Knowledge Of Adverse Effects Research Articles

Knowledge, Attitude and Practices of Complementary and Alternative Medicine Therapies and its Perspective among Healthcare Professionals: A Systematic Review

Objectives: This systematic review aims to assess the knowledge, attitude and practices of Complementary and alternative medicine therapies and its perspectives among healthcare professionals. Methods: PubMed/Medline, Google scholar, online data base were searched for relevant data from 2010 to 2021 in English language by using keywords of Complementary therapies, alternative medicine, healing science, soul healing therapies, allied therapies, energy healing science etc. The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 guideline and Patient, Intervention, Comparison, Outcomes, Study Design model were used in analyzing the studies. Results: This review included 13 studies included within the last 10 years that investigated knowledge, attitude and practices regarding CAM.Finding suggested that Folk medicines (46%) and ayurvedic medicines (45%) were most commonly used CAM. Advice from friends/relatives was the commonest source of information. None of the respondents had knowledge of adverse effects of CAM used by them and about 70% did not inform their doctor about use of CAM. 61.5% of the HCPs were aware that CAM includes AYUSH. 53% of the HCPs used CAM for self, especially for respiratory disorders (28.3%) and chronic painful conditions (21.6%). The common adverse effects attributed to use of CAM among patients which required consultation of the HCPs were hepatic (42.5%) and renal impairment (32.5%), allergy (10%), relapse Conclusion: This systematic review revealed that CAM treatments depends on various factors working at multiple levels viz., personal factors, disease’ characteristics, perceived treatment characteristics (positive attributes of CAM and negative attributes of BM) and external facilitators. Furthermore, the analysis also identifies the role of two underlining forces–push and pull–in motivating CAD patients to choose CAM treatments. The push force comprises factor that participants found to have a repelling nature, whereas pull forces were regarded as advantageous for CAM usage.

The impact of smoking on oral health and patient assessment of tobacco cessation support from Turkish dentists.

INTRODUCTIONDentists are in a critical position to help patients quit smoking. This study analyses the effectiveness of Turkish dentists in smoking cessation as part of routine patient care.METHODSAn in-person cross-sectional survey on previous dental visit experiences was completed by 226 patients recruited from the Department of Periodontology, Eskisehir Osmangazi University, Turkey, from March 2019 to September 2019. The questionnaire included topics on patient’s smoking/quit characteristics, experiences on smoking cessation from their dentists, and willingness for the implementation of smoking cessation advice by dentists.RESULTSIn all, 38% of the patients were current smokers, 8% were former smokers, and 68% tried to quit previously. Smokers demonstrated consistently higher scores for plaque index, gingival index, and probing depth, than former/non-smokers (p<0.05). Patients’ knowledge of adverse effects was high, and the patients presented a positive attitude toward receiving cessation activities from dentists (86.7%). A total of 89% responded positively to be asked about their smoking behavior. However, the dentists’ approach for cessation discussions did not go any further than listing the harmful effects. Only 32% of the patients were informed about side effects of smoking and one-third were encouraged to quit. In general, offering smoking cessation advice was relatively infrequent, and the majority of patients tried to quit smoking by themselves (76%) without using any nicotine replacement product (84%).CONCLUSIONSSmoking leads to oral health problems. Dentists in Turkey may ask their patients’ about their smoking habits but less frequently offer practical help to quit.

Liability and Failure to Warn a Patient.

This medicolegal article examines a physician's liability when he or she has knowledge of adverse effects associated with a prescription medication and suggests ways to mitigate that liability risk. The article also discusses the circumstances under which pharmaceutical companies face liability for side effects such as tardive dyskinesia.

