Journal articles on the topic 'Efficacy of medications'
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Sleath, Betsy, Susan J. Blalock, David Covert, Asheley Cockrell Skinner, Kelly W. Muir, and Alan L. Robin. "Patient Race, Reported Problems in Using Glaucoma Medications, and Adherence." ISRN Ophthalmology 2012 (November 21, 2012): 1–7. http://dx.doi.org/10.5402/2012/902819.
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Objective. The objectives of the study were to (a) describe various factors potentially related to objectively measured adherence to glaucoma medications and self-reported glaucoma medication adherence self-efficacy and (b) examine the relationship between patient race, the number of patient reported-problems, and adherence in taking their glaucoma medication. This was a cross-sectional study conducted at two glaucoma subspecialist referral ophthalmology practices. Methods. We measured subjects' reported problems in using glaucoma medications, adherence to glaucoma medications utilizing the Medication Events Monitoring System (MEMS) devices, and general glaucoma medication adherence self-efficacy using a previously validated 10-item scale. Multivariable logistic and linear regression was used to analyze the data. Results. Seventy-one percent of patients self-reported at least one problem in using their glaucoma medications. White patients were more than 3 times more likely to be 80% adherent in using their glaucoma medications than non-White patients. Patients who had glaucoma longer reported significantly higher glaucoma medication adherence self-efficacy. Patients who reported more problems in using their medications had significantly lower glaucoma medication adherence self-efficacy. Conclusions. Eye care providers should assess patient reported problems and glaucoma medication adherence self-efficacy and work with patients to find ways to reduce the number of problems that patients experience to increase their self-efficacy in using glaucoma medications.
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S, Chhabra. "Efficacy of Medications in Anaemic Women of Reproductive Age." Open Access Journal of Gynecology 5, no. 1 (January 9, 2020): 1–7. http://dx.doi.org/10.23880/oajg-16000204.
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Background: Anaemia, most common due to iron deficiency affects all ages in many populations and has become major public health global concern. Attempts continue to prevent. Objective: was to know efficacy of allopathic, ayurvedic medication, nutritional advice on women with mild, moderate anaemia with no obvious disorders which could cause anaemia. Material Methods: Institute based study was carried out after taking ethics committee’s approval. Study subjects were women of 15 to 49 years from outpatient of obstetrics gynaecology. They had disorders but not those which could have caused anaemia. Volunteers, relatives or friends of patients, were explained, included after looking into inclusion criteria. No one refused and 75% were patients. After checking haemoglobin women with mild, moderate anaemia were given medication monthly for 6 months. Nutritional advocacy was done using booklet. Total 904 anaemic women were divided in 4 groups randomly, group A Allopathic medication, group An Allopathic medication with nutritional advice, group B: Ayurvedic medication, group Bn: Ayurvedic medication with nutritional advice. Results: 1330 women screened, 904(67.96%), 168(18.6%), moderately and 736(81.41%) were mildly anaemic. Of them only 562(62.2%) women took medication though provided free, 104(61.90%) of moderately anaemic 458(62.22%), mildly anaemic. After 180 days of 104 moderately anaemic 72(69.21%) became nonanaemic, 32(30.8%) mildly anaemic and of 458 mildly anaemic, 430(93.9%) became non-anaemic women. 28(6.1%) remained mildly anaemic. Subjective analysis revealed feeling very good in most, no change in few. No one talked of negative effects. Some had side effects. Conclusion: It is essential to find ways of appropriate iron intake to prevent anaemia. In very small numbers anaemia did not change in spite of giving iron which needs research. Research on behavioural aspect is needed as noncompliance was in large numbers even with free medication.
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Hembree, Elizabeth A., David S. Riggs, Michael J. Kozak, Martin E. Franklin, and Edna B. Foa. "Long-Term Efficacy of Exposure and Ritual Prevention Therapy and Serotonergic Medications for Obsessive-Compulsive Disorder." CNS Spectrums 8, no. 5 (May 2003): 363–71. http://dx.doi.org/10.1017/s1092852900018629.
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ABSTRACTWhat is the long-term outcome of patients with obsessive-compulsive disorder (OCD) who are treatred with exposure and response (ritual) prevention (EX/RP) alone, serotonergic medications alone, or their combination? How is the long-term outcome of these patients affected by the discontinuation? Follow-up assessments were conducted with 62 patients treated for OCD an average of 17 months posttreatment (range: 6–43 months). Patients received one of three treatments: serotonergic medications (fluvoxamine or clomipramine), intensive behavior therapy involving EX/RP, or intensive EX/RP with concurrent antidepressant medication. At follow-up, no differences in OCD symptom severity were found among the three treatment groups. However, when current medication use was taken into consideration, differences among the three treatment groups emerged. Among patients who were medication-free at the time of follow-up assessment (n=37), those in the EX/RP-alone and EX/RP-with-medication groups had lower symptom severity ratings than those in the medication-only group on 4 out of 6 measures. There were no differences in OCD severity ratings among patients taking medications at follow-up (n=25). Although these findings are interpreted with caution due to the uncontrolled nature of the study, results suggested that long-term outcome may be superior following EX/RP than following serotonergic medications, after discontinuation. For patients who remain on medications, the treatment produced benefits equivalent to EX/RP.
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Park, Sea Mi, Halinder S. Mangat, Karen Berger, and Axel J. Rosengart. "Efficacy spectrum of antishivering medications." Critical Care Medicine 40, no. 11 (November 2012): 3070–82. http://dx.doi.org/10.1097/ccm.0b013e31825b931e.
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Wakai, Eri, Kenji Ikemura, Chika Kato, and Masahiro Okuda. "Effect of number of medications and complexity of regimens on medication adherence and blood pressure management in hospitalized patients with hypertension." PLOS ONE 16, no. 6 (June 10, 2021): e0252944. http://dx.doi.org/10.1371/journal.pone.0252944.
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Introduction Good adherence of antihypertensives is recommended for the accomplishment of hypertension therapy. The number of medications and characteristics contributing to medication regimen complexity, such as dosage forms and dosing frequency, are known to influence medication adherence. However, the effect of medication regimen complexity on the therapeutic efficacy of medicines remains to be clarified. In the present study, we retrospectively investigated the effect of number of medications and medication regimen complexity on medication adherence and therapeutic efficacy in patients with hypertension. Methods According to the inclusion and exclusion criteria, 1,057 patients, who were on medications including antihypertensives on admission at the Mie University Hospital between July 2018 and December 2018, were enrolled in this study. Poor blood pressure management was defined if the systolic or diastolic blood pressure were ≥140 mmHg or ≥ 90 mmHg. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI) score. Results Among 1,057 patients, 164 and 893 patients were categorized into poor and good adherence groups, respectively. The multivariate analyses revealed that age ≥ 71 years and oral MRCI score ≥ 19.5 but not number of oral medications were extracted as risk factors for poor medication adherence. Medication adherence and blood pressure management were poor in the group with oral MRCI score ≥ 19.5, regardless of the age. The rate of readmission was similar. Conclusion Our study is the first to demonstrate that medication regimen complexity rather than number of medications is closely related to medication adherence and blood pressure management. Hence, physicians and/or pharmacists should consider the complexity of medication regimens while modifying them.
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Neafsey, Patricia J. "Self-Medication Practices That Alter the Efficacy of Selected Cardiac Medications." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 22, no. 2 (February 2004): 88–98. http://dx.doi.org/10.1097/00004045-200402000-00007.
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Feren, Stephen, Anup Katyal, and James K. Walsh. "Efficacy of Hypnotic Medications and Other Medications Used for Insomnia." Sleep Medicine Clinics 1, no. 3 (September 2006): 387–97. http://dx.doi.org/10.1016/j.jsmc.2006.06.011.
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Schneider, Lon S., and Jason T. Olin. "Efficacy of Acute Treatment for Geriatric Depression." International Psychogeriatrics 7, S1 (October 1995): 7–25. http://dx.doi.org/10.1017/s1041610295002328.
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The antidepressant literature for depression in late life tends to be interpreted as saying that certain antidepressant medications—e.g., nortriptyline, doxepin, fluoxetine—have fewer and milder side effects than others, whereas overall efficacy is equivalent (Plotkin et al., 1987; Rush, 1993; Salzman et al., 1995; Schneider, 1994). Further examination of this literature, however, suggests that both efficacy and side effect rates for any particular medication vary among trials, and often depend on the medications being compared, the use of placebe, the dose, and the design of the trial.In this report we review selected clinical trials, and summarize and discuss a previously published meta-analysis. Treatment recommendations from the 1991 NIH Consensus Development Conference on the Diagnosis and Treatment of Depression in Late Life and from the Agency for Health Care Policy Research are discussed. Directions for fume research are suggested.Both antidepressant medications and brief structured psychotherapies have efficacy in the acute treatment of elderly depressed outpatients with major unipolar, nondelusional depression. Effective treatment for depression involves consideration of the type and severity of illness, adequate prescribing, patient education, and regular patient monitoring for compliance, symptom change, side effects, and intercurrent medical disorders, which may complicate antidepressant therapy.
