New Course Of Treatment Research Articles

Preferences for diagnostic pathways and treatment choice in systemic lupus erythematosus: a patient-based discrete choice experiment.

Starting from the unmet need of early diagnosis and treatment in systemic lupus erythematosus (SLE), the study aims to explore patient preferences in diagnostic pathways and treatment modalities. It seeks to integrate clinical priorities with patient perspectives, providing an optimal approach to SLE treatment that remains uncertain. A discrete choice experiment (DCE) has been conducted to investigate whether patient preferences align while maintaining consistent attributes and levels, providing a direct assessment of relative preferences and hypothetical treatment approaches in SLE. DCE results demonstrated that obtaining an early diagnosis is the most crucial attribute for patients. Additionally, a multidisciplinary care team, capable of enhancing clinical outcomes and patient satisfaction, is essential, along with a clinical centre conveniently located within 30 minutes of the patient's home. Lastly, patients prefer the opportunity to reduce glucocorticoid to a dosage ≤5 mg/day, and eventually discontinue, aligning with the new EULAR recommendations, and favour oral and subcutaneous routes of administration for new course of treatment. Patient preferences contribute to enhancing the care pathway for SLE by optimising disease management, with a focus on multidisciplinarity and psychological support.

Prescription opioid dispensing in Australian children and adolescents: a national population-based study

There are few population-based studies of paediatric opioid use. We aimed to investigate the prevalence of opioid dispensing in Australian children and adolescents. In this population-based study, we used data from a random sample of 15% of the children and adolescents who had received any medicines between Feb 1, 2013, and Dec 31, 2017, through the Australian Pharmaceutical Benefits Scheme (PBS). We identified children younger than 18 years who had been dispensed at least one PBS-listed opioid in the study period. We calculated the annual prevalence of children being dispensed one or more opioid presciptions, by age group and by opioid characteristics (such as strength and mode of action), and we assessed trends over time with negative binomial regression. We also identified new treatment episodes and quantified the number of opioid prescriptions dispensed in the ensuing year. During the study period, 78 320 opioid prescriptions were dispensed to 50 730 Australian children, aged 0-17 years, in our sample. In 2017, 135·4 children per 10 000 were dispensed opioids, representing a slight decrease equal to a change of -2·2% (95% CI -3·5 to -0·8) per annum since 2013. The prevalence of opioid dispensing was greater at older ages: in 2017, 5·7 infants per 10 000 younger than 1 year were dispensed opioids, versus 404·8 adolescents per 10 000 aged 13-17 years, meaning that roughly one in 25 adolescents were dispensed opioids. Weak opioids (ie, codeine and tramadol) accounted for 60·7% of the opioids dispensed, and codeine was the most commonly dispensed opioid, accounting for 39 531 (50·5%) prescriptions dispensed. The prevalence of weak opioid dispensing significantly decreased in all age groups (other than infants younger than 1 year), particularly in those younger than 12 years, for whom weak opioids are not recommended. Dispensing of strong opioids, particularly oxycodone, increased in every age group. Of the 29 073 children who received a new course of treatment, 23 318 (80·2%) children were dispensed only one prescription of opioids in that year. Those dispensed two or more opioids were more likely to be adolescents (vs children younger than 13 years), female, and to have been dispensed several unique medicine types in the 3 previous months (vs those receiving one or fewer types). In 2017, one in 74 Australian children, including one in 25 adolescents, were dispensed an opioid. Dispensing of weak opioids decreased between 2013 and 2017, but codeine is still commonly dispensed in younger children and education to reduce this practice is required. Dispensing of strong opioids increased in all age groups. Children and adolescents must receive appropriate pain management, but further evidence on the risks and benefits of opioid use in this young population is needed. Financial Markets Foundation for Children, National Health and Medical Research Council Centre of Research Excellence in Medicines and Ageing, Australian Government Department of Industry, Innovation and Science, Research Foundation of the Cerebral Palsy Alliance (Australia).

Long-term Vertigo Control and Vestibular Function After Low-dose On-demand Transtympanic Gentamicin for Refractory Menière's Disease.

