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At least 1,261 records · Page 70Linked to original sources
PubMed2005

Alvimopan for the management of postoperative ileus.

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical efficacy, safety, dosage, and administration of alvimopan, a peripherally acting mu-opioid receptor antagonist, in the management of postoperative ileus (POI). DATA SOURCES: A literature search (1980-October 2004) applying the terms alvimopan, ADL 8-2698, and LY246736 was conducted using MEDLINE. Information was also obtained from scientific congress abstracts and data on file with the manufacturer. STUDY SELECTION AND DATA EXTRACTION: Studies and abstracts investigating alvimopan and POI were considered for inclusion; however, they were restricted to English-language articles. DATA SYNTHESIS: Alvimopan is a novel, peripherally acting mu-opioid receptor antagonist that is currently under evaluation for the management of POI. POI presents significant clinical challenges that can delay patient recovery and contribute to increased morbidity and prolonged hospitalization after surgery. Clinical trials have demonstrated that alvimopan, at oral doses of 6 and 12 mg, can accelerate time to recovery of gastrointestinal (GI) function and time to hospital discharge following abdominal surgery. The incidence of adverse events with alvimopan therapy was shown to be similar to that of placebo. CONCLUSIONS: Alvimopan is well tolerated and effective at accelerating GI recovery and time to discharge in patients who have undergone bowel resection or hysterectomy when administered prior to surgery and twice daily thereafter until discharge or for up to 7 days. Alvimopan potentially offers significant benefits for patients with POI over currently available treatments.

Clinical Trials as Topic↗
PubMed2006

Topical alprostadil treatment of female sexual arousal disorder.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of topical alprostadil in the treatment of female sexual arousal disorder (FSAD). DATA SOURCES: A literature search was conducted using MEDLINE (1966-May 2006), EMBASE, and International Pharmaceutical Abstracts with the search terms alprostadil, female, and sexual dysfunction/drug therapy. STUDY SELECTION AND DATA EXTRACTION: All published and unpublished clinical trials and abstracts involving the efficacy and safety of topical alprostadil use in women were reviewed. Data on file with the manufacturer were also included. DATA SYNTHESIS: Topical alprostadil is a vasodilatory agent under development for the treatment of FSAD. In-clinic application of alprostadil increases genital vasocongestion, vaginal erythema, transudates, and some patient-assessed indices of sexual arousal; however, these effects have not been consistently superior to placebo. Three of 4 trials investigating at-home use of topical alprostadil have demonstrated improvements in achievement of satisfactory levels of sexual arousal and successful sexual encounters in patients with FSAD. Adverse events appear to be mild and localized and consist of burning and itching at the application site. CONCLUSIONS: Two formulations of topical alprostadil are in Phase II clinical trials for the treatment of FSAD. Initial results of clinical trials have demonstrated some beneficial effects on arousal success rates and other subjective measures of sexual arousal; however, these results have been inconsistent and not reproducible in all trials. The results of ongoing clinical studies are needed to further define the role of topical alprostadil in the treatment of FSAD.

Administration, Topical↗
PubMed2000

An analysis of factors associated with seat belt use: prevention opportunities for the medical community.

Motor vehicle collisions are a significant cause of morbidity and mortality in the Oklahoma population. The cost associated with this morbidity and mortality is exacerbated by the failure of individuals to use seat belts. Numerous organizations believe that seat belt compliance can be improved through physician counseling. This would allow medical resources to be redirected towards other health problems. Analysis was performed using the Oklahoma Department of Public Safety (ODPS) crash file and the hospital in-patient data discharge file from the Oklahoma State Department of Health (OSDH). These provide a profile of Oklahoma drivers who do not use seat belts. This analysis allows physicians to pinpoint and advise those individuals most likely to not utilize seat belts about the benefits of seat belt use. The results of the analysis show that non-seat belt-users tend to be young and male. Significant predictors of seat belt use are age, gender, alcohol use, time of day (day versus night), driver location (urban versus rural), vehicle type (pick up versus passenger car), and decreased hospital charges. These results show that increased seat belt use can lead to significant decreases in fatalities related to motor vehicle crashes and a decline in associated hospital charges for those who survive. Physicians should encourage seat belt use by their patients and inform them of the risks associated with failure to use seat belts.

Accidents, Traffic↗
PubMed2003

Cost-effectiveness of home-based care versus hospital care for chronically ill tuberculosis patients, Francistown, Botswana.