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McCulley, Caroline, Patricia Katz, Laura Trupin, Edward H. Yelin, and Jennifer L. Barton. "Association of Medication Beliefs, Self-efficacy, and Adherence in a Diverse Cohort of Adults with Rheumatoid Arthritis." Journal of Rheumatology 45, no. 12 (September 15, 2018): 1636–42. http://dx.doi.org/10.3899/jrheum.171339.
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Objective.Rheumatoid arthritis (RA) patients’ adherence to disease-modifying antirheumatic drugs (DMARD) is often suboptimal. We examined associations among medication beliefs, self-efficacy, and adherence to medications in RA.Methods.Data were from a longitudinal observational cohort of persons with RA. Subjects completed telephone interviews on self-reported adherence, self-efficacy, demographics, and the Beliefs about Medicines Questionnaire (BMQ), which assesses beliefs in necessity and beliefs about taking medication. Bivariate and multivariate logistic regression identified correlates of poor adherence to synthetic DMARD and prednisone as well as to biologic therapy, including medication concerns and necessity.Results.There were 362 patients who reported taking a synthetic DMARD and/or prednisone. Of these, 14% and 21% reported poor adherence to oral DMARD or prednisone, and biologics, respectively. There were 64% who reported concern about taking medicines, 81% about longterm effects, and 47% about becoming too dependent on medicines. In multivariate analyses, the BMQ necessity score was independently associated with better adherence to oral DMARD or prednisone (adjusted OR 0.61, 95% CI 0.41–0.91), while self-efficacy was associated with greater odds of poor adherence to oral medications (adjusted OR 1.23, 95% CI 1.01–1.59). Beliefs in medicines and self-efficacy were not associated with adherence to biologics.Conclusion.In a diverse cohort of patients with RA, stronger beliefs in the necessity of medication were associated with better adherence to oral DMARD or prednisone, while higher self-efficacy was associated with poor adherence. Providers can play important roles in eliciting patient beliefs about medications to improve adherence and ultimately health outcomes.
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Overall, Karen L. "Pharmacotherapeutics in clinical ethology: treatment efficacy, clinical pathology and outcome." Behaviour 158, no. 14-15 (June 1, 2021): 1355–419. http://dx.doi.org/10.1163/1568539x-bja10096.
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Abstract The use of psychopharmaceutical agents is a core aspect of treatment in veterinary behavioural medicine. Psychotropic medication use has shifted the focus of treatment from purely behavioural and environmental interventions to a multi-modal approach. Objective measures of efficacy are required for the licensing of medication. Pharmacotherapeutics have come to encompass supplements and diets, in addition to prescription medications. The first part of this paper examines the efficacy of medications, supplements and diets used in behavioural medicine. Foci include the role of evolution in the types of behavioural concerns reported, the importance of defining abnormal or pathological behaviour, use of terminology that supports stratified mechanistic diagnoses aid in understanding presentation and response clusters, and rational use of medication to relieve emotional, mental and behavioural suffering, given these diagnoses and clusters. The second part of this paper examines the extent to which variation in patient response to medication can enlighten us about mechanisms and outcomes of distress using a series of 3 patient populations who are the focus of studies on separation anxiety and noise reactivity. This response surface approach can be useful for understanding differences in populations in susceptibility to behavioural pathology and in medication response, and may suggest new avenues for drug development and application.
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Astakhov, Yury Sergeevich, Vitaly Olegovich Sokolov, Natalya Vladimirovna Morozova, Denis Pavlivich Novikov, and Mikhail Alexandrovich Morozov. "IOP-lowering therapy evaluation using 24-hour IOP monitoring." Ophthalmology journal 8, no. 3 (December 15, 2015): 51–55. http://dx.doi.org/10.17816/ov2015351-55.
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When choosing a medication, a doctor has to be sure in its efficacy and safety for the patient. The conduct of multiple post-registration studies on different aspects of medications’ use is aimed at helping the clinician to correctly evaluate the therapeutic potential of proposed medications. The aim of present study is to evaluate the IOP-lowering efficacy and tolerability of Glauprost, Duoprost, Dorzopt Plus in POAG patients according to 24-hour IOP monitoring data by circadian rhythms measured with Icare one tonometer. The IOP monitoring by circadian rhythms allowed obtaining considerably more data for IOP-lowering efficacy evaluation in comparison with single IOP measurement using Maklakov tonometer. This increases the IOP-lowering efficacy evaluation accuracy.
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Chung, Steve S., Norman C. Wang, and David M. Treiman. "Comparative Efficacy and Safety of Antiepileptic Drugs for the Treatment of Status Epilepticus." Journal of Pharmacy Practice 20, no. 2 (April 2007): 137–46. http://dx.doi.org/10.1177/0897190007305134.
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Status epilepticus (SE) is a medical emergency with high mortality rate. Common causes of SE include noncompliance with antiepileptic medications, drug- and alcohol-related etiologies, and central nervous system (CNS) infections. Because prolonged seizures can cause neuronal damage, treatment should be initiated promptly to avoid potential complications. Previous studies support intravenous (IV) lorazepam as first-line therapy and IV phenytoin or fosphenytoin as a second-line medication. If first-and second-line medications fail to control SE, further treatment with propofol, pentobarbital, midazolam, or other medications should be considered. Many of the drugs currently used to control SE are associated with sedation, respiratory suppression, hypotension, cardiac dysrhythmia, and anaphylactic reactions. Therefore, IV valproate or other newer antiepileptic drugs may be considered as an alternative third-line therapy for those who cannot tolerate the hypotensive effects of other anticonvulsants. This paper reviews comparative effectiveness and safety concerns among frequently used medications for SE.
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Grady, Meghan M., and Stephen M. Stahl. "A Horse of a Different Color: How Formulation Influences Medication Effects." CNS Spectrums 17, no. 2 (May 9, 2012): 63–69. http://dx.doi.org/10.1017/s1092852912000442.
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A medication's pharmacokinetic properties can be as important as its efficacy in determining how successful a treatment is. Formulation plays a critical role in absorption, distribution, and elimination of a drug, which in turn can influence the clinical profile of a medication, including onset and duration of action, consistency of plasma levels, ability to cross the blood-brain barrier, and other factors. Advances in drug delivery technology mean that formulation is now an integral component in the development of a drug. Likewise, formulation is one of the factors that may influence selection of a medication to suit the needs of a particular patient. This article briefly reviews the technologies commonly applied in the development of psychotropic medications, with emphasis on the various oral modified-release formulations, and discusses how formulation can be used to optimize the efficacy and tolerability of psychotropic drugs.
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Tully, Isabelle, Norah Simpson, Jessica Dietch, Joshua Tutek, and Rachel Manber. "356 Examining Use and Beliefs about Sleep Medications in a Sample of Older Adults: The Role of Hypnotic Dependency." Sleep 44, Supplement_2 (May 1, 2021): A142. http://dx.doi.org/10.1093/sleep/zsab072.355.
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Abstract Introduction Prevalence of insomnia and prescription of sleep medications increases in older adults and is associated with heightened risk of falls, cognitive and psychomotor detriments, and exacerbation of pre-existing conditions. The present study aimed to characterize beliefs about sleep and sleep medications, hypnotic self-efficacy, and hypnotic dependence in a sample of older adults with insomnia disorder. Methods Adults 50 years and older (N = 141) who met DSM-5 criteria for insomnia disorder were enrolled in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study. At baseline, participants completed the Beliefs about Medications Questionnaire (BMQ; subscales assess the belief that hypnotics are necessary and concern regarding consequences of use), Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pre-Sleep Arousal Scale (PSAS), and the Patient Health Questionnaire-4 (PHQ-4). Participants taking prescription sleep medications (n = 54) also reported if they had sedative hypnotic reduction goals and completed the Sleep Medications Dependency Scale and Hypnotic Self-Efficacy Scale. Results Those taking prescription sleep medications reported greater belief in the necessity of sedative hypnotics (p < .001, d = 1.69) and greater anxiety and depression (p = .005, d = .57) than those not taking prescription medications; groups did not differ significantly on the BMQ concern subscale, ISI, DBAS, or PSAS. 70.4% of participants using prescription sleep medications endorsed decrease in sedative hypnotic use as a treatment goal. Dependency on sleep medications, but not hypnotic self-efficacy, was greater in those with this goal (p = .003, d = .94). Higher levels of hypnotic dependence were associated with both greater concern (r = .40, p = .003) and belief in the necessity of sleep medications (r = .48, p < .001). Conclusion Our findings indicate that many treatment-seeking older adults with insomnia disorder take prescription sleep medications. They tend to believe in the necessity of sleep medications for controlling sleep disruption, but also identify medication reduction as a treatment goal, even if endorsing dependence on hypnotics. This highlights the importance of disseminating non-medication treatments that address both insomnia and reduction of sedative hypnotic use. Support (if any) 1R01AG057500
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Tucker, Calvin, Lyn Tucker, and Kyle Brown. "The Intranasal Route as an Alternative Method of Medication Administration." Critical Care Nurse 38, no. 5 (October 1, 2018): 26–31. http://dx.doi.org/10.4037/ccn2018836.
