Postgraduate medical journal
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When prescribing, doctors usually only consider the 'active' component of any drug's formulation ignoring the majority of the agents which make up the bulk of the tablet or capsule, collectively known as excipients. Many urological drugs contain the excipient gelatin which is, universally, of animal origin; this may conflict with the dietetic ideals of patients. A questionnaire-based study, undertaken between January and June 2010 in a mixed ethnicity inner-city population presenting with urological symptoms, asked which patients preferred not to ingest animal-based products, who would ask about the content of their prescribed treatment and who would refuse to take that medication if alternatives were available. ⋯ This study demonstrated that 43.2% of the study population would prefer not to take animal product-containing medication even if no alternative were available. 51% of men with lower urinary tract symptoms were also found to have inadvertently been prescribed gelatin-containing products against their preferred dietary restriction. Education of healthcare professionals about excipients and getting them to ask about a patient's dietetic preferences may help avoid inadvertent prescription of the excipient gelatin in oral medications. Substitution of gelatin with vegetable-based alternatives and clearer labelling on drug packaging are alternative strategies to help minimise the risks of inadvertently contravening a patient's dietetic beliefs when prescribing oral medication.
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Alzheimer's disease (AD) is a highly prevalent condition that predominantly affects older adults. AD is a complex multifactorial disorder with a number of genetic, epigenetic and environmental factors which ultimately lead to premature neuronal death. Predictive and susceptibility genes play a role in AD. ⋯ The genetic variation by susceptibility genes plays a crucial role in determining the risk of late-onset AD, as well as the onset of the disease, the course of the AD and the therapeutic response of patients to conventional drugs for AD. The newer understanding of the epigenetics in AD has also been highlighted. Recent advances in genetics, epigenetics and pharmacogenetics of AD pose new challenges to the future management of AD.
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Errors involving drug prescriptions are a key target for patient safety initiatives. Recent studies have focused on error rates across different grades of doctors in order to target interventions. However, many prescriptions are not instigated by the doctor who writes them. It is important to clarify how often this occurs in order to interpret these studies and create interventions. This study aimed to provisionally quantify and describe prescriptions where the identity of the decision maker and prescription writer differed. ⋯ Decision making and the writing of prescriptions are generally not undertaken by the same doctor. Moreover, communication about prescriptions is poor. Further research in a larger sample of hospitals is required to confirm generalisability of the results, and to inform educational interventions to reduce error rates.
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Acute myocarditis is an inflammatory disease of the heart muscle that may progress to dilated cardiomyopathy and chronic heart failure. A number of factors including the sex hormone testosterone, components of innate immunity, and profibrotic cytokines have been identified in animal models as important pathogenic mechanisms that increase inflammation and susceptibility to chronic dilated cardiomyopathy. ⋯ However, the diverse presentations of myocarditis and the lack of widely available, safe, and accurate non-invasive diagnostic tests remain major obstacles to early diagnosis and population based research. Recent advances in the understanding of disease pathogenesis described in this review should lead to more accurate diagnostic algorithms and non-invasive tests.