scholarly journals Canadian Expert Panel Recommendations on the Management of CNS Symptoms Related to Efavirenz

2001 ◽  
Vol 12 (suppl c) ◽  
pp. 20C-30C ◽  
Author(s):  
M John Gill ◽  
Anita Rachlis ◽  
Sharon Walmsley ◽  
Mark Halman ◽  
The Efavirenz Consensus Working Group
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Health Care Providers ◽  
Highly Active Antiretroviral Therapy ◽  
Primary Care Physicians ◽  
Sleep Disturbances ◽  
Present Report ◽  
Management Strategies ◽  
Routine Practice ◽  
Care Providers

Efavirenz is a potent antiretroviral agent used in combination with other antiretroviral agents as part of highly active antiretroviral therapy. Efavirenz is generally well tolerated because the majority of its adverse effects are self-limiting, with central nervous symptoms and rash being the most frequent. In routine practice, the discontinuation rate of efavirenz due to adverse effects appears higher than that described in clinical trials. To minimize early treatment interruption and maximize the benefit of long term viral suppression that can be achieved with efavirenz therapy, health care providers and patients have identified that there is a need for information, education about and practical tools for the management of efavirenz-related side effects. To this end, a panel of experts in the care of HIV patients consisting of primary care physicians, infectious disease specialists, psychiatrists and pharmacists was convened. Through the evaluation of current literature and discussion among the group, the panel arrived at consensus recommendations. The present report outlines general management recommendations that apply to adverse effects related to efavirenz initiation, as well as specific management strategies for central nervous system symptoms such as agitation, sleep disturbances, dreams, dizziness, impaired concentration and depression. It is hoped that these practical recommendations will aid clinicians in minimizing and improving patient tolerance of side effects, thereby achieving improved adherence and patient outcomes.

scholarly journals The Adverse Effect Reporting for the Most Commonly Used Antibiotics

2020 ◽  
pp. 22-28
Author(s):  
Nehad J. Ahmed ◽  
Mohammed I. Fouda ◽  
Dina I. Fouda ◽  
Ahmed I. Foudah
Keyword(s):  
Saudi Arabia ◽  
Side Effects ◽  
Adverse Effects ◽  
Health Care Providers ◽  
Allergic Reactions ◽  
Care Providers ◽  
Drug Reactions ◽  
Antibiotic Drugs ◽  
Pharmacovigilance Center ◽  
Gastrointestinal Side Effects

Aim: Antibiotics save lives, but the excess use of antibiotics leads to more side effects. Patients benefit from medications but also complain about their adverse effects. This study aims to explore the reports of the adverse effects for the most commonly used antibiotics in Saudi Arabia. Methodology: The Data regarding the adverse events reports were collected from The National Pharmacovigilance Center in Saudi Arabia. The data include the major allergic reactions and gastrointestinal side effects for the most commonly used antibiotic classes. Results: The total number of allergic and gastrointestinal adverse effects in 2017 and 2018 for the included antibiotic drugs is 583 reports. The majority of the reports were for penicillin antibiotics (39.96) particularly Amoxicillin/Clavunate. Conclusion: The most common adverse effects of antibiotics are allergic and gastrointestinal effects. It is important to report any adverse drug reactions either by health care providers or patients to the Saudi Pharmacovigilance Center.

Risks of Cardiovascular Disease and Beyond in Prescription of Nonsteroidal Anti-Inflammatory Drugs

2019 ◽  
Vol 25 (1) ◽  
pp. 3-6 ◽  
Author(s):  
Manas A. Rane ◽  
Alexander Gitin ◽  
Benjamin Fiedler ◽  
Lawrence Fiedler ◽  
Charles H. Hennekens
Keyword(s):  
Cardiovascular Disease ◽  
Side Effects ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Care Providers ◽  
Relieve Pain ◽  
Gastrointestinal Side Effects ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, naproxen, diclofenac, and ibuprofen, as well as selective cyclooxygenase 2 inhibitors such as celecoxib. Their use is common, as well as their side effects which cause 100 000 hospitalizations and 17 000 deaths annually. Recently, the US Food and Drug Administration strengthened its warning about the risks of cardiovascular disease (CVD) attributed to nonaspirin NSAIDs. Methods: When the sample size is large, randomization provides control of confounding not possible to achieve with any observational study. Further, observational studies and, especially, claims data have inherent confounding by indication larger than the small to moderate effects being sought. Results: While trials are necessary, they must be of sufficient size and duration and achieve high compliance and follow-up. Until then, clinicians should remain uncertain about benefits and risks of these drugs. Conclusions: Since the totality of evidence remains incomplete, health-care providers should consider all these aforementioned benefits and risks, both CVD and beyond, in deciding whether and, if so, which, NSAID to prescribe. The factors in the decision of whether and, if so, which NSAID to prescribe for relief of pain from inflammatory arthritis should not be limited to risks of CVD or gastrointestinal side effects but should also include potential benefits including improvements in overall quality of life resulting from decreases in pain or impairment from musculoskeletal pain syndromes. The judicious individual clinical decision-making about the prescription of NSAIDs to relieve pain based on all these considerations has the potential to do much more good than harm.

