Intensity Of Side Effects Research Articles

Decreasing the Burden of Side Effects Through Positive Message Framing: an Experimental Proof-of-Concept Study.

Informing patients about treatment side effects increases the occurrence and intensity of side effects. Since the obligatory informed consent procedure in drug treatments requires transparency and nocebo research suggests that the informed consent of a drug leads to an increased occurrence of the mentioned side effects, the aim of this proof of concept study was to determine the effect of two different framings of informed consent on the occurrence, intensity, and perceived threat of side effects. Healthy male participants (n = 80) were randomized to one of two framing groups. The positive framing group was informed that the common side effect dizziness was a sign that the drug had started to work, while the neutral framing group was told that dizziness is an unpleasant but well-known side effect. Side effects were measured after the administration of metoprolol, an antihypertensive agent. Post hoc moderator analyses investigated the effect of pre-existing negative beliefs about the general harm of medication on the framing manipulation. Metoprolol-specific drug-attributed side effects were rated significantly less threatening in the positive framing group. The between-group effect size (Cohen's d) was small (d = 0.38, p = 0.049). Exploratory post hoc moderator analyses suggest that participants who believed that medication is a source of harmful effects benefited from positive framing, compared to neutral framing of drug-attributed side effects. Positive framing was partially effective in decreasing specific side effect measures, particularly among participants with a tendency to believe that medicine is harmful. Informed consent procedures should therefore be personalized, focusing on patients with negative treatment beliefs.

Impact of chemotherapy on perceptions related to food intake in women with breast cancer: A prospective study.

Breast cancer (BC) treatment includes mostly chemotherapy (CT), which can cause side effects like nausea, taste changes, early satiety, slow gastric emptying and xerostomia. In this way, the individual’s relationship with food may change during the treatment. The aim of this study was to evaluate the impact of chemotherapy on perceptions related to food intake of women with BC. Fifty-five women with BC were followed, and data were collected at three periods during first-line CT: beginning (T0), intermediate (T1) and end (T2). A visual analogue scale (VAS) (0 to 10 cm) for hunger, appetite for various food categories and meal enjoyment was investigated. The frequency and intensity of side effects were evaluated using a 4 cm scale. The results showed a higher prevalence of taste changes in T1 (p = 0.044) and more nausea in T1 and T2 (p = 0.018). Furthermore, the intensity of nausea was higher in T2 (p = 0.01) than in the other periods. We observed moderate hunger in T0, T1 and T2 (p = 0.113), but the overall appetite increased between T0 and T2 (p = 0.003). Meal enjoyment was reduced from T0 to T1and returned back to the initial value in T2 (p = 0.021). The appetite for salty (p = 0.004) and spicy (p = 0.03) foods was increased in T1. There was an increase of body weight (p = 0.008), body mass index (BMI) (p = 0.009) and waist circumference (WC) (p = 0.03) during CT. CT changes food hedonism, increasing the overall appetite and the appetite for salty and spicy foods. Moreover, we observed the negative impact of CT on meal enjoyment and an increase in side effects and anthropometric parameters.

НЕЙРОЛЕПТИКИ В ЛЕЧЕНИИ ШИЗОФРЕНИИ (ОБЗОР ЛИТЕРАТУРЫ)

Aim. To analyze the administration of antipsychotics as main pharmaceuticals in treatment of schizophrenia as chronic mental disease involving several positive, negative, cognitive, and affective symptoms resulting in disorganization of mental activity and mental disadaptation in patients. Results. We have found the data on the absence of significant differences in efficacy of antipsychotics relative to positive symptoms and mental disorganization symptoms except for advantages of clozapine in the treatment of resistant cases. It shown that the therapy efficacy from the position of treatment of negative, depressive, and cognitive symptoms is determined depending on: (1) how the reduction of positive symptoms (delirium and hallucinations) improves the secondary symptoms of disease, and (2) how side extrapyramidal effects (EPSE) and side anticholinergic effects are corrected by drugs administered to influence EPSE aggravating the mentioned symptoms. There is a reasonable opinion that strong antipsychotics that do not have accompanying extrapyramidal actions and do not require the combined anticholinergic therapy have huge therapeutic advantages. Conclusion. It is found that having much in common in efficacy all antipsychotics greatly differ in rate and intensity of side effects. Contrary to belief that second-generation antipsychotics (so called atypical antipsychotics) are normally considered the drugs with less risk of extrapyramidal actions and higher risk of metabolic side effects in comparison with traditional antipsychotics; the significant variability of frequency of these and other side effects of these two types of drugs indicates that such categorical distinguishing of pharmaceuticals is not clinically justified. The choice of antipsychotic should be based on individual preferences of patients, their therapeutic response to the previous treatment, history of presence and specifics of antipsychotic side effects, medical data on risk factors, level of compliance to the prescribed treatment, and, especially, the profile of side effects of various antipsychotics.

