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PubMedDate not supplied

Using the Internet to teach health informatics: a case study.

BACKGROUND: It is becoming increasingly important for health professionals to have an understanding of health informatics. Education in this area must support not only undergraduate students but also the many workers who graduated before informatics education was available in the undergraduate program. To be successful, such a program must allow currently-employed students with significant work and family commitments to enroll. OBJECTIVES: The aim was to successfully create and teach a distance program in health informatics for the New Zealand environment. METHODS: Our students are primarily health professionals in full time employment. About 50% are doctors, about 25% nurses, and the rest include dentists, physiotherapists, and medical managers. Course material was delivered via the World Wide Web and CD-ROM. Communication between students and faculty, both synchronous and asynchronous, was carried out via the Internet. RESULTS: We have designed and taught a postgraduate Diploma of Health Informatics program using the Internet as a major communication medium. The course has been running since July 1998 and the first 10 students graduated in July 2000. About 45 students are currently enrolled in the course; we have had a dropout rate of 15% and a failure rate of 5%. Comparable dropout figures are hard to obtain, but a recent review has suggested that failure-to-complete rates of 30% to 33% may be expected. CONCLUSIONS: Internet technology has provided an exciting educational challenge and opportunity. Providing a web-based health informatics course has not been without its frustrations and problems, including software compatibility issues, bandwidth limitations, and the rapid change in software and hardware. Despite these challenges, the use of Internet technology has been interesting for both staff and students, and a worthwhile alternative for delivering educational material and advice to students working from their own homes.

Education, Distance↗
PubMed1993

Parametric in vivo brain imaging during activation to examine pathological mechanisms of functional failure in Alzheimer disease.

Alzheimer disease (AD) patients demonstrate reduced "resting state" regional cerebral metabolic rates for glucose (rCMRglc) and reduced regional cerebral blood flow (rCBF) in cortical association areas, early and throughout the course of disease. In this paper, we hypothesize that parametric cognitive or passive stimulation, during in vivo brain imaging, can be used to elucidate the pathological basis of these flow and metabolic abnormalities in individual AD patients. Experimental data suggest that sigmoidal relations (nonliner monotonically increasing relations reaching a horizontal asymptote) exist in the normal brain between rCBF or rCMRglc, and a function F(D,P) of task difficulty D (intensity, duration, pattern complexity) and subject performance P (reaction time, accuracy, effort, attention). Pathological mechanism I, under some conditions reversible and involving neural (including synaptic) element dropout or modification with retained capacity for full activation at high values of F(D,P), is expected early in AD and should shift the rising phase of the normal sigmoidal curve to the right. Observed rCBF responses in a face-matching task in mildly-moderately demented AD patients are consistent with mechanism I. Pathological mechanisms II and III, both irreversible and involving neural element dropout with loss of capacity for maximum activation, should alter the sigmoidal brain response at all values of F(D,P), and are expected late in disease. Our hypothesis predicts that activation paradigms with a wide range of F(D,P) values could help to distinguish among the reversible and irreversible pathological mechanisms in AD, and to evaluate drug action on these mechanisms.

Aged↗
PubMed1986

1- and 4-week cimetidine treatment for duodenal ulcer.

Forty-eight patients with symptomatic duodenal ulcer were randomized to 4 weeks' treatment with cimetidine, 1 g/day (C4), or 1 week of cimetidine treatment followed by 3 weeks of placebo (C1 + P). The study was performed double blind. The symptoms were recorded daily on a visual analogue scale. Endoscopy was performed after 4 weeks. Two patients receiving C1 + P dropped out during the 2nd week because of worsening symptoms. With the two dropouts being recorded as 'unhealed ulcers', the 4-week healing rates were 16 of 24 (67%) and 15 of 24 (63%), with C4 and C1 + P, respectively (p greater than 0.05). Even without including the two dropouts, the patients treated with C1 + P had significantly more symptoms during the 2nd and 3rd treatment week than those treated with C4. The present study indicates that 1 week of cimetidine treatment is not sufficient in patients with duodenal ulcer.

