Randomized controlled trial of postoperative belladonna and opium rectal suppositories in vaginal surgery.

BACKGROUND: After vaginal surgery, oral and parenteral narcotics are used commonly for pain relief, and their use may exacerbate the incidence of sedation, nausea, and vomiting, which ultimately delays convalescence. Previous studies have demonstrated that rectal analgesia after surgery results in lower pain scores and less intravenous morphine consumption. Belladonna and opium rectal suppositories may be used to relieve pain and minimize side effects; however, their efficacy has not been confirmed. OBJECTIVE: We aimed to evaluate the use of belladonna and opium suppositories for pain reduction in vaginal surgery. MATERIALS AND METHODS: A prospective, randomized, double-blind, placebo-controlled trial that used belladonna and opium suppositories after inpatient or outpatient vaginal surgery was conducted. Vaginal surgery was defined as (1) vaginal hysterectomy with uterosacral ligament suspension or (2) posthysterectomy prolapse repair that included uterosacral ligament suspension and/or colporrhaphy. Belladonna and opium 16A (16.2/60 mg) or placebo suppositories were administered rectally immediately after surgery and every 8 hours for a total of 3 doses. Patient-reported pain data were collected with the use of a visual analog scale (at 2, 4, 12, and 20 hours postoperatively. Opiate use was measured and converted into parenteral morphine equivalents. The primary outcome was pain, and secondary outcomes included pain medication, antiemetic medication, and a quality of recovery questionnaire. Adverse effects were surveyed at 24 hours and 7 days. Concomitant procedures for urinary incontinence or pelvic organ prolapse did not preclude enrollment. RESULTS: Ninety women were randomly assigned consecutively at a single institution under the care of a fellowship-trained surgeon group. Demographics did not differ among the groups with mean age of 55 years, procedure time of 97 minutes, and prolapse at 51%. Postoperative pain scores were equivalent among both groups at each time interval. The belladonna and opium group used a mean of 57 mg morphine compared with 66 mg for placebo (P=.43) in 24 hours. Patient satisfaction with recovery was similar (P=.59). Antiemetic and ketorolac use were comparable among groups. Subgroup analyses of patients with prolapse and patients <50 years old did not reveal differences in pain scores. The use of belladonna and opium suppositories was uncomplicated, and adverse effects, which included constipation and urinary retention, were similar among groups. CONCLUSION: Belladonna and opium suppositories are safe for use after vaginal surgery. Belladonna and opium suppositories did not reveal lower pain or substantially lower narcotic use. Further investigation may be warranted to identify a population that may benefit optimally from belladonna and opium use.

A longitudinal comparison of drug use among 10-year-old children and 15-year-old adolescents from the German GINIplus and LISAplus birth cohorts.

PURPOSE: The purpose of this study was to compare longitudinal data on drug utilization between 10-year-old children and 15-year-old adolescents and to analyse the association of drug use at the age of 15 years with drug use at the age of 10 years. METHODS: Based on the German GINIplus (German infant study on the Influence of Nutrition Intervention plus environmental and genetic influences on allergy development) and LISAplus (Influence of lifestyle factors on the immune system and allergies in East and West Germany plus the influence of traffic emissions and genetics) birth cohorts, data on drug utilization (past 4 weeks) were collected using a self-administered questionnaire for 3642 children (10-year follow-up) and 4677 adolescents (15-year follow-up). The drugs were classified by therapeutic categories (conventional drugs, homeopathic drugs, etc.) and by codes according to the anatomical therapeutic chemical (ATC) classification system. Associations of adolescents' drug use with gender, study area, maternal education, parental income, presence of chronic conditions, and prior drug use at the age of 10 years were analysed using a logistic regression model. RESULTS: The 4-week prevalence rates of overall drug use were similar for adolescents (41.1%) and children (42.3%). However, adolescents used noticeably more anti-inflammatory drugs, analgesics, and systemic antihistamines. Exactly 3194 children/adolescents participated in both follow-ups. Adolescents' use of anti-inflammatory drugs was predicted (OR = 3.37) by use of anti-inflammatory drugs as a child. In summary, the strongest predictor of adolescents' use of specific therapeutic categories or ATC groups was the previous use of the same therapeutic drug category or ATC group as a 10-year-old child. CONCLUSIONS: Despite similar prevalence rates of overall drug utilization among both age groups, there is a noticeable difference concerning the use of drugs from specific ATC groups. Drug use as a child may partly determine what they use as an adolescent.

