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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To identify the prescribing patterns in public group practice centers (GPCs), 84,453 prescription sheets written by primary care physicians in 168 GPCs during the period from December 7-12, 1992, were collected and analyzed. The average number of drugs per script was 4.3 and the ratio of drug to total medical expense was 44%. The 5 most common diagnoses were, in a descending order, upper respiratory tract infection, skeletomuscular and joint disease, hypertension, functional gastrointestinal disorder (including peptic ulcer) and diabetes mellitus. The top 5 most commonly dispensed drug categories were antacids and anti-ulcer drugs, anti-cough and anti-cold preparations, vitamins, simple analgesics and non-steroidal anti-inflammatory drugs, accounting for 48.8% of total prescriptions. In view of the frequency of relevant diagnoses, the overuse of antacids, vitamins, intravenous nutrient and electrolyte solutions, anti-cold preparations and antibiotics was apparent, as was that of drugs of questionable pharmacological value. These data indicate that polypharmacy is a widespread phenomenon and confirms our long-term concern over irrational drug use in GPCs in Taiwan. Both administrative and educational intervention should be implemented to improve prescribing quality at the primary health care level.
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PMID:Prescribing patterns in primary health care in Taiwan. 855 22

A phase II trial was planned to investigate the feasibility of radiotherapy (RT) without steroids in 20 consecutive patients with metastatic spinal cord compression (MSCC), no neurologic deficits, or only radiculopathy, and no massive invasion of the spine at magnetic resonance imaging (MRI) or computed tomography (CT). Aiming at an early diagnosis, MRI or CT was prescribed for all cancer patients with back pain and osteolysis, even when there were no signs of neurologic spinal compression. All patients were given 30 Gy in 10 fractions over 2 weeks with no steroids. Back pain and motor capacity were the parameters adopted to verify response to RT. Sixteen of 20 patients (80%) were able to walk without support, and 14 (70%) had no radiculopathy. Seventeen of 20 cases (85%) achieved relief from back pain. Regarding motor function, all patients (100%) responded to RT because the 16 patients able to walk without support at diagnosis did not deteriorate and the other 4, who needed support, became ambulatory without motor impairment. Median survival time was 14 months. Eight of 20 (40%) treated patients are still alive (14 to 36 months after end of RT), fully ambulatory, and free from relapse in the treated spine. Acute side effects were documented in only 2 patients (10%) and were managed without steroids. The results of this study suggest that RT without steroids is a feasible regimen for MSCC patients with good motor function. Elimination of steroids from the standard treatment for MSCC avoids cortisone side effects above all in those patients with diabetes, hypertension, peptic ulcer, and other steroid-sensitive medical problems.
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PMID:Radiotherapy without steroids in selected metastatic spinal cord compression patients. A phase II trial. 861 Jun 45

Over the past 40 years primary hyperparathyroidism (PHP) has changed from a rare, severe disease of the bones and kidneys to a common disease with hypertension, peptic ulcer, pancreatitis, easy fatigue and proximal muscle weakness. We have during these 40 years examined one of the greatest group of patients with PHP. PHP had its maximum incidence in women over the age of 40. The disease is four times frequent in women as in man. The incidence of hypertension and peptic ulcer between patients with PHP is higher as compared with the incidence of these diseases in general populations. The severity of bone changes in individual patients with PHP does not result from the direct action of a single hormone only. Parathyroid hormone (PTH) have hypotensive and vasodilator effects on various vascular beds. The resting blood flow in the limbs of our patients with PHP is increased in comparison with control subjects. PTH increases plasma renin activity in normotensive controls. This effect is partly blocked by beta adrenergic blockers.
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PMID:[Primary hyperparathyroidism]. 871 83

Tramadol is a centrally acting analgesic that has been shown to be effective in a variety of acute and chronic pain states. Unlike other centrally acting analgesics, it exerts a dual action by binding to the opioid receptor site in the central nervous system and by weakly inhibiting the reuptake of biogenic amines. Tramadol is rapidly and almost completely absorbed, with an onset of action occurring within 1 hour of oral administration. The recommended dosage is 50 to 100 mg every 4 to 6 hours; however, regular administration is an alternative, particularly for chronic pain states such as osteoarthritis, where the use of the recently developed sustained release formulation may represent an important advantage. Published studies specifically evaluating the use of tramadol in this disease support its effectiveness. Nausea, drowsiness, constipation, dizziness, and sweating have been reported in association with tramadol use. Nausea occurs early in the course of administration, and may be reduced by slowly titrating the dose of tramadol against response. Tramadol would appear to be particularly useful in the elderly population affected by osteoarthritis because, unlike nonsteroidal anti-inflammatory drugs, it does not aggravate hypertension or congestive heart failure, nor does it have the potential to cause peptic ulcer disease. Compared with narcotics, tramadol does not induce significant respiratory depression, constipation, or have significant abuse potential.
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PMID:Pharmacology and clinical experience with tramadol in osteoarthritis. 891 98