Cimetidine↗
PubMed1994

Optic nerve morphometry following axonal degeneration from SAIDS in rhesus monkeys.

In order to further study AIDS (acquired immunodeficiency syndrome) related neuropathologic findings, specifically progressive diffuse leuko-encephalopathy (PDL) and optic neuropathy, ten macaque monkeys (Macaca mulatta) were infected with simian immunodeficiency virus (SIV), observed for varying periods, and then sacrificed and tissue prepared for analysis. A marked difference from human AIDS pathology was found: in all monkeys, there was significant peripheral axonal dropout, as opposed to relatively little dropout in the central areas of the nerves (t stat. = -5.9, p < .001). In those monkeys infected with SIV for over one year, the axonal loss in the periphery was also greater than in the central optic nerve (t stat. = -5.03, p < .001); monkeys infected with SIV for less than one year had slightly less peripheral than central loss (t stat. = -4.5, p = .001). When compared with humans, however, it was found that the overall loss of axons was less (15% in monkeys vs. up to 45% in humans). There was also a lack of discernible retinal pathology, such as cotton wool spots, in the monkey tissue.

Animals↗
PubMed1995

Pattern of axonal loss in longstanding papilledema due to idiopathic intracranial hypertension.

There is both clinical and histopathologic evidence for peripheral visual field loss and optic nerve degeneration in longstanding papilledema due to idiopathic intracranial hypertension (IIH). The purpose of this study was to look at the extent and distribution of axonal dropout in secondary optic atrophy due to IIH. Both optic nerves from a 29-year-old man with a two year history of IIH were examined histologically and morphometrically. A high-contrast lipid (myelin) stain, paraphenylenediamine (PPD), and a semiautomated image analysis system were employed to resolve sufficiently the optic nerve fiber images for counts and for measurement. There were 80% and 90% losses of axons, respectively, in the right and left optic nerves consequent to IIH. The axonal loss in the peripheral area of each optic nerve was much more severe than that in inner sectors (= 0.001 for the right optic nerve and = 0.005 for the left). This pattern of axonal dropout is consistent with the preservation of good central visual acuity despite devastating optic nerve atrophy, and with the severe peripheral visual field loss noted in this patient.

Adult↗
PubMed2005

Cloning and characterization of a novel hepatitis B virus core binding protein C12.

AIM: To elucidate the biological function of HBV core antigen (HBcAg) on pathogenesis of hepatitis B, a novel gene C12 coding for protein with unknown function interacting with HBcAg in hepatocytes was identified and characterized. METHODS: HBcAg bait plasmid pGBKT7-HBcAg was constructed and transformed into yeast AH109, then the transformed yeast was mated with yeast Y187 containing liver complementary DNA (cDNA) library plasmid in 2XYPDA medium. Diploid yeast was plated on synthetic dropout nutrient medium (SD/-Trp-Leu-His-Ade) and synthetic dropout nutrient medium (SD/-Trp-Leu-His-Ade) containing X-alpha-gal for screening twice. After extracting and sequencing of plasmid from blue colonies, we isolated a cDNA clone encoding a novel protein designated as C12 that directly interacted with HBcAg. The interaction between HBcAg and C12 was verified again by re-mating. pEGFP-N1-C12 fluorescent protein fusion gene was transfected in 293 and L02 cell, and observed by fluorescent microscope. MTT reduction assay was used to study the action of C12 protein effect on metabolism of mammal cell. Yeast two-hybrid and cDNA microarray were performed to search binding protein and differential expression genes regulated by C12 protein. RESULTS: C12 gene was screened and identified by yeast two-hybrid system 3. The interaction between HBcAg and the novel protein coded by the new gene C12 was further confirmed by re-mating. After 48 h, fluorescence of fusion protein could be observed steadily in the 293 and L02 cell plasma. Under MTT assay, we found that the expression of C12 did not influence the growth of liver cells. Seventeen differential expression genes in HepG2 cells transfected with C12 protein expression plasmid by cDNA microarray, of which 16 genes were upregulated and 1 gene was downregulated by C12 protein. Twenty-one colonies containing 16 different genes coding for C12 protein binding proteins were isolated by yeast two-hybrid, there were 2 new genes with unknown function. CONCLUSION: The novel protein C12 is located in cell plasma, and its overexpression has no significant effect on the metabolism of liver cell. It interacts with many proteins in hepatocytes and may be involved in many processes of gene expression.

