Journal of clinical pharmacy and therapeutics
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The uptake of new medicines is slower in the UK than in many other countries. Previous research found that cost and price have little influence on general practitioner (GP) behaviour, but recent UK government policy may have heightened cost-consciousness. Focussing on new medicines, this review aimed to explore the determinants of uptake, the causes of geographical variations, and the influence of price, cost and financial incentives on prescribing behaviour. ⋯ General practitioner care has historically been patient-centred, and it is unclear whether and how GPs consider the impact of their decisions upon the wider patient population. Incorporating cost considerations into GP decision making is one way to reflect the broader impact of individual treatment decisions. Current UK government policies use incentives to improve quality and encourage financial responsibility. Although these initiatives may help foster cost-consciousness, there is a risk that unintended consequences may ensue. Therefore, future policy evaluations should assess benefits, harms and costs so that the overall impact is transparent.
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Clinical Trial
Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit.
Spontaneous breathing trials (SBT) and intermittent mandatory ventilation (IMV) are common techniques utilized to expedite the ventilator weaning process. These techniques often require the reduction and/or discontinuation of sedatives and analgesics. Reducing these medications can lead to agitation and the inability to conduct SBTs or weaning by IMV. Adding dexmedetomidine (dex), a potent alpha-2-adrenergic receptor agonist that possesses sedative, anxiolytic and analgesic effects without causing significant respiratory depression, may facilitate extubation in these patients. ⋯ Dexmedetomidine was initiated in a group of mechanically ventilated patients who failed previous attempts at weaning and extubation secondary to agitation. After dex initiation, 65% of the patients was successfully extubated. Dexmedetomidine was associated with a reduction in concomitant sedative and analgesic use with minimal adverse effect.
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Functional imaging in patients with movement disorders has suggested abnormalities of regional cerebral blood flow (rCBF). We describe a patient with thoracic cord lesion with subsequent severe neuropathic pain. Right hemichorea developed and was related to adjunctive therapy with gabapentin. ⋯ The study of rCBF revealed hypoperfusion in the contralateral basal ganglia compared with the previous study of rCBF. Our patient is the first patient with neuropathic pain, treated with gabapentin who developed hemichorea, in the absence of brain lesions. Imaging studies of rCBF showed a perfusion defect in the contralateral basal ganglion.
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Discontinuity of care bears the risk of medication errors and poor clinical outcomes. Little is known about the continuity of care related to pharmacies. Therefore, we studied the prevalence and determinants of pharmacy shopping behaviour in the Netherlands. ⋯ Pharmacy shopping behaviour is limited in the Netherlands. However, it may put the patient at risk for unintentional problems, such as drug-drug interactions with anti-infectives. A small proportion of patients exhibit possibly intentional shopping behaviour with psychotropic drugs.