Adverse drug reactions leading to hospitalization in children

A computerized method for the counting of polymorphonuclear leukocytes (PMN's) on chemotactic membranes is described. Through the use of an optical scanner-computer accurate objective quantification is obtained which is similar to the results generated by visual tabulation of the same membranes. Futhermore, the electronic quantification method is both less time consuming and highly reproducible.     

Psychosocial factors and the compliance with drug prescriptions in depressed patients: a clinical contribution

The present paper summarizes the results of a clinical investigation developed on 35 depressed outpatients. Several clinical and psychosocial variables were isolated with the aim of establishing which of them could be related with a premature treatment withdrawal. The results are discussed and the responsibility of psychosocial factors in treatment compliance is stressed. Personality traits, family support, and negative life events seem to be the most significant factors associated to non-adherence. In the author's opinion, these factors could be related to the treatment compliance not only in depressive disorders but also in many other medical and psychiatric diseases.     

The publication process: steps to success

In this article, the author discusses the six steps anyone can use to have a successful writing career. She outlines each step and encourages her audience to participate at each level in order to be successful. The steps are: need/desire; expertise; write; peer review; submit; acceptance and/or revise and re-submit.     

Reporting of adverse drug reactions: practice in the UK

As the range of available drugs becomes increasingly wide, it is ever more important for adverse drug reactions and interactions to be reported. With the extended role of the nurse moving closer towards nurse prescribing, this article seeks to demystify the adverse drug reactions reporting system in the UK, and explain the role of nurses.     

Smoking cessation: clinical steps to improve compliance

Smoking tobacco contributes to and exacerbates many chronic diseases of aging, including hypertension, stroke, COPD, heart disease, and atherosclerosis. It is also associated with an increased risk of peptic ulcers and of cancers of the lungs and oral cavity. Older patients generally continue to smoke because of physiologic and psychological addiction to nicotine. Nicotine administration through gum or patch eases the symptoms of nicotine withdrawal for highly-tolerant patients. Detecting and treating alcohol abuse, depression, or life stress may then make it easier to motivate the patient to quit smoking. Physician advice combined with follow-up visits and phone calls has been shown to be one of most effective methods of getting patients to stop smoking.     

Sulpiride: the best known atypical, safe neuroleptic drug. Review of literature

This is a review of literature data on a neuroleptic drug--sulpiride. Sulpiride, a benzamide derivative displays selective affinity for mesolimbic and mesocortical dopamine receptors. For this reason it is classified as an atypical antipsychotic drug. In clinical use, it causes undesirable side effects (particularly extrapyramidal, cholinolytical) less often than classical neuroleptics, does not cause sedation, and has activating and antidepressive properties. These characteristics caused that it is considered a drug of first choice in delusional psychoses with inhibition, depression, lowered activity, intensified negative or deterioration symptoms. The most serious drawback of the drug is the risk of symptoms caused by increased prolactine excretion, and increase in body weight.     

Newer anticonvulsant drugs: role of pharmacology, drug interactions and adverse reactions in drug choice

In the last few years a number of new anticonvulsants have been introduced into clinical practice mainly as add-on therapy in patients who do not become seizure-free while receiving established anticonvulsants. Up to now, no single drug has been shown to be more effective at controlling seizures of a particular type than another, so other factors such as mechanism of action, pharmacokinetics, dosage regimens or the spectrum of adverse drug reactions and interactions are used when making a choice between one agent and another. The mechanism of action of tiagabine and vigabatrin is very specific; both agents increase gamma-aminobutyric acid (GABA) levels through inhibition of reuptake and catabolism respectively. However, the mechanism of action of gabapentin is unknown and those of felbamate, lamotrigine and topiramate are not sufficiently clarified as yet, and may be multiple. Great advances have been made in improving the pharmacokinetic characteristics of these newer anticonvulsants. Gabapentin and vigabatrin exhibit relatively ideal pharmacokinetic properties as they are not bound to proteins, are excreted mostly unchanged in the urine and show linear pharmacokinetics. Lamotrigine possesses a highly variable elimination half-life depending on the co-medication. Tiagabine is highly protein bound and zonisamide shows nonlinear pharmacokinetics; both these drugs are extensively metabolised. Problematic drug interactions between newer anticonvulsants and other drugs in general occur rarely when these agents are given concomitantly. However, in common with most new drugs, there are very few data on the use of the newer anticonvulsants in women of childbearing age. Studies done so far on interactions with oral contraceptives used low anticonvulsant dosages for a very short time. The newer anticonvulsants elicit adverse reactions that, while not being unique, are particularly associated with that drug. For example, felbamate may cause aplastic anaemia and fulminant liver failure, lamotrigine is prone to cause skin rash, and oxcarbazepine may cause symptomatic hyponatraemia. Topiramate and zonisamide cause kidney stones, and vigabatrin may induce psychiatric syndromes. Although highly diverse in structure and activity, these newer drugs offer new possibilities for treating refractory epilepsy. However, since no single factor can dictate the choice of drug nor predict the success of treatment, prescribing of these rather expensive drugs has to depend upon careful consideration of the aims of treatment, the characteristics of the drug and the needs of the individual patient.     

