International journal of clinical practice
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Int. J. Clin. Pract. · Aug 2007
Randomized Controlled Trial Multicenter StudyThe safety and tolerability of duloxetine in depressed elderly patients with and without medical comorbidity.
The impact of medical comorbidity on the efficacy and tolerability of duloxetine in elderly patients with major depressive disorder (MDD) was investigated in this study. Data were obtained from a multicentre, randomised, double-blind, placebo-controlled study in 311 patients with MDD aged 65-89. The primary outcome measure was a prespecified composite cognitive score based on four cognitive tests: (i) Verbal Learning and Recall Test; (ii) Symbol Digit Substitution Test; (iii) 2-Digit Cancellation Test and (iv) Letter-Number Sequencing Test. Secondary measures included the Geriatric Depression Scale (GDS), 17-Item Hamilton Depression Scale (HAMD17), Clinical Global Impression-Severity (CGI-S) Scale, Visual Analogue Scale (VAS) for pain and 36-Item Short Form Health Survey (SF-36). Tolerability measures included adverse events reported as the reason for discontinuation and treatment-emergent adverse events (TEAEs). The consistency of the effect of duloxetine vs. placebo comparing patients with and without medical comorbidity (vascular disease, diabetes, arthritis or any of these) was investigated. ⋯ The present analyses suggested that the efficacy of duloxetine on cognition and depression in elderly patients, and its tolerability, were not largely affected by the comorbidity status. These results further support the use of duloxetine in elderly patients with MDD.
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Int. J. Clin. Pract. · Jul 2007
Review Multicenter StudyOpioid-induced bowel dysfunction: prevalence, pathophysiology and burden.
As a result of the undesired action of opioids on the gastrointestinal (GI) tract, patients receiving opioid medication for chronic pain often experience opioid-induced bowel dysfunction (OBD), the most common and debilitating symptom of which is constipation. Based on clinical experience and a comprehensive MEDLINE literature review, this paper provides the primary care physician with an overview of the prevalence, pathophysiology and burden of OBD. Patients with OBD suffer from a wide range of symptoms including constipation, decreased gastric emptying, abdominal cramping, spasm, bloating, delayed GI transit and the formation of hard dry stools. ⋯ Physicians should have greater appreciation of the prevalence, symptoms and burden of OBD. In light of the serious negative impact OBD can have on QoL, physicians should encourage dialogue with patients to facilitate optimal symptomatic management of the condition. There is a pressing need for new therapies that act upon the underlying mechanisms of OBD.
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Int. J. Clin. Pract. · Jul 2007
ReviewEminence-based guidelines: a quality assessment of the second Joint British Societies' guidelines on the prevention of cardiovascular disease.
The quality and independence of clinical practice guidelines developed by professional societies has previously been assessed as unsatisfactory. Calls for explicit methodological standards have lead to international consensus on standards for guideline development. The methodological quality of current British cardiovascular guidelines produced by six professional societies is assessed with reference to internationally recognised criteria (Appraisal of Guidelines Research and Evaluation) for evaluating the quality of clinical guidelines. When evaluated with reference to a recognised quality framework for guideline development, current Joint British Societies guidelines for the prevention and treatment of cardiovascular disease contain serious deficiencies, are of low quality and should not be recommended for clinical practice.
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Int. J. Clin. Pract. · Jul 2007
ReviewThe change in zoster-associated pain treated with oral valaciclovir in immunocompetent patients with acute herpes zoster.
We have analysed zoster-associated pain treated with valaciclovir (VCV) in immunocompetent patients with acute herpes zoster over 6 months, and evaluated the safety of VCV. We know of no reports that evaluate postherpetic neuralgia (PHN) treated with VCV for 6 months. ⋯ Timing of the administration of VCV before or after the onset of rash did not influence the incidence of PHN. No serious adverse reactions were observed during the administration of VCV.