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Consistency of the talk test for exercise prescription.

INTRODUCTION/PURPOSE: The Talk Test has been shown to be well correlated with the ventilatory threshold, with accepted guidelines for exercise prescription, and with the ischemic threshold. As such, it appears to be a valuable although quite simple method of exercise prescription. In this study, we evaluate the consistency of the Talk Test by comparing responses during different modes of exercise. METHODS: Healthy volunteers (N = 16) performed incremental exercise, on both treadmill and cycle ergometer. Trials were performed with respiratory gas exchange and while performing the Talk Test. Comparisons were made regarding the correspondence of the last positive, equivocal, and first negative stages of the Talk Test with ventilatory threshold. RESULTS: The %VO2peak, %VO2 reserve, %HRpeak, and %HR reserve at ventilatory threshold on treadmill versus cycle ergometer (77%, 75%. 89%, and 84% vs 67%, 64%, 82%, and 74%) were not significantly different than the equivocal stage of the Talk Test (83%, 82%, 86%, and 80% vs 73%, 70%, 87%, and 81%). The VO2 at ventilatory threshold and the last positive, equivocal and negative stages of the Talk Test were well correlated during treadmill and cycle ergometer exercise. CONCLUSIONS: The results support the hypothesis that the Talk Test approximates ventilatory threshold on both treadmill and cycle. At the point where speech first became difficult, exercise intensity was almost exactly equivalent to ventilatory threshold. When speech was not comfortable, exercise intensity was consistently above ventilatory threshold. These results suggest that the Talk Test may be a highly consistent method of exercise prescription.

Adult↗

[Exercise prescription for the elderly].

Exercise prescription has been classically based on the "biological model" for the human body. Recently, the "behavioral approach" is also highlighted as an useful technique for promoting the daily physical activity. The exercise prescription for the elderly should be basically performed under the following guidelines; (1)the prescription according to the individual level of physical function, (2)the proper objectives according to the exercise adherence for each person, (3)the mental care for the non-adherent persons.

English Abstract↗

[Long-term trends in drug prescription for hospitalized patients with congestive heart failure. Influence of type of dysfunction].

INTRODUCTION AND OBJECTIVES: To evaluate changes in drug prescription during 1991-2002 in patients hospitalized for congestive heart failure (CHF) with preserved or depressed left ventricular (LV) systolic function. PATIENTS AND METHOD: A total of 1252 CHF patients (mean age, 69.4 (11.7) years; 61.3% male) hospitalized in a cardiology department were studied. Ischemic heart disease was present in 616 (49.2%), hypertension in 693 (55.4%), and diabetes in 335 (26.8%). Some 498 (39.8%) had preserved LV systolic function, defined as an echocardiographically determined ejection fraction > or =50% at admission. Pharmacotherapy at hospital discharge was recorded for all patients. RESULTS: The changes in drug prescription observed in CHF patients with preserved LV systolic function paralleled those in patients with depressed LV systolic function. Change was influenced by the publication of major clinical trials on CHF and depressed LV systolic function. Consequently, the use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, and spironolactone progressively increased during follow-up for both types of CHF. Diuretics were prescribed for more than 70% of patients, with the rate being higher in those with depressed LV systolic function. Digoxin use decreased markedly in patients with preserved LV systolic function. CONCLUSIONS: An increase in the prescription of drugs with proven effects on mortality and morbidity in patients with CHF was observed. Nevertheless, beta-blocker and spironolactone use remains suboptimal. The trend seen after hospitalization in CHF patients with preserved LV systolic function was similar, though slightly less marked.

Aged↗

[Some preconceptions and psychotropic drugs prescription].

Prescription of psychotropic drugs should follow evidence-based medicine, i.e. be founded on well-conducted randomised controlled trials. In fact, a number of prescriptions do not follow these rules and cannot be qualified as evidence-based psychiatry. In this article, some preconceptions concerning the drug prescription in psychiatry are evoked.

