Measuring blood pressure: why readings go wrong.
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Biomedical subjects
Publications and source records attributed to D O Fedder.
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In a community-based study of older women describing the prevalence of specific medication combinations, the risk of deleterious consequence from polymedicine was concentrated in a minority of older women. There were few prevalent medication combinations, and many of the more common combinations were unavoidable. These results suggest that broad, community-based drug education programs may be less effective than those targeting medical providers and multi-drug users.
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In the elderly, a rational therapeutic intervention with drugs and drug regimens is often necessary, from the point of both therapeutics and economics. The elderly patient often presents with multiple pathology that must be managed with multiple drugs, which necessitates an approach geared to more than the simple medical needs of the patient. What is needed is a careful titration of the patient's medical needs with the patient's ability to adhere to and to tolerate the effects of the proposed therapeutic regimen, coupled with his demographic and lifestyle factors.
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Previous research reveals that pharmacist-coordinated patient education programs have been effective only if they go beyond providing information to patients. Effective programs must include strategies that assist and encourage patients to incorporate this new information into their life styles.
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Behavior characteristics of both health care practitioners and patients are discussed in terms of their effects on the delivery of care and the rational use of drugs. Three modes of behavior are described: the instrumental, the customary, and the command modes. Although most physicians follow the customary mode, an instrumental approach is recommended both for patient interactions and for drug selection. Patient education is often insufficient, and physicians tend unjustly to blame the failure of a treatment regimen on the patient's lack of compliance. An "index of risk" is presented to help spot potential drug defaulters, as are clues in the behavioral diagnosis.
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