Predicting Non-Adherence To Medication Regimen Among Patients With Hypertension: Taking Steps Toward Ecological Approach

Medication non-adherence among patients with hypertension is one of the main reasons for poor treatment efficacy, higher healthcare costs, increased patient morbidity and mortality. Despite numerous attempts to explain and improve adherence to long-term treatment regimen, the prevalence of non-adherence is still very common. Moreover, treatment adherence research rarely includes environmental variables as proposed by the ecological model. The aim of this study is to analyze the role of patient-level and micro-level variables in predicting medication non-adherence among patients with hypertension. Method. 101 hypertensive outpatients aged 33-93 (M = 60.13; SD = 11.85) volunteered to participate in the study. A self-report questionnaire was constructed to assess subjects’ adherence to medication regimen. Pivotal socioeconomic variables were recorded as well as treatment-related information, illnessrelated beliefs, perceived social support and satisfaction with the healthcare provider. Results show that perceived longer illness duration and higher satisfaction with the healthcare provider predict lower levels of intentional medication non-adherence. Younger age, higher intensity of side effects and lower levels of perceived social support predict higher unintentional medication non-adherence. Amount of prescribed medication has no direct effect on unintentional medication non-adherence, but is mediated through intensity of side effects. Results of this study emphasize the importance of environmental variables and recognition of various patterns of medication non-adherence, which provide additional understanding of the complexity of this health-related behavior.

The influence of detoxification agents on the intensity of side effects caused by medium-high doses of methotrexate in children with acute lymphoblastic leukemia: case series

SUMMARY Objective The treatment of childhood acute lymphoblastic leukemia (ALL) in Serbia is conducted according to protocol ALL IC BMF-2009. The therapy includes the application of cytostatic drugs methotrexate and 6-mercaptopurine, and drug detoxifying Calcium Folinate. At the moment, 80% of affected children could be cured with current treatment, but resistance to the therapy and its toxic effects remain serious clinical problems. The aim of the study was to investigate the influence of detoxification agents (Calcium Folinate, silymarin and ursodeoxycholic acid) on the side effects of methotrexate, applied in this protocol. Methods A modified acute toxicity form (GPOH) was used for side effects monitoring. The research included children with either standard or intermediate risk ALL in the consolidation therapy phase, who were hospitalised at the Institute for Child and Youth Health Care of Vojvodina in Novi Sad during the period from July 2010 to February 2011. Results The most frequent side effect after 40 applications of methotrexate in ten children was bone marrow depression. Methotrexate caused: leukopenia in 10 patients, thrombocytopenia in 5 patients; after the use of folic acid, platelet count grew in 8 patients, leukocyte in 2 patients. Less frequent side effects: an increase serum transaminase activity, the state of fever, bronchopneumonia, diarrhoea with mild cramps and hypercalcaemia. Conclusion The application of Calcium Folinate, silymarin and ursodeoxycholic acid prevented the occurrence of severe adverse effects caused by medium-high doses of methotrexate. Observed adverse effects were of mild to moderate intensity, reversible and did not significantly disturb the quality of life in treated patients.

