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JAAPA : Official Journal of the... Oct 2019Despite the high incidence of hyponatremia, the correct approach to management, particularly in patients with severe hyponatremia (serum sodium of 120 mEq/L or less), is... (Review)
Review
Despite the high incidence of hyponatremia, the correct approach to management, particularly in patients with severe hyponatremia (serum sodium of 120 mEq/L or less), is controversial. This article reviews two major consensus guidelines and recent studies that can help clinicians make evidence-based treatment decisions and reduce patient risk for iatrogenic osmotic demyelination from overly aggressive treatment.
Topics: Demyelinating Diseases; Disease Management; Humans; Hyponatremia; Iatrogenic Disease; Practice Guidelines as Topic; Risk Assessment; Saline Solution, Hypertonic
PubMed: 31567743
DOI: 10.1097/01.JAA.0000578796.15417.09 -
European Journal of Pharmaceutical... Aug 2023Older adults are the main users of medicine and due to common multimorbidity they are often confronted with a complex medication management. This review article provides... (Review)
Review
Older adults are the main users of medicine and due to common multimorbidity they are often confronted with a complex medication management. This review article provides a brief overview on aspects of medication management, i.e., maintaining a stock of the required medicine, understanding and following the instructions for use, coping with the primary and secondary packaging, as well as the preparation prior to use. However, the main focus is on the drug intake itself and the review provides an overview of the current understanding of real life dosing conditions in older adults and geriatric patients. It elaborates the acceptability of dosage forms, in particular solid oral dosage forms as they represent the majority of dosage forms taken by this patient population. An improved understanding of the needs of older adults and geriatric patients, their acceptability of various dosage forms, and the circumstances under which they manage their medications will allow for the design of more patient-centric drug products.
Topics: Aged; Humans; Dosage Forms; Medication Review; Pharmaceutical Preparations
PubMed: 37149104
DOI: 10.1016/j.ejps.2023.106453 -
Current Opinion in Supportive and... Dec 2012Self-management in the palliative care domain means equipping patients and carers to manage medical aspects of illness, managing life roles and allowing adaptation to... (Review)
Review
PURPOSE OF REVIEW
Self-management in the palliative care domain means equipping patients and carers to manage medical aspects of illness, managing life roles and allowing adaptation to the changing dynamics brought on by illness and its progression. As well as dealing with the psychological consequences of living with a life-threatening illness in which the aim is to optimise living. This review will consider the rationale for developing and adopting self-management as a model of care.
RECENT FINDINGS
Health policy currently advocates de-investment in traditional approaches to patient management paralleled with a re-engineering of services towards approaches required to underpin self-management care. However, the literature suggests that patients lack a fundamental knowledge and more importantly an understanding of the progression of their illness or what palliative of hospice care is. As a first step, this issue must be addressed in any self-management intervention. In terms of outcomes evidence continues to emerge that when compared with care self-management imparts sustainable understanding in targeted areas and has the potential to create a preventive spend environment.
SUMMARY
The role of self-management in palliative care requires further elucidation yet based on the evidence which is predominately gleaned from long-term conditions it would seem sensible if not ethical to educate patients/carers to actively be involved in decision making.
Topics: Caregivers; Disease Management; Europe; Humans; North America; Palliative Care; Patient Participation; Program Development; Self Care; Self Efficacy
PubMed: 23111704
DOI: 10.1097/SPC.0b013e32835a7011 -
American Journal of Health-system... May 2015
Topics: Drug Costs; Health Services Accessibility; Humans; Patient Protection and Affordable Care Act; Pharmaceutical Preparations; Pharmacy Service, Hospital; Specialization; United States
PubMed: 25873616
DOI: 10.2146/ajhp150181 -
Immunology and Allergy Clinics of North... May 2015Drug-induced anaphylaxis is a common cause of anaphylaxis and a leading cause of fatal anaphylaxis. Antibiotics, radiocontrast, and nonsteroidal anti-inflammatory drugs... (Review)
Review
Drug-induced anaphylaxis is a common cause of anaphylaxis and a leading cause of fatal anaphylaxis. Antibiotics, radiocontrast, and nonsteroidal anti-inflammatory drugs are commonly implicated drugs. Vocal cord dysfunction can mimic anaphylaxis and is often overlooked. β-Lactams are a common cause of anaphylaxis; however, skin testing and drug challenge can usually determine tolerability of other classes of β-lactams. Nonionic contrast agents cause anaphylaxis less frequently than ionic contrast, and immunoglobulin E-mediated mechanisms may have a role in some of these reactions. Skin testing with radiocontrast may have a role in evaluating patients with anaphylaxis to nonionic contrast.
