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At least 1,153 records · Page 64Linked to original sources

PubMed1996

Evaluation of dexfenfluramine in a weight loss program for obese infertile women.

OBJECTIVE: To evaluate the usefulness of dexfenfluramine as an adjunct to a group treatment program for obese infertile women. METHOD: Twenty-one obese infertile women were referred by the Reproductive Medicine Unit. They attended a 24-week group program which included exercise and educational sessions. Dexfenfluramine and placebo were given, each for 12 weeks, in a double-blind crossover design. RESULTS: Dexfenfluramine treatment was not associated with greater loss of weight. The mean weight loss during dexfenfluramine treatment was 3.21 kg (SD 3.09) and during placebo was 3.31 kg (SD 3.15). Self-esteem, anxiety, and depression ratings all improved significantly over the 24 weeks. DISCUSSION: The group treatment program appeared to be equally effective with or without dexfenfluramine. Previous studies have found dexfenfluramine to be effective in combination with individual treatment, but it has not previously been evaluated as an adjunct to group treatment. It is unclear whether dexfenfluramine may be less effective in combination with group treatment programs, or whether its usefulness is restricted in this particular population of obese patients. No differences were found associated with the order in which active and placebo treatments were given. Patients showed improvement in self-esteem and reduction in depression and anxiety, but dexfenfluramine treatment was not associated with any difference in these measures, compared to placebo.

Adult↗

PubMed2001

The influence of weight loss on fibrinolytic and metabolic parameters in obese children and adolescents.

We studied i) whether short-term weight loss alters plasminogen activator inhibitor-1 antigen (PAI-1-Ag) and tissue-type plasminogen activator antigen (tPA-Ag) in obese children, and ii) whether changes in body composition and/or abdominal adiposity are responsible for changes in PAI-1 and tPA-Ag. 20 obese boys (mean age 11.9 yr) and 40 obese girls (mean age 12 yr) were studied before and after three weeks of low-caloric diet and physical activity. Body composition was assessed by means of bioelectrical impedance, and the waist-to-hip ratio (WHR) was measured. Blood samples were determined for insulin, glucose, triglycerides, PAI-1-Ag, tPA-Ag, and the fasting insulin resistance index (FIRI) was calculated. Boys had a greater WHR, higher levels of glucose, and a slightly greater FIRI than girls. Estimates of adiposity, insulin, and triglycerides were correlated with PAI-1 and tPA-Ag. WHR was significantly correlated with fibrinolytic parameters only in girls. Insulin and tPA-Ag contributed to PAI-1 (adj. R2 = 0.36, p <0.0001), whereas percentage fat mass and triglycerides contributed to tPA-Ag (adj. R2 = 0.469, p <0.0001). The weight loss program significantly reduced adiposity, abdominal adiposity, and lowered fibrinolytic and metabolic parameters. Initial levels of PAI-1 and changes in body mass contributed to the fall in PAI-1 (adj. R2 = 0.18, p = 0.0016) and initial levels of tPA-Ag contributed significantly to changes in tPA-Ag (adj. R2 = 0.57, p <0.0001). The results suggest that changes in fibrinolytic parameters are associated with the loss in body mass but can occur independently of a concomitant reduction in fatness. Although initial PAI-1 and tPA-Ag predict the changes of these fibrinolytic parameters, the results do not exclude the possibility that the improvement in metabolic state and changes in unmeasured parameters related to physical activity and low-caloric diet could have influenced our findings.

Abdomen↗

PubMedDate not supplied

Implementing a facility-based maternal and perinatal health care surveillance system in Afghanistan.

Afghanistan has one of the highest maternal and perinatal mortality rates in the world. Lack of a health information system presented obstacles to efforts to improve the quality of care and reduce mortality. To rapidly overcome this deficit in a large women's hospital, staff implemented a facility-based maternal and perinatal surveillance system known as "BABIES," which is specially designed for intervention and evaluation in low-resource settings. During a 12-month period, 15,509 deliveries resulted in 28 maternal deaths and a perinatal mortality rate of 56 per 1000 births. When stratified by birth weight and perinatal period of death, fetuses weighing at least 2500 g who died during the antepartum period contributed the most cases of perinatal death. This finding suggests that the greatest reduction in perinatal mortality would be realized by increasing access to high-quality antepartum care. Among fetuses weighing at least 2500 g, 93 deaths occurred during the intrapartum period. These deaths will continue to be monitored to ensure that the chosen interventions are improving intrapartum care for mothers and newborns. Because of its simplicity, flexibility, and ability to identify interventions, BABIES is a valuable tool that enables clinicians and program managers to prioritize resources.