Awareness of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) use among population in Saudi Arabia

Background: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are one of the most frequently medicines used among the world. They are responsible for a wide range of adverse effects that are ranging from mild to life threatening in severe cases. The aimed of this study to ascertain user's knowledge about NSAIDs among population in Saudi Arabia Methodology: A cross-sectional study including 449 participants, who were users of NSAIDs in Saudi Arabia during October-December 2017. The data were collected using online questionnaire. The questionnaire contained basic socio-demographic information of participants and questions about the participant's knowledge of adverse effects, their types and NSAIDs uses. SPSS 23; including, frequency, description and chi square were used for analysis. Result: Majority, 80.6% of participants were female. Ibuprofen was the most common type of NSAIDs used by participants 61.9%. About 33% of participants were aware that these drugs can cause headache\dizziness and nausea\vomiting. However, 27.8% think that these drugs must be sold without a prescription. Additionally, the majority 87.5% feel that the use of NSAIDs is abused. There were a significant association between the availability of NSAIDs without a physician prescription with age, gender and employment status P-value (&lt;0.05). While there was no significant association with educational status. Conclusion: the present study revealed a limited individual's knowledge about the NSAIDs adverse effects among Saudi Arabia. People need more educations or consultations with health care team specially the pharmacists. In a way to reduce their misuse or abuse or even unnecessarily prescribed. Keywords: NSAIDs; Saudi Arabia; Awareness; Knowledge; Saudi Arabia

Dengue in Pregnancy

Dengue fever during pregnancy is increasing day by day in Bangladesh. The knowledge of adverse effects on mother and neonate remains limited and there are also lack of management guideline in this regard. Mortality rate for severe dengue fever is 0.8–2.5%, and pregnancy should be considered as a coexisting risk factor for serious infection. However, the maternal and fetal outcomes not fully understood. Some review articles on outcomes of neonates born to mother with dengue fever was reported, and demonstrated that preterm birth and low birth weight were the most common adverse pregnancy outcomes; however, dengue fever was not significantly associated with these adverse outcomes, suggesting that symptomatic dengue fever may indicate risk. Other adverse effects such as stillbirth or postpartum hemorrhage (PPH) remain unclear. Therefore, we aimed to brief review of recent management guideline of OGSB about dengue fever in pregnancy.&#x0D; Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 36-42

Prescribing Pattern and drug utilization study in inpatients of department of Orthopaedics in a rural teaching hospital of Ujjain, Madhya Pradesh, India

Background: Drug utilization study can increase our understanding of how drugs are being used. This study was done to evaluate the current drug prescribing trend in management of indoor patient of orthopaedic department and to comment on rationality of the prescribed medicines.Methods: This is a prospective observational study conducted for 12 months, in Chandrikaben Rashmikant Gardi Hospital, a 600 bedded tertiary care rural based, teaching hospital. Total 611 patients were included in this study.Results: Total 5416 drugs were prescribed in 611 prescriptions. Average number of drugs per prescription was 8.86. Average duration of prescription was 10.7 days. Percentage of drugs prescribed by generic name was 28.8%. Percentage of encounter with an Antibiotic prescribed was 60.23% i.e. out of 611 prescriptions antibiotics were prescribed in 368. Percentage of encounter with an Injection prescribed was 63% which means out of 611 prescriptions, injectables were prescribed in 385. Percentage of drugs prescribed from National Essential Medicine List was 52.63%. Percentage of drugs prescribed from WHO model List was 32.46%. Diclofenac (14.25%) was most commonly prescribed drug. Incidence of polypharmacy was quite high in context of Analgesics. Almost 40% of prescriptions had 2 drugs. Orally prescribed Analgesics were 62.6%, Injectables 34.38% and Topical 3.02%.Conclusions: This study reveals that the pattern of prescription in terms of rationality is poor. Special attention needs to be given to the irrational prescribing in terms of polypharmacy and long duration. Continuing medical education regarding appropriate use of drugs, knowledge of adverse effects and standard prescription guidelines will play pivotal role in rational prescription of drugs.

Dengue fever during pregnancy.