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Intranasal drug administration is a less invasive method of drug delivery that is easily accessible for adult and pediatric patients. Medications administered by the intranasal route have efficacy comparable to intravenous administration and typically have superior efficacy to subcutaneous or intramuscular routes. The intranasal route is beneficial in emergent situations when the intravenous route is not available. The intranasal route is safe and effective in various indications, and therapeutic systemic concentrations of medication can be attained via this route. As the evidence for and comfort with intranasal administration continue to grow, guidance on correct technique, medications, and dosing is vital for appropriate use. This article reviews the process and practices of appropriate intranasal medication administration.
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Antimisiaris, Demetra, Brittany McHolan, Daniela Moga, and Cortney Mospan. "Medication Related Problems." Senior Care Pharmacist 36, no. 2 (February 1, 2021): 68–82. http://dx.doi.org/10.4140/tcp.n.2021.68.
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When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.
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Antimisiaris, Demetra, Brittany McHolan, Daniela Moga, and Cortney Mospan. "Medication Related Problems." Senior Care Pharmacist 36, no. 2 (February 1, 2021): 68–82. http://dx.doi.org/10.4140/tcp.n.2021.68.
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When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.
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Zhu, Ying, Tong Zhang, Haiyan Li, Yang Yang, Qiong Chen, Lei Kong, and Bo Tai. "Discovering the Relative Efficacy of Inhaled Medications for Chronic Obstructive Pulmonary Disease: Multiple Treatment Comparisons." Cellular Physiology and Biochemistry 41, no. 4 (2017): 1532–46. http://dx.doi.org/10.1159/000470818.
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Background: Chronic obstructive pulmonary disease (COPD) is managed by three major classes of inhaled medications: inhaled corticosteroids (ICS), long-acting Beta 2-agonist (LABA), long-acting muscarinic antagonist (LAMA). Single inhaled medication is usually replaced by combined inhaled medications for efficacy enhancement. However, this practice should be supported by clinical evidence for large-scale implementations. Methods: The relative efficacy of inhaled medications is determined by three endpoints: changes in the trough forced expiratory volume in 1 second (tFEV1), changes in the St George’s Respiratory Questionnaire (SGRQ) score and the proportion of SGRQ responders which represents a reduction in SGRQ total score at week 24 of ≥4.0. A total of 76 eligible studies were identified in PubMed and Embase. Relevant data were extracted for the purpose of evidence synthesis. Then, raw mean differences (MD) and odds ratios (ORs) were produced by using the network meta-analysis. Results: Patients with ICS + LABA, ICS + LABA + LAMA, LABA, LABA + LAMA, LAMA exhibited significant increases in the tFEV1 compared to those with placebo (P < 0.05). Moreover, patients with ICS + LABA + LAMA exhibited the largest increase in the average tFEV1 and the largest decrease in the average SGRQ scores compared to those with placebo. COPD patients with ICS + LABA + LAMA were far more likely to achieve a significant reduction in the SGRQ scores compared to those with placebo or other inhaled medications (OR > 1). Conclusions: The combined inhaled medication of ICS + LABA + LAMA may be more efficacious than other inhaled medications for COPD patients.
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Limkakeng Jr, Alexander, Pratik Manandhar, Alaatin Erkanli, Stephanie Eucker, Adam Root, and Deepak Voora. "United States Emergency Department Use of Medications with Pharmacogenetic Recommendations." Western Journal of Emergency Medicine 22, no. 6 (September 23, 2021): 1347–54. http://dx.doi.org/10.5811/westjem.2021.5.51248.
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Introduction: Emergency departments (ED) use many medications with a range of therapeutic efficacy and potential significant side effects, and many medications have dosage adjustment recommendations based on the patient’s specific genotype. How frequently medications with such pharmaco-genetic recommendations are used in United States (US) EDs has not been studied. Methods: We conducted a cross-sectional analysis of the 2010–2015 National Hospital Ambulatory Medical Care Survey (NHAMCS). We reported the proportion of ED visits in which at least one medication with Clinical Pharmacogenetics Implementation Consortium (CPIC) recommendation of Level A or B evidence was ordered. Secondary comparisons included distributions and 95% confidence intervals of age, gender, race/ethnicity, ED disposition, geographical region, immediacy, and insurance status between all ED visits and those involving a CPIC medication. Results: From 165,155 entries representing 805,726,000 US ED visits in the 2010–2015 NHAMCS, 148,243,000 ED visits (18.4%) led to orders of CPIC medications. The most common CPIC medication was tramadol (6.3%). Visits involving CPIC medications had higher proportions of patients who were female, had private insurance and self-pay, and were discharged from the ED. They also involved lower proportions of patients with Medicare and Medicaid. Conclusion: Almost one fifth of US ED visits involve a medication with a pharmacogenetic recommendation that may impact the efficacy and toxicity for individual patients. While direct application of genotyping is still in development, it is important for emergency care providers to understand and support this technology given its potential to improve individualized, patient- centered care.
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Guilhot, Francois, Hagop Kantarjian, Neil P. Shah, Andreas Hochhaus, M. Brigid Bradley-Garelik, David Dejardin, and Jorge E. Cortes. "Dasatinib (Versus Imatinib) In Patients (Pts) with Newly Diagnosed Chronic Myeloid Leukemia In Chronic Phase (CML-CP): Analysis of Safety and Efficacy by Use of Baseline Medications In the DASISION Trial." Blood 116, no. 21 (November 19, 2010): 2295. http://dx.doi.org/10.1182/blood.v116.21.2295.2295.
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Abstract Abstract 2295 Background: During first-line BCR-ABL inhibitor therapy for CML-CP, concomitant medication use is associated with worse adherence to CML therapy, which may detrimentally affect efficacy (St Charles, ASH 2009; Marin, J Clin Oncol 2010). Medications may include adjuvants to anti-CML therapy or treatments for comorbid conditions. Depending on posology, the number of medications may affect BCR-ABL inhibitor efficacy and safety. Dasatinib is a BCR-ABL inhibitor 325-fold more potent than imatinib at inhibiting BCR-ABL in vitro and is taken once daily (QD) at any time of day with or without food. Medications that prolong QTc, or increase or decrease dasatinib levels (CYP3A4 substrates/inhibitors/inducers, PPIs and H2 antagonists) should be avoided. In the phase 3 DASISION trial, first-line dasatinib 100 mg QD had superior efficacy vs imatinib 400 mg QD in pts with newly diagnosed CML-CP, including significantly higher complete cytogenetic response (CCyR) and major molecular response (MMR) rates. Here, efficacy and safety of dasatinib (and imatinib) by number and type of baseline medications were analyzed. Methods: 519 pts with newly diagnosed CML-CP were randomized to dasatinib 100 mg QD (n=259) or imatinib 400 mg QD (n=260) arms. Exclusion criteria included prior interferon or systemic anti-CML therapy (except anagrelide, hydroxyurea, or ≤28 days of imatinib), and baseline pleural effusion, cardiovascular disease, or bleeding disorder unrelated to CML. Efficacy and safety were assessed using rates of CCyR/MMR or drug-related adverse events (AE), respectively. Baseline medications were defined as any additional medication taken prior to initiating study therapy, as reported by individual investigators. Results: 189/259 pts (73%) in the dasatinib arm and 194/260 pts (75%) in the imatinib arm were receiving ≥1 baseline medication (median 2, range 1–7). Medications taken by ≥5% of pts were prophylactic allopurinol therapy for tumor lysis syndrome (51%); alimentary tract or metabolism therapies, eg, antacids or PPIs (33%: omeprazole 6%, famotidine <1%); nervous system therapies, eg, NSAIDs or other analgesics (22%); cardiovascular therapies, eg, calcium channel blockers, loop diuretics, β blockers, and ACE inhibitors (21%); agents for blood or blood-forming organs, eg, folic acid or statins (15%); systemic antibiotics/antifungals/vaccines (7%); and respiratory system therapies, eg, antihistamines or inhaled steroids (7%). 12-month CCyR and MMR rates were unaffected by the number of baseline medications. Pts in the dasatinib arm receiving 0, 1–3, or ≥4 medications (27%, 56%, and 17%, respectively) had CCyR rates of 79%, 85%, and 87% and MMR rates of 43%, 49%, and 42%, respectively. Pts in the imatinib arm receiving 0, 1–3, or ≥4 medications had CCyR rates of 76%, 70%, and 71% and MMR rates of 35%, 26%, and 23%, respectively. In pts receiving baseline medications, safety was similar irrespective of the number received. Respective grade 3/4 thrombocytopenia rates for pts receiving 0, 1–3, or ≥4 medications were 28%, 17%, and 13% in the dasatinib arm and 9%, 9%, and 17% in the imatinib arm; grade 3/4 neutropenia rates were 29%, 13%, and 31% in the dasatinib arm and 31%, 18%, and 11% in the imatinib arm. Nonhematologic AEs of any grade occurring in ≥10% of pts receiving dasatinib and 0, 1–3, or ≥4 medications, respectively, were diarrhea in 17% vs 19% vs 13% (13% vs 19% vs 17% with imatinib), nausea/vomiting in 12% vs 9% vs 18% (25% vs 23% vs 23% with imatinib), arthralgia/myalgia in 12% vs 10% vs 11% (28% vs 13% vs 14% with imatinib), rash in 6% vs 12% vs 18% (19% vs 16% vs 20% with imatinib), fluid retention in 9% vs 23% vs 24% (41% vs 44% vs 37% with imatinib), pleural effusion in 1% vs 13% vs 13% (0% with imatinib) and superficial edema in 7% vs 8% vs 16% (25% vs 41% vs 31% with imatinib). Efficacy and safety patterns were generally comparable in pts receiving various baseline medication categories. Additional analyses of on-study medication characteristics and effects on efficacy or safety will be presented. Conclusions: Although occurrence of pleural effusion and fluid retention appeared higher in patients receiving ≥1 medication with dasatinib, overall, the number of medications administered at baseline in the DASISION trial did not appear to affect efficacy or safety of dasatinib (or imatinib) in pts with newly diagnosed CML-CP. Disclosures: Guilhot: Bristol-Myers Squibb: Honoraria, Research Funding; Novartis: Honoraria, Research Funding. Off Label Use: This abstract discusses the use of first-line dasatininb in CML-CP. Kantarjian: Bristol-Myers Squibb: Research Funding; Novartis: Consultancy, Research Funding; Wyeth: Research Funding. Shah: Bristol-Myers Squibb: Consultancy; Novartis: Consultancy; Ariad: Consultancy. Hochhaus: Bristol-Myers Squibb: Consultancy, Research Funding; Novartis: Consultancy, Research Funding. Bradley-Garelik: Bristol-Myers Squibb: Employment. Dejardin: Bristol-Myers Squibb: Employment, Equity Ownership. Cortes: Bristol-Myers Squibb: Research Funding.
