Clinical and humanistic outcomes in patients with gastroesophageal reflux disease converted from omeprazole to lansoprazole.

BACKGROUND: Omeprazole and lansoprazole are 2 proton pump inhibitors (PPIs) currently available in the United States. Both PPIs are approved for the treatment of gastroesophageal reflux disease (GERD) and are commonly converted in therapeutic interchange programs. OBJECTIVE: To measure clinical and humanistic outcomes in patients with GERD converted from treatment with omeprazole to treatment with lansoprazole through a managed care plan policy. METHODS: Patients with heartburn or GERD receiving omeprazole covered by a local health plan were surveyed by telephone. Data collected included symptom frequency, severity, over-the-counter heartburn preparation use, diet, lifestyle, and overall satisfaction. Patients were then converted to therapy with lansoprazole and again interviewed after at least 30-day use of the new PPI. Demographic data were obtained from the health plan database for analysis. RESULTS: A total of 105 patients completed both telephone surveys. After the conversion, 37% of the patients experienced more frequent symptoms while awake. Symptom severity score was significantly higher (more severe) after conversion (mean score of 1.34 vs 2.26). Thirty-three percent of study patients consumed more over-the-counter heartburn preparations, and 13% changed their diet more frequently due to heartburn symptoms after conversion. Overall patient satisfaction score decreased significantly (less satisfied) after conversion (mean score of 9.0 vs 7.2). There were no significant differences in alcohol and tobacco consumption before and after conversion, while patients consumed significantly less caffeine after conversion. CONCLUSIONS: After the PPI therapeutic interchange from omeprazole to lansoprazole, patients with GERD or heartburn previously stabilized while receiving omeprazole experienced more severe symptoms and expressed decreased patient satisfaction. These results suggest a need to monitor symptoms after similar interchange programs.

Physician attitudes toward human growth hormone products.

A national survey of the attitudes of physicians toward the selection of human growth hormone products and factors affecting physicians' prescribing decisions was conducted. A survey was mailed to 800 pediatric endocrinologists. Recipients were asked to rank eight qualities of human growth hormone therapy from a patient's perspective, to rate the importance of each of 15 factors to the prescribing of human growth hormone products, and to respond to a hypothetical clinical situation set up to assess opinions on the interchangeability of human growth hormone products. The physicians were also asked whether they thought all human growth hormone products were clinically equivalent and, if so, whether a formulary should be limited to one brand of product for all indications. The net response rate was 29%. Physicians ranked insurance coverage and out-of-pocket expenses as the most important factors from the patient's perspective and reported efficacy, patient comfort or compliance, insurance coverage, and drug cost as the most important factors to consider when selecting a human growth hormone product; patient preference was reported to be the least important. A total of 209 physicians (92%) considered all human growth hormone products to be clinically equivalent; not quite half of these favored limiting a formulary to one brand of product. Concerning the hypothetical situation, 210 of 226 (93%) respondents indicated that they would not switch all patients receiving one product (product A) to another product (product B) and 192 of 223 (86%) that they would not switch all patients receiving product B to product A. A national sample of pediatric endocrinologists agreed on the clinical equivalence of most human growth hormone products but not on limiting a formulary to one brand of product.

The functional visual field during picture viewing.

In four experiments, pictures of complex, naturalistic scenes were shown, followed by a two-alternative forced-choice recognition test in which the targets and distractors differed in only a single, critical detail. Eye movements were recorded at the time of study in the first two experiments. In Experiment 1 we investigated eye movements during short initial exposure times and found that if the nearest fixation to the critical detail was further than about 2 degrees of visual angle, performance was no better than chance. Experiment 2 replicated Experiment 1 using longer exposure times and an expanded set of pictures. Performance was still found to decrease with increase in distance of the nearest fixation to the critical detail, but not quite to chance. In Experiments 3 and 4 we controlled where the subject's first fixation occurred using a prefixation point of light. The results indicated that the performance again decreases with increasing distance from the critical detail; however, performances did not fall completely to chance levels. In Experiment 4 a verbal recognition test was included, and overall performance was still slightly better than chance at extreme distances. It was concluded that some information is stored from the visual periphery during picture viewing.

Establishment of a nonproductive herpes simplex virus infection in rabbit kidney cells.

A nonproductive infection of rabbit kidney cells was established with a type 2 strain of herpes simplex virus after incubation of the virus-infected cells at 41 C. Although infectious virus could not be recovered from cells disrupted by freeze-thawing or sonication after incubation at 41 C, spontaneous reactivation of virus growth occurred in 84% of the cultures after lag periods of variable length when cultures of viable cells were transferred to 37 C and incubated. Forty-one percent of the cultures had lag periods of 4 or more days, and 24% had lag periods of 7 or more days. The longest lag period was 45 days. A similar infection was established in WI-38 cells, but attempts to establish the infection in human kidney cells was not successful. This nonproductive infection is being used to study the effects of various physical and chemical agents on herpes simplex virus in a latent state.