ABSTRACTDengue fever during pregnancy is an expanding issue in Southeast Asia; however, the knowledge of adverse effects on mothers and neonates remains limited. Therefore, we aimed to determine the impact of dengue fever. The clinical information of 20 patients of dengue fever during pregnancy in Vietnam from January 1, 2015 to December 31, 2015 was collected and their outcomes were retrospectively investigated. A total of 18 patients (90%) presented with positivity of nonstructural protein 1, and a primary infection. Additionally, 4 patients (20%) had preterm deliveries and 1 (5%) had a stillborn child. All live-born neonates were discharged from the hospital uneventfully. Also, 6 patients (30%) required platelet transfusion and 3 of them received transfusion before delivery, but there were no maternal death. In addition, 3 cases of patients (15%) developed to postpartum hemorrhage (PPH), and their platelet concentrations were significantly lower than those of patients without PPH [90.0 (19.0 – 374.0) × 103 vs. 40.0 (12.0 – 57.0) × 103 cell/μl, p = 0.001]. In addition, patients with PPH also presented with elevated liver enzymes. Pregnant patients with low platelet counts should be recognized as being at high risk for PPH.

Assessment of Knowledge, Interventional Practices for, and Impact of Malaria in Pregnancy among Parturient Women in a Nigerian Tertiary Healthcare Facility

Purpose : To assess knowledge of and intervention for malaria in pregnancy among immediate postpartum women, as well as the impact of malaria on some specific birth outcomes. Methods : A cross-sectional study in which 358 immediate postpartum women were recruited in the labour and maternity wards of University Benin Teaching Hospital, Benin City, Nigeria. Information on demographics, knowledge of malaria, and utilization of malaria interventions were assessed. Immediately after expulsion of placentae, both maternal and placental blood samples were collected from a subset (236) of the study group for parasitaemia and haematocrit determination. Results : The mean age of the women was 29.5 ± 4.55 years. Poor knowledge of adverse effects of malaria during pregnancy was observed. Using an arbitrary scale, low, average and high knowledge of malaria were recorded in 22.4, 50.3 and 27.3 % of the respondents, respectively. Use of insecticidetreated net (ITN) was reported by 48.9, 19.1 and 14.3 % of women with high, average and low knowledge of malaria respectively (p = 0.004) while there was no statistical difference in the use of sulphadoxine/pyrimethamine (IPTp-SP) among the different levels of knowledge of malaria as its practice was reported by 61, 70 and 78.7 % of women with high, average, and low knowledge of malaria, respectively, (p = 0.078). Incidence rates of parasitaemia of 4.0, 1.6 and 6.25 % were obtained using peripheral microscopy, placental microscopy and peripheral rapid diagnostic test (RDT), respectively. Maternal infection was significantly associated with low birth weight (p = 0.020, peripheral microscopy; p = 0.020, placental microscopy) and maternal anaemia (p = 0.009, peripheral microscopy; p = 0.000, peripheral RDT). Conclusion : Knowledge gap still exists with regard to malaria and its interventions among mothers. Knowledge of malaria significantly influences the use of insecticide-treated bed nets. The negative impact of malaria infection during pregnancy is maternal anaemia and low birth weight infants. Keywords : Insecticide-treated bed nets, Low birth weight, Malaria in pregnancy, Maternal anaemia.

Biologics in dermatology: adverse effects.

Biologics are a group of drugs that precisely affect certain specific steps in the immune response and are an extremely useful group when used in an appropriate setting. However, their use can often be a double-edged sword. Careful patient selection and thorough knowledge of adverse effects is a key to their successful use in various disorders. The initial enthusiasm has gradually given way to a more cautious approach wherein a balance is sought between clinical usefulness and expected side effects. The adverse effects of the biologics most commonly used in dermatology have been carefully listed for ready reference. The plausible causes of the adverse reactions are succinctly outlined along with their incriminating factor(s). Besides, in brief, the attention has been focused on their management. The content should provide an essential didactic content for educating the practitioner.