Managing drug reactions to sulfonamides and other drugs in HIV infection: desensitization rather than rechallenge?

Drug reactions in patients with HIV infection, e.g. fever or rash, are a frequently occurring clinical problem. These side effects particularly are observed with sulfonamides; however, many other drugs have also shown to induce allergic reactions when given to patients with HIV infection. The production of hydroxylamines has been put forward as one of the explanations for these high incidence of reactions on drugs. Since sulfonamides are the first choice of therapy for the treatment and prophylaxis of Pneumocystis carinii pneumonia, several strategies have been developed to circumvent drug reactions. In general rechallenge or desensitization are recommended in literature. This article discusses the results and risks of rechallenge and desensitization with sulfonamides or other drugs, as mentioned in the literature. Furthermore preliminary results of rechallenge with a sulfonamide, which is not metabolized into hydroxylamines, are presented. From the data in the literature it is concluded that desensitization should be preferred to rechallenge.     

Reporting of adverse drug reactions by hospital doctors and the response to intervention

AIMS: In Ireland there are relatively fewer adverse drug reaction (ADR/yellow card) reports from doctors in hospital than in general practice. The aim of this study was to review the attitudes to reporting of ADRs of hospital doctors and to determine the effect of making yellow cards freely available. METHODS: A postal survey of actively practising doctors with follow-up of nonresponders was undertaken. We addressed the single most frequently claimed deterrent to reporting, unavailability of yellow cards, by making cards prominently available and placing one in patient's chart upon admission. In addition, doctors were regularly reminded that ADRs should be reported. RESULTS: Of 118 hospital based doctors, only 45% had ever reported an ADR. Fewer than 5% of pre-registration house officers had reported an ADR and the likelihood of reporting increased with seniority and was greater among physicians than surgeons. We found no evidence that doctors had published case reports in place of submitting ADR reports. Over 3 months, the greater availability of yellow cards and reminders about reporting ADRs led to an approximate five-fold increase in reports but reporting declined rapidly thereafter when verbal reminders were withdrawn, despite continued ready availability of cards suggesting that making cards available alone does not significantly increase reporting. CONCLUSIONS: This study indicates there may be more fundamental constraints to reporting than attitudinal surveys would suggest and we need to explore additional avenues to ensure a 'reporting culture'.     

Acute adverse reactions to psychoactive drugs, drug usage, and psychopathology.

Used a field survey method to examine the relationship between psychopathology and acute adverse reactions to psychoactive drugs. A paper-and-pencil measure of acute adverse reactions was developed and administered to 530 college students with drug-use experience. Acute adverse reactions were hypothesized to covary positively with regression, schizophrenia, and drug usage, and to covary negatively with adjustment and paranoia. These hypotheses were supported. The hypotheses that usage of LSD and mescaline would covary positively with regression and covary negatively with adjustment were also supported. A hypothesis that schizophrenia would positively covary with LSD and mescaline usage was not confirmed. Regression was also found to be related to marihuana usage. A recursive linear model was developed in an attempt to integrate and explain these results. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching writing to high school students: A national survey.

A random sample of language arts, social studies, and science high school teachers (N = 361; 53% women) from the United States were surveyed about what their students wrote, their use of evidence-based writing practices, the adaptations they made for weaker writers, how they assessed writing, their preparation to teach writing, beliefs about the importance of writing, and judgments about their students' writing capabilities. The findings from this survey raised some concerns about the quality of high school writing instruction. The writing activities they were assigned most frequently by teachers involved little analysis and interpretation, and almost one half of the participating teachers did not assign at least one multiparagraph writing assignment monthly. Although the majority of high school teachers did apply most of the evidence-based practices and adaptations included in the survey, they used these practices infrequently. Most teachers did not believe their college teacher education program adequately prepared them to teach writing. A sizable minority of language arts and social studies teachers indicated that their in-service preparation was inadequate too. For science teachers this was close to 60%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Avoiding the road to ethical disaster: Overcoming vulnerabilities and developing resilience.

Psychotherapists may, despite their best intentions, find themselves engaging in ethically problematic behaviors that could have been prevented. Drawing on recent research in moral psychology and longstanding community mental health approaches to prevention, we suggest that psychotherapists can reduce the likelihood of committing ethical infractions (and move in the direction of ethical excellence) by attending carefully to 4 general dimensions: the desire to facilitate positive (good) outcomes, the powerful opportunities given to professionals to effect change, personal values, and education. Each dimension can foster enhanced ethical behavior and personal resilience, but each can also contribute to ethical vulnerability. By recognizing and effectively addressing these dimensions, psychotherapists can reduce their vulnerabilities, enhance their resilience, reduce the risk of ethical infractions, and improve the quality of their work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)