134 research outputs found
Inadequate quality of administration of intranasal corticosteroid sprays
No full textCorine Rollema,1,2 Eric N van Roon,1,2 Tjalling W de Vries3 1Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands; 2Groningen Research Institute of Pharmacy, Department Pharmaco therapy, Epidemiology and Economy, University of Groningen, Groningen, The Netherlands; 3Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands Purpose: Considering the fact that many mistakes are still being made by asthmatic patients when inhaling lung medication, it is important to gain insight into current techniques used to administer intranasal corticosteroid sprays (INCS) in allergic rhinitis patients. In this study, we aimed to get insight into daily use of INCS and to determine if improvement of the technique is required. Patients and methods: A checklist, based on available patient information leaflets (PILs) and literature, was used to determine the participants’ application of the techniques used to administer INCS. These applied techniques were compared with steps described in PILs and recommended essential steps. Results: In the overall population (64 participants) four participants (6%) carried out all steps as described in the PIL and seven participants (11%) carried out all recommended essential steps. Conclusion: The technique used to administer INCS is inadequate. Uniform and generally applicable instructions are needed and patients using INCS should be guided better. Keywords: intranasal corticosteroid sprays, allergic rhinitis, administration techniques, quality of administratio
Psychological Sentiments and Economic Behavior.
Full text linkThis thesis is a contribution to the field of psychology and economics. The two central themes are gift-giving and the effects of rewards. Within these themes, it studies questions like: Why do people donate to charity funds? Why are people sometimes less motivated when they get rewarded for their behavior? Why does the value of a product increase after they have bought it? And why does the market not completely crowd-out gift-giving? Answers to the above and other questions are given by extending economic models with psychological sentiments. The broad message is that taking such sentiments into account often offers insights into why and how institutions should be designed accordingly. Disregarding these effects leads to unintended consequences of incentive schemes.
No decrease in fracture risk despite 15 years of treatment evolution for multiple myeloma patients:A Danish nationwide case-control study
Full text linkRATIONALE: While treatment strategies for multiple myeloma have evolved radically over the last decades, little is known about the risk of fractures for symptomatic multiple myeloma patients over time.OBJECTIVE: To determine the effect of different treatment periods (1996-2000, 2001-2006 and 2007-2011) on the risk of fractures in patients with multiple myeloma.METHODS: This retrospective case-control study included patients with multiple myeloma in Denmark, using the Danish National Health Service. Cases were defined as patients who had sustained a fracture between 1996 and 2011, and controls were those without a fracture. Exposure was defined as an ICD code for multiple myeloma. Vertebral fractures, gender, and age were considered in secondary analyses. Conditional logistic regression was used to estimate odd ratios (ORs) of fracture risk, and the analyses were adjusted for comorbidities and recent drug use.RESULTS: The study population consisted of 925,341 cases, and the same number of matched controls, of whom 1334 patients with multiple myeloma. Among cases, the risk of any fracture was higher in multiple myeloma patients compared to patients without multiple myeloma (any fracture: ORadj[95% CI] 1996-2000: 1.7[1.3-2.3]; 2001-2006: 1.3[1.1-1.6]; 2007-2011: 1.7[1.4-2.2]). Although fractures were mainly non-vertebral, the risk of vertebral fractures in particular was higher in multiple myeloma patients (vertebral fracture: ORadj[95% CI] 1996-2000: 3.5[1.4-8.6]; 2001-2006: 4.0[1.9-8.2]; 2007-2011: 3.0[1.6-5.7]).CONCLUSIONS: Despite new treatment strategies and improved supportive care, this study showed no decreased fracture risk for multiple myeloma patients over time. New treatment strategies, even if they have a positive impact on overall survival, offer no guarantee for a corresponding reduction in bone lesions.</p
The effect of maternal ketanserin use on the circulation of the neonate: a prospective, observational study
No full textObjective: High ketanserin levels are found in the umbilical cord after maternal treatment. However, the effect on the circulation of the neonate has never been investigated. Study design: A prospective, observational study was performed at the neonate ward at the Medical Centre Leeuwarden, The Netherlands. All neonates exposed in utero to ketanserin administered to the mother, from May 2007 to December 2009 (n = 58), were included. We studied the effect of ketanserin exposure on the circulation of the neonate, by monitoring heart rate and blood pressure during the first 24 h of life. Non-parametric as well as parametric tests were used to analyze the effect of gestational age, birth weight, gender, various ketanserin factors (cumulative dosage, duration of therapy and last dosage rate), other maternal drug use and maternal diagnosis on the blood pressure of the neonate. Results: Eight neonates became hypotensive during the first 8 h of life (13.8%). The last dosage rate as well as the mean dosage rate (cumulative dosage divided by duration of therapy in hours) were significantly higher in the group with hypotension (P=.005 and P=.002, respectively). All hypotensive neonates were exposed to a last dosage rate of at least 8 mg/h. Maternal HELLP syndrome was diagnosed more often in hypotensive compared to normotensive neonates (P=.048). Conclusion: In utero exposure to ketanserin lowers the blood pressure of the neonate. The risk of hypotension is associated with the last dosage rate of maternal ketanserin treatment and the coexistence of maternal HELLP syndrome. (C) 2012 Elsevier Ireland Ltd. All rights reserved
Coma after overdose with duloxetine
No full textOBJECTIVE: To describe a case of a patient who became comatose after taking an overdose of duloxetine, a serotonin-norepinephrine reuptake inhibitor. CASE SUMMARY: A 49-year-old male ingested an overdose of duloxetine approximately 2 hours before presentation to the emergency department. On arrival he was drowsy, but easily awakened and oriented, with Glasgow Coma Score 14 (eyes 3, motor 6, verbal 5). Immediately after admission, charcoal and magnesium sulfate were given to prevent further systemic absorption of medication through the gastrointestinal tract. No gastric lavage was performed. Six hours after drug intake the patient became unconscious (Glasgow Coma Score 7, eyes 2, motor 4, verbal 1). Full toxicologic screening showed a toxic duloxetine plasma concentration of 0.86 mg/L. The patient was admitted to the intensive care unit (ICU) and, on arrival, urinary retention was noted. During ICU admission the patient remained hemodynamically stable; approximately 12 hours after ingestion of duloxetine, he regained consciousness. Over the next 3 days the urinary output decreased to 60 mL/day. After 4 days patient was discharged without any remaining symptoms. Based on repeated plasma duloxetine serum concentration determinations, a plasma half-life of duloxetine was calculated to be 18 hours (reference range 9-19). DISCUSSION: The Naranjo probability scale suggested that duloxetine was the probable cause for the symptoms described. CONCLUSION: Overdose with duloxetine can induce coma several hours after intake, with a fast reversal in our case
Intravenous paracetamol overdose in a paediatric patient
No full textBACKGROUND: Paracetamol is a widely used drug in children. In therapeutic doses, paracetamol has an excellent safety profile. Since the introduction of the intravenous form in 2004, only three reports of accidental overdose in children have been published. The low number probably is due to underreporting. CASE DESCRIPTION: A two weeks old boy received a single intravenous dose of 90 mg/kg paracetamol - nearly a tenfold overdose. The child was not treated with acetylcysteine and developed no hepatic impairment. CONCLUSION: Intravenous paracetamol is a potentially dangerous drug. INTRAVENOUS: acetylcysteine is widely recognized as the antidote. The treatment indication is still based on an adult nomogram. Children are less at risk for complications, but this should be monitored. Acetylcysteine is effective and safe in the management of paracetamol-induced hepatotoxicity, but mild adverse drug reactions are frequently reported
- …