Pharmacogenetics of Adverse Events in Schizophrenia Treatment: Comparison Study of Ziprasidone, Olanzapine and Perazine

The primary aim of the present study was to assess the possible associations between dopaminergic, serotonergic, and glutamatergic system-related genes and adverse events after antipsychotic treatment in paranoid schizophrenia patients. The second aim of the study was to compare the intensity of these symptoms between atypical (ziprasidone and olanzapine) and typical (perazine) antipsychotic drugs. Methods One hundred ninety-one Polish patients suffering from paranoid schizophrenia were genotyped for polymorphisms of DRD2, DAT1, COMT, MAOA, SERT, 5HT2A, and GRIK3. The patients were randomized to treatment with perazine, olanzapine or ziprasidone monotherapy for 3 months. The intensity of side effects (changes in body weights and extrapyramidal symptoms) was measured at baseline and after 12 weeks of antipsychotic treatment. Results After 3 months of therapy, the weight increase was the greatest in the group treated with olanzapine and the least in the group treated with ziprasidone. None of the examined gene polymorphisms was associated with the body weight changes. Perazine treatment was associated with the significantly highest intensity of extrapyramidal symptoms. None of the examined polymorphisms was associated with the changes in extrapyramidal adverse events after antipsychotic treatment. Conclusion The selected polymorphisms are not primarily involved in changes in body weights and extrapyramidal symptoms related to antipsychotic treatment in paranoid schizophrenia patients.

Randomized controlled trial of cyclic and continuous therapy with trospium and solifenacin combination for severe overactive bladder in elderly patients with regard to patient compliance.

The aim of the study was to increase the efficiency of treatment for severe symptoms of overactive bladder (OAB) with antimuscarinic drugs in elderly men and women. A total of 341 patients over 65 years of age (average age 69.9; 186 women and 155 men) with severe symptoms of OAB (frequency of incontinence episodes [IEs] ≥ 3/day) underwent examination. Patients were distributed into three main groups: A (n = 58; trospium 60 mg/day + solifenacin 20): three cycles, each cycle 8 weeks, with an 8-week interval; B (n = 55; trospium 30 mg/day + solifenacin 10), regimen was the same as in group A; C (n = 62; trospium 30 mg/day + solifenacin 10) daily during 1 year. The most successful treatment for the clinical and urodynamic symptoms of OAB was observed in group A, without an increase in the quantity or intensity of side effects (IEs = 4.8 (0.9) → 1.4 (0.8); p ≤ 0.01). Groups B and C also demonstrated positive effects for most of the markers for lower urinary tract state with statistical significance p ≤ 0.01. Nonparametric correlation between decrease in IEs and relative number of patients who accurately fulfilled prescriptions was in group A, r = 0.53, p ≤ 0.05; in group B, r = 0.61; p ≤ 0.05; in group C, r = 0.55, p ≤ 0.05. Cyclic therapy with two different spectrum antimuscarinics appears to be effective for controlling severe OAB in elderly patients. One-year cyclic therapy with a trospium and solifenacin combination provides a high compliance level (76-84%). However, continuous therapy with standard doses of trospium and solifenacin results in low adherence and high rates of treatment withdrawals (≥ 66%) despite satisfactory clinical and urodynamic results.

Discontinuation and non-adherence to endocrine therapy in breast cancer patients: is lack of communication the decisive factor?

Non-adherence to anti-hormonal therapy is a major problem in gynecologic oncology. Reasons reported are side effects and lack of support. The aim of our study was an analysis of influence of experiences of patients with endocrine therapy and communication and information on this topic and their influence on adherence. We developed a structured questionnaire which was tested in a pilot version and then programmed as online questionnaire and presented to patient members of self-help and breast cancer organizations. Patients only had received scarce information on endocrine therapy. Only 12.8% stated that their questions were answered in detail, 43.2% got no answers or only non-detailed answers. 76% had side effects limiting functions of daily life. 60% of physicians did not react on these side effects. There is a significant correlation between number and intensity of side effects and non-adherence or disruption of therapy (p = 0.029 and p < 0.01, respectively). Women who reported having received detailed answers to their questions also reported better adherence (p = 0.014). In order to improve adherence, detailed information on side effects and answers in case of symptoms are most important. Physicians should not rely on presenting written information but should mainly engage in direct communication.

Intensity of side effects of topical glaucoma medication and its influence on adherence behavior in patients with glaucoma.