To describe the long-term clinical vertigo control along with measured lateral canal vestibular function in patients with unilateral refractory Menière's disease (MD) treated with gentamicin transtympanic injections (TTI). Retrospective analytic study. Tertiary referral center. Thirty-eight patients treated by TTI for medically refractory unilateral MD, defined by the 1995 AAO-HNS criteria, between May 2006 and December 2012. One-year course of treatment with gentamicin TTI following a low dose on-demand protocol. TTI were repeated in new courses of treatment when MD recurrence occurred. AAO-HNS class of control, caloric tests (CalT), recurrence rate. After an average clinical follow-up of 71 months, all patients entered a class of control A (78%) or B (22%), with an average of 2.3 TTI received. The mean maximal obtained deficit was 88.5%, and the mean long-term deficit was 85.5%. Ten (26%) patients had disease recurrence requiring a new course of treatment. A value of the first CalT in the 3 months following the first TTI strictly higher than 78% was significantly associated with disease control and the absence of symptom recurrence (p≤0.01). In the "recurrence" group, four patients had a significantly lower mean value of all CalT performed after the first TTI when compared with other patients (p≤0.001), indicating gentamicin resistance CONCLUSION:: Achieving a sustainable vestibular deficit on caloric testing is key for MD symptom control after gentamicin TTI. Gentamicin resistance must be diagnosed early to adapt therapeutic strategies.

Smoking increases risk of recurrence after successful anti-tuberculosis treatment: a population-based study

To investigate whether tobacco smoking increases the risk of tuberculosis (TB) recurrence and identify factors associated with TB recurrence among adults who had successfully completed anti-tuberculosis treatment in Taipei, Taiwan. Recurrence was defined as a new clinical or microbiological diagnosis of TB requiring the start of a new course of treatment in a patient who had satisfactorily completed treatment for a previous TB episode. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHRs) for recurrence. We followed 5567 adults for recurrence after successful anti-tuberculosis treatment. The mean age was 58.5 years; 62.9% were male. Overall, 84 (1.5%) had a recurrence of TB during follow-up. The incidence of TB recurrence was 4.9 episodes/1000 person-years of follow-up. Cox proportional hazards regression showed that after controlling for other variables, the risk of TB recurrence among subjects who smoked >10 cigarettes a day was double that of never/former smokers. Other independent risk factors significantly associated with TB recurrence were homelessness (aHR 3.75, 95%CI 1.17-12.07), presence of comorbidities (aHR 2.66, 95%CI 1.22-5.79) and a positive acid-fast bacilli smear (aHR 2.27, 95%CI 1.47-3.49). Smoking >10 cigarettes a day was significantly associated with TB recurrence. To reduce the risk of recurrence, we recommend including effective measures of smoking cessation in TB control programmes, as recommended by the World Health Organization Stop TB Strategy.

FRI0215 Transitional and memory b cell analysis is an essential tool to anticipate clinical relapse in rheumatoid arthritis (RA) patients treated with rituximab

BackgroundRituximab is a safe and effective treatment in RA, however the current treatment regimen requires to wait for a clinical relapse before a new course of treatment. The interval between...

Cardiotrophin-1 Is a Key Regulator of Glucose and Lipid Metabolism

Cardiotrophin-1 (CT-1) is a member of the gp130 family of cytokines. We observed that ct-1(-/-) mice develop mature-onset obesity, insulin resistance, and hypercholesterolemia despite reduced calorie intake. Decreased energy expenditure preceded and accompanied the development of obesity. Acute treatment with rCT-1 decreased blood glucose in an insulin-independent manner and increased insulin-stimulated AKT phosphorylation in muscle. These changes were associated with stimulation of fatty acid oxidation, an effect that was absent in AMPKα2(-/-) mice. Chronic rCT-1 treatment reduced food intake, enhanced energy expenditure, and induced white adipose tissue remodeling characterized by upregulation of genes implicated in the control of lipolysis, fatty acid oxidation, and mitochondrial biogenesis and genes typifying brown fat phenotype. Moreover, rCT-1 reduced body weight and corrected insulin resistance in ob/ob and in high-fat-fed obese mice. We conclude that CT-1 is a master regulator of fat and glucose metabolism with potential applications for treatment of obesity and insulin resistance.