A Cross Sectional Assessment of Health Literacy among Cardiovascular Patients in Karachi, Pakistan

Background: An adequate level of health literacy is related to positive treatment outcomes. The current study is aimed to examine factors associated with health literacy among cardiovascular patients in Karachi city, Pakistan. Method: The study was designed as a cross sectional, descriptive survey. A pre-validated questionnaire was used for data collection. One hundred and sixty three patients attending the Cardiology Outdoor Patients Department of a tertiary care hospital in Karachi were recruited for the study. Descriptive statistics were used for data elaboration. SPSS v 21.0 was used for data analysis. Results: Out of 163 patients, the cohort was almost equal in term of gender distribution. Sixty-one percent had urban residency of Karachi city and 62 (38.04%) were categorized as elderly patients. Overall, poor health literacy status was reported among the study respondents. Health literacy was evident with patient’s knowledge about medications; knowledge of adverse effects; language barriers and perception about role of exercise in improving quality of life. Conclusion: Poor health literacy was associated with multiple factors that adversely affect patient’s pharmacotherapy plans. Urgent measures by using a collaborative approach of physicians, pharmacist and nurses are required to improve health literacy of Pakistani population.

Prescribed antimicrobial therapy: what parents/carers are told and what they would like to know

AimsThe aims of this study were to:Assess the drug related information provided to parents/carers of children prescribed an antibiotic during their in-patient stay and as part of the discharge process...

Are Patients Aware of Angiotensin-Converting Enzyme Inhibitor–Associated Adverse Effects?

It is important for patients to understand the potential adverse effects (AEs) of their daily medications. Because associated adverse effects (ACEIs) may result in life-threatening angioedema, we sought to assess patients' level of awareness of ACEI AEs, determine if patients have an appropriate action plan in the event of an ACEI AE, determine if a brief educational intervention in the emergency department (ED) could improve knowledge about ACEI AEs. This was a prospective in-person survey conducted between August and December 2008 in a large urban academic ED. The survey instrument was used to collect data on demographics, recognition of ACEI AEs, and action plans. A follow-up survey to assess recall of AEs was done 7 days after ED discharge. Of 208 eligible patients, 113 enrolled: sixty-five (58%) were females, median age was 55 years [interquartile range (IQR) 47-64]. The majority of participants (69%) had a high-school diploma or less. On a 5-point Likert scale (5 = "very important"), the median reported level of overall concern for ACEI AEs was 5 (IQR 4-5). Twenty-seven (25%) of the participants reported being told that ACEIs have potential AEs at the time of the initial prescription. Correct identification of potential ACEI-associated AEs in the ED was variable with a median of 8 of 16 correctly answered questions (IQR 6-10). At follow-up, the median score was 9 (IQR 6-10). There was no association between educational level and number of correct AE responses (P = 0.10). Despite a high level of expressed concern regarding ACEI AEs, patients' knowledge of AEs was poor, and recall was minimally improved at follow-up. Most patients have a plan in the event of an AE.

Physical Restraints: Abusive and Harmful

Contemporary health care policy around the world promotes the use of evidence-based medicine and, as such, it is reasonable to assume that this would lead to similarities in health care practices in comparable economies. Interestingly, this does not seem to be the case with the use of restraining technologies and restraint policies implemented within hospitals and nursing homes. Definitional ambiguity surrounding what is an abusive act may in part account for these practice variations, given that interpretations of an abusive act are contingent on particular circumstances. For example, if a practitioner restrains a patient who is behaving aggressively, it might be interpreted as a justifiable act, or an act of abuse that may be criminal, depending on the situation. Examples of physical restraint used in acute hospitals and nursing homes include body belts, restraining vests, cuffs, and bilateral bedrails. Chemical restraints are any medication used to manage what are perceived to be challenging behaviors, such as agitation, aggression, or verbal abuse. A common feature of restraining policies is that a set of permissions is usually required before application of the restraint. These permissions often include authorization by senior medical and nursing staff, permission of relatives or a legally recognized alternate, and, where appropriate, the individual’s consent. Acquiring a restraining order is, however, an insufficient justification for restraint use, it is simply an organizational process requirement, and the decision to restrain, like any health care intervention, should be influenced by the best available evidence. Therapeutic justifications for commonly used physical and chemical restraints are usually couched in terms of safety measures associated with harm prevention and risk reduction.1 We examine this premise in terms of the strength of patient benefit evidence.1 In doing so, we are mindful of other determinants that influence practitioner decisions to use or not to use restraining devices in given situations. These broader determinants include staff perception of the benefits and acceptability of the restraining procedure, knowledge of adverse effects, local practice custom, staffing levels, opportunity to provide staff with intensive interventions, such as continuous supervision, the perceived legality of restraining devices, and societal and organizational cultural norms.