BackgroundThe aim of this study was to investigate the intensity of side effects that patients attribute to their topical glaucoma medication and their relationship to adherence behavior.MethodsThis was a questionnaire-based study of 123 glaucoma patients at a university eye clinic in Erlangen, Germany. An initial questionnaire asked about patient demographic data, the treatment plan, and intensity of side effects, and included Adherence to Refills and Medication Scale 2 (ARMS2) and visual analog scale (VAS-AD) scores. In a follow-up questionnaire, the treatment plan, intensity of side effects, ARMS2, and VAS-AD were reanalyzed.ResultsMost patients reported having few side effects, although only 20% said that they had no symptoms suggestive of side effects at all. The patients showed good adherence behavior on both the ARMS2 and VAS-AD scores, which were stable over time. The intensity of side effects experienced in the previous 7 days did not correlate with adherence scores and had no predictive value for adherence.ConclusionThis study could not detect any significant influence of the subjectively experienced intensity of side effects on patients’ adherence behavior. However, we believe that a simple and clear treatment plan with few side effects is still preferred by most patients.

Pharmacogenetics of adverse events in schizophrenia treatment: Comparison study of ziprasidone, olanzapine and perazine

The primary aim of the present study was to assess the possible associations between dopaminergic, serotonergic, and glutamatergic system-related genes and adverse events after antipsychotic treatment in paranoid schizophrenia patients. The second aim of the study was to compare the intensity of these symptoms between atypical (ziprasidone and olanzapine) and typical (perazine) antipsychotic drugs. One-hundred and ninety-one Polish patients suffering from paranoid schizophrenia were genotyped for polymorphisms of DRD2, DAT1, COMT, MAOA, SERT, 5HT2A, and GRIK3. The patients were randomized to treatment with perazine, olanzapine or ziprasidone monotherapy for 3 months. The intensity of side effects (changes in body weights and extrapyramidal symptoms (EPS)) was measured at baseline and after 12 weeks of antipsychotic treatment. After 3 months of therapy, the weight increase was the greatest in the group treated with olanzapine and the least in the group treated with ziprasidone. None of the examined gene polymorphisms was associated with the body weight changes. Perazine treatment was associated with the significantly highest intensity of EPS. None of the examined polymorphisms was associated with the changes in extrapyramidal adverse events after antipsychotic treatment. The selected polymorphisms are not primarily involved in changes in body weights and EPS related to antipsychotic treatment in paranoid schizophrenia patients.

Side Effects from Use of One or More Psychiatric Medications in a Population-Based Sample of Children and Adolescents

The purpose of this study was to investigate the side effect risks from using one or more psychiatric medications (including antipsychotics, antidepressants, α-2 agonists, benzodiazepines, mood stabilizers, and stimulants) among a national cohort of children and adolescents. A questionnaire survey was administered to parents who filled a prescription for a psychiatric medication for their child at a large national retail pharmacy chain. Primary outcome variables were the total count of side effects from a list of 12 problem areas, as well as parent-reported side effect intensity (mild/moderate/severe). Modifiers investigated included specific medication and number of medications utilized, demographics, and difficulties with access to care. A total of 1347 parents of study subjects ages 3-17 years from 30 U.S. states who were taking psychiatric medications for any indication purchased at one retail pharmacy chain enrolled following a single mail invitation (7.5% response). Of the study subjects, 80% were white/non-Hispanic, 64% were male, 63% had private health insurance, and 67% had used a current medication for >1year. Most (84%) had one or more parent-reported side effect. After adjusting for covariates, subjects with two medications reported 17% (p<0.001) and with three or more medications reported 38% (p=0.002) increases in their average number of side effects than did children taking one medication. Parental reporting of difficulties in accessing care also predicted a 42% (p<0.001) greater number of side effects than for those who had no access difficulties. Side effects were particularly more common in medication combinations including either selective serotonin reuptake inhibitors (SSRIs) (77% higher odds, p<0.001) or antipsychotics (99% higher odds, p<0.001). Side effects from psychiatric medications appear to be both more common and more severe overall with increasing numbers of medications utilized, and with perceived difficulty in accessing care. Polypharmacy regimens including either SSRIs or antipsychotics were especially associated with experiencing side effects, within this study sample.