Amino Acid Sequence↗
PubMed2006

Screening and identification of interacting proteins with hepatitis B virus core protein in leukocytes and cloning of new gene C1.

AIM: To investigate the biological function of HBcAg in pathogenesis of HBV replication in peripheral blood mononuclear cells (PBMCs). METHODS: HBcAg region was amplified by polymerase chain reaction (PCR) and HBV HBcAg bait plasmid pGBKT7-HBcAg was constructed by routine molecular biological methods. Then the recombinant plasmid DNA was transformed into yeast AH109. After the HBV core protein was expressed in AH109 yeast strains (Western blot analysis), yeast-two hybrid screening was performed by mating AH109 with Y187 containing leukocyte cDNA library plasmid. Diploid yeast cells were plated on synthetic dropout nutrient medium (SD/-Trp-Leu-His-Ade) (QDO) and synthetic dropout nutrient medium (SD/-Trp-Leu-His-Ade) (TDO). The second screening was performed with the LacZ report gene ( yeast cells were grown in QDO medium containing X-alpha-gal). The interaction between HBV core protein and the protein obtained from positive colonies was further confirmed by repeating yeast-two hybrid. After plasmid DNA was extracted from blue colonies and sequenced, the results were analyzed by bioinformatic methods. RESULTS: Eighteen colonies were obtained and sequenced, including hypermethylated in cancer 2 (3 colones), eukaryotic translation elongation factor 2 (2 colones), acetyl-coenzyme A synthetase 3 (1 colone), DNA polymerase gamma (1 colone), putative translation initiation factor (1 colone), chemokine (C-C motif) receptor 5 (1 colone), mitochondrial ribosomal protein L41 (1 colone), kyot binding protein genes (1 colone), RanBPM (1 colone), HBeAg-binding protein 3 (1 colone), programmed cell death 2 (1 colone). Four new genes with unknown function were identified. CONCLUSION: Successful cloning of genes of HBV core protein interacting proteins in leukocytes may provide some new clues for studying the biological functions of HBV core protein.

Amino Acid Sequence↗
PubMed2001

Methodological variables in Web-based research that may affect results: sample type, monetary incentives, and personal information.

There are many methodological differences between Web-based studies, differences that could substantially affect the results. The present study investigated whether sample type, offering payment through a lottery, and requiring participants to enter personal information would affect dropout rates and/or the substantive results in a study of jury decision making in capital cases. Asking participants to enter their e-mail addresses increased dropout rates, and offering payment through a lottery tended to do so as well. Participants offered payment tended to be less likely to give death sentences, and sample type moderated the influence of attitudes toward the death penalty on verdicts.

Data Collection↗
PubMed2006

Switching antidepressants after a first selective serotonin reuptake inhibitor in major depressive disorder: a systematic review.

OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are frequently used as a first antidepressant for major depressive disorder but have response rates of 50% to 60% in daily practice. For patients with insufficient response to SSRIs, switching is often applied. This article aims to systematically review the evidence for switching pharmacotherapy after a first SSRI. DATA SOURCES: A systematic literature search (updated until Feb. 10, 2005) in MEDLINE, EMBASE, CINAHL, and PsychINFO (all indexed years) identified randomized, controlled trials (RCTs) and open studies investigating switching strategies. In the absence of specific keywords for switching, we performed "sensitive" searches using free text words with wildcards ($): "switch$" or ("alternat$" adj5 "treat$") or ("alternat$" adj5 "therap$") in combination with the Cochrane Collaboration search filter for RCTs, the Cochrane Collaboration Depression Anxiety and Neurosis Group search filter for major depressive disorder, and MeSH terms for antidepressants (in combination with additional text words for all antidepressive agents). Additionally, we included 4 recent Sequenced Treatment Alternatives to Relieve Depression publications. We limited searches to adults and humans but did not apply language restrictions. STUDY SELECTION: Relevant articles were retrieved and critically appraised. The methodology of the studies, the results on efficacy and dropouts due to side effects, and remarks were summarized in an evidence table. Three studies comparing a switch to venlafaxine or SSRIs were pooled. DATA SYNTHESIS: Eight RCTs and 23 open studies were identified, studying populations with different levels of treatment resistance. Definitions of response and remission rates varied between studies. Observed response rates after switching to any of the classes of antidepressants varied between 12% and 86%. Remission rates varied between 7% and 82%. The number of previous treatments with antidepressants was negatively correlated with treatment outcome. Rates of dropout due to side effects varied considerably across agents (5%-39%). Switching to venlafaxine showed a modest and clinically equivocal benefit over SSRIs (number needed to treat = 13 [95% CI = 9.1 to 25.0]). CONCLUSIONS: After a first SSRI, any switch within or between classes of antidepressants appears legitimate (second SSRI, novel dual-acting antidepressants, selective norepinephrine or nor-adrenergic/dopaminergic agents, or tricyclic anti-depressant or mianserin). No unequivocal evidence is available to prove an advantage of a between-class switch. More guidance by randomized empirical studies is needed. Clinical implications and methodological considerations for future studies are discussed.

Antidepressive Agents↗
PubMedDate not supplied

Characterization of patients in a medical endocrine-based center for male sexual dysfunction.

OBJECTIVE: To characterize the patient population in a multidisciplinary sexual dysfunction clinic whose focal person is an endocrinologist and to summarize the initial manifestations, the demographics of the study group, and their associated medical conditions. METHODS: We undertook a retrospective analysis of the medical records of all new consultations in a center for sexual function during a recent 2-year period. RESULTS: During the period from July 1995 to July 1997, 1,050 men were seen in new consultations for sexual dysfunction at our medical facility, and complete medical records could be retrieved for 990 of them. Of the overall study group of 990 men, most (93.2%) had erectile dysfunction (versus libido or ejaculatory problems), but combinations of problems were common. Most men had organic causes of their sexual dysfunction that correlated with increasing age; however, their dysfunction was more often the result of chronic medical conditions than of advancing age itself. Most men were married (72.1%) and in long-term relationships (mean duration, more than 20 years). Hypogonadism was the most common medical condition (36.3%), a finding that reflected an endocrine referral bias. Testosterone treatment alone corrected the complaints in a minority of patients. Hypertension was a more common diagnosis than diabetes (35.8% versus 23.1%), and pituitary tumors were rare. Successful outcomes were achieved in about two-thirds of men having a strong organic cause of sexual dysfunction, but treatments were less successful when pronounced psychologic factors were present. The patient dropout rate was substantial and was similar in each of the four 6-month quarters--an indication that even as newer therapies became available, dissatisfaction was still evident. CONCLUSION: Many patients have more than one manifestation of sexual dysfunction, which may have to be addressed separately. In a sexual dysfunction clinic managed by an endocrinologist, referral bias may direct more patients with hypogonadism and fewer patients who have had transurethral retropubic prostatectomy or a radical prostatectomy. Treatment of hypogonadism corrects sexual dysfunction in only a few men, and only when other medical problems are not present. Although the percentage of men with diabetes would be expected to be high in this study, the number of patients with hypertension was higher. A considerable dropout rate during evaluation and treatment persisted throughout this study.

Journal Article↗
PubMed1999

[Evaluation of new intraurethral occlusive depot (ORIS FEMININO) in the management of female stress urinary incontinence].