La dépendance chimique et comportementale chez les étudiants en médecine. Étude comparative chez une population d’étudiants libanais

Evaluate chemical and behavioural dependence of medical students, and compare it to a control group (students in non-medical faculties), in order to underline the harmful effect of university on medical students' dependence. A three-part questionnaire was distributed to a sample of 140 medical students at the Saint-Joseph university of Beirut (USJ), and to 140 students in many other USJ faculties, and filled in anonymously. The first part is about demographic criteria and the second and third parts are respectively about chemical and behavioural dependence, based on DSM IV criteria. There is no statistically significant difference between the two studied populations concerning the dependence on alcohol, cannabis, sedatives, opiates, amphetamines, workaholism, gambling and Internet. However, the prevalence of addiction to caffeine, cocaine, nicotine; sexual addiction, and compulsive buying are significantly lower in medical students when compared to the control group. Men, compared to women, did not show significantly higher levels of dependence on chemical substances. Workaholism is not significantly more prevalent in women. Sexual addiction and compulsive buying are not significantly higher in men. However, pathological gambling and Internet addiction are significantly more prevalent in men. Finally, this study does not show a variation in dependence through the years of medical studies. Most studies show that medical students have high levels of dependence on alcohol, opiates and sedatives. The results of our study show greater dependence on caffeine followed by nicotine, alcohol and sedatives. Medical students in our population did not reveal higher dependence rates compared to other university students. Overall, substance addiction in medical students may be related to the stress of medical studies, and easy access to drugs and prescriptions. These factors may be balanced by perfectionist traits, ethical standards and knowledge of adverse effects seen in medical students resulting in more adjusted prevalence of addiction when compared to other university students. The prevalence of chemical and behavioural dependency of medical students is not higher than the other population.

An acutely confused young woman

In September, 2009, a 20-year-old previously healthy woman presented to our emergency department with altered mental status, right arm tingling and numbness, and a bilateral pulsating frontotemporal headache. Her symptoms had started several hours earlier with transient loss of consciousness. On examination, she was alert, with reduced concentration, incoherent thoughts, and poor recall for recent events. There was no evidence of localising neurological signs or neck stiff ness. Her temperature, blood pressure, and vital signs were normal. Abuse of alcohol or illicit substances was denied by a friend who accompanied the patient. Her personal and family history was negative for seizure disorders, migraine, and vascular risk factors. CT of the brain and haematological, biochemical, and cerebrospinal fl uid examination were normal. MRI of the brain, 20 h after the onset of her symptoms, showed multiple confl uent areas of abnormal high signal intensity on T2-weighted scans, symmetrically involving juxtacortical white matter of the frontal, parietal, occipital, and temporal lobes. In these areas, diff usion coeffi cient maps, generated by diff usion-weighted imaging, showed an elevated diff usion suggestive of vasogenic oedema (fi gure A, C, and webappen dix). A diagnosis of posterior reversible enceph alopathy syndrome (PRES) was suspected, and confi rmed by the almost complete disappearance of MRI abnormalities a week later. PRES is clinically characterised by confusion, headache, altered consciousness, seizures, and visual disturbance, with MRI changes of often widespread vasogenic oedema typically predominating in the occipitoparietal regions. PRES is commonly associated with hypertensive encephalopathy, eclampsia, kidney disease, hypercal caemic crisis, autoimmune disorders, transplantation, sepsis, and immunosuppressive treatment or chemo therapy. The pathophysiology is poorly understood, although the ultimate underlying process seems to be an increase in capillary hydrostatic pressure or endothelial dysfunction with a breakdown of the blood–brain barrier triggered by diff erent systemic conditions. Surprisingly, our patient’s history and examinations did not identify any known cause of PRES. However, when suffi ciently recovered for an in-depth interview, she reported sniffi ng an unknown dose of “poppers” (nitrite inhalants) for the fi rst time, just before the onset of symptoms. The close temporal association between inhalation and the onset of the neurological features suggested a causal relation. Over the next 24 h she progressively and spontaneously recovered, returning to normal within a day. In October, 2009, at fi nal follow up MRI was normal (fi gure B, D). Nitrite inhalants act through generation of nitric oxide, which activates soluble guanylyl cyclase, stimulating the production of cyclic guanosine monophosphate (cGMP), which leads to vasorelaxation via cGMP-dependent protein kinases. Vasodilation can cause the common adverse eff ects—a drop in systemic blood pressure, increased heart rate, headache, and fainting. Donors of nitric oxide are well known to cause headache and trigger migraine attacks in people who have migraines. However, PRES has not been previously described as a consequence of use of nitrite inhalers, despite their widespread use as therapeutic, diagnostic, or recreational agents. Glyceryl trinitrate was reported to aggravate pre-eclamptic PRES in one case. Nitric oxide donors dilate veins and arteries, modifying intracranial haemodynamics and resulting in an imbalance between forces that govern fl uid motion into and out of the microvasculature. We suggest in our patient’s case, that this intense vasodilation might have promoted vascular instability, breakdown of the blood–brain barrier, and fl uid extravasation. Club-drug toxic eff ects should be considered in the diff erential diagnosis when a previously healthy individual (typically a young adult) presents with an acute change in mental status. Accurate drug history and a good knowledge of adverse eff ects of individual street drugs is important for the generalist clinician to eff ectively face the diagnostic and therapeutic challenges they pose. The growing list of causes of PRES should perhaps include nitrite inhalants.

