If Migraine Prophylaxis Does Not Work, Think About Compliance

Data are presented on nine patients with migraine by IHS criteria, recruited from those presenting to the clinic for treatment and needing prophylaxis. Pizotifen 0.5 mg tds was prescribed for 8 weeks and dispensed in special containers with an electronic event recorder concealed in the lid. This responded to the pressure change with each opening of the container and recorded it in real time. The information was later downloaded to a PC for analysis. At trial end, two patients had been lost to follow-up, one had not started the treatment at all, two had dropped out because of alleged side effects (drowsiness), and four patients had completed the study. For these, the quantity of tablets used as a percentage of that prescribed (i.e., compliance assessed on the basis of returned-tablet count) ranged from 62.6% to 91.9%; the percentage of days in which three doses had been taken ranged from only 15.8% to 79%; the percentage of doses taken on schedule (8 h ± 25% after the previous dose) ranged from 21.1% to 47.3%. It is possible that all evaluations of efficacy and tolerance of migraine prophylactics reported so far have been unsoundly based.

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A prospective study to evaluate the acceptance, efficacy, side effects and expulsion rates of post-placental intrauterine device

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174628 ◽

2017 ◽

Vol 6 (11) ◽

pp. 4821

Author(s):

Richa S. Sankhe ◽

Meenal T. Kamble

Keyword(s):

Side Effects ◽

Intrauterine Device ◽

Excessive Bleeding ◽

Factors Associated ◽

Insertion Techniques ◽

Insertion Efficacy ◽

Post Placental ◽

A Prospective Study ◽

Lost To Follow Up

Background: This study was conducted to know the factors associated with acceptability of immediate post placental IUCD insertion in women and to know the level of safety, efficacy and expulsion of post placental insertion of IUCD.Methods: This study was conducted in Obstetrics and Gynecology Department of Kasturba General Hospital, Mumbai over a period of 1 year. Women admitted and delivered at KGH were informed and counselled regarding intrauterine devices regarding its insertion, efficacy and side effects. Cu T 380A was inserted within 15 minutes of delivery of placenta and membranes in women who gave consent and had no contraindications for IUD insertion. All these women were followed for 6 months in the post insertion period.Results: Total number of women counselled was 400 over the period of six months from August 2015 to January 2016. Out of these only 250 women gave consent for PPIUCD insertion. 50 were lost to follow up. 200 women were followed, out of which 15 women had expulsion, 15 women had excessive bleeding, 20 women complained of pelvic pain, bleeding and abdominal pain together was found in 25 women. 160 out of 200 continued with the method while the rest discontinued.Conclusions: Based on present study it may be concluded that post placental intrauterine device is an effective method of contraception. Proper counselling and insertion techniques would further improve the acceptability and reduce the expulsion rates.

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0695 Sleepwell24, A Smartphone Application To Promote PAP Therapy Adherence: Feasibility And Acceptability

SLEEP ◽

10.1093/sleep/zsaa056.691 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A265-A265

Author(s):

M E Petrov ◽

K Hasanaj ◽

C M Hoffmann ◽

D R Epstein ◽

L Krahn ◽

...

Keyword(s):