The Use of and Attitude Towards Telehealth in Rural Communities

2007 ◽  
Vol 13 (3) ◽  
pp. 29 ◽  
Author(s):  
Emily Mauldon
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Routine Practice ◽  
Care Providers ◽  
Urban Hospital ◽  
Primary Health ◽  
The Impact ◽  
Rural Patients

This paper reports on the attitudes of a sample of health care providers towards the use of telehealth to support rural patients and integrate rural primary health and urban hospital care. Telehealth and other information technologies hold the promise of improving the quality of care for people in rural and remote areas and for supporting rural primary health care providers. While seemingly beneficial for rural patients, study participants believed that telehealth remains underused and poorly integrated into their practice. In general, participants thought that telehealth is potentially beneficial but places constraints on their activities, and few actually used it. Published literature usually reports either on the success of telehealth pilot projects or initiatives that are well resourced and do not reflect the constraints of routine practice, or has an international focus limiting its relevance to the Australian context. Because of the paucity of systematic and generalisable research into the effects of the routine use of telehealth to support rural patients, it is unclear why health care professionals choose to provide such services or the costs and benefits they incur in doing so. Research and policy initiatives continue to be needed to identify the impact of telehealth within the context of Australian primary health care and to develop strategies to support its use.

Risk factors for glaucoma: what do they really mean?

2011 ◽  
Vol 17 (3) ◽  
pp. 233 ◽  
Author(s):  
Anthea Worley ◽  
Karen Grimmer-Somers
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Risk Factor ◽  
Health Care Providers ◽  
Management Strategies ◽  
Care Providers ◽  
Reference Guide ◽  
Future Assessment ◽  
Primary Health Care Providers ◽  
Patient’S History

Glaucoma is an insidious eye disease, potentially putting 4% of older Australians at risk of blindness, unless detected sufficiently early for initiation of effective treatment. This paper reports on the strengths of evidence and glaucoma risk factors that can be identified by primary health care providers from a patient’s history. A comprehensive search of peer-reviewed databases identified relevant secondary evidence published between 2002 and 2007. Risk factors that could be determined from a patient’s history were identified. A novel glaucoma risk factor reference guide was constructed according to evidence strength and level of concern regarding risk of developing glaucoma. The evidence is strong and consistent regarding the risk of developing glaucoma, and elevated intraocular pressure, advancing age, non-Caucasian ethnicity and family history of glaucoma. There is moderate evidence of association with glaucoma, and migraine, eye injury, myopia and long-term use of corticosteroids. There is conflicting evidence for living in a rural location, high blood pressure, diabetes and smoking. Early detection of people at risk of developing glaucoma can be initiated using our risk factor guide coupled with a comprehensive patient history. Timely future assessment and subsequent management strategies for at-risk individuals can then be effectively and efficiently actioned.

Effect of Sleep Disturbances on Blood Pressure

Hypertension ◽  
2021 ◽  
Author(s):  
Nour Makarem ◽  
Carmela Alcántara ◽  
Natasha Williams ◽  
Natalie A. Bello ◽  
Marwah Abdalla
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Shift Work ◽  
Health Care Providers ◽  
Sleep Disturbances ◽  
Care Providers ◽  
Short Sleep ◽  
Hypertension Risk ◽  
Obstructive Sleep

This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Observational studies demonstrate that subjectively assessed short sleep increases hypertension risk, though conflicting results are observed in studies of objectively assessed short sleep. Intervention studies demonstrate that mild and severe sleep restriction are associated with higher BP. Rotating and night shift work are associated with hypertension as shift work may exacerbate the detrimental impact of short sleep on BP. Further, studies demonstrate that shift work may increase nighttime BP and reduce BP control in patients with hypertension. Finally, moderate to severe obstructive sleep apnea is associated with hypertension, particularly resistant hypertension. Obstructive sleep apnea is also associated with abnormal 24-hour ambulatory BP profiles, including higher daytime and nighttime BP, nondipping BP, and a higher morning surge. Continuous positive airway pressure treatment may lower BP and improve BP dipping. In conclusion, efforts should be made to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.

