What factors must be considered in ‘return to school’ following concussion and what strategies or accommodations should be followed? A systematic review

ObjectiveTo evaluate the evidence regarding (1) factors affecting return to school (RTS) and (2) strategies/accommodations for RTS following a sport-related concussion (SRC) in children and adolescents.DesignA systematic review of original studies specifically addressing RTS following concussion in the paediatric and sporting context.Data sourcesMEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid) electronic databases and the grey literature OpenGrey, ClinicalTrials.gov and Google Advanced.Eligibility criteriaStudies were included if they were original research on RTS following SRC in children aged 5–18 years published in English between 1985 and 2017.ResultsA total of 180 articles were identified; 17 articles met inclusion criteria. Several factors should be considered for RTS after concussion, including: symptomatology; rest following injury; age/grade; and course load. On RTS after concussion, 17%–73% of students were provided academic accommodations or experienced difficulty with RTS. Students were more likely to obtain academic accommodations in schools with a concussion policy if they had a medical RTS letter and had regular medical follow-up after concussion.ConclusionsSchools should have a concussion policy and offer individualised academic accommodations to students recovering from SRC on RTS; a medical letter should be provided to facilitate provision/receipt of academic accommodations; students should have early, regular medical follow-up following SRC to help with RTS and monitor recovery; students may require temporary absence from school after SRC; clinicians should assess risk factors/modifiers that may prolong recovery and require more intensive academic accommodations.PROSPERO registration numberCRD42016039184.

Testosteron bei älteren Männern

Der amerikanische "Medical Letter" kommt in einer neueren Publikation zum Schluss, dass die Sicherheit einer Testosteron-Substitution bei älteren Männern weiterhin unklar ist. Damit sind die 2009 in unserer Zeitschrift veröffentlichten Aussagen weiterhin gültig, nämlich dass weder der Nutzen klar erwiesen noch mögliche Risiken zuverlässig ausgeschlossen sind.

Behandlung des Reizdarmsyndroms

Die verschiedenen Formen des Reizdarm-Syndroms sind nicht einfach zu behandeln. Oft sind Medikamente nicht sehr wirksam. Primär empfiehlt sich der Versuch, mit gezielten diätetischen Massnahmen eine Besserung herbeizuführen. Im "Medical Letter on Drugs and Therapeutics" ist eine Übersicht zum Reizdarm-Syndrom erschienen, die hier zusammengefasst wird.

Consequências da Polifarmacoterapia em Idosa Vestibulopata

<p>A polifarmacoterapia para tratamento de múltiplas doenças é uma realidade na população idosa. O objetivo deste trabalho foi avaliar as consequências do uso de múltiplos fármacos em idosa com vestibulopatia. O estudo foi previamente aprovado pelo Comitê de Ética em Pesquisa (Protocolo 475.835/2013) e realizado com base em informações de idosa de 64 anos, com labirintopatia vascular e queixas de tontura, zumbido e desequilíbrio, além de relato de queda. A idosa é hipertensa, apresenta insuficiência arterial e venosa crônica, aterosclerose de artérias coronárias e hérnia discal lombar. Passou por cateterismo e angioplastia. Faz uso contínuo e concomitante de nove medicamentos, cada um contendo apenas um fármaco, a saber: Captopril, Propranolol, Hidroclorotiazida, Ácido acetilsalicílico, Pravastatina, Bezafibrato, Meloxicam, Omeprazol e Hidróxido de alumínio. Os fármacos foram classificados pela Anatomical Therapeutic Chemical (ATC) e as interações analisadas pelo The Medical Letter Drug Interactions Program. Todos os fármacos fizeram algum tipo de interação, com exceção do Bezafibrato, que não pôde ser analisado. As principais consequências das diferentes interações foram: diminuição do efeito anti-hipertensivo e diurético (em diferentes interações); redução do efeito hipotensor (em diferentes interações); bloqueio do efeito terapêutico do Ácido acetilsalicílico sobre a mortalidade após infarto do miocárdio; piora da insuficiência cardíaca congestiva; arritmias cardíacas; aumento do risco de insuficiência renal; indução e agravamento da insuficiência renal (provável efeito aditivo); hiponatremia; hipotensão; maior risco de toxicidade gastrintestinal; possível toxicidade do Ácido acetilsalicílico; aumento do efeito hiperglicêmico da Hidroclorotiazida; redução da absorção e do efeito do Captopril, Propranolol e Ácido acetilsalicílico. A polifarmacoterapia utilizada resultou em diferentes interações medicamentosas, cujas consequências farmacológicas podem ter repercussões clínicas importantes para a saúde desta idosa e de outros idosos que utilizam as mesmas medicações, sobretudo os que apresentam vestibulopatias.</p>

Chronisch-entzündliche Darmkrankheiten

Wie eine Zusammenfassung eines Textes aus dem «Medical Letter on Drugs and Therapeutics» zeigt, hat sich gegenüber unserer im Jahr 2003 veröffentlichten Übersicht zur Therapie der chronisch-entzündlichen Darmkrankheiten nicht sehr viel geändert. Nach wie vor sollen vor dem Einsatz von TNF-alpha-Hemmern die «konventionellen» Therapieoptionen (Aminosalizylate, Kortikosteroide, Immunsuppressiva) optimal ausgenützt werden.