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Silberstein, SD. "Preventive Treatment of Migraine." Cephalalgia 17, no. 2 (April 1997): 67–72. http://dx.doi.org/10.1046/j.1468-2982.1997.1702067.x.
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The pharmacologic treatment of migraine may be acute (abortive, symptomatic) or preventive (prophylactic). Most migraine preventive medications were designed to treat other disorders (e.g., propranolol for hypertension, valproate for epilepsy, etc.). Preventive medication is usually given daily for months or years; however, treatment can be episodic, subacute, or chronic. The medications can be divided into two major categories: (i) Alternatives of high efficacy, which include β- blockers, tricyclic antidepressants, and divalproex, and of lower efficacy, which include selective serotonin reuptake inhibitors, calcium channel antagonists, and non-steroidal antiinflammatory drugs and (ii) second-line choices of high efficacy, which include methysergide and monoamine oxidase inhibitors. The choice of preventive treatment depends on the individual drug's efficacy and side effects, the patient's wants, needs, and response to prior treatment, and the presence of any comorbid or coexistent disease. Most patients require acute headache treatment. Some require preventive treatment. Patients on preventive medication still require acute treatment for breakthrough attacks. Many patients find that their acute attacks are more manageable if they are on a preventive medication. The choice of preventive treatment depends on the individual drug's efficacy and side effects, the patient's wants, needs, and response to prior treatment, and the presence of any comorbid or coexistent disease.
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Detweiler, Mark B. "Digestive Enzyme Adjunct to Oral Headache Medication to Improve Absorption and Reduce Vomiting." Journal of Pharmacy Technology 13, no. 4 (July 1997): 169–73. http://dx.doi.org/10.1177/875512259701300406.
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Objective: To report a case in which a digestive enzyme complex (Nature's Plus Digestive Enzymes: pancreatin, pepsin, ox bile extract, malt diatase, and papain) apparently improved the absorption and efficacy of an oral headache medication and alleviated vomiting associated with the headache. Case Summary: A 47-year-old white woman with a history of adverse drug reactions and allergies had been experiencing one to four disabling headaches per week for 2 years. One or two headaches each week would be accompanied by vomiting. This patient experienced adverse effects with most standard headache medications. For 40 months since taking a complex of digestive enzymes as an adjunct to her headache medication, the patient's vomiting has been eliminated, and her postheadache symptoms have been reduced. Discussion: Altered digestive processes are a common finding in severe headache episodes. Exogenous digestive enzymes may facilitate the absorption of oral medication during gastric disruption and consequently increase drug efficacy and the relief of symptoms. Conclusions: Digestive enzymes merit further study to ascertain their effectiveness in increasing the absorption and efficacy of oral medications prescribed for headaches accompanied by emesis.
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Boris, Jeffrey R., and Thomas Bernadzikowski. "Therapy for fatigue and cognitive dysfunction in postural orthostatic tachycardia syndrome." Cardiology in the Young 28, no. 12 (September 10, 2018): 1415–20. http://dx.doi.org/10.1017/s1047951118001415.
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AbstractIntroductionSevere fatigue and cognitive dysfunction are frequent symptoms in patients with postural orthostatic tachycardia syndrome. They can be debilitating, and often do not resolve despite improvement in haemodynamic symptoms. Our analysis was intended to assess clinical outcomes of medication treatment for these symptoms in a large, single-centre paediatric programme.Materials and MethodsWe performed a retrospective review of patients treated for fatigue and cognitive dysfunction. Patients aged 18 years or younger at the time of initial diagnosis were included. Patients who had a specific medication ordered five or more times for these symptoms were confirmed by chart review for clinical improvement. Percentage of patients with clinical improvement for each medication and overall for all medications, as well as the number of medications per patient required to achieve improvement, were assessed. Data were analysed based on gender as well. t-Test and χ2 analyses were used to assess for differences between means in variables, or specific variables.ResultsA total of 708 patients met study criteria, of whom 517 were treated for fatigue or brain fog. Overall efficacy was 68.8%, with individual medication effectiveness ranging from 53.1 (methylphenidate) to 16.5% (atomoxetine). There was no significant difference in efficacy with respect to gender. The median number of medications used per patient was 2, without gender difference. Therapy was limited by side effects or lack of efficacy.DiscussionMedications are effective in the improvement of fatigue and cognitive dysfunction in these patients. However, trials of multiple medications may be needed before achieving clinical improvement.
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Ie, Kenya, Masanori Hirose, Tsubasa Sakai, Iori Motohashi, Mari Aihara, Takuya Otsuki, Ayako Tsuboya, et al. "Protocol of a randomised controlled trial on the efficacy of medication optimisation in elderly inpatients: medication optimisation protocol efficacy for geriatric inpatients (MPEG) trial." BMJ Open 10, no. 10 (October 2020): e041125. http://dx.doi.org/10.1136/bmjopen-2020-041125.
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IntroductionWhether medication optimisation improves clinical outcomes in elderly individuals remains unclear. The current study aims to evaluate the effect of multidisciplinary team-based medication optimisation on survival, rehospitalisation and unscheduled hospital visits in elderly patients.Methods and analysisWe report the protocol of a single-centre, open-label, randomised controlled trial. The enrolled subjects will be medical inpatients, aged 65 years or older, admitted to a community hospital and receiving five or more regular medications. The participants will be randomly assigned to receive either an intervention for medication optimisation or the usual care. The intervention will consist of a multidisciplinary team-based medication review, followed by a medication optimisation proposal based on the Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment criteria and an implicit medication optimisation protocol. Medication optimisation summaries will be sent to primary care physicians and community pharmacists on discharge. The primary outcome will be a composite of death, unscheduled hospital visits and rehospitalisation until 48 weeks after randomisation. Secondary outcomes will include each of the primary endpoints, the number of prescribed medications, quality of life score, level of long-term care required, drug-related adverse events, death during hospitalisation and falls. Participants will be followed up for 48 weeks with bimonthly telephone interviews to assess the primary and secondary outcomes. A log-rank test stratified by randomisation factors will be used to compare the incidence of the composite endpoint. The study was initiated in 2019 and a minimum of 500 patients will be enrolled.Ethics and disseminationThe study protocol has been approved by the Institutional Ethical Committee of St. Marianna University School of Medicine (No. 4129). The results of the current study will be submitted to a peer-reviewed journal.Trial registration numberUMIN000035265
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Fox, Siobhán, Ashling Murphy, Aisling Jennings, Kieran Murphy, and Suzanne Timmons. "247 Antipsychotic Medication in the Management of Non-cognitive Symptoms of Dementia: An Updated Evidence Review." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.151.
