High Degree of Nonadherence to Disease-modifying Antirheumatic Drugs in Patients with Rheumatoid Arthritis

Objective.To test medication adherence using the Compliance-Questionnaire-Rheumatology (CQR).Methods.Invitation letter and CQR were sent to 240 patients with rheumatoid arthritis. Followup CQR was sent 3 months later. Adherence was evaluated using CQR 80% cutoff scores.Results.Seventy-eight patients who were being treated with disease-modifying antirheumatic drugs provided full information on the CQR at both points in time. Eleven patients (14.1%) were classified as adherent based on taking compliance (TC), with only 3 patients (3.8%) adherent in regard to correct dosing (CD) [followup: 13 (16.7%) and 3 (3.8%) for TC and CD, respectively]. Nonadherence was not related to disease activity or side effects.Conclusion.We demonstrated low adherence, suggesting differences between doctors’ records and patients’ practice of antirheumatic drug therapy.

Effectiveness of Prophylactic use of Etoricoxib in Comparison with Ibuprofen on Postendodontic Pain-randomized Double-Blind, Placebo-controlled Study: An in vivo Study

ABSTRACT Aim To determine if prophylactic etoricoxib significantly reduce postendodontic pain when compared with prophylactic ibuprofen and to establish if any relationship exists between pulpal and periapical diagnosis and the need for additional medication after completion of pulpectomy. Materials and methods Sixty patients consented to a double-blind, single-dose oral administration of 120 mg of etoricoxib or ibuprofen 600 mg or placebo before conventional root canal therapy. The patients were discharged with a VAS to fill out the intensity of pain initially first four hours every hour and then in 8, 12, 24, 48, and 72 hours after initial therapy. Each patient was given an escape envelope containing 650 mg of paracetamol in case of continued pain after taking the test medication in question. The patients were instructed to indicate in the VAS form if this additional medication was required and record the time it was taken. Results The result of the study showed that etoricoxib provided significantly better pain relief than placebo and ibuprofen. There was no statistically significant difference between placebo and ibuprofen. No difference in drug groups with respect to pulpal and periapical status was observed. Conclusion Prophylactic etoricoxib administration provides effective reduction of postendodontic pain. Furthermore, studies are required to know the pulpal and periapical status and need for additional medication.

Comparative Trial in Volunteers to Investigate Possible Ethanol-Ranitidine Interaction

OBJECTIVE: To assess the effect of ranitidine on ethanol absorption after ethanol 0.5 g/kg is given in three single doses of 0.167 g/kg to simulate normal social drinking. DESIGN: A double-blind, placebo-controlled, crossover trial was performed in 16 healthy men. Ethanol serum concentrations were measured on day 6 of each of the three treatment periods (placebo, ranitidine 150 mg bid, or ranitidine 300 mg bid). METHODS: Ethanol 0.167 g/kg was administered followed by a standard meal at 1700. The last tablet of the test medication was given 15 minutes later. Thirty and 60 minutes after the first intake, the same amount of ethanol was given again. Serum ethanol concentrations were measured multiple times during the four-hour period following oral ingestion of the first dose. RESULTS: Comparison of median serum ethanol concentrations, the areas under the curve, peak and time to peak serum ethanol concentrations showed no significant differences during medication with placebo, ranitidine 150 mg bid, or ranitidine 300 mg bid. Peak ethanol concentrations (median values) were 153, 140, and 155 mg/L, respectively. CONCLUSIONS: This study shows that treatment with ranitidine, in a dose up to 300 mg bid, has no significant effect on serum ethanol concentrations, even when ethanol was given in divided doses to simulate normal patterns of social drinking. This implies that concomitant dosing with ranitidine will not increase the adverse effects of moderate doses of ethanol on concentration and psychomotor function.

The Comparative Efficacy of Naproxen Sodium and Pirprofen in the Treatment of Post-Operative Pain

A randomized, single-blind, parallel study involving 100 adults was performed to compare the efficacy and safety of naproxen sodium with that of pirprofen in the treatment of moderate to severe pain after orthopaedic surgery. Fifty patients received 550 mg of naproxen sodium initially and 275 mg every 6 h thereafter, and 50 received 400 mg of pirprofen every 8 h until either their pain was completely relieved or the 3-day trial ended. Patients who required additional analgesia were given 500 mg of paracetamol 2 h after administration of the test medication. Both medications significantly relieved post-operative pain, and there were no statistically significant differences in efficacy between the groups. Six patients receiving naproxen sodium and two patients receiving pirprofen withdrew from the study because of lack of efficacy. Thirteen patients receiving naproxen sodium recorded 17 adverse events and 13 patients receiving pirprofen recorded 20 adverse events, again with no statistically significant differences between groups. Six patients in each group withdrew from the study because of these adverse events. Naproxen sodium and pirprofen were equally safe and effective in relieving post-operative pain following musculoskeletal surgery.

Psychological Preparation for Surgical Pediatric Patients: The Effect on Children's and Parents' Stress Responses and Adjustment

This clinical experiment tested variations of psychological preparation and supportive care designed to increase the adjustment of children (and their parents) hospitalized for elective surgery. Eighty-four children, aged 3 to 12, admitted for tonsillectomies were randomly assigned to one of three treatment conditions or to a control group: (1) a combination of systematic preparation, rehearsal, and supportive care conducted prior to each stressful procedure; (2) a single-session preparation conducted after admission; and (3) consistent supportive care given by one nurse at the same points as in the first condition, but including no systematic preparation or rehearsal. The children's hospital adjustment was measured by blind ratings of behavioral upset and cooperation during the blood test, medication injection, transport to surgery, induction, and postoperative fluid intake and by recovery room medications and pulse rates and time to first voiding. Post-hospital adjustment was assessed with Vernon et al.'s Post Hospital Behavior Inventory. Parent outcome measures included self-ratings for anxiety and satisfaction with information and care. As hypothesized, the results demonstrated that children who received condition one showed significantly less upset and more cooperation and their parents reported significantly greater satisfaction and less anxiety than did children or parents in the other groups. Younger children were significantly more upset and less cooperative than older children.