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Biomedical subjects

Melody Ryan

Publications and source records attributed to Melody Ryan.

18 recordsLinked to original sources
PubMed2006

Restless legs syndrome.

PURPOSE: The signs and symptoms, epidemiology, etiology, pathophysiology, diagnosis, pharmacologic and nonpharmacologic treatments, and options and guidelines for the treatment of restless legs syndrome (RLS) are reviewed. SUMMARY: RLS was first described in the 17th century and further characterized in 1945. RLS is a common disorder, occurring in about 10% of the population. Patients with RLS often describe the urge to move, uncomfortable sensations, and pain, which begin or worsen during rest or inactivity such as lying or sitting. Symptoms of RLS make sleeping difficult for many patients, and significant daytime difficulties result from the condition. RLS can either be primary or arise from secondary causes that lead to iron deficiency. There is a familial component in primary RLS, but its underlying mechanisms remain unknown. Of individuals with conditions associated with iron-deficiency states, including pregnancy, renal failure, and anemia, 25-30% may develop RLS. The goals of RLS treatment include improving its symptoms and the patient's quality of life. There are limited data on the treatment of RLS. Pharmacologic therapies include iron replacement, dopaminergic agents (e.g., levodopa), dopamine agonists, anticonvulsants, opioids, and benzodiazepines. There have been no systematic trials of nonpharmacologic therapies for RLS, but good sleep hygiene and avoidance of alcohol, caffeine, and nicotine may improve symptoms. CONCLUSION: RLS is a common disorder thought to involve abnormal iron metabolism and dopaminergic systems. Nonpharmacologic therapy should be suggested for all patients with RLS, but pharmacologic therapy may be required, and evidence is strongest for levodopa and dopamine agonists.

Analgesics, Opioid↗
PubMed2006

Long-term cognitive impact of anticholinergic medications in older adults.

OBJECTIVE: The objective of this study was to determine whether chronic use of medications with anticholinergic (AC) properties impact older adults' cognitive functioning. METHODS: Six years of cognitive test data from two groups of older adults (AC and control) were examined retrospectively (N = 592). RESULTS: Declines over time were found for the AC group on parts A and B of the Trail Making Test. CONCLUSION: Physicians prescribing ACs to older adult patients should be aware of their potential effects on psychomotor speed and executive functioning. These cognitive effects may lead to impairments in daily functioning resulting in the need to reevaluate patient medications.

Aged↗
PubMed2006

Characteristics of participants enrolled in a Quit and Win smoking cessation program.

Quit and Win smoking cessation incentive programs have been used to promote community-based smoking cessation in the United States and internationally. The Quit and Win contest has been offered annually by the Lexington-Fayette County Health Department since 2001. In order to engage in continuous quality assessment of the Quit and Win program, demographic analysis of program participants is critical to better extend the marketing message to target audiences. The goal of this analysis is to report various baseline parameters of the 2003 Lexington-Fayette County Quit and Win contest cohort. Of the 876 participants, most were white, had at least a high school education, smoked cigarettes for more than 10 years, and had multiple previous quit attempts. Most anticipated using nicotine replacement products to aid the current quit attempt. The demographic information from this analysis can be used to design future programs that target a wider segment of the population.

Adult↗
PubMed2005

Stability of salivary concentrations of the newer antiepileptic drugs in the postal system.

Saliva antiepileptic drug (AED) concentrations strongly correlate with serum concentrations. Saliva collection is painless and noninvasive, and untrained personnel can easily be taught the collection process. Remote patients could mail saliva samples to a laboratory for monitoring, and samples could be obtained in the immediate postictal state to provide a "real-time" concentration. The objectives of this study were to assess the stability of saliva lamotrigine (LMT), levetiracetam (LEV), oxcarbazepine (OXC), topiramate (TPM), and zonsiamide (ZNS) concentrations sent through the United States Postal Service (USPS) and to quantify the amount of time needed for patients and the USPS to return samples to clinic. Saliva samples were obtained from patients currently taking 1 of the targeted AEDs. Samples were split into 2 storage vials. One sample was sealed in an addressed envelope, which the patient mailed from home, whereas the other sample was frozen immediately. Postmark date and day returned were collected for mailed samples. Saliva concentrations were determined using HPLC. Wilcoxon rank sum tests were used to compare the immediately-frozen and mailed sample means. Correlations were determined by the Spearman test. Thirty-seven patients were enrolled in the study. The median time between collection and postmark was 1 day (range 0-6 days); and between collection and receipt was 4 days (range 1-160 days). The mean concentrations for mailed and immediately frozen samples were similar for each AED (P > 0.15). Spearman rank order correlations between mailed and immediately frozen aliquots were strong (LMT rs = 1, LEV rs = 1, OXC rs = 0.964, TPM rs = 0.90, and ZNS rs = 1). Saliva samples mailed by patients maintain stability and can be returned in a reasonable length of time. Further studies are needed to assess patient/caretaker capability of obtaining an adequate sample.