Neuroactive alkaloids that modulate the neuronal nicotinic receptor and provide neuroprotection in an Alzheimer's disease model: the case of Teline monspessulana.

Neuroactive alkaloids that modulate the neuronal nicotinic receptor and provide neuroprotection in an Alzheimer's disease model: the case of Teline monspessulana.

The influence of detoxification agents on the intensity of side effects caused by medium-high doses of methotrexate in children with acute lymphoblastic leukemia: Case series

Objective The treatment of childhood acute lymphoblastic leukemia (ALL) in Serbia is conducted according to protocol ALL IC BMF-2009. The therapy includes the application of cytostatic drugs methotrexate and 6-mercaptopurine, and drug detoxifying Calcium Folinate. At the moment, 80% of affected children could be cured with current treatment, but resistance to the therapy and its toxic effects remain serious clinical problems. The aim of the study was to investigate the influence of detoxification agents (Calcium Folinate, silymarin and ursodeoxycholic acid) on the side effects of methotrexate, applied in this protocol. Methods A modified acute toxicity form (GPOH) was used for side effects monitoring. The research included children with either standard or intermediate risk ALL in the consolidation therapy phase, who were hospitalised at the Institute for Child and Youth Health Care of Vojvodina in Novi Sad during the period from July 2010 to February 2011. Results The most frequent side effect after 40 applications of methotrexate in ten children was bone marrow depression. Methotrexate caused: leukopenia in 10 patients, thrombocytopenia in 5 patients; after the use of folic acid, platelet count grew in 8 patients, leukocyte in 2 patients. Less frequent side effects: an increase serum transaminase activity, the state of fever, bronchopneumonia, diarrhoea with mild cramps and hypercalcaemia. Conclusion The application of Calcium Folinate, silymarin and ursodeoxycholic acid prevented the occurrence of severe adverse effects caused by medium-high doses of methotrexate. Observed adverse effects were of mild to moderate intensity, reversible and did not significantly disturb the quality of life in treated patients.

Dermatology Life Quality Index and Side Effects after Topical Photodynamic Therapy of Actinic Keratosis

Background: Photodynamic therapy (PDT) is an excellent treatment option for actinic keratosis. However the side effects lead to an impairment of the patients' quality of life. Objectives: To evaluate the impact of PDT on patients' quality of life and to determine the frequency and intensity of side effects over the course of 4 weeks post PDT. Patients and Methods: 22 patients with actinic keratosis in the face were included into this prospective study. Pain was measured using a visual analog scale immediately and 8 h after PDT. The Dermatology Life Quality Index (DLQI) was assessed at screening, after treatment as well as 2 and 4 weeks after PDT. The physician and patient evaluated the intensity of side effects during the treatment, 2 and 4 weeks post PDT. Additionally, the patient documented side effects daily from the 1st to the 14th day after PDT and on day 28 post PDT, using a diary. Results: We observed a significant (p < 0.001) increase in the DLQI from 1.6 ± 1.7 prior to PDT to 7.3 ± 4.9 post PDT. The DLQI normalized in the following 4 weeks. Immediately and 8 h after PDT mean pain was 4.3 ± 2.5 and 2.3 ± 2.1. Side effects documented by the patients were erythema (100%), pain, burning, edema (90.9%), itching (86.4%), scaling (81.8%) and pustules (59.1%). No scar formation, hyper-/hypopigmentation or infections were observed. Conclusion: PDT has a significant temporary impact on patients' DLQI. Transitory side effects are common and show typical kinetics.

Therapeutic efficacy of natural prostaglandin in the treatment of pyometra in bitches

Aim: The current study was done to study the therapeutic effect of natural prostaglandin in treatment of canine pyometra. Materials and Methods: Seven bitches were treated with natural PGF · i.e. dinoprost tromethamine at the dose rate of 100 2 µg/kg body weight subcutaneously once daily for 7 days with supportive therapies. The physiological, haematological and th th biochemical parameters were studied before (0 day) and after treatment (8 day). Therapeutic efficacy was assessed in terms of return of abnormal parameters to either normal or near normal value as compared to the untreated control group, intensity of side effects and post treatment reproductive status. Results: All physiological, haematological and biochemical parameters in the seven treated bitches returned to normal range at the end of treatment. The intensity of side effects was quite severe in the treatment group. Six bitches came to estrus within 2 months of treatment and out of them four conceived on subsequent mating. In rest three bitches there was recurrence of pyometra within 4 months of treatment. Conclusion: Though conception rate of recovered bitches is decreased when compared with that of normal healthy bitches still this treatment protocol can be used successfully in treatment of canine pyometra to conserve the breeding capability of bitches.

