Prescription drug insurance for the elderly under Medicare.
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The frequency of use of various sources to answer drug information requests in a university hospital drug information service was studied. All of the drug information requests received by the University of Minnesota Drug Information Service (UMDIS) between November 1, 1983, and January 27, 1984, were included in the evaluation. A total of 1448 requests from health-care professionals and consumers were reviewed. The 10 most frequently used information sources in order of most to least often used were Facts and Comparisons, previous knowledge or experience of the UMDIS staff, Drugdex, Martindale: The Extra Pharmacopoeia, USP DI, the UMDIS files, information from pharmaceutical manufacturers, Goodman and Gilman's the Pharmacological Basis of Therapeutics, and Meyler's Side Effects of Drugs. Forty percent of the requests were from consumers. Pharmacists should characterize the type and number of drug information requests they receive and should consider the accessibility of a drug information service and biomedical library when deciding which references to purchase.
INTRODUCTION: Practitioners' experience with inconsistencies between two Danish handbooks and the SPCs have lead to this comparative analysis of information on drug interactions in these publications. On the same background, a Danish database with drug interactions based on evidence and transparency is established. MATERIALS AND METHOD: The material comprises information on 62 randomly selected drugs marketed in Denmark and described in the Laegemiddelkatalog, Medicinfortegnelse and 62 SPCs. A total of 586 drug interactions was analysed. This is a comparative analysis of the discrepancies of the information, the exactness of the name of the interacting drug, and applicability for health care personnel. RESULTS: The comparison of the three sources shows inconsistency for 78% of the interactions. Fifty-nine percent of the interactions are mentioned in one source only. The distribution among the categories in the exactness of the name of the interacting drug (p=0.02), and applicability for health care personnel (p=0.0001) is not uniform for the three sources. The SPCs are less exact in mentioning the interacting drug and more often recommend actions to be taken to ameliorate drug interactions. DISCUSSION: The consistency among the sources is relatively low. The inconsistency may contribute to patients' exposure to potentially severe drug interactions, first and foremost because of the omission of potentially severe drug interactions in the sources. It may also contribute to confusion on the part of health care personnel and drug users, which once again may lead to inadequate drug utilisation. There is a need for information on drug interactions and a consensus nationally in Denmark and probably internationally as well.
The Compendium of Pharmaceuticals and Specialties (CPS) is the most widely used source of drug information in Canada, and is heavily financed by the pharmaceutical industry. A close examination of its contents comparing a computer-drawn, randomized sample of monographs from its "White Pages" to standard pharmacological reference works demonstrates certain of its characteristics: it uncritically includes many inadequate preparations; it overstates the benefits and understates the adverse qualities of many preparations; and it contains little or no information on relative indications, efficacy, or price. These characteristics serve to promote the marketing goals of the drug manufacturers and severely limit the volume's usefulness as an objective source of drug information. The role of the CPS and similar publications in the overall context of current drug company marketing strategies is discussed. Finally, suggestions for improvements are made involving the elimination of direct manufacturer financing, and the creation of an objective, independent, nonprofit publishing agency supported by professional and governmental organizations.
Regulation of drugs from the public administration is an activity which is produced in different countries independently from the sanitary model they own. In the field of public financing of drugs there have been several measures to improve the efficiency of their use. However, the analysis of the impact of these measures is complex and this may justify the shortage of objectivable results, especially at long term. The objective of this study is to perform a systematic review of such measures due to the need to have information about the different alternatives before making a decision. The introduction of an isolated measure is in many cases compensated by other changes in other regulating or aiding fields which suggests the creation of an integral strategy which affects different fields (supply/demand of drugs and prescribers). It seems necessary to suggest a social debate taking as a basis the scientific information available at the moment and promote the taking of decisions which lead to a rational use of the available pharmacological resources.
Anecdotal case reports contribute about one-third of the published literature on adverse drug reactions and interactions, but are regarded as providing poor-quality evidence. However, they can occasionally provide proof of cause and effect, and there are many other reasons for publishing them. Because an anecdote is a narrative, narratological paradigms from literature, art, and music can show how we can make evidential use of anecdotes. Useful paradigms are the dramatic unities (of time, place, and action), comprehensive catalogues, and pattern formations. Here I give examples of each of these types of paradigm and show how they can be used to interpret anecdotes about adverse drug reactions and interactions. The dramatic unities show how a proper classification of adverse drug reactions can be achieved, according to dose-relation, time-course, and susceptibility factors; use of this classification should improve the evidential use of anecdotal reports. A high background incidence of the effect (the medical equivalent of subplots, which violate the unity of action) makes it more difficult to detect adverse drug effects using anecdotal reports. To make best evidential use of the corpus of anecdotal reports of adverse drug reactions, comprehensiveness is important: each suspected adverse reaction should be reported in detail and reactions should be reported in sufficient numbers for proper classification and for patterns to be recognized. One form of pattern recognition, teleoanalysis of data, should, when possible, include not only randomized controlled trials and observational studies, but also case series and anecdotal reports.
Prescribers today encounter increasing demands for up-to-date knowledge of medical advances and drug therapies, and for a straightforward dialogue with patients. Cost-effective drug treatment calls for fast and intuitive access to information about drugs, treatment strategies and patient data. There are several computer-based drug-prescribing systems in Sweden. Information independent of the drug industry is wanting, as are uniform national standards for medical content and functionality. Decision-support systems must facilitate decisions about therapy, drug distribution and intake, as well as quality work, i.e. support the entire process which defines an effective drug therapy. A very important feature is access to a patient's drug list showing all current drugs. This joint initiative by county councils aims at drawing up a national Swedish specification of requirements for a suitable decision-support system and at creating a national entity responsible for distributing unbiased information from a unique database to a range of computerized medical records systems.
Pancreatitis is rightly the most feared complication of endoscopic retrograde cholangiopancreatography (ERCP). Ten percent to 15% of cases of post-ERCP pancreatitis (PEP) are severe by clinical and radiologic criteria. Such cases carry significant morbidity and mortality and are responsible for the vast majority of ERCP-related deaths. The prediction and prevention of PEP have been of great interest to endoscopists since the introduction of ERCP 30 years ago. Prediction and diagnosis of PEP have become more accurate with the widespread availability of serum amylase estimation. A variety of cytokines (eg, interleukin -1, IL-6, and IL-8) and acute phase reactants (eg, C-reactive protein) are also elevated in the serum in acute pancreatitis, and these form the basis of evolving tests for PEP. Urine testing (for amylase) in acute pancreatitis is obsolete, but it may soon undergo a revival in the form of a rapid (3-minute) dipstick test for trypsinogen-2, a sensitive and specific test for this disease. The prevention of PEP takes multiple forms. The following steps are recommended for clinicians: 1) avoid ERCP when other, less invasive or noninvasive imaging tests can do the job (eg, CT or magnetic resonance imaging); 2) avoid high-risk (of PEP) procedures, such as needle-knife papillotomy, balloon dilation of the biliary sphincter, and pancreatic sphincterotomy, and take steps to reduce risk when these procedures are unavoidable; 3) ensure that those who perform ERCP have adequate training and experience; and 4) consider pharmacologic intervention. Despite a depressing catalog of drug interventions that have failed over the years (eg, antihistamines, anticholinergics, and corticosteroids), three agents have recently shown promise: somatostatin; its octapeptide analogue, octreotide; and gabexate mesylate, a protease inhibitor.
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