[Clinical analysis of Cervus and Cucumis Polypeptide injection based on real world hospital information system].

To analyze the clinical application of Cervus and Cucumis Polypeptide injection in the real world, in order to define the characteristics of clinical drug use and correlation, and provide reference for risk management and further study for Cervus and Cucumis Polypeptide injection. Descriptive analysis and association rules analysis were performed on 37 721 cases using Cervus and Cucumis Polypeptide injection in 26 hospitals nationwide. Cervus and Cucumis Polypeptide injection were mostly adopted by patients aged between 45 and 64(39.84%); mainly used to treat fracture patients in clinic(17 362 cases, 33.97%); 12 mL(41.81%) was the commonest dosage. And the course of treatment mainly lasted for 1-3 days(28 467 cases, 76.26%), which was basically consistent with the description of package insert. In clinic, traditional Chinese medicines, such as blood activating and stasis removing agents and Bushen Zhuanggu agents, were frequently combined with it(rule support degree of 19.38%). Such western medicine as antibiotics and nutritional drugs were frequently combined with it(rule support 39.9%). The main single combined medicine were vitamin C(13 202 cases, 35%), and Jintiange capsule(7 285 cases, 19.31%). The commonly used combined drug pairs were Hulisan capsule and Jintiange capsule (rule support 4.458%), phenobarbital and ceftazidime azole oxazoline(rule support degree of 10.62%). Cervus and Cucumis Polypeptide injection is mainly adopted by elderly patients in clinic, used to treat fracture patients, and often combined with blood activating and stasis removing agents, Bushen Zhuanggu agents, antibiotics, and nutritional medicine to enhance fracture healing. In clinical application, attention shall be paid to drug safety of elderly patients and types of combined medicines and their interaction, so as to prevent adverse reactions.

Homeopathy in France in 2011-2012 according to reimbursements in the French national health insurance database (SNIIRAM).

BACKGROUND: The use of homeopathic medicine is poorly described and the frequency of combined allopathic and homeopathic prescriptions is unknown. OBJECTIVE: To analyse data on medicines, prescribers and patients for homeopathic prescriptions that are reimbursed by French national health insurance. METHODS: The French national health insurance databases (SNIIRAM) were used to analyse prescriptions of reimbursed homeopathic drugs or preparations in the overall French population, during the period July 2011-June 2012. RESULTS: A total of 6,705,420 patients received at least one reimbursement for a homeopathic preparation during the 12-month period, i.e. 10.2% of the overall population, with a predominance in females (68%) and a peak frequency observed in children aged 0-4 years (18%). About one third of patients had only one reimbursement, and one half of patients had three or more reimbursements. A total of 120,110 healthcare professionals (HCPs) prescribed at least one homeopathic drug or preparation. They represented 43.5% of the overall population of HCPs, nearly 95% of general practitioners, dermatologists and pediatricians, and 75% of midwives. Homeopathy accounted for 5% of the total number of drug units prescribed by HCPs. Allopathic medicines were coprescribed with 55% of homeopathic prescriptions. CONCLUSION: Many HCPs occasionally prescribe reimbursed homeopathic preparations, representing however a small percentage of reimbursements compared to allopathic medicines. About 10% of the French population, particularly young children and women, received at least one homeopathic preparation during the year. In more than one half of cases, reimbursed homeopathic preparations are prescribed in combination with allopathic medicines.

Utilization and costs of conventional and alternative pharmaceuticals in children: results from the German GINIplus and LISAplus birth cohort studies.

