Current medical research and opinion
-
Opioid analgesics are commonly and increasingly prescribed by physicians for the management of chronic pain. However, strong evidence supports the need for strategies that reduce opioid use. The objective of this review is to outline limitations associated with opioid use and discuss therapeutic techniques that can be adopted to optimize the use of opioids in the management of chronic nonmalignant pain. ⋯ Appropriate patient selection through identification of risk factors, urine drug testing, and access to prescription monitoring programs has been shown to effectively improve care. Structured opioid therapy in a multimodal platform, including use of a low initial dose, prescription of alternative non-opioid analgesics including non-steroidal anti-inflammatory drugs and acetaminophen, as well as development of written care agreements to individualize and guide therapy has also been shown to improve patient outcomes. Implementation of opioid allocation strategies has the potential to encourage appropriate opioid use and improve patient care.
-
To investigate the long term smoking cessation behaviors in a population of Japanese current smokers (CS) and former smokers (FS). ⋯ In our survey, >70% of smokers used unaided smoking cessation methods, which may have resulted in a lower success rate. Participants relapsed after a median of 105 days of abstinence (25% within 7 days; the remainder had resumed smoking after 1260 days). As with all surveys, recall bias may have influenced the results. Our observations could be combined with other data in health economic models of smoking cessation to identify appropriate measures to reduce the prevalence of smoking in Japan.
-
Randomized Controlled Trial
Standardized modulation of the injection site allows for insulin dose reduction without deterioration of metabolic control.
Use of an injection site modulation device (InsuPad) in intensive insulin treatment reduces frequency of hypoglycemia and prandial insulin requirements by enhancing subcutaneous microcirculation. This meal tolerance test (MTT) investigation was performed as a sub-study during the real-world BARMER study to demonstrate non-inferiority of the reduced insulin doses observed in this study with respect to metabolic control. ⋯ The results of this meal tolerance sub-study confirm that the observed prandial insulin dose reduction when using the injection site modulation device has no negative impact on postprandial metabolism.
-
Observational Study
Tapentadol at medium to high doses in patients previously receiving strong opioids for the management of cancer pain.
The aim of this study was to assess the efficacy and tolerability of tapentadol (TP) for a period of 4 weeks in patients who were already treated by opioids. ⋯ In our sample, TP used in doses of 350-450 mg/day was well tolerated and effective in opioid tolerant patients with cancer pain and could be considered as a flexible drug to be used for the management of moderate to severe cancer pain. Like most studies in patients with cancer pain, it was limited by its open-label, uncontrolled design, the number of patients lost in follow-up, and discontinuation of the treatment for several reasons. Further studies in a large number of patients should confirm these preliminary results.
-
To understand academic/clinician authors' perceptions regarding the value of professional medical writers. ⋯ Respondents to this survey were generally accepting of medical writing assistance and valued many aspects of the role, in particular editorial support. The survey was small, however, and potentially biased towards authors with experience of working with medical communication agencies. Although many medical writers come from a scientific background and have relevant expertise, this was not perceived as a value. It would be beneficial to educate authors and journal editors regarding medical writers' scientific expertise and role.