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Abstract Background Antipsychotic medications are commonly used in the management of non-cognitive symptoms of dementia (also termed behavioural and psychological symptoms of dementia), such as agitation, calling out, hoarding, or aggression. This is despite increased recognition of adverse effects, including mortality, from these medications for people with dementia. The current aim was to review the most recent evidence for the efficacy and safety of antipsychotic medications in the management of non-cognitive symptoms in dementia. Methods Relevant studies published in English from March 2015 through to March 2018 were identified by searches of 5 databases: Medline, EBSCO, PsycINFO, Cochrane DARE, and Cochrane CENTRAL. Systematic reviews, meta-analyses, and controlled trials evaluating the safety of antipsychotic medication, or comparing the effectiveness of antipsychotic medication with placebo, another antipsychotic medication, or non-pharmacological intervention, were included. Independent article review and data extraction was performed by two reviewers. Study quality was appraised using the Joanna Briggs Institute critical appraisal tools. Results Thirteen studies were included. Benefits and harms vary among antipsychotic medications for people with dementia, however overall efficacy of antipsychotics remains modest at best. A significant number of side effects are associated with antipsychotics, not least cerebrovascular events, sedation, gait disturbances, falls, fractures, urinary tract infections, cognitive worsening, and mortality. Atypical antipsychotics have a more favourable safety profile in some respects. People with certain dementias, notably Lewy Body Dementia, may experience more severe side-effects. Conclusion The evidence reinforces caution when prescribing antipsychotic medications for people with dementia; these medications should only be considered when symptoms are severe or non-pharmacological interventions have failed. Clinicians should closely monitor people with dementia who are prescribed an antipsychotic for side effects, limiting use of these medications to short-term treatment if possible. The forthcoming national clinical guideline for appropriate prescribing of psychotropic medications for non-cognitive symptoms will support clinical decision-making in this regard.
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Heard, Kennon, Nathan R. Cleveland, and Shay Krier. "Benzodiazepines and antipsychotic medications for treatment of acute cocaine toxicity in animal models – A systematic review and meta-analysis." Human & Experimental Toxicology 30, no. 11 (March 7, 2011): 1849–54. http://dx.doi.org/10.1177/0960327111401435.
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There are no controlled human studies to determine the efficacy of benzodiazepines or antipsychotic medications for prevention or treatment of acute cocaine toxicity. The only available controlled data are from animal models and these studies have reported inconsistent benefits. The objective of this study was to quantify the reported efficacy of benzodiazepines and antipsychotic medication for the prevention of mortality due to cocaine poisoning. We conducted a systematic review to identify English language articles describing experiments that compared a benzodiazepine or antipsychotic medication to placebo for the prevention of acute cocaine toxicity in an animal model. We then used these articles in a meta-analysis with a random-effects model to quantify the absolute risk reduction observed in these experiments. We found 10 articles evaluating antipsychotic medications and 15 articles evaluating benzodiazepines. Antipsychotic medications reduced the risk of death by 27% (95% CI, 15.2%–38.7%) compared to placebo and benzodiazepines reduced the risk of death by 52% (42.8%–60.7%) compared to placebo. Both treatments showed evidence of a dose-response effect, and no experiment found a statistically significant increase in risk of death. We conclude that both benzodiazepines and antipsychotic medications are effective for the prevention of lethality from cocaine toxicity in animal models.
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&NA;. "CE Test: Self-Medication Practices That Alter the Efficacy of Selected Cardiac Medications." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 22, no. 2 (February 2004): 99–100. http://dx.doi.org/10.1097/00004045-200402000-00008.
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Pappachan, Joseph M. "Efficacy and Cardiovascular Safety of Antidiabetic Medications." Current Drug Safety 16, no. 2 (June 8, 2021): 115–21. http://dx.doi.org/10.2174/1574886316666210112153429.
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: Diabetes mellitus (DM) has already affected one in every eleven person in the global population, and the dis-ease prevalence continues to increase because of the obesity pandemic. Even with the availability of a multitude of antidi-abetic medications for optimal glycaemic control, cardiovascular morbidity and mortality were not largely altered until re-cently when newer antidiabetic drugs such as glucagon-like peptide-1 receptor analogues (GLP-1RAs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were introduced. Cardiovascular safety of antidiabetic drugs has also been a hot topic for global scientific debate after the US Food and Drug Administration (FDA) enforced restrictions on Rosiglita-zone in 2010 with the suspicion of increased mortality and myocardial events (with subsequent uplift of the ban on the drug in 2013 following the emergence of additional evidence on safety). After this debate, all antidiabetic should go through rigorous safety checks with cardiovascular outcome trials (CVOTs). Recent CVOTs with GLP-1RAs and SGLT2 inhibitors have revealed markedly positive outcomes that have changed the landscape of diabetes management across the world. Thus, the therapeutic algorithm for optimal management of DM should consider not only the glycaemic control ef-ficacy of the individual antidiabetic agent but also the cardiovascular safety and modifications in other anticipated long-term DM complication profiles. Therefore, it is imperative to critically appraise the efficacy and cardiovascular safety of all antidiabetic drugs to improve the scientific practice of our diabetes care globally. This issue, “Efficacy and cardiovas-cular safety of antidiabetic medications,” provides readers the back-up of up to date evidence.
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Ed, Susman. "Omalizumab enhances efficacy of established asthma medications." Inpharma Weekly &NA;, no. 1382 (April 2003): 7–8. http://dx.doi.org/10.2165/00128413-200313820-00012.
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Siedlecki, Adam R., Patrice M. Hicks, Benjamin Haaland, Margaret M. DeAngelis, and Sandra F. Sieminski. "Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma." Journal of Personalized Medicine 11, no. 8 (August 16, 2021): 797. http://dx.doi.org/10.3390/jpm11080797.
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iStent implantation is thought to augment the trabecular outflow channel in the anterior segment of the eye. We hypothesized that iStent with subsequent selective laser trabeculoplasty (SLT) would better control the intraocular pressure (IOP) compared to standalone SLT in patients with primary open-angle glaucoma (POAG). We, therefore, determined if the presence of an iStent combined with SLT was statistically associated with IOP lowering compared to standalone SLT. Through retrospective electronic medical record review, records of 824 eyes from 440 patients who received primary SLT without a history of iStent were considered. Additionally, 42 eyes from 28 patients who received SLT after combined phacoemulsification and iStent implantation that failed to control intraocular pressure (IOP) and/or the progression of the disease were retrospectively reviewed. IOP and number of medications, which were tracked in each patient for up to 12 months post laser, were also examined. Successful outcome was defined as a statistically significant reduction in IOP or number of medications at 6 months. As defined in univariate analysis (p ≤ 0.01), multivariate analysis included iStent, age, sex, race, and initial IOP as variables. IOP reduction was statistically associated with patients pre-SLT IOP (p < 0.001) but not with patients with iStent (p = 0.222). Medication reduction was statistically associated with the pre-SLT number of medications (p < 0.001) and iStent (p < 0.001). In eyes that received SLT, iStent was not statistically associated with a greater reduction in IOP compared to controls, but was associated with a higher reduction in the overall number of medications used 6 months after receiving SLT. The work presented should guide clinicians to consider SLT as an effective therapy after iStent implantation, in terms of glaucoma medication reduction in iStent patients, but clinicians should know that the presence of an iStent does not necessarily make subsequent SLT more effective at lowering IOP.
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Meraya, Abdulkarim M. "Patterns of Medication Prescription among Children and Adolescents with Attention-Deficit/Hyperactivity Disorder in the United States." Children 9, no. 2 (January 30, 2022): 171. http://dx.doi.org/10.3390/children9020171.
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The objectives of this study are to: (1) quantify the difference in the annual number of prescription medications (total and unique) between children and adolescents with ADHD and those without ADHD; and (2) identify the most prescribed medication classes and unique medications among children and adolescents with ADHD. A retrospective cross-sectional study design was employed using data from the 2015 and 2017 Medical Expenditure Panel Survey. The study sample comprised children and adolescents (5–17 years). In the 5–12-year age group, those with ADHD were 2.4%, 17%, and 15% significantly more likely to have one, 2–4, and ≥5 prescription medications, respectively. Similarly, those in the 13–17-year age group were more likely to have one prescription medication (3%), 2–4 prescription medications (15%), and ≥5 prescription medications (12%) than those without ADHD. The most prescribed medications among children and adolescents with ADHD were methylphenidate and amphetamine-dextroamphetamine. ADHD was associated with both higher annual total and unique prescription medications. Additionally, concurrent use of prescription medications was more prevalent among children and adolescents with ADHD. High-quality randomized clinical trials on the safety and efficacy of combinations of multiple psychotherapeutics and stimulants’ agents are required to guide the evidence-based practices.
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Goettemoeller, Travis, Hiba Mazhar, Jessica Chippior, and Aman Rajpal. "PSUN113 Evaluating The Efficacy Of Anti-Obesity Medications In a Multidisciplinary Weight Management Clinic At a VA Medical Center." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A21—A22. http://dx.doi.org/10.1210/jendso/bvac150.045.