DRUG-DRUG INTERACTIONS;

Introduction: This research paper is based on a study conducted on the in-doorpatients at a teaching hospital in Gujrat, Pakistan, in order to check for the frequency with whichPenicillins, Quinolones and Cephalosporins are being used together and in combinations withother drugs and the drug-drug interactions that occur due to these combinations and theirimpacts on the patients. Objectives: (1) To check the frequency with which Penicillins,Quinolone and Cephalosporins are being used in different combinations in patients. (2) Todetermine their drug-drug interactions. (3) Impact on patients due to these interactions. (4)Reasons for prescription of mismatched combinations by clinicians. Study Design: 270 randomprescriptions were collected from different wards of DHQ hospital, Gujrat. These prescriptionswere then analyzed for drug interactions among the above mentioned group of drugs, with thehelp of soft ware program named The Medical Letter Adverse Drug Interaction Program. Setting:Aziz Bhatti Shaheed Hospital (DHQ), Gujrat , Pakistan. Period: Prescriptions were collected overthe period of 3 months. Conclusions: Prescribing antibiotics for different indications in indoorpatients is unavoidable. However, it is the duty of the clinician to monitor the patient when he isusing two or more drugs together. This study recommends the use of drug-drug interactiondetecting software in hospitals, so that, the level of patients’ safety may be enhanced.

CORTICOSTERIOD;

Introduction: Indoor patients in hospitals frequently use corticosteriods for different indications. As the number of drugs inprescriptions increases, the risk of drug-drug interactions increases. This study deals with the frequent use and drug-drug ofcorticosteriods. Objective: The present study was designed to determine the frequency of use of corticosteriods in indoor patients andthe resulting drug-drug interactions. Study design: 270 Prescriptions of indoor patients from different wards of Aziz Bhatti Shahidteaching hospital Gujrat were collected randomly over the period of three months. These prescriptions were subjected to a drug-druginteraction software based analysis. The results were collected analysed and presented in the form of tables. Period: The patient chartscontaining prescriptions included in this study were collected over the period of three months. Material and Method: The software namedTHE MEDICAL LETTER ADVERSE DRUG INTERACTION PROGRAM was selected for finding the drug-drug interactions in randomlyselected indoor patient charts. Moreover, the frequency of use of corticosteriods was determined by simply counting the prescriptionscontaining corticosteriods out of total prescriptions and its percentage was found. Results: 29.25% patient charts were includingcorticosteriods in their prescriptions. Percentage of corticosteriod drug interactions found was 25.55%. Conclusions: Frequent use ofcorticosteriods in indoor patients can increase the risk of drug-drug interactions that should be monitored regularly.

POSSIBLE TOXIC EFFECTS OF BENZODIAZEPINES;

Introduction: Benzodiazepines and its derivatives are used widely as anxiolytics, hypnotics, seizure control and as musclerelaxants. Design: The prescriptions of 270 patients were evaluated for moderate to severe drug interactions using drug interactiondetection software. Setting: Teaching hospital in Gujrat, Pakistan. Objective: This study is used to evaluate the possible toxic effects ofbenzodiazepine related drug-drug interactions in prescriptions of indoor patients. Material & Methods: The prescriptions wereprocessed through a software program named, The Medical Letter Adverse Drug Interaction program. The randomly collected patientchart profiles included both male and female patients ranging from age of few months old children to old aged patients. Result: Out of 270patients medication charts 210 medication charts were having at least one or more drug interactions ranging from moderate to severe.Out of 80 interacting drug combinations found, 15 were benzodiazepine related drug interactions. So, percentage of benzodiazepinesrelated drug interactions was 18.75%.Moreover, the data also showed that the percentage of DDIs increases as the prescription sizeincreases. Our results indicate that hospitalized patients in Pakistan are at risk of ADRs caused by potential DDIs. Moreover, there arechances that the safe therapeutic doses of benzodiazepines may become toxic or ineffective due to drug-drug interactions andpolypharmacy. Conclusions: So, the use of DDIs detection software programs in hospitals and pharmacies should be promoted in orderto minimize drugs especially benzodiazepines related injuries and to ensure patient safety.

Drug Interactions in Palliative Care

PURPOSE: This review of drug interactions in palliative care examines the relevant literature in this area and summarizes the information on interactions of drugs, nutrients, and natural products that are used in the palliative care setting. Particular emphasis is placed on describing the newer information on the cytochrome P450 (CYP) system and the interactions of opioids, antidepressants, and the antitussive, dextromethorphan. METHODS: We performed a search of the MEDLINE database of the time period from 1966 until April 1998, using medical subject headings such as the names of selective serotonin reuptake inhibitors and other relevant medications in palliative care. Literature reviewed included both human and animal articles as well as non-English literature. Bibliographies of these articles and the personal libraries of several palliative care specialists were reviewed. Software developed by The Medical Letter—The Drug Interaction Program was also used. RESULTS: Drug interactions can be categorized in several ways. Drug-drug interactions are the most well known and can be kinetic, dynamic, or pharmaceutical. Pharmacokinetic interactions can involve CYP 2D6, which acts on drugs such as codeine and is responsible for its conversion to morphine. Poor metabolizers, either genotypic or due to phenocopying, are at risk for undertreatment if not recognized. Pharmacodynamic interactions with dextromethorphan may produce serotonin syndrome. CONCLUSION: Drug interactions are important in palliative care as in other aspects of medicine. These interactions are similar to those seen in other areas of medical care but have significant consequences in pain management. Failure to recognize these interactions can lead to either overdosing or undertreatment.