Afghanistan↗

PubMed1998

[The effect of an education and rehabilitation program for blind diabetics on the level of metabolic equalization].

AIM: Evaluating efficiency of the education and rehabilitation programme for patients suffering from diabetes on the level of metabolic equalization. Two modules for patients have been introduced. The first is group education conducted in groups of 20 patients. This covers basic information concerning diabetes, self-monitoring interventional actions and using the insulin-injector. The second model is repeated every three months: one-day observation in a room for daily-basis patients, which is combined with an individual educational programme and evaluation of metabolic equalization. After 6 and 24 months the level of patients knowledge was checked with the test containing 12 questions and with application of 1-5 point scale. The state of metabolic equalization was also tested, by means of evaluating the average glycaemia, serum concentration of HbA1c and the dosage of insulin. The level of patients knowledge increased after 6 months from 39 +/- 18% to 44 +/- 19%, and after 24 months by 68 +/- 21. The average glycaemia was lowered from 14.04 +/- 9.32 to 8.10 +/- 5.05 mmol/l after 24 months. The average serum cholesterol level was lowered from 6.7 +/- 1.21 to 6.51 +/- 1.39 mmol/l. At the same time there was an increase in the fractions HDL from 1.26 +/- 0.32 to 1.34 +/- 0.46 mmol/l HbA1c from 10.1 +/- 1.4% to 8.5 +/- 1.2%. The daily dose of insulin was reduced from 58.6 +/- 29.3 units a day 44.2 +/- 22.1 +/- units a day. A positive body weight reduction was observed. BMI was lowered from 30.1 +/- 3.96 to 28 +/- 5 kg/m2.

Adult↗

PubMed2006

Effect of weight loss on cellulite: gynoid lypodystrophy.

BACKGROUND: Gynoid lipodystrophy (cellulite) affects most women, and many seek plastic surgery consultation to improve appearance. Various products are offered, but the literature on the cause and treatment is limited. Understanding the biological and biophysical factors that affect severity may facilitate the development of effective therapies. There has been a dramatic increase in the number of people who have lost significant weight as a result of bariatric surgery or medically supervised weight programs. The effect of weight loss on cellulite severity has not been systematically studied and remains a common patient concern. The authors hypothesized that cellulite severity would decrease with weight loss and subsequent decrease in subcutaneous fat in most subjects. METHODS: The authors examined the cellulite changes in female subjects who were enrolled in medically supervised weight loss programs using quantitative surface roughness by three-dimensional laser surface scanning, tissue composition by dual energy x-ray absorptiometry, dermal-subcutaneous structure with three-dimensional ultrasound, and tissue elasticity with biomechanical measurements. RESULTS: The majority of subjects had an improvement in cellulite with weight loss, but the condition worsened for others. Improvement was associated with significant reductions in weight and percentage of thigh fat, significantly higher starting body mass index, and significantly greater initial severity. Cellulite worsened with a significantly smaller starting body mass index, smaller reductions in weight accompanied by no change in percentage of thigh fat, and significant increases in tissue compliance. CONCLUSIONS: Cellulite is a complex condition, and treatments such as weight loss have variable effects on the improvement or worsening of this condition. Additional studies are required to understand how the factors that influence and modulate cellulite severity, particularly those at the level of the subcutaneous tissue septa, can be manipulated to improve this condition.

Absorptiometry, Photon↗

PubMed1991

Response of broiler breeder females to feed restriction below recommended levels. 1. Growth and reproductive performance.

Arbor Acre broiler breeders were used to determine the effects on growth and reproductive performance of quantitative feed restriction below breeder recommended levels. Feed treatments were: 8% above standard (+8%); standard feeding program (STD); and 8 (-8%), 16 (-16%), and 24% (-24%) below standard. Proportional decreases in feed allocation resulted in corresponding decreases in body weight, frequency of double-yolked eggs, and number of days in production. Egg weight, fertility, hatchability, and female mortality to 64 wk of age were not significantly (P greater than or equal to .05) affected by the reduction in feed intake. Shell quality was significantly improved with the -16 and -24% feed treatments. A delay in sexual maturity caused a significant (P less than or equal to .05) decrease in average rate of lay (%hen-day) but not in total settable eggs for treatments -16 and -24% to 64 wk of age.

Animals↗

PubMed2004

Improving control of high blood pressure among middle-aged Turkish women of low socio-economic status through public health training.