Acceptability and Adherence in a Chemoprevention Trial among Women at Increased Risk for Breast Cancer Attending the Modena Familial Breast and Ovarian Cancer Center (Italy)

Chemoprevention for women at risk for breast cancer has been shown to be effective, but in actual practice, women's uptake of chemoprevention has been poor. We explored factors that influence acceptability, adherence, and dropout in the International Breast (Prevention) Intervention Study during our first 3 years of activity at the Modena Familial Breast and Ovarian Cancer Center. We evaluated socio-demographic characteristics, health status, adherence, and side effect intensity. Semi-structured interviews analyzed reasons for accepting/refusing/stopping the trial. A total of 471 postmenopausal women were invited to participate, of which 319 declined to participate (68%), 137 accepted to participate (29%), and 15 participants did not make a final decision (3%). Breast cancer-related worries and trust in our preventive and surveillance programs were the most frequent reasons for accepting. Side effect-related worry was the most frequent reason for refusing. General practitioners' and family members' opinions played an important role in the decision-making process. Adherence significantly decreased after a 12-month follow-up, but it remained unchanged after 24- and 36-month follow-ups. Mild/moderate side effects reported by women did not change after 12 months of treatment. Forty percent of women withdrew from the study due to complaints of side effects. We concluded that chemoprevention trials are difficult medical experiments and that the process of deciding about whether or not to participate is based mainly on beliefs and values. This study has important clinical implications. During counselling with prospective participants, it is important to emphasize the potential benefits and to promote an informed choice. How participants make decisions, their belief systems, and their perception of risk are all factors that should be investigated in future research.

Glycolic acid peeling in the treatment of mild to moderate inflammatory facial acne vulgaris

Chemical peeling of the skin involves the topical application of a chemical agent in order to produce a controlled injury to a desired depth, thus allowing subsequent regeneration of the skin which can result in improved texture, more homogeneous pigmentation and less wrinkling. Acne vulgaris is one of the most common skin diseases. The aim of the actual study was to examine and compare the efficiency, skin tolerance and side effects of a 35% glycolic acid combined with antibiotic therapy in patients with inflammatory aspects of acne. The sample consisted of 120 subjects, divided into two experimental sub-samples of 60 subjects each. The first sub-sample consisted of patients with acne papulosa, while the second sub-sample consisted of patients with acne papulopustulosa.The patients from both sub-samples were additionally divided into two groups of 30 patients each. To the first group of 30 patients (within each sub-sample, respectively), glycolic acid in a concentration of 35% was applied after adjusted antibiotic therapy, while to the second group of 30 patients (within each sub-sample, respectively) glycolic acid in a concentration of 35% was applied without previous adjustment of antibiotic therapy. In each sub-sample, the differences in the manifested symptoms of the ailment and the side effects were analyzed. Glycolic acid had a significant effect in the treatment of acne papulosa and acne papulopustulosa, as a monotherapy, as well as combined therapy, that is, after adjusted antibiotic therapy. Side-effects were experienced by patients treated only by glycolic acid, that is, without previously adjusted antibiotic therapy. Glycolic acid chemical peels in concentration of 35% had overall efficiency and a superior therapeutic effect and are recommended by the authors after adjusted antibiotic therapy. The appearance and intensity of side effects in patients after adjusted monotherapy, adduced us to the choice of combined therapeutic treatment. Key words: Acne papulosa, acne papulopustulosa, chemical peeling, glycolic acid.