OBJECTIVE: To determine the utility and safety of an intraurethral device (Oris Femenino) in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted on 54 female patients, mean age 46.4 years, with stress urinary incontinence. The degree and severity of the incontinence was determined before and one month after treatment with the intraurethral device. The reasons for the dropouts were analyzed and the rehabilitative effects two months after treatment had been completed were evaluated in 22 patients. RESULTS: 83% of the patients who completed the study referred positive results. A significant improvement was demonstrated for the degree of incontinence as well as the number of absorbent pads used. Age and severity of incontinence inversely correlated with positive results. A correlation between the absence of a previous urethropexy and positive results was also found. The dropout rate was 44% (24 patients) and was chiefly due to symptomatic bacteriuria in 14 cases and the difficulty in fixation and degree of incontinence. A statistically significant reduction was found in the number of pads used in the group of patients evaluated two months after treatment had been completed. CONCLUSIONS: The intraurethral device analyzed in this study significantly reduced urinary incontinence. This method appears to be more effective in younger women who are not severely incontinent and have not previously undergone urethropexy. The intraurethral device appears to have some rehabilitative effect on the perineal muscle. Symptomatic bacteriuria was found to be the main disadvantage.

Female↗
PubMed1999

Physiological benefits of a prolonged moderate-intensity endurance training programme in patients with coronary artery disease.

OBJECTIVES: To assess the physiological changes that take place in patients with coronary artery disease after 6 and 18 months of moderate-intensity endurance training. DESIGN: Prospective non-randomised controlled study. SETTING: Johannesburg Cardiac Rehabilitation Centre, a community-based phase III cardiac rehabilitation programme. SUBJECTS: The 93 patients who completed 18 months of training form the experimental or 'complier' group, while the 18 patients who discontinued the programme form the comparison or 'dropout' group. OUTCOME MEASURES: Haemodynamic, electrocardiographic and metabolic measurements at rest and at submaximal and peak exercise levels on admission and after 6 and 18 months of endurance training. RESULTS: Among the compliers several significant changes took place. Resting heart rate and blood pressure decreased at 6 months (P < 0.005). Submaximal heart rate, blood pressure, rate-pressure product and ventilation decreased at 6 months (P < 0.0001, P < 0.01, P < 0.001, P < 0.01 respectively), and the rate-pressure product decreased further at 18 months (P < 0.05). Ventilatory threshold increased at 6 months (P < 0.0001). Peak oxygen uptake, heart rate and ventilation increased at 6 months (P < 0.0001, P < 0.005 and P < 0.0001, respectively), with no further changes at 18 months. Treadmill time increased at 6 months and again at 18 months (P < 0.0001). The only significant change in the dropout group was an increase in ST-segment depression on the exercise ECG from 0.2 to 0.6 mm (P < 0.05). CONCLUSION: The study confirms that cardiac rehabilitation is beneficial. Most changes occurred in the first 6 months, the longer period of 18 months serving mostly as reinforcement of these and other lifestyle changes.

Adaptation, Physiological↗
PubMedDate not supplied

Pharmacological and psychological treatments for depressed older patients: a meta-analysis and overview of recent findings.

A meta-analysis was carried out to evaluate data published between January 1974 and February 1998 comparing rates of treatment response and tolerability of pharmacological and psychological treatments for depression in persons over age 55. Drugs (tricyclic antidepressants, selective serotonin-reuptake inhibitors, and a mixed group of other drugs) were significantly better than placebo, with an average reduction in symptom severity of 48.0% versus 31.3% (analysis weighted by sample size; 50.6% vs. 21.4% unweighted). No single drug or group of drugs was superior in terms of efficacy, and no statistically significant differences in tolerability emerged between tricyclic antidepressants and selective serotonin-reuptake inhibitors, whether measured by total dropouts or by dropouts due to side effects. Compared to the data on pharmacological treatments, those for outcomes of psychological treatments are very limited. Existing data indicate that cognitive-behavioral, behavioral, and psychodynamic therapies are significantly better than placebo. In the current meta-analysis, response rates to these nondrug therapies did not differ significantly from those observed with tricyclic antidepressants or selective serotonin-reuptake inhibitors, but direct comparison data are insufficient for firm conclusions to be drawn about comparative efficacy. It is possible, even likely, that not only different subtypes of depression but also different patients vary in their treatment responses. However, lack of adequate data prevented the current meta-analysis from addressing these issues. Rigorously designed prospective studies on treatment outcome, taking into account the above differences, are urgently needed to provide robust data on which to base clinical recommendations for the treatment of depression in older patients.

