Current medical research and opinion
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To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognized source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage, and referral of bowel symptoms suggestive of carcinoma, in pharmacies. ⋯ A pre-post design was considered more appropriate than a randomized control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer.
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The prevalence of medication non-adherence is 50% in chronic disease conditions and varies from 30% to 70% in asthma maintenance medications. A major drawback in addressing medication non-adherence is the short time available for patient consultations, which limits the ability of the clinician in identifying the problem. Thus, this study explores how medication adherence behavior can be clustered and identifies the unique characteristics of each cluster so that clinicians can recognize the cluster characteristics in patients to provide targeted interventions. The study objectives were to: (1) cluster patients' medication adherence behavior with asthma maintenance medications based on their beliefs in medicines and illness perceptions, and (2) describe the characteristics of the patients in each cluster based on psychosocial, clinical, and demographic characteristics. ⋯ The study demonstrated how the concept of 'non-adherence' is different for different patients and the need for tailored interventions for each type of non-adherence. With the limited consultation time available for clinicians to communicate with the patients, identifying the characteristics of patients in different clusters can assist clinicians in providing appropriate targeted interventions.
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Meta Analysis
The safety and efficacy of pregabalin for treating subjects with fibromyalgia and moderate or severe baseline widespread pain.
To evaluate pregabalin's efficacy (≤12 weeks) for pain relief and sleep improvement in patients with fibromyalgia (FM) and moderate-to-severe baseline pain. ⋯ Pregabalin was efficacious through 12 weeks for reducing pain and improving sleep quality in FM patients with baseline moderate or severe pain, with larger effects in the baseline severe pain subgroup. AEs were consistent with pregabalin's known safety profile and did not differ between moderate and severe pain subgroups.
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Postoperative leg position has been reported as an efficient and convenient technique to minimize blood loss and improve early recovery following total knee arthroplasty (TKA); however, no single study was large enough to definitively determine optimal leg position. Therefore, we performed a meta-analysis pooling the results from randomized controlled trials (RCTs) to evaluate the effect of postoperative leg position on blood loss and range of motion (ROM) in TKA. ⋯ This meta-analysis indicated that the postoperative flexion position of the leg in TKA was effective and safe, significantly decreasing total blood loss, hidden blood loss and blood transfusion requirement. In addition, the postoperative range of motion is significantly improved by the flexion position of the leg.
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Review Comparative Study
Efficacy and tolerability of switching therapy to vortioxetine versus other antidepressants in patients with major depressive disorder.
To assess the relative efficacy and tolerability of vortioxetine against different antidepressant monotherapies in patients with major depressive disorder (MDD) with inadequate response to selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) therapy. ⋯ The current systematic literature review found a few high quality switch studies assessing monotherapies in patients with MDD with inadequate response to SSRI/SNRIs. ITCs indicated that switching to vortioxetine leads to numerically higher remission rates compared with other antidepressants. Vortioxetine is a well tolerated treatment, showing statistically lower withdrawal rates due to AEs compared with other antidepressants. Vortioxetine is a relevant therapeutic alternative in patients experiencing inadequate response to prior SSRI or SNRI therapy.