Real Time ◽

Smartphone Application ◽

Sleep Medicine ◽

Retention Rates ◽

Activity Levels ◽

Post Intervention ◽

Personal Technology ◽

Lost To Follow Up ◽

First Time

Abstract Introduction We aimed to test the feasibility and acceptability of SleepWell24, a multicomponent, smartphone-delivered intervention to increase positive airway pressure (PAP) adherence among newly diagnosed OSA patients. Methods SleepWell24 targets PAP adherence along with other health behaviors through education, trouble-shooting, goal-setting, and near real-time biofeedback of PAP machine use, and sleep and physical activity levels (via Fitbit integration), and other chronic disease self-management components. Patients with a first-time diagnosis of OSA (AHI≥5) and prescribed PAP therapy were enrolled from the Centers for Sleep Medicine at Mayo Clinic in Rochester, MN and Phoenix, AZ. Patients were randomized to SleepWell24 or usual care (UC) and assessed for PAP use over 60 consecutive nights. UC patients received a Fitbit monitor to control for non-specific intervention effects related to the introduction of a new personal technology. Feasibility was assessed with recruitment and retention rates and acceptability was assessed post-intervention with the validated, 8-item Treatment Evaluation Questionnaire (TEQ; range:0-4). ANCOVA models, adjusting for age, sex, and AHI severity, compared intervention arms on acceptability ratings. Results OSA patients were consented and randomized (N=111). Before the intervention began 4 participants withdrew, 12 were lost to follow-up, and 5 could not start the trial due to durable medical equipment (DME) vendor barriers. Ninety OSA patients (n=41 SleepWell24, n=49 UC; age M±SD=57.2±12.2; 44.4% female, 61.1% AHI≥15) started the intervention, with 2 participants withdrawing, 1 becoming deceased (unrelated to treatment) and 7 with missing PAP data due to DME vendor barriers. There was no significant between-groups differences on post-treatment acceptability (SleepWell24 M±SD=2.7±1.1 vs. UC M±SD=3.1±0.9, F[1,73]=2.3, p=0.11), and 77% of SleepWell24 participants found the app to be moderately to totally acceptable. Conclusion Overall, SleepWell24 was found to be feasible for delivery in two large clinical sleep medicine centers, and patients found the app to be acceptable. A number of challenges in trial delivery were encountered that have implications for scaled-up efficacy testing: (a) partnerships with DME vendors for near real-time PAP data integration; (b) alignment with clinical practice (i.e., referral, medical record integration); and (c) patient engagement. Support National Institute of Nursing Research / National Institutes of Health: R21NR016046

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A Follow-Up Study of 60 Patients After an Assumed First Period of Cluster Headache

Cephalalgia ◽

10.1111/j.1468-2982.2000.00104.x ◽

2000 ◽

Vol 20 (7) ◽

pp. 653-657 ◽

Cited By ~ 10

Author(s):

C Sjöstrand ◽

E Waldenlind ◽

K Ekbom

Keyword(s):

Cluster Headache ◽

International Headache Society ◽

Observation Time ◽

Follow Up Study ◽

Ihs Criteria ◽

Lost To Follow Up ◽

Second Period ◽

Final Group

During 1981–96 a series of 60 consecutive out-patients was examined in relation to an assumed first period of cluster headache (CH). On follow up in 1998 we found that six were deceased at a mean age of 56.5 years (range 45–74 years), of whom one had a definitive CH diagnosis and five had one documented headache period only. Six patients were lost to follow up because they could not be reached. In the final group for evaluation ( n = 49) it was found that 13 (26.5%) patients had had one cluster period only during a mean observation time of 8.9 years. Out of 36 patients with a definitive CH diagnosis according to International Headache Society (IHS) criteria, 31 patients had episodic CH, four patients had primary chronic CH and one patient had secondary chronic CH. Of the patients with a definitive CH diagnosis, 83% on follow up had had a recurrence of a second period of CH within 3 years or continuous attacks (chronic/semichronic CH) from the onset. Evidently some patients may suffer from one cluster period only. In our patient material only 17% had a second cluster period after 3 years.

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Completed Audit Cycle on Lithium Monitoring on Older Adults in Northumbria Healthcare NHS Trust, UK

European Psychiatry ◽

10.1016/s0924-9338(09)71082-x ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

A. Ghosh Nodiyal ◽

G. Ramsay ◽

S. Wilson

Keyword(s):

Side Effects ◽

General Hospital ◽

Similar Distribution ◽

National Formulary ◽

Information Leaflets ◽

Audit Data ◽

Audit Cycle ◽

One Year ◽

Lost To Follow Up

Aims:The aim of this study was to audit the practise of Lithium monitoring on all patients over the age of 65 years, over a one-year period in North Tyneside General Hospital, against the recommended standards, and re-auditing the following year.Methods:During the audit; data was collected from the medical notes of all patients prescribed Lithium, over 65 years in North Tyneside General Hospital. This was from January 2004 - January 2005. The standards used were the recommendations of The British National Formulary. The monitoring of urea, electrolytes, TSH and Lithium were recorded. The presence of an ECG, documentation of side effects, information leaflets’ distribution and patients lost to follow up were noted. Following the audit, recommendations were made and prescribing Consultants were informed. A re-audit was conducted on all patients on Lithium the next year from January 2006 - June 2006, using the same designed tool.Results:22 patient's notes were audited and 29 notes re-audited. 41% were males and 59% females in the audit, with similar distribution in the re-audit. 54% were between 65-75 years and 45% over the age of 75years in the audit. 41% and 59% respectively in the re-audit. Blood monitoring followed the standards in 86% in the audit and 95% in the re-audit. 32% had documentation of side effects in the audit, increasing to 72% in the re-audit. While 23% patients were lost to follow up in the audit, all were followed up in the re-audit.Conclusions:The re-audit encouragingly showed significant improvement in practise.