Patterns of discontinuation of atypical antipsychotics in the province of Québec: A retrospective prescription claims database analysis

Background: Patterns of discontinuation of atypical antipsychotic drugs, including the return to therapy after an interruption, have not been examined longitudinally. Objective: This study was conducted to describe discontinuation patterns of atypical antipsychotic drugs across a spectrum of outpatients in the province of Québec. Methods: This retrospective, inception cohort study employed data from the Québec health insurance board databases and the Québec hospitalization registry on Québec Drug Plan beneficiaries between the ages of 20 and 64 years who first filled a prescription for any antipsychotic drug between January 1, 2000, and December 31, 2007. Five subcohorts were constructed according to the initial antipsychotic received: either 1 of the 4 atypical antipsychotics covered by the Québec drug plan at the time of the study—olanzapine, quetiapine, risperidone, and clozapine—or polytherapy (>1 atypical antipsychotic, or 1 atypical and 1 typical antipsychotic). Discontinuation was defined as a failure to refill the initial prescription within 2 times the days' supply of the preceding claim. In individuals who discontinued initial drug treatment, a new course of treatment was defined as initiation of treatment with any antipsychotic drug after a first treatment discontinuation. Discontinuation of a second course of treatment was defined as failure to refill a prescription for the second drug within 2 times the days' supply of the preceding claim. Patients were followed from initiation to December 31, 2004, ineligibility for the drug plan, or death, whichever came first. Kaplan-Meier curves and Cox regression models were used to compare discontinuations and new courses of treatment by initial atypical antipsychotic. Results: The overall cohort consisted of 46,074 drug plan beneficiaries who had initiated antipsychotic treatment during the specified period. The majority of individuals were female (54.6%) and lived in urban areas (79.2%); the median age ranged from 40 to 44 years. The mean (SD) duration of follow-up was 2.67 (1.91) years. Compared with individuals whose initial therapy was olanzapine, those whose initial therapy was quetiapine had a significantly higher likelihood of discontinuing initial treatment (adjusted hazard ratio [AHR] = 1.06; 95% CI, 1.04–1.09; P < 0.001). The likelihood of discontinuing initial treatment was significantly lower among those whose initial therapy was risperidone (AHR = 0.93; 95% CI, 0.90–0.95; P < 0.001), clozapine (AHR = 0.56; 95% CI, 0.46–0.68; P < 0.001), or polytherapy (AHR = 0.69; 95% CI, 0.64–0.74; P < 0.001). Those whose initial therapy was quetiapine were significantly less likely than those whose initial therapy was olanzapine to begin a second course of treatment (AHR = 0.95; 95% CI, 0.90–0.99; P = 0.02). Compared with individuals who initiated a second course of treatment with olanzapine, those who initiated a second course with quetiapine were more likely to discontinue again (AHR = 1.09; 95% CI, 1.04–1.14; P < 0.001), whereas those who initiated a second course with risperidone were less likely to discontinue again (AHR = 0.95; 95% CI, 0.90–1.00; P = 0.04). Conclusions: This study population had a high risk of discontinuing initial atypical antipsychotic therapy within 1 year. Those who discontinued had a low likelihood of returning to treatment, and those who did return to treatment had a high likelihood of discontinuing again. These patterns of use may have serious consequences for patients' health and for the utilization of health services.

Preliminary outcomes from the MMX mesalamine patient experience program in patients with ulcerative colitis

The MMX mesalamine patient experience program was designed to evaluate the efficacy of MMX mesalamine treatment in patients who were beginning a new course of therapy for ulcerative colitis (UC). This program was launched in October 2007. Patients who were beginning a new course of treatment on or after this date were invited to participate. Surveys were completed via the internet or an automated telephone system, and questions examined perceived symptom severity, self-assessed disruption to daily activities, prior UC medication and treatment satisfaction, at baseline and at approximately 30 and 60 days post-baseline. Additional disease education and related questions was included in the survey and further questions included examined patients' understanding of their disease and its management. Reponses from patients who completed the baseline and 60-day surveys are included in this analysis. In total, 319 patients were enrolled into the program, of whom 110 had completed the 60-day post baseline questionnaire at the time of reporting. Almost 75% of patients had previously received UC medication (most had received a mesalamine formulation [other than MMX mesalamine]). Patients' self-reported adherence to MMX mesalamine was 88%, and higher satisfaction was reported for MMX mesalamine than with other formulations, giving an average satisfaction score of over 7 out of 9. Indeed, after 60 days' treatment, patients reported a 36-57% reduction in symptom severity, with an approximately 46% reduction in the disruption to their daily activities. Overall, 81% of patients indicated that they would continue taking MMX mesalamine, with 78% stating that they would recommend it. The majority of patients (67%) felt that the patient experience program enhanced communication with their physician, with 80% stating that they would participate in similar programs in the future. The results of this patient experience program indicate that treatment of UC with MMX mesalamine could reduce symptom severity and disruption to daily activities. In general, patients preferred this formulation over previous treatments that they had received, and most would continue using MMX mesalamine. Positive perception of their medication regimen may benefit patient adherence with MMX mesalamine therapy. This research was funded by Shire Pharmaceuticals Inc., Wayne, Pennsylvania, USA.

