Current medical research and opinion
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Levodopa is currently the most effective treatment for Parkinson's disease (PD); however, long-term levodopa therapy often results in motor complications, such as motor fluctuations and dyskinesia. The initial complication is commonly wearing-off, which is the re-emergence of motor and non-motor symptoms before the next scheduled levodopa dose. ⋯ Current evidence indicates that a consistent delivery of levodopa should improve long-term symptomatic efficacy and may prevent or delay motor complications. A number of therapeutic options are available to optimize therapeutic outcome, including modification of the levodopa dose or dosing schedule,switching to another levodopa formulation and the use of adjunct therapies, such as catechol-O-methyl transferase inhibitors, dopamine agonists and monoamine oxidase-B inhibitors. The management of wearing-off is dependent upon the early identification of symptoms and the initiation of effective treatment. Key issues are the need to educate patients and to facilitate good communication with both primary and secondary healthcare professionals. In most cases, patients with PD initially present to primary healthcare professionals who may refer the patient to a neurologist once disease management becomes more complex. However, in many cases, especially in rural areas where neurologists may not be widely available, the primary healthcare professionals may manage the patient throughout the disease course. Limitations of this review include the restricted search criteria and selected search period.
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Reducing operating room (OR) time is of interest to hospital administrators because of high costs of OR utilization. Neuromuscular blocking agents (NMBAs) induce muscle relaxation during surgery. Several acetylcholinesterase inhibitors are used to reverse neuromuscular blockade to shorten recovery time. This study explored the relationship between elapsed OR time and the use of specific NMBAs and reversal agents among patients undergoing selected surgeries based on data from two large hospitals. Specifically, this study sought to test the hypothesis that the application of reversal agents in surgeries using a neuromuscular block would be associated with a decrease in elapsed OR time. ⋯ This analysis has shown that use of selected neuromuscular blockade reversal agents may lead to more efficient OR resource use.
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There is conflicting clinical evidence describing the response to long-acting beta-agonist (LABA) bronchodilators for patients with Arg16Gly beta(2)-adrenergic receptor (ADRB2 ) genotype differences. Furthermore, the role of inhaled corticosteroids (ICS) in modulating Arg16Gly clinical responses is not well understood. The objective of this study was to investigate the effects of Arg16Gly polymorphism on the 12 hour post-dose bronchodilator response to the LABA salmeterol (SAL) or SAL plus fluticasone propionate (FSC) on first administration and following 12 weeks of treatment. ⋯ In subjects with persistent asthma, the ADRB2 Arg16Gly polymorphism does not alter lung function responses to SAL or FSC over the 12 hour dosing interval following acute and chronic dosing.
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To evaluate treatment patterns and costs among new initiators of topical prostaglandin analogs in a managed-care population. ⋯ Use of adjunctive therapy in glaucoma is an important driver of glaucoma management costs. Based on the results of this study, it is possible that longer duration of monotherapy with prostaglandin analogs may be associated with lower annual costs. Further study should be conducted to validate these findings.
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The study objective is to compare the annual total medical and indirect costs of newly treated and untreated employees with multiple sclerosis (MS). ⋯ Initiation of MS disease-modifying drugs was associated with substantial significant medical and indirect savings for employees with MS. Study findings should be considered in the context of the study limitations (e.g., analytic focus on employees with at least 12-month follow-up; lack of clinical detail on MS severity).