Integrative Sleep Medicine

2021 ◽  
Keyword(s):  
Circadian Rhythm ◽  
Sleep Disorders ◽  
Health Care Providers ◽  
Sleep Disturbances ◽  
Well Being ◽  
Sleep Medicine ◽  
Whole Body ◽  
Care Providers ◽  
Obstructive Sleep ◽  
The Many

Sleep is one of the key underpinnings of human health, yet sleep disturbances and impaired sleep are rampant in modern life. Healthy sleep is a whole-body process impacted by circadian rhythm, daily activities, and emotional well-being, among others. When properly aligned, these work in concert to produce restorative and refreshing sleep. When not in balance, however, sleep disorders result. Yet too often, the approach to treatment of sleep disorders is compartmentalized, failing to recognize all of the complex interactions that are involved. This text offers a comprehensive approach to sleep and sleep disorders by delineating the many factors that interplay into healthy sleep. Health care providers can learn how to better manage their patients with sleep disorders by integrating complementary and conventional approaches. Using an evidence-based approach throughout, this book describes the basics of normal sleep then delves into the foundations of integrative sleep medicine, including the circadian rhythm, mind/body-sleep connection, light, dreaming, the gastrointestinal system, and botanicals/supplements. Specific sleep issues and disorders are then addressed from an integrative perspective, including insomnia, obstructive sleep apnea, sleep related movement disorders, and parasomnias.

scholarly journals Assessment of Females Awareness in Saudi Arabia about Long term use of COCP and Venous Thromboembolism Risk: A Cross Sectional Study

2021 ◽  
Vol 6 (01) ◽  
pp. 62-66
Author(s):  
Basmah Mohammed Alazmi ◽  
Shaikha Sulayyem Alsharari ◽  
Razan motawkel ◽  
Sara Alzahrani ◽  
Anhar Alfateel ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Side Effects ◽  
Sample Size ◽  
Health Care Providers ◽  
Cross Sectional Study ◽  
University Education ◽  
Care Providers ◽  
Sectional Study ◽  
Cross Sectional ◽  
Study Participants

Background: Nowadays there are a lot of women using contraceptive oral combined pills for birth control and as we know VTE is one of the complications when it used for a long time, and here in this study our aim is to assess the awareness and knowledge of females who live in Saudi Arabia about COCP and its complications like VTE. A cross-sectional observational study based on a questionnaire conducted among females who live in Saudi Arabia. Data collection was done by using online survey which contains questions about the age, education and contraception. Methods: An observational cross-sectional study carried out during December 2020 in Saudi Arabia. We minimize our target population through inclusion criteria: 1- Female 2- Live in Saudi Arabia 3- Agree to participate. Sample size was 454 participants calculated by using survey system website through sample size calculator with Confidence Level 95% and margin of error 5%. Result: A total of 454 patients completed the survey questionnaire. The results showed that the vast majority of the study participants aged 20 years or more. Moreover, more than 90% of the study participants were Saudi females. The average body weight is around 95 kg and height 164.2 cm. The results also indicated that two-third of the study participants attained university education level compared to 16.1% obtained secondary education. Additionally, 36.6% of the study participants worked as a housewife, 18.1% working in health field. Moreover, 40% of the respondents reside in the western regions, 34% live in eastern regions compared to the lowest percentage in South region 3.3%. Conclusion: In summary, this study revealed that the internet was the main source of knowledge. Health care providers should perform their intended role in improving the female’s awareness regarding family planning. The criteria for preferable contraceptive method are that it has few or no side effects, also it depends on how much effective and convenient it is. Educational programs may be warranted to minimize the fear of side effects and to enhance the general knowledge about contraception.

scholarly journals IUCD-Related Knowledge, Attitudes and Practice among Primary Health Care Providers in Oman: Areas for Improvement

2020 ◽  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Side Effects ◽  
Health Care Providers ◽  
Factual Knowledge ◽  
Care Providers ◽  
Primary Health ◽  
Attitude And Practice ◽  
Primary Health Care Providers ◽  
Knowledge Attitude And Practice