Humans↗

Peritoneal dialysis prescription for diabetic patients.

The number of end-stage renal disease (ESRD) patients with diabetes mellitus has increased dramatically during the past few years and, in many countries, diabetes has become the most important cause of ESRD in patients admitted to dialysis. Furthermore, compared to nondiabetic patients, diabetic patients continue to suffer from more frequent and severe comorbidity and complications, including cardiovascular disease, poor fluid balance, worse quality of life, as well as high morbidity and mortality after initiation of dialysis. These systemic problems in diabetic patients should influence the dialysis prescription. In addition, the structure and transport properties of the peritoneal membrane may deteriorate as a consequence of diabetes. Thus, both the systemic and the peritoneal consequences of diabetes influence the dialysis prescription in diabetic patients. In this brief review, we discuss the care of diabetic ESRD patients on peritoneal dialysis--which, compared with hemodialysis, has both advantages and disadvantages in this group of patients--focusing on the special needs for intense and integrated care involving individualized dialysis prescription as well as care of diabetic complications and comorbidity in this diseased patient group.

Diabetes Complications↗

[Morphine prescription to terminal cancer patients suffering from severe pain: results of a French survey].

This study aimed to determine factors associated with the prescription of morphine to terminal cancer patients suffering from severe pain. A phone survey was conducted among a sample of French GPs, neurologists and oncologists. Two short clinical cases described a terminally-ill patient with either a peritoneal carcinosis and intestinal occlusion, or a lung cancer, and in both cases suffering from severe pain. Overall, 917 agreed to participate among the 1,743 physicians contacted (global response rate 53%). About half of respondents did not support the prescription of morphine if the patient had an intestinal occlusion. Beliefs toward morphine, uneasiness with terminally-ill patients, age and female gender were independently associated with reluctance to prescribe morphine in presented cases. Specialised training has not completely remove reluctance toward morphine prescription in end-of-life care. Non-medical factors correlated to such reluctance, and especially gender, deserve more attention.

Adult↗

Medicare prescription drug coverage: preparing for January 1, 2006.

After many years of effort by health advocates, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (called the MMA) in December 2003. The law updates the benefits provided to Medicare beneficiaries by adding coverage for prescription drugs beginning January 1, 2006. Prescription drugs play a central role in modern health care, and extending drug coverage to Medicare beneficiaries is an important goal. The way in which Congress tackled this problem, however, has been highly contentious. This article will describe the law as it was passed, the issues that remain to be resolved, and what ia all means for people with HIV/AIDS.

Fees and Charges↗

[Prescriptions following acute coronary syndrome].

Each year in France, 150,000 to 180,000 new patients are the subject of prescriptions following acute coronary syndrome with or without ST segment elevation. There are two targets of the treatment, atherosclerosis, a diffuse, evolving trouble which, in this situation, is coming out of an unstable phase, and the myocardium, which has often been revascularised and has suffered deterioration of its contractile and electrophysiological characteristics to a greater or lesser extent. Prescriptions, based on proven factors and always centred on hygiene and dietary advice and the use of a combination of statins and aspirin, are adapted to suit the atherosclerotic and myocardial risk assessed for the individual patient. The prescription starts off the secondary preventive phase. It marks the first stage of the follow up, which is inevitable though of variable duration, for a disease which may evolve. It is the first step in the accompaniment of an attentive, informed patient whose confidence has been restored and who must now avoid falling into the double trap of not taking the treatment sufficiently seriously or of obsessively over-reacting.

Angina, Unstable↗

A battle over birth "control": legal and legislative employer prescription contraception benefit mandates.

Under the Pregnancy Discrimination Act (PDA), employers are prohibited from discriminating against women by treating pregnancy and childbirth different from other medical conditions. Employers who offer medical benefits to their employees have thus been required to cover pregnancy-related medical costs on the same terms as other medical coverage. The cost of prescription contraception, however, has generally not been covered by employer-sponsored medical plans, even while other prescription drugs were. This Note examines the recent case of Erickson v. Bartell Drug Co., which challenged this practice of excluding prescription contraception coverage as discriminatory under the PDA, and argues that further federal legislation is necessary to ensure the equal treatment of women in the workplace.