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Prestim in the Management of Mild to Moderate Essential Hypertension in General Practice

Journal of International Medical Research ◽

10.1177/030006058301100310 ◽

1983 ◽

Vol 11 (3) ◽

pp. 186-189 ◽

Cited By ~ 1

Author(s):

K Peacock ◽

B Hodge

Keyword(s):

Blood Pressure ◽

Side Effects ◽

Maximum Dose ◽

Fixed Dose ◽

Dose Titration ◽

Timolol Maleate ◽

Daily Dose ◽

Dose Combination ◽

Lost To Follow Up

Fifty-three hypertensive patients from one practice, of whom forty-two were new patients, were treated with Prestim — a fixed dose combination of 10 mg timolol maleate and 2·5 mg bendrofluazide. After a 2-week placebo run-in period, dose titration took place at weekly intervals up to a maximum of 4 tablets daily. Stabilized patients were followed-up at 3 months and approximately 1 year. At the 3-month follow-up, forty-nine patients were evaluated. Forty-two patients (85%) were well controlled (diastolic blood pressure below 95 mm Hg) on Prestim at a mean daily dose of 1·4 tablets. Four patients stopped therapy due to side-effects and in three patients the blood pressure was uncontrolled on the maximum dose of 4 tablets daily. After 1 year, thirty-four patients (75%) were still well controlled on a mean dose of 1·3 tablets daily. A further two patients were lost to follow-up and six other patients stopped therapy during the last nine months of the study. There were no unexpected side-effects and the general biochemical profile remained unaltered.

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The Effectiveness of Nortriptyline and Tolerability of Side Effects in Neurogenic Cough Patients

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420970234 ◽

2020 ◽

pp. 000348942097023

Author(s):

Sungjin A. Song ◽

Kanittha Choksawad ◽

Ramon A. Franco

Keyword(s):

Side Effects ◽

Case Series ◽

Clinical History ◽

Demographic Information ◽

Retrospective Case ◽

Exclusion Criteria ◽

Level Of Evidence ◽

Medication Dosage ◽

Lost To Follow Up

Objective: To determine the effectiveness of nortriptyline and tolerability of side effects in the treatment of neurogenic cough. Secondary goal is to evaluate the association between laryngeal asymmetry and clinical response to nortriptyline. Study Design: Retrospective case series. Materials and Methods: Consecutive patients diagnosed with neurogenic cough at a quaternary care specialty hospital from 2001 to 2020 were identified. Subjects <18 years old, not treated with nortriptyline, did not have a nasolaryngoscopic examination and were lost to follow-up were excluded. Charts were reviewed for demographic information, clinical history, nasolaryngoscopic findings, medication dosage, side effects, and follow-up time. Results: Forty-two patients met inclusion and exclusion criteria, 7 males and 35 females with an average age of 56.5 (±13.1) years. There were 26/36 (72.2%) responders and 10/36 (27.8%) non-responders; 6 patients stopped nortriptyline due to side effects and were not included in the response comparison. Laryngeal asymmetry was present in 36/42 (85.7%) patients. No factors related to laryngeal asymmetry were significantly different between responders and non-responders. Medication tolerance was observed in 3/42 (7.1%) patients. Side effects were reported in 16/42 (38.1%) patients. The most common side effects were sedation 9/42 (21.4%) and xerostomia 3/42 (7.1%). Conclusion: Nortriptyline is effective for treating neurogenic cough with 72% of patients reporting improvement in cough. Evidence of laryngeal asymmetry was not associated with better treatment response. Although 38% experienced side effects, the majority of patients continued nortriptyline despite side effects. Level of Evidence: 4

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Randomized Prospective Study Comparing Erythromycin, Amoxicillin, and Clindamycin for the Treatment ofChlamydia trachomatisin Pregnancy

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744995000020 ◽

1995 ◽

Vol 2 (5) ◽

pp. 205-209 ◽

Cited By ~ 5

Author(s):