AIM: To assess the effects of health training course aimed at educating middle-aged women of low socio-economic status in Turkey how to better control high blood pressure. METHODS: The intervention study included 400 randomly selected women aged (mean+/-standard deviation) 34.1+/-8.6 years. After their body size and blood pressure were measured, the women were randomly divided into two groups. The intervention group underwent public health training on high blood pressure control and obesity reduction, whereas control group had no training at all. After six months, blood pressure and body size of women in both groups were measured again. RESULTS: Overall, the initial high blood pressure and obesity ratio in the intervention and control group were 20.0% and 31.7%, respectively. After 6 months of the intervention program, the number of women within the optimal weight range significantly increased in the intervention group compared with control group (p=0.009). After the intervention program, the number of women with normal weight and normal blood pressure in the intervention group significantly increased (weight: 130 women before vs 150 after, p=0.001; blood pressure: 160 women before vs 173 after, p<0.001). After the intervention, the percentage of meals consisting of fried food in the intervention group was lower by 31.9%, and by 5.0% in the control group. After the intervention the percentage of boiled food increased by 15.7% in the intervention group, compared with no change in the control group. The consumption of food high in salt decreased by 5.5% in the control and by 72.2% in the intervention group. Similarly, the percentage of women who exercised almost doubled in the intervention group, whereas there was no change in the control group. CONCLUSION: The changes in the lifestyle significantly reduced hypertension and obesity ratio among women. The public health center can provide initial health training support as a part of the broader public health management program, aimed at helping people tackle health problems.

Adult↗

PubMedDate not supplied

Home blood glucose monitoring as an aid in diabetes management.

Home blood glucose monitoring, using Dextrostix and an Eyetone meter, has been utilized in several subcategories of patients with insulin-dependent diabetes mellitus. These include pregnant patients, anephric patients, patients undergoing weight reduction, patients with altered renal threshold for glucose reabsorption, and patients in whom diabetic regulation is difficult. Patients monitored home blood glucose continually (on a daily basis), intermittently, or only for particular problems or symptoms. Such monitoring can be practically accomplished in a manner acceptable to patients. Motivation, compliance with protocol, and an understanding of the objectives of the program are essential on the part of the patient. Home blood glucose monitoring, however, can provide an insight diabetes regulation that cannot be attained in any other way and can greatly facilitate regulation of diabetes. Such home blood glucose monitoring may increase the likelihood of achievement of a degree of control approximating euglycemia.

Adolescent↗

PubMed2000

Overweight, obesity, and blood pressure: the effects of modest weight reduction.

Several large epidemiological studies have shown an association between body mass index and blood pressure in normal weight and overweight patients. Weight gain in adult life especially seems to be an important risk factor for the development of hypertension. Weight loss has been recommended for the obese hypertensive patient and has been shown to be the most effective nonpharmacological treatment approach. However, long-term results of weight loss programs are disappointing with people often regaining most of the weight initially lost. In recent years, a modest weight loss, defined as a weight loss of 5% to 10% of baseline weight, has received increasing attention as a new treatment strategy for overweight and obese patients. A more gradual and moderate weight loss is more likely to be maintained over a longer period of time. Several studies have confirmed the blood pressure-lowering effect of a modest weight loss in both hypertensive and nonhypertensive patients. A modest weight loss can normalize blood pressure levels even without reaching ideal weight. In patients taking antihypertensive medication, a modest weight loss has been shown to lower or even discontinue the need for antihypertensive medication. In patients with high normal blood pressure, a modest weight loss can prevent the onset of frank hypertension. The blood pressure-lowering effect of weight loss is most likely a result of an improvement in insulin sensitivity and a decrease in sympathetic nervous system activity and occurs independent of salt restriction. In conclusion, a modest weight loss that can be maintained over a longer period of time is a valuable treatment goal in hypertensive patients.

Adult↗

PubMed1998

Reduced oxidized LDL levels after a 10-month exercise program.

