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A Review of Risperidone Long Acting Injection in Schizophrenia Spectrum Illnesses:
Evaluating Outcomes Compared to First Generation Depot Treatments.
Laura Lammers, BScPharm; Bree Zehm, PharmD; Richard Williams, MD, FRCPsych.
Introduction
Results
Results
Schizophrenia is a chronic, progressively debilitating illness with no cure; Figure 1: Kaplan Meier survival curve of time to treatment discontinuation
the mainstay of therapy is antipsychotic medication. Figure 3: Incidence of Extra Pyramidal Symptoms (EPS)
Many studies have demonstrated that poor adherence to medications is a primary contributor to relapse in schizophrenia. For patients who have shown First generation antipsychotic depot injections (FGAI) or typicals include: flupenthixol decanoate, zuclopenthixol decanoate, fluphenazine decanoate, haloperidol decanoate, and pipotiazine palmitate. FGAI treat the positive symptoms of schizophrenia (hallucinations, delusions and disorganized speech or behaviour), but have no benefits in improving negative symptoms (alogia, anhedonia, affective flattening, and avolition) or cognition. Often the main drawback of these agents is the risk of extra pyramidal symptoms (EPS) and P < 0.001
injection (RLAI) is the only one available in depot form. Atypical antipsychotics Discussion
treat the positive symptoms and are reported to have fewer motor side effects than typical agents. In addition, they may also reduce negative symptoms and – No statistically significant differences were seen for the primary outcomes of time to discontinuation or hospitalization (P value > 0.05) – The significant finding was the proportion with EPS in the FGAI group → there was 3X the incidence of EPS with FGAI as compared to RLAI Objectives
Figure 2: Kaplan Meier survival curve of time to hospitalization
– RLAI is 19X more expensive than FGAI (based on cost of medication) → a more comprehensive cost analysis is necessary to fully evaluate Primary objectives
differences between treatments in overall economic burden – Cox proportional hazards modeling resulted in no significant predictors - Determine the time to discontinuation and the time to hospitalization for patients receiving risperidone long acting injection (RLAI) as compared to first generation depot antipsychotic injections (FGAI) – Predictors analyzed were: depot antipsychotic, age, gender, Secondary objectives
– A subgroup analysis of those on mono depot therapy was conducted as ~35% of patients were taking additional oral antipsychotics - Determine the use of concomitant medications (additional antipsychotics, → similar results to the total study population were found anticholinergics, mood stabilizers, antidepressants, and benzodiazepines) – Groups had similar characteristics for age (41 years) and gender (63% - Determine the incidence of side effects, including TD and EPS male), however time since diagnosis was 3.75 years longer in FGAI - Conduct a direct drug cost comparison of RLAI and FGAI acquisition – Retrospective review → limited by available data– Limited to current patients of the PMC → patients on depots who had an event and are no longer on depot injections were Methods
– There are a limited number of patients who have been exposed - Single center → Victoria Mental Health Centre, Partnership Medication Clinic to RLAI for a significant duration (drug is relatively new to the - Retrospective chart review of all active outpatients → sample size calculation Table 1: Summary of Primary & Secondary Outcomes
market), thus many may not have had significant exposure to Hospitalization
– The event rates for discontinuation and hospitalization were Inclusion Criteria
small, and the sample size available was limited, therefore - Individuals with a DSM IV diagnosis of Schizophrenia, Schizophreniform power may be insufficient to detect significant differences Discontinuation
- Have received at least 3 injections of depot antipsychotic Abnormal Movement Assessments
Exclusion Criteria
Conclusions
- Prior clozapine trial (considered treatment resistant) Concomitant Medications
There is insufficient evidence to demonstrate differences in discontinuation or hospitalization with RLAI as compared to FGAI. RLAI resulted in decreased incidence of EPS, but the direct cost of Statistical Analysis
- Pearson chi square and Fisher’s exact tests performed for categorical variables - Student’s t-test performed for parametric variables Side Effects
The results of this review are hypothesis generating; a larger - KS-test performed for non-parametric variables study is needed to determine if outcomes are improved with RLAI - Cox proportional hazards modeling performed to determine if any baseline Cost Analysis
characteristics were predictors of the primary outcomes

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