Persistency with Mesalamine Therapy: Long-Term Results in Patients Persistent with Therapy at Outset

Purpose: To examine the long-term persistency (number of patients who keep taking prescribed medication over an extended period) of a patient population who had been identified as being persistent with their mesalamine therapy at the outset of treatment. Methods: Between March and September 2007, pharmacy database refill records* of patients filling a new prescription° for LIALDA® (Shire Pharmaceuticals Inc., USA), ASACOL® (Procter & Gamble, USA), PENTASA® (250 or 500mg; Shire Pharmaceuticals Inc., USA), DIPENTUM® (UCB, USA) or balsalazide (combined results from generic balsalazide disodium and COLAZAL® [Salix Pharmaceuticals Inc., USA]), were followed. Those patients who refilled their prescription within a time frame of up to double the duration of their prescription were defined as ‘continuing’. Patients who had refilled their prescription after this time were defined as ‘restarting’. Refill records for patients who were considered persistent over the initial 3 months of treatment were analyzed at 12 and 18 months. Results: In total, 19,398 patients were identified as ‘continuing’ after 3 months of therapy and were included in this analysis. The persistency rates for ‘continuing’ as well as ‘continuing’ and ‘restart’ patients are shown below for 12 and 18 months after the initiation of treatment. Conclusion: Among patients who were persistent from the start of a new course of treatment, the rate of persistency at 12 and 18 months was highest in patients receiving LIALDA compared with the other formulations. These findings may be explained by once-daily dosing, lower pill burden or patient satisfaction (i.e. feeling better) with LIALDA. *Data owned and analyzed by SDI. †All pharmacy records were included independent of diagnosis. This research was funded by Shire Pharmaceuticals Inc., Wayne, Pennsylvania, USA. Disclosure: Dr S Kane - Consultant, Shire Pharmaceuticals Inc Dr M Sumner - Employee, Shire Pharmaceuticals Inc Dr D Solomon - Employee, Shire Pharmaceuticals Inc Mr M Jenkins - Employee, Shire Pharmaceuticals Inc. This research was supported by an industry grant from Funded by Shire Pharmaceuticals Inc.Table

M1584 Intestinal Surgery for Crohn's Disease: Predictors of Recovery, Complications and Health Related Quality of Life