Objectives: The primary objective of this study is to assess three domains - the knowledge, attitude and practice related to the Intrauterine Contraceptive Device (IUCD) among primary health care providers (physicians and nurses) in Oman. The secondary objective is to compare the IUCD-related knowledge, attitude and practice of health care providers in primary health care between physicians and nurses. Methods: A descriptive cross-sectional survey was conducted in primary health care centers in Muscat region of Oman from May, 2014 until September, 2015. The survey was a self-administered questionnaire contained questions to assess factual knowledge, attitudes and practice of IUCD. The questionnaire was distributed to female health care providers only. Data was collected by researchers and analyzed using SPSS version 20. Results: Total 269 primary health care providers completed the questionnaire. 109 (40.52%) participants had good and 131 (48.70%) had average actual knowledge related to IUCD. The main reasons providers cited for not recommending the IUCD were concerns about the side effects; 174 (64.68%) mentioned that it causes bleeding and 127 (47.21%) reported that it needs service provider. Only 140 (52.43%) of the providers would routinely recommend IUCD to their clients. Conclusion: Future educational programs for health care providers should address the educational needs in the identified areas including misconceptions with regards to IUCD failure rate and side effects. Future training programs are also required to increase the technical competence of insertion and confidence in handling the side effects of IUCD.

Current Practices of Antiseptic Use in Canadian Neonatal Intensive Care Units

2018 ◽  
Vol 36 (02) ◽  
pp. 141-147 ◽  
Author(s):  
Helen McCord ◽  
Elise Fieldhouse ◽  
Walid El-Naggar
Keyword(s):  
Intensive Care ◽  
Adverse Effects ◽  
Intensive Care Units ◽  
Health Care Providers ◽  
Neonatal Intensive Care ◽  
Chlorhexidine Gluconate ◽  
Neonatal Intensive Care Units ◽  
Care Providers ◽  
Level Ii ◽  
Canadian Provinces

Objective This article assesses the degree of variability in the current practice of skin antiseptics used in Canadian neonatal intensive care units (NICUs) and different experiences related to each antiseptic used. Methods An anonymous survey was distributed to a clinical representative of each of the 124 Canadian level II and level III NICUs. Results One hundred and two respondents (82.2%), representing all Canadian provinces, completed the survey. Chlorhexidine gluconate with/without alcohol was the antiseptic most used (96%) and the antiseptic with the highest reported adverse effects (68% reported skin burns/breakdown). Other antiseptics used include povidone-iodine (35%) and isopropyl alcohol (22%). Specific guidelines for antiseptic use were available in only 50% of the units with many NICUs lacking gestational and/or chronological age restrictions. Only 23% of responders believed that there was awareness among health care providers of the adverse effects of antiseptics used. Less than half (43%) were completely satisfied with the antiseptics used in their units. Conclusion Chlorhexidine gluconate is the most commonly used antiseptic in Canadian NICUs. The high number of associated adverse effects and the lack of guidelines regulating antiseptic use are of concern. Large clinical trials are urgently needed to guide practice and improve the safety of antiseptics.

scholarly journals Risk Perception and Worries among Health Care Workers in the COVID-19 Pandemic: Findings from an Italian Survey

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 535
Author(s):  
Mariangela Valentina Puci ◽  
Guido Nosari ◽  
Federica Loi ◽  
Giulia Virginia Puci ◽  
Cristina Montomoli ◽  
...  
Keyword(s):  
Health Care ◽  
Risk Perception ◽  
Health Care Providers ◽  
Health Care Workers ◽  
Health Care Professionals ◽  
Sleep Disturbances ◽  
Well Being ◽  
Care Providers ◽  
Cross Sectional ◽  
Care Workers

The ongoing pandemic scenario, due to the coronavirus disease 2019 (COVID-19), has had a considerable impact on public health all over the world. Italy was one of the most affected countries, as the first European full-blown outbreak occurred there. The exposure of the Italian health care workers to COVID-19 may be an important risk factor for psychological distress. The aim of this cross-sectional study was to describe worries and risk perception of being infected among Italian Health Care Workers (HCWs) during the first wave of the pandemic. In total, 2078 HCWs participated in a web survey (78.8% were females). The highest percentage of respondents were physicians (40.75%) and nurses (32.15%), followed by medical (18.00%), health care support (4.50%) and administrative (4.60%) staff. In a score range between 0 (not worried) and 4 (very worried), our results showed that participants declared that they were worried about the Coronavirus infection with a median score of 3 (IQR 2-3) and for 59.19% the risk perception of being infected was very high. In addition, HCWs reported they suffered from sleep disturbances (63.43%). From the analysis of the psychological aspect, a possible divergence emerged between the perceived need for psychological support (83.85%) and the relative lack of this service among health care providers emerged (9.38%). Our findings highlight the importance of psychological and psychiatric support services not only during the COVID-19 pandemic, but also in other emerging infectious diseases (EIDs) scenarios. These services may be useful for health authorities and policymakers to ensure the psychological well-being of health care professionals and to promote precautionary behaviors among them.

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