Postgraduate medicine
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Postgraduate medicine · May 2014
Safety and tolerability of canagliflozin in patients with type 2 diabetes mellitus: pooled analysis of phase 3 study results.
Canagliflozin is a sodium glucose cotransporter 2 inhibitor developed for treating type 2 diabetes mellitus (T2DM). ⋯ The safety/tolerability profile of canagliflozin 100 and 300 mg over 26 weeks was assessed using an integrated analysis of data pooled from 4 placebo-controlled, phase 3 studies representing a broad range of patients with T2DM (N = 2313; mean age, 56.0 years; glycated hemoglobin [HbA1c], 8.0%; body mass index, 32.1 kg/m2; estimated glomerular filtration rate, 88.1 mL/min/1.73 m2) on various prespecified background diabetes mellitus treatments. Safety/tolerability evaluations included adverse event (AE) reporting, with additional data collection prespecified for selected AEs, and assessments of renal-related, lipid, and other safety laboratory parameters.
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Postgraduate medicine · May 2014
Health care provider management of patients with type 2 diabetes mellitus: analysis of trends in attitudes and practices.
To identify attitudes and practices of endocrinologists (ENDOs), family practitioners (FPs), internists (IMs), primary care nurse practitioners (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 diabetes mellitus (T2DM) management; to compare current study data with results from a similar 2011 study. ⋯ Notable shifts from 2011 included NPs' increased familiarity with American Diabetes Association (ADA) guidelines; FPs, IMs, NPs, and PAs continued comfort with prescribing long-acting basal insulin but less with basal-bolus, Neutral Protamine Hagedorn insulin alone, or human premixed insulin; increased pharmacists' comfort in discussing long-acting basal insulin; increased likelihood that FPs will refer patients with recurrent hypoglycemia unable to achieve target glycated hemoglobin level to an ENDO; and continued incorporation of insulin and incretins into treatment regimens. The trends suggest gaps in perception, knowledge, and management practices to be addressed by education. Most HCPs lack confidence in using insulin regimens more complex than long-acting insulin alone. All providers need education on T2DM management guidelines, differences between GLP-1 agonists and DPP-4 inhibitors, and how to intensify therapy for patients not reaching goal blood glycemic level with use of multiple agents. Pharmacists might benefit from education on glycemic treatment goals.
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Postgraduate medicine · May 2014
Physician adherence to ACR gout treatment guidelines: perception versus practice.
In October 2012, the American College of Rheumatology (ACR) published recommendations for chronic gout treatment goals and pharmacotherapy. ⋯ Although adherence with ACR guidelines is higher among rheumatologists than PCPs in treating patients with gout, overall adherence could be improved by both specialties.
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Postgraduate medicine · Mar 2014
Randomized Controlled TrialDouble-blind, placebo-controlled, crossover study of early-intervention with sumatriptan 85/naproxen sodium 500 in (truly) episodic migraine: what's neck pain got to do with it?
Published studies of triptans in acute migraine have shown relatively disappointing 2-hour pain-free rates, ranging from 18% to 58%, with 2- to 24-hour sustained pain-free rates from 17% to 25%. A major flaw in the design of previous studies may have contributed to disappointing results: many subjects are not truly episodic in the nature of their headaches-they discount days with mild headache and ignore days with migraine-related neck pain. Believing that neck pain is integrally related to migraine, we sought to ascertain whether early treatment with sumatriptan 85/naproxen sodium 500 (sumatriptan/naproxen) in truly episodic migraineurs is more robust than results when neck pain has not been considered. ⋯ Our study results support a fundamental re-evaluation of the role of neck pain in migraine.
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Postgraduate medicine · Mar 2014
ReviewPsychosocial and pharmacological management of pain in pediatric sickle cell disease.
For children with sickle cell disease (SCD), pain is associated with significant current and future morbidity and mortality. Unfortunately, few evidence-based guidelines exist for the management of pain episodes in children with SCD. To inform empirically based treatment strategies for pain management in pediatric SCD, this review integrates and evaluates the extant literature on psychosocial and pharmacological approaches to the management of pain. ⋯ However, to date there is not a "gold standard" for pain management among children with SCD. Because psychosocial and physiological processes each play a role in the etiology and experience of pain, effective pain management requires multidimensional, comprehensive treatment approaches. Considering the significant impact of pain on functional outcomes and quality of life among children with SCD, additional clinical trials are warranted to ensure that interventions are safe and efficacious.