Mark A. Turrentine ◽

Lisa Troyer ◽

Bernard Gonik

Keyword(s):

Side Effects ◽

Chlamydia Trachomatis ◽

Prospective Study ◽

Genital Tract ◽

Gastrointestinal Symptoms ◽

Sexual Partners ◽

Lower Genital Tract ◽

Barrier Contraception ◽

Lost To Follow Up

Objective:The purpose of this study was to compare the efficacy and side effects of erythromycin, amoxicillin, and clindamycin in eradicatingChlamydia trachomatisfrom the lower genital tract of pregnant women.Methods:A total of 174 women at <36 weeks gestation with positive cervical cultures forC. trachomatiswere enrolled. Patients were assigned in a randomized prospective fashion to either erythromycin (500 mg q.i.d, for 7 days), amoxicillin (500 mg t.i.d, for 7 days), or clindamycin (600 mg t.i.d, for 10 days). Six women elected not to participate and 8 patients were lost to follow-up, leaving 53 patients in the erythromycin group, 55 patients in the amoxicillin group, and 52 patients in the clindamycin group. All sexual partners of the enrolled women were offered doxycycline (100 mg b.i.d. for 7 days) and patients were instructed to use barrier contraception until treatment was complete.Results:All 3 medications were effective agents for the treatment of antenatalC. trachomatisinfection with treatment efficacies of 96%, 94%, and 98% for the erythromycin, amoxicillin, and clindamycin groups, respectively. When the antibiotic groups were compared, no statistically significant differences were noted in intolerance. However, the differences in the incidence of gastrointestinal symptoms between erythromycin and amoxicillin and/or clindamycin were significant (P < 0.05).Conclusions:These findings suggest that 1) all 3 antibiotic regimens are efficacious, 2) erythromycin has a higher incidence of side effects, and 3) amoxicillin or clindamycin are reasonable alternatives for the treatment ofC. trachomatisin pregnant patients unable to tolerate erythromycin.

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Failure of radiotherapy in acromegaly

Acta Endocrinologica ◽

10.1530/eje.0.1450717 ◽

2001 ◽

pp. 717-726 ◽

Cited By ~ 57

Author(s):

R Cozzi ◽

M Barausse ◽

D Asnaghi ◽

D Dallabonzana ◽

S Lodrini ◽

...

Keyword(s):

Side Effects ◽

Tumor Size ◽

Primary Treatment ◽

Large Tumor ◽

Antisecretory Drug ◽

Igf I ◽

Surgical Failure ◽

Antisecretory Treatment ◽

Lost To Follow Up

BACKGROUND: Recent data has raised skepticism regarding the long-term effectiveness of radiotherapy (RxT) in acromegaly and its role as an ancillary tool to neurosurgery (Tx). PATIENTS: We evaluated 72 acromegalic patients previously submitted to RxT. Data were discarded in 23 patients, who were lost to follow-up, operated on after RxT or irradiated with techniques different from external conventional fractionated RxT. Among the remaining 49 (five with mixed GH-prolactin adenoma), 34 were irradiated after surgical failure and 15 as primary treatment. A second cycle of RxT was administered in two. RESULTS: (i) GH/IGF-I. After a median follow-up of 14 years (range 3-41), normal age-matched IGF-I levels were reached in eight patients (16%) after 10 years, and GH levels <2.5 microg/l in six (12%) after 9 years. The rate of persistently pathological hormonal levels was still 90% at 25 years. All patients with GH/IGF-I normalization had undergone irradiation without any antisecretory drug. Neither basal GH nor tumor size affected the outcome of RxT. In three patients (6%) a relapse/worsening occurred. (ii) Tumor size. Tumor shrank after 8.5 years in 24 patients (49%), in nine of whom during GH-suppressive treatment. Tumor shrinkage was not predictive of hormonal normalization. (iii) Side-effects. Hypopituitarism was diagnosed in four patients (selective in three and global in one) and GH deficiency in one. Three patients had neurological side-effects and meningioma was shown in two patients. CONCLUSION: RxT is unable to cure acromegaly, because it seldom achieves hormonal normalization even after a very prolonged follow-up. Concomitant antisecretory treatment seems to counteract its effects. RxT can still play a role in those patients with large tumor remnants, because of its capacity to shrink tumor size.

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