Toxicity after radiochemotherapy for glioblastoma using temozolomide - a retrospective evaluation

PurposeRetrospective evaluation of toxicity and results after radiochemotherapy for glioblastoma.Methods46 patients with histopathologically proven glioblastoma received simultaneous radiochemotherapy (RCT). The mean age at the beginning of therapy was 59 years, the mean Karnofsky performance index 80%. 44 patients had been operated on before radiotherapy, two had not. A total dose of 60 Gy was applied in daily single fractions of 2.0 Gy within six weeks, 75 mg/m2/day Temozolomide were given orally during the whole radiotherapy period.ResultsA local progression could be diagnosed in 34/46 patients (70%). The median survival time amounted to 13.6 months resulting in one-year and two-year survival probabilities of 48% and 8%, respectively.Radiotherapy could be applied completely in 89% of the patients. Chemotherapy could be completed according to schedule only in 56.5%, the main reason being blood toxicity (50% of the interruptions). Most of those patients suffered from leucopenia and/or thrombopenia grade III and IV CTC (Common toxicity criteria). Further reasons were an unfavourable general health status or a rise of liver enzymes.The mean duration of thrombopenia and leucopenia amounted to 64 and 20 days. In two patients, blood cell counts remained abnormal until death. In two patients we noticed a rise of liver enzymes. In one of these in the healing phase of hepatitis a rise of ASAT and ALAT CTC grade IV was diagnosed. These values normalized after termination of temozolomide medication. One patient died of pneumonia during therapy.ConclusionOur survival data were well within the range taken from the literature. However, we noticed a considerable frequency and intensity of side effects to bone marrow and liver. These lead to the recommendations that regular examinations of blood cell count and liver enzymes should be performed during therapy and temozolomide should not be applied or application should be terminated according to the criteria given by the manufacturer.

Smoking outcome by psychiatric history after behavioral and varenicline treatment

Treatment outcomes were compared across smokers enrolled in the COMPASS cessation trial with (positive psychiatric history [PH+], n = 271) and without (PH−, n = 271) a diagnosis of PH based on medical record evidence of anxiety, depression, psychotic disorder, or bipolar disorder. Everyone received behavioral counseling plus varenicline and was followed for 6 months post quit date. PH+ smokers took varenicline for fewer days on average (59.4 vs. 68.5, p ≤ .01) but did not differ in their use of behavioral treatment. PH+ smokers were more likely to report anxiety and depression, but side-effect intensity ratings did not differ after adjusting for multiple comparisons. Overall, all side effects were rated as moderate intensity or less. Groups had similar 30-day abstinence rates at 6 months (31.5% PH+ vs. 35.4% PH−, p = .35). In sum, having a psychiatric diagnosis in this trial did not predict worse treatment outcome or worse treatment side effects.

Medicinal Systems of Complementary and Alternative Medicine: A Cross-Sectional Survey at a Pediatric Emergency Department

The purpose of this study was to find out which experiences adults are making while treating children with complementary and alternative medicine (CAM) therapies in German-speaking Switzerland. A cross-sectional survey was performed on adults accompanying the children presenting to an urban, tertiary pediatric emergency department in Zurich; 71% of the distributed questionnaires (1143 of 1600) could be used for data analysis. The respondents were asked about their experiences while treating the child with CAM and--for comparison reasons--with conventional medicine (CM). The respondents perceived the effectiveness of CAM therapies in general to be inferior to that of CM, although 49% of all respondents stated that CAM therapies were more effective than CM in certain cases/against certain diseases and 13% that CAM therapies were as effective as CM. Higher frequency of use and lower compliance were observed in the case of CAM, relatively to CM. Respondents described the direct costs for the patient of both types of medicine to be comparable. Ninety-three percent (93%) of the respondents experienced no side-effects with CAM therapies, whereas only 52% of the respondents stated the same about CM therapies; the observed side-effects of CAM were weaker than those of CM. Homeopathy was the most frequently used form of CAM (77% of all CAM users), followed by herbal medicine (64%), anthroposophic medicine (24%), Traditional Chinese Medicine (13%), Ayurveda (5%), and others (34%). From the respondents' point of view, the most marked difference between CAM- and CM therapies concerns the frequency and intensity of side-effects, which were markedly higher in the latter case. The respondents made use of a wide variety of CAM therapies.