To evaluate the efficacy and long-term course of topical steroids treatment in oral lichen planus (OLP), an open trial has been carried out in 30 patients with atrophic-erosive or symptomatic varieties of OLP confirmed histologically with relative contraindications for systemic steroid treatment (namely, liver disease, peptic ulcer, diabetes, blood hypertension or osteoporosis). The treatment was the following: Fluocinonide (Topsyn) 0.025% in 4% idrossiethylcellulose gel applied 3 times/daily for two months, 2 times/daily for the next 2 months and 1 times/daily for other 2 months. Moreover, chlorhexidine (Plakout) 0.12%, 3 mouthwashes/daily and miconazole gel (Micotef) applied 1 times/daily were used for the entire period of the steroid therapy as antimycotics. The clinical evaluation of signs and symptoms was assessed on a scale of 0 to 5 and of 0 to 3, respectively. Twenty patients concluded the entire therapeutical scheme, whereas 5 (17%) interrupted the treatment for the appearance of side-effects (namely, gastroesophageal disturbances, mucosal bleeding and pruritus), 1 interrupted voluntarily the treatment and 4 cases did not present at the controls. No cases of oral candidiasis were seen. Eighteen patients (90%) had improvements of oral lesions with significant statically reductions in the scores of signs (p < 0.002) and of symptoms (p < 0.02) (Wilcoxon test). We emphasize also that in 61% of the responders the oral conditions were stable after 6 months of follow-up. In conclusion our results suggest the following: a) fluocinonide is an effective and safe drug for the treatment of OLP, especially in addition with chlorehixidine and miconazole; b) the stability of our results demonstrates that probably an adequate steroid therapeutical scheme is more useful than continuous steroid administration in the treatment of OLP.
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PMID:[The topical treatment of atrophic-erosive oral lichen planus with fluocinonide in a bioadhesive gel, chlorhexidine and miconazole gel. A totally open trial]. 892 75

In the Netherlands the general practitioner (GP) plays an important role in prevention. Every Dutch citizen has to be registered with one GP and GPs know their patients well. Face-to-face contact is a relatively effective means of influencing behavior; if preventive advice is related to a patient's state of health, compliance may be stimulated. However, Dutch GPs have shown reluctance toward preventive work. Curing rather than preventing disease is emphasized in medical school. Many GPs doubt that they are entitled to interfere with a patients' lifestyle unless asked. Some GPs are aware of their limited knowledge of nutrition. Preventive work requires some reorganization of medical practice and can lead to an increased workload, without financial compensation. Then there is the "prevention paradox": preventive actions that have a demonstrable effect on the whole population bring only small benefits for individuals. Since 1989 the Dutch College of General Practitioners has published 60 standards for general practice. Several of these include advice on lifestyle and diet, eg, for non-insulin-dependent diabetes mellitus, hypertension, hypercholesterolemia, peptic ulcer, and heart failure. Prevention work in general practice must use only interventions proved to be effective and they must be feasible in the context of general practice. A trial collaboration of 118 GPs and 5 public health authorities between 1988 and 1990 for screening and lifestyle management of hypertension was a limited success. It brought to light the practical problems of this type of work in general practice. Present government priorities for GP-public health collaboration are influenza vaccination and cervical screening.
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PMID:Challenges to prevention in Dutch general practice. 917 99

Present study comprised of 1070 elderly patients coming to P.H.C. Bhopauli, Varanasi during January 1991-December 1992. Males were 578 and females were 492. Male predominance was present in younger elderly whereas female predominance was seen among those over 75 years of age. Socio-economic status-wise 265 cases belonged to upper, 394 middle and 411 to lower income group. Arthritis (615) was the commonest disease in elderly followed by hypertension (510), visual problems (400), ischaemic heart disease (IHD) (350), hearing impairement (300), diabetes mellitus (DM) (280), protozoal and worm infestations (240), chronic bronchitis, asthma, emphysema (238), tuberculosis (220), peptic ulcer syndrome (210), varicose vein (200), haemorrhoids (180), urinary problems (154). Two hundred and forty seven cases had 2 diseases followed by 3 diseases (239), 4 diseases (165), 5 diseases (127) and more than 5 diseases (81). Multiple diseases were more frequent among those above 75 years of age. Atypical presentations and complications of different diseases were more frequent among older elderly.
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PMID:Health problems in rural elderly at Varanasi, Uttar Pradesh. 925 27

