Information of China (English)

    李忠达; 彭智

    2016-01-01

    Infantile hemangiomas (IH) are the most common tumors of infancy, with a prevalence of approxi-mately 4~10%of infants. Although the natural history of IH is to spontaneously involute, a significant minority of IH re-quire therapy with the aim to prevent disfigurement, functional impairment, or ulceration. In 2008, propranolol, a non-se-lective beta (β)-blocker, was reported to be highly effective in treating IH. Since that time there have been more than 200 articles published regarding the efficacy and potential toxicity ofβ-blockers, both systemic and topical, for the treatment of IH. Based on these findings,β-blockers appear to be highly effective in treating IH and are well tolerated, though side effects have been reported. When therapy is appropriately monitored,β-blockers have been proven to be a safer and su-perior alternative to systemic steroids. This paper mainly reviews the treatment of IH through beta-blockers in recent years involving the mechanism, side effects, usage and dosage.%婴幼儿血管瘤(IH)是一种最常见的良性肿瘤,在婴幼儿中患病率为4%~10%,虽然有部分IH存在自然消退过程,但少数IH仍需要有效治疗,以防止其对皮肤的损害,导致肢体功能障碍以及发生局部溃疡.自2008年,普萘洛尔,一种非选择性β-受体阻滞剂被报道能高效治疗婴幼儿血管瘤之后,目前有约200篇文献报道β-受体阻滞剂对IH治疗存在全身性、局部性疗效及潜在毒性.基于以上发现,β-受体阻滞剂在治疗IH中产生非常高的疗效并得到了认可.与类固醇比较,即使β-受体阻滞剂在使用过程中产生一定的副作用,如果在治疗过程中得到适当监测,其更加安全与优质.本文主要对近几年来β-受体阻滞剂治疗IH作用机制,不良反应,用法、用量做一综述.

  14. Using situation investigation on beta-blockers in patients with chronic heart failure combined chronic obstructive pulmonary disease%β受体阻滞剂在慢性心力衰竭合并慢性阻塞性肺疾病患者中的使用状况调查

    Institute of Scientific and Technical Information of China (English)

    丁旭; 林海龙; 李雅洁; 赵洪涛

    2014-01-01

    目的:了解慢性心力衰竭(CHF)患者合并慢性阻塞性肺疾病(COPD)发生率,了解β受体阻滞剂使用情况,为未来针对这部分患者β受体阻滞剂的使用提供依据。方法根据2007年1月1日~2009年12月31日出院诊断CHF患者住院资料和用药资料,研究慢性阻塞性肺病共存检出率、分析β受体阻滞剂使用比例、类型、剂量和未应用的原因。结果共有598例CHF患者,其中合并慢性阻塞性肺病的患者74例(12.4%),β受体阻滞剂药物使用11例(14.9%),最常用的为美托洛尔(29.4±10.1) mg/d,所有使用剂量均未达到目标剂量。有β受体阻滞剂禁忌证患者26例(35.1%),没有明确的原因未应用β受体阻滞剂患者37例(50.0%)。结论 CHF患者合并COPD并不少见,β受体阻滞剂在这组患者中使用比例及用量明显不足,在未来应对相关的诊断和治疗给予足够的关注。%Objective To know about the detection rate of chronic obstructive pulmonary disease ( COPD) in hospitalized cases with chronic heart failure ( CHF) , and to explore the usage state of the beta-blockers performed in these cases. Methods General data and medication data from January 1, 2007 to December31, 2009 were collected in hospitalized cases whose diagnosis was CHF after discharge. To find out the detection rate of COPD in hospitalized cases with CHF, the usage rate, category, dosage and causes failed to perform of beta-blockers in these cases. Results 598 cases with CHF were selected, among them 74 cases who complicated with COPD were detective the detection rate was 12.4%, the usage rate of beta-blockers performed in these cases was 14.9%. Metoprolol was the most common category, and the average dosage was (29.4±10.1) mg per day. No one received the target dose that the guide line had been recommended.26 cases (35.1%) had contraindication in medication of beta-blockers, but yet 37 cases (50.0%) who had no contraindication could not receive beta-blockers owing

  15. Diltiazem como alternativa ao betabloqueador na angiotomografia de artérias coronárias Diltiazem as an alternative to beta-blocker in coronary artery computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Rochitte

    2012-08-01

    Full Text Available FUNDAMENTO: A redução da frequência cardíaca (FC na angiografia por tomografia das artérias coronarianas (ATCCor é fundamental para a qualidade de imagem. A eficácia dos bloqueadores de cálcio como alternativas para pacientes com contraindicações aos betabloqueadores não foi definida. OBJETIVOS: Comparar a eficácia na redução da FC e variabilidade RR do metoprolol e diltiazem na ATCCor. MÉTODOS: Estudo prospectivo, randomizado, aberto, incluiu pacientes com indicação clínica de ATCCor, em ritmo sinusal, com FC>70bpm e sem uso de agentes que interferissem com a FC. Cinquenta pacientes foram randomizados para grupos: metoprolol IV 5-15 mg ou até FC≤60 bpm(M, e diltiazem IV 0,25-0,60mg/kg ou até FC≤60 bpm (D. Pressão arterial (PA e FC foram aferidas na condição basal, 1min, 3min e 5min após agentes, na aquisição e após ATCCor. RESULTADOS: A redução da FC em valores absolutos foi maior no grupo M que no grupo D (1, 3, 5min, aquisição e pós-exame. A redução percentual da FC foi significativamente maior no grupo M apenas no 1 min e 3 min após início dos agentes. Não houve diferença no 5 min, durante a aquisição e após exame. A variabilidade RR percentual do grupo D foi estatisticamente menor do que a do grupo M durante a aquisição (variabilidade RR/ FC média da aquisição. Um único caso de BAV, 2:1 Mobitz I, revertido espontaneamente ocorreu (grupo D. CONCLUSÃO: Concluímos que o diltiazem é uma alternativa eficaz e segura aos betabloqueadores na redução da FC na realização de angiografia por tomografia computadorizada das artérias coronarianas. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0BACKGROUND: Reducing heart rate (HR in CT angiography of the coronary arteries (CTACor is critical to image quality. The effectiveness of calcium channel blockers as alternatives for patients with contraindications to beta-blockers has not been established. OBJECTIVES: To compare the efficacy in the

  16. Exploring the equity of GP practice prescribing rates for selected coronary heart disease drugs: a multiple regression analysis with proxies of healthcare need

    Directory of Open Access Journals (Sweden)

    St Leger Antony S

    2005-02-01

    Full Text Available Abstract Background There is a small, but growing body of literature highlighting inequities in GP practice prescribing rates for many drug therapies. The aim of this paper is to further explore the equity of prescribing for five major CHD drug groups and to explain the amount of variation in GP practice prescribing rates that can be explained by a range of healthcare needs indicators (HCNIs. Methods The study involved a cross-sectional secondary analysis in four primary care trusts (PCTs 1–4 in the North West of England, including 132 GP practices. Prescribing rates (average daily quantities per registered patient aged over 35 years and HCNIs were developed for all GP practices. Analysis was undertaken using multiple linear regression. Results Between 22–25% of the variation in prescribing rates for statins, beta-blockers and bendrofluazide was explained in the multiple regression models. Slightly more variation was explained for ACE inhibitors (31.6% and considerably more for aspirin (51.2%. Prescribing rates were positively associated with CHD hospital diagnoses and procedures for all drug groups other than ACE inhibitors. The proportion of patients aged 55–74 years was positively related to all prescribing rates other than aspirin, where they were positively related to the proportion of patients aged >75 years. However, prescribing rates for statins and ACE inhibitors were negatively associated with the proportion of patients aged >75 years in addition to the proportion of patients from minority ethnic groups. Prescribing rates for aspirin, bendrofluazide and all CHD drugs combined were negatively associated with deprivation. Conclusion Although around 25–50% of the variation in prescribing rates was explained by HCNIs, this varied markedly between PCTs and drug groups. Prescribing rates were generally characterised by both positive and negative associations with HCNIs, suggesting possible inequities in prescribing rates on the basis

  17. A PROSPECTIVE STUDY OF PRESCRIBING PATTERN OF ANTIHYPERTENSIVE DRUGS IN TERTIARY CARE HOSPITAL, BANGALORE

    Directory of Open Access Journals (Sweden)

    Anand R

    2013-12-01

    Full Text Available BACKGROUND : Hypertension is the most common cardiovascular disease . Sustained arterial hypertension damages blood vessel s in kidney , heart , brain and leads to an increased incidence of renal failure , coronary disease , heart failure and stroke. Effective pharmacologic lowering of blood pressure has been shown to prevent damage to blood vessel and so substantially reduce morbidity and mortality rates. AIM : This drug utilization study wa s intended to find out the preferred drug group prescribed either alone o r in combinations and their adherence to the JNC7 guidelines. Furthermore the prescription variations as regards to t he age and concomitant illness we re also analyzed . METHODS AND MATERIAL : Drug utilization data were analyzed after getting the patient ’ s pa rticulars regarding age , sex , drugs , concomitant illness etc. in the proforma . RESULTS : After analysis , it was found that most frequently prescribed antihypertensive drugs were ARBs ( 58 %, CCBs ( 50 %, Beta blockers(15 % , Diuretics ( 14 %. 68 % received monotherapy while remaining 32 % received combination therapy . CONCLUSION : The prescription pattern was found to be partly in accordance with JNC VII guidelines . KEY WORDS : Antihypertensives , Drug utilization , ARBs

  18. β受体阻滞剂应用于慢性阻塞性肺疾病治疗的Meta分析%Meta-analysis of beta-blockers for chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    徐婷娟; 胡世莲; 沈干; 徐维平; 吴蕾; 陈尹

    2013-01-01

    ) . P > 0. 051 and FEV1% increased 0. 89% 「 95% CI( - 1. 26. 3. 04) . P > 0.05」 after treatment with beta-blockers. Conclusion Cardioselective beta — blockers do not produce obvious adverse respiratory effects.

  19. Discussion of Beta-blocker in the treatment of chronic obstructive pulmonary disease complicated with chronic heart failure%慢性阻塞性肺疾病合并慢性心力衰竭患者使用β阻滞剂的探讨

    Institute of Scientific and Technical Information of China (English)

    赵华昌

    2014-01-01

    Chronic obstructive pulmonary disease(COPD) is one of the common diseases in respiratory system, and a group of systemic inflammatory diseases which are positively correlated to ages; chronic heart failure(CHF) is a syndrome characterized by impaired cardiac functions which are caused by hypertension and coronary heart disease to a certain developmental stage. The two groups of diseases usually co-exist clinically and become severe along with the ages.The CHF guides, home and abroad, both recommend cardioselective beta-blocker, but clinical physicians, considering its adverse effects, tend to refuse or avoid the use of beta-blocker on patients with COPD complicated with CHF. In recent years, increasing evidence shows that the beta-blocker in the treatment of COPD complicated with CHF does not have significant adverse effects, and its safety has been confirmed. No evidence shows that its function in reducing pulmonary ventilation equals to FEV1. In clinical practices, however, relevant studies warn that the beta-blocker may lead to condition deterioration. Through observation, the current author suggests that the strategy of"individualization"may be adopted for patients with COPD complicated with CHF when receiving cardioselective beta-blocker.%慢性阻塞性肺疾病(COPD)是呼吸系统常见病,是一组与年龄呈正相关的全身炎症性疾病;慢性心力衰竭(CHF)多系高血压、冠心病发展到一定程度后导致心功能损害为主的综合征。在临床上这两组疾病常常合并存在,且随着年龄的增加而增加。国内外的慢性心力衰竭指南均推荐使用心脏选择性β受体阻滞剂,但是临床医师遇到COPD合并CHF患者因担心β受体阻滞剂的不良反而拒绝或回避使用。近年来越来越多的证据表明,心脏选择性β受体阻滞剂在COPD合并CHF患者中没有明显的不良反应,且安全性得到证实,没有证据显示其降低肺通气功能如第1

  20. Changing physician prescribing behaviour.

    Science.gov (United States)

    Gray, J

    2006-01-01

    Didactic approaches to educating physicians and/or other health professionals do not produce changes in learner behaviour. Similarly, printed materials and practice guidelines have not been shown to change prescribing behaviour. Evidence-based educational approaches that do have an impact on provider behaviour include: teaching aimed at identified learning needs; interactive educational activities; sequenced and multifaceted interventions; enabling tools such as patient education programs, flow charts, and reminders; educational outreach or academic detailing; and audit and feedback to prescribers. Dr. Jean Gray reflects over the past 25 years on how there has been a transformation in the types of activities employed to improve prescribing practices in Nova Scotia. The evolution of Continuing Medical Education (CME) has resulted in the creation of the Drug Evaluation Alliance of Nova Scotia (DEANS) program, which is one exemplar of an evidence-based educational approach to improving physician prescribing in that province. Key words: Evidence-based, education, prescribing.

  1. CCB+利尿剂+β受体阻滞剂联合降压治疗与动脉弹性的相关性%The Correlation of CCB Add Diuretics and Beta-blockers Joint Antihypertensive Therapy Correlation of Arterial Elasticity

    Institute of Scientific and Technical Information of China (English)

    王淑霞

    2015-01-01

    Objective To study the CCB add diuretic and beta blockers combination therapy and the correlation of arterial elasticity. Methods Selected 50 cases of patients with high blood pressure in our hospital as research object, were divided into the treatment group and the control group, each group had 25 cases, the control group mainly uesed the CCB and ACEI treatment, the treatment group mainly adopts CCB added diuretic and beta blockers with antihypertensive therapy, compared the clinical effect of two groups of patients.Results The total effective was 94.43% in the treatment group and the control group total effective was 87.55%, the treatment group treatment effect was bettere than the control group, P<0.05, was difference had statistically significance.Conclusion Patients with hypertension by CCB add diuretica and beta blockers joint treatment, which could effectively improve patients wiht hypertensive in small artery elasticity, has obtained the good curative effect in clinical.%目的 探讨CCB+利尿剂+β受体阻滞剂联合降压治疗与动脉弹性的相关性.方法 选取我院收治的50例高血压患者作为研究对象,将其分为治疗组与对照组,各25例,对照组主要采用CCB+ACEI治疗,治疗组主要采用CCB+利尿剂+β受体阻滞剂联合降压治疗,对两组患者的临床效果进行比较.结果 治疗组的总有效为94.43%,对照组的总有效为87.55%,治疗组的效果优于对照组,P<0.05,差异不具有统计学意义.结论 对高血压患者采用CCB+利尿剂+β受体阻滞剂联合降压治疗,能够有效的改善高血压患者的小动脉弹性,在临床中取得了良好的治疗效果.

  2. Treating effect analysis of big dose oryzanol with beta blocker for cardiovascular neurosis disease%大剂量谷维素联合β-受体阻滞剂治疗心血管神经症的疗效分析

    Institute of Scientific and Technical Information of China (English)

    王云

    2014-01-01

    目的:探究大剂量谷维素联合β-受体阻滞剂治疗心血管神经症的临床疗效。方法抽取2012年2月至2013年2月在我院就诊的80例心血管神经症患者作为研究对象,以随机的方式分为观察组与对照组,各40例;对照组使用常规治疗方法进行治疗,观察组使用大剂量谷维素联合β-受体阻滞剂进行治疗;对两组患者临床治疗效果进行观察比较。结果观察组治疗有效率(97.50%)明显高于对照组(72.50%),两组数据差异明显(P<0.05),有统计学意义。结论对于心血管神经症患者,采取大剂量谷维素联合β-受体阻滞剂进行治疗效果良好,能够提高患者临床治疗有效率,改善患者生活质量。%ObjectiveTo explore a big dose of oryzanol beta blockers clinical efifcacy in the treatment of cardiovascular neurosis.Methods from february 2012 to february 2013 in our hospital 80 cases of patients with cardiovascular neurosis as the research object, in the form of random divided into observation group and control group, 40 cases; control group treated with conventional treatment methods, the observation group used high doses of oryzanol joint treated with beta blockers; to compare clinical therapeutic effects in both groups.Results treatment efifcient (97.50%) of the observation group was obviously higher than that of control group (72.50%), two groups of data difference obvious (P < 0.05=, having statistical signiifcance. Conclusion for patients with cardiovascular neurosis, taking high doses of oryzanol in combination with beta blockers treatment effect is good, can effectively improve the clinical treatment, improve patient quality of life.

  3. Changing doctor prescribing behaviour

    DEFF Research Database (Denmark)

    Gill, P.S.; Mäkelä, M.; Vermeulen, K.M.;

    1999-01-01

    The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane Collabora......The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane...... Collaboration on Effective Professional Practice. This register is kept up to date by searching the following databases for reports of relevant research: DHSS-DATA; EMBASE; MEDLINE; SIGLE; Resource Database in Continuing Medical Education (1975-1994), along with bibliographies of related topics, hand searching...

  4. When Medication Is Prescribed

    Science.gov (United States)

    ... page please turn Javascript on. Feature: Depression When Medication Is Prescribed Past Issues / Fall 2009 Table of ... you have about the medicine. —NIMH Types of Medications There are several types of medications used to ...

  5. 感染性休克患者心脏及微循环的功能变化与β受体阻滞剂的血流动力学效应%Functional changes of heart and microcirculation in patients with septic shock and analysis of the hemodynamic effects of beta blockers

    Institute of Scientific and Technical Information of China (English)

    孙志宝; 安庆华; 郑玉明; 齐凯; 程悦

    2016-01-01

    目的:探讨β受体阻滞剂在改善心脏及微循环功能的作用以及对血流动力学参数的影响,为临床更好的使用β受体阻滞剂治疗感染性休克提供参考。方法选取2012年3月-2014年2月医院81例感染性休克患者,随机分为观察组41例和对照组40例;对照组采用常规体液复苏的治疗方法,观察组在此基础上采用β受体阻滞剂的治疗方法,比较两组患者血流动力学指标及组织氧合指数参数,数据采用SPSS 17.0软件进行统计分析。结果观察组患者治疗后心率(HR)、心脏指数(CI)显著低于对照组;每搏输出量指数(SVI)显著高于对照组,差异有统计学意义(P<0.05);两组患者各时间点中心静脉血氧饱和度(ScvO2)比较差异无统计学意义,说明β受体阻滞剂有效的降低了血乳酸值。结论β受体阻滞剂可以改善心室顺应性以及舒张功能,血流动力学参数有所变化,提高组织灌注水平,可作为临床治疗感染性休克的有效手段之一。%OBJECTIVE To investigate the effect of beta blockers in improving the function of the heart and micro‐circulation and the influence of the parameters of the blood flow so as to provide references for using beta blockers to cure septic shock in clinical practice .METHODS Totally 81 patients with septic shock in our hospital from Mar . 2012 to Feb .2014 were selected and these patients were randomly divided into observation group (41 cases) and control group (40 cases) .The control group was treated with routine fluid resuscitation ,and on the basis of this , the observation group was treated with beta blockers .The hemodynamic parameters and tissue oxygenation index were measured in two groups .All data were statistically analyzed by SPSS 17 .0 software .RESULTS The heart rate (HR) and cardiac index (CI) of the observation group were significantly lower than those in the control group ,and the stroke

  6. Matrix with Prescribed Eigenvectors

    Science.gov (United States)

    Ahmad, Faiz

    2011-01-01

    It is a routine matter for undergraduates to find eigenvalues and eigenvectors of a given matrix. But the converse problem of finding a matrix with prescribed eigenvalues and eigenvectors is rarely discussed in elementary texts on linear algebra. This problem is related to the "spectral" decomposition of a matrix and has important technical…

  7. Design of materials with prescribed nonlinear properties

    DEFF Research Database (Denmark)

    Wang, Fengwen; Sigmund, Ole; Jensen, Jakob Søndergaard

    2014-01-01

    We systematically design materials using topology optimization to achieve prescribed nonlinear properties under finite deformation. Instead of a formal homogenization procedure, a numerical experiment is proposed to evaluate the material performance in longitudinal and transverse tensile tests un....... The numerical examples illustrate optimized materials with rubber-like behavior and also optimized materials with extreme strain-independent Poisson's ratio for axial strain intervals of εi ∈ [0.00,0.30]. © 2014 Elsevier Ltd. All rights reserved....... under finite deformation, i.e. stress-strain relations and Poisson's ratio. By minimizing errors between actual and prescribed properties, materials are tailored to achieve the target. Both two dimensional (2D) truss-based and continuum materials are designed with various prescribed nonlinear properties...

  8. Insight into the rational use of nonselective beta-blockers in cirrhotic patients with portal hypertension%非选择性β受体拮抗剂在肝硬化门静脉高压患者中的合理应用

    Institute of Scientific and Technical Information of China (English)

    涂传涛(综述); 王吉耀(审校)

    2014-01-01

    It is well established that variceal hemorrhage is one of the most common and severe complications in patients with liver cirrhosis and portal hypertension. Despite the advances in the last three decades in its treatment, mortality from variceal bleeding is still around 15%~20%. Moreover,variceal bleeding often leads to deterioration of liver functions. Furthermore,it is a common trigger for other complications of liver cirrhosis. Therefore, primary and secondary preventions of variceal hemorrhageare important strategy for improving the survival in patients with decompensated liver cirrhosis and esophageal varices. Nonselective beta-blockers (NSBB) have been shown to reduce the hepatic venous portal pressure gradient and are recommended for the prevention of the first variceal hemorrhage and rebleeding. The advantages of NSBB therapy are good tolerance,oral administrationand lowcost.However,the indication of NSBB should be limited to patientswith a high risk of variceal bleeding because of the potential side effects of the therapy.%曲张静脉出血是肝硬化门静脉高压患者最常见和最严重的并发症之一。近三十余年来,尽管对其治疗取得了进展,但其相关病死率仍达15%~20%左右。不仅如此,曲张静脉出血常导致肝功能进一步的恶化,也是诱发肝硬化其他并发症的共同启动因素。因此,预防曲张静脉首次出血与再出血是提高失代偿期肝硬化和食管曲张静脉患者生存率的重要措施。非选择性β受体阻滞剂(nonselective beta-blockers, NSBB)因具有明确地降低肝静脉压力剃度的作用,被推荐用于预防曲张静脉首次出血和再出血。尽管该类药物具有耐受性好、口服方便和经济实惠的优点,但在使用过程中因存在副作用和潜在的不良作用,一般推荐应有选择地用于那些高危的曲张静脉患者。

  9. The Prescribed Velocity Method

    DEFF Research Database (Denmark)

    Nielsen, Peter Vilhelm

    The- velocity level in a room ventilated by jet ventilation is strongly influenced by the supply conditions. The momentum flow in the supply jets controls the air movement in the room and, therefore, it is very important that the inlet conditions and the numerical method can generate a satisfactory...... description of this momentum flow. The Prescribed Velocity Method is a practical method for the description of an Air Terminal Device which will save grid points close to the opening and ensure the right level of the momentum flow....

  10. Relationship between response to cardiac resynchronization therapy and beta-blocker and angiotensin-converting enzyme inhibitor%心脏再同步治疗反应性与β受体阻滞剂及血管紧张素转化酶抑制剂的关系

    Institute of Scientific and Technical Information of China (English)

    高运来; 张常莹; 陆娟; 戴敏; 李库林; 郑杰; 郁志明; 王如兴

    2015-01-01

    Objective To investigate pharmacologic therapy in patients receiving cardiac resynchronization therapy (CRT)and relationship with CRT response.Methods A total of 35 patients consisting 25 males and 10 females,mean age 64.1 ± 9.7 (48-75 )years old,who underwent CRT implantation for chronic heart failure were enrolled in this study.All patients were evaluated with conventional echocardiography before and 6 months after implantation.Cardiac function class (New York Heart Association,NYHA)was also assessed according to clinical performance.Medications such as beta-blocker and angiotensin-converting enzyme inhibitor (ACEI)were analyzed before and after CRT implantation.Patients were divided into responder group and non-responder group according to response to CRT. Beta-blocker and ACEI before and after CRT implantation were compared, respectively. Relationship between doses change of beta-blocker or ACEI and response to CRT were analyzed.Results There were 28 responders and 7 non-responders. Patients of responder group received larger metoprolol succinate therapy postoperatively compared with preoperatively(average daily dose 59.6±24.4 mg/d vs 25.0±1 1.0 mg/d,P 0.05 ).Patients of responder group received larger perindopril therapy postoperatively compared with preoperatively (average daily dose 4.74±1.52 mg/d vs 3.47±0.91 mg/d,P 0.05 ). Furthermore,change of beta-blocker therapy had a good correlation with CRT response (r =0.688,P 0.05).Conclusion Response to cardiac resynchronization therapy correlated with optimal pharmacologic therapy postoperatively. Optimal pharmacologic therapy and CRT may work together to improve outcomes.%目的:分析心脏再同步治疗(CRT)患者术后药物治疗情况及与 CRT 反应性的关系。方法行 CRT 的慢性心力衰竭患者35例,平均年龄(64.1±9.7)岁;所有患者术前及术后6个月均行常规超声心动图检查,并根据临床表现评估术前及术后6个月患者心功能分级。对患者 CRT 植入

  11. 非瓣膜性心房颤动患者内皮和血小板功能及β受体阻滞剂干预的临床意义%Endothelial function and platelet activation in patients with non-valvular atrial fibrillation and the influence of beta-blocker on them

    Institute of Scientific and Technical Information of China (English)

    种甲; 杨杰孚

    2011-01-01

    目的 探讨非瓣膜性心房颤动(房颤)与内皮细胞功能及血小板功能的关系,观察β受体阻滞剂治疗对房颤患者内皮功能及血小板功能的影响.方法 非瓣膜性持续性房颤患者(房颤组)25例,窦性心律组(窦律组)35例,通过竞争性酶联免疫(ELASA)分析定量测定两组血清血管性血友病因子(von Willebrand Factor,vWF)和可溶性P选择素水平,及房颤组β受体阻滞剂治疗后上述指标的变化.结果 房颤组血清vWF水平(1945.2±111.3)g/L高于窦律组(1862.3±101.6)g/L,差异有统计学意义(P<0.05).房颤组患者服用β受体阻滞剂(阿替洛尔)后,血清vWF水平下降至(1758.3±152.4)g/L,与服药前比较差异有统计学意义(P<0.01).血清可溶性P选择素水平房颤组与窦律组[分别为(24.32±9.21)g/L与(24.68±11.70)g/L]比较,差异无统计学意义(P>0.05),服用β受体阻滞剂后血清可溶性P选择素水平下降至(21.05±8.94)g/L,但与服药前相比差异无统计学意义(P>0.05).vWF与可溶性P选择素无相关性(Pearson相关系数为-0.008,P>0.05).结论 房颤患者血清vWF水平较窦性心律者升高,提示存在心血管内皮损伤.服用阿替洛尔后,房颤患者血清vWF水平下降,提示阿替洛尔用于房颤患者除能有效控制心室率外,还可能具有内皮保护功能.%Objective To examine the serum von Willebrand factor (vWF) and soluble Pselectin levels in patients with non-valvular atrial fibrillation (NVAF), and to observe the influence of beta-blocker treatment on endothelial function and platelet activation in NVAF patients. Methods The 25 subjects, 17 males and 8 females, with persistent NVAF and left ventricular ejection fraction (LVEF)≥50%, were enrolled in NVAF group. Those with myocardial infarction, cardiomyopathy or hyperthyroidism were excluded. Another 35 subjects with sinus rhythm were as control (age,gender and LVEF matched with NVAF group, and with similar cardiovascular diseases). Serum

  12. The effect of early intravenous beta blockers on prognosis in patients with acute myocardial infarction:a Meta analy-sis%早期静脉应用β受体阻滞剂对急性心肌梗死患者预后影响的 Meta 分析

    Institute of Scientific and Technical Information of China (English)

    王丹宁; 陈鹏飞; 黄颖; 陈侃; 王磊; 廖德宁

    2015-01-01

    目的:系统评价再灌注时心肌梗死后早期静脉应用β受体阻滞剂对患者预后的影响。方法检索Pubmed、Embase、Cochrane 图书馆、中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献数据库,收集比较再灌注背景下心肌梗死后早期静脉使用β受体阻滞剂(试验组)不使用或者使用安慰剂(对照组)对患者预后影响的研究。主要观察指标为短期及长期的全因病死率及恶性心律失常、心肌再梗死、心源性休克等发生率。采用Revman5.2软件对提取的数据进行荟萃分析。结果纳入8项临床研究,共48367例患者。 Meta分析显示,试验组与对照组相比,心肌梗死患者恶性室性心律失常发生率下降(OR=0.83,95%CI 0.75~0.93, P =0.0009);心源性休克、心力衰竭发生率增加(OR=1.29,95%CI 1.18~1.41, P <0.01),2组心肌梗死患者全因病死率、再梗死、缺血等不良事件发生率差异无统计学意义(OR=0.98 ,95%CI 0.92~1.05, P =0.63;OR=0.95 ,95%CI 0.88~1.03, P =0.21)。结论在心肌梗死早期静脉给予β受体阻滞剂可以降低梗死后恶性室性心律失常发生率,但同时也有增加心源性休克、心力衰竭发生的风险,在改善病死率方面没有明显获益。%Objective To evaluate the effect of early intravenous beta blockers on prognosis in patients with acute myocardial infarction( AMI) .Methods Searched on PubMed, Embase, Cochrane library, CNKI, Wanfang Data,VIP journal resources integration service platform, the Chinese biomedical literature database, collected and compared AMI reperfusion pa-tients received early intravenous beta blockers ( test group) and does not use beta blockers or placebo ( control group) to study the impact on prognosis.Main outcome measurements included short-term and long-term all

  13. Treatment and Management

    Science.gov (United States)

    ... benefits found on adults, other medications such as beta-blockers and aldosterone may also be used in children. ... of blood flow out of the heart. Instead, beta blockers and calcium channel blockers are prescribed to patients ...

  14. Graves' Disease

    Science.gov (United States)

    ... medication that replaces their natural thyroid hormone. Medications Beta blockers. Health care providers may prescribe a medication called a beta blocker to reduce many of the symptoms of hyperthyroidism, ...

  15. NSAID prescribing precautions.

    Science.gov (United States)

    Risser, Amanda; Donovan, Deirdre; Heintzman, John; Page, Tanya

    2009-12-15

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used, but have risks associated with their use, including significant upper gastrointestinal tract bleeding. Older persons, persons taking anticoagulants, and persons with a history of upper gastrointestinal tract bleeding associated with NSAIDs are at especially high risk. Although aspirin is cardioprotective, other NSAIDs can worsen congestive heart failure, can increase blood pressure, and are related to adverse cardiovascular events, such as myocardial infarction and ischemia. Cyclooxygenase-2 inhibitors have been associated with increased risk of myocardial infarction; however, the only cyclooxygenase-2 inhibitor still available in the United States, celecoxib, seems to be safer in this regard. Hepatic damage from NSAIDs is rare, but these medications should not be used in persons with cirrhotic liver diseases because bleeding problems and renal failure are more likely. Care should be used when prescribing NSAIDs in persons taking anticoagulants and in those with platelet dysfunction, as well as immediately before surgery. Potential central nervous system effects include aseptic meningitis, psychosis, and tinnitus. Asthma may be induced or exacerbated by NSAIDs. Although most NSAIDs are likely safe in pregnancy, they should be avoided in the last six to eight weeks of pregnancy to prevent prolonged gestation from inhibition of prostaglandin synthesis, premature closure of the ductus arteriosus, and maternal and fetal complications from antiplatelet activity. Ibuprofen, indomethacin, and naproxen are safe in breastfeeding women. Care should be taken to prevent accidental NSAID overdose in children by educating parents about correct dosing and storage in childproof containers.

  16. Beta-blockers decreases Th17/Treg cytokine ratios by down regulation of GRK2 synthesis in lymphocytes of patients with ACS%β受体阻滞剂对急性冠脉综合征Th17/Treg的作用研究

    Institute of Scientific and Technical Information of China (English)

    田秀青; 王清; 葛庆玲

    2016-01-01

    Objective To observe the effects of g protein-coupled receptor kinase-2 (GRK2) in peripheral lymphocytes on Th17/Treg cytokine ratios and investigate the potential impact and mechanism of beta-blockers on immune function in patients with acute coronary syndrome (ACS). Methods One hundred-four patients with ACS and forty-five normal coronary angiography (NCA) hospitalized patients as control group were enrolled in the study. ACS group was randomly divided into metoprolol group(n=52) and carvedilol group(n=52).The levels of lymphocyte GRK2 were detected by means of a sensitive sandwich enzyme-linked immunosorbent assay (ELISA) and IL-17 and FoxP3 in lymphocytes using flow cytometry at baseline and 6 months after the treatment. Results The levels of lymphocyte GRK2 and Th17/Treg in ACS patients were significantly higher than those of the UCA controls (both P0.05). Conclusion These results suggest that the increase of GRK2 may affect GRK2 in peripheral lymphocytes of ACS. Beta-blockers appear to have a beneficial effect on the Th17/Treg balance of immune system through decreasing activities of GRK2.%目的:探讨β受体阻滞剂对急性冠脉综合征(ACS)患者淋巴细胞G蛋白偶联受体激酶2(GRK2)和Th17/Treg的作用及意义。方法选择2013年2月至2015年12月千佛山医院心内科收治的CHD患者104例以及非CHD住院患者35例(NCA组)作为研究对象。ACS患者随机分为美托洛尔和卡维地洛治疗组。流式细胞仪测定淋巴细胞IL-17和Foxp3水平,酶联免疫吸附法测定GRK2水平。随访6个月。结果 ACS患者GRK2及IL-17/Foxp3比值均较非冠心病组明显升高(P0.05)。GRK2与IL-17/FoxP3比值呈显著正相关(P<0.01)。结论 ACS患者Th17/Treg失调与GRK2升高有关。β受体阻滞剂可降低GRK2水平,改善Th17/Treg平衡,具有免疫调节作用。

  17. 非选择性β受体阻滞剂预防食管胃静脉曲张破裂出血的研究进展%Advances in Study on Preventive Efficacy of Non-selective beta-Blockers in Patients with Esophageal Gastric Variceal Bleeding

    Institute of Scientific and Technical Information of China (English)

    段旭红; 诸葛宇征; 张峰

    2015-01-01

    Esophageal gastric variceal bleeding(EGVB)is a serious complication of cirrhotic portal hypertension with high mortality rate. Prevention of EGVB is an important mean to improve the survival of patients. Non-selective beta-blockers(NSBBs)is one of the first-line drugs for primary and secondary prevention of EGVB,however,only about 1 / 3 of cirrhotic patients respond to this treatment when evaluated by hepatic venous pressure gradient( HVPG). This may be related to the genetic polymorphisms of NSBBs’receptors and the metabolic enzymes. This article reviewed the progress in study on therapeutic efficacy of NSBBs and its influencing factors for preventing EGVB in cirrhotic patients.%食管胃静脉曲张破裂出血(EGVB)是肝硬化门静脉高压的常见严重并发症,死亡率高,预防 EGVB 是提高患者生存期的重要手段。非选择性β受体阻滞剂(NSBBs)是 EGVB 一级和二级预防的主要方法之一,但仅1/3患者的肝静脉压力梯度对其治疗有应答;这可能与 NSBBs 受体及其代谢酶的基因多态性有关。本文就 NSBBs 预防 EGVB 的疗效和影响因素作一综述。

  18. Prescribing antibiotics in general practice:

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

    the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data......Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how...

  19. The prognostic analysis of dose adjustment for beta blockers in the acute exacerbation of chronic congestive heart failure in the elderly%老年慢性充血性心力衰竭急性加重期患者美托洛尔剂量调整的临床研究

    Institute of Scientific and Technical Information of China (English)

    陈春泉; 王敏; 李庆丰; 翁小雁; 陈积党

    2015-01-01

    Objective To evaluate the effects and the prognosis of beta receptor blocker (metoprolol)dose adjustment of senile patients with chronic congestive heart failure (CHF)of acute exacerbation,and to provide reference for clinical treatment.Methods 76 cases with chronic CHF in acute exacerbation who treated with beta blockers and other reasonable treatment were randomly divided into half dose group (40 cases)and full stop group (36 cases).After adjusted for 3 months,the clinical symptoms were observed,noninvasive hemodynamic machine was used to detect cardiac index (CI),left cardiac work (LCW),cardiac output (CO)and changes of other indicators. Immunoradiometric analysis was used to detect plasma type B natriuretic peptide (BNP).Results 72h after treatment,in the half dose group,the progression of the disease in 13 cases,improved in 27 cases,in the full stop group,progression in 20 cases,improvement in 16 cases,the difference was statistically significant (χ2 =4.09,P <0.05).Before the adjustment of metoprolol,the index of the two groups had statistically significant difference(χ2 =4.52,P <0.05 ).Compared with pretreatment,the changes of NYHA classification,Co,CI,LCW of the half dose group were not obvious,and he change of NYHA of the full stop group was obvious,,III /IV the progression of the disease the number of cases increased in 5 cases and 3 cases,Co,Ci,LCW were reduced by about 25%,35% and 30%.After the adjustment of metoprolol,BNP of the half dose group was (321.8 ±97.6 )mg/L,which was significantly lower than (422.3 ±139.4)mg/L of the full stop group,the difference was statistically significant (t =3.94,P <0.05 ).Conclusion In the patients with beta blockers combined with other reasonable treatment, CHF patients with acute exacerbation of the beta blockers than the discontinuation of the prognosis,and the safety is high.%目的:评价美托洛尔剂量调整对老年人慢性充血性心力衰竭急性加重期的临床疗效和对预后的影响,为

  20. Beta blockers, norepinephrine, and cancer: an epidemiological viewpoint

    OpenAIRE

    2012-01-01

    Paul J FitzgeraldThe Zanvyl Krieger Mind/Brain Institute, Solomon H Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USAAbstract: There is growing evidence that the neurotransmitter norepinephrine (NE) and its sister molecule epinephrine (EPI) (adrenaline) affect some types of cancer. Several recent epidemiological studies have shown that chronic use of beta blocking drugs (which antagonize NE/EPI receptors) results in lower recurrence, progression, or mortality of ...

