Comparison Levitra Viagra

High-risk patients who took a combination of three older heart drugs — a generic statin, a generic blood pressure pill and a low-dose aspirin — cut their risk of a heart attack or stroke by as much as 80 percent, U.S. researchers said on Thursday.

They said their study offers a simple, effective and inexpensive way to help people with diabetes or heart disease avoid heart attacks and strokes.

“Even in people who took it less than half the time, they got over a 60 percent drop in heart attacks and strokes,” said Dr. R. James Dudl of Kaiser Permanente in California, whose study was published in the American Journal of Managed Care.

“Those who took it more than half the time — they got more like an 80 percent drop,” Dudl said in a telephone interview.

The study set out to offer a uniform approach to preventing heart attacks and strokes in people with heart disease or diabetes. Adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than people without diabetes, according to the American Heart Association.

Several recent large studies found that aggressive efforts to control blood sugar do little to prevent heart attacks and strokes in diabetics.

Researchers at Kaiser Permanente followed 68,560 people with diabetes or heart disease who each day took the drug combination, consisting of 40 milligrams of the cholesterol fighter lovastatin and 20 milligrams of the blood pressure pill lisinopril for two years. People were also encouraged to take a low-dose aspirin.

The treatment prevented 1,271 heart attacks and strokes in the first year of follow up, Dudl said.

By checking prescription records, they were able to see which patients took their drugs most frequently. They found that even when people took their medications only 22 percent of the time, they had a 60 percent drop in heart attacks and strokes.

Dudl said many doctors like to start patients out with lower doses of drugs and gradually increase them to find the ideal dose for each patient, but often people who do not see results right away stop taking their medications.

“This is a proven program that can be applied in many settings to reduce heart attacks and strokes, and at the same time decrease the cost of care for those events,” Dudl said.

It also suggests that people do not need to take a name-brand statin drug — which Dudl said costs up to eight times more than a generic — to achieve a major reduction in risks.

Although in the study the team used lovastatin, the generic name for Merck’s Mevacor, Dudl said the team now recommends Merck’s Zocor, or simvastatin — which has been shown to be a more effective statin — as part of the three-drug regimen.

People who need a blood stem-cell transplant may be able to lessen the chances that the transplanted material will attack the body — what’s known as graft-versus-host disease — by being treated with anti-T-cell globulin, a new study has shown.

Graft-versus-host disease (GVHD) occurs in up to 60 percent of those who have a transplant of blood stem cells — called hematopoietic cell transplantation — from the bone marrow or peripheral blood of unrelated donors. In GVHD, the immune system or T-cells from the donor recognize the recipient’s tissues as foreign and attack. Previous research has suggested that antibodies that eliminate T-cells might prevent this attack.

The new study included 201 adults with blood cancer who were scheduled for a transplant from an unrelated donor. One group was given standard treatment to prevent GVHD prophylaxis (cyclosporine and methotrexate), and the others were given the standard therapy plus anti-T-cell globulin (anti-Jurkat ATG-Fresenius, or ATG-F).

Within 100 days, about 34 percent (33 people) in the standard treatment group had developed acute GVHD or had died, compared with 21 percent (22 people) of those in the ATG-F group. The difference during the first 100 days was not considered statistically significant, the researchers noted.

However, the study found that the overall incidence of acute GVHD was less in the ATG-F group (12 percent) than among those who’d gotten just the standard treatment (24 percent). One person given ATG-F died, compared with nine who had not gotten ATG-F.

The phase 3 trial also found that the two-year cumulative incidence of chronic GVHD and extensive chronic GVHD in the ATG-F group was about 31 percent and 12 percent, respectively, compared with 59 percent and 43 percent for the standard treatment group.

The ATG-F group did not have higher rates than the standard treatment group for relapse, deaths not related to relapse or deaths from infection, the study authors found.

“This is the first randomized clinical trial to show that ATG-F can reduce severe acute and clinically relevant chronic GVHD without compromising disease-free survival or overall survival,” Dr. Jurgen Finke, of Universitatsklinikum Freiburg in Germany, and fellow researchers said in a news release from The Lancet Oncology, which is publishing the study online Aug. 19 and in its September print issue.

Many teenagers may be sharing their prescription medications with their friends, putting them at risk of drug side effects or having a health problem go undiagnosed, a new survey finds.

The survey, of 592 12- to 17-year-olds from across the U.S., found that 20 percent admitted to having lent a prescription drug to a friend, while a similar percentage said they had done the borrowing.

The most commonly shared prescriptions were allergy drugs and narcotic pain relievers like Oxycontin and Darvocet, followed by antibiotics, acne medications like Accutane, and mood drugs such antidepressants and anti-anxiety medications.

What’s more, the study found, three-quarters of prescription “borrowers” said they did so instead of seeing a doctor. Some eventually did make a trip to the doctor, but, in 40 percent of cases, failed to mention the borrowed medication.

The findings, published in the Journal of Adolescent Health, also point to the potential safety risks teens face when they share prescriptions.

Less than half said their borrowed medication came with written instructions on how to use it safely. And more than one-third of teens who borrowed prescriptions said they had suffered an allergic reaction or other side effect.

Teenagers are not alone in the practice of prescription sharing.

Previous research has suggested that almost 40 percent of U.S. adults have lent or borrowed a prescription to a family member or friend.

“However, prior to our study, no one had asked adolescents how often they shared prescription medications, which meds they shared and what some of the outcomes were,” lead researcher Dr. Richard Goldsworthy, of Academic Edge, Inc., in Bloomington, Indiana, noted in a written statement.

