Patient characteristics and treatment patterns for patients with benign prostatic hyperplasia, erectile dysfunction or co-occurring benign prostatic hyperplasia and erectile dysfunction in general practices in the UK: a retrospective observational study.

AIMS: The aim of this study was to assess patient characteristics, medication treatment patterns and healthcare resource utilization among men with existing erectile dysfunction (ED) or benign prostatic hyperplasia (BPH), who are newly diagnosed with the second condition (BPH or ED) compared with those with only one condition. METHODS: This retrospective cohort study utilized the Clinical Practice Research Datalink. Males, aged 40 years or older, newly diagnosed with ED or symptomatic BPH between 1 June 2010 and 31 May 2011, were selected. Patient demographics, existing comorbidities and baseline medication use were analysed. Treatments initiated for the incident condition and treatment patterns were reported at 6, 12, 18 and 24-months postdiagnosis. Referrals to urologists and visits to general practitioners were reported around diagnosis and during follow-up. RESULTS: This study included 11,501 incident patients with BPH, of which 23% had a prior ED diagnosis and 9,734 incident patients with ED, of which 17% had a prior BPH diagnosis. The average age at diagnosis of BPH was similar across both cohorts. Among incident patients with ED, those with prior diagnosis of BPH were diagnosed at an older average age (65 ± 9.2 years) compared to those without BPH (57 ± 9.1 years). The majority of patients in both incident BPH cohorts (62.9-65.5%) were prescribed alpha-blockers as initial treatment. The majority of patients in both incident ED cohorts (49.6-51.6%) were prescribed sildenafil as initial treatment followed by tadalafil (24.3-26.0%). At 12 months, 50% of incident patients with BPH and 80% of patients with ED had discontinued the therapy initiated. CONCLUSION: This study found that in the UK, patients with co-occurring BPH and ED when newly diagnosed with the second condition initiated the same treatments as those without prior ED or BPH. During the first year, treatment patterns including discontinuation were comparable in the groups with one of the conditions and co-occurring BPH and ED.

New antidiabetic medications. Clinical evidence, clinical practice and pharmacoeconomics.

BACKGROUND: Type 2 diabetes is a progressive and complex disease with underlying defects in insulin sensitivity, insulin secretion and hepatic glucose production. There is a range of antidiabetic treatment options now available to address these defects. Determination of which therapy for which patient is not always apparent from the clinical literature or the product information. OBJECTIVE: To summarise the extent and use of clinical evidence, clinical practice and pharmacoeconomics in positioning antidiabetic agents in Australian clinical practice. DISCUSSION: This paper summarises the introduction of new agents into the options for treatment of type 2 diabetes through the Pharmaceutical Benefits Scheme. Combining evidence based medicine, accepted clinical practice and decision analysis, allows the controlled introduction of new therapies in a climate of limited resources and a population with increasing therapeutic needs.

The cost-effectiveness of a cardiovascular risk reduction program in general practice.

An economic evaluation was conducted alongside a randomised controlled trial of two lifestyle interventions and a routine care (control) group to assess the cost-effectiveness of a general practice-based lifestyle change program for patients with risk factors for cardiovascular disease. Routine care was the base case comparator because it represents 'current therapy' for cardiovascular disease (CVD). A 'no care' control group was not considered a clinically acceptable alternative to lifestyle interventions. The interventions consisted of an education guide and video for GPs to assess individual patient risk factors and plan a program for risk factor behavior change. Each patient received a risk factor assessment, education materials, a series of videos to watch on lifestyle behaviors and some patients received a self-help booklet. Eighty-two general practitioners were randomised from 75 general practices in Sydney's Western Metropolitan Region to (i) routine care (n = 25), (ii) video group (n = 29) or (iii) video + self help group (n = 28). GPs enrolled patients into the trial who met selection criteria for being at risk of CVD. There were 255 patients in the routine care (control) group, 270 in the video (intervention) group and 232 in the video + self help (intervention) group enrolled in the trial. Outcome measures included patient risk factor status: blood pressure, body mass index, cholesterol and smoking status at entry to trial and after 1 year. Changes in risk factors were used to estimate quality adjusted life years (QALYs) gained. One hundred and thirty patients in the routine care group, 199 in the video group and 155 in the video + self help group remained in the trial at the 12-month review and had complete data. The cost per QALY for males ranged from $AUD152,000 to 204,000. Further analysis suggests that a program targeted at 'high risk' males would cost approximately $30,000 per QALY. The lifestyle interventions had no significant effect on cardiovascular risk factors when compared to routine patient care. There remains insufficient evidence that lifestyle programs conducted in general practices are effective. Resources for general practice-based lifestyle programs may be better spent on high risk patients who are contemplating changes in risk factor behaviours.

Lifestyle change and cardiovascular disease. Principles and practice.

Changes in patients' lifestyles can be approached in a practical fashion by working through the relevant 'stages of change'. Helping patients to change their lifestyles does not have to be a very time-consuming process for the clinician, but it does require planning, and attention to those factors that are important at each stage of the process. Although this paper has a focus on lifestyle change for the reduction of CVD risk factors, the same principles can apply to lifestyle change and disease prevention for other disorders.

Lifestyle change and cardiovascular disease. Evidence and issues.

Lifestyle change is an area in which the medical practitioner has a great deal to offer: to high-risk patients and to individuals generally. The evidence supporting the cardiovascular health benefits of lifestyle change comes from a variety of scientific sources. While the recent large-scale intervention studies have not always had unequivocal outcomes, on balance, the epidemiological evidence points to the central importance of lifestyle change in reducing CVD risk. Recently the United States Preventive Services Task Force22 has published guidelines on lifestyle change and other interventions for CVD risk and for a range of other preventable health problems. The United States Task Force's recommendations have been favourably reviewed by the National Health and Medical Research Council in Australia, and are considered to be relevant to medical practice in this country.

Cardiovascular risk reduction through lifestyle change in clinical settings.

A large amount of observational and experimental research has demonstrated that lifestyle factors are important determinants of cardiovascular disease. In particular, epidemiological evidence from large, controlled multiple risk factor intervention trials and research examining the effects of secular changes in lifestyle on changing morbidity and mortality rates indicate that changes in lifestyle can reduce the risk of coronary heart disease (CHD). This paper provides an overview of the lifestyle change process and provides guidelines for increasing the efficacy of lifestyle change interventions in clinical settings.

Temporal patterns of the rabbit's nictitating membrane response to compound and component stimuli under mixed CS-US intervals.

The acquisition of the rabbit's nictitating membrane response to a tone and light compound and to its components was examined when compound presentations were reinforced at one conditioned stimulus-unconditioned stimulus (CS-US) interval and individual component presentations were reinforced at another CS-US interval. Examination of the time course of the CRs revealed that (a) despite the mixture of CS-US intervals, conditioned response (CR) timing remained accurate, that is, CRs reached their peaks at the alternative points of US delivery; (b) the momentary magnitude of the CR to the compound was predominantly an additive function of the CR magnitude to the individual components; but (c) there was modest evidence of differentiation between the compound as a unit and the individual components. The results are discussed in terms of their implications for the study of the neural substrates of temporal and sensory integration as they modulate CR acquisition.