PURPOSE: The socioeconomic determinants for drug utilization, especially in children, have not been investigated sufficiently so far. The study's aim was the estimation of prevalences and determinants of conventional, homeopathic and phytotherapeutic drugs and expenditures. METHODS: Population-based data on drug utilization of 3,642 children in two German birth cohorts (GINIplus and LISAplus, 10-year follow-up) were collected using a self-administered questionnaire. For analysis, the reported drugs (use within the last four weeks) were classified into the therapeutic categories of 'conventional medicine', 'homeopathy', 'phytotherapy' and 'others'. Drug costs were estimated using pharmaceutical identification numbers. RESULTS: In all, 42.3% of the children reported drug use; 24.1% of the drugs were homeopathic and 11.5% were phytotherapeutic. The proportion of children who took at least one homeopathic remedy was 14.3%. Drugs prescribed by physicians were dominated by conventional medicine (76.5%), whereas in non-prescribed drugs, both homeopathy and conventional medicine accounted for 37% each. Boys (OR = 0.78) used less homeopathy than girls. Income showed only a weak influence. Education had a strong effect on the use of phytotherapy such that children of mothers with higher school education (>10 years vs. <10 years) used more phytotherapy (OR = 2.01). If out-of-pocket payments arose (n = 613), the mean was €20. On average, total drug expenditures summed up to €39 in 4 weeks for drug users if only clearly identifiable prices for drugs were considered (58% of all data). CONCLUSIONS: Utilization of homeopathy is common in children from the analyzed cohort. User profiles of homeopathy and phytotherapy differ from each other and should be analyzed separately.

Drug utilization patterns in Rawalpindi and Islamabad, Pakistan.

OBJECTIVES: To assess the prevalence of self medication among Pakistanis in rural and urban settings. METHODS: A door-to-door survey was carried out during June and July 2008 and 2009 after due verbal consent taken from the residents. The houses were randomly selected from ultra posh area, quarters of government employees, residents of Barani Training Institute, low socio-economic population in the surrounding of Adiallah road near Rawalpindi, and a remote village Raye Chak, (population 5000) some 50 kilometers away from the city. RESULTS: There were 2042 dosage forms of drugs from 430 houses; allopathic medicine 89.3%; traditional medicines 6.7%; and homeopathic drugs 4% representation. The top 10 companies had more than 57% market share among 147 firms whose products were reported. The availability of paediatric drugs mixtures/syrups was 24%, and injectiables, 5.5%. Nonsteroidal anti-inflammatory drugs (NSAID) had 38% representation; antimicrobials 25%, multivitamins and haematinics were 1.6% that was contrary to the general perception of the irrational use of this group of medicines. CONCLUSION: Alternative medicine is gaining ground. Overuse of anti-inflammatory drugs suggest higher prevalence of pain, inflammation and infections than systemic disorders in society.

[Prevalence of psychiatric disorders in French general practice using the patient health questionnaire: comparison with GP case-recognition and psychotropic medication prescription]. / Prévalence des troubles psychiatriques en médecine générale selon le patient health questionnaire: adéquation avec la détection par le médecin et le traitement prescrit.

INTRODUCTION: Psychiatric disorders, mainly depression and anxiety, are frequently encountered in primary care and are a major cause of distress and disability. Nearly half of cases go unnoticed and among those that are recognised, many do not receive adequate treatment. In France, there is limited research concerning the prevalence, detection and management of these conditions in primary care. OBJECTIVES: To estimate the prevalence of psychiatric disorders, overall and for the main psychiatric diagnostic categories, encountered in primary care; to describe general practitioners' (GPs') case identification rate; to examine psychotropic medication prescription according to diagnosis, in a regionally representative sample of GP attenders. METHODS: GP practicing standard general practice in an urban area of the city of Montpellier and a nearby semi-rural region were recruited to participate. The response rate was 32.8% (n=41). Five additional GP almost exclusively offering homeopathy and acupuncture were recruited nonrandomly for convenience purposes. In each GP surgery, consecutive patients entering the waiting room were invited by a research assistant to participate until 25 patients per GP were recruited. Each participant completed self-report questionnaires in the waiting time, including the patient health questionnaire (PHQ), which yields provisional DSM-IV diagnoses. The GP completed a brief questionnaire during the consultation, giving his/her rating of the severity of any psychiatric disorder present and action taken. RESULTS: The patient response rate was 89.8%. In all, 14.9% of patients reached DSM-IV criteria for major depression or anxiety disorder on the PHQ (9.1% for major depression, 7.5% for panic disorder; 6% for other anxiety disorders). For the subthreshold categories, 7.4% met criteria for other depressive disorders, 11.8% for somatoform disorders and 10.9% for probable alcohol abuse or dependence. 66.3% of patients with DSM-IV diagnoses of major depression or anxiety disorder were identified by the GP as having a psychiatric disorder. The identification rate was 51% for all depressive disorders, anxiety and somatoform disorders. Of patients receiving a prescription for anxiolytic or antidepressant medication on the survey day, 80% were classified as cases of psychiatric disorder by the GP. Only 48.8% met criteria for major depression or anxiety disorder on the PHQ. CONCLUSION: This study highlights the frequency of psychiatric disorders in a regional study of French general practice. Overall, prevalence rates were similar to those found elsewhere, except for probable alcohol abuse and dependence, which was considerably higher than in the USA PHQ validation study. As in other countries, GP identified roughly half of psychiatric cases. Furthermore, half of patients treated by anxiolytic or antidepressant medication did not meet the diagnostic criteria on the survey day for which these medications have mainly shown their efficacy. This confirms the French paradox of one of the highest psychotropic medication consumption rates in Europe despite many cases of depression remaining untreated. The PHQ could be a rapid and acceptable diagnostic aid tool for French general practice but first needs to be validated against the diagnosis of mental health professionals in this setting.

