Medication, allergy, and adverse drug event discrepancies in ambulatory care.

BACKGROUND AND OBJECTIVES: A first step in reducing medication errors is for health care workers to be aware of a patient's medications, allergies, and any previously documented adverse drug events (ADEs). This study sought to determine the frequency of medication and allergy/ADE-related discrepancies in a family medicine residency clinic. METHODS: Patients were contacted prior to appointments and asked to bring in prescription and over-the-counter medications. A research assistant interviewed 157 patients and recorded each drug a patient was taking, together with dosage, dosing frequency, known allergies, and demographic information. This information was then compared to similar information in the medical record. RESULTS: Overall, 97% of patients had at least one discrepancy between medications listed in the medical record and medications they were taking, and 32% had an allergy/ADE discrepancy. Discrepancies were highest for women, those with cardiovascular disease, and those hospitalized within the last year. Only the total number of medications was predictive of a discrepancy, however, accounting for 25% of the variability. CONCLUSIONS: A higher medication discrepancy rate existed in this family medicine residency clinic than the 26%--76% rate that is documented in the literature. The results point to a need for better medication, allergy, and ADE awareness.

Therapeutic options for the treatment of hypertension in children and adolescents.

Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%-5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies.

Assessing medical decision making using human patient simulation.

BACKGROUND: This pilot study describes an Objective Structured Clinical Examination (OSCE) developed using Human Patient Simulation (HPS). METHODS: Eight residents completed two iterations of this HPS OSCE containing seven stations and utilizing checklists, global ratings, and scoring sheets. RESULTS: The first- and second-year residents scored similarly with mean scores of 64/104 and 62/123, respectively. No statistical difference was noted between the resident scores. CONCLUSIONS: The HPS OSCE is feasible for small groups. A larger study will be needed to determine the effectiveness of this tool for evaluation.

Treatment of knee osteoarthritis with Orthokine-derived autologous conditioned serum.

Osteoarthritis (OA) is the most prevalent arthritis in the world with increasing numbers of people expected to acquire the disease as the population ages. Therapies commonly used to manage the disease have limited efficacy and some carry significant risks. Current data suggest that the anti-inflammatory cytokine IL-1 receptor antagonist (IL-1Ra) can alter the inflammatory response and cartilage erosion present in OA. Intra-articular gene expression of IL-1Ra has shown promising results in animal models to provide symptomatic improvement and minimize osteoarthritic changes. Orthogen AG (Dusseldorf, Germany) has developed a method to produce an autologous conditioned serum (ACS) rich in IL-1Ra marketed as Orthokine. Study participants treated with ACS have improved pain and function; however, these results are preliminary and need confirmation. If ongoing trials prove that ACS can retard cartilage degeneration and reduce inflammation, the management of OA would be dramatically altered, perhaps providing a mechanism to prevent the disease or at least its progression.

Glucosamine/chondroitin/primorine combination therapy for osteoarthritis.

Osteoarthritis (OA) is the most common arthritis affecting the aging population. This degenerative disease can cause significant pain and functional disability in affected individuals. Despite advances in the retardation of rheumatoid arthritis with disease-modifying agents, comparable oral agents have been relatively unavailable for OA. The mainstays of therapy continue to be acetaminophen and nonsteroidal antiinflammatory medications to manage symptoms. Unfortunately, these medications can precipitate severe adverse events in some patients or may be contraindicated, leaving few choices remaining to control pain and suffering. Glucosamine sulfate and chondroitin sulfate have been evaluated in many studies as agents to relieve pain, improve functional activity, and slow disease progression in OA especially of the hip and knee. Studies have reported conflicting results regarding improvement in the pain and disability associated with OA with the use of glucosamine and chondroitin as single agents; however, when improvement has been demonstrated, the formulation has primarily been glucosamine sulfate combined with chondroitin sulfate. Recently, as a result of information implicating the role of reactive oxygen species and oxidative cellular stress reactions on the onset of neurodegenerative and inflammatory disorders, it has been theorized that medications that could control or alter these reactions might improve or prevent the onset of these conditions. Primorine is a combination of products thought to alter these biochemical oxidative byproducts. Based on current evidence, the use of a combination product of glucosamine sulfate and chondroitin sulfate seems to have the greatest potential as a therapeutic intervention for patients at increased risk from the adverse events of accepted current oral therapies. The use of primorine and its combination of products as an intervention in OA has theoretical advantages but its benefits are unproven. A new product, relamine, is a combination of these three formulations. While no studies have evaluated glucosamine sulfate, chondroitin sulfate and primorine in a single product, it may be an option for those who wish to try an alternate therapy for OA, as there appears to be a low risk for serious adverse events.

Glucosamine hydrochloride for the treatment of osteoarthritis symptoms.

Osteoarthritis is the most common arthritis in the world. It affects millions of people with age being the greatest risk factor for developing the disease. The burden of disease will worsen with the aging of the world's population. The disease causes pain and functional disability. The direct costs of osteoarthritis include hospital and physician visits, medications, and assistive services. The indirect costs include work absences and lost wages. Many studies have sought to find a therapy to relieve pain and reduce disability. Glucosamine hydrochloride (HCl) is one of these therapies. There are limited studies of glucosamine HCl in humans. Although some subjects do report statistically significant improvement in pain and function from products combining glucosamine HCl and other agents, glucosamine HCl by itself appears to offer little benefit to those suffering from osteoarthritis.