Aged↗
PubMed1999

A double-blind randomized comparison of nortriptyline and paroxetine in the treatment of late-life depression: 6-week outcome.

BACKGROUND: Some studies have suggested that selective serotonin reuptake inhibitors may be less efficacious than tricyclic antidepressants in the treatment of severe depression in older patients. The objective of this study was to compare the 6-week outcome of treatment with nortriptyline and paroxetine in older patients with a major depressive episode. METHOD: A double-blind randomized comparison of nortriptyline and paroxetine was conducted in 80 elderly (mean +/- SD age = 75.0 +/- 7.4 years) psychiatric inpatients and outpatients who presented with a major depressive episode. Dropout and response rates were compared in patients who began or completed treatment. Rates of response of inpatients and patients with melancholic depression were also compared. RESULTS: Over 6 weeks, there were no significant differences in dropout rates due to side effects (nortriptyline, 14% vs. paroxetine, 19%) or for any reason (27% vs. 33%). Similarly, there were no significant differences between the rates of favorable response to nortriptyline or paroxetine (intent-to-treat analysis, 57% vs. 44%; completer analysis, 78% vs. 66%). Analyses restricted to inpatients or to patients with melancholic depression yielded similar results. CONCLUSION: Nortriptyline and paroxetine appear to have similar efficacy and tolerability in the acute (6-week) treatment of older depressed patients, including hospitalized patients and those with melancholic features.

Age Factors↗
PubMed1999

Impact of mid day meal program on educational and nutritional status of school children in Karnataka.

OBJECTIVE: To assess the effect of the Mid Day Meal (MDM) Program on enrollment, attendance, dropout rate and retention rate in the schools and its impact on nutritional status as well as on school performance. DESIGN: Comparison by multistage random sampling. SUBJECTS: Primary school children, who are attending the school in the MDM and non-MDM areas. RESULTS: A total of 2,694 children (MDM: 1361; Non-MDM : 1333) from 60 schools were covered in the study. Results of the study indicated better enrollment (p<0.05) and attendance (p<0.001), higher retention rate with reduced dropout rate (p<0.001) a marginally higher scholastic performance and marginally higher growth performance of MDM children. CONCLUSION: MDM program is associated with a better educational and nutritional status of school children in Karnataka.

Child↗
PubMed2000

Cholinesterase inhibitors and Gingko extracts--are they comparable in the treatment of dementia? Comparison of published placebo-controlled efficacy studies of at least six months' duration.

The efficacy of four cholinesterase inhibitors (tacrine, donepezil, rivastigmine, metrifonate) and Ginkgo special extract EGb 761 in Alzheimer's disease were compared. The differences in the effects of the active substance and placebo on cognition were measured on the ADAS-Cog scale, taking into account the different degrees of dementia in the various studies and the dropout rate due to adverse drug reactions. Efficacy, expressed as the delay in symptom progression or the difference in response rate between active substance and placebo, showed no major differences between the four cholinesterase inhibitors and the Ginkgo special extract. Only tacrine exhibited a high dropout rate due to adverse drug reactions. In view of this, the subject of new prescriptions should be critically reviewed. Second-generation cholinesterase inhibitors (donepezil, rivastigmine, metrifonate) and Ginkgo special extract EGb 761 should be considered equally effective in the treatment of mild to moderate Alzheimer's dementia.

Alzheimer Disease↗
PubMed2000

The prevention of chronic NSAID induced upper gastrointestinal toxicity: a Cochrane collaboration metaanalysis of randomized controlled trials.