[Pattern of medicine consumption among users of the primary health care services in Lorena, SP]. / Perfil de utilização de medicamentos em usuários da rede básica de satide de Lorena, SP.

This cross-sectional study was aimed at describing the pattern of medicine consumption of adults and elderly, users of the primary health care services in Lorena, state of Sao Paulo. Information with regard to the following characteristics was collected: social-demographic data, the reason for seeking the service, medical prescription and medication used in the last month, where this medication was purchased, self-medication and use of homeopathic medication. 766 individuals were interviewed, 66% of them women. More than 40% informed having a chronic disease and most of them considered themselves to be in good health. Approximately 70% of the studied population used drugs following medical prescription with a medicament/person average of 1.5, most of them for high blood pressure. This number increased with the age, was higher in situations of maintenance of health and cases of disease, in case of existence of chronic disease, in cases self-reported as in bad health conditions for men and regular health conditions for women. For the women the number was also higher for those not regularly using some primary care unit and those in return visits. Self medication and use of homeopathic medication were low.

Questionnaire survey of disease prevalence and veterinary treatments in organic layer husbandry in the Netherlands.

Disease prevalence and veterinary treatments in organic animal production differ from those in conventional systems. In order to gather information about current practices in organic layer husbandry, 33 organic egg producers of 16 small, 12 medium-sized, and 5 large farms were asked to complete a questionnaire on disease prevalence and treatments. On these farms, the mean mortality was 9% and the mean laying percentage was 79%. In contrast with the regulations for organic farming, the use of chemotherapeutics was not recorded on 30% of the farms. One third of the farmers were not aware of the type of vaccination given to their hens, and on the other farms hens had been vaccinated as pullets against nine or more viral and bacterial diseases. Several health problems were mentioned, such as feather pecking, red mites, helminths, infectious bronchitis, colibacillosis, and coccidiosis. On 19 farms, diseases were treated with homeopathic, phytotherapeutic, or other alternative medicines; on 10 of these farms chemotherapeutics were also used. On 4 farms only chemotherapeutics were used, on 10 farms no products were used, and on some farms up to seven products were used. Although quite a large number of organic layer farmers in the Netherlands used homeopathic, phytotherapeutic, or other alternative medicines, the use of chemotherapeutics is currently inevitable to prevent animal suffering or distress in organic husbandry.

Psychopharmacological Prescriptions in Children and Adolescents in Germany.

BACKGROUND: In view of the well-known increase in prescriptions of stimulants for children and adolescents over the last 20 years, it is important to study trends in the prevalence and incidence of the use of other psychotropic drugs by this age group as well, to enable an early response to potential problems in the current care situation. METHODS: We used nationwide data from German statutory health insurance funds (Allgemeine Ortskrankenkasse [AOK], all insurees; Techniker Kranken - kasse [TK], a 50% randomized sample) concerning all insurees aged 0-17 years (5.0 million people in 2012) to study trends in the prevalence and incidence of psychotropic medication use as well as initially prescribing medical specialties over the period 2004-2012, both for the overall group of psychotropic drugs and for selected subgroups of drugs. RESULTS: From 2004 to 2012, the prevalence of psychotropic drug prescriptions (not including herbal and homeopathic substances) for children and adolescents rose from 19.6 to 27.1 per 1000 individuals. Marked rises were seen for stimulants (10.5 to 19.1 per 1000) and antipsychotic drugs (2.3 to 3.1 per 1000), while the prevalence of antidepressant prescriptions remained constant at about 2 per 1000. The rates of new prescriptions from 2006 to 2012 were generally constant or decreasing; for the overall group of (non-herbal, nonhomeopathic) psychotropic drugs, the rate of new prescriptions fell from 9.9 to 8.7 per 1000. There was a trend toward the issuance of new prescriptions by medical specialists, rather than by family physicians and pediatricians. CONCLUSION: The observed increased prevalence of psychotropic drug use among children and adolescents appears to be due not to an increased rate of initial prescriptions for these drugs, but rather to a rise in the number of patients who, once having received such drugs, were given further prescriptions for them in the years that followed.