Recent reports commissioned by the Australian Government have highlighted the need to improve medication use in both community and hospital settings. Nurses are placed ideally to promote safe and effective drug use. The aim of this project was to develop and evaluate a computer-assisted instruction package, to help undergraduate nursing students improve their knowledge of clinical pharmacology, and to enhance their ability to contribute to the quality use of medications. In a collaborative project, staff of the Tasmanian Schools of Pharmacy and Nursing have produced the program PharmaCAL, using HyperCard 2.2 for the Apple Macintosh. A wide range of clinical pharmacology units are covered extensively, concentrating on drugs in common use and based on body systems: cardiovascular pharmacology (including hypertension, cardiac failure and angina); respiratory pharmacology; alimentary tract pharmacology (including peptic ulcer, diarrhea, and constipation); central nervous system pharmacology (analgesia, anxiety and insomnia, depression, psychoses, and epilepsy); antibiotic chemotherapy; and diabetes mellitus. Many color illustrations have been included. Each unit has a set of multiple choice questions to provide feedback to students. The package was evaluated in two ways. First, a questionnaire was used to assess users' opinions of the package. Second, a validated multiple choice test on clinical pharmacology and therapeutics was administered to 24 third-year nursing students before and after a set of sessions using the package and to a control group of 28 nursing students who were not exposed to the PharmaCAL package. The package generally was well received by the nursing students. Clinical pharmacology test scores significantly improved after using the package and were significantly higher than for the control group of students. The program is a useful adjunct to the existing nursing curriculum. It also could be used in postgraduate nursing education and other health sciences.
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PMID:Development and evaluation of a computer-assisted instruction package in clinical pharmacology for nursing students. 945 93

We used data from the 1993 Italian Household Multipurpose Survey, based on a sample of 46,693 subjects ages 15 years or over, to analyze the relation between frequency of vegetable consumption and prevalence of 12 chronic diseases. We observed little association with diabetes mellitus, hypertension, and allergy. There were inverse relations between vegetable consumption and myocardial infarction [odds ratio (OR) = 0.79 for the highest tertile], angina pectoris (OR = 0.89), chronic bronchitis (OR = 0.69), bronchial asthma (OR = 0.70), peptic ulcer (OR = 0.74), gallstones (OR = 0.92), liver cirrhosis (OR = 0.71), kidney stones (OR = 0.68), and arthritis (OR = 0.84). Adjustment for alcohol and tobacco use made little difference.
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PMID:Vegetable consumption and risk of chronic disease. 950 93

Two Gallup telephone interview surveys were conducted during 1996 of 320 American primary care physicians and 1011 adults to assess their knowledge and attitudes about medical chronobiology and chronotherapeutics. Of the doctors, 88% claimed to possess at least some familiarity with the concept of chronobiology and circadian rhythms; however, many were not often able to identify correctly the time of day or night when common medical conditions and events most likely occur or worsen. Furthermore, a significant number of doctors believed that chronotherapies, special dosage forms that proportion medications during the day and night in synchrony to need with reference to 24 h patterns in the intensity of symptoms and risk of severe medical events, were already being marketed in the United States for angina pectoris, hypertension, respiratory allergies, and other medical conditions even though this was not the case at the time of the survey. On the other hand, the doctors were relatively unaware of those chronotherapies that actually did exist to treat asthma and peptic ulcer disease. American adults also lacked knowledge of temporal patterns in disease and were seldom able to identify the clock time when asthma and myocardial infarction are of greatest risk or when blood pressure is highest. Although neither the American physicians nor adults possessed knowledge of these facts, both had a strong positive attitude toward the concept of chronotherapeutics. Overall, the findings of these Gallup surveys indicate that a massive educational effort is necessary immediately to ensure new developments in medical chronobiology and chronotherapeutics are correctly comprehended and properly incorporated by physicians into clinical medicine and wisely utilized by patients.
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PMID:Knowledge and attitudes of American physicians and public about medical chronobiology and chronotherapeutics. Findings of two 1996 Gallup surveys. 970 14


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