  1. NEW ADVANCES IN BETA-BLOCKER THERAPY IN HEART FAILURE

    Directory of Open Access Journals (Sweden)

    Vincenzo eBarrese

    2013-11-01

    Full Text Available The use of -blockers (BB in heart failure (HF has been considered a contradiction for many years. Considering HF simply as a state of inadequate systolic function, BB were contraindicated because of their negative effects on myocardial contractility. Nevertheless, evidence collected in the past years have suggested that additional mechanisms, such as compensatory neuro-humoral hyperactivation or inflammation, could participate in the pathogenesis of this complex disease. Indeed, chronic activation of the sympathetic nervous system, although initially compensating the reduced cardiac output from the failing heart, increases myocardial oxygen demand, ischemia and oxidative stress; moreover, high catecholamine levels induce peripheral vasoconstriction and increase both cardiac pre- and after-load, thus determining additional stress to the cardiac muscle (1. As a consequence of such a different view of the pathogenic mechanisms of HF, the efficacy of BB in the treatment of HF has been investigated in numerous clinical trials. Results from these trials highlighted BB as valid therapeutic tools in HF, providing rational basis for their inclusion in many HF treatment guidelines. However, controversy still exists about their use, in particular with regards to the selection of specific molecules, since BB differ in terms of adrenergic -receptors selectivity, adjunctive effects on -receptors, and effects on reactive oxygen species and inflammatory cytokines production. Further concerns about the heterogeneity in the response to , as well as the use in specific patients, are matter of debate among clinicians. In this review, we will recapitulate the pharmacological properties and the classification of BB, and the alteration of the adrenergic system occurring during HF that provide a rationale for their use; we will also focus on the possible molecular mechanisms, such as genetic polymorphisms, underlying the different efficacy of molecules belonging to this class.

  2. Inappropriate prescribing in the elderly.

    LENUS (Irish Health Repository)

    Gallagher, P

    2012-02-03

    BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

  3. Spacebody actual virtual

    DEFF Research Database (Denmark)

    Kjøbek, Jytte; Sørensen, Gert

    2005-01-01

    DVD som indeholder filmen 'spacebody actual virtual' . Videoen er værkdelen af forskningsprojektet Arkitektur og skikkelse, spacebody actual virtual. Foruden DVD'en indeholder projektet et reflekterende materiale på hjemmesiden www.spacebody.dk Fysisk medie: DVD......DVD som indeholder filmen 'spacebody actual virtual' . Videoen er værkdelen af forskningsprojektet Arkitektur og skikkelse, spacebody actual virtual. Foruden DVD'en indeholder projektet et reflekterende materiale på hjemmesiden www.spacebody.dk Fysisk medie: DVD...

  4. ELECTORAL PRESCRIBERS. WHO ARE THEY?

    Directory of Open Access Journals (Sweden)

    Constantin SASU

    2016-12-01

    Full Text Available The decision to vote and choosing among the candidates is an extremely important one with repercussions on everyday life by determining, in global mode, its quality for the whole society. Therefore the whole process by which the voter decides becomes a central concern. Prescribers, supposed to have a big influence on the electoral market, are a component of the microenvironment political organizations. These are people who occupy important positions that can influence the behavior of others. In the political environment, prescribers are known under the name of "opinion formers", "opinion leaders", "mediators" (Beciu, 2009 or "influencers" (Keller and Berry, 2003 Weimann, 1994. This paper aims to review the central opinions on what is the influence prescribers, opinion makers on voting behavior, voting and decisions on whether and how they act?

  5. Assessment of antibiotic prescribing in Latvian general practitioners

    Directory of Open Access Journals (Sweden)

    Dumpis Uga

    2013-01-01

    Full Text Available Abstract Background Though general antibiotic consumption data is available, information on the actual patterns of prescribing antibiotics locally is difficult to obtain. An easy to use methodology was designed to assess ambulatory management of infections by Latvian general practitioners (GPs. Methods GPs were asked to record data in a patient data collection form for every patient that received antibiotics. Study period – (7 days one week in November, 2008. Data recorded included the following details: an antibiotic, the prescribed dose, dosing interval, route of administration combined with the demographic factors of the patient and clinical diagnosis based on a pre-defined list. Results Two hundred forty eight forms out of the 600 (41% were returned by post. Antibiotics were prescribed in 6.4% (1711/26803 of outpatient consultations. In total, 1763 antibiotics were prescribed during the study period. Ninety seven percent of the patients received monotherapy and only 47 (2.7% patients were prescribed two antibiotics. The most commonly prescribed antibiotics were amoxicillin (33.9% of prescribed, amoxicillin/clavulanate (18,7% and clarithromycin (7.6%. The most commonly treated indications were pharyngitis (29.8%, acute bronchitis (25.3% and rhinosinusitis (10.2%. Pneumonia was mostly treated with amoxicillin/clavulanate (25,7%, amoxicillin (15.7% and clarithromycin (19.3%. Conclusions Methodology employed provided useful additional information on ambulatory practice of prescribing antibiotics and could be used in further assessment studies. Educational interventions should be focused on treatment of acute pharyngitis and bronchitis in children and unnecessary use of quinolones in adults for uncomplicated urinary tract infection.

  6. Prescribing patterns for thiazide diuretics in a large health maintenance organization: relationship to participation as an ALLHAT clinical center.

    Science.gov (United States)

    Petitti, Diana B; Xie, Fagen; Barzilay, Joshua I

    2006-10-01

    The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) published its main findings in December, 2002. It recommended thiazide diuretics as a first-line treatment of hypertension. The current study describes the prescribing patterns of thiazide diuretics in four regions of Kaiser Permanente, a large national United States Health Maintenance Organization--two regions that had an ALLHAT clinical center and two that did not. We tested the hypothesis that participation in a clinical trial leads to quicker and greater adoption of study recommendations than non-participation in a trial. The relative percentage of filled outpatient prescriptions for the period 2 or 3 years before the ALLHAT main publication through December 31, 2004 was calculated by region for thiazide-type diuretics and for calcium channel blockers (CCBs), beta-blockers, central alpha-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and other antihypertensive diuretics. In the 2 years after publication of the ALLHAT trial findings, the percentage of all prescriptions for thiazide diuretics increased from 11.2% to 12.4% in the two regions with an ALLHAT clinical site and from 8.9% to 10.1% in the two regions without an ALLHAT clinical site (p > 0.05). The percentage of new prescriptions for thiazide diuretics increased from 13.7% to 16.6% in the two regions with an ALLHAT clinical site and from 10.8% to 13.0% in the two regions without an ALLHAT clinical site (p > 0.05). Participation in a clinical hypertension study does not appear to accelerate adoption of study recommendations.

  7. Analgesic prescribing in palliative care.

    Science.gov (United States)

    Lowe, Emma; Hanchanale, Sarika; Hurlow, Adam

    2014-12-01

    Pain management requires a multimodal approach involving pharmacological and non-pharmacological strategies. It is important to take a detailed history and examine the patient before prescribing any analgesia. This article focuses on assessment and management of pain in palliative care patients.

  8. Nurse prescribing: radicalism or tokenism?

    Science.gov (United States)

    McCartney, W; Tyrer, S; Brazier, M; Prayle, D

    1999-02-01

    The creation of The Medical Products (Prescription by Nurses, etc.) Act 1992 has been generally welcomed by the nursing profession. This article seeks to introduce a note of scepticism about the assumed motivations for its introduction through an analysis of various legal, ethical, economic and political dimensions. In reviewing the position of nursing vis-à-vis medicine it is argued that one of the ways that nursing has sought to improve its professional position is to take on work previously done by doctors, and nurse prescribing can be seen in the context of the concurrent de-regulation of medicines, allowing greater access to medicines and therefore greater consumer choice. This de-regulation stems from the liberation ideology of the previous Conservative government. Viewed in this way nurse prescribing, particularly with reference to the limited nature of the nursing formulary, can be seen to be anomalous. In the light of this analysis, the reasons generally put forward (notably in the Crown Report 1989) for the introduction of nurse prescribing could be seen to be peripheral to its real purpose. It is argued that the most convincing reasons for its introduction relate to the medical profession as a social institution. It is proposed that the three primary aims behind the introduction of nurse prescribing are: the saving of money; the transfer of routine medical work to nursing; and a challenge to the professional monolith of medicine.

  9. Clinical observation on treating CHD plus arrhythmia with beta-blocker and amiodarone plus the Shensong Yangxin granules%受体阻滞剂、胺碘酮等药物联合参松养心胶囊治疗冠心病合并心律失常的疗效观察

    Institute of Scientific and Technical Information of China (English)

    付振强

    2016-01-01

    Objective: To explore clinical efficacy of beta-blocker and amiodarone plus the Shensong Yangxin granules on coronary heart disease plus arrhythmia. Methods: 100 cases were randomly divided into the normal group and observed group, 50 cases in each group. The normal group received amiodarone; the other group took the Shensong Yangxin granules more, for 3 weeks. Results: In the observed group, recovery of symptoms was 92%, and was better than 80% in the normal group (P﹤0.05); improvement of electrocardiogram was 94%, and better than 74% in the normal group (P﹤0.05); Cases of suffering from adverse reactions were significantly lower than those in the normal group (P﹤0.05). Conclusion: Amiodarone plus the Shensong Yangxin granules was obviously effective on CHD, with little adverse reactions.%目的::探讨受体阻滞剂、胺碘酮等药物与参松养心胶囊对冠心病合并心律失常患者的临床治疗效果以及可行性分析。方法:把所收集到的100例冠心病合并心律失常患者在正常规范诊疗的基础上随机分成正常组与观察组各50例。正常组使用胺碘酮,观察组使用胺碘酮联合参松养心胶囊,疗程为3周,观察分析治疗后临床的效果及其可行性。结果:观察组的病情恢复改善率高达92%,明显比正常组的80%高(P﹤0.05),观察组心率失常症状改善率为92%,高出正常组的82%(P﹤0.05),观察组正常心电图改善率为94%,高出正常组(74%)(P﹤0.05),观察组出现不良反应的患者人数及所占的比例都显著低于正常组(P﹤0.05)。结论:药物胺碘酮与参松养心胶囊具有协同互补作用,二种药物联合使用可明显提高疗效,有极少数不良反应。

  10. The influence of user fees and patient demand on prescribers in rural Nepal.

    Science.gov (United States)

    Holloway, Kathleen A; Gautam, Bharat R; Harpham, Trudy; Taket, Ann

    2002-03-01

    Irrational prescribing and over-prescription is a world-wide problem. Prescribers often cite patient demand as one of the main reasons why they over-prescribe, but the degree to which this is so is unknown. This article describes a study to test the hypothesis that patient demand causes over-prescription. The study occurred within the context of different kinds of nominal user fee for drugs in Nepal, where it was assumed that charging per drug item would deter patient demand, and hence over-prescription, as compared to charging per prescription. Focus group discussions with patients attending rural health facilities explored patient attitudes towards drugs. Patients and health workers were interviewed to gather quantitative data on (1) patient demand, and (2) health worker views of patient demand and their own prescribing habits, and comparing these with the drugs actually prescribed and dispensed to patients. Patients felt they needed more drugs than they were prescribed or dispensed, but stated that they would be happy to accept advice from prescribers for fewer drugs. In all areas of whatever fee type, there was no association between the number of drug items patients felt they needed pre-consultation and the number of drug items that they actually received as observed postconsultation. However, there was a significant association between the average number of drug items per patient that prescribers stated they usually prescribed and the actual number that were prescribed. It was concluded that patient demand was not affected by different kinds of user fee and did not directly influence prescribing behaviour.

  11. New drug prescribing by hospital doctors: the nature and meaning of knowledge.

    Science.gov (United States)

    Prosser, Helen; Walley, Tom

    2006-04-01

    In the UK the high cost of new drugs is partly accountable for the growth in spending on prescription drugs. Most prescribing takes place in general practice and the influence of secondary care prescribing on primary care prescribing is well recognized; yet the factors that influence hospital prescribing have been little researched. Drawing on accounts of actual prescribing events from hospital doctors from a range of specialties, we investigated the processes by which new drugs come into practice, from hospital doctors' awareness of new drugs to the assimilation and interpretation of evidential sources. The determinants of new drug prescribing were interconnected within four forms of knowledge: scientific knowledge, social knowledge, patient knowledge and experiential knowledge. Furthermore, the nature of knowledge could only be understood within its situated context. The revelation of multiple and contingent forms of knowledge highlights the problematic nature of knowledge construction within the approaches of evidence-based medicine.

  12. Provider Profiling: A Population Health Improvement Tool for the Southeast Military Health System

    Science.gov (United States)

    1999-06-01

    Diabetics HEDIS 3.0 (1998) Beta Blockers Prescribed After Heart Attacks HEDIS 3.0 (1998) Preferred Rx for Childhood Ear Infections HEDIS 3.0 (1997) The...designated Profiling 29 performance measures, Beta Blockers Prescribed After Heart Attack and Eye Exams for Diabetics were not reported due to...Center UM Utilization Management Profiling 45 Appendix B Performance Measures Summary Benchmark HEDIS 3.0 (1998) Measure Name Beta Blockers Prescribed

  13. Medicare Provider Data - Part D Prescriber

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other health care providers and paid...

  14. 27 CFR 20.21 - Forms prescribed.

    Science.gov (United States)

    2010-04-01

    ... OF THE TREASURY LIQUORS DISTRIBUTION AND USE OF DENATURED ALCOHOL AND RUM Administrative Provisions Authorities § 20.21 Forms prescribed. (a) The appropriate TTB officer is authorized to prescribe all...

  15. Why Does My Dentist Prescribe Medication?

    Science.gov (United States)

    ... your desktop! more... Why Does My Dentist Prescribe Medication? Article Chapters Why Does My Dentist Prescribe Medication? ... dentist or pharmacist. Reviewed: January 2012 Related Articles: Medication Epilepsy, Seizure Meds Have Oral Health Implications How ...

  16. Inappropriate prescribing: criteria, detection and prevention.

    LENUS (Irish Health Repository)

    O'Connor, Marie N

    2012-06-01

    Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

  17. International rigid contact lens prescribing.

    Science.gov (United States)

    Efron, Nathan; Morgan, Philip B; Helland, Magne; Itoi, Motozumi; Jones, Deborah; Nichols, Jason J; van der Worp, Eef; Woods, Craig A

    2010-06-01

    Rigid lenses have been fitted less since the introduction of soft lenses nearly 40 years ago. Data that we have gathered from annual contact lens fitting surveys conducted in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA between 2000 and 2008 facilitate an accurate characterization of the pattern of the decline of rigid lens fitting during the first decade of this century. There is a trend for rigid lenses to be utilized primarily for refitting those patients who are already successful rigid lens wearers-most typically older females being refit with higher Dk materials. Rigid lenses are generally fitted on a full-time basis (four or more days of wear per week) without a planned replacement schedule. Orthokeratology is especially popular in the Netherlands, but is seldom prescribed in the other countries surveyed.

  18. Inappropriate prescribing in geriatric patients.

    LENUS (Irish Health Repository)

    Barry, Patrick J

    2012-02-03

    Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.

  19. Evaluation of prescribing patterns in a German network of CAM physicians for the treatment of patients with hypertension: a prospective observational study

    Directory of Open Access Journals (Sweden)

    Witt Claudia M

    2009-12-01

    Full Text Available Abstract Background The management of hypertension is a key challenge in modern health systems. This study aimed to investigate hypertension treatment strategies among physicians specialized in complementary and alternative medicine (CAM in Germany by analysing prescribing patterns and comparing these to the current treatment guidelines issued by the German Hypertension Society. Methods In this prospective, multicentre observational study, which included 25 primary care physicians specialized in CAM treatment, prescriptions and diagnoses were analysed for each consecutive hypertensive patient using routine electronic data. Data analysis was performed using univariate statistical tests (Chi square test, Cochran-Armitage trend test. Multiple logistic regression was used to determine factors associated with antihypertensive medication. Results In the year 2005, 1320 patients with 3278 prescriptions were included (mean age = 64.2 years (SD = 14.5, 63.5% women. Most patients were treated with conventional antihypertensive monotherapies (n = 838, 63.5%. Beta-blockers were the most commonly prescribed monotherapy (30.7%, followed by ACE inhibitors (24.0%. Combination treatment usually consisted of two antihypertensive drugs administered either as separate agents or as a coformulation. The most common combination was a diuretic plus an ACE inhibitor (31.2% of dual therapies. Patient gender, age, and comorbidities significantly influenced which treatment was prescribed. 187 patients (14.2% received one or more CAM remedies, most of which were administered in addition to classic monotherapies (n = 104. Men (OR = 0.66; 95% CI: 0.54-0.80 and patients with diabetes (OR = 0.55; 95% CI: 0.42-0.0.73, hypercholesterolaemia (OR = 0.59; 95% CI: 0.47-0.75, obesity (OR = 0.74; 95% CI: 0.57-0.97, stroke (OR = 0.54; 95% CI: 0.40-0.74, or prior myocardial infarction (OR = 0.37; 95% CI: 0.17-0.81 were less likely to receive CAM treatment. Conclusions The large majority

  20. Associação de betabloqueadores e treinamento físico na insuficiência cardíaca de camundongos Asociación de betabloqueantes y entrenamiento físico en la insuficiencia cardíaca de ratones Association of physical training with beta-blockers in heart failure in mice

    Directory of Open Access Journals (Sweden)

    Andréa Somolanji Vanzelli

    2010-09-01

    tolerancia al esfuerzo se evaluó por prueba progresivo máxima y la fracción de acortamiento se evaluó (FE por ecocardiografía. El diámetro de los cardiomiocitos y la fracción de colágeno fueron evaluados por medio de análisis histológico. Los dados fueron comparados por ANOVA de un camino con post hoc de Duncan. El nivel de significancia se consideró como p BACKGROUND: Currently there are several types of interventions for the treatment of heart failure (HF. Among these are beta-blocker therapy (BB and physical training (PT. However, the effects of the combination of these therapies are poorly studied. OBJECTIVE: To investigate the effects of BB treatment with metoprolol (M and carvedilol (C associated with PT in mice with HF. METHODS: We used a genetic model of sympathetic hyperactivity-induced heart failure in mice. Initially, we divided the HF animals into three groups: sedentary (S; trained (T; treated with M (138 mg/kg (M; or C (65 mg/kg (C. In the second part, we divided the groups into three subgroups: sedentary (S; trained and treated with M (TM; and trained and treated with C (CT. The PT consisted of aerobic training on a treadmill for 8 weeks. Exercise tolerance was assessed by maximal graded test, and fractional shortening (FS was assessed by echocardiography. Cardiomyocyte diameter and collagen volume fraction were evaluated by histological analysis. Data were compared by one way ANOVA and post hoc Duncan test. The significance level was set at p < 0.05. RESULTS: As to FS and cardiac remodeling, we found that, in isolation, T, M, and C showed an improvement of the variables analyzed. As to therapy combination, after the intervention period, we observed an increase in exercise tolerance in MT and CT (43.0% and 33.0% respectively. There was also a reduction in cardiomyocyte diameter (10.0% and 9.0% respectively and in collagen volume fraction (52.0% and 63.0% after the intervention. However, only CT significantly improved FS. CONCLUSION: The association

  1. Leucoplasia oral: Conceptos actuales

    Directory of Open Access Journals (Sweden)

    M. Escribano-Bermejo

    Full Text Available La leucoplasia es la lesión premaligna más frecuente de la cavidad oral. La Organización Mundial de la Salud la define clínicamente como una lesión predominantemente blanca de la mucosa oral que no puede caracterizarse como ninguna otra lesión conocida y con una elevada tendencia a convertirse en un cáncer oral. El objetivo de esta revisión es hacer un repaso al conocimiento actual acerca de la leucoplasia oral prestando especial atención a su nomenclatura, su etiología, su potencial maligno y su tratamiento.

  2. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt

    2007-01-01

    OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...... medications prescribed over 3 months by the patients' own GPs. The GPs were asked to provide baseline information regarding the patients' medical history and detailed information regarding the subsidised and non-subsidised medications prescribed to the patients. A MAI was scored for medication prescribed...... most commonly involved in inappropriate prescribing were medications for treatment of peptic ulcer, cardiovascular medications, anti-inflammatory medications, antidepressants, hypnotics and anti-asthmatics. CONCLUSION: The overall prescribing quality in primary care in Copenhagen County, Denmark...

  3. District nurses: relationships in nurse prescribing.

    OpenAIRE

    Fisher, Richard

    2004-01-01

    Although nurse prescribing has been established in the UK for approximately 8 years, little is known about the effect this additional role is having on those who are involved in its processes. This article reports on the early phrases of an ethnographic study which is aiming to discover how prescribing is altering the ways in which district nurses relate to general practitioners, pharmacists, other community nurses, patients and carers during the experience of nurse prescribing. Using qualita...

  4. Redução da prevalência de apneia central em pacientes com insuficiência cardíaca sob uso de betabloqueador Reducción de la prevalencia de apnea central en pacientes con insuficiencia cardiaca bajo uso de betabloqueante Reduction of central sleep apnea in heart failure patients with beta-blockers therapy

    Directory of Open Access Journals (Sweden)

    Christiano Pereira Silva

    2010-02-01

    portadores de IC. MÉTODOS: 65 pacientes portadores de IC fueron sometidos a polisonografía diagnóstica. Los resultados de la polisonografía se evaluaron según el empleo o no de BB. El día del examen, los pacientes contestaron el cuestionario de Minnesota para la calidad de vida con IC. Tras 6 y 12 meses de la fecha de la polisonografía, hubo contacto telefónico con todos los pacientes, para la repetición del cuestionario de Minnesota. RESULTADOS: La prevalencia de apnea del sueño (IAH > 15/h fue de un 46,1% en la población total, además de la apnea central se identificó en solamente un 18,4% de los pacientes. El empleo de BB, en análisis multivariado, fue el único predictor de ocurrencia de menor índice de apnea e hipopnea (IAH central (p=0,002, mayor saturación (p=0,02 y menor desaturación promedio de oxígeno (p=0,03. Además de ello, el empleo de BB fue predictor de mejor calidad de vida tras 6 y 12 meses (p=0,002 y 0,001 respectivamente y de menor número de hospitalizaciones en estos períodos (p=0,001 y p=0,05 respectivamente. CONCLUSIÓN: El empleo de BB reduzco la incidencia de apnea central en la población total, si lo comparamos con los datos de la literatura. Además de esto, los BB mejoran parámetros de la calidad del sueño y de vida de portadores de IC.BACKGROUND: Sleep apneas are frequent in patients with heart failure (HF. Estimate of the pre-beta blocker age (BB point out to 45% of central apneas in these patients. OBJECTIVE: Assess the influence of BB in central apneas and their interference in the quality of sleep and life of patients with heart failure. METHODS: 65 patients with heart failure underwent diagnostic polysomnography. Polysomnography have been assessed according to the use or not of BB. On the day of examination, the patients answered the Minessota questionnaire for quality of life with HF. After 6 and 12 months from the polysomnography date, all patients were contacted by phone, in order to repeat the Minessota

  5. Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment

    Science.gov (United States)

    Gong, Cynthia L; Hay, Joel W; Meeker, Daniella; Doctor, Jason N

    2016-01-01

    Objective To elicit prescribers' preferences for behavioural economics interventions designed to reduce inappropriate antibiotic prescribing, and compare these to actual behaviour. Design Discrete choice experiment (DCE). Setting 47 primary care centres in Boston and Los Angeles. Participants 234 primary care providers, with an average 20 years of practice. Main outcomes and measures Results of a behavioural economic intervention trial were compared to prescribers' stated preferences for the same interventions relative to monetary and time rewards for improved prescribing outcomes. In the randomised controlled trial (RCT) component, the 3 computerised prescription order entry-triggered interventions studied included: Suggested Alternatives (SA), an alert that populated non-antibiotic treatment options if an inappropriate antibiotic was prescribed; Accountable Justifications (JA), which prompted the prescriber to enter a justification for an inappropriately prescribed antibiotic that would then be documented in the patient's chart; and Peer Comparison (PC), an email periodically sent to each prescriber comparing his/her antibiotic prescribing rate with those who had the lowest rates of inappropriate antibiotic prescribing. A DCE study component was administered to determine whether prescribers felt SA, JA, PC, pay-for-performance or additional clinic time would most effectively reduce their inappropriate antibiotic prescribing. Willingness-to-pay (WTP) was calculated for each intervention. Results In the RCT, PC and JA were found to be the most effective interventions to reduce inappropriate antibiotic prescribing, whereas SA was not significantly different from controls. In the DCE however, regardless of treatment intervention received during the RCT, prescribers overwhelmingly preferred SA, followed by PC, then JA. WTP estimates indicated that each intervention would be significantly cheaper to implement than pay-for-performance incentives of $200/month

  6. Psychiatric Prescribers' Experiences With Doctor Shoppers.

    Science.gov (United States)

    Worley, Julie; Johnson, Mary; Karnik, Niranjan

    2015-01-01

    Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs.

  7. 48 CFR 52.222-32 - Davis-Bacon Act-Price Adjustment (Actual Method).

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Davis-Bacon Act-Price... Provisions and Clauses 52.222-32 Davis-Bacon Act—Price Adjustment (Actual Method). As prescribed in 22.407(g), insert the following clause: Davis-Bacon Act—Price Adjustment (Actual Method) (DEC 2001) (a) The...

  8. β受体阻滞剂分别联合血管紧张素受体拮抗剂和钙离子拮抗剂治疗江门地区中青年高血压的临床效果观察%Curative Effect of Beta-blockers Respectively Combination of Angiotensin Receptor Blockers and Calcium Antagonists in the Treatment of Young and Middle-Aged High Blood Pressure in Jiangmen

    Institute of Scientific and Technical Information of China (English)

    黄享贞; 钟洁霞

    2015-01-01

    目的:比较β受体阻滞剂分别联合血管紧张素受体拮抗剂(ARB)和钙离子拮抗剂(CCB)治疗江门地区中青年高血压的治疗效果。方法:选取2012年12月-2014年12月收治的江门地区中青年高血压患者300例,随机数字表法分为观察组和对照组各150例。观察组患者给予ARB联合β受体阻滞剂治疗,对照组给予CCB联合β受体阻滞剂治疗,观察两组治疗前后的血压、心率变化情况以及降压疗效和症状改变情况。结果:治疗8周后两组患者的血压、心率均较治疗前下降(P0.05),观察组心率下降较对照组明显,差异有统计学意义(P0.05),heart rate decline in treatment group and control group,the difference was statistically significant(P<0.05).In terms of hypertension treatment,observation group total effective rate was 94.67%,control group total effective rate was 82.00%, total effective rate of observation group was obviously higher than that of control group,the difference was statistically significant (P<0.05).In terms of symptom improvement,observation group total effective rate was 96.67%,control group total effective rate was 84.67%,total effective observation group was obviously higher than that of control group,the difference was statistically significant(P<0.05).Conclusion:The application of combined beta-blockers ARB can significantly reduce the diastolic and systolic blood pressure of patients,slow heart rate,and in terms of antihypertensive effects and symptoms improve curative effect is good,worthy of clinical promotion.

  9. Effect of opioid prescribing guidelines in primary care.

    Science.gov (United States)

    Chen, Jonathan H; Hom, Jason; Richman, Ilana; Asch, Steven M; Podchiyska, Tanya; Johansen, Nawal Atwan

    2016-08-01

    Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education.We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed.After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed.An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical practice.

  10. Nurse practitioner prescribing: an international perspective

    Directory of Open Access Journals (Sweden)

    Fong J

    2015-10-01

    Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and

  11. [Appropriate medication prescribing in older people].

    Science.gov (United States)

    Blain, H; Rambourg, P; Le Quellec, A; Ayach, L; Biboulet, P; Bismuth, M; Blain, A; Boulenger, J-P; Celton, B; Combe, B; Dauvilliers, Y; Davy, J-M; Geny, C; Hemmi, P; Hillaire-Buys, D; Jalabert, A; Jung, B; Leclercq, F; Léglise, M-S; Morel, J; Mourad, G; Ponrouch, M-P; Puisieux, F; Quantin, X; Quéré, I; Renard, E; Ribstein, J; Roch-Torreilles, I; Rolland, Y; Rosant, D; Terminet, A; Thuret, R; Villiet, M; Deshormières, N; Bourret, R; Bousquet, J; Jonquet, O; Millat, B

    2015-10-01

    Drug-induced adverse effects are one of the main avoidable causes of hospitalization in older people. Numerous lists of potentially inappropriate medications for older people have been published, as national and international guidelines for appropriate prescribing in numerous diseases and for different age categories. The present review describes the general rules for an appropriate prescribing in older people and summarizes, for the main conditions encountered in older people, medications that are too often under-prescribed, the precautions of use of the main drugs that induce adverse effects, and drugs for which the benefit to risk ratio is unfavourable in older people. All these data are assembled in educational tables designed to be printed in a practical pocket format and used in daily practice by prescribers, whether physicians, surgeons or pharmacists.

  12. The Web site your doctor prescribes

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues The Web site your doctor prescribes Past Issues / Summer 2008 ... gov® is a free, comprehensive, up-to-date Web site with health information from the world's largest ...

  13. Prescribed fire monitoring protocol : Medicine Lake NWR

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Initial Survey Instructions for prescribed fire monitoring at Medicine Lake National Wildlife Refuge. Instructions contain methods on data collection, an equipment...

  14. Are You Taking Medication as Prescribed?

    Science.gov (United States)

    ... Home For Consumers Consumer Updates Are You Taking Medication as Prescribed? Share Tweet Linkedin Pin it More ... another time. back to top Taking HIV/AIDS Medications People with HIV/AIDS can have a particularly ...

  15. Nurse prescribing ethics and medical marketing.

    Science.gov (United States)

    Adams, J

    This article suggests that nurse prescribers require an awareness of key concepts in ethics, such as deontology and utilitarianism to reflect on current debates and contribute to them. The principles of biomedical ethics have also been influential in the development of professional codes of conduct. Attention is drawn to the importance of the Association of the British Pharmaceutical Industry's code of practice for the pharmaceutical industry in regulating marketing aimed at prescribers.

  16. Chemotherapy e-prescribing: opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Elsaid KA

    2015-05-01

    Full Text Available Khaled A Elsaid,1,2 Steven Garguilo,1 Christine M Collins2 1Department of Pharmaceutical Sciences, School of Pharmacy, MCPHS University, Boston, MA, 2Pharmacy Services, Rhode Island Hospital, Providence, RI, USA Abstract: Chemotherapy drugs are characterized by low therapeutic indices and significant toxicities at clinically prescribed doses, raising serious issues of drug safety. The safety of the chemotherapy medication use process is further challenged by regimen complexity and need to tailor treatment to patient status. Errors that occur during chemotherapy prescribing are associated with serious and life-threatening outcomes. Computerized provider order entry (CPOE systems were shown to reduce overall medication errors in ambulatory and inpatient settings. The adoption of chemotherapy CPOE is lagging due to financial cost and cultural and technological challenges. Institutions that adopted infusional or oral chemotherapy electronic prescribing modified existing CPOE systems to allow chemotherapy prescribing, implemented chemotherapy-specific CPOE systems, or developed home-grown chemotherapy electronic prescribing programs. Implementation of chemotherapy electronic prescribing was associated with a significant reduction in the risk of prescribing errors, most significantly dose calculation and adjustment errors. In certain cases, implementation of chemotherapy CPOE was shown to improve the chemotherapy use process. The implementation of chemotherapy CPOE may increase the risk of new types of errors, especially if processes are not redesigned and adapted to CPOE. Organizations aiming to implement chemotherapy CPOE should pursue a multidisciplinary approach engaging all stakeholders to guide system selection and implementation. Following implementation, organizations should develop and use a risk assessment process to identify and evaluate unanticipated consequences and CPOE-generated errors. The results of these analyses should serve to

  17. Pharmaco-epistemology for the prescribing geriatrician.

    Science.gov (United States)

    Le Couteur, David G; Kendig, Hal

    2008-03-01

    Clinicians are becoming more reliant on their interpretation of clinical trial information to guide prescribing rather than their clinical skills. Thus to improve prescribing, it is increasingly important for clinicians to have an appreciation of epistemology (the science of knowledge and its interpretation) and the broader social context of knowledge. The insights of epistemologists can be useful in understanding the different ways in which clinical trials data are interpreted.

  18. Pharmaceutical marketing research and the prescribing physician.

    Science.gov (United States)

    Greene, Jeremy A

    2007-05-15

    Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.

  19. Errors associated with outpatient computerized prescribing systems

    Science.gov (United States)

    Rothschild, Jeffrey M; Salzberg, Claudia; Keohane, Carol A; Zigmont, Katherine; Devita, Jim; Gandhi, Tejal K; Dalal, Anuj K; Bates, David W; Poon, Eric G

    2011-01-01

    Objective To report the frequency, types, and causes of errors associated with outpatient computer-generated prescriptions, and to develop a framework to classify these errors to determine which strategies have greatest potential for preventing them. Materials and methods This is a retrospective cohort study of 3850 computer-generated prescriptions received by a commercial outpatient pharmacy chain across three states over 4 weeks in 2008. A clinician panel reviewed the prescriptions using a previously described method to identify and classify medication errors. Primary outcomes were the incidence of medication errors; potential adverse drug events, defined as errors with potential for harm; and rate of prescribing errors by error type and by prescribing system. Results Of 3850 prescriptions, 452 (11.7%) contained 466 total errors, of which 163 (35.0%) were considered potential adverse drug events. Error rates varied by computerized prescribing system, from 5.1% to 37.5%. The most common error was omitted information (60.7% of all errors). Discussion About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm. This is consistent with the literature on manual handwritten prescription error rates. The number, type, and severity of errors varied by computerized prescribing system, suggesting that some systems may be better at preventing errors than others. Conclusions Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful system use does not decrease medication errors. The authors offer targeted recommendations on improving computerized prescribing systems to prevent errors. PMID:21715428

  20. Prescribing restrictions – a necessary strategy among some European countries to enhance future prescribing efficiency?

    Directory of Open Access Journals (Sweden)

    Brian Godman

    2012-01-01

    Full Text Available The unsustainable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower prices of generics and enhance their utilisation. These include prescribing restrictions. However, there have been concerns with their impact on subsequent quality of care as well as their influence in reality. OBJECTIVES: (a Review the influence of prescribing restrictions and whether there are any differences depending on their nature and drug classes; (b Ascertain whether prescribing restrictions can be added to existing demand-side measures to further enhance prescribing efficiency; (c Whether they compromise subsequent quality of care. RESULTS: Prescribing restrictions have a variable impact on subsequent utilisation of patented protected products versus generics in a class, with their influence depending on the nature and follow-up of the restrictions rather than the class of drug. This is seen among the proton pump inhibitors, statins, and renin-angiotensin drugs. Prescribing restrictions can be successfully added to existing measures to further enhance prescribing efficiency, and do not appear to compromise subsequent quality of care. CONCLUSIONS: Prescribing restrictions can be a successful strategy as countries strive to maintain the European ideals for healthcare. However, care is needed when planning these programmes: else health authorities could be disappointed with their outcome.

  1. Auditing GPs' prescribing habits : Cardiovascular prescribing frequently continues medication initiated by specialists

    NARCIS (Netherlands)

    deVries, CS; vanDiepen, NM; Tromp, TFJ; deJongvandenBerg, LTW

    1996-01-01

    Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs. Next

  2. The use of prescribed and non-prescribed medication by Dutch children.

    NARCIS (Netherlands)

    Dijk, L. van; Lindert, H. van

    2002-01-01

    Background: Most research on the use of medication focuses on adults. Children, however, use medication too, most of which is prescribed by GP's. Children also use non-prescribed medication (f.e. bought in the drugstore), but the extent to which is not known. Moreover, it is not known to what extent

  3. Prescribed Fire is Cool on Florida Highway

    OpenAIRE

    Caster, Jeff; McBurney, Willson; Farley, Patricia; Rodriguez, Rose; Green, Lane; McGorty, Kevin

    2007-01-01

    Though unprecedented in the sunshine state, plans for a prescribed fire on US319/SR61, Kate Ireland Parkway in north Florida sparked enthusiasm and excitement among roadside managers. The recently expanded high speed corridor passes for ten miles through the Red Hills Region (www.ttrs.org/rhcp); a rural landscape that is host to America’s largest remnant of the great longleaf pine forest (www.longleafalliance.org). Prescribed fire is a necessary and popular landscape management tool used by g...