Cultivation of genetically modified organisms: resource needs for monitoring adverse effects on biodiversity

Genetically modified organisms (GMO) in non-European countries are introduced into the agro-environment on large scale with little knowledge of adverse effects on biodiversity. In the European Union (EU) possible effects of GMOs on biodiversity have to be accurately and precisely monitored. Monitoring biodiversity with a high precision is expensive and may only be achieved in close cooperation between GMO monitoring and general biodiversity monitoring. The EuMon project sampled metadata on biodiversity monitoring in Europe. Basing on the metadata, we estimated resource needs for biodiversity monitoring as needed for detecting potential adverse effects of GMOs on biodiversity. On average the analyzed schemes with a potential to detect at least a 5% change of biodiversity monitor 242.6 ± 105.4 sites at 322.6 ± 172.1 person days employing 63 ± 23 persons per year. The time invested in monitoring, given as person days, however, differed greatly between schemes and species groups, so that real manpower might be considerably higher.

Tailored Chemotherapy Information Faxed to General Practitioners Improves Confidence in Managing Adverse Effects and Satisfaction With Shared Care: Results From a Randomized Controlled Trial

General practitioners (GPs) play a critical role in the treatment of patients with cancer; yet often lack information for optimal care. We developed standardized information for GPs about chemotherapy (CT). In a randomized controlled trial we assessed the impact of sending, by fax, information tailored to the particular patient's CT regimen. Primary end points were: confidence treating patients who were receiving CT (confidence), knowledge of adverse effects and reasons to refer the patient to the treatment center (knowledge), and satisfaction with information and shared care of patients (satisfaction). Focus group work informed the development of the CT information which focused on potential adverse effects and recommended management strategies. GPs of patients due to commence CT were randomly assigned to receive usual correspondence with or without the faxed patient/regimen-specific information. Telephone questionnaire at baseline and 1 week postintervention assessed knowledge, confidence, and satisfaction. Ninety-seven GPs managed 97 patients receiving 23 types of CT. Eighty-one (83.5%) completed the follow-up questionnaire. GPs in the intervention group demonstrated a significantly greater increase in confidence (mean difference, 0.28; 95% CI, 0.10 to 0.47) and satisfaction (mean difference, 0.57; 95% CI, 0.27 to 0.88) compared with usual care, reflecting a 7.1% and 10.5% difference in score, respectively. No differences were detected for knowledge. GPs receiving the CT sheet found correspondence significantly more useful (P < .001) and instructive (P < .001) than GPs who received standard correspondence alone. Information about CT faxed to GPs is a simple, inexpensive intervention that increases confidence managing CT adverse effects and satisfaction with shared care. This intervention could have widespread application.