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Abstract Objective Anti-obesity medications have been shown to be effective in multiple randomized clinical trials, but there is limited data on the efficacy of these medications in the veteran population. This study was aimed to evaluate the effectiveness of anti-obesity medications in a multidisciplinary weight management clinic at our VA medical center. Methods This was a retrospective, descriptive study of 98 patients seen in a multidisciplinary weight management clinic at our VA medical center between January 1, 2019 and October 31, 2021. General requirements to be seen in the clinic were a BMI >30 or BMI >27 with comorbid conditions. Patients seen at least twice in the clinic were included in the study. Patients who received anti-obesity medications (phentermine-topiramate, naltrexone-bupropion, or GLP-1 receptor agonist (liraglutide or semaglutide)) had weights recorded at medication start date and at 2-4 months, 4-8 months, 8-10 months, and 10-14 months intervals. Baseline BMI, HbA1c, LDL-C and triglycerides were recorded at the medication start and followed up at similar intervals. Results There were 98 participants (56% males) within this study, with mean age of 54.9 years, mean baseline weight of 127.3 kg, and BMI of 43.5. Of all 98 patients seen in the clinic (regardless of being on anti-obesity medicine), 85 experienced some weight loss with 39 losing at least 5% of their body weight. The average weight loss from first to last visit was 4.1%. There were 72 patients who received anti-obesity medications for at least 3 consecutive months, including 12 patients who were subsequently trialed on a second class of anti-obesity medication. There were 35 trials of Qsymia, 43 trials of GLP-1 receptor agonists, and 6 trials of naltrexone-bupropion. For those patients receiving medications, average weight loss at 2-4 months was 3.7% (N=73), 4-8 months was 4.9% (N=58), 8-10 months was 6.0% (N=32), and 10-14 months was 5.5% (N=29). The percentage of patients able to lose at least 5.0% of their weight was 30.1% at 2-4 months, 43.1% at 4-8 months, 68.8% at 8-10 months, and 51.7% at 10-14 months. There was a decrease noted in HbA1c and LDL-C at all time periods, while there was no change in triglycerides. Conclusion Our data shows the effectiveness of anti-obesity medications in a veteran population seen in a multidisciplinary weight management clinic, though to a lesser extent as compared to clinical trials. Given the higher prevalence of multiple chronic conditions seen in veterans when compared to the general population, these patients have additional challenges when trying to achieve their weight loss goals. Further study must be performed to determine the long-term effectiveness and tolerability of these medications in this population. The differential effects among the anti-obesity medications should also be investigated further. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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Hofer, Rebecca, Hwajung Choi, Rebecca Mase, Angela Fagerlin, Michael Spencer, and Michele Heisler. "Mediators and Moderators of Improvements in Medication Adherence." Health Education & Behavior 44, no. 2 (July 18, 2016): 285–96. http://dx.doi.org/10.1177/1090198116656331.
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Objective. In a randomized controlled trial we compared two models of community health worker–led diabetes medication decision support for low-income Latino and African American adults with diabetes. Most outcomes were improved when community health workers used either an interactive e-Health tool or print materials. This article investigates mediators and moderators of improved medication adherence in these two models. Method. Because both programs significantly improved satisfaction with medication information, medication knowledge, and decisional conflict, we examined whether improvements in each of these outcomes in turn were associated with improvements in self-reported medication adherence, and if so, whether these improvements were mediated by improvements in diabetes self-efficacy or diabetes distress. Potential moderators of improvement included gender, race/ethnicity, age, education, insulin use, health literacy, and baseline self-efficacy, diabetes distress, and A1c. Results. A total of 176 participants (94%) completed all assessments. After adjusting for potential confounders, only increased satisfaction with medication information was correlated with improved medication adherence ( p = .024). Improved self-efficacy, but not diabetes distress, was associated with improvements in both satisfaction with medication information and medication adherence. However, the Sobel–Goodman Mediation test did not support improvements in self-efficacy as a mechanism by which improved satisfaction led to better adherence. None of the examined variables achieved statistical significance as moderators. Conclusions. Improvements in satisfaction with medication information but not in medication knowledge or decision conflict were associated with improvements in medication adherence. Interventions that target low-income ethnic and racial minorities may need to focus on increasing participants’ satisfaction with information provided on diabetes medications and not just improving their knowledge about medications. Future research should explore in more depth other possible mediators and moderators of improvements in medication adherence in low-income minority populations.
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Kekic, Adrijana, Mahesh Seetharam, Parminder Singh, Katie Kunze, Michael A. Golafshar, Cindy Azevedo, Sydney Welp, et al. "Integrating pharmacogenomics panel testing for supportive care medications in patients with solid tumors." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e24114-e24114. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e24114.
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e24114 Background: Pharmacogenomics (PGx) testing is used increasingly in cancer supportive care for drug and dose selection, and side effects prediction with antidepressants, antiemetics, and pain medications. Genetic variants in genes that encode for drug metabolizing enzymes (CYPs), transporters (SLC6A4) and drug receptors (HTR2A, OPRM1, etc) are well known for these medications. They contribute to inter-individual differences in medication safety and efficacy. We report on their frequency and effect on supportive care drugs in patients with solid tumors. Methods: Between 06/06/19 and 12/18/19, solid tumor cancer patients at Mayo Clinic Arizona were enrolled in a PGx prospective study. They were genotyped using a multi-gene panel, OneOme RightMed. The panel assessed 27 genes, including CYP2C9, CYP2C19, CYP2D6, CYP3A4, COMT, OPRM1, GRIK4, HTR2A, SLC6A4, associated with pain medications, antidepressants, and antiemetics. PGx pharmacist provided medication recommendations and dose adjustments based on PGx test results and concurrent medications. Results: 200 patients were swabbed and 196 patients were genotyped. The results were available within 5 days. All patients were also assessed for pheno-conversion (drug-drug-gene interactions) by a pharmacist. Recommendations were made based on predicted phenotype. Various solid tumor types were represented, including prostate (19.9%), colorectal (17.9%), melanoma (14.8%), and others (47.4%). Median age was 65 with 59.2% patients being male and 40.85% female. All had at least one actionable polymorphism related to these medications. The most significant findings were related to CYP2C19 and CYP2D6 genes. Of 196 patients, a total of 132 (67.3%) had other than normal CYP2D6 metabolizer phenotype and 112 (57.1%) had other than normal CYP2C19 metabolizer phenotype. Based on these genotypes, alternatives to pain medications were recommended for 37 patients, to ondansetron in 9 patients, and to anti-depressants in 51 patients. Conclusions: Genetic variants were commonly found that affect supportive care medications used in oncology practice and contribute to inter-individual differences associated with increased risk of adverse drug effects and reduced efficacy. PGx guided recommendation may help physicians in individualizing medication treatment outcomes for patients with different cancer types and with polypharmacy. PGx trained pharmacist can serve as a valuable asset in optimizing personalized medication management.
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Benson, Nicole M., Caryn Belisle, David W. Bates, and Hojjat Salmasian. "Low Efficacy of Medication Shortage Clinical Decision Support Alerts." Applied Clinical Informatics 12, no. 05 (October 2021): 1144–49. http://dx.doi.org/10.1055/s-0041-1740257.
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Abstract Objective We examined clinical decision support (CDS) alerts designed specifically for medication shortages to characterize and assess provider behavior in response to these short-term clinical situations. Materials and Methods We conducted a retrospective analysis of the usage of medication shortage alerts (MSAs) that included at least one alternative medication suggestion and were active for 60 or more days during the 2-year study period, January 1, 2018 to December 31, 2019, in a large health care system. We characterized ordering provider behavior in response to inpatient MSAs. We then developed a linear regression model to predict provider response to alerts using the characteristics of the ordering provider and alert frequency groupings. Results During the study period, there were 67 MSAs in use that focused on 42 distinct medications in shortage. The MSAs suggested an average of 3.9 alternative medications. Adjusting for the different alerts, fellows (p = 0.004), residents (p = 0.03), and physician assistants (p = 0.02) were less likely to accept alerts on average compared with attending physicians. Further, female ordering clinicians (p < 0.001) were more likely to accept alerts on average compared with male ordering clinicians. Conclusion Our findings demonstrate that providers tended to reject MSAs, even those who were sometimes flexible about their responses. The low overall acceptance rate supports the theory that alerts appearing at the time of order entry may have limited value, as they may be presented too late in the decision-making process. Though MSAs are designed to be attention-grabbing and higher impact than traditional CDS, our findings suggest that providers rarely change their clinical decisions when presented with these alerts.
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Phillips McEnany, Geoffry. "Psychopharmacologic Strategies and Associated Challenges in the Long-Term Treatment of Schizophrenia." Journal of the American Psychiatric Nurses Association 13, no. 5_suppl (October 2007): S6—S15. http://dx.doi.org/10.1177/1078390307304078.
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The comprehensive treatment of persons who have been diagnosed with schizophrenia requires the application of an effective and tolerable pharmacologic treatment regimen in conjunction with psychosocial interventions. The mainstay of pharmacologic treatment of persons diagnosed with schizophrenia is antipsychotic medication. The most commonly prescribed are the atypical or second-generation antipsychotic medications that have efficacy that matches, or in many cases is superior to that of conventional antipsychotics. In practice, however, medication adherence, as much as medication efficacy, is the key to improving patient outcomes.J Am Psychiatr Nurses Assoc, 2007; 13(S5), S6.-S15. DOI: 10.1177/1078390307304078
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Habert, Jeffrey, Howard C. Margolese, Adriana Wilson, Matthieu Boucher, and Pierre Blier. "Switching among branded and generic medication products during ongoing treatment of psychiatric illness." BMJ Innovations 6, no. 1 (January 2020): 39–43. http://dx.doi.org/10.1136/bmjinnov-2019-000370.