  4. A Helping Hand: Individually Prescribed Instruction (IPI

    Directory of Open Access Journals (Sweden)

    Bernard W. Andrews

    2014-10-01

    Full Text Available Individually Prescribed Instruction (IPI is an approach to teaching that emphasizes the diagnosis of learning problems and the provision of prescriptive assignments to assist individual students overcome their difficulties.  When this strategy is employed effectively, the teaching environment is highly adaptive.  The teacher matches the students' abilities to alternate ways of learning, and also provides remedial assistance and positive reinforcement.  Individually Prescribed Instruction has been shown to be effective across the school curriculum.  This writer reviews the success of this strategy for assisting students overcome learning problems, and proposes a model for its implementation in music instruction.

  5. Antidepressant prescribing in five European countries

    DEFF Research Database (Denmark)

    Abbing-Karahagopian, V; Huerta, C; Souverein, P C

    2014-01-01

    PURPOSE: Drug utilization studies have applied different methods to various data types to describe medication use, which hampers comparisons across populations. The aim of this study was to describe the time trends in antidepressant prescribing in the last decade and the variation in the prevalen...

  6. BIFURCATION IN PRESCRIBED MEAN CURVATURE PROBLEM

    Institute of Scientific and Technical Information of China (English)

    马力

    2002-01-01

    This paper discusses the existence problem in the study of some partial differential equations. The author gets some bifurcation on the prescribed mean curvature problem on the unit ball, the scalar curvature problem on the n-sphere, and some field equations. The author gives some natural conditions such that the standard bifurcation or Thom-Mather theory can be used.

  7. 16 CFR 315.5 - Prescriber verification.

    Science.gov (United States)

    2010-01-01

    ... time of verification request; (6) The name of a contact person at the seller's company, including... that the same company manufactures and sells under different labels. (f) Recordkeeping requirement... digital image of the prescription), that was presented to the seller by the patient or prescriber. (2)...

  8. Optimization of electronic prescribing in pediatric patients

    NARCIS (Netherlands)

    Maat, B.

    2014-01-01

    Improving pediatric patient safety by preventing medication errors that may result in adverse drug events and consequent healthcare expenditure,is a worldwide challenge to healthcare. In pediatrics, reported medication error rates in general, and prescribing error rates in particular, vary between s

  9. Photographic cockpit model for prescribing multifocals.

    Science.gov (United States)

    Powell, J H

    1992-01-01

    Recent interest in the relevancy of near vision tests for presbyopic aircrew members has led to the development of a photographic cockpit model. This model is used to prescribe more accurately for flying personnel. Prescriptions can be evaluated by use of trial lenses. This allows the aircrew members to experience the effect of viewing instruments in the cockpit of a C-130 aircraft.

  10. Prescribing of benzodiazepines by casualty officers.

    OpenAIRE

    1989-01-01

    The prescribing of benzodiazepines by casualty officers in a busy district hospital over a three month period was examined by a retrospective review of case notes. Benzodiazepines, mainly diazepam, were given to 1.1% of attenders, the majority of whom had disorders involving minor muscle spasm. The efficacy of diazepam in these conditions, as well as its potential for dependence, is discussed.

  11. A Comparison between Prescribed Exercise Programs.

    Science.gov (United States)

    Hultgren, Philip B.; Burke, Edmund J., Jr.

    This paper compares the methods for prescribing exercise according to various contemporary authorities. The programs are compared as to their goals, the testing modalities and physiological parameters used for prescription of the initial training session, and the methods and the progression of training. Regarding goals, there is a general…

  12. 27 CFR 24.20 - Forms prescribed.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 24.20 Section 24.20 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Administrative and Miscellaneous Provisions Authorities § 24.20...

  13. 7 CFR 28.956 - Prescribed fees.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Prescribed fees. 28.956 Section 28.956 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... continental United States 135.00 1.1High Volume Instrument (HVI) System Check Level. Furnishing two...

  14. Nonlinear Differential Systems with Prescribed Invariant Sets

    DEFF Research Database (Denmark)

    Sandqvist, Allan

    1999-01-01

    We present a class of nonlinear differential systems for which invariant sets can be prescribed.Moreover,we show that a system in this class can be explicitly solved if a certain associated linear homogeneous system can be solved.As a simple application we construct a plane autonomous system having...

  15. Top 200 Prescribed Drugs Mostly Prescribed by the Physician in Pharmacies at Medan City

    Science.gov (United States)

    Tanjung, H. R.; Nasution, E. S.

    2017-03-01

    The drug information literatures usually contains thousands of drugs, which much of them were rare or never prescribed by the physicians. It caused pharmacy students must learn thousands of drugs that will depleted resources and the study result was not effective. The aim of the study was to identify 200 items of drugs that mostly prescribed by the physicians in the pharmacies at Medan City. The study was a descriptive study that used a cross sectional survey methodology. The 200 items of drugs that mostly prescribed by the physician obtained from the pharmacies selected regarding to random sampling method. The study was conducted from August to September 2016. The 200 items of drugs that mostly prescribed by the physician resulted from 21.962 prescribed drugs item of 16.352 prescriptions of 100 pharmacies. The list revealed that the most prescribed drugs was amoxicilline (5.55 %), followed by dexamethasone (4.44%), mefenamic acid (3.73%), cetirizine (3.16%), and ciprofloxacine (2.97%). It shows that the antibiotic drug was the most prescribed drug by the physician in pharmacies at Medan City. Further studies are required to develop the study card from the list.

  16. Self-reported confidence in prescribing skills correlates poorly with assessed competence in fourth-year medical students.

    Science.gov (United States)

    Brinkman, David J; Tichelaar, Jelle; van Agtmael, Michiel A; de Vries, Theo P G M; Richir, Milan C

    2015-07-01

    The objective of this study was to investigate the relationship between students' self-reported confidence and their objectively assessed competence in prescribing. We assessed the competence in several prescribing skills of 403 fourth-year medical students at the VU University Medical Center, the Netherlands, in a formative simulated examination on a 10-point scale (1 = very low; 10 = very high). Afterwards, the students were asked to rate their confidence in performing each of the prescribing skills on a 5-point Likert scale (1 = very unsure; 5 = very confident). Their assessments were then compared with their self-confidence ratings. Students' overall prescribing performance was adequate (7.0 ± 0.8), but they lacked confidence in 2 essential prescribing skills. Overall, there was a weak positive correlation (r = 0.2, P confidence and actual competence. Therefore, this study suggests that self-reported confidence is not an accurate measure of prescribing competence, and that students lack insight into their own strengths and weaknesses in prescribing. Future studies should focus on developing validated and reliable instruments so that students can assess their prescribing skills.

  17. Linguistic Theory and Actual Language.

    Science.gov (United States)

    Segerdahl, Par

    1995-01-01

    Examines Noam Chomsky's (1957) discussion of "grammaticalness" and the role of linguistics in the "correct" way of speaking and writing. It is argued that the concern of linguistics with the tools of grammar has resulted in confusion, with the tools becoming mixed up with the actual language, thereby becoming the central…

  18. Potentiality, Actuality, and Quantum Mechanics

    Directory of Open Access Journals (Sweden)

    Boris Koznjak

    2007-12-01

    Full Text Available In this paper a possible interpretative value of Aristotle’s fundamental ontological doctrine of potentiality (δύναµις and actuality (ἐνέργεια is considered in the context of operationally undoubtedly the most successful but interpretatively still controversial theory of modern physics – quantum mechanics – especially regarding understanding the nature of the world, the phenomena of which it describes and predicts so successfully. In particular, beings of the atomic world are interpreted as real potential beings (δυνάµει ὄντα actualized by the measurement process in appropriate experimental arrangement, and the problem of actual beings (ἐνεργείᾳ ὄντα of the atomic world (better known as the measurement problem in quantum mechanics is considered in the context of Aristotle’s threefold requirement for the priority of actuality over potentiality – in time (χρόνος, definition or knowledge (λόγος, and substantiality (οὐσία.

  19. El Observatorio Gemini - Status actual

    Science.gov (United States)

    Levato, H.

    Se hace una breve descripción de la situación actual del Observatorio Gemini y de las últimas decisiones del Board para incrementar la eficiencia operativa. Se hace también una breve referencia al uso argentino del observatorio.

  20. More than a prescriber: gerontological nurse practitioners' perspectives on prescribing and pharmaceutical marketing.

    Science.gov (United States)

    Mahoney, Diane Feeney; Ladd, Elissa

    2010-01-01

    The purpose of this study was to gain understanding about nurse practitioners' (NPs') prescriptive decision making for geriatric patients with attention to pharmaceutical marketing influences. Prior research has focused on physician prescribers and identified suboptimal practices. Because the majority of medications are prescribed to older adults, NPs in geriatric practice were targeted as an information-rich group to interview about prescribing issues. Given the exploratory nature of this research, qualitative focus group methods were employed using content analysis. Fifteen NPs were recruited at an annual national geriatric NP conference. They worked in all regions of the United States, had an average of 9 years prescribing experience, and participated in 1 of the 2 focus groups. The key theme that emerged was that they were more than a prescriber. Findings revealed overwhelming consistency among the NP participants that their nursing background instilled a holistic approach that encompassed both nondrug and therapeutic drug options and skepticism about drug marketing, as well as offered a positive difference by tailoring to their patients' biophysical, psychological, and economic needs with an involvement in the interplay of geriatric care issues not typically addressed by physicians. The participants' reported approaches were in alignment with geriatric prescribing recommendations.

  1. Automated quality checks on repeat prescribing.

    OpenAIRE

    Rogers, Jeremy E; Wroe, Christopher J; Roberts, Angus; Swallow, Angela; Stables, David; Cantrill, Judith A; Rector, Alan L.

    2003-01-01

    BACKGROUND: Good clinical practice in primary care includes periodic review of repeat prescriptions. Markers of prescriptions that may need review have been described, but manually checking all repeat prescriptions against the markers would be impractical. AIM: To investigate the feasibility of computerising the application of repeat prescribing quality checks to electronic patient records in United Kingdom (UK) primary care. DESIGN OF STUDY: Software performance test against benchmark manual...

  2. Angiotensin AT1-receptor blockers and cerebrovascular protection: do they actually have a cutting edge over angiotensin-converting enzyme inhibitors?

    DEFF Research Database (Denmark)

    Oprisiu-Fournier, Roxana; Faure, Sébastien; Mazouz, Hakim

    2009-01-01

    is presented to support the hypothesis that antihypertensive drugs that increase angiotensin II formation, such as diuretics, AT1-receptor blockers and dihydropyridines, may have greater brain anti-ischemic effects than antihypertensive drugs that decrease angiotensin II formation, such as beta-blockers...

  3. ATHENA: an actual antihydrogen annihilation

    CERN Multimedia

    2002-01-01

    This is an image of an actual matter-antimatter annihilation due to an atom of antihydrogen in the ATHENA experiment, located on the Antiproton Decelerator (AD) at CERN since 2001. The antiproton produces four charged pions (yellow) whose positions are given by silicon microstrips (pink) before depositing energy in CsI crystals (yellow cubes). The positron also annihilates to produce back-to-back gamma rays (red).

  4. Local and regional smoke impacts from prescribed fires

    Science.gov (United States)

    Price, Owen F.; Horsey, Bronwyn; Jiang, Ningbo

    2016-10-01

    Smoke from wildfires poses a significant threat to affected communities. Prescribed burning is conducted to reduce the extent and potential damage of wildfires, but produces its own smoke threat. Planners of prescribed fires model the likely dispersion of smoke to help manage the impacts on local communities. Significant uncertainty remains about the actual smoke impact from prescribed fires, especially near the fire, and the accuracy of smoke dispersal models. To address this uncertainty, a detailed study of smoke dispersal was conducted for one small (52 ha) and one large (700 ha) prescribed fire near Appin in New South Wales, Australia, through the use of stationary and handheld pollution monitors, visual observations and rain radar data, and by comparing observations to predictions from an atmospheric dispersion model. The 52 ha fire produced a smoke plume about 800 m high and 9 km long. Particle concentrations (PM2.5) reached very high peak values (> 400 µg m-3) and high 24 h average values (> 100 µg m-3) at several locations next to or within ˜ 500 m downwind from the fire, but low levels elsewhere. The 700 ha fire produced a much larger plume, peaking at ˜ 2000 m altitude and affecting downwind areas up to 14 km away. Both peak and 24 h average PM2.5 values near the fire were lower than for the 52 ha fire, but this may be because the monitoring locations were further away from the fire. Some lofted smoke spread north against the ground-level wind direction. Smoke from this fire collapsed to the ground during the night at different times in different locations. Although it is hard to attribute particle concentrations definitively to smoke, it seems that the collapsed plume affected a huge area including the towns of Wollongong, Bargo, Oakdale, Camden and Campbelltown (˜ 1200 km2). PM2.5 concentrations up to 169 µg m-3 were recorded on the morning following the fire. The atmospheric dispersion model accurately predicted the general

  5. Soil heating and impact of prescribed burning

    Science.gov (United States)

    Stoof, Cathelijne

    2016-04-01

    Prescribed burning is highly uncommon in the Netherlands, where wildfire awareness is increasing but its risk management does not yet include fuel management strategies. A major exception is on two military bases, that need to burn their fields in winter and spring to prevent wildfires during summer shooting practice. Research on these very frequent burns has so far been limited to effects on biodiversity, yet site managers and policy makers have questions regarding the soil temperatures reached during these burns because of potential impact on soil properties and soil dwelling fauna. In March 2015, I therefore measured soil and litter temperatures under heath and grass vegetation during a prescribed burn on military terrain in the Netherlands. Soil and litter moisture were sampled pre- and post-fire, ash was collected, and fireline intensity was estimated from flame length. While standing vegetation was dry (0.13 g water/g biomass for grass and 0.6 g/g for heather), soil and litter were moist (0.21 cm3/cm3 and 1.6 g/g, respectively). Soil heating was therefore very limited, with maximum soil temperature at the soil-litter interface remaining being as low as 6.5 to 11.5°C, and litter temperatures reaching a maximum of 77.5°C at the top of the litter layer. As a result, any changes in physical properties like soil organic matter content and bulk density were not significant. These results are a first step towards a database of soil heating in relation to fuel load and fire intensity in this temperate country, which is not only valuable to increase understanding of the relationships between fire intensity and severity, but also instrumental in the policy debate regarding the sustainability of prescribed burns.

  6. What You Need to Know When Prescribed an Opioid Painkiller

    Science.gov (United States)

    ... You Need to Know When Prescribed an Opioid Painkiller Tell your doctor if you or anyone in ... doctor or other health care provider prescribes opioid painkillers such as Oxycontin, Vicodin, codeine and morphine, the ...

  7. 20 CFR 404.1530 - Need to follow prescribed treatment.

    Science.gov (United States)

    2010-04-01

    ... English language) when determining if you have an acceptable reason for failure to follow prescribed... treatment is contrary to the established teaching and tenets of your religion. (2) The prescribed...

  8. Prescribing tests must have curriculum support

    Directory of Open Access Journals (Sweden)

    Lemon TI

    2013-05-01

    Full Text Available Rupali D Shah, Thomas I LemonSchool of Medicine, Cardiff University, University Hospital of Wales, Cardiff, WalesGordon, Catchpole and Baker1 have discussed and investigated a very interesting, currently relevant, subject in medical education; particularly with the introduction of the prescribing test for undergraduates trialled in the UK this year and set to become a fully-fledged part of the curriculum and assessment criteria for 2014 graduates.2 It would of course be of great interest to compare the themes discussed in this paper and see they how would compare to recent graduates in late 2014.View original paper by Gordon and colleagues.

  9. How to prescribe physical exercise in rheumatology

    Directory of Open Access Journals (Sweden)

    S. Maddali Bongi

    2011-06-01

    Full Text Available Physical exercise, aiming to improve range of movement, muscle strength and physical well being, lately substituted the immobilization previously prescribed in rheumatic diseases. International guidelines, recommendations of Scientific Societies, and structured reviews regard physical exercise as of pivotal importance in treating rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, fibromyalgia syndrome, osteoporosis, and to be considered in connective tissue diseases. Therapeutic exercise should: aim to improve firstly local symptoms and then general health; respect the pain threshold; be a part of a treatment including pharmacological therapies and other rehabilitation techniques, be administered by skilled physiotherapist under the guide of a rheumatologist, be different according to different diseases, disease phases and patient expectations.

  10. Los Retos del Mercado Actual

    OpenAIRE

    Quirós Sáenz, Juan

    2013-01-01

    Probablemente la empresa que sobreviva en laeconomía actual, no será la que tenga el mejor productoo servicio, sino la que tenga la mayor eficienciaoperacional y ofrezca un servicio sorprendente paraobtener la lealtad de sus clientes. Pero también, la quetenga ejecutivos de mercadeo con el conocimiento,carácter y determinación, para enfrentar estos retos deuna manera creativa. ABSTRACTMost probably the companies that will survive presentday’s economy will not be the ones with the better produ...

  11. Is new drug prescribing in primary care specialist induced?

    NARCIS (Netherlands)

    Florentinus, S.R.; Heerdink, R.; Dijk, L. van; Griens, F.A.M.G.; Groenewegen, P.P.; Leufkens, H.G.M

    2009-01-01

    Background: Medical specialists are often seen as the first prescribers of new drugs. However, the extent to which specialists influence new drug prescribing in primary care is largely unknown. Methods: This study estimates the influence of medical specialists on new drug prescribing in primary care

  12. Is new drug prescribing in primary care specialist induced?

    NARCIS (Netherlands)

    Florentinus, S.R.; Heerdink, E.R.; Dijk, L. van; Griens, F.; Groenewegen, P.P.; Leufkens, H.G.M.

    2009-01-01

    BACKGROUND: Medical specialists are often seen as the first prescribers of new drugs. However, the extent to which specialists influence new drug prescribing in primary care is largely unknown. METHODS: This study estimates the influence of medical specialists on new drug prescribing in primary care

  13. Undergraduate Medical Students' Reasoning with Regard to the Prescribing Process

    Science.gov (United States)

    Harries, C. S.; Botha, J.

    2007-01-01

    When final year medical students reporting poor prescribing confidence were tested, key prescribing weaknesses emerged. This study aimed to characterize student variability in both the experience of and cognitive levels displayed during prescribing. Blooms Taxonomy cognitive categories were assigned to each question of a student test measuring…

  14. Does prescribed fire benefit wetland vegetation?

    Science.gov (United States)

    Flores, C.; Bounds, D.L.; Ruby, D.E.

    2011-01-01

    The effects of fire on wetland vegetation in the mid-Atlantic region of the United States are poorly known, despite the historical use of fire by federal, state, and private landowners in the Chesapeake Bay Region. Prescribed fire is widely used by land managers to promote vegetation that is beneficial to migratory waterfowl, muskrats, and other native wildlife and to reduce competition from less desirable plant species. We compared vegetative response to two fire rotations, annual burns and 3-year burns, and two control sites, Control 1 and Control 2. We tested the effects of fire within six tidal marsh wetlands at Blackwater National Wildlife Refuge and Fishing Bay Wildlife Management Area in Maryland. We examined changes in total live biomass (all species), total stem density, litter, and changes in live biomass and stem density of four dominant wetland plant species (11 variables). Our results suggest that annual prescribed fires will decrease the accumulation of litter, increase the biomass and stem densities of some wetland plants generally considered less desirable for wildlife, and have little or no effect on other wetland plants previously thought to benefit from fire. ?? 2011 US Government.

  15. How People Actually Use Thermostats

    Energy Technology Data Exchange (ETDEWEB)

    Meier, Alan; Aragon, Cecilia; Hurwitz, Becky; Mujumdar, Dhawal; Peffer, Therese; Perry, Daniel; Pritoni, Marco

    2010-08-15

    Residential thermostats have been a key element in controlling heating and cooling systems for over sixty years. However, today's modern programmable thermostats (PTs) are complicated and difficult for users to understand, leading to errors in operation and wasted energy. Four separate tests of usability were conducted in preparation for a larger study. These tests included personal interviews, an on-line survey, photographing actual thermostat settings, and measurements of ability to accomplish four tasks related to effective use of a PT. The interviews revealed that many occupants used the PT as an on-off switch and most demonstrated little knowledge of how to operate it. The on-line survey found that 89% of the respondents rarely or never used the PT to set a weekday or weekend program. The photographic survey (in low income homes) found that only 30% of the PTs were actually programmed. In the usability test, we found that we could quantify the difference in usability of two PTs as measured in time to accomplish tasks. Users accomplished the tasks in consistently shorter times with the touchscreen unit than with buttons. None of these studies are representative of the entire population of users but, together, they illustrate the importance of improving user interfaces in PTs.

  16. Antibiotic prescribing in primary care: first choice and restrictive prescribing are two different traits.

    NARCIS (Netherlands)

    Roosmalen, M.S van; Braspenning, J.C.C.; Smet, P.A.G.M. de; Grol, R.P.T.M.

    2007-01-01

    OBJECTIVE: To investigate the quality of antibiotic prescribing in primary care using quality indicators and the relatedness of these indicators. To determine the influence of general practice and practice population characteristics on the indicator scores. METHODS: Data on performance were collecte

  17. Los Retos del Mercado Actual

    Directory of Open Access Journals (Sweden)

    Juan Quirós Sáenz

    2013-01-01

    Full Text Available Probablemente la empresa que sobreviva en laeconomía actual, no será la que tenga el mejor productoo servicio, sino la que tenga la mayor eficienciaoperacional y ofrezca un servicio sorprendente paraobtener la lealtad de sus clientes. Pero también, la quetenga ejecutivos de mercadeo con el conocimiento,carácter y determinación, para enfrentar estos retos deuna manera creativa.   ABSTRACT Most probably the companies that will survive presentday’s economy will not be the ones with the better productor service but the ones with greater operational efficiencywho offers outstanding service to attain customer loyalty.But also the companies with marketing executives thatpossess the knowledge, temper and determination to facethese challenges in a creative way.

  18. Should we prescribe heroin? A current Scottish debate.

    Science.gov (United States)

    Gallagher, J; McKeganey, N

    2007-11-01

    There have been recent calls from within both Scotland and England for the wider prescription of heroin to heroin addicts as a way of coping with our burgeoning drug problem and as a route to reducing drug related criminality. But how feasible is heroin prescribing in this context? This paper considers some of the existing research evidence relating to heroin prescribing and looks also at the ethics and practicalities of prescribing heroin to heroin addicts in Scotland. We conclude that whilst the evidence on the benefits of heroin prescribing is far from clear cut there is a case for mounting a Scottish trial of heroin prescribing. Such a trial would need to be tightly controlled and rigorously evaluated. It would need to show that heroin prescribing was associated not only with a comparable level of harm reduction, as methadone prescribing, but that it was also an effective route towards drug users' eventual recovery and drug cessation.

  19. Cimentaciones actuales de los rascacielos de Chicago

    Directory of Open Access Journals (Sweden)

    López Ruiz, Álvaro

    1972-05-01

    Full Text Available The main characteristics of the land and the supporting rock are given, and the pattern of present performance of Chicago's deep foundations is briefly described. This city probably has some of the highest skyscrapers in the world with deep foundations resting on rock, and possibly as well, the highest building with foundations resting on soil. The construction of piles of large diameter, resting on rock and concreted dry, as prescribed by the City Code, is the weak point which sometimes makes it necessary to insert a permanent lining tube deep into the rock in order to obtain the required leaktightness, or to pump out significant quantities of water from the bottom of the excavations. The latter can cause the dragging away of earth from adjacent foundations resting on soil at a higher level, as with the drift of the phreatic level, with the consequent risk of producing appreciable subsidence, and even undermining. To overcome this problem we carried out for the first time in Chicago, a pre-sealing, by means of chemical injections, of the supporting rock of the periphery piles of some deep foundations, by drilling into the centre of each pile, which has also been useful as a means of examining the subsoil before proceeding to the perforation of each pile. This operation was carried out on the large diameter piles of the foundations of the Northern Trust Bank skyscraper, at present under construction, with very satisfactory results. The method of pre-sealing the rock used and the results obtained are described.Se presentan las características principales del terreno y de la roca de apoyo y se describe someramente la forma de ejecución actual de las cimentaciones profundas de Chicago. Esta ciudad tendrá (en breve varios de los rascacielos más altos del mundo apoyados en cimentaciones profundas sobre roca y, posiblemente, también el edificio más alto apoyado sobre suelo. La construcción de pilotes de gran diámetro apoyados sobre roca y

  20. Lorentzian Einstein metrics with prescribed conformal infinity

    CERN Document Server

    Enciso, Alberto

    2014-01-01

    We prove that there are asymptotically anti-de Sitter Einstein metrics with prescribed conformal infinity. More precisely we show that, given any suitably small perturbation $\\hat g$ of the conformal metric of the $(n+1)$-dimensional anti-de Sitter space at timelike infinity, which is given by the canonical Lorentzian metric on the $n$-dimensional cylinder, there is a Lorentzian Einstein metric on $(-T,T)\\times \\mathbb{B}^n$ whose conformal geometry is given by $\\hat g$. This is a Lorentzian counterpart of the Graham-Lee theorem in Riemannian geometry and is motivated by the holographic prescription problem in the context of the AdS/CFT correspondence in string theory.

  1. Doctors' attitudes about prescribing and knowledge of the costs of common medications.

    LENUS (Irish Health Repository)

    McGuire, C

    2012-02-01

    INTRODUCTION: Compliance with medical therapy may be compromised because of the affordability of medications. Inadequate physician knowledge of drug costs may unwittingly contribute to this problem. METHODS: We measured attitudes about prescribing and knowledge of medication costs by written survey of medical and surgical non consultant hospital doctors and consultants in two University teaching hospitals (n = 102). Sixty-eight percent felt the cost of medicines was an important consideration in the prescribing decision, however, 88% often felt unaware of the actual costs. Only 33% had easy access to drug cost data, and only 3% had been formally educated about drug costs. Doctors\\' estimates of the cost of a supply of ten commonly used medications were accurate in only 12% of cases, too low for 50%, and too high for 38%. CONCLUSIONS: Interventions are needed to educate doctors about drug costs and provide them with reliable, easily accessible cost information in real-world practice.

  2. Topical ophthalmic beta blockers may cause release of histamine through cytotoxic effects of inflammatory cells

    NARCIS (Netherlands)

    Beek, van L.M.; Mulder, M.; Haeringen, van N.J.; Kijlstra, A.

    2000-01-01

    Aim - To evaluate the effects of β blockers used in ophthalmology on the release of histamine from mixed cell preparations containing human leucocytes and basophils. Methods - A mixed leucocyte and basophil preparation was obtained from venous blood of healthy non-atopic volunteers. Cell preparation

  3. Incidence of ocular side effects of topical beta blockers in the Netherlands

    NARCIS (Netherlands)

    Beek, van L.M.; Keizer, de R.J.W.; Polak, B.C.P.; Elzenaar, P.R.; Haeringen, van N.J.; Kijlstra, A.

    2000-01-01

    Background - Several ocular side effects including uveitis, have been reported following topical β blocker treatment for glaucoma and ocular hypertension. The incidence of these side effects was investigated in the Netherlands. Methods - A prospective observational design was used whereby monthly qu

  4. Banding ligation or beta-blockers for primary prevention of variceal bleeding?

    Directory of Open Access Journals (Sweden)

    Petre Cotoras Viedma

    2016-12-01

    Full Text Available Resumen La hemorragia digestiva alta variceal es una de las complicaciones más serias de la cirrosis hepática. Los betabloqueadores no selectivos y la ligadura endoscópica se consideran efectivos como estrategia de prevención primaria de hemorragia variceal, pero no hay consenso sobre cuál de las dos constituye la mejor opción. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos siete revisiones sistemáticas que en conjunto incluyen 21 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la ligadura variceal probablemente disminuye el riesgo de sangrado digestivo variceal y se asocia a menos efectos adversos al ser comparada con betabloqueadores no selectivos, aunque probablemente no existen diferencias en términos de mortalidad.

  5. Effects of Beta-blockers on Punished Responding and on Heart Rate in Pigeons

    Science.gov (United States)

    1986-06-17

    Dissertation directed by: DavidS . Knmtz, Ph.D. Department of Medical Psychology and James E. Barrett, Ph. D. Department of Psychiatry Beta-adrenergic...experimental settings with humans (Beer and Migler, 1975; Carlton, Siegel, Murphee, and Cook, 1981; Fischman , Schuster, and Uhlenhuth, 1977). Cook (1982...B. F. (1957). Schedules of Reinforcement, New York: Appleton Century-Crofts. Fischman , M. W., Schuster, C. R., & Uhlenhuth, E. H. (1977). Extension

  6. Are angiotensin converting enzyme inhibitors superior to beta blockers in retarding progressive renal function decline?

    NARCIS (Netherlands)

    vanEssen, GG; Apperloo, AJ; Rensma, PL; Stegeman, CA; Sluiter, WJ; deZeeuw, D; deJong, PE

    1997-01-01

    We questioned the superiority of angiotensin converting enzyme (ACE) inhibitors to beta blocking drugs with regard to renal function outcome in patients with mild to moderate renal insufficiency and normal to moderately elevated blood pressure (BP). We therefore studied 89 patients in a prospective

  7. Bioaccumulation and biotransformation of the beta-blocker propranolol in multigenerational exposure to Daphnia magna.

    Science.gov (United States)

    Jeong, Tae-Yong; Kim, Tae-Hun; Kim, Sang Don

    2016-09-01

    Multigenerational bioaccumulation and biotransformation activity and short-term kinetics (e.g., uptake and depuration) of propranolol in Daphnia magna were investigated at environmental concentration. The body burden and the major metabolite, desisopropyl propranolol (DIP), of propranolol were quantified using LC-MS/MS at the end of each generation after exposure for 11 generations. The accumulation of propranolol in D. magna at an environmental concentration of 0.2 μg/L was not much different between the parent (F0) and the eleventh filial (F10) generation. However, at 28 μg/L, its accumulation was 1.6 times higher-up to 18.9 μg/g-in the F10 generation relative to the F0. In contrast to propranolol, DIP intensity gradually increased from F0 to F10 at 0.2 μg/L, reflecting an increase in detoxification load and biotransformation performance; no increasing trend was observed at 28 μg/L. The bioaccumulation factor (BAF) showed higher values with a lower concentration and longer period of exposure. The average values of the BAF for 21 days of long-term exposure in successive 11 generations were 440.4 ± 119.7 and 1026.5 ± 208.6 L/kg for 28 μg/L and 0.2 μg/L, respectively. These are comparable to the BAF of 192 for the short-term 72-h exposure at 28 μg/L in the parent generation. It is also recommended that future studies for pharmaceutical ingredients be conducted on drug-drug interaction and structural characteristics on the prediction of biotransformation activity and bioaccumulation rate.

  8. Are beta-blockers effective in heart failure with preserved ejection fraction?

    Directory of Open Access Journals (Sweden)

    Javier Alegría

    2016-12-01

    Full Text Available Resumen Los betabloqueadores tienen un beneficio demostrado en el tratamiento de la insuficiencia cardíaca con fracción de eyección disminuida. Sin embargo, su rol en pacientes con fracción de eyección preservada no está tan claro. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, identificamos cuatro revisiones sistemáticas que en conjunto incluyen 19 estudios primarios, entre ellos siete estudios aleatorizados que responden la pregunta de este resumen. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de betabloqueadores en pacientes con insuficiencia cardiaca con fracción de eyección preservada probablemente resulta en poca o nula diferencia en el riesgo de muerte u hospitalización por cualquier causa.

  9. Interaction of selected vasodilating beta-blockers with adrenergic receptors in human cardiovascular tissues

    Energy Technology Data Exchange (ETDEWEB)

    Monopoli, A.; Forlani, A.; Bevilacqua, M.; Vago, T.; Norbiato, G.; Bertora, P.; Biglioli, P.; Alamanni, F.; Ongini, E. (Essex Italia, Subsidiary of Schering-Plough, Milan)

    1989-07-01

    beta- And alpha 1-adrenoceptor antagonist properties of bufuralol, carvedilol, celiprolol, dilevalol, labetalol, and pindolol were investigated in human myocardium and mammary artery using binding techniques and functional studies. In myocardial membranes, beta-adrenoceptor antagonists showed monophasic competition isotherms for (125I)pindolol binding with high affinity (Ki from 1-100 nM), except for celiprolol which displayed a biphasic competition isotherm (pKi = 6.4 +/- 0.06 for beta 1- and 4.8 +/- 0.07 for beta 2-adrenoceptors). Drug interactions with alpha 1-adrenoceptors were evaluated in human mammary artery by (3H)prazosin binding and by measuring contractile responses to norepinephrine (NE). Labetalol and carvedilol showed a moderate affinity for alpha 1-adrenoceptors (pKi = 6.2 +/- 0.01 and 6.1 +/- 0.06, respectively), and inhibited NE-induced contractions (pA2 = 6.93 +/- 0.23 and 8.64 +/- 0.24, respectively). Dilevalol, bufuralol, and pindolol displayed weak effect both in binding (Ki in micromolar range) and functional experiments (pA2 = 5.98, 5.54, and 6.23, respectively). Celiprolol did not show antagonist properties up to 100 microM in functional studies, but displayed a slight affinity for alpha 1-adrenoceptors in binding studies. The data indicate that the vasodilating activity of these beta-adrenoceptor antagonists is caused in some instances by an alpha 1-adrenoceptor antagonism (labetalol, carvedilol), whereas for the others alternative mechanisms should be considered.

  10. Practical guidelines for treatment with beta-blockers and nitrates in patients with acute myocardial infarction

    NARCIS (Netherlands)

    M.L. Simoons (Maarten); P.W.J.C. Serruys (Patrick); P.M. Fioretti (Paolo); M.J.B.M. van den Brand (Marcel); P.G. Hugenholtz (Paul)

    1983-01-01

    textabstractTreatment of a patient with myocardial infarction might include opiates and sedatives to reduce pain and anxiety, heparin, antiarrhythmic drugs, diuretics which aim at improvement of myocardial function and drugs which might reduce the ischemic area at risk and thus mortality such as bet

  11. The current status of beta blockers' use in the management of hypertension.

    Science.gov (United States)

    Akbar, Shahid; Alorainy, Mohammad S

    2014-11-01

    The invention of beta (β)-blockers culminated in a new era in the treatment of cardiovascular diseases (CD), and changed the course of pharmacology research for years to come. Since the introduction of propranolol into clinical practice in 1964, β-blockers enjoyed a special place in the clinicians' armamentarium against CDs, especially for patients with ischemic heart diseases, and are still one of the most extensively used therapeutic drugs in both cardiac and non-cardiac ailments. Current uses of β-blockers in CDs include ischemic heart diseases, hypertension, cardiac arrhythmias, and heart failure. Other substantial non-cardiac uses include glaucoma, migraine, situational anxiety, benign essential tremors, and cardiac symptoms of thyrotoxicosis. This review covers some of the evolutionary changes of clinical uses of β-blockers, the rationale for their use, some recent controversies surrounding their use for treatment of hypertension, and advantages of newer additions to the group. 

  12. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies.

    Science.gov (United States)

    Graudins, Andis; Lee, Hwee Min; Druda, Dino

    2016-03-01

    Management of cardiovascular instability resulting from calcium channel antagonist (CCB) or beta-adrenergic receptor antagonist (BB) poisoning follows similar principles. Significant myocardial depression, bradycardia and hypotension result in both cases. CCBs can also produce vasodilatory shock. Additionally, CCBs, such as verapamil and diltiazem, are commonly ingested in sustained-release formulations. This can also be the case for some BBs. Peak toxicity can be delayed by several hours. Provision of early gastrointestinal decontamination with activated charcoal and whole-bowel irrigation might mitigate this. Treatment of shock requires a multimodal approach to inotropic therapy that can be guided by echocardiographic or invasive haemodynamic assessment of myocardial function. High-dose insulin euglycaemia is commonly recommended as a first-line treatment in these poisonings, to improve myocardial contractility, and should be instituted early when myocardial dysfunction is suspected. Catecholamine infusions are complementary to this therapy for both inotropic and chronotropic support. Catecholamine vasopressors and vasopressin are used in the treatment of vasodilatory shock. Optimizing serum calcium concentration can confer some benefit to improving myocardial function and vascular tone after CCB poisoning. High-dose glucagon infusions have provided moderate chronotropic and inotropic benefits in BB poisoning. Phosphodiesterase inhibitors and levosimendan have positive inotropic effects but also produce peripheral vasodilation, which can limit blood pressure improvement. In cases of severe cardiogenic shock and/or cardiac arrest post-poisoning, extracorporeal cardiac assist devices have resulted in successful recovery. Other treatments used in refractory hypotension include intravenous lipid emulsion for lipophilic CCB and BB poisoning and methylene blue for refractory vasodilatory shock.

  13. From beta-blockers to boot camp: Preparing students for the NCLEX-RN.

    Science.gov (United States)

    Herrman, Judith W; Johnson, Amy Nagorski

    2009-01-01

    Although it is thought that reviewing essential materials and learning how to answer computer-generated questions are optimal preparations for NCLEX-RN, strategies that build knowledge, self-confidence, and professionalism of the nurse taking the exam are equally important. A senior seminar course that guides formal NCLEX-RN preparation is presented in this article with specific course strategies and a blueprint of seminar content that can be adapted to the nursing curriculum.