Catholicism↗

Possibilities of application of non-ionic surfactants belonging to Rofam, Rokopol and Rokanol class in the prescription of dental anti-inflammatory gels.

Belonging to the classes of: Rofams, Rokopols and Rokanols were used to form the gels soap base. The model gels extensibility was investigated by extensometric method, while their viscosity parameters were determined with cone-plate digital rheometer. Regardless of the applied gel vehicle, model prescriptions of dental anti-inflammatory gels with sodium ibuprofen have been worked out. Natural polysaccharides: xanthan gum, tragacanth, guar gum were the vehicles of the formed gels. New non-ionic surfactants the most beneficial results of rheological measurements were obtained for model gels with Rofam R-15. The calculated areas under extensibility curves of preparations with Rofam R-15 are greater than for gels with Rokopol RF55 or Rokanol OC9. Introduction of Rofam R-15 into the prescription is associated with maintenance of low value of yield stress. When this value is exceeded under the effect of slight shear, the gel does not stay long on the surface of its application. High values of theoretical coefficients of sodium ibuprofen diffusion from gels with Rofam R-15, calculated from Einstein-Smoluchowski equation, are the consequence of their low viscosity. The carried out in vitro comparative testing of the kinetics of sodium ibuprofen release from the gel with Rofam R-15 and from gel with sodium estolate of parallel prescription did not demonstrate any basic differences in the size of the areas under the release curves (14,4046 and 13,5308 c.u. for the vehicle with xanthan gum).

Administration, Topical↗

The community safety net and prescription drug access for low-income, uninsured people.

While the new Medicare drug benefit has helped alleviate concerns about prescription drug access for elderly and disabled Americans, many low-income, uninsured people under age 65 continue to rely on community safety nets to get needed medications. As the number of uninsured Americans increases, safety net providers are stretching limited resources to meet growing prescription drug needs, according to findings from the Center for Studying Health System Change's (HSC) 2005 site visits to 12 nationally representative communities. Despite redoubled efforts--centered on obtaining discounted drugs and donated medications--to make affordable drugs available to needy patients, safety net providers and community advocates report that many low-income, uninsured people continue to face major barriers to obtaining prescription drugs.

Cost Sharing↗

Impact of functional testing results on prescription patterns of anti-anginal medication after coronary artery bypass graft surgery: results from the ROSETTA-CABG Registry.

BACKGROUND: Although coronary artery bypass graft surgery (CABG) is known to reduce angina, previous studies have suggested that anti-anginal medication use is not significantly reduced after CABG. However, it is unclear how functional testing results have an impact on anti-anginal medication prescription patterns. OBJECTIVES: To determine whether post-CABG functional testing results impact prescription patterns of anti-anginal medication during the 12 months after CABG. METHODS: The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter study. We examined anti-anginal medication use (beta blockers, calcium channel blockers and nitrates) at discharge and at 12 months post-CABG with respect to functional testing results among 392 patients. RESULTS: Among the 392 patients, 146 had at least one functional test over the 12-month follow up period. Among the 146 patients, 17% had positive functional tests, 69% had negative tests, and 14% had indeterminate tests. Both beta blocker and calcium channel blocker use did not increase from discharge to 12 months following a positive test (N = 25) (84% vs. 80%; p = NS; 16% vs. 16%; p = NS), while nitrate use increased seven-fold (4% vs. 28%; p = 0.03). However, following a negative test (N = 100), beta blocker use only decreased modestly (85% vs. 70%; p = 0.01), while both calcium channel blocker and nitrate use were unchanged (30% vs. 20%; p = NS; 4% vs. 6%; p = NS, respectively). Following an indeterminate test (N = 21), anti-anginal medication use was unchanged (p = NS for all 3 classes of medication). CONCLUSION: The use of anti-anginal medication is only modestly reduced after CABG, and functional testing results during the first year post-CABG do not have a strong impact on prescription patterns of anti-anginal agents.

