Current medical research and opinion
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Multicenter Study
Once-daily insulin detemir in a cohort of insulin-naïve patients with type 2 diabetes: a sub-analysis from the PREDICTIVE study.
PREDICTIVE is a large, observational study of the empirical use of insulin detemir in patients with type 1 or type 2 diabetes (T1DM/T2DM). This post hoc analysis evaluates insulin-naïve patients with T2DM uncontrolled on oral antidiabetic drugs (OADs) who were initiated and remained on once-daily insulin detemir for 12 weeks. ⋯ Empirical use of insulin detemir as an insulin initiation strategy can improve glycemic control with good tolerability, including a low risk of hypoglycemia and a weight benefit, in a majority of insulin-naïve patients uncontrolled on OADs.
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To quantify and compare direct costs, utilization, and the rate of comorbidities in a sample of patients with fibromyalgia (FM), a poorly understood illness associated with chronic widespread pain that is commonly treated by rheumatologists, to patients with rheumatoid arthritis (RA), a well studied rheumatologic illness associated with inflammatory joint pain. Patients with both illnesses were isolated and reported as a third group. A secondary analysis of work loss was performed for an employed subset of these patients. ⋯ The burden of illness in FM is substantial and comparable to RA. Patients with FM incurred direct costs approximately equal to RA patients. Patients with FM had more ED, physician, and physical therapy visits than RA patients. Patients in both groups had several comorbidities. Patients with FM+RA incurred direct costs almost double those of the patients with either diagnosis alone. FM and RA patients incurred similar overall absence and short-term disability costs.
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The aim of this study was to investigate in vitro the delivery of a new long-acting beta2-agonist (LABA) drug formoterol fumarate inhalation solution (20 microg/2 mL) nebulized with and without ipratropium bromide (0.5 mg/2.5 mL) at different administration times (2.5-22.5 min), airflows (5-28.3 L/min), nebulizer fill volumes (2-6 mL),and nebulizer brands (Pari LC+, Ventstream and DeVilbiss). ⋯ The results demonstrated that administration of nebulized formoterol fumarate require proper selection of a delivery system/method for safe and effective therapy of the medication with and without ipratropium bromide.
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Levodopa is currently the most effective treatment for Parkinson's disease (PD); however, long-term levodopa therapy often results in motor complications, such as motor fluctuations and dyskinesia. The initial complication is commonly wearing-off, which is the re-emergence of motor and non-motor symptoms before the next scheduled levodopa dose. ⋯ Current evidence indicates that a consistent delivery of levodopa should improve long-term symptomatic efficacy and may prevent or delay motor complications. A number of therapeutic options are available to optimize therapeutic outcome, including modification of the levodopa dose or dosing schedule,switching to another levodopa formulation and the use of adjunct therapies, such as catechol-O-methyl transferase inhibitors, dopamine agonists and monoamine oxidase-B inhibitors. The management of wearing-off is dependent upon the early identification of symptoms and the initiation of effective treatment. Key issues are the need to educate patients and to facilitate good communication with both primary and secondary healthcare professionals. In most cases, patients with PD initially present to primary healthcare professionals who may refer the patient to a neurologist once disease management becomes more complex. However, in many cases, especially in rural areas where neurologists may not be widely available, the primary healthcare professionals may manage the patient throughout the disease course. Limitations of this review include the restricted search criteria and selected search period.
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The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend that community-acquired pneumonia (CAP) patients admitted to hospital wards initially receive respiratory fluoroquinolone monotherapy or beta-lactam plus macrolide combination therapy. There is little evidence as to which regimen is preferred, or if differences in medical resource utilization exist between therapies. Thus, the authors compared length of hospital stay (LOS) and length of intravenous antibiotic therapy (LOIV) for patients who received initial levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily ('combination therapy'). ⋯ Given the LOS and LOIV reductions of 0.8 and 1.2 days, respectively, utilization of levofloxacin 750 mg daily for CAP patients admitted to the medical floor has the potential to result in substantial cost savings for US hospitals.