s of the 4th Congress of ECCO the European Crohn’s and Colitis Organisation S55 agents, OR 1.4, 95%CI (1.01 1.9). The area under the ROC curve was 0.7 CI95% (0.5 0.9) for TPMT levels for predicting AZA withdrawal due gastrointestinal intolerance, with a sensitivity of 73% and a specificity of 67%. A new course of treatment with 6MP was offered in all patients with gastrointestinal intolerance to AZA. Fourteen patients accepted. Five, (38%) per protocol and 36% per intention to treat tolerated the treatment with MP. Tolerance to MP was not associated with any of the variables studied. Conclusions: Incidence of gastrointestinal intolerance is relevant during AZA treatment; slow dose escalation could be useful. A shift to MP should be considered in case of severe gastrointestinal intolerance. The association with TPMT levels could reflect the role of 6-methylmercaptopurine nucleotide metabolites in its pathogenesis. P112 Intestinal surgery for Crohn’s disease: predictors of recovery, complications and health related quality of life M. Scarpa1 *, C. Ruffolo2, D. Bassi2, R. Boetto3, R. D’Inca3, A. Buda3, G.C. Sturniolo3, I. Angriman3. 1Veneto Oncological Institute, Dept of Surgery, Padova, Italy, 2University of Padova, Dept of Surgical and Gastroenterological Sciences, Padova, Italy, 3University of Padova, Dept of Surgical and Gastroenterological Sciences, Padova, Italy, Padova, Italy Introduction: During their life, 80% of patients affected by Crohn’s disease (CD) require at least one surgical procedure. Surgery is among the most important concerns of these patients. Minimally invasive surgery and strictureplasty were introduced to ameliorate the burden of surgery in these patients. However, extensive bowel resection and/or stoma creation may be still necessary. The aim of this study was to evaluate the predictors of recovery, complications and quality of life on an unselected cohort of patients submitted to intestinal surgery for CD. Patients and Methods:All the 47 consecutive patients admitted for intestinal surgery for CD in our department from May 2006 to July 2008 were enrolled in this prospective study. Patients’ characteristics are shown in Table 1. Surgical predictors (video assisted intestinal surgery, strictureplasty, stoma creation, ileal resection and colonic resection) as well as clinical predictors (age, gender, CD duration, activity and localization, recurrent CD) were evaluated. Outcome measures were medical and surgical complication, reoperation, day of first bowel movement, postoperative hospital stay and Barthel’s score. After at least 3 months, an interview that included the Cleveland Global Quality of Life score, the Body Image Score and the Harvey BradshawActivity Index was made. Univariate and multivariate analysis were performed. Results: The median post operative stay duration was 7 (5 20) days and the first bowel movement occurred medially on the 3rd (1st 6th) post operative day. Two anastomotic leaks, 3 intestinal obstruction, 2 intestinal bleeding and a wound infection occurred and 2 re-laparotomy were necessary. Median sick leave was 30 (2 360) days. Stoma creation was the only independent predictor of the post operative hospital stay (p = 0.006) in a model that also included minimally invasive surgery, colonic resection, small bowel resection and CD duration (R2=0.38). Patients who had strictureplasty had their first bowel movement later than those who had bowel resection (p = 0.042). Barthel’s score on the 3rd postoperative day significantly correlated with number of intestinal localisation, stoma creation and perianal CD. Nevertheless, none of them was an independent predictor at multivariate analysis. After follow up, CGQL score correlated only with Harvey Bradshaw Activity Index (t = 0.42, p < 0.001). Body image score was independently predicted by the Harvey Bradshaw Activity Index (p = 0.006) and the use of video assisted surgery (p = 0.036). Conclusions: Stoma creation was associated to a long post operative hospital stay and strictureplasty was associated to a slower recovery of bowel function. However, none of them seemed related to postoperative complication. Body image score was independently predicted by disease activity and the use of video assisted surgery. Health related quality of life appeared to be significantly related only to current disease activity independently from the surgical procedure.

Endoscopic findings in a cohort of newly diagnosed gastroesophageal reflux disease patients registered in a UK primary care database

Gastroesophageal reflux disease (GERD) may be accompanied by erosive complications that are diagnosed by endoscopy. This study aimed to describe the characteristics of patients newly diagnosed with GERD who are referred for endoscopy, and the factors associated with esophageal endoscopic findings. This study included patients aged 2-79 years with a first recorded diagnosis of GERD in 1996, as identified in a previous cohort study in the UK General Practice Research Database. The rate and results of endoscopy were recorded. Unconditional logistic regression analysis was used to estimate the odds ratios and 95% confidence intervals for the relationship between a range of factors and endoscopy and its findings. Of the 7159 patients with a new GERD diagnosis, 805 (11%) underwent endoscopy close to the time of first consultation for GERD. Endoscopic findings indicative of esophageal damage were recorded in 73% of these patients. Esophageal endoscopic findings were significantly more likely in males, older patients, and individuals with a history of peptic ulcer disease or gastrointestinal bleeding. Use of acid-suppressive drugs, particularly proton pump inhibitors, was inversely associated with erosive endoscopic findings. Patients with erosive endoscopic findings were more likely to start a new course of treatment with a proton pump inhibitor. In conclusion, relatively few patients are referred for endoscopy close to the first consultation for GERD, and the majority of these individuals have esophageal findings. Male gender, increasing age and a history of bleeding were risk factors for esophageal complications.