Adolescent↗
PubMed2004

Physician preference for antiepileptic drug concentration testing.

A four-item questionnaire asked active U.S. members of the Child Neurology Society to value painless antiepileptic drug concentration monitoring, whether members had ordered a saliva level (the best established painless method) in the last year, and whether such levels were available. Value was quantified by time per patient that the physician would willingly expend to arrange for the test. Of 945 questionnaires sent, 544 (58%) were returned. When asked the value of a painless method for children, 286/522 (55%) reported willingness to expend 10 to 30 minutes to arrange the test; 498/522 (95%) would use a painless method if available. When asked the value of an immediate sample at home during a seizure or adverse event, a substantial majority, 370/526 (70%), would make an important donation of their own time to arrange for the sample. Only 5% would not use it. Just 2/544 respondents had obtained a painless (saliva) concentration, and merely 33/544 (6%) perceived such tests as being available. We conclude that child neurologists put a high value on painless antiepileptic monitoring. These data suggest that a painless method of measuring antiepileptic drug concentrations--especially if it could be performed at home--would fulfill an unmet need in the care of children with epilepsy.

Anticonvulsants↗
PubMed2004

Board of Pharmaceutical Specialties-certified faculty: a survey of United States colleges of pharmacy.

Board certification of pharmacists has been a reality in the United States since 1976, when the Board of Pharmaceutical Specialties (BPS) was founded. Little has been reported about the effects of board certification of pharmacists, particularly pharmacy practice faculty, since 1992, when the BPS administered its first certification examination. We developed and pretested a survey to describe and measure the effect of BPS certification on the realm of academia as perceived by deans of colleges of pharmacy in the United States. Deans or other appropriate officials at all 84 colleges of pharmacy in the United States were asked to complete and submit this 13-question survey, which was administered through the Web and maintained respondents' anonymity. Officials from 35 of the 84 colleges completed the survey, for a response rate of 42%. No college reported that board certification was a condition for employment. Eight schools (23%) anticipated a certification requirement in the future. The most commonly reimbursed items associated with certification were fees for the American College of Clinical Pharmacy preparatory course and the BPS examination. Twelve schools (34%) provided no reimbursement toward certification. The most common incentive for faculty to obtain certification was consideration in promotion and tenure (66%). We believe that this information will facilitate efforts to gauge the effects of BPS certification on colleges of pharmacy. We also anticipate that it will assist colleges as they attempt to recruit and retain the most qualified faculty members possible, particularly in light of the national pharmacist shortage.

Certification↗
PubMed2003

Correlation of levetiracetam concentrations between serum and saliva.

PURPOSE: More than 100 drugs have been evaluated for salivary therapeutic drug monitoring since the 1970s. The most studied drugs are the anticonvulsants phenytoin, phenobarbital, and carbamazepine, demonstrating strong correlations between serum and saliva concentrations. No published data exist for levetiracetam (LEV) to the authors' knowledge. This study's objective is to determine the correlation between LEV serum and saliva concentrations. METHODS: Investigators identified subjects seen in neurology clinics at the University of Kentucky. Patients were eligible if they agreed to participate in this study, were taking LEV for a minimum of 4 weeks, and if a serum LEV concentration had been ordered by their physician. Patients spit a minimum of 0.25 mL into a cup to obtain saliva samples. Blood samples were obtained by phlebotomy. RESULTS: Serum and saliva LEV concentrations were determined via high-performance liquid chromatography (HPLC) in two separate reference laboratories. Linear regression analysis was used to evaluate correlations. Serum and saliva samples were obtained from 40 patients (22 female, 18 male), ranging from 3 to 57 years of age. The mean +/- SD serum LEV concentration for reference laboratory A was significantly lower (P < 0.0001) than reference laboratory B, 23.6 +/- 13.8 microg/mL and 27.0 +/- 16.9 microg/mL, respectively. The mean +/- SD saliva to serum concentration fraction was also different for the two laboratories, i.e., 41.0% +/- 0.15% for lab A and 36.0% +/- 0.15% for lab B (P = 0.001). The correlation coefficients for the two laboratories were similar, 0.87 and 0.86 (both P < 0.0001) for labs A and B, respectively. CONCLUSION: A significant positive correlation exists between LEV saliva and serum concentrations. The ability to monitor LEV therapy using saliva may provide benefits that include facilitating sample collection and improving the quality of life for persons with epilepsy. Patients with poor venous access, such as children and elderly patients, and persons afraid of needles may particularly benefit from this method.

Adolescent↗
PubMed2003

Correlation of lamotrigine concentrations between serum and saliva.