Complementary and Alternative Medicine Use Among Chronically Ill Adolescents from 2 German Birth Cohorts.

BACKGROUND: Pediatric use of complementary and alternative medicine (CAM) is popular in Europe, and utilization may be even more prevalent in chronically ill children/adolescents. This study's aim is to assess CAM use among adolescents with chronic conditions. METHODS: Data on drug utilization (past 4 weeks) and consultation with CAM providers (past year) were collected using a self-administered questionnaire from 4,677 adolescents from the German GINIplus/LISAplus birth cohorts. All reported drugs were classified into therapeutic categories (conventional drugs, homeopathy, herbal drugs, etc.). Additionally, participants were asked to list any chronic diseases (that were parent-reported, physician-verified diagnoses such as allergies, atopic dermatitis, asthma, or other chronic diseases) that they had had over the previous 5 years. RESULTS: Compared with the total sample, drug utilization in general (60.1% vs. 41.1%), homeopathy use (11.1% vs. 8.1%), and consultation with CAM providers (16.9% vs. 10.9%) was significantly more prevalent among chronically ill adolescents. However, chronically ill adolescents used relatively (proportion of the defined therapeutic category among all drugs used) more conventional drugs than healthy adolescents. CONCLUSION: Compared with healthy adolescents, CAM use is more prevalent among adolescents with chronic conditions. Nevertheless, CAM may predominantly be used as a complementary treatment option rather than substituting conventional drugs.

Utility of nutraceutical products marketed for cognitive and memory enhancement.

This article identifies a convenience sample of 14 memory-enhancing herbal products that were found to be available commercially, examines their active ingredients, states their claims, and evaluates the available evidence to determine their efficacy. The analyses identified four problematic areas. First, a majority of the products use cognitive terminology, which leads consumers to anticipate an intended cognitive benefit. Second, some ingredients are completely homeopathic and contain components not known outside of the homeopathic field. Third, the evidence of treatment efficacy is often contradictory, because products are recommended for purposes other than cognitive or memory loss. Finally, the manufacturers of the product have usually conducted the research on individual products. Until more research is available, it is suggested that holistic nursing professionals exercise caution in recommending nutraceuticals to their patients/clients for the use of cognitive improvement or memory enhancement.

Drug consumption in workers in France: a comparative study at a 10-year interval (1996 versus 1986).

This study compared drug consumption and associated social factors in workers in France between 1986 and 1996. The same transversal survey was performed in 1986 and 1996 using the same methodology by means of an anonymous questionnaire given to the subject and answered in the presence of an occupational physician. The 1996 population (2674 subjects) was found to be older (37.0 +/- 9.8 versus 35.7 +/-10.2 years) and to take more drugs (+5.1%) than the population of 1986 (2221 subjects). There were fewer manual workers in the 1996 population. In both periods, women used significantly more drugs in general and more psychoactive (mainly anxiolytic), cardiovascular, endocrine metabolic, and homeopathic drugs than men. The mean value of estimated difficulty of work was higher in subjects taking drugs in general, and especially those taking hypnotic, anxiolytic, psychoactive, antiinflammatory, and digestive drugs in 1986 as well in 1996. In 1986 as well as in 1996, manual workers took no more drugs than did nonmanual workers in general, except for analgesic and antiinflammatory drugs. Nonmanual workers used homeopathic drugs more than manual workers. The presence of extraprofessional problems was associated with an increase in consumption of drugs in general and psychoactive, hypnotic, anxiolytic, antiinflammatory, cardiovascular, digestive, and endocrine metabolic drugs in particular, in 1986 as well as in 1996. After adjustment for variables linked to drug use, there was no significant change in total drug consumption in general but a significant decrease in psychoactive (-49%) (mainly hypnotic [-71%]), and digestive (-39%) drug consumption in this population between 1986 and 1996. In contrast, analgesic use significantly increased (+36%). This study underscores the high level of drug consumption in workers (more than 40% of the subjects were taking drugs). Although there were no quantitative changes, marked qualitative modifications were found with a decrease in consumption of psychoactive (and mainly hypnotic) and digestive drugs and an increase in analgesic drug use between 1986 and 1996. Thus, specific drug information programs designed to reduce psychoactive drug consumption and to favor analgesic drugs for better pain management seem to have been (at least partly) followed. The study also underscores the importance of some social factors associated to general and specific drug use (mainly difficulty of work and presence of extraprofessional problems, and to a lesser extent, kind of work). Their weight remained similar in 1986 and 1996.

