Pharmacotherapy
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Randomized Controlled Trial Multicenter Study Clinical Trial
Effect of self-efficacy and social support on adherence to antihypertensive drugs.
To determine the relationship between poor adherence and self-efficacy or social support after a pharmacist intervention. ⋯ Social support and self-efficacy improved significantly in the intervention group at the end of the pharmacist intervention. Drug adherence was correlated with self-efficacy even though drug adherence did not improve significantly in the intervention group. The fact that social support and self-efficacy improved as a function of duration of study participation suggests that participation in a research study may have had a positive influence on these measures. Even though the changes in social support, self-efficacy, and drug adherence were modest, there was significantly better blood pressure control in the intervention group compared with the control group. These findings indicate that changes in drug adherence, self-efficacy, or social support probably played a minor role in the blood pressure outcomes in these studies.
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Review Comparative Study
Clevidipine: a short-acting intravenous dihydropyridine calcium channel blocker for the management of hypertension.
Drugs used to acutely lower blood pressure have specific indications and precautions for use. Clevidipine is a third-generation parenteral dihydropyridine calcium channel blocker that received United States Food and Drug Administration approval in August 2008 for blood pressure reduction when oral therapy is not feasible or desirable. Formulated as an injectable oil-in-water emulsion, the drug is a short-acting arterial-selective vasodilator. ⋯ In phase III trials, clevidipine demonstrated efficacy in blood pressure lowering, with a relatively low occurrence of adverse events. Reflex tachycardia, atrial fibrillation, and acute renal failure were observed in these studies and merit additional analysis. The lack of specific clinical outcomes documenting improved morbidity and mortality rates as compared with other agents, the small numbers of treated patients, and concerns regarding the lipid formulation necessitate further investigation to help define the therapeutic role of clevidipine.
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Stroke is the third most common cause of death in the United States and is the number one cause of long-term disability. Legislative mandates, largely the result of the American Heart Association, American Stroke Association, and Brain Attack Coalition working cooperatively, have resulted in nationwide standardization of care for patients who experience a stroke. Transport to a skilled facility that can provide optimal care, including immediate treatment to halt or reverse the damage caused by stroke, must occur swiftly. ⋯ Other findings included clinically useful biomarkers, the role of inflammation and infection, an expanded role for placement of intracranial stents, a reduced role for urgent carotid endarterectomy, alternative treatments for large-vessel disease, identification of nontraditional risk factors, including risk factors for women, and newly published pediatric stroke guidelines. In addition, new devices for thrombolectomy are being developed, and neuroprotective therapies such as the use of magnesium, statins, and induced hypothermia are being explored. As treatment interventions become more clearly defined in special subgroups of patients, outcomes in patients with acute ischemic stroke will likely continue to improve.
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Comparative Study
Length of stay and hospital costs associated with a pharmacodynamic-based clinical pathway for empiric antibiotic choice for ventilator-associated pneumonia.
To determine hospital costs associated with the use of a clinical pathway implemented in our intensive care units (ICUs) to optimize antibiotic regimen selection for patients with ventilator-associated pneumonia (VAP) compared with costs in a historical control group treated according to prescriber preference. ⋯ Although aggressive dosing of more costly antibiotics was empirically prescribed using the clinical pathway, patients in this group exhibited a shorter duration of treatment, reduced hospital length of stay after VAP, and lower hospital costs without any significant increase in antibiotic expenditures.
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Review Meta Analysis
Meta-analysis of the efficacy and safety of adalimumab, etanercept, and infliximab for the treatment of rheumatoid arthritis.
To evaluate the efficacy and safety of using the anti-tumor necrosis factor-alpha (anti-TNF-alpha) drugs adalimumab, etanercept, and infliximab for the treatment of rheumatoid arthritis. ⋯ With short-term treatment, etanercept and adalimumab had higher efficacy results; with long-term treatment, adalimumab appeared to be the most effective. Clinicians should be aware that each of the three drugs has different rates of efficacy and different safety considerations that must be taken into account when selecting the best treatment for an individual with rheumatoid arthritis.