Clinical therapeutics
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Clinical therapeutics · Feb 2003
ReviewOutcomes research related to patient decision making in oncology.
For outcomes research, what are the implications of seeing the patient as a decision maker? In the current medical environment, greater emphasis is placed on the role played by the patient in clinical decision making. In the past 2 decades, considerable work has been done to identify and measure decision-related outcomes, including knowledge about the treatment options (risks and benefits), satisfaction, anxiety, decisional conflict, and involvement in the decision process. ⋯ Future research is needed to understand which aspects of the interventions work and for what types of patients. Research is also needed to better understand the decision making process of patients who do not use decision aids.
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Clinical therapeutics · Feb 2003
Comparative StudyA model analysis of costs of blood pressure destabilization and edema associated with rofecoxib and celecoxib among older patients with osteoarthritis and hypertension in a Medicare Choice population.
Economic analyses consider all costs relevant to the use of a particular treatment or treatments. Recently, head-to-head, randomized, controlled trials have shown a significantly higher incidence of blood pressure (BP) destabilization and clinically significant edema with rofecoxib than with celecoxib among older, hypertensive patients with osteoarthritis (OA). ⋯ Celecoxib was a less costly treatment option than rofecoxib among OA patients with hypertension aged > or = 65 years, based on our model of the direct costs of COX-2 specific inhibitor therapy combined with those associated with physician monitoring and treatment of edema and BP destabilization.
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Clinical therapeutics · Feb 2003
Comparative StudyA post hoc analysis of the impact on hostility and agitation of quetiapine and haloperidol among patients with schizophrenia.
Quetiapine, a drug with a broad pharmacologic profile (similar to that of clozapine), may show benefits for agitation in patients with psychoses. Also, quetiapine may be superior to placebo and either equal or superior to haloperidol in treating this symptom. Available data for other second-generation antipsychotic agents show that quetiapine may have better efficacy in improving agitation compared with haloperidol. ⋯ The data in this study suggest that quetiapine treatment has benefits for hostility and agitation among patients experiencing an acute exacerbation of schizophrenia. Furthermore, the path analysis indicated that, relative to haloperidol, quetiapine appeared to have direct effects on agitation that were independent of improvements in psychoses or overall psychopathology, as assessed by the BPRS.
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Clinical therapeutics · Feb 2003
Comparative StudyFactors associated with hospitalization costs for patients with community-acquired pneumonia.
Combined mortality rates for pneumonia and influenza suggest that the 2 conditions represent the sixth leading cause of death in the United States. The total cost of pneumonia, including indirect costs, was estimated to be approximately $23 billion per year in 1994. ⋯ The findings of this study suggest that guidelines for CAP management, such as those developed by managed care plans, may help reduce costs by minimizing unnecessary ICU admissions and appropriately managing patients with CAP.