Clinical effects of parenteral narcotics in hospitalized medical patients.

Of 38,221 hospitalized medical patients monitored by a drug surveillance program, 1821 (4.8 per cent) received morphine, 504 (1.3 per cent) received codeine, 493 (1.3 per cent) received papaveretum, 115 (0.3 per cent) received hydromorphone, and 101 (0.3 per cent) received methadone parenterally. Hydromorphone had an unusually high adverse reaction rate (18 per cent); therefore, it probably should not be used since other equally effective strong analgesics are available. Adverse reactions occurred in 2 per cent of papaveretum recipients, in 4 per cent of methadone and codeine recipients, and in 6 per cent of morphine recipients. Gastrointestinal reactions (primarily nausea, vomiting, and constipation) were most common. Central nervous system disturbances (primarily respiratory depression, drowsiness, and confusion) were second most common. Adverse reactions occurred more often with higher doses of morphine and codeine; the dose-response relationship could not be evaluated for the other three drugs. Life-threatening adverse reactions were reported in 28 patients. Respiratory depression was the most common life-threatening reaction. Most patients with these reactions were seriously ill, and many received other drugs that may have contributed to the event.

The impact of practice guidelines on prescribing patterns of nondepolarizing neuromuscular blocking agents.

Guidelines for selecting nondepolarizing neuromuscular blocking agents (NNMBAs) were developed and implemented by an interdisciplinary team for use in our intensive care units. They suggest pancuronium as the drug of choice if the patient does not have renal insufficiency and is hemodynamically stable. If either of these criteria is not met and hepatic function is normal, vecuronium is recommended. Atracurium is reserved for patients not meeting either criterion. A 12-month retrospective chart review was performed for 24 patients 18 years of age or older who received continuous infusion of an NNMBA beginning 7 months after the guidelines were implemented. Before the guidelines, atracurium, vecuronium, and pancuronium were prescribed for 68% (17), 24% (6), and 8% (2) of patients, respectively. Their use was inappropriate based on organ function and hemodynamic stability in 88% (15), 83% (5), and 0% of patients, respectively. After guideline implementation, atracurium, vecuronium, and pancuronium were prescribed for 33% (8), 21% (5), and 46% (11) of patients, respectively, and use was inappropriate in 38% (3), 60% (3), and 0% of patients, respectively. Overall, the prevalence of inappropriate NNMBA selection decreased from 80% (20) to 25% (6). Further analysis is necessary to determine the associated pharmacoeconomic impact of decreased inappropriate NNMBA prescribing.

Study of drug consumption in a working environment in France.

1. The present study was conducted to investigate drug consumption in a working environment by means of an anonymous questionnaire given to 2221 subjects and answered in the presence of the work physician. 2. Among the 2221 subjects, 922 had taken at least 1 drug during the week just preceding the medical visit to the company. 3. Women used significantly more hypnotics, sedatives, analgesics, and endocrinologic drugs and homeopathic agents than men, who tended to take more respiratory drugs. 4. Consumption of drugs significantly increased with age. 5. The mean value of estimated difficulty of work was higher in subjects taking drugs in general, as well as hypnotics, sedatives, analgesics, anti-inflammatory agents and gastrointestinal drugs. There was a significant relationship between difficulty of work and total number of medicines taken. 6. Manual workers in general, took no more drugs than nonmanual workers, except for analgesics, anti-inflammatory drugs, and antibiotics. Nonmanual workers used homeopathy more than manual workers. 7. The presence of extraprofessional problems was associated with an increase in drug consumption.

Effects of homeopathic intervention on medication consumption in atopic and allergic disorders.