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Switches between branded (reference) medications and the corresponding generic medications or between two different corresponding generic medications occur commonly during the treatment of central nervous system disorders. Prescribing a generic product in place of a reference product can reduce patient and pharmacy costs. But there can be implications. Planned or unplanned switches from one product to another during ongoing treatment may introduce variability in drug exposure which could in turn compromise efficacy and/or tolerability. Studies comparing the initiation of reference versus generic products do not provide clear evidence of the superiority of reference or generic products generally, whereas several studies examining a switch between reference and generic products suggest that reductions in efficacy or medication adherence and persistence may be associated with generic substitution. Clinicians should work with patients to facilitate a consistent supply of reference or generic drug product that provides stable exposure to avoid clinical deterioration or poor tolerability.
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Babic, Nikola. "Fixed combinations of glaucoma medications." Srpski arhiv za celokupno lekarstvo 143, no. 9-10 (2015): 626–31. http://dx.doi.org/10.2298/sarh1510626b.
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The first line treatment in the management of glaucoma is topical medical therapy. Many patients with glaucoma require multiple medications for adequate intraocular pressure control. For patients who need multi-dose regimens to control intraocular pressure, fixed combinations offer convenience, efficacy and safety. This review summarizes the role, efficacy, mechanism of action and indications for use of modern fixed combination of topical glaucoma medications. The review shows the advantages and disadvantages of a prescribing fixed combination in daily clinical practice.
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Gabbay, Itay Elimelech, Felicity Allen, Christine Morley, Tahmina Pearsall, Oliver Martyn Bowes, and Simon Ruben. "Efficacy and safety data for the XEN45 implant at 2 years: a retrospective analysis." British Journal of Ophthalmology 104, no. 8 (November 14, 2019): 1125–30. http://dx.doi.org/10.1136/bjophthalmol-2019-313870.
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AimTo report efficacy and safety measures for XEN45 in a National Health Service setting after 24-month follow-up.MethodsThis is a retrospective, non-comparative audit of records of patients who underwent XEN45 procedure between June 2015 and May 2017. The main outcome measures were intraocular pressure (IOP) reduction and number of antihypertensive medications at each timepoint. Failure was defined as requiring further surgery or removal of XEN. Success was defined as 20% reduction of IOP without additional glaucoma medications or reduction in antihypertensive medications without increase in baseline IOP. Needling rates were assessed and subgroup analysis was performed.ResultsA total of 151 eyes were included in the study. The main diagnoses were primary open angle glaucoma (84.1%), angle closure glaucoma (8.6%) and refractory glaucoma (7.3%). Stand-alone procedure was performed in 62.3% and combined phaco-XEN was done in 37.7%. The mean IOP at baseline was 22.1±6.5 mm Hg, and the mean IOP at 12 and 24 months was 15.4±5.9 mm Hg and 14.5±3.3 mm Hg, respectively (p<0.001). The mean number of medications was 2.77±1.1 at baseline, and 0.3±0.7 and 0.5±1.0 medications at 12 and 24 months, respectively (p<0.001). 25% of patients failed at the 24-month timepoint. Needling was required in 37.7% of patients at 24 months. Non-Caucasian ethnicity was found to be related to higher failure rate. No significant adverse events were noted.ConclusionXEN45 is a viable, effective and safe procedure after 2 years of follow-up. Patients should be advised regarding failure rate as well as possible need for bleb revisions and medication use.
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Cohen, Harold C. "Assessment of the EMT-P Medications Used by Baltimore County Fire Department EMS Supervisors/EMT-Ps." Prehospital and Disaster Medicine 5, no. 1 (March 1990): 19–23. http://dx.doi.org/10.1017/s1049023x00026467.
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AbstractMany authorities in EMS have cited the lack of data concerning the efficacy of medications administered by prehospital providers. This paper reports the results of a prospective assessment of the efficacy and safety of certain medications used by emergency medical technician-paramedics (EMT-Ps) in a three-tiered response system. Data were collected for six months using forms that were completed by the EMT-P at the conclusion of an incident. Medication efficacy was measured for: bretylium tosylate, 14 patients/3 conversions to a sustaining rhythm (21 %); diazepam, 20 patients/17 stopped seizing or converted to focal motor seizure (85 %); dopamine hydrochloride, 14 patients/9 experiencing increase of blood pressure (64%); furosemide, 49 patients/28 instances of decreased respiratory distress (57%); and terbutaline sulfate, 46 patients/34 instances of decreased respiratory distress (74%). Serious side effects were rare and well managed by the EMT-Ps. These data indicate that these medications are effective and safe when used in the prehospital environment. Analysis of more data from different delivery profiles is necessary prior to drawing appropriate scientific conclusions. Data collected should include patient follow-up through hospital discharge.
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Allison, Katie. "Audit and re-audit of medication use in patients with impaired kidney function." Journal of Prescribing Practice 4, no. 4 (April 2, 2022): 148–55. http://dx.doi.org/10.12968/jprp.2022.4.4.148.
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Background: Medications prescribed for patients with chronic kidney disease (CKD) often require dose adjustments to ensure safety and efficacy. An audit was undertaken in primary care to assess how appropriate current medication use is in this patient cohort. Aim: To identify medications most likely to be prescribed at inappropriate doses in patients with CKD 3-5. Methods: Level 2 medication reviews were carried out by a clinical pharmacist for patients with a diagnosis of CKD level 3-5. The reviews focused on how appropriate medication use/dosages were where dose reduction or discontinuation would be recommended for patients with poor renal function. The audit was repeated a year later. Findings: Drugs that required creatinine clearance (CrCl) to be calculated had the most interventions: eight patients had dose changes implemented for rivaroxaban. Conclusion: The use of the correct calculation and regular review to assess the use and dose of medications in patients with poor renal function is vital in improving health outcomes.
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Hina, Mehwish, Tania Sultana, and Sophia Youn. "Efficacy, Tolerability, and Safety of Atypical Antipsychotics in East Asian Ethnicity." CNS Spectrums 27, no. 2 (April 2022): 244–45. http://dx.doi.org/10.1017/s1092852922000529.
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AbstractBackgroundA number of intrinsic (age, gender, physical comorbidities, genetic factors, and ethnicity), and extrinsic factors (diet, concomitant medications, alcohol use, and smoking) influence an individual’s response to psychotropic medications. Data suggest that ethnicity may affect medication efficacy, tolerability, and safety through different pharmacokinetics and pharmacodynamics. Asians have been found to have a high frequency of reduced function of CYP2D6 allele (CYP2D6*10), which contributes to the slower metabolism of some medications compared to other ethnic groups. The previous study has shown East Asians appear to have a clinically relevant decrease in clozapine clearance compared with Caucasians. This review will explore the magnitude of the impact of ethnicity, especially the East Asian population on psychotropic medications such as atypical antipsychotics.ObjectiveTo understand the efficacy, safety, and tolerability of atypical antipsychotics in East Asian ethnicity. To emphasize the importance of ethnicity in clinical practice while offering/prescribing atypical antipsychotic medications.DiscussionSeveral previous studies reported the diverse response to the antipsychotics among different ethnicities secondary to differences in pharmacokinetics and pharmacodynamics. One study revealed White Europeans may require higher doses of therapeutic antipsychotics than Asians and Hispanics. Aripiprazole in Asians had a relatively higher rate of akathesia, and a significantly increased risk of tremor compared to placebo. A significantly increased risk of weight gain and fasting total cholesterol from olanzapine were observed in Japanese patients. Olanzapine was also associated with somnolence and dizziness. Quetiapine XR was associated with a significant increase risk of somnolence and dizziness in Chinese patients.ConclusionIt is indicated from previous studies antipsychotics respond in various ways in different ethnicity in terms of metabolism, clearance, and adverse effects. Further research could be beneficial on what is clinically most effective dosing of different antipsychotics among different populations including East Asians.FundingNo funding
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Orayj, Khalid, and Emma Lane. "Patterns and Determinants of Prescribing for Parkinson’s Disease: A Systematic Literature Review." Parkinson's Disease 2019 (November 3, 2019): 1–40. http://dx.doi.org/10.1155/2019/9237181.
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Since the discovery of levodopa (L-dopa) in 1967, the range of medications available to treat Parkinson’s disease has increased significantly and guidance on the use, efficacy, and safety of these medications has evolved. To assess levels of adherence to national prescribing guidelines and awareness of changes in the efficacy and safety data published in the profiles of medications for the treatment of PD, we have reviewed studies on patterns and determinants of prescribing PD medications conducted in the last 50 years (since the discovery of L-dopa). A systematic literature review was conducted using EMBASE (1967 to March, 2018), Ovid MEDLINE(R) ALL (1967 to March 16, 2018), PsycINFO (1967 to the 2nd week of March, 2018), and PubMed to identify all studies measuring prescribing patterns of PD medication between 1967 and 2017. Study design, source of data, country, year of study, number of patients and/or prescriptions, unit of analysis, prescribing determinants, and percentage utilisation of PD medications were extracted where possible. 44 studies examining prescribing patterns and/or prescribing determinants across 17 countries were identified. Unsurprisingly, L-dopa was the most commonly prescribed medication in all studies, accounting for 46.50% to 100% of all prescriptions for PD. In several studies, the prescribing rate of ergot-derived dopamine agonists (DAs) decreased over time in concordance with guidance. In contrast, the prescribing rates of non-ergot DAs increased over the last ten years in most of the included studies. In examining prescribing factors, two major categories were exemplified, patients’ factors and prescribers’ factors, with patients’ age being the most common factor that affected the prescription in most studies. In conclusion, L-dopa is now the most commonly prescribed medication for cases of PD but there is large variation in the prescribing rates of catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, amantadine, and anticholinergics between countries. New studies examining the effects of recent clinical trials and measuring the prescribing rates of newly approved medications are warranted.