  14. THE ROLE OF BETA-BLOCKERS IN THE TREATMENT OF CARDIOVASCULAR DISEASES IN PREGNANT WOMEN

    Directory of Open Access Journals (Sweden)

    R. I. Striuk

    2012-01-01

    Full Text Available Highly selective β-adrenoblockers (β-AB are used in pregnant women with cardiovascular diseases (arterial hypertension, arrhythmia, Marfan syndrome, hypertrophic cardiomyopathy. β-AB fall into the category C according to safety classification of Food and Drug Administration (US FDA. Their prescription in different clinical situations meets the principle of "risk–benefit". Fetus and newborn status should be monitored because β-AB can cause bradycardia, hypoglycemia, apnea and metabolic disorders. The risk of these side effects is extremely low, while β-AB clinical efficacy is high.

  15. Tendencias Actuales del Constitucionalismo Latinoamericano

    Directory of Open Access Journals (Sweden)

    Jorge Carpizo

    2009-12-01

    Full Text Available El artículo analiza los cambios constitucionales que ha habido en América Latina y que han tenido incidencia directa en el progreso de la democracia en la región; de esta manera, hace una amplia comparación de la creación de instituciones que persiguen este fin en los diferentes estados. Desde una definición amplia y actual de democracia, se revelan sus principales focos de peligro como la ilegitimidad del Estado de derecho o la percepción de corrupción predominante en la población. El escrito hace un estudio de los atributos más importantes que pueden encontrarse actualmente en esta parte del continente, y no todos ellos parecen ser siempre optimistas; tal es el caso, por ejemplo, de los referendos cuando no son conducidos conforme a la ley o los no siempre exitosos gobiernos divididos y de coalición. Es claro que el avance en materia de democracia ha sido significativo en los últimos treinta años, pero aún existen factores de riesgo que no deben perderse de vista puesto que resulta imperativo seguir el camino sin retroceder.

  16. Tendencias actuales del constitucionalismo latinoamericano

    Directory of Open Access Journals (Sweden)

    Jorge Carpizo

    2009-12-01

    Full Text Available El artículo analiza los cambios constitucionales que ha habido en América Latina y que han tenido incidencia directa en el progreso de la democracia en la región; de esta manera, hace una amplia comparación de la creación de instituciones que persiguen este fin en los diferentes estados. Desde una definición amplia y actual de democracia, se revelan sus principales focos de peligro como la ilegitimidad del Estado de derecho o la percepción de corrupción predominante en la población. El escrito hace un estudio de los atributos más importantes que pueden encontrarse actualmente en esta parte del continente, y no todos ellos parecen ser siempre optimistas; tal es el caso, por ejemplo, de los referendos cuando no son conducidos conforme a la ley o los no siempre exitosos gobiernos divididos y de coalición. Es claro que el avance en materia de democracia ha sido significativo en los últimos treinta años, pero aún existen factores de riesgo que no deben perderse de vista puesto que resulta imperativo seguir el camino sin retroceder.

  17. The actual goals of geoethics

    Science.gov (United States)

    Nemec, Vaclav

    2014-05-01

    The most actual goals of geoethics have been formulated as results of the International Conference on Geoethics (October 2013) held at the geoethics birth-place Pribram (Czech Republic): In the sphere of education and public enlightenment an appropriate needed minimum know how of Earth sciences should be intensively promoted together with cultivating ethical way of thinking and acting for the sustainable well-being of the society. The actual activities of the Intergovernmental Panel of Climate Changes are not sustainable with the existing knowledge of the Earth sciences (as presented in the results of the 33rd and 34th International Geological Congresses). This knowledge should be incorporated into any further work of the IPCC. In the sphere of legislation in a large international co-operation following steps are needed: - to re-formulate the term of a "false alarm" and its legal consequences, - to demand very consequently the needed evaluation of existing risks, - to solve problems of rights of individuals and minorities in cases of the optimum use of mineral resources and of the optimum protection of the local population against emergency dangers and disasters; common good (well-being) must be considered as the priority when solving ethical dilemmas. The precaution principle should be applied in any decision making process. Earth scientists presenting their expert opinions are not exempted from civil, administrative or even criminal liabilities. Details must be established by national law and jurisprudence. The well known case of the L'Aquila earthquake (2009) should serve as a serious warning because of the proven misuse of geoethics for protecting top Italian seismologists responsible and sentenced for their inadequate superficial behaviour causing lot of human victims. Another recent scandal with the Himalayan fossil fraud will be also documented. A support is needed for any effort to analyze and to disclose the problems of the deformation of the contemporary

  18. Antiepileptic drug prescribing before, during and after pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel; Garne, Ester; Wang, Hao;

    2015-01-01

    and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choice of AEDs and co-prescribing of folic acid were evaluated. Results In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy...... co-prescribed with high-dose folic acid: ranging from 1.0% (CI950.3–1.8%) in Emilia Romagna to 33.5% (CI9528.7–38.4%) in Wales. Conclusion The country's differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evidence base. The low co......-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearing age taking AEDs about the need to offer and receive complete preconception care....

  19. Prescribed Travel Schedules for Fatigue Management

    Science.gov (United States)

    Whitmire, Alexandra; Johnston, Smith; Lockley, Steven

    2011-01-01

    The NASA Fatigue Management Team is developing recommendations for managing fatigue during travel and for shift work operations, as Clinical Practice Guidelines for the Management of Circadian Desynchrony in ISS Operations. The Guidelines provide the International Space Station (ISS ) flight surgeons and other operational clinicians with evidence-based recommendations for mitigating fatigue and other factors related to sleep loss and circadian desynchronization. As much international travel is involved both before and after flight, the guidelines provide recommendations for: pre-flight training, in-flight operations, and post-flight rehabilitation. The objective of is to standardize the process by which care is provided to crewmembers, ground controllers, and other support personnel such as trainers, when overseas travel or schedule shifting is required. Proper scheduling of countermeasures - light, darkness, melatonin, diet, exercise, and medications - is the cornerstone for facilitating circadian adaptation, improving sleep, enhancing alertness, and optimizing performance. The Guidelines provide, among other things, prescribed travel schedules that outline the specific implementation of these mitigation strategies. Each travel schedule offers evidence based protocols for properly using the NASA identified countermeasures for fatigue. This presentation will describe the travel implementation schedules and how these can be used to alleviate the effects of jet lag and/or schedule shifts.

  20. How and when to prescribe sodium fluoride.

    Science.gov (United States)

    Shambaugh, G E

    1989-03-01

    Sodium fluoride has now been used for 24 years in an effort to slow down or arrest sensorineural hearing nerve deterioration in patients with stapedial otosclerosis or after stapedectomy, as well as in patients with pure cochlear otosclerosis. Extensive clinical experience in thousands of patients with this therapy has demonstrated its value in arresting previously progressive sensorineural hearing loss. For a long time there were those who objected to this therapy on the basis that it had not been adequately proven by double-blind, placebo-controlled studies. They have been answered by Bretlau's study in Denmark and Fisch's from Switzerland; both investigators confirmed on small groups the value of sodium fluoride by double-blind, placebo-controlled studies. Extensive research by Professor Petrovic of Strasbourg while at our tissue culture laboratory at Northwestern University demonstrated the action of sodium fluoride on bone. A nicely designed study with radioactive strontium by Linthicum, House, and Althaus demonstrated its value in promoting maturation of a spongiotic focus. Today there is no reason to hesitate in prescribing this useful, effective, and safe medication to promote maturation of otospongiotic lesions, and thus to slow down or to arrest progression in sensorineural hearing loss.

  1. A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing.

    LENUS (Irish Health Repository)

    Naughton, Corina

    2009-10-01

    The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated.

  2. [How should drugs for anxiety be prescribed?].

    Science.gov (United States)

    Baylé, F J

    1998-01-01

    Difficulties in anxiety treatment is emphasized by benzodiazepine use and misuse. Pathological anxiety threshold can be understood in a dimensional perspective or by large in philosophical considerations. Therapeutic guidelines can be defined on the length of disease or by a categorical and nosological approach. Actually, this one appears more efficient. Numerous studies lead to better selection of psychotropics for each disorders (panic disorder; general anxiety disorder; social phobia; obsessive-compulsive disorder; post-traumatic stress disorder). Therapeutic choice is under others conditions such as length of prescription, severity of the disorders; comorbidity; individual feature to patient. Improvement in therapeutic efficacy needs further studies. Some directions could be: better definition of disorders and their link with personality, appreciation of intensity and chronicity, biological parameters.

  3. Prescriber adoption of newly approved selective COX-2 inhibitors

    NARCIS (Netherlands)

    Layton, Deborah; Souverein, Patrick C.; Heerdink, Eibert R.; Shakir, Saad A. W.; Egberts, A. G. C.

    2008-01-01

    Introduction There is no consistent definition of prescribers who adopt new drug treatments early. This study examines if COX-2 inhibitors (coxibs) were prescribed by subsets of practitioners and describes GP adoption patterns of coxibs and existing NSAIDs over time. Methods A population-based drug

  4. An expanded prescribing role for pharmacists – an Australian perspective

    Directory of Open Access Journals (Sweden)

    Kreshnik Hoti

    2011-04-01

    Full Text Available Expanded pharmacist prescribing is a new professionalpractice area for pharmacists. Currently, Australianpharmacists’ prescribing role is limited to over-the-countermedications. This review aims to identify Australian studiesinvolving the area of expanded pharmacist prescribing.Australian studies exploring the issues of pharmacistprescribing were identified and considered in the context ofits implementation internationally. Australian studies havemainly focused on the attitudes of community and hospitalpharmacists towards such an expansion. Studies evaluatingthe views of Australian consumers and pharmacy clients werealso considered. The available Australian literature indicatedsupport from pharmacists and pharmacy clients for anexpanded pharmacist prescribing role, with preference fordoctors retaining a primary role in diagnosis. Australianpharmacists and pharmacy client’s views were also inagreement in terms of other key issues surrounding expandedpharmacist prescribing. These included the nature of anexpanded prescribing model, the need for additional trainingfor pharmacists and the potential for pharmacy clients gainingimproved medication access, which could be achieved withinan expanded role that pharmacists could provide. Currentevidence from studies conducted in Australia providesvaluable insight to relevant policymakers on the issue ofpharmacist prescribing in order to move the agenda ofpharmacist prescribing forwards.

  5. Prescribing quality indicators of type 2 diabetes mellitus ambulatory care

    NARCIS (Netherlands)

    Martirosyan, L.; Braspenning, J.; Denig, P.; de Grauw, W. J. C.; Bouma, M.; Storms, F.; Haaijer-Ruskamp, F. M.

    2008-01-01

    Background: Existing performance indicators for assessing quality of care in type 2 diabetes mellitus (T2DM) focus mostly on registration of measurements and clinical outcomes, and not on quality of prescribing. Objective: To develop a set of valid prescribing quality indicators (PQI) for internal u

  6. Proton pump inhibitors: potential cost reductions by applying prescribing guidelines.

    LENUS (Irish Health Repository)

    Cahir, Caitriona

    2012-01-01

    There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing.

  7. How often do general practitioners prescribe antibiotics for otitis media and the most common respiratory tract infections?

    Directory of Open Access Journals (Sweden)

    Jørund Straand

    2009-11-01

    Full Text Available  ABSTRACTObjective:  Design:  Setting:  Material:  Results:  Conclusion:  Key words:  Antibiotics, general practice, diagnoses, respiratory tract infections, otitis media, pharmacoepidemiologyExcept for upper respiratory tract infection, antibiotic treatment is the rule not an exception, forall the diagnoses studied. In general practice, improved communication- and prescribing-skills are probablyessentials for implementing a more evidence based treatment of otitis media, and the common respiratorytract infections. The significance of patient related factors for seeing a GP (or not and for (not expectingantibiotics for otitis media and the common respiratory tract infections should be explored in future research.Antibiotics were issued during 57% of all contacts for the included diagnoses, ranging from 22%(upper respiratory tract infection to 91% (tonsillitis. All patients who had first time office consultations fortonsillitis, acute bronchitis and pneumonia, were prescribed antibiotics. One out of three patients who consultedthe doctor on the telephone for these diagnoses, were also prescribed an antibiotic.8610 physician-patient contacts, and 4909 antibiotic prescriptions for otitis media, upper respiratorytract infection, tonsillitis, sinusitis, acute bronchitis, and pneumonia.Cross sectional, multipractice study.GPs in the Norwegian county of Møre & Romsdal. Data were recorded during two months.To examine how frequently general practitioners actually prescribe antibiotics for patientscontacting them for otitis media, and the most common respiratory tract infection diagnoses, – by the type ofdoctor-patient contact during prescribing, and patients' age and sex.

  8. Legal and actual central bank independence

    OpenAIRE

    Artha, I.K.D.S.; de Haan, J.

    2010-01-01

    Indicators of central bank independence (CBI) based on the interpretation central bank laws in place may not capture the actual independence of the central bank. This paper develops an indicator of actual independence of the Bank Indonesia (BI), the central bank of Indonesia, for the period 1953-2008 and compares it with a new legal CBI indicator based on Cukierman (1992). The indicator of actual independence captures institutional and economic factors that affect CBI. We find that before 199...

  9. Pharmacist independent prescribing in secondary care: opportunities and challenges.

    Science.gov (United States)

    Bourne, Richard S; Baqir, Wasim; Onatade, Raliat

    2016-02-01

    In recent years a number of countries have extended prescribing rights to pharmacists in a variety of formats. The latter includes independent prescribing, which is a developing area of practice for pharmacists in secondary care. Potential opportunities presented by wide scale implementation of pharmacist prescribing in secondary care include improved prescribing safety, more efficient pharmacist medication reviews, increased scope of practice with greater pharmacist integration into acute patient care pathways and enhanced professional or job satisfaction. However, notable challenges remain and these need to be acknowledged and addressed if a pharmacist prescribing is to develop sufficiently within developing healthcare systems. These barriers can be broadly categorised as lack of support (financial and time resources), medical staff acceptance and the pharmacy profession itself (adoption, implementation strategy, research resources, second pharmacist clinical check). Larger multicentre studies that investigate the contribution of hospital-based pharmacist prescribers to medicines optimisation and patient-related outcomes are still needed. Furthermore, a strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies.

  10. Is new drug prescribing in primary care specialist induced?

    Directory of Open Access Journals (Sweden)

    Groenewegen Peter P

    2009-01-01

    Full Text Available Abstract Background Medical specialists are often seen as the first prescribers of new drugs. However, the extent to which specialists influence new drug prescribing in primary care is largely unknown. Methods This study estimates the influence of medical specialists on new drug prescribing in primary care shortly after market introduction. The influence of medical specialists on prescribing of five new drugs was measured in a cohort of 103 GPs, working in 59 practices, over the period 1999 until 2003. The influence of medical specialists on new drug prescribing in primary care was assessed using three outcome measures. Firstly, the proportion of patients receiving their first prescription for a new or reference drug from a specialist. Secondly, the proportion of GPs prescribing new drugs before any specialist prescribes to their patients. Thirdly, we compared the time until the GP's first own prescribing between GPs who waited for prescriptions from specialists and those who did not. Results The influence of specialists showed considerable differences among the new drugs studied. The proportion of patients receiving their first prescription from a specialist was greatest for the combination salmeterol/fluticasone (60.2%, and lowest for rofecoxib (23.0%. The proportion of GPs prescribing new drugs before waiting for prescriptions from medical specialists ranged from 21.1% in the case of esomeprazole to 32.9% for rofecoxib. Prescribing new drugs by specialists did not shorten the GP's own time to prescribing. Conclusion This study shows that the influence of medical specialists is clearly visible for all new drugs and often greater than for the existing older drugs, but the rapid uptake of new drugs in primary care does not seem specialist induced in all cases. GPs are responsible for a substantial amount of all early prescriptions for new drugs and for a subpopulation specialist endorsement is not a requisite to initiate in new drug prescribing

  11. Racial Discrimination in Occupations; Perceived and Actual.

    Science.gov (United States)

    Turner, Castellano B.; Turner, Barbara F.

    1981-01-01

    A study of perceived discrimination by race and by sex for each of 21 occupations was compared with actual percentages of Blacks in each field. The study suggested that: (1) perception of opportunity corresponded to actual structure of opportunity; and (2) both a change in the social structure and individual belief systems is needed to further…

  12. Prime Hook National Wildlife Refuge Prescribed Fire Plan March 2014

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The plan describes how the refuge will use prescribed fire to treat hazardous fuels, enhance wildlife habitats, biological diversity and integrity, and delineates...

  13. New opioid prescribing guidelines favor non-opioid alternatives.

    Science.gov (United States)

    2016-05-01

    Determined to make a dent in the growing problem of opioid addiction, the CDC has unveiled new guidelines for opioid prescribing for chronic pain. The recommendations urge providers to be more judicious in their prescribing, opting for opioids only after carefully weighing substantial risks and benefits. Public health authorities note the rampant use and misuse of opioids have "blurred the lines" between prescription opioids and illicit opioids. The new guidelines are designed to help frontline providers balance the need to manage their patients' chronic pain with the duty to curb dangerous prescribing practices. The recommendations are built around three principles: favor non-opioid alternatives for most cases of chronic pain, use the lowest effective dose when prescribing opioids, and exercise caution/monitor patients who are treated with opioids.

  14. Prescribed Burning Plan for 1985 : Parker River National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This is the 1985 prescribed burning plan for Parker River National Wildlife Refuge. Treatment Area #3 is the area consisting of the fresh water marsh inside the...

  15. Medicare Part D Prescriber Look-up Tool

    Data.gov (United States)

    U.S. Department of Health & Human Services — This look-up tool is a searchable database that allows you to look up a Medicare Part D prescriber by National Provider Identifier (NPI), or by name and location....

  16. Prime Hook National Wildlife Refuge 1993 Prescribed Fire Program

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — When environmental and weather conditions are right prescribed fire will be used for the reduction of hazardous fuels, wildlife habitat management and the...

  17. How can we improve antibiotic prescribing in primary care?

    NARCIS (Netherlands)

    Dyar, Oliver J.; Beović, Bojana; Vlahović-Palčevski, Vera; Verheij, Theo; Pulcini, Céline

    2016-01-01

    Antibiotic stewardship is a necessity given the worldwide antimicrobial resistance crisis. Outpatient antibiotic use represents around 90% of total antibiotic use, with more than half of these prescriptions being either unnecessary or inappropriate. Efforts to improve antibiotic prescribing need to

  18. Annual Prescribed Burn Plan: [Rice Lake National Wildlife Refuge 1994

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This document contains prescribed fire proposals for Rice Lake NWR during 1994. Details on the physical features, primary resource objective, vegetation cover types,...

  19. Eight principles for safer opioid prescribing and cautions with benzodiazepines.

    Science.gov (United States)

    Webster, Lynn R; Reisfield, Gary M; Dasgupta, Nabarun

    2015-01-01

    The provision of long-term opioid analgesic therapy for chronic pain requires a careful risk/benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and their associated morbidity and mortality. Multiple data sources show that benzodiazepines, prescribed for comorbid insomnia, anxiety, and mood disorders, heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. Evidence is presented for hazards associated with coadministration of opioids and benzodiazepines and the need for caution when initiating opioid therapy for chronic pain. Clinical recommendations follow, as drawn from 2 previously published literature reviews, one of which proffers 8 principles for safer opioid prescribing; the other review presents risks associated with benzodiazepines, suggests alternatives for co-prescribing benzodiazepines and opioids, and outlines recommendations regarding co-prescribing if alternative therapies are ineffective.

  20. Crab Orchard National Wildlife Refuge : Prescribed Fire Plan : 1995

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Crab Orchard National Wildlife Refuge Prescribed Fire Plan has been developed to meet the station objectives set forth in the Master Plan, by aiding the forest...

  1. Existence of conformal metrics on spheres with prescribed Paneitz curvature

    CERN Document Server

    Ben-Ayed, M

    2003-01-01

    In this paper we study the problem of prescribing a fourth order conformal invariant (the Paneitz curvature) on the n-spheres, with n >= 5. Using tools from the theory of critical points at infinity, we provide some topological conditions on the level sets of a given function defined on the sphere, under which we prove the existence of conformal metric with prescribed Paneitz curvature.

  2. Fluorine prescribing practice of paediatricians in Berlin, Germany

    OpenAIRE

    Mittelsdorf, Arlette

    2010-01-01

    The subject of this study was to find out about paediatricians' approach towards fluoride within the municipal area of Berlin, Germany. For this purpose, an anonymous questionnaire consisting of 14 questions had been mailed; it was answered by a total number of 33 paediatricians. Basically, the survey indicates that they all prescribe fluorine in tablet form, but they differ about initiation and duration. About 30% prescribe fluorine between the age of 30 days and 6 years. All of ...

  3. [Formal criteria for good prescribing in the hospital].

    Science.gov (United States)

    Langebrake, Claudia; Melzer, Simone; Baehr, Michael

    2014-06-01

    The provision of drugs to hospitalised patients is a complex process with the involvement of different healthcare professionals. As pharmacotherapy is (1) one of the most common medical interventions, (2) a high-risk procedure, and (3) affects the majority of hospitalised patients, medication errors have sustainable impact on patient safety. Although medication errors can occur at different stages of drug use (prescribing, dispensing, administration), they are most likely within the prescribing process. According to the Reason's model of accident causation, these errors can be divided into active failures, error-provoking conditions, and latent conditions. Commonly, the complex interaction between lacking knowledge and/or experience, rule-based mistakes, skill-based slips and memory lapses, inadequate working environment (exessive work load, fatigue) as well as poor communication and safety culture is causative for prescribing errors. Therefore, good prescribing should include the following items: Adherence to formal criteria (e. g. avoidance of abbreviations), performance of medication reconciliation, implementation of an electronic prescribing system (computerised physician order entry, CPOE) - preferably combined with a clinical decision support system (CDSS), education and training as well as the establishment of a positive error management culture. The implementation of recommendations to reduce prescribing errors is described on the basis of established processes in hospitals.

  4. Teaching safe prescribing to medical students: perspectives in the UK

    Directory of Open Access Journals (Sweden)

    Nazar H

    2015-04-01

    Full Text Available Hamde Nazar,1 Mahdi Nazar,2 Charlotte Rothwell,1 Jane Portlock,3 Andrew Chaytor,1 Andrew Husband1 1School of Medicine, Pharmacy and Health, Durham University, UK; 2Cumberland Infirmary, North Cumbria University Hospitals NHS Trust, UK; 3School of Pharmacy and Biomedical Sciences, University of Portsmouth, UK Abstract: Prescribing is a characteristic role of a medical practitioner. On graduating from medical school, students are presumed to have acquired the necessary pharmacology knowledge underpinning the therapeutics and developed their personal skills and behaviors in order to write a safe and effective prescription (The Four Ps. However, there are reports of errors in medical prescribing and dissatisfied feedback from recent graduates, which evidence potential flaws in the current training in the practice of prescribing. We examine the Four Ps from a systems approach and offer scope for educators and curriculum designers to review and reflect on their current undergraduate teaching, learning, and assessment strategies in a similar manner. We also adopt a national framework of common competencies required of all prescribers to remain effective and safe in their area of practice as a more objective layer to the broader learning outcomes of the General Medical Council Tomorrow's Doctors 2009. This exercise demonstrates where standard, recognized competencies for safe prescribing can be accommodated pedagogically within existing medical curricula.Keywords: prescribing, medical curriculum, clinical pharmacology teaching, therapeutics, education

  5. Putting Pediatric Off Label Prescribing on the Map: A Study to Understand which Children, Medications and Physicians are Involved in Prescribing Drugs for Unapproved Uses

    OpenAIRE

    Bazzano, Alicia Theresa Francesca

    2012-01-01

    Background: Prescribing medications for an indication or age outside of the terms of U.S. Food and Drug Administration (FDA) approval is called off label prescribing. In children, off label prescribing has resulted in drug disasters and increased adverse events and has been the subject of recent legislation promoting medication study. Off label prescribing appears to be a very common pediatric practice; nonetheless, the pharmacoepidemiology of off label prescribing has not been systematically...

  6. Conterminous U.S. actual evapotranspiration data

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Actual ET (ETa) is produced using the operational Simplified Surface Energy Balance (SSEBop) model (Senay and others, 2013) for the period 2000 to present. The...

  7. Tolerance for ambiguity and self-actualization.

    Science.gov (United States)

    Foxman, P

    1976-02-01

    This study was designed to test the hypothesis, implicit in several areas of previous research, that high tolerance for ambiguity is a cognitive style which reflects high levels of underlying psychological health. Using Self-Actualization scores on the Tennessee Self Concept Scale, 36 adult subjects were defined as relatively high or low in self-actualization with equal numbers of males and females in each group. All subjects then performed individually on the Rorschach test and the Rorschach protocols were rated reliably for degree of tolerance for ambiguity. It was found that regardless of sex the high self-actualization group exhibited a significantly higher level of tolerance for ambiguity than the low self-actualization group. The finding was interpreted as confirmation of the study's hypothesis.

  8. Las neurosis actuales y las psicosis ordinarias

    OpenAIRE

    Aguirre, Javier

    2013-01-01

    El trabajo tiene por finalidad poner en tensión las categorías de psicosis ordinaria y neurosis actuales. En primer lugar, se procede a examinar ambas categorías para luego establecer sus puntos de coincidencia y disidencia. Se concluye que la categoría de neurosis actual propuesta por Freud, es una posible expresión de lo que en la actualidad se llama psicosis ordinaria.

  9. Does fire severity influence shrub resprouting after spring prescribed burning?

    Science.gov (United States)

    Fernández, Cristina; Vega, José A.; Fonturbel, Teresa

    2013-04-01

    Prescribed burning is commonly used to reduce the risk of severe wildfire. However, further information about the associated environmental effects is required to help forest managers select the most appropriate treatment. To address this question, we evaluated if fire severity during spring prescribed burning significantly affects the resprouting ability of two common shrub species in shrubland under a Mediterranean climate in NW Spain. Fire behaviour and temperatures were recorded in tagged individuals of Erica australis and Pterospartum tridentatum during prescribed burning. The number and length of resprouted shoots were measured three times (6, 12 and 18 months) after the prescribed burning. The influence of a series of fire severity indicators on some plant resprouting vigour parameters was tested by canonical correlation analysis. Six months and one year after prescribed burning, soil burn severity (measured by the absolute reduction in depth of the organic soil layer, maximum temperatures in the organic soil layer and the mineral soil surface during burning and the post-fire depth of the organic soil layer) reduced the resprouting vigour of E. australis and P. tridentatum. In contrast, direct measurements of fire effects on plants (minimum branch diameter, duration of temperatures above 300 °C in the shrub crown and fireline intensity) did not affect the post-fire plant vigour. Soil burn severity during spring prescribed burning significantly affected the short-term resprouting vigour in a mixed heathland in Galicia. The lack of effects eighteen months after prescribed burning indicates the high resilience of these species and illustrates the need to conciliate fire prevention and conservation goals.

  10. Factors influencing the choice of antidepressants: A study of antidepressant prescribing practice at University psychiatric clinic in Belgrade

    Directory of Open Access Journals (Sweden)

    Marić Nađa P.

    2012-01-01

    Full Text Available Background/Aim. Antidepressants are a widely used class of drugs. The aim of this study was to investigate different aspects of antidepressant prescribing practice at University Psychiatric Clinic in Belgrade. Methods. This cross-sectional study was carried out by retrospective analysis of the patient's medical charts. The study included all patients with antidepressant prescribed at discharge during 2009 (n = 296. The evaluation was focused on patient- related factors (socio-demographic and illness related, psychiatrist-related factors (sex and duration of working experience and drug related factors (type of antidepressant, dose, polypharmacy and reimbursement by national health insurance. Results. Antidepressants were prescribed for unipolar depression (F32-34, ICD X either without comorbidity (46.2% or with comorbidity (24.7%, mostly as a monotherapy (91% had one antidepressant, to the patients who were 65% female, aged 50.1 ± 8.9, most of them with 12 years of education (52.6%, married (69.3% and employed (55.9%. The majority of patients had a history of two hospitalizations (Med 2; 25th-75th perc. 1-4 during nine years (Med 9; 25th-75th perc. 2-15 after the first episode of depression. Among them, 19% were found to be suicidal in a lifetime. The single most prescribed antidepressant was sertraline (20.4%, followed by fluoxetine (13.3% and maprotiline (11.7%. Utilization of antidepressants was positively correlated with the rate of reimbursement (p < 0.01. The most prescribed antidepressant group was selective serotonin reuptake inhibitors (SSRI (47.8%, followed by tricyclic antidepresants (TCA (25.3% and new antidepressants - venlafaxine, tianeptine, mirtazapine, bupropion, trazodone (15.1%. Most of the drugs were prescribed in doses which are at the lower end of the recommended dose-range. Regarding severity of the actual depressive episode, TCA were prescribed for severe depression with psychotic features, while SSRI were choice for

  11. Advancing practice through prescribing: is there a better way?

    Science.gov (United States)

    Harding, Stephen; Gardner, Andrew

    2006-07-01

    The literature demonstrates a clear relationship between the rate of adverse effects and the number of prescribers that a service consumer may consult. This brings into question the benefits, for the service consumer, of nurses prescribing. Given the complexities of care for certain population groups, for example older people, it is suggested that there is greater benefit in professionals working collaboratively toward the best outcome for the person in care, with nurses offering more informed advice to their partners in service delivery. Nurses who advance their practice through the development of an expert knowledge base relevant to their area of expertise can contribute to the diagnosis and management of particular client groups by providing specialist advice to primary and direct care professionals. It is proposed that this could be achieved using an 'academic detailing' approach rather than becoming another prescriber of pharmacotherapy.

  12. An audit of generic prescribing in a general surgical department.

    LENUS (Irish Health Repository)

    Gleeson, M

    2013-01-17

    BACKGROUND: The Health Service Executive introduced a generic prescription policy to reduce costs. Despite this, generic prescription rates remain low. AIM: To audit in-patient prescription practice in a single surgical department and identify potential savings which could be realised by adherence to the generic prescribing policy. METHODS: Surgical in-patient charts were obtained at the point of discharge and their drug prescription information was recorded. RESULTS: 51 % of prescriptions involved a trade-name prescription where an appropriate generic equivalent existed. The cost implications for hospital and community patients were found to be greatly affected by substitution policies that exist at hospital pharmacy level. CONCLUSION: There is a need to promote greater adherence to generic prescribing amongst hospital doctors in line with international best practice. It can have a positive impact in terms of safe prescribing and can have cost implications at both hospital and community level.

  13. Asthma medication prescribing before, during and after pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel A; Pierini, Anna; Klungsøyr, Kari;

    2016-01-01

    OBJECTIVES: To explore utilisation patterns of asthma medication before, during and after pregnancy as recorded in seven European population-based databases. DESIGN: A descriptive drug utilisation study. SETTING: 7 electronic healthcare databases in Denmark, Norway, the Netherlands, Italy (Emilia...... pregnancy. MAIN OUTCOME MEASURES: The percentage of deliveries where the woman received an asthma medicine prescription, based on prescriptions issued (UK) or dispensed (non-UK), during the year before, throughout or during the year following pregnancy. Asthma medicine prescribing patterns were described...... for 3-month time periods and the choice of asthma medicine and changes in prescribing over the study period were evaluated in each database. RESULTS: In total, 1 165 435 deliveries were identified. The prevalence of asthma medication prescribing during pregnancy was highest in the UK and Wales databases...

  14. Statin prescribing according to gender, age and indication

    DEFF Research Database (Denmark)

    Wallach-Kildemoes, Helle; Støvring, Henrik; Holme Hansen, Ebba

    2016-01-01

    RATIONALES, AIMS AND OBJECTIVES: The increasing dispensing of statins has raised concern about the appropriateness of prescribing to various population groups. We aimed to (1) investigate incident and prevalent statin prescribing according to indication, gender and age and (2) relate prescribing...... numbers of statin users according to register proxies for indication, gender and age. RESULTS: In 2010, the prevalence became highest for ages 75-84 and was higher in men than women (37% and 33%, respectively). Indication-specific incidences and prevalences peaked at ages around 65-70, but in myocardial...... infarction, the prevalence was about 80% at ages 45-80. Particularly, incidences tended to be lower in women until ages of about 60 where after gender differences were negligible. In asymptomatic individuals (hypercholesterolaemia, presumably only indication) aged 50+, dispensing was highest in women...

  15. Inappropriate prescribing in the older population: need for new criteria.

    LENUS (Irish Health Repository)

    O'Mahony, Denis

    2012-02-03

    Inappropriate prescribing (IP) is a common and serious global healthcare problem in elderly people, leading to increased risk of adverse drug reactions (ADRs), polypharmacy being the main risk factor for both IP and ADRs. IP in older people is highly prevalent but preventable; hence screening tools for IP have been devised, principally Beers\\' Criteria and the Inappropriate Prescribing in the Elderly Tool (IPET). Although Beers\\' Criteria have become the most widely cited IP criteria in the literature, nevertheless, they have serious deficiencies, including several drugs that are rarely prescribed nowadays, a lack of structure in the presentation of the criteria and omission of several important and common IP instances. New, more up-to-date, systems-based and easily applicable criteria are needed that can be applied in the routine clinical setting.

  16. Prescribing of Antidiabetic Medicines before, during and after Pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel A.; Klungsøyr, Kari; Neville, Amanda J.;

    2016-01-01

    Aim: To explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe. Methods: A common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women ...... in the treatment of gestational diabetes despite international guidelines....... and 88.8% in the Netherlands received an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries...

  17. Developing Human Resources through Actualizing Human Potential

    Science.gov (United States)

    Clarken, Rodney H.

    2012-01-01

    The key to human resource development is in actualizing individual and collective thinking, feeling and choosing potentials related to our minds, hearts and wills respectively. These capacities and faculties must be balanced and regulated according to the standards of truth, love and justice for individual, community and institutional development,…

  18. Humanistic Education and Self-Actualization Theory.

    Science.gov (United States)

    Farmer, Rod

    1984-01-01

    Stresses the need for theoretical justification for the development of humanistic education programs in today's schools. Explores Abraham Maslow's hierarchy of needs and theory of self-actualization. Argues that Maslow's theory may be the best available for educators concerned with educating the whole child. (JHZ)

  19. Prescribing style and variation in antibiotic prescriptions for sore throat

    DEFF Research Database (Denmark)

    Cordoba Currea, Gloria Cristina; Siersma, Volkert Dirk; Lopez-Valcarcel, Beatriz Gonzalez

    2015-01-01

    Background: Variation in prescription of antibiotics in primary care can indicate poor clinical practice that contributes to the increase of resistant strains. General Practitioners (GPs), as a professional group, are expected to have a fairly homogeneous prescribing style. In this paper, we...

  20. GPs motivations of prescribing antidepressants and their practical relevance.

    NARCIS (Netherlands)

    Volkers, A.; Jong, A. de; Braspenning, J.C.C.; Bakker, D. de; Dijk, L. van

    2004-01-01

    Background: Insight in the motivations of prescribing antidepressants may contribute to advance the efficiency of the current, large antidepressant prescription rate. Less is known about why general practitioners (GPs) treat patients with antidepressants or not and choose modern SSRIs instead of the

  1. Prescribed Spatial Prepositions Influence How We Think about Time

    Science.gov (United States)

    Kranjec, Alexander; Cardillo, Eileen R.; Schmidt, Gwenda L.; Chatterjee, Anjan

    2010-01-01

    Prepositions combine with nouns flexibly when describing concrete locative relations (e.g. "at/on/in" the school) but are rigidly prescribed when paired with abstract concepts (e.g. "at" risk; "on" Wednesday; "in" trouble). In the former case they do linguistic work based on their discrete semantic qualities, and in the latter they appear to serve…

  2. New drugs in general practice: prescribing patterns and external influences

    NARCIS (Netherlands)

    Florentinus, S.R.

    2006-01-01

    In this thesis several studies are presented with the objective to detect and elucidate the patterns by which new drugs are prescribed by general practitioners (GPs). Furthermore, we studied the influences of medical specialists and community pharmacists as important factors on the GP's decision to

  3. Prescribing the Families Own Dysfunctional Rules as a Therapeutic Strategy.

    Science.gov (United States)

    Andolfi, Maurizio

    1980-01-01

    The use of paradox-strategy in therapy is motivated by the fact that many families request help but at the same time seem to reject all offers of help. By prescribing its own dysfunctional rules to the family, the therapist can stimulate the tendencies toward change present in the system. (Author)

  4. Serial pharmacological prescribing practices for tic management in Tourette syndrome.

    Science.gov (United States)

    Farag, Mena; Stern, Jeremy S; Simmons, Helen; Robertson, Mary M

    2015-11-01

    Pharmacological treatments for Tourette syndrome (TS) vary in efficacy between different patients. The evidence base is limited as even high quality controlled studies tend to be of relatively short duration which may lose relevance in clinical usage. Patients are frequently treated with serial agents in the search for efficacy and tolerability. The success of this strategy has not been previously documented. We examined 400 consecutive TS patients seen over a 10-year period, some with a longer prior history in other clinics; 255/400 (64%) were prescribed medication. We present this heterogeneous cohort in terms of the number of drugs they had tried, and as a proxy measure of some benefit of the last drug used, whether it had been prescribed under our supervision for ≥ 5 months. The most commonly prescribed medications were aripiprazole (64%), clonidine (40%), risperidone (30%) and sulpiride (29%) with changes in prescribing practises over the period examined. The number of different drugs tried were one (n = 155), two (n = 69), three (n = 36), four (n = 14), five (n = 15), six (n = 5), seven (n = 2) and eight (n = 1). The data illustrate the difficulty in drug treatment of tics and suggest that even after trials of several agents there is potential benefit in trying further options.