CONTEXT: Allergies are the most common immunologic diseases among the general population. Increasing evidence suggests that the incidence of allergic disorders is rising dramatically. Conventional medicine provides only limited relief and does not offer a complete cure to this health problem. Consequently, patients seek additional approaches and therapies to integrate into their healthcare. Homeopathy is one of the leading complementary modalities used to treat this health problem. OBJECTIVE: This preliminary study assessed the effect of integrating homeopathic treatment in allergic diseases on conventional medication consumption in a health maintenance organization. DESIGN: Retrospective outcome study designed as a before-after trial. SETTING: Patients were studied in a complementary medicine clinic affiliated with an Israeli health maintenance organization. PARTICIPANTS: Forty-eight patients were treated for allergic diseases with homeopathic remedies and conventional medications. MAIN OUTCOME MEASURES: A computerized medication chart for each patient was evaluated for conventional medication consumption 3 months before and 3 months after the homeopathic intervention. Each patient served as his or her own control. RESULTS: Fifty-six percent of patients in this study reduced their use of conventional medication following the homeopathic intervention. Patients who used conventional medications for their allergic disorders reduced their medication expense by an average of 60%, with an average savings of $24 per patient in the 3-month period following the homeopathic intervention. CONCLUSIONS: This retrospective outcome study demonstrates cost savings for an Israeli health maintenance organization. The homeopathic intervention led to a modest but significant reduction in the use of medications commonly used to treat allergic conditions and their complications. Larger controlled studies are needed to verify these findings.

Neuromuscular blocking agents in the emergency department.

Neuromuscular blocking agents (NMBAs) are utilized frequently in the emergency department (ED). We begin with a brief history of neuromuscular blockade, then review the indications and guidelines for its use in the emergency department setting. The relevant agents will be discussed focusing on dosage, side effects, and adverse reactions. Special attention will be paid to succinylcholine, the drug most commonly employed in the ED setting, followed by a summary of the nondepolarizing agents currently available, in particular the four shorter-acting agents that are most appropriate for administration in the ED.

Effect of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections.

OBJECTIVE: To investigate the intrinsic effects of individually prescribed homoeopathic medicines. DESIGN: Randomised double blind placebo controlled study. SETTING: Paediatric outpatient department of university hospital. PATIENTS: 175 children with frequently recurring upper respiratory tract infections. Of the 170 children evaluable, 86 were randomised to homoeopathic medicines (47 boys, 39 girls; median age at start 4.2 years; median number of episodes in past year 4) and 84 to placebo (43 boys, 41 girls; median age at start 3.6 years; median number of episodes in past year 4). MAIN OUTCOME MEASURES: Mean score for daily symptoms, number of antibiotic courses, and number of adenoidectomies and tonsillectomies over one year of follow up. RESULTS: The mean daily symptom score was 2.61 in the placebo group and 2.21 in the treatment group (difference 0.41; 95% confidence interval -0.02 to 0.83). In both groups the use of antibiotics was greatly reduced compared with that in the year before entering the trial (from 73 to 33 in the treatment group and from 69 to 43 in the placebo group). The proportion of children in the treatment group having adenoidectomies was lower in the treatment group (16%, 8/50) than in the placebo group (21%, 9/42). The proportion having tonsillectomies was the same in both groups (5%). CONCLUSION: Individually prescribed homoeopathic medicines seem to add little to careful counselling of children with recurrent upper respiratory tract infection in reducing the daily burden of symptoms, use of antibiotics, and need for adenoidectomy and tonsillectomy.

[Natural remedies during pregnancy and lactation]. / Naturheilmittel während Schwangerschaft und Stillzeit.

Up to date there is a lack of systematically gathered data on the use of natural remedies (phytotherapeutic, homeopathic, anthroposophic, spagyric, Bach and Schussler remedies) during pregnancy and lactation. The aim of this non-representative pilot study on 139 women, who came for delivery to three institutions between mid-1997 and the beginning of 1998, was to receive data about how often and within which spectrum natural remedies are used during pregnancy and lactation. During pregnancy 96% and within the lactation period 84% of the women consumed at least 1 natural remedy. Phytotherapeutic drugs were used most frequently. In contrast to the widespread use of natural remedies by pregnant women and nursing mothers in this study, little information on the effectiveness and possible risks is available. Therefore it seems necessary to examine and evaluate natural remedies used during pregnancy and lactation.