Mother-infant consultation during drug treatment: Research and innovative clinical practice

Systolic/diastolic blood pressure of 130 to 139/80 to 89 mm Hg has been defined as stage I hypertension by the 2017 Hypertension Clinical Practice Guidelines. Drug treatment is recommended for stage I hypertensive patients aged ≥65 years without cardiovascular disease in the 2017 Hypertension Clinical Practice Guidelines but not in the 2018 Chinese guidelines. However, the cost-effectiveness of drug treatment among this subgroup of Chinese patients is unclear. This study developed a microsimulation model to compare costs and effectiveness of drug treatment and nondrug treatment for the subgroup of stage I hypertensive patients over a lifetime horizon from a government affordability perspective. Event rates of mortality and cardiovascular complications were estimated from 3 cohorts in the Chinese population. Costs and health utilities were obtained from the national statistics report and published literature. The model predicted that drug treatment generated quality-adjusted life-years of 13.52 and associated with expected costs of $6825 in comparison with 13.81 and $7328 produced by nondrug treatment over a lifetime horizon among stage I hypertensive patients aged ≥65 years without cardiovascular disease. At a willingness-to-pay threshold of $8836/quality-adjusted life-year (the GDP per capita in 2017), drug treatment only had a 1.8% probability of being cost-effective compared with nondrug treatment after 10 000 probabilistic simulations. Sensitivity analysis of treatment costs, benefits expected from treatment, health utilities, and discount rates did not change the results. Our results suggested that drug treatment was not cost-effective compared with nondrug treatment for stage I hypertensive patients aged ≥65 years without cardiovascular disease in China.

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Patients with History of Myocardial Infarction and Acute Cerebrovascular Accidentin Clinical Practice: Demographic, Clinical Characteristics, Drug Treatment and Outcomes (Data of Outpatient and Hospital Registry REGION)

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-5-656-662 ◽

2019 ◽

Vol 15 (5) ◽

pp. 656-662 ◽

Cited By ~ 1

Author(s):

E. Yu. Okshina ◽

M. M. Loukianov ◽

S. Yu. Martsevich ◽

S. S. Yakushin ◽

N. P. Kutishenko ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Practice ◽

Family History ◽

Drug Treatment ◽

Clinical Characteristics ◽

Beta Blockers ◽

All Cause Mortality ◽

History Of ◽

Hospital Registry

Aim. To assess the demographic and clinical characteristics, drug treatment and outcomes in patients with a history of acute cerebrovascular accident (ACVA) and with concomitant history of myocardial infarction (MI) in clinical practice based on outpatient and hospital parts of REGION registry.Material and methods. The total 1886 patients with a history of ACVA (aged of 70.6±12.5 years, 41.9% men) were enrolled into the outpatient registry REGION (Ryazan) and the hospital registry REGION (Moscow). 356 patients had ACVA and a history of MI (group “ACVA+MI” and 1530 patients had ACVA without history of MI (group “ACVA without MI”). The incidence of cardiovascular diseases (CVD), non-CVD comorbidities, drug therapy and outcomes were analyzed.Results. In the group ACVA+MI compared with group ACVA without MI the significantly higher proportions of patients with the following conditions (diagnosis) were revealed: arterial hypertension (AH) – 99.1% and 94.2%; coronary heart disease (CHD) – 100% and 57%; chronic heart failure (CHF) – 61.5% and 41.8%; atrial fibrillation (AF) – 42.7% and 23.8%; repeated ACVA – 32.9% and 18.9%, respectively, p<0.0001 for all. In ACVA+MI and ACVA without MI groups the respective proportions of patients were smokers – 16.2% and 23.7% (p=0.10), had a family history of premature CVD – 3.2% and 1.2% (p=0.01), and had a hypercholesterolemia – 47% and 59.7% (p<0.001). The incidence of drug administration with proved positive prognostic effect was insufficient in both groups, but higher in the ACVA+MI group compared with ACVA without MI group (on average 47.1% and 40%, respectively), including: anticoagulants in AF – 19.1% and 21.4% (p=0.55); antiplatelets in CHD without AF – 69.4% and 42% (p<0.001); statins in CHD – 26.4% and 17.2% (p<0.001); beta-blockers in CHF – 39% and 23.8% (p=0.002), respectively. During 4- year follow-up in the group ACVA+MI compared with group ACVA without MI there were significantly higher all-cause mortality – 44.9% and 26.8% (p<0.001), nonfatal recurrent ACVA – 13.7% and 5.6% (p=0.0001), and nonfatal MI – 6.9% and 1.0% (p<0.0001), respectively.Conclusion. The proportion of patients with a history of MI was 18.9% among the patients with a history of ACVA. In patients of ACVA+MI group, compared with patients of ACVA without MI group a higher incidence of the following characteristics was revealed: a presence of AH, CHD, CHF, AF, repeated ACVA and a family history of premature CVD. The incidence of taking drug with proved positive effect on prognosis in patients of the compared groups was insufficient, especially of statins and anticoagulants in AF. During the follow-up period ACVA+MI group was characterized by a higher all-cause mortality and higher incidence of nonfatal ACVA and MI. In these patients the improvement of the quality of pharmacotherapy and of the secondary prevention effectiveness are the measures of especial importance.