  5. Does comorbidity explain trends in prescribing of newer antihypertensive agents?

    NARCIS (Netherlands)

    Greving, JP; Denig, P; van der Veen, WJ; Beltman, FW; Sturkenboom, MCJM; de Zeeuw, D; Haaijer-Ruskamp, FM

    2004-01-01

    Objective Concerns exist about heavily prescribing of new drugs when the evidence on hard outcomes is still limited. This has been the case for the newer classes of anti hypertensives, especially in hypertensive patients without additional comorbidity. The association between comorbidity and trends

  6. Prescribed burning plan : Stillwater NWR : de Braga Burn Unit 67

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This 1991 Annual Prescribed Burning Plan for Stillwater NWR calls for all 67 acres of the de Braga burn unit to be burned. The objective of this burn is to remove...

  7. Identification of Associations Between Prescribed Medications and Cancer

    DEFF Research Database (Denmark)

    Pottegård, Anton; Friis, Søren; Christensen, René dePont;

    2016-01-01

    PURPOSE: We present a systematic screening for identifying associations between prescribed drugs and cancer risk using the high quality Danish nationwide health registries. METHODS: We identified all patients (cases) with incident cancer in Denmark during 2000-2012 (n=278,485) and matched each ca...

  8. Trends in Antibiotic Prescribing in Adults in Dutch General Practice

    NARCIS (Netherlands)

    M.B. Haeseker (Michiel); N.H.T.M. Dukers-Muijrers (Nicole); C.J.P.A. Hoebe (Christian); C.A. Bruggeman (Cathrien); J.W.L. Cals (Jochen); A. Verbon (Annelies)

    2012-01-01

    textabstractBackground: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this stud

  9. Urinary Tract Infection: Analysis of Prescribing Pattern of Antibiotics

    Directory of Open Access Journals (Sweden)

    MAHADEVAMMA L

    2012-03-01

    Full Text Available Antibiotics are one of most common drugs prescribed in hospital today. It has been estimated that up to onethird of all patients receive at least one antibiotics during hospitalization`. The cost involved is therefore correspondingly high and up to 40% of a hospital’s drug expenditure may be devoted to the purchase of antibiotics1. The objective of this study was to analyze the prescribing pattern of antibiotics in Urinary Tract Infection (UTI. A prospective cross sectional and observational study was conducted on patients diagnosed with UTI. The study was carried out in the OBG and Urology departments of both in-patients and out-patients, for a period of 5 months (Aug 2011 to Dec 2011. Patients diagnosed with UTI and who were above age group of 15-years were included in the study. A suitable data collection form was prepared to collect the required data. Among 162 patents, 54 were in-patients and 108 were out-patients. Most of the in-patients were prescribed with Ciprofloxacin 13(22.8%, and Ceftriaxone 19(33.3%. In out-patients, Ciprofloxacin 25(23.8%, Norfloxacin 15(14.3% and Ceftriaxone 14(13.3% were prescribed frequently. The study found that gram negative organisms like E. coli and Klebsills was the most predominant organisms associated with infection. It was also found that Cephalosporin's were most commonly used and Quinolones were the second most commonly used drugs for the treatment of UTI.

  10. Antibiotic prescribing in dutch nursing homes: how appropriate is it?

    NARCIS (Netherlands)

    Buul, L.W. van; Veenhuizen, R.B.; Achterberg, W.P.; Schellevis, F.G.; Essink, R.T.; Greeff, S.C. de; Natsch, S.S.; Steen, J.T. van der; Hertogh, C.M.P.M.

    2015-01-01

    OBJECTIVE: To investigate the appropriateness of decisions to prescribe or withhold antibiotics for nursing home (NH) residents with infections of the urinary tract (UTI), respiratory tract (RTI), and skin (SI). DESIGN: Prospective study. SETTING: Ten NHs in the central-west region of the Netherland

  11. Antibiotic prescribing in Dutch nursing homes: how appropriate is it?

    NARCIS (Netherlands)

    Buul, L.W. van; Veenhuizen, R.B.; Achterberg, W.P.; Schellevis, F.G.; Essink, R.T.G.M.; Greeff, S.C. de; Natsch, S.; Steen, J.T. van der; Hertogh, C.M.P.M.

    2015-01-01

    Objective: To investigate the appropriateness of decisions to prescribe or withhold antibiotics for nursing home (NH) residents with infections of the urinary tract (UTI), respiratory tract (RTI), and skin (SI). Design: Prospective study. Setting: Ten NHs in the central-west region of the Netherland

  12. 20 CFR 416.930 - Need to follow prescribed treatment.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Need to follow prescribed treatment. 416.930 Section 416.930 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Medical Considerations § 416.930 Need...

  13. Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing.

    Science.gov (United States)

    Broom, Alex; Broom, Jennifer; Kirby, Emma

    2014-06-01

    The prospect of an 'antimicrobial perfect storm' in the coming decades through the emergence and proliferation of multi-resistant organisms has become an urgent public health concern. With limited drug discovery solutions foreseeable in the immediate future, and with evidence that resistance can be ameliorated by optimisation of prescribing, focus currently centres on antibiotic use. In hospitals, this is manifest in the development of stewardship programs that aim to alter doctors' prescribing behaviour. Yet, in many clinical contexts, doctors' antibiotic prescribing continues to elude best practice. In this paper, drawing on qualitative interviews with 30 Australian hospital-based doctors in mid-2013, we draw on Bourdieu's theory of practice to illustrate that 'sub-optimal' antibiotic prescribing is a logical choice within the habitus of the social world of the hospital. That is, the rules of the game within the field are heavily weighted in favour of the management of immediate clinical risks, reputation and concordance with peer practice vis-à-vis longer-term population consequences. Antimicrobial resistance is thus a principal of limited significance in the hospital. We conclude that understanding the habitus of the hospital and the logics underpinning practice is a critical step toward developing governance practices that can respond to clinically 'sub-optimal' antibiotic use.

  14. Practices in prescribing protein substitutes for PKU in Europe

    DEFF Research Database (Denmark)

    Aguiar, A; Ahring, K; Almeida, M F;

    2015-01-01

    BACKGROUND: There appears little consensus concerning protein requirements in phenylketonuria (PKU). METHODS: A questionnaire completed by 63 European and Turkish IMD centres from 18 countries collected data on prescribed total protein intake (natural/intact protein and phenylalanine-free protein...

  15. Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Bhanu P. Kolasani

    2016-12-01

    Full Text Available Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute. Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed. Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52% were the most commonly prescribed category followed by analgesics (19.60% and Intravenous fluids (13.53%. Metronidazole (27.02% was the most commonly prescribed antimicrobial, Diclofenac (68.04% was the commonly prescribed analgesics and Ringer lactate (38.81% was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%, antiemetic was Ondansetron (76.39%. Majority of drugs (72.54% were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM was 82.16%. Injection (57.78% was the most common drug formulation. Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial

  16. Variation in opioid prescribing patterns between ED providers.

    Science.gov (United States)

    Smulowitz, Peter B; Cary, Chris; Boyle, Katherine L; Novack, Victor; Jagminas, Liudvikas

    2016-12-01

    Abuse of opioid prescription drugs has become an epidemic across the developed world. Despite the fact that emergency physicians overall account for a small proportion of total opioids prescribed, the number of prescriptions has risen dramatically in the past decade and, to some degree, contributes to the available supply of opioids in the community, some of which are diverted for non-medical use. Since successfully reducing opioid prescribing on the individual level first requires knowledge of current prescribing patterns, we sought to determine to what extent variation exists in opioid prescribing patterns at our institution. This was a single-institution observational study at a community hospital with an annual ED volume of 47,000 visits. We determined the number of prescriptions written by each provider, both total number and accounting for the number of patients seen. Our primary outcome measure was the level of variation at the physician level for number of prescriptions written per patient. We also identified the mean number of pills written per prescription. We analyzed data from November 13, 2014 through July 31, 2015 for 21 full-time providers. There were a total of 2211 prescriptions for opioids written over this time period for a total of 17,382 patients seen. On a per-patient basis, the rate of opioid prescriptions written per patient during this period was 127 per 1000 visits (95 % CI 122-132). There was a variation on the individual provider level, with rates ranging from 33 per to 332 per 1000 visits. There was also substantial variation by provider in the number of pills written per prescription with coefficient of variation (standard deviation divided by mean) averaged over different opioids ranging from 16 to 40 %. There was significant variation in opioid prescribing patterns at the individual physician level, even when accounting for the number of patients seen.

  17. Inappropriate prescribing and adverse drug events in older people.

    LENUS (Irish Health Repository)

    Hamilton, Hilary J

    2009-01-01

    Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  18. Inappropriate prescribing and adverse drug events in older people

    Directory of Open Access Journals (Sweden)

    Gallagher Paul F

    2009-01-01

    Full Text Available Abstract Inappropriate prescribing (IP in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs, morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  19. Towards Designing Android Faces after Actual Humans

    DEFF Research Database (Denmark)

    Vlachos, Evgenios; Schärfe, Henrik

    2015-01-01

    Using their face as their prior affective interface, android robots and other agents embody emotional facial expressions, and convey messages on their identity, gender, age, race, and attractiveness. We are examining whether androids can convey emotionally relevant information via their static...... facial sig-nals, just as humans do. Based on the fact that social information can be accu-rately identified from still images of nonexpressive unknown faces, a judgment paradigm was employed to discover, and compare the style of facial expres-sions of the Geminoid-DK android (modeled after an actual...... initially made for the Original, suggesting that androids inherit the same style of facial expression as their originals. Our findings support the case of designing android faces after specific actual persons who portray facial features that are familiar to the users, and also relevant to the notion...

  20. El valor actual de la Universidad

    Directory of Open Access Journals (Sweden)

    Fernando Sancén Contreras

    2003-01-01

    Full Text Available El presente artículo aborda el concepto mismo de valor, y se le concibe como una creación y una práctica individual y social. Definir el valor actual de la Universidad lleva a una discusión que se resuelve en la búsqueda de lo que ella ha de significar para la sociedad actual. El valor que tradicionalmente se le atribuye —transmisión de conocimientos e investigación— es ya inoperante dado que sus funciones centrales se realizan con éxito fuera de Ella. Por eso se postula el valor de la Universidad en la incorporación de la imaginación creativa para formar a los estudiantes en la conciencia y la responsabilidad de crear su futuro personal y el de la sociedad. Dicho valor no se limita al pasado ni al presente; asume a éstos como lo que da forma al futuro. Enseñar e investigar los asuntos de la sociedad y de sus miembros para construir su futuro a través de una actitud imaginativa, creadora, es el valor actual de la Universidad.

  1. Prescribing under the Influence: The Business of Breastmilk Substitutes

    Directory of Open Access Journals (Sweden)

    Rosa Rios

    2016-09-01

    Full Text Available This study draws on a general theoretical framework comprising of a decision maker (a doctor, perceived moral intensity of the issue (breastfeeding substitute prescription, and the situational environment (hospital policy, pharma company promotions, and mother’s beliefs regarding breastfeeding to explain the physician’s role and influence on mothers’ infant feeding choices when prescribing infant formula in Kuwait, Middle East. Moral intensity is an issue-contingent model that suggests ethical decisions vary in terms of how much a moral imperative is present in a situation. The moral intensity of the issue is assessed using six components. Path Least Squares results indicate the following moral intensity components have significant impact on prescription behavior: magnitude of consequences, probability of effect, and temporal immediacy. Company promotion and hospital policy also significantly influence doctor’s prescription of infant formula. Doctors appear to disengage from the consequences of over prescribing infant formula.

  2. Prescribers' experiences with powered mobility prescription among older adults.

    Science.gov (United States)

    Mortenson, W Ben; Clarke, Laura Hurd; Best, Krista

    2013-01-01

    Despite the potential benefits of powered mobility, many older adults do not have access to this technology. To date, few studies have explored how prescribers make decisions regarding provision of powered mobility. Therefore, we undertook a qualitative study to develop a better understanding of prescribers' attitudes toward and practices with older adult candidates for powered mobility devices. Our analysis of 10 in-depth interviews identified three main themes: (1) "Deciding who should be entitled" explored how therapists decided who should have access to powered mobility, (2) "power wheelchair negotiation" described the discord between clients and therapists that became apparent during this process, and (3) "practical considerations" revealed how contextual factors shaped the provision of powered mobility. The findings suggest that the ways in which powered mobility is funded, provided, and accommodated should be improved so that more older adults have access to these devices and can use them to their full potential.

  3. Potentially inappropriate prescribing in a population of frail elderly people.

    Science.gov (United States)

    Récoché, Isabelle; Lebaudy, Cécile; Cool, Charlène; Sourdet, Sandrine; Piau, Antoine; Lapeyre-Mestre, Maryse; Vellas, Bruno; Cestac, Philippe

    2017-02-01

    Background Frailty is a clinical syndrome highly predictive of functional decline after a stress or a medical event, such as adverse drug events. Objective To describe the prevalence of potentially inappropriate prescribing in a population of frail elderly patients. Setting Geriatric day hospital for assessment of frailty and prevention of disability, Toulouse, France. Method A cross-sectional study performed from January to April 2014. Two pharmacists retrospectively analyzed the prescriptions of elderly patients who were sent to the day hospital to assess their frailty and to be given a personalized plan of care and prevention. Potentially inappropriate prescribing was defined by combining explicit criteria: Laroche list, screening tool of older people's prescriptions, and screening tool to alert to right treatment with an implicit method (drug utilization review for each medication). Prescriptions' optimizations were then suggested to the geriatricians of the day hospital and classified according to criteria defined by the French Society of Clinical Pharmacy. Main outcome measure Prevalence of potentially inappropriate prescribing. Results Among the 229 patients included, 71.2% had potentially inappropriate prescribing. 76 patients (33.2%) had at least one drug without any valid indication. 51 (22.3%) had at least one drug with an unfavorable benefit-to-risk ratio according to their clinical and biological data, 42 (18.3%) according to the Laroche list and 38 (16.6%) had at least one drug with questionable efficacy. Conclusion Our work shows that the incidence of PIP is high in the frail elderly and that, in most cases, it could be avoided with an adequate and regular reassessment of the prescriptions. In future, prescription optimization will be integrated into the personalized medical care plan to further prevent drug-related disability.

  4. Analysis for commonly prescribed non-sedating antihistamines

    Directory of Open Access Journals (Sweden)

    Michael E. El-Kommos

    2015-03-01

    Full Text Available A comprehensive review with 185 references for the analysis of commonly prescribed members of an important class of drugs, non-sedating antihistamines (NSAs, is presented. The review covers most of the methods described for the analysis of cetirizine (CTZ, ebastine (EBS, fexofenadine (FXD, ketotifen (KET and loratadine (LOR in pure forms, in different pharmaceutical dosage forms and in biological fluids. The review covers the period from 1991 till now.

  5. Antibiotic-prescribing patterns for Iraqi patients during Ramadan

    Directory of Open Access Journals (Sweden)

    Mikhael EM

    2014-11-01

    Full Text Available Ehab Mudher Mikhael, Ali Lateef Jasim Clinical Pharmacy Department, College of Pharmacy, Baghdad University, Baghdad, Iraq Background: During Ramadan, Muslims fast throughout daylight hours. There is a direct link between fasting and increasing incidence of infections. Antibiotic usage for treatment of infections should be based on accurate diagnosis, with the correct dose and dosing regimen for the shortest period to avoid bacterial resistance. This study aimed to evaluate the practices of physicians in prescribing suitable antibiotics for fasting patients and the compliance of the patients in using such antibiotics at regular intervals.Materials and methods: An observational study was carried out during the middle 10 days of Ramadan 2014 in two pharmacies at Baghdad. A total of 34 prescriptions (Rx for adults who suffered from infections were examined. For each included Rx, the researchers documented the age and sex of the patient, the diagnosis of the case, and the name of the given antibiotic(s with dose and frequency of usage. A direct interview with the patient was also done, at which each patient was asked about fasting and if he/she would like to continue fasting during the remaining period of Ramadan. The patient was also asked if the physician asked him/her about fasting before writing the Rx.Results: More than two-thirds of participating patients were fasting during Ramadan. Antibiotics were prescribed at a higher percentage by dentists and surgeons, for which a single antibiotic with a twice-daily regimen was the most commonly prescribed by physicians for patients during the Ramadan month.Conclusion: Physicians fail to take patient fasting status into consideration when prescribing antibiotics for their fasting patients. Antibiotics with a twice-daily regimen are not suitable and best to be avoided for fasting patients in Iraq during Ramadan – especially if it occurs during summer months – to avoid treatment failure and provoking

  6. Antimicrobial stewardship: Improving antibiotic prescribing practice in a respiratory ward.

    Science.gov (United States)

    Yeo, Jing Ming

    2016-01-01

    International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice.

  7. Evaluation of prescribing indicators and pattern among dermatological outpatients in a teaching hospital of central Nepal

    Directory of Open Access Journals (Sweden)

    Manohar Pradhan

    2016-08-01

    Full Text Available Background: Evaluation of prescribing indicators by proper analysis of prescriptions under the guidelines of World Health Organization enables us to detect some of the common problems of prescribing.Methodology: This study was conducted on randomly selected 325 prescriptions of dermatological outpatients of teaching hospital of College of Medical Sciences Bharatpur (Nepal with an objective to detect the problems of prescribing as well as to delineate the pattern of medicines prescribing.Results: Total number of medicines prescribed on these prescriptions was 743. The average number of medicines per encounter was 2.28. Antihistamines, antifungals, corticosteroids and antibiotics were four most frequently prescribed therapeutic classes. One systemic as well as one topical medicine belonging to same therapeutic class was prescribed on about one-third of totally analyzed prescriptions. Cetrizine was the most common individually prescribed medicine and fluconazole was the most commonly prescribed antifungal. Medicines prescribed by their generic name were 15.07% and those prescribed from national essential medicines list were 23.42%.Conclusion: This study reveals polypharmacy, inclination of prescribers for branded medicines and prescribing out of national formulary as problems. Educational and managerial interventions are required to rationalize the prescribing practice.JCMS Nepal. 2016;12(2:44-9.

  8. Legal and regulatory aspects of prescribing and marketing emergency contraception in Nigeria.

    Science.gov (United States)

    Adekunle, A O; Babarinsa, I A; Akinyemi, Z; Okediran, A Y

    2001-01-01

    Emergency contraception remains so little used or understood and the lack of its awareness can be traced to a myriad of factors including legal and regulatory obstacles. The aim of this study was to determine the legal and regulatory aspects of dispensing or marketing a contraceptive method for reasons (especially emergency purposes) other than stated by the manufacturers. The existing drugs' and devices' regulatory systems in Nigeria, especially those governing family planning methods, were reviewed. A questionnaire was administered to 363 health workers, comprising of physicians, pharmacists, nurses and midwives, to determine the implications of dispensing some currently available oral contraceptives (OCs) for emergency purposes despite the fact that there is no explicit description of emergency use in the labelling of such drugs. In addition, in-depth interviews were conducted with regulatory bodies. It was observed that, with the exception of Postinor, the drug manufacturers' leaflets did not indicate that they could be used for emergency contraceptive purposes. Although 64.5% of the healthcare providers were aware that OCs and intrauterine contraceptive devices (IUCDs) can be used for emergency purposes, 42.1% actually prescribed or recommended them. Many health workers (62.3%) were unaware of any legal implication with regards to prescribing unregistered drugs in Nigeria. The existing guidelines stipulate that a manufacturer or marketer should 're-register' a product if a new indication or use not contained in the initial application was found later. To satisfy legal requirements, it does appear that the currently available OCs and IUCDs in Nigeria must be labelled and registered for emergency contraceptive purposes.

  9. 7 CFR 1437.101 - Actual production history.

    Science.gov (United States)

    2010-01-01

    ... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The APH... 7 Agriculture 10 2010-01-01 2010-01-01 false Actual production history. 1437.101 Section...

  10. Actual service life prediction of building components

    DEFF Research Database (Denmark)

    Aagaard, Niels-Jørgen; Brandt, Erik; Hansen, Ernst Jan de Place

    2014-01-01

    a condensed method for assessment of life cycle costs for buildings. Estimation of life cycle costs has traditionally been based on predicted service life for building components in terms of technical performance. This paper suggests a method for taking into account other contributing factors...... such as economics, aesthetics and use of the building. Each of these factors is regarded as a stochastic variable and can be seen as competing causes of bringing service life to an end. A model is proposed for combining such variables resulting in the actual service life of building components. Furthermore......, the paper presents an analysis of service life of buildings as such with respect to the use of the building partially based on analysis of data from the nationwide Danish register of buildings and housing as well as turnover in the Danish construction industry from refurbishment and demolition activities...

  11. Tendencias y Direcciones Del Teatro Chileno Actual

    Directory of Open Access Journals (Sweden)

    Sergio Pereira Poza

    1997-01-01

    Full Text Available Este artículo se propone entregar una visión panorámica del teatro contemporáneo en Chile en el contexto de lo que se ha denominado la crisis de la modernidad. A partir de la premisa de que las muestras tendenciales del teatro de hoy son el resultado del proceso de revisión que vive la cultura de la modernidad, el trabajo se ocupa, primeramente, de examinar las características que presenta en el mundo occidental el recusamiento de la modernidad y sus reflejos en el teatro actual y en el nuevo teatro chileno. En un segundo momento, se estudian los términos con los que nuestro teatro responde a la crisis en desarrollo, proponiendo las tres direcciones que muestra la práctica escénica contemporánea en Chile: Teatro Verbal, Teatro Espectáculo y Teatro Gestual

  12. Las cubiertas de grandes luces. Soluciones actuales

    Directory of Open Access Journals (Sweden)

    de Alarcón Álvarez, C.

    1971-04-01

    Full Text Available This article deals generally with the problems connected with the construction of large span roofs, and also with the various types of designs that are currently in practice. It may be said that at present the only limitation to these designs is the imagination of the designer and the financial restrictions imposed on him.Se exponen en este artículo, de forma panorámica, los problemas que presenta la cobertura de grandes vanos y las diversas soluciones que se han adoptado hasta los tiempos actuales, en los que puede afirmarse que no existe más límite para la fantasía del proyectista que el condicionamiento del presupuesto de la obra.

  13. Drug Use Evaluation of Three Widely Prescribed Antibiotics in a

    Directory of Open Access Journals (Sweden)

    Mehdi Mohammadi

    2015-10-01

    Full Text Available Background: Drug utilization studies are helpful in understanding the current practice. We have conducted a retrospective study to evaluate the relevant use of a group of most commonly prescribed antibiotics in a teaching hospital in Iran.  The results of this study may be of help for clinicians to improve the patient care.Methods: Patients who received parenteral ceftazidim, vancomycin and amikacin from December2010 to May 2011 were enrolled in this study. Patient’s data including demographic, length of Hospital stay, drug allergy, first and final diagnosis were recorded in a predesigned data collection form. American Hospital Formulary Services (AHFS book were used as a reference for evaluation of study drug indication and dosing according to diagnosis and microbiological culture. Defined Daily Dose (DDD of each drug extracted from Anatomic and Therapeutic Chemical classification system (ATC/DDD and drug usage data evaluated by calculating the ratio of prescribed drug to its DDD.Results: The ratio of prescribed daily dose to DDD was 0.78, 0.95 and 0.86 for amikacin, ceftazidime and vancomycin respectively. Between amikacin group, 43 patients (86% received drug empirically, the number of empiric treatments for ceftazidim and vancomycin were 45(90% and 44 patients (88%. The renal function tests (Blood Urea Nitrogen, Serum Creatinin were evaluated in 56% of amikacin group, 64% in ceftazidime group and 78% in vancomycin group.Conclusion: The results of this study indicate the need to establish continuing medical education (CME courses for physicians to familiarize them with standards required to use and monitor these agents.

  14. Educational Outreach to Opioid Prescribers: The Case for Academic Detailing.

    Science.gov (United States)

    Trotter Davis, Margot; Bateman, Brian; Avorn, Jerry

    2017-02-01

    Nonmedical use of opioid medications constitutes a serious health threat as the rates of addiction, overdoses, and deaths have risen in recent years. Increasingly, inappropriate and excessively liberal prescribing of opioids by physicians is understood to be a central part of the crisis. Public health officials, hospital systems, and legislators are developing programs and regulations to address the problem in sustained and systematic ways that both insures effective treatment of pain and appropriate limits on the availability of opioids. Three approaches have obtained prominence as means of avoiding excessive and inappropriate prescribing, including: providing financial incentives to physicians to change their clinical decision through pay-for-performance contracts, monitoring patient medications through Prescription Drug Monitoring Programs, and educational outreach to physicians. A promising approach to educational outreach to physicians is an intervention known as "academic detailing." It was developed in the 1980s to provide one-on-one educational outreach to physicians using similar methods as the pharmaceutical industry that sends "detailers" to market their products to physician practices. Core to academic detailing, however, is the idea that medical decisions should be based on evidence-based information, including managing conditions with updated assessment measures, behavioral, and nonpharmacological interventions. With the pharmaceutical industry spending billions of dollars to advertise their products, individual practitioners can have difficulty gathering unbiased information, especially as the number of approved medications grows each year. Academic detailing has successfully affected the management of health conditions, such as atrial fibrillation, chronic obstructive pulmonary disease, and recently, has targeted physicians who prescribe opioids. This article discusses the approach as a potentially effective preventative intervention to address the

  15. Effects of prescribed fire in the coastal prairies of Texas

    Science.gov (United States)

    Grace, James B.; Allain, Larry K.; Baldwin, Heather Q.; Billock, Arlene G.; Eddleman, William R.; Given, Aaron M.; Jeske, Clint W.; Moss, Rebecca

    2005-01-01

    Prescribed fire is widely applied for habitat management in coastal ecosystems. Fire management plans typically list a variety of objectives for prescribed burning, including succession management, promotion of native flora and fauna, providing habitat for species of importance, wildfire risk reduction (fuels management), as well as reduction and/or prevention of invasive species. In most cases, the information needed to determine the degree to which management objectives are met is not available. This study sought to provide an assessment of key objectives of fire management at the U.S. Fish and Wildlife Service (USFWS) Texas Mid-coast National Wildlife Refuge Complex. The main purpose of this work was to provide information and recommendations that will support Region 2 of the USFWS in the conduct of their fire and habitat management activities in the Western Gulf coast region. There were four main components of this project: (1) a historical analysis of the role of fire in this ecosystem, (2) the development of standard methodology for assessing and monitoring fire effects in this system, (3) an evaluation of the effects of prescribed burning on the habitat being managed, and (4) an evaluation of the effects of burning on select fauna of special concern. A team of researchers, including some from the U.S. Geological Survey (USGS), Southeast Missouri State University, and Louisiana State University were involved in the various components of this project. Extensive support by USFWS personnel, both at the Texas Mid-coast National Wildlife Refuge Complex and in the Regional Office (Region 2, USFWS), was a key component in this work. Data from the three years of this study were combined with the results of previous USGS studies performed at the site to strengthen our conclusions.

  16. Rapidly increasing prescribing of proton pump inhibitors in primary care despite interventions

    DEFF Research Database (Denmark)

    Haastrup, Peter; Paulsen, Maja Skov; Zwisler, Jon Eik;

    2014-01-01

    Background: Guideline and reimbursement modifications have been introduced to optimize prescribing of antisecretory medication in Danish general practice. Impacts of the interventions have not been evaluated. Objectives: To analyse developments in prescribing of antisecretory medication in Denmar...

  17. A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

    NARCIS (Netherlands)

    Martirosyan, Liana; Markhorst, Joekie; Denig, Petra; Haaijer-Ruskamp, Flora M.; Braspenning, Joze

    2012-01-01

    Background: Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use

  18. A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

    NARCIS (Netherlands)

    Martirosyan, L.; Markhorst, J.; Denig, P.; Haaijer-Ruskamp, F.M.; Braspenning, J.C.

    2012-01-01

    BACKGROUND: Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use

  19. Primary-care prescribing of anti-osteoporotic-type medications following hospitalisation for fractures.

    LENUS (Irish Health Repository)

    McGowan, Bernie M

    2011-03-01

    We examined the prescribing of antiosteoporotic medications pre- and post hospital admission in patients with fragility fractures as well as factors associated with prescribing of these treatments following admission.

  20. TIMING OF PRE-OPERATIVE BETA-BLOCKER TREATMENT IN VASCULAR SURGERY PATIENTS: INFLUENCE ON POST-OPERATIVE OUTCOME

    Directory of Open Access Journals (Sweden)

    W.-J. Flu

    2016-01-01

    Full Text Available Введение. В соответствии с мнением экспертов, рекомендуется начинать терапию β-блокаторами в сроки от нескольких дней до нескольких недель до операции. Цель. Оценить влияние срока начала терапии β-блокаторами перед операцией на частоту сердечных сокращений (ЧСС и уровень высокочувствительного С-реактивного белка (вч-СРБ 1 в предоперационном периоде и 2 на послеоперационный исход. Материал и методы. У 940 больных, которым проведены операции на сосудах, учитывалось время начала терапии β-блокаторами (0-1 нед, от >1 до 4 нед и >4 нед перед операцией и определялись ЧСС и уровень вч-СРБ перед операцией. До и после операции проводилось рутинное измерение уровня Т-тропонина и регистрировались электрокардиограммы. Конечными точками исследования были сердечные события в течение 30 дней (объединенная частота инфаркта миокарда и летальности от сердечных причин и отдаленная летальность. Взаимосвязь между сроком начала лечения β-блокаторами и исходом оценивалась с помощью многофакторного регрессионного анализа с учетом факторов сердечного риска. Результаты. Лечение β-блокатором за 0-1 нед до операции начинали у 158 (17% больных, от 1 до 4 нед — у 393 (42% больных и от 4 нед — у 389 (41% больных. Медиана ЧСС в день операции у больных этих подгрупп составляла, соответственно, 74 (±17, 70 (±16 и 66 (±15 уд/мин (р<0,001 при сравнении групп больных с продолжительностью лечения более и менее 1 нед до операции. Уровень вч-СРБ, соответственно, был 4,9 (±7,5, 4,1 (±6,0 и 4,5 (±6,3 мг/л (р=0,782. Лечение, начатое за >1 до 4 нед и >4 нед до операции ассоциировалось с меньшей частотой сердечных событий в течение 30 дней после операции [отношение шансов (ОШ 0,46; 95% доверительный интервал [ДИ]: 0,27-0,76; ОШ 0,48; 95% ДИ 0,29-0,79] и более низкой летальностью при отдаленном наблюдении [относительный риск (ОР 0,52, 95% ДИ 0,21-0,67 и ОР 0,50, 95% ДИ 0,25-0,71], чем лечение, начатое в срок <1 нед перед операцией. Заключение. Результаты исследования указывают, что лечение β-блокаторами, начатое в срок >1 нед перед операцией, связано с более низкой предоперационной ЧСС и улучшением исходов по сравнению с лечением, начатым в срок <1 нед перед операцией. Однако снижение медианы концентрации вч-СРБ у больных, получавших лечение β-блокатором >1 нед, в сравнении с больными, у которых лечение было начато в срок от 0 до 1 нед до операции, не наблюдалось.

  1. TIMING OF PRE-OPERATIVE BETA-BLOCKER TREATMENT IN VASCULAR SURGERY PATIENTS: INFLUENCE ON POST-OPERATIVE OUTCOME

    Directory of Open Access Journals (Sweden)

    W.-J. Flu

    2011-01-01

    Full Text Available Введение. В соответствии с мнением экспертов, рекомендуется начинать терапию β-блокаторами в сроки от нескольких дней до нескольких недель до операции. Цель. Оценить влияние срока начала терапии β-блокаторами перед операцией на частоту сердечных сокращений (ЧСС и уровень высокочувствительного С-реактивного белка (вч-СРБ 1 в предоперационном периоде и 2 на послеоперационный исход. Материал и методы. У 940 больных, которым проведены операции на сосудах, учитывалось время начала терапии β-блокаторами (0-1 нед, от >1 до 4 нед и >4 нед перед операцией и определялись ЧСС и уровень вч-СРБ перед операцией. До и после операции проводилось рутинное измерение уровня Т-тропонина и регистрировались электрокардиограммы. Конечными точками исследования были сердечные события в течение 30 дней (объединенная частота инфаркта миокарда и летальности от сердечных причин и отдаленная летальность. Взаимосвязь между сроком начала лечения β-блокаторами и исходом оценивалась с помощью многофакторного регрессионного анализа с учетом факторов сердечного риска. Результаты. Лечение β-блокатором за 0-1 нед до операции начинали у 158 (17% больных, от 1 до 4 нед — у 393 (42% больных и от 4 нед — у 389 (41% больных. Медиана ЧСС в день операции у больных этих подгрупп составляла, соответственно, 74 (±17, 70 (±16 и 66 (±15 уд/мин (р<0,001 при сравнении групп больных с продолжительностью лечения более и менее 1 нед до операции. Уровень вч-СРБ, соответственно, был 4,9 (±7,5, 4,1 (±6,0 и 4,5 (±6,3 мг/л (р=0,782. Лечение, начатое за >1 до 4 нед и >4 нед до операции ассоциировалось с меньшей частотой сердечных событий в течение 30 дней после операции [отношение шансов (ОШ 0,46; 95% доверительный интервал [ДИ]: 0,27-0,76; ОШ 0,48; 95% ДИ 0,29-0,79] и более низкой летальностью при отдаленном наблюдении [относительный риск (ОР 0,52, 95% ДИ 0,21-0,67 и ОР 0,50, 95% ДИ 0,25-0,71], чем лечение, начатое в срок <1 нед перед операцией. Заключение. Результаты исследования указывают, что лечение β-блокаторами, начатое в срок >1 нед перед операцией, связано с более низкой предоперационной ЧСС и улучшением исходов по сравнению с лечением, начатым в срок <1 нед перед операцией. Однако снижение медианы концентрации вч-СРБ у больных, получавших лечение β-блокатором >1 нед, в сравнении с больными, у которых лечение было начато в срок от 0 до 1 нед до операции, не наблюдалось.

  2. Brain death provokes very acute alteration in myocardial morphology detected by echocardiography: preventive effect of beta-blockers.

    Science.gov (United States)

    Ferrera, René; Hadour, Guylaine; Tamion, Fabienne; Henry, Jean-Paul; Mulder, Paul; Richard, Vincent; Thuillez, Christian; Ovize, Michel; Derumeaux, Geneviève

    2011-03-01

    Our objective was to evaluate immediate acute changes in myocardial function during the autonomic storm of brain death (BD). Wistar rats were divided into four groups (n = 8/group): controls without any treatment, β-blocker (Esmolol®, 10 mg/kg), calcium channel blocker (Diltiazem®, 10 mg/kg), or alpha-blocker (Prazosin®, 0.3 mg/kg). Treatments were administered intravenously 5 min before BD induction. Echocardiography (ATL-5000, 8 MHz) was performed to measure left ventricular (LV) dimensions and fractional shortening at baseline, during BD induction and 5 min and 15 min after BD. In controls, BD was immediately associated with an increase in wall thickness and a decrease in LV cavity dimension. This myocardial wall hypertrophy was completely prevented by β-blockers, but not with calcium- and alpha-blockers. Extensive myocardial interstitial edema was found in all groups, except in the β-blocker group. Myocardial wall hypertrophy was also prevented during a longer follow-up of 180 min after BD in β-blocker group as opposed to controls. In conclusion, BD is associated with an immediate and severe myocardial damage related to an important interstitial edema which is prevented by β-blockers.

  3. Effect of Beta-Blockers on Number of Osteoblasts and Osteoclasts in Alveolar Socket Following Tooth Extraction in Wistar Rats

    Science.gov (United States)

    Sadr, Katayoun; Aghbali, Amirala; Sadr, Makan; Abachizadeh, Hamed; Azizi, Maryam; Mesgari Abbasi, Mehran

    2017-01-01

    Statement of the Problem: Various researchers have suggested the use of β2-adrenergic receptor antagonists in prevention or treatment of bone resorption. Purpose: This study aimed to evaluate the effect of β2-adrenergic receptor antagonists on number of osteoclasts and osteoblasts involved in the healing of extraction socket of maxillary first molar in rats. Materials and Method: Maxillary first molars of 40 rats were extracted and divided into two groups. The test group received 0.1 mg/kg propranolol intraperitoneally daily. The controls received normal saline. At days 7, 14, 21 and 28 post-extraction, 5 rats were euthanized from each group. Maxillary bone was resected and the mean number of osteoblasts and osteoclasts in tooth socket was measured. Results: After 1 week, the number of osteoclasts in the controls was significantly higher than the test group. A significant increase in the number of osteoclasts in both groups at week 1 was observed compared to the following weeks (p< 0.05). The number of osteoblasts in the controls at second week reached its maximum rate but stayed constant in the 3rd and 4th weeks. Osteoblasts in the test group increased similar to the controls but reached its maximum at 3rd week and showed a significant increase compared to the controls (p< 0.05). Conclusion: β2 adrenergic receptor antagonists decrease the number of osteoclasts and increase the number of osteoblasts during extraction socket healing. PMID:28280758

  4. Effect of Beta-Blockers on Number of Osteoblasts and Osteoclasts in Alveolar Socket Following Tooth Extraction in Wistar Rats

    Directory of Open Access Journals (Sweden)

    Katayoun Sadr

    2017-03-01

    Full Text Available Statement of the Problem: Various researchers have suggested the use of β2-adrenergic receptor antagonists in prevention or treatment of bone resorption. Purpose: This study aimed to evaluate the effect of β2-adrenergic receptor antagonists on number of osteoclasts and osteoblasts involved in the healing of extraction socket of maxillary first molar in rats. Materials and Method: Maxillary first molars of 40 rats were extracted and divided into two groups. The test group received 0.1 mg/kg propranolol intraperitoneally daily. The controls received normal saline. At days 7, 14, 21 and 28 post-extraction, 5 rats were euthanized from each group. Maxillary bone was resected and the mean number of osteoblasts and osteoclasts in tooth socket was measured. Results: After 1 week, the number of osteoclasts in the controls was significantly higher than the test group. A significant increase in the number of osteoclasts in both groups at week 1 was observed compared to the following weeks (p< 0.05. The number of osteoblasts in the controls at second week reached its maximum rate but stayed constant in the 3rd and 4th weeks. Osteoblasts in the test group increased similar to the controls but reached its maximum at 3rd week and showed a significant increase compared to the controls (p< 0.05. Conclusion: β2 adrenergic receptor antagonists decrease the number of osteoclasts and increase the number of osteoblasts during extraction socket healing.