PURPOSE: We studied the effect of a 10-month exercise program on LDL oxidation and other lipid risk factors in 34 sedentary men and 70 women. We hypothesized that decreasing LDL oxidation by raising exercise activity would decrease the risk of atherosclerosis. METHODS: The men and women subjects had a mean (range) age of 43.6 (34-52) and 44.6 (31-58) yr, a body mass of 94.4 (78-144) and 77.6 (56-117) kg, a body mass index of 29.6 (24-44) and 28.6 (21-41), a body fat percentage of 20.4 (13-29) and 31.4 (16-39), and a maximal oxygen uptake of 33.3 (15-50) and 30.4 (18-49) mL.kg-1.min-1, respectively. We measured the baseline levels of conjugated dienes extracted from LDL (LDL-BDC) to assess the amount of circulating LDL oxidation products. The antioxidant potential of LDL samples was estimated in vitro by their potency to resist 2,2'-azobis(2-amidinopropane)HCl-induced peroxidation. The exercise program was tailored individually based on indirect measurement of VO2max at baseline. RESULTS: The mean time of exercise was 257 min.wk-1 for men and 209 min.wk-1 for women. Estimated VO2max increased by 19% during the exercise program in both men and women (both P < 0.0001). Concurrently, the concentration of HDL cholesterol increased by 15% in men (P = 0.0004) and 5% in women (P = 0.043) and that of LDL cholesterol decreased by 10% (P = 0.026) and 11% (P < 0.0001), respectively, whereas serum total cholesterol and triglyceride concentrations remained unchanged. The concentrations of LDL-BDC decreased by 23% (P = 0.0010) and 26% (P < 0.0001) and the ratio of LDL-BDC to LDL by 14% (P = 0.016) and 18% (P < 0.0001) in men and women. The ratio of LDL antioxidant potential to LDL rose by 16% (P = 0.011) and 11% (P = 0.0016), respectively. The mean weight loss during the exercise program was 2.9 kg in men and 1.8 kg in women (both P < 0.0001), whereas body fat percentage fell by 2.3% and 3.2%, respectively. CONCLUSIONS: In addition to increasing HDL cholesterol and decreasing LDL cholesterol, the exercise program is concluded to have improved the quality of the circulating LDL (less oxidized LDL), which may reduce the risk of atherosclerosis.

Adipose Tissue↗

PubMed2006

Malaria prevention during pregnancy: assessing the disease burden one year after implementing a program of intermittent preventive treatment in Koupela District, Burkina Faso.

The World Health Organization recommends that pregnant women in malaria-endemic areas receive >or= 2 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp/SP) in the second and third trimesters of pregnancy to prevent maternal anemia, placental parasitemia, and low birth weight (LBW). In 2001, a program evaluation in Koupéla District, Burkina Faso demonstrated that despite widespread use of chloroquine chemoprophylaxis, the burden of malaria during pregnancy remained high. In 2003, the Burkina Faso Ministry of Health piloted a program of IPTp/SP (three doses) and accelerated distribution of insecticide-treated nets (ITN) to pregnant women in Koupéla District. In 2004, a follow-up program evaluation was conducted. Coverage with >or= 1 doses of IPTp/SP was high among women attending antenatal clinics (ANCs) (96.2%) and delivery units (DUs) (93.5%); ITN ownership was moderately high (ANC = 53.9%, DU = 61.6%). In multivariate analysis, >or= 1 dose of IPTp/SP was associated with a significant reduction in the prevalence of peripheral parasitemia at ANCs (risk ratio [RR] = 0.49, P = 0.008), >or= 2 doses of IPTp/SP were associated with a reduction in the prevalence of placental parasitemia (RR = 0.56, P = 0.02), and three doses of IPTp/SP were associated with a reduced risk of LBW (RR = 0.51, P = 0.04). The proportions of women at ANCs with peripheral parasitemia and anemia were significantly lower in 2004 than in 2001 (RR = 0.53, P = 0.001 and RR = 0.78, P = 0.003, respectively). The proportions of women at DUs with peripheral and placental parasitemia were also significantly lower in 2004 than in 2001 (RR = 0.66, P < 0.0001 and RR = 0.71, P = 0.0002, respectively). These data suggest that a package of IPTp/SP and ITNs is effective in reducing the burden of malaria during pregnancy in Burkina Faso.

Adolescent↗

PubMed2004

Attempting to lose weight: specific practices among U.S. adults.

