International journal of clinical practice
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Int. J. Clin. Pract. · Oct 2008
Randomized Controlled Trial Multicenter StudyA novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile.
We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease (CHD) risk could lower patients' predicted Framingham CHD risk vs. usual care. ⋯ A physician-implemented CHD risk evaluation/communication programme improved patients' modifiable risk factor profile, and lowered predicted CHD risk compared with usual care. By combining this strategy with more intensive treatment to reduce residual modifiable risk, we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice.
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Int. J. Clin. Pract. · Sep 2008
Randomized Controlled Trial Multicenter StudyA pilot study of high-dose short duration daptomycin for the treatment of patients with complicated skin and skin structure infections caused by gram-positive bacteria.
Methicillin-susceptible and -resistant (MRSA) Staphylococcus aureus are significant causes of complicated skin and skin structure infections (cSSSI). The bactericidal antibiotic daptomycin is approved for gram-positive cSSSI at 4 mg/kg/day for 7-14 days, but the optimal dose level and duration of therapy have not been firmly established. This pilot study evaluated the efficacy and safety of daptomycin at 10 mg/kg every 24 h for 4 days [high-dose short duration (HDSD) regimen] vs. standard of care therapy with vancomycin or semi-synthetic penicillin for the treatment of cSSSI. ⋯ We found that the HDSD regimen had a safety profile similar to that seen in previous studies. Although the differences were not statistically significant, clinical success rates for comparator were higher than for daptomycin. In post hoc analyses HDSD daptomycin performed better in some subgroups (e.g. outpatients) than in others (e.g. certain MRSA infections). These observations require confirmation in larger trials.
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Int. J. Clin. Pract. · Sep 2008
Randomized Controlled Trial Multicenter Study Comparative StudyPostprandial blood glucose response to a standard test meal in insulin-requiring patients with diabetes treated with insulin lispro mix 50 or human insulin mix 50.
To compare the 2-h postprandial blood glucose (PPBG) excursion following a standard test meal in insulin-requiring patients with diabetes treated twice daily with human insulin mix 50 vs. insulin lispro mix 50 (LM50). ⋯ Insulin lispro mix 50 provided better postprandial glycaemic control compared with human insulin mix 50 while providing the convenience of injecting immediately before meals. Both treatments were generally well tolerated by all randomly assigned patients.
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Int. J. Clin. Pract. · Sep 2008
ReviewExtended administration of erythropoiesis-stimulating agents for optimising the management of renal anaemia: what is the evidence?
Erythropoiesis-stimulating agents (ESAs) have transformed the management of anaemia in patients with chronic kidney disease (CKD), reducing transfusion requirements and leading to improved quality of life. However, effective anaemia management with current ESAs is labour-intensive and time-consuming. Approaches are required to simplify anaemia management and reduce the burden on healthcare systems. There is increasing interest in extending the administration interval of ESAs. This would result in considerable time-savings, reducing the workload of healthcare providers and potentially reducing healthcare system costs. Time saved could be utilised in improving other aspects of patient care, such as implementation of guidelines, or treating more patients. Potential benefits of extended administration intervals for patients include a less demanding regimen and fewer injections, which could lead to improved adherence to treatment. ⋯ Patients who are already stable on more frequent ESA therapy and who respond well to treatment may be able to maintain stable Hb with extended dosing regimens with established ESAs. However, few patients with CKD currently receive ESAs once-monthly in clinical practice. New agents with long half-lives offer the potential for extended dosing regimens in all patients with CKD.
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Int. J. Clin. Pract. · Sep 2008
Frailty, health-related quality of life and mental well-being in older adults with cardiometabolic risk factors.
Frailty is an emergent health-related problem in older adults. The aim of this study was to examine the health-related quality of life (HRQOL) and the effect of frailty in elderly patients with cardiometabolic risk factors. ⋯ Frail older adults had a significant lower HRQOL, as well as lower mental well-being, independent of age, diabetes, macrovascular complication, kidney dysfunction and depressed mood.