STUDY OBJECTIVE: To compare the relationship between serum and salivary concentrations of lamotrigine in pediatric and adult epilepsy populations. DESIGN: Paired-sample pharmacokinetic study. SETTING: University neurology clinic. PATIENTS: Thirty-seven patients with epilepsy, aged 2-60 years, who were taking lamotrigine and whose physicians had ordered a lamotrigine serum concentration. MEASUREMENTS AND MAIN RESULTS: Patients spit a minimum of 0.25 ml into a cup to provide saliva samples. Blood samples were obtained by phlebotomy. Serum and salivary lamotrigine concentrations were determined by high-performance liquid chromatography. Linear regression analysis was used to evaluate correlations. Six patients' results were omitted due to the lack of a serum or saliva specimen or clearly erroneous results, leaving 31 patients for analysis. There was a strong correlation between the serum results reported by two reference laboratories (coefficient of correlation [r] = 0.988). The correlations between salivary and serum lamotrigine concentrations were similar for reference laboratory A (r = 0.81) and reference laboratory B (r = 0.84). Saliva:serum concentration ratios ranged from 0.41-1.26 (mean +/- SD 0.62 +/- 0.19) for reference laboratory A and from 0.40-1.19 ((mean +/- SD 0.64 +/- 0.18) for reference laboratory B. CONCLUSION: There is a good correlation between salivary and serum concentrations for lamotrigine. However, there is wide interpatient variability in the saliva:serum ratio. The data suggest that salivary monitoring may play a role in the monitoring of lamotrigine for adult and pediatric patients.

Adolescent↗
PubMed2002

Valproate-associated stomatitis.

The purpose of this article is to report a case of severe stomatitis in a patient with pediatric epilepsy taking divalproex sodium. The case was reviewed with detailed oral examinations. This 5-year-old child developed severe stomatitis 18 months after institution of divalproex sodium. Cessation of the medication was associated with resolution of the stomatitis. A review of the pertinent literature is also provided. Stomatitis is a rare but potentially serious adverse effect of divalproex sodium administration.

Anticonvulsants↗
PubMed2002

Use of alternative medications in patients with neurologic disorders.

OBJECTIVE: To determine alternative medication use in a neurology clinic population and to predict patients likely to use alternative medications. DESIGN: Survey of 216 adults presenting to a university-affiliated neurology clinic. METHODS: Subjects were queried regarding diagnosis, medications, satisfaction with medications, alternative medications, and demographics. Alternative medications were defined as herbal therapies, holistic therapies, minerals, or vitamins other than multiple vitamins. Frequencies were tabulated for categorical data; means and standard deviations were calculated for continuous data. Logistic regression was performed to predict use of alternative therapies. RESULTS: The most frequent conditions seen in all subjects were headache, epilepsy, and stroke. Mean ratings of patients' satisfaction with their conventional medications and health were 6.8 +/- 2.64 and 6.4 +/- 2.23 on a 10-point scale, respectively. Forty subjects were taking alternative therapies. Regression analysis suggests that patients with higher levels of education are more likely to use alternative therapies. CONCLUSIONS: Forty of 216 subjects (18.5%) seen in the neurology clinic took alternative therapies. Increased educational level was associated with use of alternative therapies.

Adolescent↗
PubMed2002

Experience with an adverse drug reaction reporting program in a neurology specialty clinic.

OBJECTIVE: To describe an adverse drug reaction (ADR) reporting program that was developed in a university-affiliated neurology specialty clinic. METHODS: Reportable ADRs were identified through 3 mechanisms: by clinicians through routine visits, by patients who were encouraged to follow up with the pharmacist in the clinic, and by the pharmacist who contacted high-risk patients. Patient demographics, the suspected drug(s), elements to define probability, and outcomes were documented, collated, and analyzed for trends and opportunities for continuous quality-improvement efforts. Information was shared with clinic administrators and clinicians. Serious ADRs were reported to the Food and Drug Administration. RESULTS: The experience during a 1-year period, during which 40 ADRs were reported, is described. Medications by frequency of report and types of reactions are reported. None of the ADRs required admission to the hospital. Pharmacy personnel reported the majority of ADRs (92.5%). CONCLUSIONS: This program is successfully incorporated within daily practice and is an integral part of quality-improvement efforts.

Adverse Drug Reaction Reporting Systems↗
PubMed2002

Effectiveness of a pharmacist-based smoking-cessation program and its impact on quality of life.