SETTING: Francistown, Botswana, 1999. OBJECTIVE: To determine the affordability and cost-effectiveness of home-based directly observed therapy (DOT) compared to hospital-based DOT for chronically ill tuberculosis (TB) patients, and to describe the characteristics of patients and their caregivers. DESIGN: Costs for each alternative strategy were analysed from the perspective of the health system and caregivers, in 1998 US dollars. Caregiver costs were assessed using a structured questionnaire administered to a sample of 50 caregivers. Health system costs were assessed using interviews with relevant staff and documentary data such as medical records and expenditure files. These data were used to calculate the average cost of individual components of care, and, for each alternative strategy, the average cost per patient treated. Cost-effectiveness was calculated as the cost per patient compliant with treatment. The characteristics of caregivers and patients were assessed using demographic and socio-economic data collected during interviews, and medical records. RESULTS: Overall, home-based care reduced the cost per patient treated by 44% compared with hospital-based treatment (dollars 1657 vs. dollars 2970). The cost to the caregiver was reduced by 23% (dollars 551 vs. dollars 720), while the cost to the health system was reduced by 50% (dollars 1106 vs. dollars 2206). The cost per patient complying with treatment was dollars 1726 for home-based care and dollars 2970 for hospitalisation. Caregivers were predominantly female relatives (88%), unemployed (48%), with primary school education or less (82%), and with an income of less than dollars 1000 per annum (71%). Of those patients with an HIV test result, 98% were HIV-positive. CONCLUSION: Home-based care is more affordable and cost-effective than hospital-based care for chronically ill TB patients, although costs to caregivers remain high in relation to their incomes. Structured home-based DOT should be included as a component of the National Tuberculosis Control Programme in Botswana.

Adolescent↗
PubMed2004

Spontaneous reports of hypertension leading to hospitalisation in association with rofecoxib, celecoxib, nabumetone and oxaprozin.

BACKGROUND AND OBJECTIVE: Data on file with the US FDA, and other published studies, suggest that the selective cyclo-oxygenase (COX)-2 inhibitor NSAID rofecoxib has a greater hypertensive adverse effect than other NSAIDs, including celecoxib. In this study we describe a pharmacoepidemiologic analysis of spontaneous adverse event reports of acute, clinically serious hypertension (as defined by hospitalisation) reported in association with rofecoxib, celecoxib, nabumetone and oxaprozin. The objective of this analysis is to assess whether postmarketing data are consistent with results of clinical trials. We also collapse cases into series for the identification of possible risk factors for clinically severe, NSAID-associated hypertension. METHODS: Domestic (US) cases of apparently unconfounded, acute hypertension leading to hospitalisation were collected and reviewed from the spontaneous adverse events database of the FDA for rofecoxib, celecoxib, nabumetone and oxaprozin for the initial 3 years of marketing. Drug use data for the same intervals enabled calculation of reporting rates. RESULTS: In an analysis of reporting rates, hospitalisation for acute blood pressure (BP) elevation was reported more frequently (3.8-fold) for rofecoxib compared with celecoxib. A total of 34 cases are collapsed into case series. No cases were identified for either nabumetone or oxaprozin. Inspection of reviewed cases for celecoxib and rofecoxib suggest that these patients (average age 72 years) were potentially high-risk candidates for NSAID therapy. DISCUSSION AND CONCLUSION: During early marketing, hospitalisation for acute BP elevation appears to have been reported more frequently for rofecoxib compared with celecoxib. This is consistent with clinical trial data on file with the FDA, and other published studies that found rofecoxib to have a greater effect on BP than other NSAIDs, including celecoxib. This finding may be particularly relevant in older patients given the prevalence of hypertension and cardiovascular disease in this age group.

Adult↗
PubMed1991

Calculating DWI/DWAI recidivism with limited data: using state driver license file for drinking and driving research.

One major research issue in drinking-driving is the volume of DWI/DWAI recidivism in a political unit during a given period of time. This article addresses a methodological issue: How can limited data from the official driver license file be used to calculate drinking-driving recidivism rates? New York State maintains one of the most comprehensive driver license files in the nation, but a dynamic process purges records on the file that are more than ten years old. The magnitude of the recidivism rate calculated from this file, thus, is influenced by the number of data points included: the more years of data included, the higher the rate. We used OLS to examine the impact of the dimension of the data on the recidivism rate and mathematically extended the file to the point where the impact of the data dimension is minimum. We, then, calculated the New York State DWI/DWAI recidivism with an "extended dimension."

Alcohol Drinking↗
PubMed2000

A novel energy-based stochastic method for positioning polar protons in protein structures from X-rays.

A novel automated method for the optimal placement of polar hydrogens in a protein structure is presented. The algorithm adds initially, to a protein data bank file of the protein, nonrotatable hydrogens such as peptide backbone hydrogens according to geometric considerations. Then, water protons and polar side chain protons of lysine, serine, threonine, tyrosine, aspartic acid, glutamic acid, and the C and N termini of a protein are added according to energy considerations. A unique stochastic approach has been developed to overcome a combinatorial explosion in the search for the lowest energy structure. First, the system is divided into ensembles. Each ensemble is treated separately: N conformations are sampled at random, their energies computed, whereas common components of high-energy combinations are gathered on one hand, and low-energy combinations on the other. Components that yield only high-energy conformations and do not contribute to any low energies are excluded. This is reiterated while the total amount of combinations is decreased along the iterative process. When the total number of combinations is lower than a user defined threshold, all remaining combinations are evaluated by exhaustive search. Energy evaluations use nonbonding energy expressions alone. The program was tested on five high-resolution crystal structures: bovine pancreatic trypsin inhibitor (Brookhaven Protein Data Bank file 5PTI), RNase-A (5RSA), trypsin (1NTP), and carbon monoxymyoglobin (2MB5), for which neutron diffraction structures are available, as well as phosphate binding protein (1IXH) for which very high resolution X-ray crystallography was used. The low RMS values prove the efficiency of this algorithm as a tool for positioning protons in proteins. It may be used for other biological structures.

Algorithms↗