Adrenergic beta-Antagonists↗

Medicare program; identification of backward compatible version of adopted standard for e-prescribing and the Medicare prescription drug program (version 8.1). Interim final rule with comment period.

This interim final rule with comment period identifies the Prescriber/Pharmacist Interface SCRIPT Standard, Implementation Guide, Version 8.1 (hereafter referred to as "Version 8.1 of the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard") as a backward compatible update of the adopted Version 5.0. This interim final rule with comment period also permits the voluntary use of Version 8.1 of the NCPDP SCRIPT Standard for conducting certain e-prescribing transactions for the electronic prescription drug program under Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

Humans↗

[Screening for mental disorders in the community 1984 and 2002 and prescriptions for psychopharmaca in 1984 and 2001.].

BACKGROUND: During the past 15 years the use of psycho tropic medication has increased markedly. The question addressed in this paper is whether this increase is related to change in prevalence of psychiatric disorders or symptoms. MATERIAL AND METHODS: Two data sets were used. Data from a screening of the population aged 20 to 59 years in 1984 using GHQ- 30 and prescriptions for pychotropic medications filled during March that year for outpatients in Reykjavík. Secondly, data from a population screening in January 2002 using GHQ- 12 for the same age range, and all psychotropic prescriptions filled by outpatients in 2001. RESULTS: The prevalence of those without complaints did not change. It remained about 60%. Using a cut off 4/3 for GHQ-30 and 3/2 for GHQ-12 the prevalence rates were 16.1 % and 17.5%, respectively. By assuming that symptom-free drug users would have reached the cut-off level the prevalence increased to 20.7% Using a cut off score of 3/2 and 2/1, respectively, the prevalence for men in both years was around 18 % while that for women increased from 20.5% to 29.4% (p<0.05). In both years the prevalence was highest in the youngest age group and lowest in the oldest. Psychotropic presciptions other than hypnotics doubled. Proportionally the increase was similar for men and women, but more marked among the younger age groups. The increase in prescriptions filled for all psychotropics was 56% compared to 47% increase in the sale of all medications. CONCLUSION: Increase in the use of psychotropics is explained to a limited extent only by possibly higher prevalence of psychiatric disorders. The use of psychotropics has increased along with that of other medications, but at slightly higher pace, which may reflect the results of awareness campaigns among physicians and the general public and more effective and better tolerated medications.

English Abstract↗

Evaluation of abuse of prescription and illicit drugs in chronic pain patients receiving short-acting (hydrocodone) or long-acting (methadone) opioids.

BACKGROUND: Multiple studies have documented the incidence of illicit drug use and abuse of opioids. Over the years, several hypotheses have been proposed. Short-acting opioids such as hydrocodone are generally considered to predispose patients to poor pain management, dependency, misuse, or abuse; whereas long-acting opioids such as methadone are thought to provide sustained pain management without dependency or abuse. OBJECTIVES: To evaluate and identify the prevalence of illicit drug use and prescription drug abuse or misuse in patients receiving hydrocodone or methadone. STUDY DESIGN: A prospective, comparative evaluation. METHODS: A total of 200 patients from an interventional pain management setting, divided into two groups of 100 consecutive patients receiving either hydrocodone (Group I) or methadone (Group II) were evaluated with urine testing for illicit drug use, and/or misuse or abuse of opioids. Drug testing was carried out by Rapid Drug Screen(R). RESULTS: Results of this study showed that 22% (95% CI, 13% - 30%) of Group I patients receiving hydrocodone used illicit drugs as compared with 24% (95% CI, 15% - 32%) of those in Group II who were receiving methadone. The misuse or abuse of a prescription opioid was seen in 3% (95% CI, 0% - 6%) of the patients in Group I and 12% (95% CI, 5% - 18%) in Group II. In a significant proportion of patients in both groups, the drug prescribed for them was not detected on testing. The combined use of illicit drugs and misuse of prescription drugs was noted in 24% (95% CI, 15% - 32%) in Group I and 33% (95% CI, 23% - 42%) in Group II. CONCLUSIONS: There were no significant differences as to illicit drug use and/or misuse of opioids in patients treated with hydrocodone or methadone. These findings suggest that the use of a long acting opioid formulation by patients with chronic pain does not reduce the risk of drug abuse or improve compliance with medical therapy.

