Clinical therapeutics
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Clinical therapeutics · Apr 2010
Randomized Controlled Trial Comparative StudyPropofol/dexmedetomidine and propofol/ketamine combinations for anesthesia in pediatric patients undergoing transcatheter atrial septal defect closure: a prospective randomized study.
Children undergoing cardiac catheterization usually need general anesthesia or deep sedation. ⋯ In this small study, both dexmedetomidine and ketamine in combination with propofol were well tolerated in these pediatric patients who required ASD closure. The recovery period was significantly shorter in the dexmedetomidine group.
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Clinical therapeutics · Apr 2010
Impact of two Medicaid prior-authorization policies on antihypertensive use and costs among Michigan and Indiana residents dually enrolled in Medicaid and Medicare: results of a longitudinal, population-based study.
In response to rising pharmaceutical costs, many state Medicaid programs have implemented policies requiring prior authorization for high-cost medications, even for established users. However, little is known about the impact of these policies on the use of antihypertensive medicines in the United States. ⋯ Prior authorization was associated with lower use of nonpreferred antihypertensive drugs that was largely offset by increases in the use of preferred drugs. The possible clinical consequences of policy-induced drug switching for individual patients remain unknown because the present study did not include access to medical record data. Further research is needed to establish whether large-scale switches in medicines following the inception of prior-authorization policies have any long-term health effects.
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Clinical therapeutics · Apr 2010
Randomized Controlled TrialThree-week combination treatment with ACTH + magnesium sulfate versus ACTH monotherapy for infantile spasms: a 24-week, randomized, open-label, follow-up study in China.
Infantile spasms (IS) is an age-specific and severe epileptic encephalopathy that occurs in infancy and early childhood and is usually refractory to conventional antiepileptic drugs. Adrenocorticotropic hormone (ACTH) has been the treatment of choice for IS, but ACTH use has been associated with infection and hypertension. Magnesium ion is an N-methyl-D-aspartic acid (NMDA)-noncompetitive antagonist that might inhibit NMDA activity and has antiepileptic and neuroprotective effects. ⋯ In this study in infants with IS, the proportions of patients who were seizure free from 4 to 24 weeks were significantly greater in the ACTH + MgSO(4) group compared with the ACTH monotherapy group. Personal-social neurodevelopment was significantly improved from baseline in the group that received combination treatment. Both treatments were generally well tolerated. International Standard Randomized Controlled Trial no. ISRCTN 78654111.
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Clinical therapeutics · Apr 2010
ReviewOnset of relief of symptoms of gastroesophageal reflux disease: post hoc analysis of two previously published studies comparing pantoprazole 20 mg once daily with nizatidine or ranitidine 150 mg twice daily.
Systematic assessments of the onset of symptom relief in the treatment of gastroesophageal reflux disease (GERD) are lacking. ⋯ In this post hoc reanalysis of data from 2 previously published clinical trials, use of pantoprazole 20 mg once daily was associated with effective early relief from heartburn and acid regurgitation among these patients with GERD and NERD; relief occurred as fast as and, in some cases, even faster than that seen with nizatidine or ranitidine.
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Clinical therapeutics · Apr 2010
ReviewStrategies to optimize treatment with NSAIDs in patients at risk for gastrointestinal and cardiovascular adverse events.
NSAIDs, including cyclooxygenase (COX)-2 inhibitors, are among the most widely prescribed medications worldwide. However, NSAIDs have been associated with gastrointestinal (GI) toxicity. The cardiovascular (CV) toxicity associated with COX-2 inhibitors and some other NSAIDs further complicates the choice of therapy. ⋯ The choice of NSAID should be tailored to the GI and CV risks in the patient. The risk profile can be affected by numerous factors, including NSAID dosing and concurrent aspirin use. Thus, individualized risk stratification should be the clinician's primary consideration when selecting treatment.