Topics: Anaphylaxis; Comorbidity; Disease Management; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Pharmaceutical Preparations; Risk Factors
PubMed: 25841553
DOI: 10.1016/j.iac.2015.01.008 -
Cirugia Y Cirujanos 2018In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young... (Review)
Review
In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly poses knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important.
Topics: Burnout, Professional; Clinical Competence; Clinical Decision-Making; Disease Management; Hospital Administration; Humans; Internship and Residency; Mexico; Organizational Culture; Staff Development
PubMed: 29681631
DOI: 10.24875/CIRU.M18000005 -
Expert Opinion on Pharmacotherapy Jan 2006Obstructive sleep apnoea poses a significant health hazard that is associated with leading causes of mortality and morbidity. Nasal continuous positive airway pressure... (Review)
Review
Obstructive sleep apnoea poses a significant health hazard that is associated with leading causes of mortality and morbidity. Nasal continuous positive airway pressure is the primary treatment modality, with surgical treatments as alternatives. Oral appliances and pharmacological therapy remain adjunctive modalities. Non-specific treatments include weight loss, postural therapy and behavioural measures. Pharmacotherapy goals include the reduction of risk factors for sleep apnoea; correction of underlying predisposing metabolic diseases, such as hypothyroidism or acromegaly; treatment of associated symptoms, including excessive daytime sleepiness; and prevention of apnoeas/hypopnoeas. This paper reviews data supporting the treatment of sleep apnoea with various pharmacological agents, including intranasal corticosteroids, decongestant sprays, nicotine therapy, opiate antagonists, methylxanthine derivatives, oestrogen and progesterone, testosterone, thyroid hormone, growth hormone therapy for acromegaly, beta-blockers, alpha-adrenergic agonists, angiotensin-converting enzyme inhibitors, glutamate antagonists, acetazolamide, selective serotonin re-uptake inhibitors, tricyclic antidepressants, physostigmine, modafinil and TNF-alpha antagonists, in addition to supplemental oxygen, and carbon dioxide inhalation. Some of these drugs have received very little testing and are the subject of few research articles.
Topics: Disease Management; Drug Delivery Systems; Humans; Pharmaceutical Preparations; Sleep Apnea Syndromes
PubMed: 16370918
DOI: 10.1517/14656566.7.1.11 -
Population Health Management Apr 2013The United States Food and Drug Administration (FDA) has the primary regulatory responsibility to ensure that medications are safe and effective both prior to drug... (Review)
Review
The United States Food and Drug Administration (FDA) has the primary regulatory responsibility to ensure that medications are safe and effective both prior to drug approval and while the medication is being actively marketed by manufacturers. The responsibility for safe medications prior to marketing was signed into law in 1938 under the Federal Food, Drug, and Cosmetic Act; however, a significant risk management evolution has taken place since 1938. Additional federal rules, entitled the Food and Drug Administration Amendments Act, were established in 2007 and extended the government's oversight through the addition of a Risk Evaluation and Mitigation Strategy (REMS) for certain drugs. REMS is a mandated strategy to manage a known or potentially serious risk associated with a medication or biological product. Reasons for this extension of oversight were driven primarily by the FDA's movement to ensure that patients and providers are better informed of drug therapies and their specific benefits and risks prior to initiation. This article provides an historical perspective of the evolution of medication risk management policy and includes a review of REMS programs, an assessment of the positive and negative aspects of REMS, and provides suggestions for planning and measuring outcomes. In particular, this publication presents an overview of the evolution of the REMS program and its implications.