Clinical use of carbamazepine for bipolar disorders

Two recently completed large, randomised, double-blind, placebo-controlled trials supporting the efficacy of carbamazepine (CBZ) extended-release capsules (ERC) for the treatment of acute manic and mixed episodes have resulted in US FDA approval of CBZ-ERC, and have reinvigorated the importance of understanding the role of CBZ in bipolar disorder (BD) pharmacotherapy. Additional data suggest that CBZ may have a use in BD maintenance treatment and possibly in acute BD depression. Optimal use of CBZ requires sound knowledge of adverse effects and pharmacokinetic interactions with this agent. Adverse effects commonly involve benign side effects but can rarely include serious haematological, dermatological and hepatic manifestations. On the other hand, metabolic adverse effects (thyroid, glucose, lipid disturbances and significant weight gain) can be less problematic with CBZ, compared with lithium, valproate and atypical antipsychotics. Pharmacokinetic considerations (cytochrome P450 3A3/4 metabolism, active epoxide metabolite and catabolic enzyme induction) can influence the clinical use of CBZ. Managing adverse effects and pharmacokinetic complexities is important for optimising pharmacotherapy with CBZ in patients with BD. This paper reviews the chemistry, pharmacodynamics and pharmacokinetics of CBZ, as well as reviews of the controlled trials of CBZ in acute bipolar mania, acute bipolar depression and bipolar maintenance treatment.

Principes des traitements des patients infectés par le VIH

HIV infection has become a chronic disease since the amendment of efficient antiretroviral therapy. Modern treatments reduce and control the viral load significantly as to allow a solid immune response. Initiation of first-line antiretroviral treatments is now clearly established; it combines two nucleoside inhibitors of the HIV reverse transcriptase with either one of a non-nucleoside inhibitor or an HIV protease inhibitor. There is no combination applicable to every patient; the choice must take into account the possible and/or expected adverse effects. One must insist on the patient's observance and adherence to his treatment. The decision of treatment initiation, modification or interruption must be taken in collusion with the patient. A better knowledge of adverse effects allows a better follow-up and thereby improves observance. Pregnancy and antiretroviral therapy can be compatible. Furthermore a proper medical monitoring during pregnancy has reduced mother-child transmission under 2%. Undertaking of associated infections by viral hepatitis is now better defined and treatment remains delicate although it has largely been eased.

Quality of care for NSAID users: development of an assessment tool

Assessments of NSAID use based on authoritative guidelines typically overlook patients' views and nuances of medical history. Our objective was to develop an assessment tool that incorporates these aspects, and technical items, for quality of care assessments in NSAID users. Patients newly referred to a university hospital were interviewed by a nurse using an agreed template. A multidisciplinary group of rheumatologists, nurse specialists, primary care physicians and a pharmacist reviewed current guidance and systematic reviews on NSAID use, and a series of interview transcripts. The group agreed, by informal consensus, important determinants of effective and safe NSAID use. Technical aspects of medical care and items that reflected interpersonal care were included in an index for assessing quality of care for individual patients. Interview transcripts of 100 patients were scored by panel members and reliability of scores was tested by calculating weighted percentage agreement and the kappa statistic. Our final index had five domains: medical risk factors; steps taken to reduce risk; knowledge of adverse effects; NSAID dose; and cost efficiency. Each item was scored 0, 1 or 2. Scores were summed, giving a maximum of 10 (low scores indicating low quality). Intra-rater agreement was >90%; kappa was 0.47-0.87 for individual domains and 0.59 for overall score. Inter-rater agreement for overall score was 95%; kappa was 0.25-0.78 for domains and 0.48 for overall score. Patients with especially low scores were identified using the mode of scores for five assessors; obvious clinical concerns were identified, supporting index face validity. A simple index to evaluate quality of care for NSAID users based on a patient interview is described. This may be used by one or more assessors to examine care standards and highlight deficiencies in relation to NSAID use in practice.