Clinical therapeutics
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Clinical therapeutics · Jan 2007
Randomized Controlled Trial Multicenter StudyPsychometric testing and validation of the Chronic Pain Sleep Inventory.
Patients with chronic pain often experience significant disruptions in sleep. A potential benefit of treatment aimed at pain relief is improved quality of sleep in patients with chronic pain. ⋯ CPSI items showed good construct validity, and the results support the scoring of a reliable single index from 3 of the 5 CPSI items that all attributed sleep problems to pain.
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Clinical therapeutics · Jan 2007
ReviewAdverse drug interactions involving common prescription and over-the-counter analgesic agents.
Eight analgesic preparations with approved indications for acute pain were among the top 200 drugs prescribed in the United States in 2006. In addition, an estimated 36 million Americans use over-the-counter (OTC) analgesics daily. Given this volume of use, it is not surprising that a number of drug interactions involving analgesic drugs have been reported. ⋯ Considering the widespread use of analgesic agents, the overall incidence of serious drug-drug interactions involving these agents has been relatively low. The most serious interactions usually involved other interacting drugs with low therapeutic indices or chronic and/or high-dose use of an analgesic and the interacting drug.
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Clinical therapeutics · Jan 2007
ReviewA review of the clinical efficacy and safety of 5alpha-reductase inhibitors for the enlarged prostate.
Enlargement of the prostate is common among aging men, with an incidence of 90% by the age of 85 years. It is a progressive condition, with growth in prostate size accompanied by lower urinary tract symptoms that can result in long-term complications (eg, acute urinary retention [AUR], need for enlarged prostate-related surgery). Current pharmacologic treatment options include alpha-blockers (alfuzosin, doxazosin, tamsulosin, and terazosin) and 5alpha-reductase inhibitors (5ARIs) (finasteride and dutasteride). ⋯ The use of 5ARI therapy is a rational approach to symptom management and prevention of long-term negative outcomes in men with enlarged prostates.V 3.
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Clinical therapeutics · Jan 2007
Health care costs and mortality for Canadian urban and rural patients with diabetes: population-based trends from 1993-2001.
Recent reports suggest that the health status of individuals residing in rural areas (as much as one third of the Canadian population) may be inferior to those who live in urban areas. ⋯ From 1993 to 2001, we observed systematic differences in costs of individual resource categories according to urban/rural residence in Saskatchewan, with urban dwellers with diabetes incurring greater costs in most categories. Age-adjusted total costs and mortality rates were similar, however, suggesting that rural populations with diabetes may not be as disadvantaged as commonly believed. Investing in better primary care access for all patients with diabetes may reduce downstream costs in Saskatchewan's provincial health care system.
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Clinical therapeutics · Jan 2007
Influences of attitudes on family physicians' willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain.
The treatment of moderate to severe chronic nonmalignant pain (CNMP) is a challenge for both the patient and health care provider. Conflicting information exists regarding the appropriate use of long-acting (ie, controlled-release [CR]) opioid analgesics for CNMP, and physicians may be reluctant to prescribe them even when medically appropriate. ⋯ About two thirds of physician respondents were willing to prescribe long-acting opioids for patients with CNMP, and physician attitudes were marginally favorable. Further study should investigate how physicians' attitudes and willingness translate into actual prescribing behavior.