We conducted a prospective, open-label trial to evaluate the effectiveness of a pharmacist-based, comprehensive, smoking-cessation program with 31 self-referred subjects. A secondary goal was to measure changes in health-related quality of life (HRQOL) during the cessation attempt. The program consisted of weekly, 1-hour group sessions over 12 weeks. It incorporated nicotine replacement therapy (patch, gum) with extensive behavior modification counseling. Trained pharmacists served as program facilitators. Smoking cessation was chemically verified at 3 and 6 months by exhaled carbon monoxide. The patients' HRQOL was measured using the smoking-cessation quality of life questionnaire at baseline, 2 weeks, and 1, 2, 3, and 6 months. Chemically verified abstinence rates at 3 and 6 months were 42% (13 patients) and 26% (8 patients), respectively. Among patients who quit, vitality, mental health, and self-control significantly improved during the 3-month program. Six-month cessation rates were modest, although HRQOL improved within 3 months of abstinence.

Administration, Topical↗
PubMed2002

Seizures in HIV-seropositive individuals: epidemiology and treatment.

Seizures are a relatively common occurrence in patients with HIV infection. They may be a result of HIV infection of the CNS or a manifestation of an opportunistic infection. Because seizures are likely to recur in patients infected with HIV and because they are a poor prognostic indicator, it is generally recommended that all HIV-seropositive patients experiencing a first seizure without a recognisable and reversible cause be treated. Clinicians faced with treating seizures in HIV-seropositive patients often encounter a therapeutic dilemma since few data exist in this area. In selecting appropriate anticonvulsant therapy, clinicians must consider both therapy-compromising drug-drug and drug-disease interactions. Ideal anticonvulsants for this setting are those that do not effect viral replication, have limited protein binding and have no effects on the cytochrome P450 system, such as gabapentin, topiramate and tiagabine. Unless the benefits outweigh the risks, valproic acid (sodium valproate) should be avoided as it has been shown to stimulate HIV replication. Since few data exist, controlled trials examining pharmacokinetic and pharmacodynamic interactions between anticonvulsants and antiretrovirals are needed. Until such time, clinicians caring for these patients should examine existing data carefully and employ vigilant monitoring.

Drug Interactions↗
PubMedDate not supplied

Providing pharmaceutical care to the multiple sclerosis patient.

OBJECTIVE: To review the pathophysiology, symptoms, and treatment of multiple sclerosis (MS). DATA SOURCES: Recently published clinical literature identified through review of articles abstracted at MEDLINE. Search terms included multiple sclerosis, interferon beta, glatiramer acetate, mitoxantrone, treatment, symptoms, steroids, etiology, and neutralizing antibodies. STUDY SELECTION: Performed manually by the authors. DATA EXTRACTION: Performed manually by the authors. DATA SYNTHESIS: MS is a chronic disease of the central nervous system that most often strikes patients in their early 30s. Noticeable geographic, ethnic, racial, and sex differences in incidence remain unexplained. Diagnosis relies heavily on the presence of neurologic signs and symptoms, and magnetic resonance imaging of the brain is increasingly useful. Treatment with steroids, interferon beta-1b (Betaseron-Berlex) and interferon beta-1a (Avonex-Biogen; Rebif-Serono), and glatiramer acetate (Copaxone-Teva) can produce periods of remission in patients with MS. Management of adverse medication effects and disease-related symptoms of fatigue, pain, and bladder dysfunction is important in these patients. CONCLUSION: MS is currently incurable but largely treatable. Research has produced promising new medications, and investigational therapies hold promise for better treatment of this debilitating condition.

Counseling↗
PubMedDate not supplied

Factors leading patients to discontinue multiple sclerosis therapies.

OBJECTIVES: To determine the percentages of patients who discontinued treatment with the multiple sclerosis medications intramuscular interferon beta-1a (IFN-beta-1a; Avonex-Biogen), interferon beta-1b (IFN-beta-1b; Betaseron-Berlex), and glatiramer acetate (Copaxone-Teva) and to determine the factors that led to discontinuation of the medications. DESIGN: Cross-sectional study. SETTING: University-based neurology clinic. PATIENTS: 108 patients with multiple sclerosis who were prescribed intramuscular interferon beta-1a, subcutaneous interferon beta-1b, or subcutaneous glatiramer acetate. INTERVENTION: Telephone survey. MAIN OUTCOME MEASURES: Discontinuation percentages and the factors that contributed to discontinuation. RESULTS: There was no significant difference between the percentages of patients who discontinued and did not restart treatment with the products (interferon beta-1b, 41%; intramuscular interferon beta-1a, 34%; and glatiramer acetate, 28%). Four main reasons for medication discontinuation emerged: adverse effects (52%), physician-documented disease progression (40%), patient perception of drug ineffectiveness (20%), and cost (4%). No statistical differences were identified among the three agents for any of the reasons for discontinuation. CONCLUSION: Patient education on adverse effects and realistic patient expectations may be potential areas of study to improve discontinuation percentages with these agents.

Adjuvants, Immunologic↗