Summary
Objective:
The objective of this study is to estimate the amount of severe drug-drug interaction warnings per medical specialist group triggered by prescribed drugs of a patient before and ...after the introduction of a nationwide eMedication system in Austria planned for 2015.
Methods:
The estimations of interaction warnings are based on patients’ prescriptions of a single health care professional per patient, as well as all patients’ prescriptions from all visited health care professionals. We used a research database of the Main Association of Austrian Social Security Organizations that contains health claims data of the years 2006 and 2007.
Results:
The study cohort consists of about 1 million patients, with 26.4 million prescribed drugs from about 3,400 different health care professionals. The estimation of interaction warnings show a heterogeneous pattern of severe drug-drug-interaction warnings across medical specialist groups.
Conclusion:
During an eMedication implementation it must be taken into consideration that different medical specialist groups require customized support.
Citation:
Rinner C, Sauter SK, Neuhofer LM, Edlinger D, Grossmann W, Wolzt M, Endel G, Gall W. Estimation of severe drug-drug interaction warnings by medical specialist groups for Austrian nationwide eMedication. Appl Clin Inf 2014; 5: 603–611
http://dx.doi.org/10.4338/ACI-04-RA-0030
Although previous research has shown that certain medical data and psychosocial factors predict postoperative pain, it remains unclear whether they also contribute to a more distinct outcome measure ...that is based on classification of self-reported outcome criteria. To assess the prognostic power of somatic, psychologic, and social predictors when evident outcome criteria of surgical treatment are investigated, this study used a prospective longitudinal design examining preoperative factors associated with outcome six months after lumbar discectomy.
Forty-eight out of 58 consecutive patients were included (60% male, 40% female, mean age 47 years). Preoperative data comprised of Lasegue sign (straight leg raising test), pain duration, paresis and radicular distribution, depression, pain disability, pain coping strategies, and qualitative descriptions of pain. Additionally, sociodemographic and occupational characteristics were observed. Six months' postoperative classification of outcome included pain intensity, pain locations, functional capacity, return to work, and health-related quality of life.
From a surgical point of view, lumbar discectomy was successfully carried out on all patients. But, when subjective criteria of outcome were investigated, 56% of patients benefited from lumbar discectomy, whereas 44% of patients had poor results. Lasegue sign, depression, and sensory pain descriptions proved to be significant predictors, whereas pain cognition and pain coping strategies had no significant influence on evident outcome classification.
Classification of patients regarding their individual outcome profiles showed that patients responded differently to lumbar disc-surgery. High risk factors for poor outcome of surgery are Laseque-sign and depression.
Background: Chronic adipose tissue inflammation is a hallmark of obesity, triggering the development of associated pathologies, particularly type 2 diabetes. Long-chain n−3 PUFAs reduce ...cardiovascular events and exert well-established antiinflammatory effects, but their effects on human adipose tissue inflammation are unknown.
Objective: We investigated whether n−3 PUFAs reduce adipose tissue inflammation in severely obese nondiabetic patients.
Design: We treated 55 severely obese nondiabetic patients, scheduled to undergo elective bariatric surgery, with 3.36 g long-chain n−3 PUFAs/d (EPA, DHA) or an equivalent amount of butterfat as control, for 8 wk, in a randomized open-label controlled clinical trial. The primary efficacy measure was inflammatory gene expression in visceral and subcutaneous adipose tissue samples (subcutaneous adipose tissue and visceral adipose tissue), collected during surgery after the intervention. Secondary efficacy variables were adipose tissue production of antiinflammatory n−3 PUFA–derived eicosanoids, plasma concentrations of inflammatory markers, metabolic control, and the effect of the Pro12Ala PPARG polymorphism on the treatment response.
Results: Treatment with n−3 PUFAs, which was well tolerated, decreased the gene expression of most analyzed inflammatory genes in subcutaneous adipose tissue (P < 0.05) and increased production of antiinflammatory eicosanoids in visceral adipose tissue and subcutaneous adipose tissue (P < 0.05). In comparison with control subjects who received butterfat, circulating interleukin-6 and triglyceride concentrations decreased significantly in the n−3 PUFA group (P = 0.04 and P = 0.03, respectively). The Pro12Ala polymorphism affected the serum cholesterol response to n−3 PUFA treatment.
Conclusions: Treatment with long-chain n−3 PUFAs favorably modulated adipose tissue and systemic inflammation in severely obese nondiabetic patients and improved lipid metabolism. These effects may be beneficial in the long-term treatment of obesity. This trial was registered at clinicaltrials.gov as NCT00760760.
Cationic amino acid transporter mRNA expression in kidney and liver. Expression of rat cationic amino acid transporter 2 (r-CAT-2) mRNA was studied in kidney and liver using Northern blot analysis ...and nonradioactive in situ hybridization with a probe identifying both the r-CAT-2α and -2β splice variants. Expression of r-CAT-2 mRNA was higher in the liver than in the kidney. Within the kidney, r-CAT-2 mRNA was more abundant in the outer and inner medulla than in the cortex. In the liver lobule, the intensity of the hybridization signal in hepatocytes decreased between the portal area and the central vein. In the kidney, hybridization signals were detected in parietal cells of Bowman‘s capsule, various tubule cells of outer and inner medulla, in endothelial and interstitial cells of inner medulla, and in papillary epithelial cells.
Four cases are described in which livedo reticularis was associated with repeated cerebrovascular accidents, which eventually resulted in severe disability in two cases. Patients with severe ...disability had a history of many years, whereas two patients with little or moderate residual disability had a follow-up of 3 years each. CT scan revealed multifocal cerebral infarctions and cortical atrophy in all cases. Repeated cerebral angiograms, done in three cases, showed no signs of a vascular disease. There were no parameters that pointed to active immunological or inflammatory disorder. Neither clinical evidence of heart or large vessel disease was found. Observations suggest that a so-far unknown progressive cerebral vessel disease associated with livedo is the cause of a steady increase in multiple small cerebral infarctions. Because of the progressive character of the disease the search for effective therapy is needed.
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