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Sayin, Nihat, Zeynep Alkin, Abdullah Ozkaya, Abdulvahit Demir, Ahmet Taylan Yazici, Ercument Bozkurt, and Ahmet Demirok. "Efficacy of Selective Laser Trabeculoplasty in Medically Uncontrolled Glaucoma." ISRN Ophthalmology 2013 (January 8, 2013): 1–4. http://dx.doi.org/10.1155/2013/975281.
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Purpose. To investigate the efficacy and safety of 360° selective laser trabeculoplasty (SLT) on medically uncontrolled open-angle glaucoma (OAG) and to evaluate the effects of antiglaucomatous medications on the results of therapy. Materials and Methods. The medical records of 62 eyes of 51 patients with OAG, which did not reach the targeted intraocular pressure (IOP) with maximum antiglaucomatous medical therapy, were retrospectively reviewed. Results. A statistically significant decrease was observed in the mean baseline IOP at 1, 3, 6, and 12 months of followup (P<0.01). The success rate was 64.5% in all of the patients. The success rates did not vary significantly by taking 1, 2, 3, or 4 medications with the rates of 63.6%, 71.4%, 64.2%, and 58.3% (P=0.06). The success rate of eyes on medication more or less than 6 months was 62.5% or 66.7%, respectively (P=0.3). There was a positive correlation between mean baseline IOP and mean reduction in IOP from baseline (P<0.001, r=0.8). Conclusion. Application of 360° of SLT provided an effective and safe IOP reduction in medically uncontrolled OAG. Baseline IOP was found to be the most important factor in the efficacy of therapy.
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Klemperer, Elias M., John R. Hughes, and Shelly Naud. "Study Characteristics Influence the Efficacy of Substance Abuse Treatments: A Meta-analysis of Medications for Smoking Cessation." Nicotine & Tobacco Research 22, no. 3 (October 20, 2018): 317–23. http://dx.doi.org/10.1093/ntr/nty225.
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Abstract Background Understanding study characteristics’ influence on treatment efficacy could improve interpretation of trials’ outcomes. We examined study characteristics as predictors of outcomes in clinical trials of medications for tobacco use. Methods We obtained and analyzed data on 44 trials of nicotine gum, 37 trials of nicotine patch, 27 trials of varenicline, and 43 trials of bupropion from Cochrane reviews. We extracted and analyzed data for 15 study characteristics, odds ratios (ORs), and percent abstinent in control and medication conditions. We used general linear models to determine which study characteristics explained the variability among outcomes after controlling for medication characteristics. Results Study characteristics accounted for 12% of the variance in odds ratios among patch trials, 16% among gum trials, 16% among varenicline trials, and 34% among bupropion trials above and beyond medication characteristics. Patch and gum trials with industry funding had larger odds ratios than those without. Among patch trials, this appeared to be due to less abstinence in industry-funded trials’ control conditions. Bupropion trials published earlier had larger odds ratios, which appeared to be due to less abstinence in control conditions. The reason for study characteristics’ influence on varenicline trials was unclear. Discussion Study characteristics influenced the assessment of treatment efficacy above and beyond medication characteristics in smoking cessation trials. Our findings that study characteristics are associated with higher or lower efficacy does not suggest that the effect size under one versus another condition is the more valid outcome. Future studies are needed to determine which study characteristics reliably influence efficacy because this would help investigators and clinicians interpret trials. Implications Study characteristics influenced the estimates of treatment efficacy but individual characteristics’ influence on efficacy appeared to differ among different medications for smoking cessation. We encourage researchers to report study characteristics to improve interpretation of findings and systematic reviews, and to account for nontreatment-related variables to better estimate the efficacy of treatments.
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Werremeyer, Amy B., Gina Aalgaard-Kelly, and Elizabeth Skoy. "Using Photovoice to explore patients' experiences with mental health medication: A pilot study." Mental Health Clinician 6, no. 3 (January 1, 2016): 142–53. http://dx.doi.org/10.9740/mhc.2016.05.142.
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Abstract Introduction: The objective of this research is to explore and share the medication experience of those with a mental illness in order to gain understanding of the patient's medication perceptions as well as the impact of medication upon patients' lives. Methods: Patients with a mental disorder were given cameras and asked to capture the experience of “living with my medication.” Using Photovoice methodology, participants reflected on their photos individually and in focus groups. Conceptual themes were drawn from the data. Results: Five participants captured an average of 14 photos each. Self-efficacy with mental illness, mental and physical health connections, and education were the 3 most prominent themes. Aspects of medications were interwoven within these themes but were not the primary focus of the participants. Discussion: Medication experiences of patients with mental illness may encompass much more than the medications themselves.
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Huang, Yen-Ming, Kristen E. Pecanac, and Olayinka O. Shiyanbola. "“Why Am I Not Taking Medications?” Barriers and Facilitators of Diabetes Medication Adherence Across Different Health Literacy Levels." Qualitative Health Research 30, no. 14 (July 29, 2020): 2331–42. http://dx.doi.org/10.1177/1049732320945296.
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Medication adherence is important for diabetes management. Better knowledge of how patient factors relate to medication adherence allows us to develop more tailored interventions. We explore patients’ perceptions of the barriers to and facilitators of medication adherence across different levels of health literacy. Semi-structured interviews with 23 participants with type 2 diabetes (T2D) were completed, and direct content analysis identified the facilitators of and the barriers to medication adherence through the lens of the Health Literacy Pathway model. Linking medication-taking to daily routine and focusing on the internal locus of control are imperative approaches to fostering self-efficacy of medication use. Understanding patients’ life experiences and clarifying medication misinformation help patients address their concerns with medications. Lowering the cost of medications and simplifying therapy regimens can alleviate participants’ perceived barriers to medication-taking. In this study, we explore medication adherence from the experience of people with T2D and can inform tailored interventions to improve medication adherence.
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Sturm, Noemi, Regina Stolz, Friederike Schalhorn, Jan Valentini, Johannes Krisam, Eckhard Frick, Ruth Mächler, Joachim Szecsenyi, and Cornelia Straßner. "Self-Efficacy, Social Activity, and Spirituality in the Care of Elderly Patients with Polypharmacy in Germany—A Multicentric Cross-Sectional Study within the HoPES3 Trial." Healthcare 9, no. 10 (October 1, 2021): 1312. http://dx.doi.org/10.3390/healthcare9101312.
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About one third of Europe’s elderly population takes ≥5 drugs. Polypharmacy increases their risk of adverse drug reactions. To ensure drug safety, innovative approaches are needed. The aim of this cross-sectional study was to explore the relationship between psychosocial factors and medication-related beliefs and behaviors. Medication lists of 297 patients were recorded according to the ATC classification. Correlations between the dependent variables, Medication Adherence (MARS) and Beliefs about Medicines (BMQ), and independent variables, General Self-Efficacy (GSE), self-efficacy for managing chronic diseases (SES6G), spiritual needs (SpNQ), patient activity (PAM), loneliness (DJG), and social networks (LSNS), were measured. Patients with higher self-efficacy (OR: 1.113; 95% CI [1.056–1.174]; p < 0.001) or self-confidence in managing their chronic condition (OR: 1.188; 95% CI [1.048–1.346]; p < 0.007) also showed higher adherence. Lonely patients (OR: 0.420; 95% CI [0.267–0.660]; p < 0.001) and those with a need for inner peace (OR: 0.613; 95% CI [0.444–0.846], p = 0.003) were more likely nonadherent. Stronger positive beliefs about medications’ usefulness weakly correlated with higher scores on the SES6G (ρ = 0.178, p = 0.003) and GSES scale (ρ = 0.121, p = 0.042), patient activity (ρ = 0.155, p = 0.010) and functioning social networks scale (ρ = 0.159, p = 0.008). A weak positive correlation was found between loneliness and the belief that drugs were harmful (ρ = 0.194, p = 0.001). Furthermore, interesting correlations were detected regarding the number of medications and overuse beliefs. Psychosocial factors, such as self-efficacy, loneliness, and spiritual needs and medication-related beliefs and behaviors seem to interrelate. Addressing these factors may improve medication management and drug safety.
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Kwon, Hyuk-Sang. "Mechanism and Efficacy of New Anti-diabetic Medications." Journal of Korean Diabetes 13, no. 4 (2012): 167. http://dx.doi.org/10.4093/jkd.2012.13.4.167.
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Arya, Ravindra, Harsh Kothari, Zongjun Zhang, Baoguang Han, Paul S. Horn, and Tracy A. Glauser. "Efficacy of nonvenous medications for acute convulsive seizures." Neurology 85, no. 21 (October 28, 2015): 1859–68. http://dx.doi.org/10.1212/wnl.0000000000002142.
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