BACKGROUND: Americans spend over $33 billion annually on weight-loss products and services. Although weight-control methods are of considerable public health interest, few national data on weight-loss practices are available. This paper examines the prevalence of specific weight-loss practices among U.S. adults trying to lose weight. METHODS: Data from the 1998 National Health Interview Survey, which was conducted through face-to-face interviews of a nationally representative sample of U.S. adults (n =32,440), were analyzed in 2003. RESULTS: Twenty-four percent of men and 38% of women were trying to lose weight. Attempting weight loss was less common among normal weight (body mass index [BMI]<25 kg/m(2)) people (6% men, 24% women) than overweight (BMI>/=25 to 30 kg/m(2)) people (28%, 49%) or obese (BMI>/=30 kg/m(2)) people (50%, 58%). Among those trying to lose weight, the most common strategies were eating fewer calories (58% men, 63% women); eating less fat (49%, 56%); and exercising more (54%, 52%). Less frequent strategies were skipping meals (11% men, 9% women); eating food supplements (5%, 6%); joining a weight-loss program (3%, 5%); taking diet pills (2%, 3%); taking water pills or diuretics (1%, 2%); or fasting for >/=24 hours (0.6%, 0.7%). Only one third of all those trying to lose weight reported eating fewer calories and exercising more. CONCLUSIONS: Increased efforts are needed among all those trying to lose weight to promote effective strategies for weight loss, including the use of calorie reduction and increased physical activity.

Adolescent↗

PubMed1999

Effect of a moderate weight loss on adipose tissue lipoprotein lipase activity and expression: existence of sexual variation and regional differences.

OBJECTIVE: To evaluate the impact of moderate body weight loss on both adipose tissue lipoprotein lipase (AT-LPL) activity and expression and to verify whether variation in AT-LPL could be related to changes in lipid-lipoprotein metabolism. DESIGN: Intervention study of a 15-week weight reducing program (energy deficit: 500-800 kcal/d below the subjects' estimated sedentary energy expenditure). SUBJECTS: Thirty two obese subjects (14 men and 18 premenopausal women; aged 36-50 y) whose body fatness ranged from 34 to 54% fat. MEASUREMENTS: Adipose tissue biopsies from the abdominal and femoral depots, various fatness and fat distribution parameters (computed tomography and anthropometry), fasting plasma concentrations of high- and low-density lipoprotein cholesterol (HDL-C, LDL-C), and triglycerides at baseline and 4-6 weeks after the 15-week weight reducing program, when subjects were weight stable. RESULTS: In response to weight loss, AT-LPL activity of both regions did not change in men, but decreased in women. Regarding AT-LPL expression, no interaction between time and sex was observed in response to the treatment. In both genders, the higher was the basal AT-LPL activity, the greater was the reduction of this enzyme activity in response to weight loss, in both the abdominal and femoral depots (-0.53<r<-0.84, P values ranging from 0.0001 to 0.05). Body weight loss promoted a significant reduction in plasma triglyceride (TG), insulin and LDL-cholesterol (C) concentrations in men whereas only plasma TG and LDL-C levels were decreased in women (P<0.05). Although the average reduction in HDL-C levels in response to weight loss was not significant, the higher was the decrease in femoral AT-LPL activity, the greater was the reduction in plasma HDL-C levels (r=0.50, P<0.05) in response to weight loss, in women. An inverse relationship was observed between changes in femoral AT-LPL activity and HDL-C levels variation in men (r=-0.64, P<0.05). CONCLUSION: (1) variation in AT-LPL activity differs between men and women in response to moderate body weight loss although the corresponding enzyme mRNA levels remain unchanged; and (2) changes in femoral AT-LPL activity are related to weight loss induced variation in plasma HDL-C concentrations.

Adipose Tissue↗

PubMed1978

A program of heart disease intervention for public employees. A five year report.

The five-year experience involving over 800 employees has effected reduced coronary risk factors, improved physical work capacity and maximal oxygen uptake and reduced employee absenteeism from personal sick leave. As in all instances where the self-selection process confounds the nature of the results, the extent of extrapolation from these data must be guarded. Nevertheless, the results support and further extend previous studies suggesting a reduction of CVD following formal behavior and life-style modification. It is the opinion of the authors that similar programs can be implemented where health services, flexible hours, agency cooperation and salaried coordinators can be assembled.

Adolescent↗

PubMed2005

Low birth weight, nephron number, and kidney disease.

