Int J Clin Pharm Th
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Int J Clin Pharm Th · Jul 2006
Potentially inappropriate prescribing for insomnia in elderly outpatients in Taiwan.
This study was based on Taiwan's National Health Insurance (NHI) claim records with the aim of identifying specific types of potentially inappropriate sedative-hypnotic prescribing in elderly outpatients with insomnia. The potentially inappropriate prescribing included duplicate treatment, excessive dosage and duration or treatment and prescribing of hypnotics that are too long-acting. ⋯ Elderly people in Taiwan with insomnia receive potentially inappropriate prescriptions for sleep medications. Similar data could possibly be extracted from similar databases in other countries throughout the world. Some of these potentially inappropriate prescriptions are avoidable in terms of restricting the length of outpatient sedative-hypnotic treatment, introducing hypnotics in small dosage forms and continuously educating clinicians on the safety of geriatric medication.
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Int J Clin Pharm Th · Jul 2006
ReviewGlucocorticoid treatment in patients with septic shock: effects on vasopressor use and mortality.
Corticosteroids were proposed for the treatment of sepsis as early as 1940. Several RCTs cast serious doubts on the usefulness of high dose corticosteroids and doubt still persists regarding the efficacy of replacement therapy. Adrenal insufficiency (non-responders to the 250 microg corticotropin test: increase in cortisol < 9 microg/dl) is present in about half of patients with septic shock and is associated with higher rates of refractory hypotension and mortality. ⋯ On the other hand, analysis of studies where low doses of glucocorticoids were given for prolonged periods showed a 24% reduction in the risk of all-cause mortality at 28 days in treated patients (RR = 0.76, 95% CI: 0.64 - 0.90; p = 0.002) without heterogeneity across the trials (p = 0.28). In conclusion, in severe sepsis, high doses of corticosteroids should not be given. Septic shock should be treated with a replacement dose of hydrocortisone.