OBJECTIVE: To review the effectiveness of common interventions for the prevention of nonsteroidal antiinflammatory drug (NSAID) induced upper gastrointestinal (GI) toxicity. METHODS: Randomized controlled clinical trials (RCT) of prostaglandin analogs, H2-receptor antagonists (H2RA), or proton pump inhibitors (PPI) for the prevention of chronic NSAID induced upper GI toxicity were identified through electronic databases, the Cochrane control trials register, conference proceedings, and by contacting content experts and companies. Outcome measures investigated were endoscopic ulcers, ulcer complications, symptoms, overall dropouts, dropouts due to symptoms, and study quality. RESULTS: Thirty-four RCT met the inclusion criteria. All doses of misoprostol significantly reduced the risk of endoscopic ulcers. Misoprostol 800 microg/day was superior to 400 microg/day for the prevention of endoscopic gastric ulcers (RR 0.18, RR 0.38, respectively; p = 0.0055). A dose-response relationship was not seen with duodenal ulcers. Misoprostol caused diarrhea at all doses, although significantly more at 800 than 400 microg/day (p = 0.0012). Misoprostol was the only prophylactic agent documented to reduce ulcer complications. Standard doses of H2RA were effective at reducing the risk of endoscopic duodenal (RR 0.24, 95% CI 0.10-0.57) but not gastric ulcers (RR 0.73, 95% CI 0.50-1.09). Both double dose H2RA and PPI were effective at reducing the risk of endoscopic duodenal and gastric ulcers (RR 0.44, 95% CI 0.26-0.74 and RR 0.37, 95% CI 0.27-0.51, respectively, for gastric ulcer) and were better tolerated than misoprostol. CONCLUSION: Misoprostol, PPI, and double dose H2RA are effective in preventing chronic NSAID related endoscopic gastric and duodenal ulcers. Lower doses of misoprostol are less effective and are still associated with diarrhea. Only misoprostol 800 microg/day has been directly shown to reduce the risk of ulcer complications.

Adult↗
PubMedDate not supplied

Effects of fosinopril on exercise tolerance, symptoms, and clinical outcomes in patients with decompensated heart failure.

The purpose of this prospective, multicenter, randomized, double blind, placebo controlled study was to determine the clinical effects of fosinopril in patients with decompensated or worsening heart failure (HF). Patients >/=18 years with New York Heart Association (NYHA) functional class II-IV HF who had been hospitalized or seen in the ER or outpatient clinic for treatment of worsening or decompensated HF were eligible. Patients had to be on diuretic therapy and have a left ventricular ejection fraction (LVEF) </=35% and a treadmill exercise tolerance test (ETT) duration of </=8 minutes. Randomized patients began 12 weeks of fosinopril 10 mg (or placebo) qAM and were titrated within 4 weeks to fosinopril 20 mg and then to 40 mg (or placebo) qAM (if seated, systolic blood pressure (SBP) >/=90 mm Hg). ETTs (modified Naughton protocol) were performed at weeks 1, 3, 6, and 12. A total of 206 patients (mean age 62 years) were randomized to fosinopril (n=102) or placebo (n=104). Most patients were NYHA functional class III (58%) or IV (30%) at presentation; 145 patients completed 12 weeks of treatment (fosinopril, n=85; placebo, n=60). After adjustment for baseline imbalances and investigator effects, fosinopril-treated patients had a 513 second mean exercise duration at endpoint vs. a 489 second duration in placebo-treated patients (p=0.353). When the analysis was adjusted for the impact of dropouts on ETT time, fosinopril-treated patients had a greater exercise duration than those treated with placebo (p=0.043). Fewer patients in the fosinopril group were discontinued from study medication (p=0.008) or hospitalized (p=0.005) for worsening HF. At endpoint, more patients improved their NYHA Functional Class and fewer had worsened with fosinopril vs. placebo (p=0.018); fosinopril-treated patients showed improvements in dyspnea (p=0.054), fatigue (p=0.052), edema (p=0.012), and paroxysmal nocturnal dyspnea (p=0.003) vs. the placebo group. Once-daily fosinopril had a favorable effect on dropout-adjusted exercise tolerance, reduced the frequency of discontinuations or hospitalizations for worsening HF, improved HF signs and symptoms, and was safe and well tolerated. (c)1999 by CHF, Inc.

Journal Article↗