  5. The Influence of Molecular Structure Modifications on Vibrational Properties of Some Beta Blockers: A Combined Raman and DFT Study

    OpenAIRE

    A. Farcaș; C. Iacoviță; Vințeler, E.; V. Chiș; R. Știufiuc; Lucaciu, C. M.

    2016-01-01

    We report results of a systematic Raman, SERS, and DFT study on four beta blocking molecules: Atenolol, Metoprolol, Propranolol, and, for the first time reported in the literature, Bisoprolol. The choice of these molecules was motivated by the structural similarities between Atenolol, Bisoprolol, and Metoprolol on one hand and by their differences relative to Propranolol. The density functional theory (DFT) approach, using the B3LYP method at the 6-311+G(d,p) level of theory, has been employe...

  6. Stress-mediated increases in systemic and local epinephrine impair skin wound healing: potential new indication for beta blockers.

    Directory of Open Access Journals (Sweden)

    Raja K Sivamani

    2009-01-01

    Full Text Available BACKGROUND: Stress, both acute and chronic, can impair cutaneous wound repair, which has previously been mechanistically ascribed to stress-induced elevations of cortisol. Here we aimed to examine an alternate explanation that the stress-induced hormone epinephrine directly impairs keratinocyte motility and wound re-epithelialization. Burn wounds are examined as a prototype of a high-stress, high-epinephrine, wound environment. Because keratinocytes express the beta2-adrenergic receptor (beta2AR, another study objective was to determine whether beta2AR antagonists could block epinephrine effects on healing and improve wound repair. METHODS AND FINDINGS: Migratory rates of normal human keratinocytes exposed to physiologically relevant levels of epinephrine were measured. To determine the role of the receptor, keratinocytes derived from animals in which the beta2AR had been genetically deleted were similarly examined. The rate of healing of burn wounds generated in excised human skin in high and low epinephrine environments was measured. We utilized an in vivo burn wound model in animals with implanted pumps to deliver beta2AR active drugs to study how these alter healing in vivo. Immunocytochemistry and immunoblotting were used to examine the up-regulation of catecholamine synthetic enzymes in burned tissue, and immunoassay for epinephrine determined the levels of this catecholamine in affected tissue and in the circulation. When epinephrine levels in the culture medium are elevated to the range found in burn-stressed animals, the migratory rate of both cultured human and murine keratinocytes is impaired (reduced by 76%, 95% confidence interval [CI] 56%-95% in humans, p < 0.001, and by 36%, 95% CI 24%-49% in mice, p = 0.001, and wound re-epithelialization in explanted burned human skin is delayed (by 23%, 95% CI 10%-36%, p = 0.001, as compared to cells or tissues incubated in medium without added epinephrine. This impairment is reversed by beta2AR antagonists, is absent in murine keratinocytes that are genetically depleted of the beta2AR, and is reproduced by incubation of keratinocytes with other beta2AR-specific agonists. Activation of the beta2AR in cultured keratinocytes signals the down-regulation of the AKT pathway, accompanied by a stabilization of the actin cytoskeleton and an increase in focal adhesion formation, resulting in a nonmigratory phenotype. Burn wound injury in excised human skin also rapidly up-regulates the intra-epithelial expression of the epinephrine synthesizing enzyme phenylethanolamine-N-methyltransferase, and tissue levels of epinephrine rise dramatically (15-fold in the burn wounded tissue (values of epinephrine expressed as pg/ug protein +/- standard error of the mean: unburned control, 0.6 +/- 0.36; immediately postburn, 9.6 +/- 1.58; 2 h postburn, 3.1 +/- 1.08; 24 h post-burn, 6.7 +/- 0.94. Finally, using an animal burn wound model (20% body surface in mice, we found that systemic treatment with betaAR antagonists results in a significant increase (44%, 95% CI 27%-61%, p < 0.00000001 in the rate of burn wound re-epithelialization. CONCLUSIONS: This work demonstrates an alternate pathway by which stress can impair healing: by stress-induced elevation of epinephrine levels resulting in activation of the keratinocyte beta2AR and the impairment of cell motility and wound re-epithelialization. Furthermore, since the burn wound locally generates epinephrine in response to wounding, epinephrine levels are locally, as well as systemically, elevated, and wound healing is impacted by these dual mechanisms. Treatment with beta adrenergic antagonists significantly improves the rate of burn wound re-epithelialization. This work suggests that specific beta2AR antagonists may be apt, near-term translational therapeutic targets for enhancing burn wound healing, and may provide a novel, low-cost, safe approach to improving skin wound repair in the stressed individual.

  7. Dobutamine stress echo is superior to exercise stress testing in achieving target heart rate among patients on beta blockers.

    Science.gov (United States)

    Sabbath, Adam; Pack, Michael; Markiewicz, Richard; John, Jooby; Gaballa, Mohamed; Goldman, Steven; Thai, Hoang

    2005-01-01

    Published guidelines recommend continuing beta-adrenergic receptor blockade in patients undergoing stress testing. We evaluated the role of pharmacological versus exercise stress testing in achieving target heart rate (THR) among patients on beta-adrenergic blockade. We compared data from 140 patients who underwent dobutamine stress echo (DSE) and 143 patients who underwent exercise treadmill testing (ETT). In both groups, beta-adrenergic blocker was continued at the time of stress testing. Overall, patients undergoing DSE achieved THR more frequently than ETT. With beta-adrenergic blockade, DSE patients met THR more frequently than ETT patients (p < 0.001). Without beta-adrenergic blockade, there was no difference between either modality in achieving THR. In both DSE and ETT patients, absence of beta-adrenergic blockade increased the odds of achieving THR [odds ratio (OR): 2.46, p = 0.042 and OR: 7.44, p < 0.001, respectively]. Atropine use with DSE increased the odds of achieving THR (OR: 3.76, p = 0.006). In conclusion, pharmacological stress testing appears to be superior to exercise stress testing in achieving THR among patients on beta-adrenergic blockade.

  8. EFFECTS OF BETA-BLOCKER METOPROLOL ON QUALITY OF LIFE IN ELDERLY PATIENTS WITH CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    I. V. Vologdina

    2007-01-01

    Full Text Available Aim. To study effect of cardioselective β-adrenoblocker metoprolol tartrate (in retarded formulation on quality of life in elderly patients with chronic heart failure (CHF of ischemic etiology.Material and methods. 78 patients with CHF class III (NYHA were involved in the study. Patients were 81,6±0,25 y.o. in average. All patients had clinical signs of mild-to-moderate depressive disorders. Patients were split on 2 groups comparable in sex and age. Patients of the 1st group (n=43 received metoprolol tartrate (Egilok Retard, 50-100 mg/d additionally to standard therapy. Patients of the 2nd group (n=35 received only standard therapy. The somatic status was assessed before and after 1 and 3 months of therapy by clinical condition evaluated scale (CCES, 6-minute walking test, left ventricular ejection fraction (Echocardiography as well as mental status by special tests (SMSP, BDI, Hamilton scale, C.D.Spilberger-Y.L.Hanin scale and qualities of life (MLHFQ, SF-36.Results. Reduction of CHF class from III to II was observed in 31 (76,7% patients of the 1st group and in 23 (65,7% patients of the 2nd group. Tolerability of Egilok Retard was good and there were not cessations because of side effects. In 3 months of therapy severity of the somatic status according to CCES reduced more significantly in the 1st group in comparison with the 2nd group (29,5 % vs 11,5 %, p <0,001. The exercise tolerance increased higher in the 1st group comparing with the 2nd one (34 % vs 17 %, respectively, p<0,001. The severity of depression reduced (according to SMSP, Hamilton scale more significantly in the 1st group in comparison with this in the 2nd one. Quality of life also improved more significantly in the 1st group according to MLHFQ and SF-36 (physical functions, role physical functions, social function scales at the end of therapy.Conclusion. Metoprolol tartrate (in retarded formulation improves somatic and mental status as well as quality of life in elderly patients with CHF.

  9. THE ROLE OF S-AMLODIPINE IN ARTERIAL HYPERTENSION THERAPY WITH COMBINATION OF CALCIUM CHANNEL BLOCKERS AND BETA-BLOCKERS

    Directory of Open Access Journals (Sweden)

    M. A. Maksimova

    2013-01-01

    Full Text Available Aim. To study efficacy and safety of calcium channel blocker, S-amlodipine, in combination with β-blocker, atenolol, in patients with arterial hypertension (HT 1-2 degree com- pared to fixed combination of racemic amlodipine and atenolol.Material and methods. Patients (n=31, 7 men and 24 women with HT 1–2 degree were included into the study. The patients were randomized into two groups by the com- binations sequence. Treatment with each combination lasted 4 weeks. Office blood pressure (BP was assessed at baseline and at the end of the treatment periods, possible side effects were registered.Results. All patients completed the study. Both combination of S-amlodipine+atenolol and fixed combination of racemic amlodipine+atenolol reduced systolic (in average, -15.9 and -12.7 mm Hg, respectively and diastolic (in average, -7.3 and -5.3 mmHg, respectively BP significantly. Heart rate also decreased during therapy (in average, -3 and -4 bt/min, respectively. The differences between combinations BP and heart rate effects were not significant. 8 and 16 adverse events were registered during S-amlodipine+atenolol and racemic amlodipine+atenolol therapies, respectively Conclusion. Combination of S-amlodipine+atenolol, as well as combination of racemic amlodipine+atenolol are effective in the treatment of patients with HT 1-2 degree, however combination with S-amlodipine has less number of adverse events.

  10. Role of the sympathetic nervous system in vasovagal syncope and rationale for beta-blockers and norepinephrine transporter inhibitors

    Directory of Open Access Journals (Sweden)

    Jorge Rafael Gómez-Flores

    2016-12-01

    Full Text Available Resumen El síncope vasovagal o neurocardiogénico es una situación clínica común, y así como en otras entidades asociadas con la intolerancia ortostática, la condición de base es una disfunción del sistema nervioso autónomo. En este artículo se revisan diversos aspectos sobre el síncope vasovagal, incluyendo su relación con la intolerancia ortostática y el papel que juega el sistema nervioso autónomo. Se da una breve reseña histórica del problema, así como una descripción de la forma en que han evolucionado los términos y conceptos asociados al mismo. Se hace un análisis sobre la respuesta del sistema nervioso simpático al estrés ortostático, la fisiología del sistema barorreflejo y los cambios neurohumorales que ocurren. Se muestra evidencia sobre el papel del sistema nervioso autónomo, incluyendo estudios sobre variabilidad de la frecuencia cardiaca, microneurografía, inervación cardiaca y estudios genéticos moleculares. Finalmente, se describen diferentes estudios sobre el uso de betabloqueadores e inhibidores del transportador de noradrenalina (sibutramina, reboxetina y la justificación de su uso en la prevención de este tipo de síncope.

  11. Meta-analysis of carvedilol versus beta 1 selective beta-blockers (atenolol, bisoprolol, metoprolol, and nebivolol).

    Science.gov (United States)

    DiNicolantonio, James J; Lavie, Carl J; Fares, Hassan; Menezes, Arthur R; O'Keefe, James H

    2013-03-01

    Because carvedilol is a unique vasodilating β blocker (BB) exerting antioxidant activity and pleiotropic effects, it was theorized that it may confer more potent beneficial effects on cardiovascular mortality and morbidity in acute myocardial infarction (AMI) and heart failure (HF) settings. A systematic review and meta-analysis was performed of randomized, controlled, direct-comparison trials that included adults receiving atenolol, bisoprolol, metoprolol, nebivolol, or carvedilol to evaluate the effects of carvedilol compared to other BBs on mortality, cardiovascular events, and hospital readmissions in the setting of AMI or systolic HF. Compared to β(1)-selective BBs used in HF (8 trials, n = 4,563), carvedilol significantly reduced all-cause mortality (risk ratio 0.85, 95% confidence interval 0.78 to 0.93, p = 0.0006). In 3 trials of patients with AMI (n = 644), carvedilol significantly reduced all-cause mortality by 45% (fixed-effects model: risk ratio 0.55, 95% confidence interval 0.32 to 0.94, p = 0.03, random-effects model: risk ratio 0.56, 95% confidence interval 0.26 to 1.12, p = 0.10), with no reduction in non-fatal MI (risk ratio 0.61, 95% confidence interval 0.31 to 1.22, p = 0.16). In conclusion, carvedilol, as compared against atenolol, bisoprolol, metoprolol and nebivolol in randomized direct comparison trials, significantly reduced all-cause mortality in systolic HF patients. Additionally, carvedilol significantly reduced all-cause mortality compared with β(1)-selective BBs in AMI patients using the fixed-effects model but not using the random-effects model.

  12. EFFECTS OF BETA-BLOCKER METOPROLOL ON QUALITY OF LIFE IN ELDERLY PATIENTS WITH CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    I. V. Vologdina

    2015-12-01

    Full Text Available Aim. To study effect of cardioselective β-adrenoblocker metoprolol tartrate (in retarded formulation on quality of life in elderly patients with chronic heart failure (CHF of ischemic etiology.Material and methods. 78 patients with CHF class III (NYHA were involved in the study. Patients were 81,6±0,25 y.o. in average. All patients had clinical signs of mild-to-moderate depressive disorders. Patients were split on 2 groups comparable in sex and age. Patients of the 1st group (n=43 received metoprolol tartrate (Egilok Retard, 50-100 mg/d additionally to standard therapy. Patients of the 2nd group (n=35 received only standard therapy. The somatic status was assessed before and after 1 and 3 months of therapy by clinical condition evaluated scale (CCES, 6-minute walking test, left ventricular ejection fraction (Echocardiography as well as mental status by special tests (SMSP, BDI, Hamilton scale, C.D.Spilberger-Y.L.Hanin scale and qualities of life (MLHFQ, SF-36.Results. Reduction of CHF class from III to II was observed in 31 (76,7% patients of the 1st group and in 23 (65,7% patients of the 2nd group. Tolerability of Egilok Retard was good and there were not cessations because of side effects. In 3 months of therapy severity of the somatic status according to CCES reduced more significantly in the 1st group in comparison with the 2nd group (29,5 % vs 11,5 %, p <0,001. The exercise tolerance increased higher in the 1st group comparing with the 2nd one (34 % vs 17 %, respectively, p<0,001. The severity of depression reduced (according to SMSP, Hamilton scale more significantly in the 1st group in comparison with this in the 2nd one. Quality of life also improved more significantly in the 1st group according to MLHFQ and SF-36 (physical functions, role physical functions, social function scales at the end of therapy.Conclusion. Metoprolol tartrate (in retarded formulation improves somatic and mental status as well as quality of life in elderly patients with CHF.

  13. Enabling factors for antibiotic prescribing for upper respiratory tract infections

    DEFF Research Database (Denmark)

    Jaruseviciene, Lina; Radzeviciene Jurgute, Ruta; Bjerrum, Lars;

    2013-01-01

    . This study aimed to explore experiences of GPs in Lithuania and the Russian Federation with regard to antibiotic prescription for upper respiratory tract infections. By such means it might be possible to reveal external enabling factors that influence antibiotic prescribing in these countries. Method. Five...... focus groups were performed with 22 GPs from Lithuania and 29 GPs from the Kaliningrad Region of the Russian Federation; then, thematic analysis of data was performed. Results. Six thematic categories were identified that are related to external forces enabling antibiotic prescription: the necessity...

  14. Impact of prescribed diabatic heating on short range weather forecasts

    Science.gov (United States)

    Marx, L.; Shukla, J.

    1984-01-01

    Using the 9 layer general circulation model developed at the Goddard Laboratory for Atmospheric Sciences (GLAS), several 4 to 5 day integrations were made to assess the impact that latent heating processes (supersaturation and moist convective) have on the model forecasts. In an earlier study by Shukla (1981) it was hypothesized that because of strong interaction between dynamics and moist convection, small initial errors grow very fast and make short range forecasting difficult. The purpose of this study was to examine if prescribed heating rates can improve the forecasts for a few days.

  15. Design objectives with non-zero prescribed support displacements

    DEFF Research Database (Denmark)

    Pedersen, Pauli; Pedersen, Niels Leergaard

    2011-01-01

    When non-zero prescribed support displacements are involved in addition to design independent loads for a continuum/structure, then the objectives of minimum compliance (total elastic energy) and of maximum strength lead to different designs. This is verified by the presented sensitivities. Designs...... minimization as well as that of direct strength maximization; we choose the objective of obtaining uniform energy density and show by examples that the obtained solutions are close to fulfilling also strength maximization, with the price of increased compliance. Optimal design examples are presented...

  16. Dental students′ compliance with antibiotic prescribing guidelines for dental infections in children

    OpenAIRE

    Yee Chen Wong; Mandakini Mohan; Allan Pau

    2016-01-01

    Context: To investigate the antibiotic prescribing training received by dental students, clinical experience in treating child patients, awareness of antibiotic prescribing guidelines, preparedness in antibiotic prescribing, and compliance with antibiotic prescribing guidelines for the management of dental infections in children. Methods: This was a cross-sectional study involving final year dentals students from Malaysian and Asian dental schools. A self-administered questionnaire consisting...

  17. Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections

    DEFF Research Database (Denmark)

    Malo, Sara; Bjerrum, Lars; Feja, Cristina;

    2015-01-01

    , and adherence to recommendations for antibiotic prescribing was assessed. One third of patients with a RTI were prescribed an antibiotic, with young adults (aged 15-64 years) being the most treated. High prescribing rates were observed in patients with acute otitis, sinusitis and acute tonsillitis (about 70...

  18. The Great Boundary Crossing: Perceptions on Training Pharmacists as Supplementary Prescribers in the UK

    Science.gov (United States)

    Tann, Jennifer; Blenkinsopp, Alison; Grime, Janet; Evans, Amanda

    2010-01-01

    Objective: To explore the perceptions of General Medical Practitioners and pharmacist supplementary prescribers of the training provided for qualification as a pharmacist supplementary prescriber, and the experience of pharmacist supplementary prescribers of subsequent continuing professional development in practice. Design: A qualitative study of…

  19. Evaluation of prescribing indicators in prescriptions of private practitioners in Kolkata, India

    Directory of Open Access Journals (Sweden)

    Pragnadyuti Mandal

    2015-10-01

    Conclusion: Poly-pharmacy, lack of generic prescribing, low rate of prescriptions from EDL is the present prescribing scenario of private set-up based practitioners of Kolkata. Regulation and intervention is required to improve the irrational prescribing practices. [Int J Basic Clin Pharmacol 2015; 4(5.000: 919-923

  20. Timing of Administration: For Commonly-Prescribed Medicines in Australia

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    Gagandeep Kaur

    2016-04-01

    Full Text Available Chronotherapy involves the administration of medication in coordination with the body’s circadian rhythms to maximise therapeutic effectiveness and minimise/avoid adverse effects. The aim of this study is to investigate the “time of administration” recommendations on chronotherapy for commonly-prescribed medicines in Australia. This study also aimed to explore the quality of information on the timing of administration presented in drug information sources, such as consumer medicine information (CMI and approved product information (PI. Databases were searched for original research studies reporting on the impact of “time of administration” of the 30 most commonly-prescribed medicines in Australia for 2014. Further, time of administration recommendations from drug information sources were compared to the evidence from chronotherapy trials. Our search revealed 27 research studies, matching the inclusion and exclusion criteria. In 56% (n = 15 of the research studies, the therapeutic effect of the medicine varied with the time of administration, i.e., supported chronotherapy. For some medicines (e.g., simvastatin, circadian-based optimal administration time was evident in the information sources. Overall, dedicated studies on the timing of administration of medicines are sparse, and more studies are required. As it stands, information provision to consumers and health professionals about the optimal “time” to take medications lags behind emerging evidence.

  1. [Prescribing drugs to patients receiving out-patient care].

    Science.gov (United States)

    Garjón Parra, F J

    2009-01-01

    Drug prescription has evolved to deal mainly with chronic diseases. Nowadays, repeating prescriptions using computers results in problems if this is not done with adequate control. Steps proposed for appropriate prescription are: defining the problem; specifying the objective; selecting the drug; initiating therapy with appropriate details; giving information; regular evaluation; considering cost; and using tools to reduce errors. Published recommendations for prescription, which have focused on elderly patients, include: avoiding polypharmacy; carrying out a regular medication review; stopping any current drugs that are not indicated and prescribing new drugs that have a clear indication; avoiding drugs that have deleterious effects; using dosages that are suitable for the age and renal function; using simple drug regimes and appropriate administration systems; considering non-pharmacological treatments; limiting the number of practitioners prescribing for each patient; and avoiding treating adverse drug reactions with further drugs. Examples of compliance with those recommendations in the Navarre Health Service, extracted from the prescription information system, are provided. The measures for improving prescription are: education, auditing, collaboration between health professionals and use of electronic tools.

  2. Prescribing trends for dabigatran etexilate in primary care.

    LENUS (Irish Health Repository)

    McCullagh, L

    2012-05-01

    At the time of the analysis, dabigatran etexilate was licensed, in Ireland, for thromboprophylaxis in adults after elective total hip- and total knee-replacement only. A retrospective review (January 2010 to June 2011) of the National General Medical Services Prescription Database showed that 1929 patients had received prescriptions for dabigatran etexilate. Of these, 42% had received it for longer than the licensed maximum duration (at that time) of 35 days. The Eastern Health board dabigatran etexilate cohort (n = 510) was analysed further. Here 64.5% had received the drug for longer than 35 days. Seventy-six (32.5%) of the 234 patients who had received more than 90 days of dabigatran etexilate had concurrently received rate\\/rhythm control therapy. Likewise, 47 (31%) of the 152 patients who had received more than 180 days of dabigatran etexilate had been co-prescribed rate\\/rhythm control therapy. It is possible that dabigatran etexilate had been prescribed for stroke prevention in atrial fibrillation.

  3. Association between obesity and prescribed medication use in England.

    Science.gov (United States)

    Kinge, Jonas Minet; Morris, Stephen

    2014-12-01

    We investigate the association between obesity and use of prescribed medications in England. Data were taken from fourteen rounds of the Health Survey for England (1999-2012), which has measures of current prescribed medication use based on therapeutic classifications in the British National Formulary, and nurse-measured height and weight. We find that obesity has a statistically significant and positive association with use of a range of medicines for managing diseases associated with obesity. The mean probability of using any type of medication is 0.40 in those of normal weight, 0.44 in the overweight, 0.52 in obesity class I and 0.60 in obesity class II/III. Significant positive associations were found between obesity and the use of medication for diseases of the cardiovascular system, gastrointestinal system, respiratory system, and central nervous system, as well as for infections, endocrine system disorders, gynaecological/urinary disorders and musculoskeletal and joint disorders. Use of anti-obesity medication is low, even among those with class II/III obesity.

  4. La estructura resistente en la arquitectura actual

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    Manterola Armisén, J.

    1998-10-01

    Full Text Available A significant portion in nowadays architecture uses the resistant structures as a fundamental element conveying expression to a building. Resistant structures usually designed, calculated and built by engineers are in some occasions -those that draw our attention now- designed by architects who stress the plastic dimension. Sometimes architects have just tried to soften the elementality of the resistance per se. To abandon the quantitative element to get centered in the qualitative and expressive is a leitmotiv in the architectural proceedings that has been brilliantly fruitful in many an occasion -notice Frei Otto's work among others- but that, in other cases, damages the understanding of the resistant aspect by excessively priorizing the structure appearance upon the structure itself. This article makes a critical account of a series of structures in recent buildings, classified by resistance typologies, flat or spatial trusses, frames, domes, hanging and distensible roofs, tensigrity structures, etc., preceded by a retrospect on how resistance has been traditionally understood.

    Una parte de la arquitectura actual se caracteriza por utilizar la estructura resistente como el elemento expresivo fundamental del edificio. Las estructuras resistentes, diseñadas, calculadas y construidas hasta ahora por ingenieros, han pasado, en algunas ocasiones -las que aquí nos interesan-, a ser diseñadas por arquitectos que acentúan su dimensión plástica. En otras ocasiones los arquitectos se han reducido a dulcificar la elementalidad de lo resistente en cuanto tal. El abandono de lo cuantitativo, para centrarse en lo cualitativo y expresivo, es el "leit motiv" de ese proceder arquitectónico que ha dado frutos muy brillantes en bastantes ocasiones, no hay sino que ver el trabajo de Frei Otto y otros, pero que, en otros casos, perjudican el entendimiento de lo resistente al primar, excesivamente, la apariencia de estructura sobre lo que es la

  5. Validity of the Prescriber Information in the Danish National Prescription Registry

    DEFF Research Database (Denmark)

    Rasmussen, Lotte; Valentin, Julie; Gesser, Katarina Margareta

    2016-01-01

    in the DNPR. Further, the problem of validity of the prescriber information pertains only to non-electronic prescriptions, as these are manually entered into the dispensing system. The recorded prescriber information was thus validated against information from a total of 2,000 non-electronic prescriptions.......6-24.3) when considering individual prescriber identifiers and 17.8% (95% CI: 16.1-19.5) when considering prescriber type. When excluding prescriptions specifically registered as 'missing prescriber identifier', the proportions decreased to 9.5% (95% CI: 8.2-11.0) and 4.1% (95% CI: 3.2-5.1), respectively...

  6. An overiew of non medical prescribing across one strategic health authority: a questionnaire survey

    Directory of Open Access Journals (Sweden)

    Courtenay Molly

    2012-06-01

    Full Text Available Abstract Background Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP has been implemented within organisations across a strategic health authority (SHA. The aim of the study was to provide an overview of NMP across one SHA. Methods NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7% participants responded. Data was collected between November 2010 and February 2011. Results The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6% compared to community practitioner prescribers (198 or 22.4%, pharmacist independent supplementary prescribers (35 or 4%, and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%. Nearly all (over 90% of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p  Conclusion NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and

  7. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    LENUS (Irish Health Repository)

    Ryan, Cristín

    2009-12-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

  8. Airborne characterization of smoke marker ratios from prescribed burning

    Science.gov (United States)

    Sullivan, A. P.; May, A. A.; Lee, T.; McMeeking, G. R.; Kreidenweis, S. M.; Akagi, S. K.; Yokelson, R. J.; Urbanski, S. P.; Collett, J. L., Jr.

    2014-10-01

    A Particle-Into-Liquid Sampler - Total Organic Carbon (PILS-TOC) and fraction collector system was flown aboard a Twin Otter aircraft sampling prescribed burning emissions in South Carolina in November 2011 to obtain smoke marker measurements. The fraction collector provided 2 min time-integrated offline samples for carbohydrate (i.e., smoke markers levoglucosan, mannosan, and galactosan) analysis by high-performance anion-exchange chromatography with pulsed amperometric detection. Each fire location appeared to have a unique Δlevoglucosan/Δwater-soluble organic carbon (WSOC) ratio (RF01/RF02/RF03/RF05 = 0.163 ± 0.007 μg C μg-1 C, RF08 = 0.115 ± 0.011 μg C μg-1 C, RF09A = 0.072 ± 0.028 μg C μg-1 C, and RF09B = 0.042 ± 0.008 μg C μg-1 C, where RF means research flight). These ratios were comparable to those obtained from controlled laboratory burns and suggested that the emissions sampled during RF01/F02/RF03/RF05 were dominated by the burning of grasses, RF08 by leaves, RF09A by needles, and RF09B by marsh grasses. These findings were further supported by the Δgalactosan/Δlevoglucosan ratios (RF01/RF02/RF03/RF05 = 0.067 ± 0.004 μg μg-1, RF08 = 0.085 ± 0.009 μg μg-1, and RF09A = 0.101 ± 0.029 μg μg-1) obtained as well as by the ground-based fuel and filter sample analyses during RF01/RF02/RF03/RF05. Differences between Δpotassium/Δlevoglucosan ratios obtained for these prescribed fires vs. laboratory-scale measurements suggest that some laboratory burns may not accurately represent potassium emissions from prescribed burns. The Δlevoglucosan/ΔWSOC ratio had no clear dependence on smoke age or fire dynamics suggesting that this ratio is more dependent on the type of fuel being burned. Levoglucosan was stable over a timescale of at least 1.5 h and could be useful to help estimate the air quality impacts of biomass burning.

  9. Potentially inappropriate prescribing in older primary care patients.

    Directory of Open Access Journals (Sweden)

    Sandra Vezmar Kovačević

    Full Text Available OBJECTIVES: The aim of the study was to determine the rate of Potentially Inappropriate Medicines (PIM and Potential Prescription Omissions (PPO according to Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START criteria. STUDY DESIGN: A cross-sectional survey in community pharmacy. METHOD: A prospective cross-sectional study was performed, during March-May 2012, in five community pharmacies. Patients aged ≥65 years, who collected one or more prescribed medications, were asked to participate in the study, and an interview was scheduled. Patients were asked to provide their complete medical and biochemical record from their general practitioner. RESULTS: 509 patients, mean age 74.8±6.5 years, 57.4% female, participated in the study. 164 PIM were identified in 139 patients (27.3%. The most common were: long-term use of long-acting benzodiazepines (20.7%, use of non-steroidal antiinflammatory drugs (NSAID in patients with moderate-severe hypertension (20.1%, use of theophylline as monotherapy for chronic obstructive pulmonary disease (COPD, 15.9% and use of aspirin without appropriate indication (15.2%. Patients with more than four prescpritions had a higher risk for PIM (OR 2.85, 95% CI 1.97-4.14, p<0.001. There were 439 PPO, identified in 257, (50.5% patients. Predictors for PPO were older age, presence of diabetes, myocardial infarction, osteoporosis, stroke, COPD and/or angina pectoris. CONCLUSION: STOPP/START criteria may be useful in identifying inappropriate prescribing and improving the current prescribing practices. Pharmacists should focus more on patients with more than four medications and/or patients with gout or pain accompanied with arterial hypertension because those patient may be at higher risk of PIM. Additionlly, patients older than 74 years with diabetes, osteoporosis, myocardial infarction, stroke, angina pectoris and/or COPD may have an

  10. Airborne characterization of smoke marker ratios from prescribed burning

    Directory of Open Access Journals (Sweden)

    A. P. Sullivan

    2014-05-01

    Full Text Available A Particle-into-Liquid Sampler – Total Organic Carbon and fraction collector system was flown aboard aTwin Otter aircraft sampling prescribed burning emissions in South Carolina in November2011 to obtain smoke marker measurements. The fraction collector provided 2 min time-integrated off-line samples for carbohydrate (i.e., smoke markers levoglucosan, mannosan, galactosan analysis by high-performance anion-exchange chromatography with pulsed amperometric detection. Each fire location appeared to have aunique Δ levoglucosan / Δ water-soluble organic carbon (WSOC ratio (RF01/RF02/RF03/RF05 = 0.163 ± 0.007 μg C μg C−1, RF08 = 0.115 ± 0.011 μg C μg C−1, RF09A = 0.072 ± 0.028 μg C μg C−1, RF09B = 0.042 ± 0.008 μg C μg C−1. These ratios were comparable to those obtained from controlled laboratory burns and suggested that the emissions sampled during RF01/RF02/RF03/RF05 were dominated by the burning of grasses, RF08 by leaves, RF09A by needles, and RF09B by marsh grasses. These findings were further supported by the Δ galactosan / Δ levoglucosan ratios (RF01/RF02/RF03/RF05 = 0.067 ± 0.004 μg μg−1, RF08 = 0.085 ± 0.009 μg μg−1, RF09A = 0.101 ± 0.029 μg μg−1 obtained as well as by the ground-based fuel and filter sample analyses during RF01/RF02/RF03/RF05. Differences between Δ potassium / Δ levoglucosan ratios obtained for these prescribed fires vs. laboratory-scale measurements suggest that some laboratory burns may not accurately represent potassium emissions from prescribed burns. The Δ levoglucosan / Δ WSOC ratio had no clear dependence on smoke age or fire dynamics suggesting that this ratio is more dependent on the type of fuel being burned. Levoglucosan was stable over a timescale of at least 1.5 h and could be useful to help estimate the air quality impacts of biomass burning.

  11. An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland.

    LENUS (Irish Health Repository)

    Naughton, Corina

    2012-09-19

    AIM: To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice. BACKGROUND: The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain. DESIGN: A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients\\' records and 208 medications prescribed by 25 Registered Nurse Prescribers. METHODS: Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen\\'s kappa statistic (inter-rater reliability). RESULTS: Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)-80% (reviewer 1) of prescribing decisions met all eight criteria. CONCLUSION: The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.

  12. Evaluation of prescribing pattern of the private practitioners by the undergraduate medical students

    Directory of Open Access Journals (Sweden)

    Zaida Rahman

    2009-03-01

    Full Text Available To sensitize the fourth year undergraduate medical students about rational prescribing, 600 prescriptions of private practitioners were collected by them and analyzed using WHO/INRUD indicators. There were average 3.81 drugs per prescriptions. Drugs were prescribed in generic name only in 5 prescriptions. About 50% drugs were prescribed from the Essential Drug List; only 17.5% of prescriptions were complete in respect to patient medical information. Antibiotics were prescribed in 72.5% of the prescriptions; injections were prescribed in about 12.1% of the prescriptions. Although the exercise revealed few elementary aspects of the prescribing, the medical students participated in the exercise enthusiastically and perhaps understood the issues related to rational prescribing effectively.

  13. DRUG UTILIZATION STUDY OF PSYCHOTROPIC DRUGS PRESCRIBED IN PSYCHIATRY OPD OF L. N. MEDICAL COLLEGE ASSOCIATED J. K. HOSPITAL, BHOPAL DISTRICT, MADHYA PRADESH

    Directory of Open Access Journals (Sweden)

    Richa

    2016-06-01

    Full Text Available BACKGROUND Utilization pattern of drugs varies from place to place and is influenced by differing patient characteristics, type of disease prevalent, cultural and environmental influences, socioeconomic states, availability of newer drugs and prescribing habit of physicians. Psychiatric disorders are one of the major causes of morbidity. Development of newer drugs like SSRIs and atypical antipsychotics has altered the treatment paradigms. Various factors like cost of drugs, local paradigms, etc. play a role in the selection of drug therapy and hence affect the outcome. Keeping this in mind, we conducted a study to delineate the various drugs used in psychiatric disorders. Psychotropic drugs have had a remarkable impact in psychiatric practice. However, their utilization in actual clinical practice, effectiveness and safety in real life situation needs continuous studies. So our aim to study the prevalence of psychiatric morbidity and analyse drug prescribing pattern in various psychiatric illnesses. METHODOLOGY A prospective cross sectional study was carried out for 6 months (Dec. 2014 - May. 2015 in psychiatry OPD of L. N. Medical College, Bhopal. Patients of all ages and both sexes were included in the study and 600 prescriptions were randomly selected. RESULT Antipsychotic drugs (75.33% were most frequently prescribed psychotropic drugs in various psychiatric disorders followed by Anti-Depressants (48.33% and Anxiolytics (26%. CONCLUSION This study shows that antipsychotics are the most common antipsychotic drugs prescribed in patients with psychotic illness. Depression is the most common disease. Prescription rate was higher in men between 21-40 yrs. age

  14. Evaluation of trends of drug-prescribing patterns based on WHO prescribing indicators at outpatient departments of four hospitals in southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Summoro TS

    2015-08-01

    Full Text Available Temesgen Sidamo Summoro,1 Kassa Daka Gidebo,2 Zewde Zemma Kanche,1 Eskinder Wolka Woticha2 1School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Background: Rational prescribing is a primary step to ensure rational drug use. Often, half of the medicines are prescribed irrationally and half of these are even used incorrectly as the patients fail to take their medicines appropriately. The aim of this research was to evaluate drug-prescribing patterns of four hospitals in southern Ethiopia.Methods: A retrospective cross-sectional study was conducted between May 15 and June 25, 2014, to evaluate the drug-prescribing patterns based on the World health Organization (WHO prescribing indicators. The prescription papers, kept for the last 1 year in the outpatient departments of the four hospitals, were analyzed according to WHO guidelines. Also, prescriptions in the hospitals were analyzed to determine the most frequently prescribed drugs. All the statistical calculations were performed using SPSS® version 20.0 software.Results and discussion: The average number of drugs per prescription ranges from 1.82±0.90 to 2.28±0.90, whereas the percentage of use of antibiotics and injections ranged from 46.7 to 85 and 15 to 61.7, respectively. The average percentages of drugs prescribed by generic name and from the essential drugs list were 95.8 and 94.1, respectively. Anti-infective and analgesic drugs are found to be the most frequently prescribed medicines. In terms of polypharmacy, there was a slight deviation in prescribing patterns from what is acceptable according to the WHO criteria. Prescribing by generic name and from essential drug list was almost optimal. There was a significant deviation in the use of injectables in two of the four hospitals (50%, whereas their use in the other

  15. Consequences of Predicted or Actual Asteroid Impacts

    Science.gov (United States)

    Chapman, C. R.

