Health effects of using cannabis for therapeutic purposes: a gender analysis of users' perspectives.

The purpose of this qualitative study was to describe how individuals who self-report therapeutic use of cannabis perceive its health effects. Data from 23 individual interviews were transcribed and analyzed. Understandings of gendered roles and identities were used to explore the data and interpret differences in perceptions. Descriptions of the health benefits of cannabis for therapeutic purposes included cannabis as life preserving, a disease therapy, a medicine for the mind, a means for self-management, and a way to manage addiction. Self-management of risks focused on the potential effects of excessive use, smoking-related risks, and purchasing precautions. Although the reports of women and men were similar in many respects, there were important differences in patterns and practices of use that reflected gender influences. Insights from the study provide direction for developing gender-specific information to support decision making and usage for therapeutic users.

Aminophylline in bradyasystolic cardiac arrest: a randomised placebo-controlled trial.

BACKGROUND: Endogenous adenosine might cause or perpetuate bradyasystole. Our aim was to determine whether aminophylline, an adenosine antagonist, increases the rate of return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. METHODS: In a double-blind trial, we randomly assigned 971 patients older than 16 years with asystole or pulseless electrical activity at fewer than 60 beats per minute, and who were unresponsive to initial treatment with epinephrine and atropine, to receive intravenous aminophylline (250 mg, and an additional 250 mg if necessary) (n=486) or placebo (n=485). The patients were enrolled between January, 2001 and September, 2003, from 1886 people who had had cardiac arrests. Standard resuscitation measures were used for at least 10 mins after the study drug was administered. Analysis was by intention-to-treat. This trial is registered with the ClinicalTrials.gov registry with the number NCT00312273. FINDINGS: Baseline characteristics and survival predictors were similar in both groups. The median time from the arrival of the advanced life-support paramedic team to study drug administration was 13 min. The proportion of patients who had an ROSC was 24.5% in the aminophylline group and 23.7% in the placebo group (difference 0.8%; 95% CI -4.6% to 6.2%; p=0.778). The proportion of patients with non-sinus tachyarrhythmias after study drug administration was 34.6% in the aminophylline group and 26.2% in the placebo group (p=0.004). Survival to hospital admission and survival to hospital discharge were not significantly different between the groups. A multivariate logistic regression analysis showed no evidence of a significant subgroup or interactive effect from aminophylline. INTERPRETATION: Although aminophylline increases non-sinus tachyarrhythmias, we noted no evidence that it significantly increases the proportion of patients who achieve ROSC after bradyasystolic cardiac arrest.

Impact on patient satisfaction with a structured counselling approach on natural health products.

PURPOSE: Natural health products (NHP) are commonly used by cancer patients. The provision of better information on NHP may improve the patient satisfaction and quality of life. We report the impact on patient satisfaction by routine counselling on NHP. METHODS: Patients visiting the pharmacy of a comprehensive cancer centre for the first time were recruited before (control) and after (intervention) the introduction of routine structured counselling on NHP by pharmacists. The primary endpoint was patient satisfaction. Overall cost and cost per improvement in satisfaction were estimated. RESULTS: 265 patients completed the questionnaires. The average age was about 60 years old, with roughly equal number of men and women. Breast and genitor-urinary cancers made up about 80% of the patients. Nearly 45% of patients had some college or university education. The scores for overall satisfaction and each subscale were all increased in the intervention group. This was statistically significant regarding information on NHP. Counselling was associated with an increase of about 9 minutes of counselling time and a mean additional cost of CDN$7.49 per patient. CONCLUSION: We found increased patient satisfaction with routine counselling on NHP. There was only minimal increase in workload and cost for each counselling section.

Advising cancer patients on natural health products--a structured approach.

BACKGROUND: Many patients with cancer (45-60%) use natural health products (NHPs). Pharmacists often find it difficult to advise these patients effectively. OBJECTIVE: To explore pharmacists' perceptions of the information needed to advise cancer patients on NHPs and develop a structured counseling approach. METHODS: A qualitative study was conducted using a focus group of pharmacists from an integrated cancer care organization in Canada. The outcome measures were the definitions of and reasons for the information needed to advise patients on NHPs and a counseling approach using laymen terms. RESULTS: Eight focus group sessions took place, from which 6 categories of information emerged: role of the advisor, evaluation of evidence, assessment of efficacy, assessment of toxicity, monitoring parameters, and provision of a closure. A patient counseling approach was developed based on this information. CONCLUSIONS: The findings provided a description of and rationale for categories of information needed to advise cancer patients on NHPs. A structured, step-by-step approach to counseling these patients was developed.