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At least 253 records · Page 14Linked to original sources
PubMed2005

Acute sensorineural hearing loss associated with peginterferon and ribavirin combination therapy during hepatitis C treatment: outcome after resumption of therapy.

Peginterferon and ribavirin combination therapy for the treatment of hepatitis C virus (HCV) is well known to be associated with significant adverse effects. Sensorineural hearing loss, that in most cases is unilateral, has been reported as a consequence of therapy with both non-pegylated and pegylated interferon (pegIFN) but is not a well-known adverse effect. We report a 45-year-old Caucasian woman who developed acute sensorineural hearing loss 2 mo after starting therapy with pegIFN-alpha 2b and ribavirin for the treatment of chronic HCV, genotype 1a. She did not report the hearing loss to the hepatitis clinic until 1 mo, later whereupon therapy was promptly discontinued. Although her serum alanine aminotransferase (ALT) normalized and her HCV-RNA became undetectable after 12 wk of pegIFN and ribavirin therapy, after discontinuation, her HCV-RNA became detectable with significant elevations of serum ALT. Four months after initial discontinuation, the patient re-commenced pegIFN and ribavirin combination therapy. After 44 of 48 wk of therapy, the patient's liver biochemistry has normalized and the HCV-RNA is undetectable. She has not developed worsening of her hearing loss and hearing on the left-side is unaffected. Both patients and physicians should be aware that sensorineural hearing loss may occur with pegIFN therapy. Our experience suggests that re-institution of therapy is not always associated with further hearing impairment.

Acute Disease↗
PubMed1998

United Kingdom Prospective Diabetes Study 24: a 6-year, randomized, controlled trial comparing sulfonylurea, insulin, and metformin therapy in patients with newly diagnosed type 2 diabetes that could not be controlled with diet therapy. United Kingdom Prospective Diabetes Study Group.

BACKGROUND: Uncertainty exists about the suitability of oral hypoglycemic drugs and insulin therapy for patients with newly diagnosed type 2 diabetes. OBJECTIVE: To assess and compare response to sulfonylurea, insulin, or metformin over 6 years in patients with newly diagnosed type 2 diabetes in whom disease could and could not be controlled with diet therapy alone. DESIGN: Multicenter, randomized, controlled trial. SETTING: Outpatient diabetes clinics of 15 hospitals in the United Kingdom. INTERVENTION: Sulfonylurea (chlorpropamide or glyburide), insulin, or metformin (if patients were obese). PATIENTS: 458 patients with newly diagnosed type 2 diabetes that could not be controlled with diet and had hyperglycemic symptoms or fasting plasma glucose levels greater than 15 mmol/L during the initial 3 months of diet therapy (primary diet failure group) and 1620 patients in whom disease was controlled by diet therapy and who had fasting plasma glucose levels of 6 to 15 mmol/L and no hyperglycemic symptoms while receiving diet therapy alone. MEASUREMENTS: Fasting plasma levels of glucose and insulin, hemoglobin A1c concentrations, body weight, and therapy required. RESULTS: Compared with the diet-controlled group, the primary diet failure group was younger and less obese and had more retinopathy, lower fasting plasma insulin levels, and reduced beta-cell function. At 6 years, patients allocated to insulin had lower fasting plasma glucose levels than did patients allocated to oral agents, but hemoglobin A1c concentrations were similar. Forty-eight percent (95% CI, 37% to 58%) of patients in the primary diet failure group maintained hemoglobin A1c concentrations less than 0.08. By 6 years, 51% of patients (CI, 42% to 62%) allocated to ultralente insulin required additional short-acting insulin and 66% of patients (CI, 58% to 73%) allocated to sulfonylurea required additional therapy with metformin or insulin to control symptoms and maintain fasting plasma glucose levels less than 15 mmol/L. Patients allocated to insulin gained more weight and had more hypoglycemic attacks than did patients allocated to sulfonylurea. Obese patients allocated to metformin gained the least weight and had the fewest hypoglycemic attacks. For all therapies, control achieved at 6 years was worse in the primary diet failure group than in the diet-controlled group. CONCLUSIONS: Because initial insulin therapy induced more hypoglycemic reactions and weight gain without necessarily providing better control, it may be reasonable to start with oral agents and change to insulin if goals for glycemic levels are not achieved.

Adult↗
PubMed1995

The impact of a postoperative oxygen therapy protocol on use of pulse oximetry and oxygen therapy.