    2003-12-01

    Earth impact by an asteroid could have enormous physical and environmental consequences. Impactors larger than 2 km diameter could be so destructive as to threaten civilization. Since such events greatly exceed any other natural or man-made catastrophe, much extrapolation is necessary just to understand environmental implications (e.g. sudden global cooling, tsunami magnitude, toxic effects). Responses of vital elements of the ecosystem (e.g. agriculture) and of human society to such an impact are conjectural. For instance, response to the Blackout of 2003 was restrained, but response to 9/11 terrorism was arguably exaggerated and dysfunctional; would society be fragile or robust in the face of global catastrophe? Even small impacts, or predictions of impacts (accurate or faulty), could generate disproportionate responses, especially if news media reports are hyped or inaccurate or if responsible entities (e.g. military organizations in regions of conflict) are inadequately aware of the phenomenology of small impacts. Asteroid impact is the one geophysical hazard of high potential consequence with which we, fortunately, have essentially no historical experience. It is thus important that decision makers familiarize themselves with the hazard and that society (perhaps using a formal procedure, like a National Academy of Sciences study) evaluate the priority of addressing the hazard by (a) further telescopic searches for dangerous but still-undiscovered asteroids and (b) development of mitigation strategies (including deflection of an oncoming asteroid and on- Earth civil defense). I exemplify these issues by discussing several representative cases that span the range of parameters. Many of the specific physical consequences of impact involve effects like those of other geophysical disasters (flood, fire, earthquake, etc.), but the psychological and sociological aspects of predicted and actual impacts are distinctive. Standard economic cost/benefit analyses may not

  16. Validity of the Prescriber Information in the Danish National Prescription Registry.

    Science.gov (United States)

    Rasmussen, Lotte; Valentin, Julie; Gesser, Katarina Margareta; Hallas, Jesper; Pottegård, Anton

    2016-10-01

    The aim of this study was to measure the validity of the prescriber information recorded in the Danish National Prescription Registry (DNPR). The prescriber information recorded in the pharmacies' electronic dispensing system was considered to represent the prescriber information recorded in the DNPR. Further, the problem of validity of the prescriber information pertains only to non-electronic prescriptions, as these are manually entered into the dispensing system. The recorded prescriber information was thus validated against information from a total of 2000 non-electronic prescriptions at five Danish community pharmacies. The validity of the recorded prescriber information was measured at the level of the individual prescriber and the prescriber type, respectively. The proportion of non-electronic prescriptions with incorrect registrations was 22.4% (95% confidence interval (CI): 20.6-24.3) when considering individual prescriber identifiers and 17.8% (95% CI: 16.1-19.5) when considering prescriber type. When excluding prescriptions specifically registered as 'missing prescriber identifier', the proportions decreased to 9.5% (95% CI: 8.2-11.0) and 4.1% (95% CI: 3.2-5.1), respectively. The positive predictive values for the classification of prescriber types were in the range of 94.0-99.2%, while the sensitivity ranged between 64.6% and 91.8%. With a maximum of 14% non-electronic prescriptions of all prescriptions in the DNPR in 2015, this corresponds to correct classification of prescriber types in the DNPR of at least 97.5%. In conclusion, the prescriber information in the DNPR was found to be valid, especially in recent years. Researchers should be aware of the low sensitivity towards prescriptions from private practicing specialists.

  17. Special Needs to Prescribe Exercise Intensity for Scientific Studies

    Directory of Open Access Journals (Sweden)

    Peter Hofmann

    2011-01-01

    exercise training. A wide range of intensities is used to prescribe exercise, but this approach is limited. Usually percentages of maximal oxygen uptake (VO2 or heart rate (HR are applied to set exercise training intensity but this approach yields substantially variable metabolic and cardiocirculatory responses. Heterogeneous acute responses and training effects are explained by the nonuniform heart rate performance curve during incremental exercise which significantly alters the calculations of %HRmax and %HRR target HR data. Similar limitations hold true for using %VO2max and %VO2R. The solution of these shortcomings is to strictly apply objective submaximal markers such as thresholds or turn points and to tailor exercise training within defined regions.

  18. Secular trends in opioid prescribing in the USA

    Science.gov (United States)

    Pezalla, Edmund J; Rosen, David; Erensen, Jennifer G; Haddox, J David; Mayne, Tracy J

    2017-01-01

    Opioid abuse and misuse in the USA is a public health crisis. The use of prescription opioid analgesics increased substantially from 2002 through 2010, then plateaued and began to decrease in 2011. This study examined prescriptions of branded and generic immediate- and extended-release opioid analgesics from 1992 to 2016. This was juxtaposed against state and federal policies designed to decrease overutilization and abuse, as well as the launch of new opioid products, including opioids with abuse-deterrent properties (OADPs). The data indicate that these health policies, including the utilization and reimbursement of OADPs, have coincided with decreased opioid utilization. The hypothesis that OADPs will paradoxically increase opioid prescribing is not supported. PMID:28243142

  19. Secular trends in opioid prescribing in the USA.

    Science.gov (United States)

    Pezalla, Edmund J; Rosen, David; Erensen, Jennifer G; Haddox, J David; Mayne, Tracy J

    2017-01-01

    Opioid abuse and misuse in the USA is a public health crisis. The use of prescription opioid analgesics increased substantially from 2002 through 2010, then plateaued and began to decrease in 2011. This study examined prescriptions of branded and generic immediate- and extended-release opioid analgesics from 1992 to 2016. This was juxtaposed against state and federal policies designed to decrease overutilization and abuse, as well as the launch of new opioid products, including opioids with abuse-deterrent properties (OADPs). The data indicate that these health policies, including the utilization and reimbursement of OADPs, have coincided with decreased opioid utilization. The hypothesis that OADPs will paradoxically increase opioid prescribing is not supported.

  20. Design of Ultraspherical Window Functions with Prescribed Spectral Characteristics

    Directory of Open Access Journals (Sweden)

    Stuart W. A. Bergen

    2004-10-01

    Full Text Available A method for the design of ultraspherical window functions that achieves prescribed spectral characteristics is proposed. The method comprises a collection of techniques that can be used to determine the three independent parameters of the ultraspherical window such that a specified ripple ratio and main-lobe width or null-to-null width along with a user-defined side-lobe pattern can be achieved. Other known two-parameter windows can achieve a specified ripple ratio and main-lobe width; however, their side-lobe pattern cannot be controlled as in the proposed method. A comparison with other windows has shown that a difference in performance exists between the ultraspherical and Kaiser windows, which depends critically on the required specifications. The paper also highlights some applications of the proposed method in the areas of digital beamforming and image processing.

  1. Prescribing errors in a Brazilian neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Ana Paula Cezar Machado

    2015-12-01

    Full Text Available Abstract Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU, are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems.

  2. Nursing process: from literature to practice. What are we actually doing?

    Directory of Open Access Journals (Sweden)

    Simoni Pokorski

    Full Text Available OBJECTIVES: To describe the steps of the nursing process as prescribed in the literature and to investigate the process as actually applied in the daily routine of a general hospital. METHODS: Cross-sectional retrospective study (May/June 2005, performed in a hospital in Porto Alegre, RS. Medical records of adult patients admitted to a surgical, clinical or intensive care unit were reviewed to identify the nursing process steps accomplished during the first 48h after admission. The form for data collection was structured according to other reports. RESULTS: 302 medical records were evaluated. Nursing records and physical examination were included in over 90% of them. Nursing diagnosis was not found in any of the records. Among the steps performed, prescription was the least frequent. Evolution of the case was described in over 95% of the records. CONCLUSIONS: All nursing steps recommended in the literature, except for diagnosis, are performed in the research institution.

  3. A practical guide for prescribing birth control pills.

    Science.gov (United States)

    Abrams, J

    1994-06-01

    More than 50 million US women have used oral contraceptives (OCs) in the past 25 years, and the consensus is that the benefits and advantages of OC use outweigh most of the disadvantages. Side effects have been reduced or eliminated by reduced dosage preparations, and effectiveness has been virtually 100%. Despite this widespread use, most US women are misinformed about OCs, perhaps because pediatricians, family physicians, and nurse-practitioners are insufficiently informed. The economic power of the drug manufacturers has been brought to bear on the medical profession to prescribe OCs for virtually every woman of child-bearing age. The drug industry which has been touting the safety of OCs has recently introduced new progestins which are supposed to be "lipid-neutral" and have fewer androgenic effects. Therefore, the potentially harmful effects of the old progestins were deemphasized deliberately. A cautious but advisable approach for physicians to follow in prescribing OCs has 8 points. 1) All sexually active females should be advised that barrier contraception is the best protection (except abstinence) from sexually transmitted diseases, including AIDS. 2) OCs with more than 35 mcg estrogen should be withdrawn from the market. 3) All patients should be encouraged to lead a healthy lifestyle. 4) Barrier methods should be encouraged for patients with such medical conditions as migraine headaches, prominent varicose veins, diabetes, increasing weight gain, hypertension, thyroid dysfunction, and mitral valve prolapse. 5) Switching to a preparation with the new progestins should be considered for some patients who are smokers or have abnormal lipid profiles. 6) It might be advantageous under certain circumstances for a patient to discontinue OC use for a period of time. 7) Women who no longer desire a pregnancy should be encouraged to consider surgical sterilization. 8) Nulliparous women over 30 years old should discontinue OC use to diminish their risk of breast

  4. Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing

    Directory of Open Access Journals (Sweden)

    John H. Burton

    2016-05-01

    Full Text Available Introduction: Addressing pain is a crucial aspect of emergency medicine. Prescription opioids are commonly prescribed for moderate to severe pain in the emergency department (ED; unfortunately, prescribing practices are variable. High variability of opioid prescribing decisions suggests a lack of consensus and an opportunity to improve care. This quality improvement (QI initiative aimed to reduce variability in ED opioid analgesic prescribing. Methods: We evaluated the impact of a three-part QI initiative on ED opioid prescribing by physicians at seven sites. Stage 1: Retrospective baseline period (nine months. Stage 2: Physicians were informed that opioid prescribing information would be prospectively collected and feedback on their prescribing and that of the group would be shared at the end of the stage (three months. Stage 3: After physicians received their individual opioid prescribing data with blinded comparison to the group means (from Stage 2 they were informed that individual prescribing data would be unblinded and shared with the group after three months. The primary outcome was variability of the standard error of the mean and standard deviation of the opioid prescribing rate (defined as number of patients discharged with an opioid divided by total number of discharges for each provider. Secondary observations included mean quantity of pills per opioid prescription, and overall frequency of opioid prescribing. Results: The study group included 47 physicians with 149,884 ED patient encounters. The variability in prescribing decreased through each stage of the initiative as represented by the distributions for the opioid prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction, p<0.01, and Stage 3 mean 8% (60% reduction, p<0.01. The mean quantity of pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage 2 (18% reduction, p<0.01, and 13 pills in Stage 3 (18% reduction, p<0.01. The group mean

  5. Cognition-Enhancing Drugs and Their Appropriateness for Aviation and Ground Troops: A Meta-Analysis

    Science.gov (United States)

    2010-12-01

    treating ADD and narcolepsy. The effects of methylphenidate in healthy populations are promising; however, its potential for abuse is high, given its...limited to, beta- blockers, typically prescribed for cardiac arrhythmia; methylphenidate , prescribed attention- deficit disorder (ADD); modafinil, a wake...Pharmaceuticals that enhance attention (e.g., methylphenidate ) are becoming increasingly popular among students as study aids on college campuses across the

  6. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists.

    LENUS (Irish Health Repository)

    Lockwood, Emily B

    2008-10-01

    AIM: Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. BACKGROUND: The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. METHOD: A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study. RESULTS AND CONCLUSIONS: Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. IMPLICATIONS FOR NURSING MANAGEMENT: While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers

  7. Views on nurse prescribing: a survey of community mental health nurses in the Republic of Ireland.

    Science.gov (United States)

    Wells, J; Bergin, M; Gooney, M; Jones, A

    2009-02-01

    A nurse prescribing scheme has recently been implemented within the Republic of Ireland. This paper reports on the views of community mental health nurses on nurse prescribing just prior to the implementation of the scheme. Data were gathered through a 13-item questionnaire administered to 103 members of the Association of Community Mental Health Nurses in Ireland. Results indicated a distinct difference of view between male and female community mental health nurses, with female nurses having greater reservations towards the desirability of nurse prescribing in relation to educational preparation and impact on professional relationships. Overall, only 17% of respondents favoured being supervised in their prescribing practice by their consultant psychiatrist. The paper concludes that there is ambivalence towards prescribing in this important group of nurses which may need to be taken into account if nurse prescribing is to be successfully implemented within the Irish mental health service context.

  8. Comparisons of anti-diabetic prescriptions of private practitioners and hospital prescribers: A survey

    Directory of Open Access Journals (Sweden)

    Ananya Mandal

    2013-01-01

    Full Text Available Monotherapy as well as effective and safe combination therapy for diabetes is practiced widely by both private and government hospital prescribers. This study attempted to compare the prescriptions of government and private practitioners to obtain a fair idea of the trends of diabetes management in either group. Prescriptions for diabetic patients from both private practitioners and government medical college prescribers were collected. These were analyzed for parameters such as number and type of drugs, cost, and generic prescription. Private prescribers were not significantly different from hospital prescribers in terms of number of drugs per prescription, cost of therapy, and treatment regimens. However, there was a dearth of generic prescriptions from private consultants (33% vs. 9%. Metformin and Glimepiride were the most prescribed drugs in both groups. However, private practitioners preferred Gliclazide, Glipizide, and Glibenclamide more than hospital prescribers.

  9. Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland.

    LENUS (Irish Health Repository)

    Ryan, C

    2009-08-01

    Elderly patients are particularly vulnerable to inappropriate prescribing, with increased risk of adverse drug reactions and consequently higher rates of morbidity and mortality. A large proportion of inappropriate prescribing is preventable by adherence to prescribing guidelines, suitable monitoring and regular medication review. As a result, screening tools have been developed to help clinicians improve their prescribing.

  10. Stakeholders' views on granting prescribing authority to pharmacists in Nigeria: a qualitative study.

    Science.gov (United States)

    Auta, Asa; Strickland-Hodge, Barry; Maz, Julia

    2016-08-01

    Background In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines to patients. Patients' access to prescription medicines can be seriously affected by the shortage of prescribers leading to longer waiting times in hospitals. Objective This research was carried out to investigate stakeholders' views on granting prescribing authority to pharmacists in Nigeria. Setting The study was conducted in Nigeria. Methods Qualitative, semi-structured interviews were conducted with 43 Nigerian stakeholders including policymakers, pharmacists, doctors and patient group representatives. Transcribed interviews were entered into the QSR NVivo 10 software and analysed using a thematic approach. Main outcome measure Stakeholders' perception on the granting of prescribing authority to pharmacists in Nigeria. Results Three major themes emerged from the interviews: (1) prescribing as a logical role for pharmacists, (2) pharmacist prescribing- an opportunity or a threat and (3) the potential barriers to pharmacist prescribing. Many non-medical stakeholders including pharmacists and patient group representatives supported an extended role for pharmacists in prescribing while the majority of medical doctors including those in policy making were reluctant to do so. Generally, all stakeholders perceived that pharmacist prescribing represents an opportunity to increase patients' access to medicines, reduce doctors' workload and promote the utilisation of pharmacists' skills. However, many stakeholders including pharmacists and doctors commonly identified pharmacists' inadequate skills in diagnosis, medical resistance and shortage of pharmacists as potential barriers to the introduction of pharmacist prescribing in Nigeria. Conclusion The present study showed a split of opinion between participants who were medical doctors and those who were non-doctors in their support for pharmacist prescribing. However, all

  11. Fermion N-representability for prescribed density and paramagnetic current density

    OpenAIRE

    Tellgren, Erik I; Kvaal, Simen; Helgaker, Trygve

    2014-01-01

    The $N$-representability problem is the problem of determining whether or not there exists $N$-particle states with some prescribed property. Here we report an affirmative solution to the fermion $N$-representability problem when both the density and paramagnetic current density are prescribed. This problem arises in current-density functional theory and is a generalization of the well-studied corresponding problem (only the density prescribed) in density functional theory. Given any density ...

  12. Potentially inappropriate prescribing and cost outcomes for older people: a national population study.

    LENUS (Irish Health Repository)

    Cahir, Caitriona

    2010-05-01

    Optimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP.

  13. Rewiring dynamical networks with prescribed degree distribution for enhancing synchronizability.

    Science.gov (United States)

    Dadashi, Majid; Barjasteh, Iman; Jalili, Mahdi

    2010-12-01

    In this paper, we present an algorithm for enhancing synchronizability of dynamical networks with prescribed degree distribution. The algorithm takes an unweighted and undirected network as input and outputs a network with the same node-degree distribution and enhanced synchronization properties. The rewirings are based on the properties of the Laplacian of the connection graph, i.e., the eigenvectors corresponding to the second smallest and the largest eigenvalues of the Laplacian. A term proportional to the eigenvectors is adopted to choose potential edges for rewiring, provided that the node-degree distribution is preserved. The algorithm can be implemented on networks of any sizes as long as their eigenvalues and eigenvectors can be calculated with standard algorithms. The effectiveness of the proposed algorithm in enhancing the network synchronizability is revealed by numerical simulation on a number of sample networks including scale-free, Watts-Strogatz, and Erdős-Rényi graphs. Furthermore, a number of network's structural parameters such as node betweenness centrality, edge betweenness centrality, average path length, clustering coefficient, and degree assortativity are tracked as a function of optimization steps.

  14. Secular trends in opioid prescribing in the USA

    Directory of Open Access Journals (Sweden)

    Pezalla EJ

    2017-02-01

    Full Text Available Edmund J Pezalla,1 David Rosen,2 Jennifer G Erensen,2 J David Haddox,2,3 Tracy J Mayne2 1Bioconsult, LLC, Wethersfield, 2Purdue Pharma L.P., Stamford, CT, 3Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA Abstract: Opioid abuse and misuse in the USA is a public health crisis. The use of prescription opioid analgesics increased substantially from 2002 through 2010, then plateaued and began to decrease in 2011. This study examined prescriptions of branded and generic immediate- and extended-release opioid analgesics from 1992 to 2016. This was juxtaposed against state and federal policies designed to decrease overutilization and abuse, as well as the launch of new opioid products, including opioids with abuse-deterrent properties (OADPs. The data indicate that these health policies, including the utilization and reimbursement of OADPs, have coincided with decreased opioid utilization. The hypothesis that OADPs will paradoxically increase opioid prescribing is not supported. Keywords: OADP, prescription, utilization trends, legislation, opioids

  15. Information Rx: prescribing good consumerism and responsible citizenship.

    Science.gov (United States)

    Adams, Samantha; de Bont, Antoinette

    2007-12-01

    Recent medical informatics and sociological literature has painted the image of a new type of patient--one that is reflexive and informed, with highly specified information needs and perceptions, as well as highly developed skills and tactics for acquiring information. Patients have been re-named "reflexive consumers." At the same time, literature about the questionable reliability of web-based information has suggested the need to create both user tools that have pre-selected information and special guidelines for individuals to use to check the individual characteristics of the information they encounter. In this article, we examine suggestions that individuals must be assisted in developing skills for "reflexive consumerism" and what these particular skills should be. Using two types of data (discursive data from websites and promotional items, and supplementary data from interviews and ethnographic observations carried out with those working to sustain these initiatives), we examine how users are directly addressed and discussed. We argue that these initiatives prescribe skills and practices that extend beyond finding and assessing information on the internet and demonstrate that they include ideals of consumerism and citizenship.

  16. Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice

    DEFF Research Database (Denmark)

    Sigurðardóttir, Nanna Rún; Nielsen, Anni Brit Sternhagen; Munck, Anders;

    2015-01-01

    antibiotics (Iceland = 75.8% vs. Denmark = 59.3%), but Danish GPs had a higher percentage of inappropriate antibiotic prescribing for sinusitis, and Icelandic GPs for pharyngotonsillitis. No differences were found for acute otitis media (AOM). The different antibiotic prescribing patterns between Denmark...... and Iceland could not fully be explained by different symptoms and signs among patients. Conclusion: Icelandic GPs have a higher antibiotic prescribing rate compared with Danish GPs, but the percentage of inappropriate antibiotic prescribing is highest in Denmark for sinusitis, and in Iceland...

  17. Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior

    Science.gov (United States)

    Tang, Yan; Chang, Chung-Chou H.; Lave, Judith R.; Gellad, Walid F.; Huskamp, Haiden A.; Donohue, Julie M.

    2016-01-01

    Background Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes. Aims of the Study To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing. Methods Using 2011 data from Pennsylvania’s Medicaid program, IMS Health’s HCOS™ database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to ≥10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing. Results There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average. Discussion Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians

  18. Trends in the Association Between Prescribed and Non-Prescribed Use of Tranquillisers or Sedatives Among Adolescents in 22 European Countries

    Directory of Open Access Journals (Sweden)

    Fotiou Anastasios

    2014-10-01

    Full Text Available AIMS – Tranquillisers and sedatives are valuable medicines with high misuse potential, increasingly used by adolescents without a doctor’s prescription. We examined the changing association between lifetime non-prescribed use of tranquillisers or sedatives and their prescribed use in European adolescents in 2003–2011. DESIGN – Cross-sectional data from 199,231 16-year-old students were collected through anonymous questionnaires administered in schools in 22 European countries participating in the European School Survey Project on Alcohol and Other Drugs (ESPAD in 2003, 2007 and 2011. RESULTS – Logistic regression analyses showed a modest increase in lifetime non-prescribed use of tranquillisers or sedatives (adjusted OR [AOR] = 1.08, 95% CI: 1.06–1.11, p < 0.001 and a decrease in prescribed use (AOR = 0.89, 95% CI: 0.87–0.91, p < 0.001 between 2003 and 2011. Adjusting for gender and survey year, any versus no prescribed use increased the odds tenfold for non-prescribed use (AOR = 10.15, 99% CI: 9.60–10.74, p < 0.001. Adjusting also for changes in cannabis use did not affect the strength of the association. Interactions of factors with survey year showed that between 2003 and 2011, there was an increase of 38% in the odds that tranquilliser or sedative misusers had not used these drugs also with a doctor’s prescription (AOR = 1.38, 99% CI: 1.28–1.50, p < 0.001. CONCLUSION – The waning strength of the association between prescribed and non-prescribed use of tranquillisers or sedatives among adolescents may suggest changes both in the patterns of use and the channels of diversion and access to this class of medication in Europe.

  19. Legal barriers to effective ecosystem management: exploring linkages between liability, regulations, and prescribed fire.

    Science.gov (United States)

    Wonkka, Carissa L; Rogers, William E; Kreuter, Urs P

    2015-12-01

    Resistance to the use of prescribed fire is strong among many private land managers despite the advantages it offers for maintaining fire-adapted ecosystems. Even managers who are aware of the benefits of using prescribed fire as a management tool avoid using it, citing potential liability as a major reason for their aversion. Recognizing the importance of prescribed fire for ecosystem management and the constraints current statutory schemes impose on its use, several states in the United States have undertaken prescribed burn statutory reform. The stated purpose of these statutory reforms, often called "right to burn" or "prescribed burning" acts, is to encourage prescribed burning for resource protection, public safety, and land management. Our research assessed the consequences of prescribed burn statutory reform by identifying legal incentives and impediments to prescribed fire application for ecosystem restoration and management, as well as fuel reduction. Specifically, we explored the relationship between prescribed burning laws and decisions made by land managers by exploiting a geographic-based natural experiment to compare landowner-prescribed fire use in contiguous counties with different regulations and legal liability standards. Controlling for potentially confounding variables, we found that private landowners in counties with gross negligence liability standards burn significantly more hectares than those in counties with simple negligence standards (F6,72 = 4.16, P = 0.046). There was no difference in hectares burned on private land between counties with additional statutorily mandated regulatory requirements and those requiring only a permit to complete a prescribed burn (F6,72 = 1.42, P = 0.24) or between counties with burn ban exemptions for certified prescribed burn managers and those with no exemptions during burn bans (F6,72 = 1.39, P = 0.24). Lawmakers attempting to develop prescribed burning statutes to promote the safe use of prescribed fire

  20. Long-term oxygen therapy: Are we prescribing appropriately?

    Directory of Open Access Journals (Sweden)

    Mª Rosa Güell Rous

    2008-06-01

    Full Text Available Mª Rosa Güell RousDepartament de Pneumologia, Hospital de la Santa Creu I de Sant Pau, Barcelona, SpainAbstract: Long-term oxygen therapy (LTOT is the treatment proven to improve survival in chronic obstructive pulmonary disease (COPD patients with chronic respiratory failure. It also appears to reduce the number of hospitalizations, increase effort capacity, and improve health-related quality of life. Standard LTOT criteria are related to COPD patients who have PaO2 <60 mmHg, are in a clinical stable situation, and are receiving optimal pharmacological treatment. According to LTOT guidelines, oxygen should be prescribed for at least 18 hours per day although some authors consider 24 hours would be more beneficial. The benefits of LTOT depend on correction of hypoxemia. Arterial blood gases should be measured at rest. During exercise, an effort test should be done to assure adequate SaO2. During sleep, continuous monitoring of SaO2 and PaCO2 should be performed to confirm correction of SaO2 overnight. An arterial blood gas sample should be taken at awakening to assess PaCO2 in order to prevent hypoventilation from the oxygen therapy. Several issues that need to be addressed are the use of LTOT in COPD patients with moderate hypoxemia, the efficacy of LTOT in patients who desaturate during exercise or during sleep, the optimal dosage of oxygen supplementation, LTOT compliance, and the LTOT prescription in diseases other than COPD.Keywords: long-term oxygen therapy, COPD, oxygen supplementation, chronic respiratory failure, hypoxemia

  1. Acute oxygen therapy: a review of prescribing and delivery practices

    Directory of Open Access Journals (Sweden)

    Cousins JL

    2016-05-01

    Full Text Available Joyce L Cousins,1–3 Peter AB Wark,3–5 Vanessa M McDonald2–5 1Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, Sydney, 2School of Nursing and Midwifery, 3Priority Research Centre for Healthy Lungs, 4School of Medicine and Public Health, The University of Newcastle, 5Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia Abstract: Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully. This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations. Multiple interventions have been tested to improve concordance, and while some of these interventions show promise, the sustainability of these interventions are less convincing. In this review, we summarize data that have been published on the prevalence of oxygen prescription and the accurate and appropriate administration of this drug therapy. We also identify strategies that have shown promise in facilitating changes to oxygen prescription and delivery practice. There is a clear need to investigate the barriers, facilitators, and attitudes of clinicians in relation to the prescription of oxygen therapy in acute care. Interventions based on these findings then need to be designed and tested to facilitate the application of evidence-based guidelines to support sustained changes in practice, and ultimately improve patient care. Keywords: chronic obstructive pulmonary disease, COPD, type II respiratory failure, oxygen therapy, prescribing, hypoxia, hypercapnia

  2. Antiaging treatments have been legally prescribed for approximately thirty years.

    Science.gov (United States)

    Ukraintseva, Svetlana V; Arbeev, Konstantin G; Michalsky, Anatoly I; Yashin, Anatoly I

    2004-06-01

    There is an interesting divergence between the achievements of geriatrics and gerontology. On the one hand, during the last 30 years physicians in many developed countries have successfully prescribed several medicines to cure various symptoms of senescence. On the other hand, the influence of such medicines on human life span practically has not been studied. The most common of the relevant medicines are nootropic piracetam, gamma-aminobutyric acid (GABA), selegiline, Ginkgo biloba, pentoxifylline, cerebrolysin, solcoseryl, ergoloid, vinpocetin, sertraline, and estrogens, among others. Available data from human clinical practices and experimental animal studies indicate that treatments with these drugs improve learning, memory, brain metabolism, and capacity. Some of these drugs increase tolerance to various stresses such as oxygen deficit and exercise, stimulate the regeneration of neurons in the old brain, and speed up the performance of mental and physical tasks. This means that modern medicine already has "antiaging" treatments at its disposal. However, the influence of such treatments on the mean and maximal life span of humans, and on the age trajectory of a human survival curve has been poorly studied. The increase in human life expectancy at birth in the second half of the last century was mostly caused by the better survival at the old and oldest old rather than at the young ages. In parallel, the consumption of brain protective and regenerative drugs has been expanding in the elderly population. We provide evidence in support of the idea that the consumption of medicines exerting antiaging properties may contribute to the increase in human longevity.

  3. Prescribing for unlabeled conditions: patient benefit or therapeutic roulette?

    Science.gov (United States)

    Serradell, J; Rucker, T D

    1990-01-01

    There is ample evidence that prescribed medications are employed for uses far broader than the approved label indications in the U.S. An enormous research agenda thus exists that should be addressed in the not-too-distant future. In fact, it seems essential that operation of the Medicare Catastrophic Drug Benefit program be designed with the best available knowledge in this area. Perhaps it might be appropriate for several universities, the U.S. Pharmacopeial Convention, and/or the FDA to establish a center to study this question. This model has been applied with clinical/surgical registries, with adverse reaction reporting, and with device failures. We need a rational, science-compatible, and uniform policy free of political and emotional arguments to address the issue of handling, monitoring, and regulating the use of drugs for unlabeled conditions. Comprehensive data should be provided for policy makers, regulators, payers, and clinicians in their evaluating the use of different drug products. Even a brief glance at any page from the National Disease and Therapeutic Index shows intended use that would cause most experts to react in disbelief. Further, there seem to be relatively few instances in which the use of a given pharmaceutical for an unlabeled indication would qualify as a drug of choice in the first place. The therapeutic and economic consequences of the use of legend drugs for unlabeled indications are difficult to document. We do know that a significant proportion of hospital admissions and days can be traced to the inappropriate use of pharmaceutical products but the net impact of our subject on institution cost has not been established.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Polypharmacy patterns: unravelling systematic associations between prescribed medications.

    Directory of Open Access Journals (Sweden)

    Amaia Calderón-Larrañaga

    Full Text Available OBJECTIVES: The aim of this study was to demonstrate the existence of systematic associations in drug prescription that lead to the establishment of patterns of polypharmacy, and the clinical interpretation of the associations found in each pattern. METHODS: A cross-sectional study was conducted based on information obtained from electronic medical records and the primary care pharmacy database in 2008. An exploratory factor analysis of drug dispensing information regarding 79,089 adult patients was performed to identify the patterns of polypharmacy. The analysis was stratified by age and sex. RESULTS: Seven patterns of polypharmacy were identified, which may be classified depending on the type of disease they are intended to treat: cardiovascular, depression-anxiety, acute respiratory infection (ARI, chronic obstructive pulmonary disease (COPD, rhinitis-asthma, pain, and menopause. Some of these patterns revealed a clear clinical consistency and included drugs that are prescribed together for the same clinical indication (i.e., ARI and COPD patterns. Other patterns were more complex but also clinically consistent: in the cardiovascular pattern, drugs for the treatment of known risk factors-such as hypertension or dyslipidemia-were combined with other medications for the treatment of diabetes or established cardiovascular pathology (e.g., antiplatelet agents. Almost all of the patterns included drugs for preventing or treating potential side effects of other drugs in the same pattern. CONCLUSIONS: The present study demonstrated the existence of non-random associations in drug prescription, resulting in patterns of polypharmacy that are sound from the pharmacological and clinical viewpoints and that exist in a significant proportion of the population. This finding necessitates future longitudinal studies to confirm some of the proposed causal associations. The information discovered would further the development and/or adaptation of clinical

  5. An Analysis of Personal Factors that Determine Carrie’s Self -Actual-ization in Sister Carrie

    Institute of Scientific and Technical Information of China (English)

    YU Shuang-shuang

    2014-01-01

    In Dreiser’s novel Sister Carrie, the heroine Carrie’s self-actualizing natures are reflected in her self-actualization ef-fort. Those natures include the acceptance of reality and potential to be actress, etc., which play the crucial role of her star jour-ney and self-actualizing effort. Therefore, every woman should have the spiritual spirit;and, at the same time, pursue nobler spiri-tual life.

  6. Trends in co-prescribing of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in Ireland.

    LENUS (Irish Health Repository)

    Wan Md Adnan, Wan A H

    2011-03-01

    (i) To examine the trends in co-prescribing of angiotensin converting enzyme inhibitor (ACEI) and angiotensin-II receptor blocker (ARB) therapy and (ii) to examine the influence of major clinical trials (CALM, COOPERATE, VALIANT and ONTARGET) on co-prescribing.

  7. 25 CFR 900.54 - Should the property management system prescribe internal controls?

    Science.gov (United States)

    2010-04-01

    ... System Standards § 900.54 Should the property management system prescribe internal controls? Yes. Effective internal controls should include procedures: (a) For the conduct of periodic inventories; (b) To... 25 Indians 2 2010-04-01 2010-04-01 false Should the property management system prescribe...

  8. Replacing hormone therapy-is the decline in prescribing sustained, and are nonhormonal drugs substituted?

    NARCIS (Netherlands)

    Vegter, Stefan; Kolling, Pieternel; Toben, Marjolijn; Visser, Sipke T.; de Jong-van den Berg, Lolkje T. W.

    2009-01-01

    Objectives: After two cautioning landmark studies in 2002 and 2003, a dramatic decrease in hormonal therapy (HT) prescribing for menopausal symptoms was seen. Our objectives were to (1) determine whether this decline in HT prescribing sustained until 2007 and (2) investigate nonhormonal drug prescri

  9. 17 CFR 250.27 - Classification of accounts prescribed for utility companies not already subject thereto.

    Science.gov (United States)

    2010-04-01

    ... HOLDING COMPANY ACT OF 1935 Forms, Procedure and Accounts § 250.27 Classification of accounts prescribed... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Classification of accounts prescribed for utility companies not already subject thereto. 250.27 Section 250.27 Commodity and...

  10. Off-label and unlicensed prescribing of psychotropics in children in Dutch general practice .

    NARCIS (Netherlands)

    Volkers, A.; Dijk, L. van

    2006-01-01

    Background: Unsafe drug use is a point of concern in children with psychotropics. Methylfenidate is licensed to prescribe above the age of 6 years, but most of the antidepressants and benzodiazepines are not approved in children. We studied the off-label and unlicensed prescribing of psychotropics i

  11. Developing Baselines for Prescribed Burning Smoke Management Plans and Best Management Practices

    Science.gov (United States)

    2015-09-01

    27 5.3 Track fire activity...management practices (BSMP), was in place. When prescribed fires are applied at the natural return interval for an eco - system and the prescribed fire is...Dispersion Evaluation C C R Monitoring C C R Track Fire Activity C C R Share the Airshed/Air Basin O O R Public Notification O O R Exposure

  12. The appropriateness of prescribing antibiotics in the community in Europe: study design

    NARCIS (Netherlands)

    Bijnen, E.M. van; Heijer, C. den; Paget, W.J.; Stobberingh, E.E.; Verheij, R.A.; Bruggeman, C.A.; Pringle, M.; Goossens, H.; Schellevis, F.G.

    2011-01-01

    ABSTRACT: BACKGROUND: Over 90% of all antibiotics in Europe are prescribed in primary care. It is important that antibiotics are prescribed that are likely to be effective; however, information about antibiotic resistance in the community is incomplete. The aim of our study is to investigate the app

  13. The appropriateness of prescribing antibiotics in the community in Europe: study design.

    NARCIS (Netherlands)

    Bijnen, E.M.E. van; Heijer, C.D.J. den; Paget, W.J.; Stobberingh, E.E.; Verheij, R.A.; Bruggeman, C.A.; Pringle, M.; Goossens, H.; Schellevis, F.G.

    2011-01-01

    Background: Over 90% of all antibiotics in Europe are prescribed in primary care. It is important that antibiotics are prescribed that are likely to be effective; however, information about antibiotic resistance in the community is incomplete. The aim of our study is to investigate the appropriatene

  14. Cross-national comparison of prescribing patterns in Australian and dutch nursing homes

    NARCIS (Netherlands)

    Taxis, Katja; Kochen, Sjoerd; Geerens, Sanne; Wouters, Hans; Boersma, Froukje; Maring, Jan G.; Mulder, Hans; Pavlovic, Jugoslav; Stevens, Gerard; McLachlan, Andrew J.; Pont, Lisa

    2014-01-01

    Background: Prescribing quality is a major issue in nursing home patients. Few cross-national comparisons of prescribing patterns have been carried out in this population. Objectives: To compare prevalence of medication use in nursing home patients between Australia and The Netherlands. Methods: An

  15. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    LENUS (Irish Health Repository)

    Kennelly, S

    2011-10-01

    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later.