Manual Acupuncture as An Adjunctive Treatment of Nausea in Patients with Cancer in Palliative Care – a Prospective, Observational Pilot Study

Good clinical evidence has been reported for the effect of PC6 acupuncture in preventing or attenuating postoperative and pregnancy related nausea. Our primary aim was to examine whether PC6 acupuncture during a period of chemotherapy could complement pharmacological treatment of nausea in cancer patients in the palliative stage of their disease. We conducted a prospective observational pilot study to measure changes in nausea, and also explored the relationship between nausea, pain and constipation. Twelve patients suffering from nausea and four nausea free patients participated in the study. The nausea free patients were included because they had been troubled by nausea in a previous course of chemotherapy, despite medication with antiemetic drugs, and were about to start a new course of treatment. The patients rated their intensity of nausea, pain and constipation on a numerical rating scale before each of 10 treatment sessions with PC6 acupuncture over the course of three weeks, and at two follow ups during the following week. Fifteen patients completed the study. Compared to before treatment, the patients scored a significantly reduced intensity of nausea before the last treatment session (P<0.01) and at the first follow up (P<0.05). Three out of four nausea free patients were still nausea free before the last treatment session with acupuncture. No relationship could be found between nausea, pain and constipation before, during or after the treatment period had finished. The study demonstrated that acupuncture treatment in cancer patients can be associated with a significantly reduced intensity of nausea during a period of chemotherapy in their final phase of life.

Treatment of Diabetic Foot Ulcers in the Home: Video Consultations as an Alternative to Outpatient Hospital Care

The aim of this study was to investigate whether video consultations in the home can support a viable alternative to visits to the hospital outpatient clinic for patients with diabetic foot ulcers. And furthermore whether patients, relatives, visiting nurses, and experts at the hospital will experience satisfaction and increased confidence with this new course of treatment. Participatory design methods were applied as well as field observations, semistructured interviews, focus groups, and qualitative analysis of transcriptions of telemedical consultations conducted during a pilot test. This study shows that it is possible for experts at the hospital to conduct clinical examinations and decision making at a distance, in close cooperation with the visiting nurse and the patient. The visiting nurse experienced increased confidence with the treatment of the foot ulcer and characterized the consultations as a learning situation. All patients expressed satisfaction and felt confidence with this new way of working.

Endoscopic findings in a cohort of newly diagnosed gastroesophageal reflux disease patients registered in a UK primary care database

Gastroesophageal reflux disease (GERD) may be accompanied by erosive complications that are diagnosed by endoscopy. This study aimed to describe the characteristics of patients newly diagnosed with GERD who are referred for endoscopy, and the factors associated with esophageal endoscopic findings. The study included patients aged 2-79 years with a first recorded diagnosis of GERD in 1996, as identified in a previous cohort study in the UK General Practice Research database. The rate and results of endoscopy were recorded. Unconditional logistic regression analysis was used to estimate the odds ratios and 95% confidence intervals for the relationship between a range of factors and endoscopy and its findings. Of the 7159 patients with a new GERD diagnosis, 805 (11%) underwent endoscopy close to the time of first consultation for GERD. Endoscopic findings indicative of esophageal damage were recorded in 73% of these patients. Esophageal endoscopic findings were significantly more likely in males, older patients, and individuals with a history of peptic ulcer disease or gastrointestinal bleeding. Use of acid-suppressive drugs, particularly proton pump inhibitors, was inversely associated with erosive endoscopic findings. Patients with erosive endoscopic findings were more likely to start a new course of treatment with a proton pump inhibitor. In conclusion, relatively few patients are referred for endoscopy close to the first consultation for GERD and the majority of these individuals have esophageal findings. Male gender, increasing age and a history of bleeding were risk factors for esophageal complications.

Infertility-related stress in men and women predicts treatment outcome 1 year later

To examine the separate and joint effects of male and female fertility problem (FP) stress and the source of stress (e.g., personal, social, marital) on treatment outcome. Prospective, epidemiological cohort design. Fertility clinics in Denmark. Eight hundred eighteen couples who were about to begin a new course of treatment. An FP stress inventory was administered at the start of treatment, and the treatment outcome was evaluated 12 months later. Number of treatment cycles in 12-month study period and treatment outcome (i.e., success, no success). Fertility problem stress was associated with a poorer treatment outcome in women (pooled within-groups [WGr] correlation,WGr = .517) and men (WGr = .392) with the effect significantly more pronounced for women (z = 3.19, P<.001). Fertility problem stress arising in the personal and marital domain showed greater associations with treatment outcome than did FP stress from the social domain. Logistic regression indicated that women who reported more marital distress required more treatment cycles to conceive (median 3) than women reporting less marital distress (median 2) (odds ratio [OR] = 1.20: Model chi2(3) = 77.21, P<.001). The findings provide evidence that infertility-related stress has direct and indirect effects on treatment outcome.

Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic.

Little is known about the prevalence of specific depressive and anxiety disorders in women before a new course of assisted reproductive technology treatment. Few studies have adopted the proper psychiatric diagnostic procedures. All consecutive women visiting the assisted reproduction clinic of a university-affiliated medical centre, with the intention of starting a new assisted reproduction treatment course, were recruited. A psychiatrist made a diagnosis of psychiatric disorders using a structured interview, the Mini-International Neuropsychiatric Interview (MINI). Of a total of 112 participants, 40.2% had a psychiatric disorder. The most common diagnosis was generalized anxiety disorder (23.2%), followed by major depressive disorder (17.0%), and dysthymic disorder (9.8%). Participants with a psychiatric morbidity did not differ from those without in terms of age, education, income, or years of infertility. Women with a history of previous assisted reproduction treatment did not differ from those without in depression or anxiety. Depressive and anxiety disorders were highly prevalent among women who visited an assisted reproduction clinic for a new course of the treatment. Demographic features and a history of previous assisted reproduction treatment were not risk factors for these psychiatric morbidities in the assisted reproduction clinic.

Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population.

To evaluate the incidence of discontinuation of and changes in treatment after newly prescribed courses of antihypertensive drugs of the four primary therapeutic classes: beta blocker, calcium channel blocker, and angiotensin converting enzyme inhibitor. A retrospective analysis of patients on an automated database of 1.2 million patients was conducted on visits between 1 October 1992 and 30 September 1993. General practices in the United Kingdom. 37,643 patients with hypertension receiving a relevant drug in the time period were identified. A new course of treatment in at least one of the four therapeutic classes, defined as a drug not prescribed in the previous four months, was observed in 10,222 patients aged > or = 40 years. Patients changing to other treatment or discontinuing after initiating a new course of treatment, defined as the absence of a refill prescription for the new drug or another in its category within a six month observation period. Changes in or discontinuation of treatment were frequently observed, and by month six continuation rates ranged between 40% to 50% for all four classes of drugs. Low rates of continuation with a newly prescribed antihypertensive drug exist regardless of which drug is prescribed.

Enhancement of PUVA Phototoxic Effects Following Celery Ingestion: Cool Broth Also Can Burn

Severe phototoxic burn following celery ingestion was first reported in a 65-year-old woman who visited her suntan parlor 1 hour after the ingestion of 450 g of celery.¹We describe a similar reaction in a patient receiving photochemotherapy. <h3>Report of a Case.</h3> A 53-year-old woman, skin type IV, had relapsing generalized eruptive lichen planus, confirmed by biopsy, since 1987. She had been treated with four courses of oral prednisone (30 mg/d) for 15 days and photochemotherapy for 3 months, leading to clearance with no untoward effects. In July 1991, another relapse of her skin disease prompted a new course of treatment with methoxypsoralen (Oxsoralen, Galderma SA, Madrid, Spain), 40 mg/d (0.6 mg/kg per day), taken with breakfast 2 hours before the irradiation, twice a week. Twelve hours after the eighth PUVA session, a typical PUVA burn developed, with dusky red erythema, stinging, and burning on the exposed areas. No

Isotretinoin and acne in practice: a prospective analysis of 188 cases over 9 years.

A total of 188 acne patients (113 male and 75 female) with a mean age of 25 years (range 15-42 years) were treated with isotretinoin in doses ranging from 0.5 to 1 mg/kg. The study lasted 9 years. The treatment was not terminated until 2 months after total healing. The patients were then re-examined at regular intervals. In the event of a recurrence greater than grade 2 (pre-nodular threshold grade), they underwent a new course of treatment. At the end of the study, three groups were distinguished: (1) immediate, long-term, stable remissions following one single course of isotretinoin (111 patients with an average follow-up period of 27 months); (2) stable remissions following 2 or 3 courses of isotretinoin (54 patients with an average follow-up period of 16 months); (3) immediate partial remissions or partial remissions following several courses of treatment in 23 patients who continued to present with at least grade 3 acne. There was no significant statistical difference between the first two groups with respect to the age and sex of the patients and the grade and prior duration of the acne. The third group differed from the other two in having a greater proportion of patients with microcystic acne (p < 0.05) and women with endocrinological problems ((p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)