Biomedical subjects
Publications and source records attributed to D Gilden.
Patients who cannot construct a viable antiretroviral regimen with approved drugs will now have easier access to tenofovir, a drug that is currently experimental but may be approved in about six months. Tenofovir is significant because it appears to maintain its antiretroviral activity, with resistant HIV developing relatively slowly.
BACKGROUND: Treatment of benign prostatic hyperplasia (BPH) with nonselective alpha1 antagonists such as terazosin, doxazosin, and prazosin results in blood pressure reduction due to vasodilation. OBJECTIVE: Using claims data from a large Medigap plan, we examined the effect of initiating nonselective alpha1-antagonist therapy on the incidence of hypotension-related adverse events likely to be associated with vascular alpha-adrenoreceptor antagonism in patients with BPH. METHODS: Medical and prescription claims data were obtained from the MEDSTAT Group for 53,824 men with a diagnosis code for BPH during the study period (January 1995-December 1997). We examined the rate of possible hypotension-related adverse events (diagnosis codes for hypotension, syncope, dizziness, fractures, and other injuries) per 10,000 person-days for men who began therapy with alpha1 antagonists and for a random sample of nonusers, stratified by prior use of other antihypertensive agents. RESULTS: After adjusting for baseline differences in event rates, those who initiated alpha1-antagonist therapy (n = 1564) had a significantly greater increase in hypotension-related adverse-event rates in the 4 months after initiation (vs the 4 months before initiation) than randomly selected nonusers (n = 8641) (increase of 1.82 vs decrease of 0.02 events per 10,000 person-days among those not taking antihypertensive agents; increase of 0.94 vs 0.69 events per 10,000 person-days among those taking other antihypertensive agents; P < 0.01). This increase began earlier and lasted longer among patients taking other antihypertensive agents. Those who discontinued their alpha1 antagonist had a higher rate of hypotensive events at baseline than those who did not (5.09 vs 3.19 events per 10,000 person-days among those using other antihypertensive agents; 3.62 vs 2.27 events per 10,000 person-days among those not using other antihypertensive agents; P < 0.05). CONCLUSIONS: Initiation of nonselective alpha1-antagonist therapy for the treatment of BPH increases the risk of a cluster of clinical events consistent with vascular alpha-adrenoreceptor antagonism. This effect is seen during a 4-month period around the initiation date. Prior initiation of other antihypertensive medication increases this effect. Urologists should consult with a patient's primary care physician about use of other antihypertensive agents before initiating nonselective alpha1-antagonist therapy for BPH.
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Much has been done to give blind people access to text-based information through computers. Unfortunately, the recent development of Windows operating systems and GUIs jeopardize these gains. Spatial information which is becoming more important to the sighted has never been widely available to blind people. Through a combination of gesture input with audio output, the KnowWare system offers blind users a new way to access spatial information. An invisible virtual map is defined on the desktop. When the user touches a feature on the map with the tip of his index finger, the computer tells him what he has touched by means of computer-generated speech or synthesized sound codes. Touching is detected by means of an overhead video camera that looks down at the user's hands as they rest upon the desktop. Specialized processors analyze the image of the user's hands and locate the fingertips. Because KnowWare is an electronic medium, it is possible to instantly zoom in on a particular state or country to examine it in more detail. Similarly, panning and overlays are possible. Twenty blind subjects have tested KnowWare and have been able to use it as well as they do traditional raised-line maps.
In this article the authors present population-level prevalence rates for 61 specific drug-related problems occurring in three State Medicaid programs (Maryland, Iowa, and Washington) from 1989 through 1996 and a fourth (Georgia) from 1994 through 1996. The findings represent the first application of a consistent drug utilization review (DUR) screener program to Medicaid data across States. The study finds major differences in DUR failure rates among the four States with the lowest rates in Georgia and the highest in Washington. Only Iowa showed any population-level reduction in DUR failure rates during the study period, however, rates for community-dwelling elderly fell in most States.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.