  16. Prescribing pattern in orthopedics outpatient department of a medical college in India

    Directory of Open Access Journals (Sweden)

    Indranil Banerjee

    2015-12-01

    Conclusion: The current piece of work pointed out certain lacunae in the prescribing practices of the orthopedicians of the institute as evidenced by low generic prescribing, inadequate information about the duration of therapy and frequency of administration in many prescriptions. [Int J Basic Clin Pharmacol 2015; 4(6.000: 1175-1177

  17. Shift in antibiotic prescribing patterns in relation to antibiotic expenditure in paediatrics

    NARCIS (Netherlands)

    Kimpen, JLL; van Houten, M.A.

    1998-01-01

    In paediatrics, antibiotics are among the most commonly prescribed drugs. Because of an overall rise in health care costs, lack of uniformity in drug prescribing and the emergence of antibiotic resistance, monitoring and control of antibiotic use is of growing concern and strict antibiotic policies

  18. Rational use of medicines: prescribing indicators at different levels of health care

    Directory of Open Access Journals (Sweden)

    Maria Beatriz Cardoso Ferreira

    2013-06-01

    Full Text Available This multicenter study aimed to investigate prescribing patterns of drugs at different levels of health care delivery in university-affiliated outpatient clinics located in eight cities in the South and Midwest of Brazil. All prescriptions collected were analyzed for various items, including WHO prescribing indicators. A total of 2,411 prescriptions were analyzed, and 469 drugs were identified. The number of drugs prescribed per encounter, the frequency of polypharmacy, and the percentage of encounters with at least one injection or antibiotic prescribed were higher in centers providing primary health care services, compared to those where this type of care is not provided. Most drugs (86.1% were prescribed by generic name. In centers with primary health care services, drug availability was higher, drugs included in the National and Municipal Lists of Essential Medicines were more frequently prescribed, and patients were given more instructions. However, warnings and non-pharmacological measures were less frequently recommended. This study reveals trends in drug prescribing at different levels of health care delivery in university-affiliated outpatient clinics and indicates possible areas for improvement in prescribing practices.

  19. 38 CFR 17.96 - Medication prescribed by non-VA physicians.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Medication prescribed by non-VA physicians. 17.96 Section 17.96 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Outpatient Treatment § 17.96 Medication prescribed by non-VA physicians. Any...

  20. Encouraging good antimicrobial prescribing practice: A review of antibiotic prescribing policies used in the South East Region of England

    Directory of Open Access Journals (Sweden)

    Mayon White Richard T

    2001-05-01

    Full Text Available Abstract Background Good prescribing practice has an important part to play in the fight against antimicrobial resistance. Whilst it was perceived that most hospitals and Health Authorities possessed an antibiotic policy, a review of antibiotic policies was conducted to gain an understanding of the extent, quality and usefulness of these policies. Methods Letters were sent to pharmacists in hospitals and health authorities in across the South East region of the National Health Service Executive (NHSE requesting antibiotic policies. data were extracted from the policies to assess four areas; antibiotic specific, condition specific, patient specific issues and underpinning evidence. Results Of a possible 41 hospital trusts and 14 health authorities, 33 trusts and 9 health authorities (HAs provided policies. Both trust and HA policies had a median publication date of 1998 (trust range 1993-99, HA 1994-99. Eleven policies were undated. The majority of policies had no supporting references for the statements made. All policies provided some details on specific antibiotics. Gentamicin and ciprofloxacin were the preferred aminoglycoside and quinolone respectively with cephalosporins being represented by cefuroxime or cefotaxime in trusts and cephradine or cephalexin in HAs. 26 trusts provided advice on surgical prophylaxis, 17 had meningococcal prophylaxis policies and 11 covered methicillin resistant Staphylococcus aureus (MRSA. There was little information for certain groups such as neonates or children, the pregnant or the elderly. Conclusion There was considerable variation in content and quality across policies, a clear lack of an evidence base and a need to revise policies in line with current recommendations.

  1. An audit of prescribing practices for benzodiazepines and Z-drugs.

    LENUS (Irish Health Repository)

    Cadogan, C

    2015-03-01

    Concerns persist over the use of benzodiazepines and Z-drugs in Ireland. A prospective prescription audit was conducted in 81 community pharmacies across Ireland over a four week period. The study sought to assess the level of prescription compliance with key components of benzodiazepine and Z-drug prescribing guidelines. 28% of audit booklets issued were returned, yielding data on 4,418 prescriptions. The findings suggest that little progress has been made in improving the prescribing of benzodiazepines and Z-drugs in Ireland in the decade since publication of the Benzodiazepine Committee\\'s report. Fewer than one fifth of prescriptions (18.8%) were fully compliant with the assessment criteria and the majority (53.7%) had multiple discrepancies. This study highlights the importance of monitoring and auditing benzodiazepine and Z-drug prescribing practices. Interventions involving patients, prescribers and pharmacists are required to improve the prescribing and use of these medications in Ireland.

  2. Factors Influencing Successful Prescribing by Intern Doctors: A Qualitative Systematic Review

    Directory of Open Access Journals (Sweden)

    Christina R. Hansen

    2016-08-01

    Full Text Available As the majority of prescribing in hospital is undertaken by intern doctors, the aims of this systematic review were to compile the evidence of the qualitative literature on the views and experiences of intern doctors and to examine the role of the pharmacist in assisting in prescribing by interns. A systematic review of the qualitative literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement. The findings were synthesized using thematic analysis. Seven publications were included. Factors influencing prescribing behaviour were related to the environment; collaboration in medical teams; hierarchical structures; and patient and individual factors. This review confirmed that interns’ prescribing behaviour is influenced by multiple factors, and further highlighted the need for an educational intervention that supports the intern completing the prescribing task in a complex environment, and not just addresses the presumed knowledge gap(s.

  3. Monitoring of Patients Aged 0–2 Years Drug Prescribing Pattern Used Indicator from WHO

    Directory of Open Access Journals (Sweden)

    Ahmad Priyadi

    2013-03-01

    Full Text Available The aim of this study was to evaluate drug used by patients 0–2 years old using five World Health Organization guideline for prescribing indicators, which include average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotics, injection prescribed, and drugs prescribed from essential drugs list or formulary. Outpatient prescription of patients 0–2 years old period Januari–Desember 2012 were collected retrospectively in one of health facility in Bandung. Average number of drugs per encounter was gained by dividing 6350 drugs with 2741 prescriptions. Percentage of using generic drugs was 9,19 %, antibiotics were 67,53 % and no injections per encounters, whereas percentage of drugs prescribed from essential drugs list was 45,02 %. The result showed that usage of generic drugs and essential drugs were low while the usage of antibiotics is relatively higher than World Health Organization recommendation.

  4. Self-Actualizing Men and Women: A Comparison Study.

    Science.gov (United States)

    Hall, Eleanor G.; Hansen, Jan B.

    1997-01-01

    The self-actualization of 167 women who lived in the Martha Cook (MC) dormitory of the University of Michigan (1950-1970) was compared to that of a group of Ivy League men researched in another study. In addition, two groups of MC women were compared to each other to identify differences which might explain why some self-actualized while other did…

  5. The Self-Actualization of Polk Community College Students.

    Science.gov (United States)

    Pearsall, Howard E.; Thompson, Paul V., Jr.

    This article investigates the concept of self-actualization introduced by Abraham Maslow (1954). A summary of Maslow's Needs Hierarchy, along with a description of the characteristics of the self-actualized person, is presented. An analysis of humanistic education reveals it has much to offer as a means of promoting the principles of…

  6. Facebook as a Library Tool: Perceived vs. Actual Use

    Science.gov (United States)

    Jacobson, Terra B.

    2011-01-01

    As Facebook has come to dominate the social networking site arena, more libraries have created their own library pages on Facebook to create library awareness and to function as a marketing tool. This paper examines reported versus actual use of Facebook in libraries to identify discrepancies between intended goals and actual use. The results of a…

  7. 26 CFR 1.953-2 - Actual United States risks.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Actual United States risks. 1.953-2 Section 1... (CONTINUED) INCOME TAXES Controlled Foreign Corporations § 1.953-2 Actual United States risks. (a) In general. For purposes of paragraph (a) of § 1.953-1, the term “United States risks” means risks described...

  8. Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study.

    Directory of Open Access Journals (Sweden)

    Johanna I Westbrook

    2012-01-01

    Full Text Available BACKGROUND: Considerable investments are being made in commercial electronic prescribing systems (e-prescribing in many countries. Few studies have measured or evaluated their effectiveness at reducing prescribing error rates, and interactions between system design and errors are not well understood, despite increasing concerns regarding new errors associated with system use. This study evaluated the effectiveness of two commercial e-prescribing systems in reducing prescribing error rates and their propensities for introducing new types of error. METHODS AND RESULTS: We conducted a before and after study involving medication chart audit of 3,291 admissions (1,923 at baseline and 1,368 post e-prescribing system at two Australian teaching hospitals. In Hospital A, the Cerner Millennium e-prescribing system was implemented on one ward, and three wards, which did not receive the e-prescribing system, acted as controls. In Hospital B, the iSoft MedChart system was implemented on two wards and we compared before and after error rates. Procedural (e.g., unclear and incomplete prescribing orders and clinical (e.g., wrong dose, wrong drug errors were identified. Prescribing error rates per admission and per 100 patient days; rates of serious errors (5-point severity scale, those ≥3 were categorised as serious by hospital and study period; and rates and categories of postintervention "system-related" errors (where system functionality or design contributed to the error were calculated. Use of an e-prescribing system was associated with a statistically significant reduction in error rates in all three intervention wards (respectively reductions of 66.1% [95% CI 53.9%-78.3%]; 57.5% [33.8%-81.2%]; and 60.5% [48.5%-72.4%]. The use of the system resulted in a decline in errors at Hospital A from 6.25 per admission (95% CI 5.23-7.28 to 2.12 (95% CI 1.71-2.54; p<0.0001 and at Hospital B from 3.62 (95% CI 3.30-3.93 to 1.46 (95% CI 1.20-1.73; p<0.0001. This

  9. BAP Position Statement: Off-label prescribing of psychotropic medication to children and adolescents.

    Science.gov (United States)

    Sharma, Aditya N; Arango, Celso; Coghill, David; Gringras, Paul; Nutt, David J; Pratt, Peter; Young, Allan H; Hollis, Chris

    2016-05-01

    The off-label use of medicines for children and adolescents remains a common and important issue for prescribing practice across child and adolescent psychiatry, paediatrics and primary care. This editorial focusses on psychotropic drug treatment, which plays an essential part in the comprehensive management of a range of child and adolescent psychiatric disorders. Despite a growing evidence base for drug treatment in child and adolescent psychiatric disorders, much psychotropic medication continues to be prescribed off-label (i.e. outside the limits of the marketing authorisation or product license). The reasons for and implications of off-label prescribing, including the potential clinical benefits/risks and medico-legal implications, are often poorly understood by both patients and prescribers. An important unintended consequence of the uncertainties and confusion surrounding the status of off-label prescribing for children and adolescents may be that effective drug treatments are being withheld or underused. This BAP Position Statement aims to clarify these issues, challenge some of the myths surrounding off-label prescribing for children and adolescents and offer practical guidance for prescribers.

  10. Taking stock: provider prescribing practices in the presence and absence of ACT stock

    Directory of Open Access Journals (Sweden)

    Jones Caroline

    2011-08-01

    Full Text Available Abstract Background Globally, the monitoring of prompt and effective treatment for malaria with artemisinin combination therapy (ACT is conducted largely through household surveys. This measure; however, provides no information on case management processes at the health facility level. The aim of this review was to assess evidence from health facility surveys on malaria prescribing practices using ACT, in the presence and absence of ACT stock, at time and place where treatment was sought. Methods A systematic search of published literature was conducted. Findings were collated and data extracted on proportion of patients prescribed ACT and alternative anti-malarials in the presence and absence of ACT stock. Results Of the 14 studies identified in which ACT prescription for uncomplicated malaria in the public sector was evaluated, just six, from three countries (Kenya, Uganda and Zambia, reported this in the context of ACT stock. Comparing facilities with ACT stock to facilities without stock (i ACT prescribing was significantly higher in all six studies, increasing by a range of 21.3% in children Conclusions Prescriber practices vary based on ACT availability. Although ACT prescriptions increased and alternative anti-malarials prescriptions decreased in the presence of ACT stock, ACT was prescribed in the absence, and alternative anti-malarials were prescribed in the presence of, ACT. Presence of stock alone does not ensure that treatment guidelines are followed. More health facility surveys, together with qualitative research, are needed to understand the role of ACT stock-outs on provider prescribing behaviours and preferences.

  11. Causes and consequences of e-prescribing errors in community pharmacies

    Directory of Open Access Journals (Sweden)

    Abramson EL

    2015-05-01

    Full Text Available Erika L Abramson Departments of Pediatrics and Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Abstract: Major national policy forces are promoting the adoption and use of health information technology (health IT to improve the quality, safety, and efficiency of health care delivery. One such health IT is electronic prescribing (e-prescribing, which is the direct transmission of prescription information from a provider to a pharmacy. Given research showing that handwritten prescriptions are unsafe and associated errors can lead to tremendous inefficiency for patients and pharmacists, e-prescribing has many potential benefits. However, as with the introduction of any new technology, unintended, adverse consequences may result. The purpose of this review is to explore the causes and consequences of e-prescribing errors in community pharmacies, which are pharmacies not affiliated with a hospital or clinic. Many new types of errors – including provider order entry errors, transcription errors, and dispensing errors – appear to result from e-prescribing. These lead to important consequences for pharmacies, including safety threats to patients, reduced efficiency for pharmacists, processing delays, and increased pharmacy cost. Increased attention to system design and pharmacist training, as well as additional research in this area, will be critical to realize the full benefits of e-prescribing. Keywords: electronic prescribing, medication errors, community pharmacies 

  12. Incidences of new prescribing by British child and adolescent psychiatrists: a prospective study over 12 months.

    Science.gov (United States)

    Clark, Andrew F

    2004-03-01

    Little is known about the epidemiology of pharmacotherapy in the treatment of child psychiatric disorder. This study reports on the systematic prospective collection of instances of new prescribing by child and adolescent mental health services serving a population of approximately four million people in North West England. Diagnostic and demographic information regarding new prescribing by child and adolescent mental health services within Greater Manchester and Lancashire was systematically collected prospectively over two 6-month periods between 2000 and 2002. Within the 12 months studied, there were 845 instances of a drug being newly prescribed to a child or adolescent in the treatment of a psychiatric disorder. In total, 48 different drugs were prescribed for 25 different diagnoses. The eight most commonly prescribed drugs were methylphenidate, methylphenidate/placebo trial, paroxetine, fluoxetine, risperidone, imipramine, dexamphetamine and melatonin, accounting for 73% of all prescribing. There was marked variation between services in the amount of prescribing with significant correlation between prescription of stimulants and prescription of selective serotonin reuptake inhibitor antidepressants. Prescription of medications in the treatment of child psychiatric disorder has become a significant part of child and adolescent mental health practice. However, the evidence base underpinning this usage remains limited, and further high quality therapeutic clinical trials are urgently needed.

  13. Antibiotic prescribing in DR Congo: a knowledge, attitude and practice survey among medical doctors and students.

    Directory of Open Access Journals (Sweden)

    Kamala Thriemer

    Full Text Available OBJECTIVES: Antibiotic resistance (ABR particularly hits resource poor countries, and is fuelled by irrational antibiotic (AB prescribing. We surveyed knowledge, attitudes and practices of AB prescribing among medical students and doctors in Kisangani, DR Congo. METHODS: Self-administered questionnaires. RESULTS: A total of 184 questionnaires were completed (response rate 94.4%. Knowledge about AB was low (mean score 4.9/8 points, as was the estimation of local resistance rates of S. Typhi and Klebsiella spp.(correct by 42.5% and 6.9% of respondents respectively. ABR was recognized as a problem though less in their own practice (67.4% than nation- or worldwide (92.9% and 85.5%, p<.0001. Confidence in AB prescribing was high (88.6% and students consulted more frequently colleagues than medical doctors when prescribing (25.4% versus 11.6%, p= 0.19. Sources of AB prescribing included pharmaceutical companies (73.9%, antibiotic guidelines (66.3%, university courses (63.6%, internet-sites (45.7% and WHO guidelines (26.6%. Only 30.4% and 16.3% respondents perceived AB procured through the central procurement and local pharmacies as of good quality. Local AB guidelines and courses about AB prescribing are welcomed (73.4% and 98.8% respectively. CONCLUSIONS: This data shows the need for interventions that support rational AB prescribing.

  14. Impact of pharmaceutical promotion on prescribing decisions of general practitioners in Eastern Turkey

    Directory of Open Access Journals (Sweden)

    Beyhun Nazim E

    2007-06-01

    Full Text Available Abstract Background Commercial sources of information are known to have greater influence than scientific sources on general practitioners' (GPs prescribing behavior in under developed and developing countries. The study aimed to determine the self-reported impact of pharmaceutical promotion on the decision-making process of prescription of GPs in Eastern Turkey. Methods A cross-sectional, exploratory survey was performed among 152 GPs working in the primary health centers and hospitals in Erzurum province of Eastern Turkey in 2006. A self-administered structured questionnaire was used. The questionnaire included questions regarding sociodemographics, number of patients per day, time per patient, frequency of sales representative visits to GPs, participation of GPs in training courses on prescribing (in-service training, drug companies, factors affecting prescribing decision, reference sources concerning prescribing and self-reported and self-rated effect of the activities of sales representatives on GPs prescribing decisions. Results Of 152 subjects, 53.3% were male and 65.8% were working at primary health care centers, respectively. Mean patient per day was 58.3 ± 28.8 patients per GP. For majority of the GPs (73.7%, the most frequent resource used in case of any problems in prescribing process was drug guides of pharmaceutical companies. According to self-report of the GPs, their prescribing decisions were affected by participation in any training activity of drug companies, frequent visits by sales representatives, high number of patient examinations per day and low year of practice (p Conclusion The results of this study suggest that for the majority of the GPs, primary reference sources concerning prescribing was commercial information provided by sales representatives of pharmaceutical companies, which were reported to be highly influential on their decision-making process of prescribing by GPs. Since this study was based on self

  15. Antiepileptic drugs prescribed in pregnancy and prevalence of major congenital malformations: comparative prevalence studies

    Science.gov (United States)

    Petersen, Irene; Collings, Shuk-Li; McCrea, Rachel L; Nazareth, Irwin; Osborn, David P; Cowen, Phil J; Sammon, Cormac J

    2017-01-01

    Objective The aim of this study was to examine the prevalence of major congenital malformations associated with antiepileptic drug (AED) treatment in pregnancy. Patients and methods Using data from The Health Improvement Network, we identified women who have given live birth and their offspring. Four subgroups were selected based on the AED treatment in early pregnancy, valproate, carbamazepine, lamotrigine and women not receiving AED treatment. We compared the prevalence of major congenital malformations within children of these four groups and estimated prevalence ratios (PRs) using Poisson regression adjusted for maternal age, sex of child, quintiles of Townsend deprivation score and indication for treatment. Results In total, 240,071 women were included in the study. A total of 229 women were prescribed valproate in pregnancy, 357 were prescribed lamotrigine and 334 were prescribed carbamazepine and 239,151 women were not prescribed AEDs. Fifteen out of 229 (6.6%) women prescribed valproate gave birth to a child with a major congenital malformation. The figures for lamotrigine, carbamazepine and women not prescribed AEDs were 2.7%, 3.3% and 2.2%, respectively. The prevalence of major congenital malformation was similar for women prescribed lamotrigine or carbamazepine compared to women with no AED treatment in pregnancy. For women prescribed valproate in polytherapy, the prevalence was fourfold higher. After adjustments, the effect of estimates attenuated, but the prevalence remained two- to threefold higher in women prescribed valproate. Conclusion The results of our study suggest that lamotrigine and carbamazepine are safer treatment options than valproate in pregnancy and should be considered as alternative treatment options for women of childbearing potential and in pregnancy. PMID:28243149

  16. Connecting primary care clinics and community pharmacies through a nationwide electronic prescribing network: A qualitative study

    Directory of Open Access Journals (Sweden)

    Marie-Pierre Gagnon

    2015-10-01

    Full Text Available Background The use of medication is at the heart of primary care, but is also the cause for major health concerns. It is therefore important to examine the prescription of medication process.Objective This study identifies the barriers and facilitators perceived by community pharmacists and primary care physicians concerning the adoption of a nationwide electronic prescribing (e-prescribing network in the province of Quebec, Canada.Methods We used purposive sampling to identify the most intensive users of the e-prescribing network. We conducted phone and in-person interviews. Interviews were transcribed, and we analysed their content with NVivo, using the clinical adoption framework (CAF for the codification of the data.Results We interviewed 33 pharmacists, 2 pharmacy technicians, 11 physicians and 3 clinic managers. Adoption of the e-prescribing network was fairly low. The respondents underlined adaptation of their work environment, openness to change and perception of benefits as facilitators to the adoption of the network. However, important barriers were perceived, including system quality issues and paper prescriptions being the only legal document in the prescribing process. Even if respondents recognised that the e-prescribing network can offer substantial benefits to the prescribing process, issues still persisted and raised barriers to the full use of such a network, especially in a context where different local information systems are connected within a nationwide e-prescribing network.Conclusion This study, based on the CAF, provides a better understanding of the factors related to the adoption of a nationwide e-prescribing network connecting primary care clinics and community pharmacies. 

  17. What are the perceived learning needs of Australian general practice registrars for quality prescribing?

    Directory of Open Access Journals (Sweden)

    Aslani Parisa

    2010-12-01

    Full Text Available Abstract Background Little is known about the perceived learning needs of Australian general practice (GP registrars in relation to the quality use of medicines (QUM or the difficulties experienced when learning to prescribe. This study aimed to address this gap. Methods GP registrars' perceived learning needs were investigated through an online national survey, interviews and focus groups. Medical educators' perceptions were canvassed in semi-structured interviews in order to gain a broader perspective of the registrars' needs. Qualitative data analysis was informed by a systematic framework method involving a number of stages. Survey data were analysed descriptively. Results The two most commonly attended QUM educational activities took place in the workplace and through regional training providers. Outside of these structured educational activities, registrars learned to prescribe mainly through social and situated means. Difficulties encountered by GP registrars included the transition from hospital prescribing to prescribing in the GP context, judging how well they were prescribing and identifying appropriate and efficient sources of information at the point of care. Conclusions GP registrars learn to prescribe primarily and opportunistically in the workplace. Despite many resources being expended on the provision of guidelines, decision-support systems and training, GP registrars expressed difficulties related to QUM. Ways of easing the transition into GP and of managing the information 'overload' related to medicines (and prescribing in an evidence-guided, efficient and timely manner are needed. GP registrars should be provided with explicit feedback about the process and outcomes of prescribing decisions, including the use of audits, in order to improve their ability to judge their own prescribing.

  18. Physician Payments from Industry Are Associated with Greater Medicare Part D Prescribing Costs.

    Directory of Open Access Journals (Sweden)

    Roy H Perlis

    Full Text Available The U.S. Physician Payments Sunshine Act mandates the reporting of payments or items of value received by physicians from drug, medical device, and biological agent manufacturers. The impact of these payments on physician prescribing has not been examined at large scale.We linked public Medicare Part D prescribing data and Sunshine Act data for 2013. Physician payments were examined descriptively within specialties, and then for association with prescribing costs and patterns using regression models. Models were adjusted for potential physician-level confounding features, including sex, geographic region, and practice size.Among 725,169 individuals with Medicare prescribing data, 341,644 had documented payments in the OPP data (47.1%. Among all physicians receiving funds, mean payment was $1750 (SD $28336; median was $138 (IQR $48-$394. Across the 12 specialties examined, a dose-response relationship was observed in which greater payments were associated with greater prescribing costs per patient. In adjusted regression models, being in the top quintile of payment receipt was associated with incremental prescribing cost per patient ranging from $27 (general surgery to $2931 (neurology. Similar associations were observed with proportion of branded prescriptions written.While distribution and amount of payments differed widely across medical specialties, for each of the 12 specialties examined the receipt of payments was associated with greater prescribing costs per patient, and greater proportion of branded medication prescribing. We cannot infer a causal relationship, but interventions aimed at those physicians receiving the most payments may present an opportunity to address prescribing costs in the US.

  19. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J

    2012-02-03

    BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers\\' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers\\' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers\\' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +\\/- 6.1 years) and all patients had both Beers\\' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community

  20. Prescribing patterns of gastrointestinal drugs in private clinics in Benghazi-Libya

    Directory of Open Access Journals (Sweden)

    Nouh M. H. Aljarari

    2016-12-01

    Full Text Available Background: Prescription analysis can pinpoint areas of improvement in encounters issued by prescribing physicians. The present study was carried out to analyze prescribing trends for outpatients among consultants in the city of Benghazi-Libya. Methods: A total of 4000 prescriptions were collected from private pharmacies around the city of Benghazi, Libya. Indicators addressed included the patient's name, age, sex, and address, and the physician's name, address, and signature. The percentage of prescriptions lacking this information was calculated. Drugs prescribed by dosage, duration of treatment were also considered. The study focused on the commonly prescribed classes of gastrointestinal drugs and the most frequently prescribed drug of each common class. No attempt was made to evaluate the incidence of various gastrointestinal disorders. Results are expressed as frequency and percentage of prescribed medicines. Results: Information present in prescriptions and pertaining to the patient were name (2972, 74.3%, age (468, 11.7%, date of visit (107, 2.7% while those for prescriber were name (1902, 47.6% and signature (3612, 90.3%. None of the prescriptions contained sex of patient, his/her address, or registration number of the prescriber. All prescribed drugs were in brand names. Polypharmacy was not evident as all prescriptions contained 1-2 drugs. The number of prescriptions with a gastrointestinal drug(s counted to 421 (10.5% out of the total 4000 prescriptions. The most commonly prescribed classes of gastrointestinal drugs include in order, anti-hyperacidity, anti-emetics, anti-spasmodic, laxatives and anti-diarrheal with the most frequently prescribed drug of each therapeutic class being omeprazole (67, 48.9%, metoclopramide (57, 57%, hyoscine-N-butyl bromide (42, 55.3%, bisacodyl (44, 59.5% and loperamide (30, 88.3% respectively. Conclusions: The results of the present study indicate the need to improve prescribing among physicians, a task

  1. Prevalence & Prescription: Prescribing Practices of Clozapine in Australia between 2005 & 2010

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    Shae-Leigh C. Vella

    2012-04-01

    Full Text Available Clozapine is an anti-psychotic used to treat refractory schizophrenia. This study reviews the rates of clozapine prescription for refractory schizophrenia in a region of Australia and compares the prescribing patterns to the estimated prevalence rates of refractory schizophrenia in the region. Utilising a pharmacoepidemiological approach; the results indicated that only 8.4% of the individuals estimated to be suffering from refractory schizophrenia in the region were prescribed clozapine between 2005 and 2010, with only 4.1% continuing clozapine to the conclusion of the study. In conclusion it is evident that clozapine is widely under-prescribed in this area of Australia.

  2. [Temporary recommendation for use on off-label baclofen: viewpoint of Prescribers of the CAMTEA system].

    Science.gov (United States)

    Rolland, Benjamin; Deheul, Sylvie; Danel, Thierry; Bence, Camille; Blanquart, Marie-Christine; Bonord, Alexandre; Semal, Robin; Briand, Thierry; Sochala, Michel; Dubocage, Christelle; Dupriez, François; Duquesne, Damien; Gibour, Bernard; Loosfeld, Xavier; Henebelle, Dorothée; Henon, Michael; Vernalde, Elodie; Matton, Christian; Bacquet, Jean-Eudes; Molmy, Lucie; Sarasy, François; Simioni, Nicolas; Richez, Cécile; Gentil-Spinosi, Laure; Vosgien, Véronique; Yguel, Jacques; Ledent, Thierry; Auffret, Marine; Wilquin, Maroussia; Ziolkowski, Danièle; Sochala, Michel; Gautier, Sophie; Bordet, Régis; Cottencin, Olivier

    2015-01-01

    The use of high dose baclofen for alcohol-dependence emerged in France from 2008 based on empirical findings, and is still off-label. However, due to the rapid increase in this prescribing practice, the French health authorities have decided to frame it using an extraordinary regulatory measure named "temporary recommendation for use" (TRU). Baclofen prescribers from CAMTEA, a regional team-based off-label system for supervising baclofen prescribing, which was developed much prior to the TRU, discuss herein the pros and cons of this measure and the applicability of its different aspects in the daily clinical practice.

  3. The antecedents of herbal product actual purchase in Malaysia

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    Sarina Ismail

    2015-08-01

    Full Text Available This study is meant to examine the relationships of several antecedents of actual purchase of herbal product in Malaysia. Actual purchase is considered to have a vital link to a business success. The study identified eight antecedents of consumer actual purchase such as intention, attitude, social influence, product safety and culture belief. A total of 473 respondents (about 82% completed and returned the questionnaire. A seven point Likert scale was used to measure responses. The data were analyzed using Partial Least Squares (PLS path modeling. The path coefficient results supported the direct influence of intention, attitude, social influence and product safety on actual buying. Moreover, the findings reveal that attitude, social influence, product safety, and culture belief also influenced buying intention.

  4. Electrodermal responses to implied versus actual violence on television.

    Science.gov (United States)

    Kalamas, A D; Gruber, M L

    1998-01-01

    The electrodermal response (EDR) of children watching a violent show was measured. Particular attention was paid to the type of violence (actual or implied) that prompted an EDR. In addition, the impact of the auditory component (sounds associated with violence) of the show was evaluated. Implied violent stimuli, such as the villain's face, elicited the strongest EDR. The elements that elicited the weakest responses were the actual violent stimuli, such as stabbing. The background noise and voices of the sound track enhanced the total number of EDRs. The results suggest that implied violence may elicit more fear (as measured by EDRs) than actual violence does and that sounds alone contribute significantly to the emotional response to television violence. One should not, therefore, categorically assume that a show with mostly actual violence evokes less fear than one with mostly implied violence.

  5. Estimating actual irrigation application by remotely sensed evapotranspiration observations

    NARCIS (Netherlands)

    Droogers, P.; Immerzeel, W.W.; Lorite, I.J.; SWAP, PEST

    2010-01-01

    Water managers and policy makers need accurate estimates of real (actual) irrigation applications for effective monitoring of irrigation and efficient irrigation management. However, this information is not readily available at field level for larger irrigation areas. An innovative inverse modeling

  6. Actuarial and actual analysis of surgical results: empirical validation.

    Science.gov (United States)

    Grunkemeier, G L; Anderson, R P; Starr, A

    2001-06-01

    This report validates the use of the Kaplan-Meier (actuarial) method of computing survival curves by comparing 12-year estimates published in 1978 with current assessments. It also contrasts cumulative incidence curves, referred to as "actual" analysis in the cardiac-related literature with Kaplan-Meier curves for thromboembolism and demonstrates that with the former estimate the percentage of events that will actually occur.

  7. Use of Medication Prescribed for Emotional or Behavioral Difficulties among Children Aged 6-17 Years in the United ...

    Science.gov (United States)

    ... the National Technical Information Service NCHS Use of Medication Prescribed for Emotional or Behavioral Difficulties Among Children ... prescription medication, mental health treatment Use of prescribed medication during the past 6 months for emotional or ...

  8. Section 7 Biological Evaluation : FY07 Prescribed Fire Management Plan for Compartment 10 and 13

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This document examines the effects that prescribed fire on St. Vincent National Wildlife Refuge will have on red wolves and bald eagles. It is determined that the...

  9. Differences between integrated and stand-alone E-prescribing systems have implications for future use.

    Science.gov (United States)

    Desroches, Catherine M; Agarwal, Ritu; Angst, Corey M; Fischer, Michael A

    2010-12-01

    Understanding the benefits of electronic prescribing systems has important implications for quality and efficiency in medical care. We surveyed physicians about their use of e-prescribing in outpatient practices. We found that physicians who use e-prescribing systems integrated into an electronic health record have different characteristics, usage patterns, perceived benefits, and levels of satisfaction than physicians who use stand-alone systems. For example, although only 56 percent of the physicians we surveyed said that they checked a patient's drug history most or all of the time when writing a prescription, those with integrated systems were significantly more likely to report doing so than their counterparts with stand-alone systems. Our findings have implications for the American Recovery and Reinvestment Act's requirements for e-prescribing and the future use of this technology. Because many stand-alone systems cannot meet meaningful-use requirements, there is likely to be a shift toward integrated systems.

  10. Antibiotic prescribing in patients with acute rhinosinusitis is not in agreement with European recommendations

    DEFF Research Database (Denmark)

    Jørgensen, Lars Christian; Friis Christensen, Sarah; Cordoba Currea, Gloria;

    2013-01-01

    Abstract Objective. To assess the potential overprescribing in patients with acute rhinosinusitis across six countries with different antibiotic prescribing rates and different prevalence of antibiotic resistance. Design, setting and subjects. A cross-sectional study including GPs from two Nordic...

  11. Prescribed Fire Plan : Stillwater National Wildlife Refuge : West Upper Foxtail 2009

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This is the 2009 prescribed fire plan for the West Upper Foxtail unit of Stillwater National Wildlife Refuge. The objective of this plan is to reduce...

  12. Nurse prescribing: a vehicle for improved collaboration, or a stumbling block to inter-professional working?

    Science.gov (United States)

    Fisher, Richard

    2010-12-01

    Prescribing by community nurses is established practice in the UK National Health Service. Although much has been written about the technical aspects of prescribing, little published work addresses the ways in which prescribing might affect relationships. Part of a PhD project set in southern England, this ethnographic project used semistructured interviews with a purposive sample of district nurses (n = 17), staff nurses (n = 4), pharmacists (n = 2) and a general practitioner to investigate the real world of nurse prescribing. Using theories of domination, power and legitimacy from Weber and Foucault, this paper sets out to demonstrate that despite government efforts to encourage collaborative working, power relationships still play an important part in some areas of practice. Analysis, building from Morrell's notion of naïve functionalism, reveals strategies used by actors in community practice to manage such relationships.

  13. Recurrent fuzzy neural network backstepping control for the prescribed output tracking performance of nonlinear dynamic systems.

    Science.gov (United States)

    Han, Seong-Ik; Lee, Jang-Myung

    2014-01-01

    This paper proposes a backstepping control system that uses a tracking error constraint and recurrent fuzzy neural networks (RFNNs) to achieve a prescribed tracking performance for a strict-feedback nonlinear dynamic system. A new constraint variable was defined to generate the virtual control that forces the tracking error to fall within prescribed boundaries. An adaptive RFNN was also used to obtain the required improvement on the approximation performances in order to avoid calculating the explosive number of terms generated by the recursive steps of traditional backstepping control. The boundedness and convergence of the closed-loop system was confirmed based on the Lyapunov stability theory. The prescribed performance of the proposed control scheme was validated by using it to control the prescribed error of a nonlinear system and a robot manipulator.

  14. Prescribed burning plan : Stillwater NWR : Roadside ditches, canals, and brush piles

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This 1997 Annual Prescribed Burning Plan for Stillwater NWR calls for all units, roads, and delivery canals to be burned. The objective of this burn is to return...

  15. European survey on principles of prudent antibiotic prescribing teaching in undergraduate students

    NARCIS (Netherlands)

    Pulcini, C.; Wencker, F.; Frimodt-Moller, N.; Kern, W.V.; Nathwani, D.; Rodriguez-Bano, J.; Simonsen, G.S.; Vlahovic-Palcevski, V.; Gyssens, I.C.J.

    2015-01-01

    We surveyed European medical schools regarding teaching of prudent antibiotic prescribing in the undergraduate curriculum. We performed a cross-sectional survey in 13 European countries (Belgium, Croatia, Denmark, France, Germany, Italy, Netherlands, Norway, Serbia, Slovenia, Spain, Switzerland, Uni

  16. On the construction of symmetric nonnegative matrix with prescribed Ritz values

    Directory of Open Access Journals (Sweden)

    Alimohammad Nazari

    2014-09-01

    Full Text Available In this paper for a given prescribed Ritz values that satisfy inthe some  special conditions,  we find a symmetric nonnegativematrix, such that  the given set be its Ritz values.

  17. Emissions from Combustion of Open Area Sources: Prescribed Forest and Agricultural Burns

    Science.gov (United States)

    Emissions from wildfires and prescribed forest and agricultural burns generate a variety of emissions that can cause adverse health effects for humans, contribute to climate change, and decrease visibility. Only limited pollutant data are available for these sources, particularly...

  18. [Prescribed fire in northern mixed grass prairie] 2001 field season progress report, J. Clark Salyer NWR

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Progress report on the 2001 field season for the project titled "Prescribed fire for fuel reduction in northern mixed grass prairie : Influence on habitat and...

  19. Prescribed Burning Plan for FY 1988 : Parker River National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This is the 1988 prescribed burning plan for Parker River National Wildlife Refuge. Treatment #1 is the area consisting of the fresh water marsh inside the Stage...

  20. Prescribed Fire Plan : Stillwater National Wildlife Refuge : Kent Fields Programmatic Maintenance Burning

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The objective of this prescribed fire plan for Stillwater National Wildlife Refuge is to remove stubble and weeds to enhance wildlife forage crop productivity on the...