BACKGROUND: Recent evidence suggests that both pulse oximetry monitoring and oxygen (O2) therapy may be used inappropriately at times, implying the need for improved use of pulse oximetry by health-care providers. METHODS: We studied the clinical and financial impact of a postoperative O2-therapy protocol in 2 groups of patients. Group 1 (n = 20) was comprised of patients whose physicians made all O2 therapy management decisions. Group 2 (n = 20) was comprised of patients whose O2 therapy management was performed by respiratory therapists according to an algorithm with a stop criterion of SpO2 > or = 92%. The duration of postoperative O2 therapy, the frequency of unnecessary O2 therapy, and group totals of SpO2 measurements were compared between groups using the Mann-Whitney Rank Sum Test. RESULTS: O2 therapy was used on average (SD) 3.45 (1.28) days/patient in Group 1 and 2.1 (0.64) days/patient in Group 2 (p < 0.003). Sixteen Group-1 patients continued to receive O2 at least 24 hours after achieving a room-air SpO2 > or = 92%. Group 1 had 57 SpO2 measurements and Group 2 had 24 (p < 0.003). No adverse clinical events ascribed to hypoxemia were noted in either group. CONCLUSIONS: Our experience suggest that implementing a uniform, clinically appropriate 'stop criterion' for low-flow O2 therapy in nonthoracic postoperative patients can shorten the duration of O2 therapy and reduce the number of SpO2 measurements without incurring additional complications.

Adult↗
PubMed1985

One-person family therapy: a modality of brief strategic family therapy.

The One-Person Family Therapy approach to the treatment of drug abuse described here is based on the Brief Strategic Family Therapy conceptual framework. It represents an innovative integration of family therapy techniques that have proven effective in working with entire families and techniques specifically designed for use with one family member. OPFT appears to be as effective as conjoint family therapy with adolescent drug abusers and their families. It thus provides skilled family therapists (generally master's-level social workers and psychologists with training and experience in structural family therapy) with a novel and useful tool for carrying out family therapy, while minimizing the problem of retaining entire families in therapy. Further work should concentrate on improving our ability to engage families of drug-abusing adolescents in the therapy process, generalizing results to other types of samples, learning more about using an OP who is not also the identified patient, exploring the possibility of switching OPs, exploring the use of spaced followup therapy, and integrating OPFT and CFT sessions more fully. However, it is clear that OPFT is a practical, cost-effective, field-oriented intervention for use with drug-abusing adolescents.

Adolescent↗
PubMedDate not supplied

Concomitant therapy with anxiolytics or hypnotics and maintenance of initial SSRI therapy.

We conducted a retrospective analysis to evaluate the relationship between anxiolytic or hypnotic therapy and maintenance of therapy with selective serotonin reuptake inhibitors (SSRIs). Subjects were 654 patients who received anxiolytics or hypnotics early in SSRI therapy (study group ) and 15,172 patients who did not (controls). Maintenance of SSRI therapy was evaluated during the 6 months after start of therapy and included days of initial SSRI therapy and rates of discontinuation, defined as a break of more than 30 days. Rates of discontinuation in study and control groups (84% and 77%, p=0.001) and average days of initial SSRI therapy (77 and 94 days, p<0.0001) were statistically different. Thus patients receiving anxiolytic or hypnotics in the first 60 days of therapy were less likely to continue initial SSRI therapy.

Adult↗
PubMed1992

[Physical therapy and speech therapy in Parkinson syndrome--a status assessment].

74 inpatients and outpatients (mean age 71.9 years) with idiopathic Parkinson's disease, a vascular pseudo-parkinsonian syndrome or a Parkinson-associated dementia were analysed by present-state clinical rating with regard to use and needs of physical and speech therapy. 55% of the patients had physical therapy whatsoever, 32% of them on a daily schedule. 58% of patients without everyday physical therapy indicated to do less physical therapy than one year ago or that they have quite any exercise. This item showed significant correlations with: age of disease onset over 70 years, Hoehn-Yahr stage of 3 and over, activities of daily living according to Schwab-England of less than 60%, diagnosis of vascular pseudoparkinsonian syndrome or Parkinson-associated dementia, more frequent use of community support services for the ambulatory elderly. Only 8% of the patients had ever had speech therapy. Using both ratings of complaints and clinical findings, about 30% of patients had moderate to severe impairment of speech, 80% of these had also considerable memory disturbances. The study suggests that the need for physical therapy might be derived more from patient's assessment of reduced daytime motor activities than from a scaled item rating of an external observer. Use and continuity of physical and speech therapy in Parkinsonism seems to be limited largely by cognitive disturbances and social variables. Speech therapy appears to be useful only for a subgroup of Parkinsonian patients.

Aged↗