Topics: Consumer Product Safety; Drug Industry; Government Regulation; Health Policy; Pharmaceutical Preparations; Policy Making; Risk Assessment; Risk Management; United States; United States Food and Drug Administration
PubMed: 23113627
DOI: 10.1089/pop.2012.0021 -
Journal of Clinical Pharmacy and... Aug 2017Proactive synchronization of medication refills through an appointment-based model (ABM) is a community pharmacy-based intervention targeting adherence to medications.... (Review)
Review
WHAT IS KNOWN AND OBJECTIVE
Proactive synchronization of medication refills through an appointment-based model (ABM) is a community pharmacy-based intervention targeting adherence to medications. We aimed to systematically review evidence on the impact of the ABM on medication taking behaviour, health resource utilization, clinical outcomes and the preferences of patients and providers.
METHODS
We conducted a systematic literature search of MEDLINE and Scopus from database inception through 6 February 2017. Studies were included if they were original investigations evaluating the impact of the ABM on at least one outcome of interest and published in the peer-reviewed literature as a full-text manuscript in the English language. Outcomes included medication taking behaviour, clinical and economic outcomes, health resource utilization, and patient or provider satisfaction. Data were synthesized qualitatively.
RESULTS
Five studies, mostly observational in design and with low risk of bias, were included. Objective measures of medication taking behaviour were consistently improved in patients enrolled in an ABM vs control, indicating an association between appointment-based medication synchronization with improved adherence and decreased likelihood of non-persistence. A single decision analysis indicates a cost savings over 1 year associated with the appointment-based medication synchronization programme modelled, for hypertension, diabetes and hyperlipidaemia. Limited data regarding health resource utilization and clinical outcomes and patient or provider satisfaction exist and are currently inconclusive.
WHAT IS NEW AND CONCLUSION
The ABM provides a unique, patient-centred service to improve medication adherence amongst patients taking chronic medications while demonstrating a positive financial return on investment. Future research is needed to determine the impact of the ABM on final health outcomes.
Topics: Appointments and Schedules; Community Pharmacy Services; Diabetes Mellitus; Humans; Hyperlipidemias; Hypertension; Medication Adherence; Pharmaceutical Preparations
PubMed: 28485006
DOI: 10.1111/jcpt.12554 -
Postgraduate Medicine Jan 2013The common cold, an acute upper respiratory tract infection of viral origin, is among the most widespread ailments in the world. Although the general public usually... (Review)
Review
The common cold, an acute upper respiratory tract infection of viral origin, is among the most widespread ailments in the world. Although the general public usually relies on over-the-counter (OTC) medication(s) to treat cough/cold symptoms, reliable guidance is needed to help select the appropriate OTC medication for each individual. Consumers may be confused by the wide variety of products available, containing ≥ 1 active pharmaceutical ingredient. Health care professionals are in a position to help people identify the most bothersome symptom(s), evaluate underlying medical conditions and medications, and recommend the most appropriate OTC active ingredient(s) for treatment. Patients should be educated about available OTC medications to manage cough/cold symptoms and the importance of learning to read the package labeling for appropriate dosing and administration. In addition, potentially serious causes of cough/cold symptoms (eg, influenza, asthma, bronchitis) or underlying medical conditions that put the individual at increased risk for complications should be ruled out when symptoms do not resolve within a typical cold timeline. This review article discusses the active ingredients found in OTC medications and the clinical evidence supporting their use. The need to educate health care professionals and patients on the safe and effective use of OTC medications is addressed, and we offer a guide for the management of symptoms that appear during the timeline of a typical common cold.
Topics: Common Cold; Disease Management; Humans; Nonprescription Drugs; Respiratory Tract Infections
PubMed: 23391673
DOI: 10.3810/pgm.2013.01.2607