More and more evidence is emerging that highlights the far-reaching consequences of prenatal (intrauterine) programming on organ function and adult disease. In humans, low birth weight (LBW) occurs more frequently in disadvantaged communities among whom there is often a disproportionately high incidence of adult cardiovascular disease, hypertension, diabetes mellitus, and kidney disease. Indeed, many epidemiologic studies have found an inverse association between LBW and higher blood pressures in infancy and childhood, and overt hypertension in adulthood. Multiple animal models have demonstrated the association of LBW with later hypertension, mediated, at least in part, by an associated congenital nephron deficit. Although no direct correlation has been shown between nephron number and birth weight in humans with hypertension, nephron numbers were found to be lower in adults with essential hypertension, and glomeruli tend to be larger in humans of lower birth weight. An increase in glomerular size is consistent with hyperfiltration necessitated by a reduction in total filtration surface area, which suggests a congenital nephron deficit. Hyperfiltration manifests clinically as microalbuminuria and accelerated loss of renal function, the prevalence of which are higher among adults who had been of LBW. A kidney with a reduced nephron number has less renal reserve to adapt to dietary excesses or to compensate for renal injury, as is highlighted in the setting of renal transplantation, where smaller kidney to recipient body-weight ratios are associated with poorer outcomes, independent of immunologic factors. Both hypertension and diabetes are leading causes of end-stage renal disease worldwide, and their incidences are increasing, especially in underdeveloped communities. Perinatal programming of these 2 diseases, as well as of nephron number, may therefore have a synergistic impact on the development of hypertension and kidney disease in later life. Existing evidence suggests that birth weight should be used as a surrogate marker for future risk of adult disease. Although the ideal solution to minimize morbidity would be to eradicate LBW, until this panacea is realized, it is imperative to raise awareness of its prognostic implications and to focus special attention toward early modification of risk factors for cardiovascular and renal disease in individuals of LBW.

Adult↗

PubMed2002

Needle exchange: how the meanings ascribed to needles impact exchange practices and policies.

The consistency among needle exchange practices, HIV prevention, harm reduction goals, and potential program effectiveness are analyzed. Using a modified ethnographic approach, qualitative interviews were conducted with staff (n = 59) of needle exchange programs (NEPs; n = 15). Interviews addressed operational policies; funding and challenges. An iterative, inductive analytic process was used. Differences in exchange practices are traced to differences in how workers define needles as objects of "risk" and/or "prevention." The weight accorded to each definition has implications for service delivery. Among NEPs that ascribe a "risk" meaning, workers enforce a strict one-for-one exchange, encourage clients to take fewer needles, and penalize clients. Programs that focus on the "prevention" meaning of needles work towards improving access, problem solving about proper disposal and do not penalize clients. Operational policies that restrict access to sterile equipment or discourage attendance need to be reconsidered if HIV prevention goals are to be realized.

Canada↗

PubMed1991

Evaluation of a parallel implementation of the learning portion of the backward error propagation neural network: experiments in artifact identification.

Various methods have been proposed in an attempt to solve problems in artifact and/or alarm identification including expert systems, statistical signal processing techniques, and artificial neural networks (ANN). ANNs consist of a large number of simple processing units connected by weighted links. To develop truly robust ANNs, investigators are required to train their networks on huge training data sets, requiring enormous computing power. We implemented a parallel version of the backward error propagation neural network training algorithm in the widely portable parallel programming language C-Linda. A maximum speedup of 4.06 was obtained with six processors. This speedup represents a reduction in total run-time from approximately 6.4 hours to 1.5 hours. We conclude that use of the master-worker model of parallel computation is an excellent method for obtaining speedups in the backward error propagation neural network training algorithm.

Algorithms↗

PubMed2002

Justifying high-cost anticoagulant therapy.

The application of pharmacoeconomics for choosing low-molecular-weight heparins (LMWHs) to facilitate better clinical and economic outcomes is examined. Today's pharmacy paradigm challenges pharmacists to weigh budgetary concerns with optimal patient outcomes to ensure medication-use practices represent the interests of both the health care system and the patient. Pharmacy is attempting to apply pharmacoeconomics to daily practice to influence these outcomes. By using pharmacoeconomic principles, methods, and data, pharmacists can project the impact of a new drug, such as LMWHs, on a pharmacy budget or overall hospital expenditures. LMWHs have demonstrated superior clinical outcomes and overall cost-of-care advantages over traditional anticoagulant agents. Although LMWHs are more expensive than unfractionated heparins, the costs are partially offset by reductions of hospital length of stay, rates of heparin-induced thrombocytopenia, and the monitoring of certain laboratory test values. LMWHs also facilitate the use of bridge therapy for patients with venous thromboembolism, atrial fibrillation, or prosthetic-valve replacements, allowing drastic cost savings for health systems that far offset their acquisition costs. LMWHs can also provide health care systems the opportunity to implement targeted dose-reduction and rounding programs and appropriate dosing guidelines. Pharmacoeconomics provides pharmacy professionals a method to document potential cost savings, cost avoidances, and costs offsets as well as a means to justify additional pharmacy staff. Applying pharmacoeconomics when choosing LMWHs for anticoagulant therapy can assist pharmacy practitioners in facilitating better clinical and economic outcomes.

Anticoagulants↗