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The drug treatment research of gastrointestinal cancer in China

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2020.06.004 ◽

2020 ◽

Vol 46 (10) ◽

pp. e3-e6 ◽

Cited By ~ 1

Author(s):

Chao Ren ◽

Rui-hua Xu

Keyword(s):

Drug Treatment ◽

Gastrointestinal Cancer ◽

Treatment Research

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Real-world systemic therapy treatment patterns for squamous cell carcinoma of the head and neck in Canada

Current Oncology ◽

10.3747/co.26.3946 ◽

2019 ◽

Vol 26 (2) ◽

Cited By ~ 1

Author(s):

K. Byrne ◽

P. Hallworth ◽

A. Abbas Tahami Monfared ◽

A. Moshyk ◽

J. W. Shaw

Keyword(s):

Squamous Cell Carcinoma ◽

Clinical Practice ◽

Drug Treatment ◽

Real World ◽

Treatment Patterns ◽

Line Treatment ◽

Second Line ◽

First Line ◽

Line Drug ◽

First Line Treatment

Background In the present study, we examined real-world treatment patterns for squamous cell carcinoma of the head and neck (scchn) in Canada, which are largely unknown.Methods Oncologists across Canada provided data for disease history, characteristics, and treatment patterns during May–July 2016 for 6–8 consecutive patients receiving first-line or second-line drug treatment for scchn (including locally advanced and recurrent or metastatic disease).Results Information from 16 physicians for 109 patients receiving drug treatment for scchn was provided; 1 patient was excluded from the treatment-pattern analysis. Median age in the cohort was 63 years [interquartile range (iqr): 57–68 years], and 24% were current smokers, with a mean exposure of 26.2 ± 12.7 pack–years. The most common tumour site was the oropharynx (48%). Most patients (84%) received platinum-based regimens as first-line treatment (44% received cisplatin monotherapy). Use of cetuximab-based regimens as first-line treatment was limited (17%). Of 53 patients receiving second-line treatment, 87% received a first-line platinum-based regimen. Median time between first-line treatment with a platinum-based regimen and initiation of second-line treatment was 55 days (iqr: 20–146 days). The most common second-line regimen was cetuximab monotherapy (43%); platinum-based regimens were markedly infrequent (13%).Conclusions Our analysis provides real-world insight into scchn clinical practice patterns in Canada, which could inform reimbursement decision-making. High use of platinum-based regimens in first-line drug treatment was generally reflective of treatment guidelines; cetuximab use in the second-line was higher than anticipated. Additional real-world studies are needed to understand the effect of novel therapies such as immuno-oncology agents on clinical practice and outcomes, particularly for recurrent or metastatic scchn.

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Evidence-Based Assessment of Child Obsessive Compulsive Disorder: Recommendations for Clinical Practice and Treatment Research

Child & Youth Care Forum ◽

10.1007/s10566-009-9092-8 ◽

2010 ◽

Vol 39 (2) ◽

pp. 73-89 ◽

Cited By ~ 64

Author(s):

Adam B. Lewin ◽

John Piacentini

Keyword(s):

Clinical Practice ◽

Obsessive Compulsive Disorder ◽

Evidence Based ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Treatment Research

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A bioenergetic model that links psychopathology and intelligence: Implications for research and clinical practice

10.31234/osf.io/b3qf5 ◽

2022 ◽

Author(s):

Patrick Fissler ◽

R. Nehir Mavioglu ◽

Maya Wenzel ◽

Steffen Stoewer ◽

Wanja Wolff ◽

...

Keyword(s):

Risk Factors ◽

Clinical Practice ◽

Affect Regulation ◽

Factor Model ◽

Higher Order ◽

General Factor ◽

Cerebral Function ◽

Bioenergetic Model ◽

Treatment Research ◽

P Factor

Decomposing the structure of human cerebral function in its domains, such as affect regulation or cognition, forms the backbone of psychiatric diagnosis and treatment. Research continues to decipher the domains and hierarchical structure of cerebral function. So far, the findings strongly suggest two higher-order latent factors of general psychopathology (p factor) and general intelligence (g factor). Both general factors are functions of the same organ, covary, share risk factors as well as biomarkers, and benefit from the same treatments. However, to our knowledge, a model that connects both components of cerebral function within a higher-order latent factor and describes its potential biological underpinning is lacking. First, we suggest the general factor of cerebral function (c factor) as the shared variance of the measures of g and p in a bi-factor model. Second, we propose and provide evidence that mitochondrial bioenergetics (MB) is one core biological underpinning of c. Third, we describe how this c factor mito-bioenergetics (CMB) model may transform research and clinical practice by advancing knowledge of treatment effects, risk factors, biomarkers and clinical outcomes. Finally, we present a CMB model-based hypothesis stating that fatigue—as a phenotypical correlate of MB—directly loads on c.

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Drug treatment in attention deficit disorder: a survey of professional consensus

Psychiatric Bulletin ◽

10.1192/pb.21.7.398 ◽

1997 ◽

Vol 21 (7) ◽

pp. 398-400 ◽

Cited By ~ 2

Author(s):

Kapil Sayal ◽

Eric Taylor

Keyword(s):

Clinical Practice ◽

Drug Treatment ◽

Public Interest ◽

Attention Deficit ◽

Attention Deficit Disorder ◽

Current Level ◽

Psychological Treatments ◽

High Level

The strong recent public interest in attention deficit disorder and its drug treatment has led to the need for, and development of, guidelines for clinical practice. As a first step in this process our aim was to ascertain the current level of professional consensus on certain points regarding the use of medication in attention deficit disorder. Although a high level of consensus was found in relation to indications and prescribing issues, opinion was divided on details of how the treatment should be delivered – including the role of paediatricians, and the use of psychological treatments.

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