Journal Article↗

Development of a screening tool to detect the risk of inappropriate prescription opioid use in patients with chronic pain.

BACKGROUND: Effective use of opioids in patients with chronic pain has been hindered by their potential for drug abuse. There are no reliable means to distinguish those who use the opioids in an inappropriate manner from those who do not. OBJECTIVE: To develop a screening tool to distinguish patients at risk for inappropriate prescription opioid use among patients with chronic pain. METHODS: We conducted a case-control study of adults with chronic pain. Patients dismissed from the pain clinic for inappropriate prescription opioid use were placed in the "inappropriate opioid use group". Randomly chosen patients with chronic pain on opioids, who did not have any evidence of inappropriate use were in the "control group". We performed a review of the clinical notes of all the patients enrolled in the study and extracted clinical criteria. We analyzed these criteria to identify independent predictors of inappropriate opioid use. Based on these criteria, a screening tool was developed to stratify patients into low-and high-risk categories. This screening tool was then applied to both groups. RESULTS: There were 107 patients in the inappropriate use group and 103 patients in the control group. On multivariate analysis, six criteria were significantly associated with inappropriate drug abuse. These included focus on opioids, opioid overuse, other substance use, nonfunctional status, unclear etiology of pain, and exaggeration of pain. A screening tool was developed by giving one point to each of these criteria so that a patient's score can range from 0 to 6. In the "inappropriate opioid use" group, 77% of patients scored more than 3 points as opposed to 16% in the control group. In the "inappropriate opioid use group", 23% scored 3 or less, in comparison to 84% in the control group. CONCLUSION: We have identified six clinical criteria, which were significantly more prevalent in the 'inappropriate opioid use group'. Using these criteria, we have developed a screening tool that appears to predict inappropriate use of prescription opioids in patients with chronic pain.

Journal Article↗

[Survey of point prescriptions of acupuncture treatment for urinary retention].

OBJECTIVE: To summarize characteristics of the point prescriptions for acupuncture treatment of urinary retention from 1994 to 2005. METHODS: Review of literature was made from following five aspects: body acupuncture, scalp acupuncture, ear acupuncture, hand acupuncture and abdomen acupuncture. For the prescriptions of body acupuncture, further analysis was made on single point prescription, distal-proximal point association, superior-inferior point association, point selection according to syndrome differentiation and point selection according to disease differentiation. CONCLUSION: Acupuncture has affirmative therapeutic effect on urinary retention. However, there are still problems to be resolved in clinical researches at present.

Acupuncture Points↗

[Studies on characteristics of absorption and separation of traditional Chinese medicine compound prescription by macroporous resin].

OBJECTIVE: Study the characteristics of absorption and separation of traditional Chinese medicine compound prescription using macroporous resin. METHOD: Study the techniquecs and characteristics of absorption and separation of a sample by macroporous resin, which is composed of coptis root, rhubarb and common anemarrhena rhizome, containing alkaloid, anthraquinone and saponin. RESULT: It is proved by qualitative and quantitative researches studies that after absorbed and separated by optimized technics process, most prime effective components or section fractions in traditional Chinese medicine compound prescription can be reserved maintained. CONCLUSION: If the techniquecs of separation is properly designed, the same kind of macropore resin can absorbd and separate various effective components or section in traditional Chinese medicine compound prescription which have with different chemical structures efficiently.

Alkaloids↗