The findings, he and his colleagues conclude, suggest that doctors need to talk to teenage patients about the risks of using other people’s prescriptions. Given the high rate of prescription sharing among adults, many parents likely need the same advice, the researchers note.

Wider efforts — like public health campaigns or warnings about medication sharing on product packaging — might also be worthwhile.

Researchers funded by the National Institutes of Health have found that the activity of a protein in brain cells helps stimulate the spread of an aggressive brain cancer called glioblastoma multiforme (GBM). In a move toward therapy, the researchers showed that a small designer protein can block this activity and reduce the spreading of GBM cells grown in the laboratory.

GBM is the most lethal form of brain cancer, with about half of patients expected to die within a year of diagnosis. GBM is named for the fact that the cancerous cells have properties of support cells in the brain called glial cells. Rather than simply growing in a single tumor mass, GBM cells tend to migrate throughout the brain, making it difficult to remove them surgically. As the cells spread and multiply, they also tend to become resistant to radiation and chemotherapy.

“Interventions to control the spreading of glioblastoma multiforme have the potential to slow the clinical course of the disease and improve overall survival rates,” says Jane Fountain, Ph.D., a program director at NIH’s National Institute of Neurological Disorders and Stroke (NINDS). NINDS funded the new study through an initiative that encourages research on why brain tumor cells are so highly invasive and how to therapeutically target these cells.

The study’s senior author is Susann Brady-Kalnay, Ph.D., a neuroscientist at Case Western Reserve University in Cleveland and an expert on the development of the retina. For years, she has studied how cells migrate to their proper places in the developing retina. In particular, she studied how this process is regulated by cell adhesion molecules — proteins at a cell’s surface that can keep the cell stuck to its surroundings, or help the cell move. She has shown that a cell adhesion molecule called PTPmu is required for retinal cell migration. Investigating the role of PTPmu in GBM dispersal was a logical extension, she says.

“We know that cell adhesion is important for development, and that there are many parallels between what happens during development and what happens in cancer,” says Dr. Brady-Kalnay. For instance, she notes there is some evidence that cancer cells have turned back the developmental clock and reverted to an embryonic stem cell-like state.

In their new study published in Cancer Research, Dr. Brady-Kalnay and her team report that in GBM cancer cells, the PTPmu protein is cut into fragments, a process known as proteolysis. One might expect that the loss of intact PTPmu would simply cause the cells to detach from their surroundings. However, the fragments also appear to act as signals that stimulate the cells to move and to thrive outside of their normal surroundings.

The researchers found the PTPmu fragments in GBM tumors that had been surgically removed from patients and in GBM cells grown in the laboratory. Next, they examined how these fragments affected the migration of GBM cells in a petri dish. They observed that adding more of the intact protein to the cells or treating the cells with a chemical inhibitor of proteolysis reduced the cells’ ability to migrate.

Finally, they showed that it is possible to suppress the effect of the fragments, even without restoring the intact PTPmu protein. This last experiment built upon a collaboration between Dr. Brady-Kalnay and Frank Longo, M.D., chair of the neurology department at Stanford University School of Medicine. The two researchers had previously designed a very small protein, or peptide, capable of attaching to PTPmu and blocking its effects on retinal cell migration. Here, Dr. Brady-Kalnay and her team tested this peptide in GBM cells, and found that it blocked their ability to migrate, too.

The peptide cannot currently be used to treat GBM, because it would be broken down rapidly if it was injected directly into the body. The researchers hope to develop injectable compounds that mimic the peptide, and to test those compounds in animal models of GBM.

The study’s first author was Adam Burgoyne, a graduate student in the Department of Molecular Biology and Microbiology at Case Western. Case Western faculty who contributed to the study included neurosurgeons Shenandoah Robinson, M.D. and Andrew E. Sloan, M.D., and Robert H Miller, Ph.D., an expert on glial cell development.

The study received additional funding from NIH’s National Cancer Institute, National Eye Institute, and National Institute of General Medical Sciences, and from the Ivy Brain Tumor Foundation.

Binge drinking is usually seen as a problem of college campuses, but many older adults may be overindulging in alcohol as well, a study published Monday suggests.

Using data from a government survey of nearly 11,000 Americans age 50 and up, researchers found that 23 percent of men between the ages of 50 and 64 admitted to binge drinking in the past month, as did roughly 9 percent of women.

Among adults age 65 and older, more than 14 percent of men and 3 percent of women reported bingeing — defined as having five or more drinks on one occasion, on at least one day in the past month.

Alcohol binges are often considered a problem of youth. One recent government study found that among U.S. college students between the ages of 18 and 24, 45 percent reported a recent drinking binge.

But the new findings, published in the American Journal of Psychiatry, show that older adults can be susceptible too.

“We feel that our findings are important to the public health of middle-aged and elderly persons as they point to a potentially unrecognized problem that often ‘flies beneath’ the typical screen for alcohol problems in psychiatry practices,” lead researcher Dr. Dan G.

Blazer, of Duke University Medical Center in Durham, North Carolina, noted in a written statement.

Blazer and colleague Dr. Li-Tzy Wu based their findings on a national health survey conducted between 2005 and 2006. Along with binge drinking, the survey looked at so-called at-risk drinking — drinking habits that could have negative effects on a person’s health. In this study, that was defined as averaging at least two drinks per day.

Among 50- to 64-year-olds, 19 percent of men and 13 percent of women were at-risk drinkers. The figures among older men and women were 13 percent and 8 percent, respectively.

Binge drinking carries a number of risks, including accidental injuries, violent behavior, neurological damage and blood pressure increases. These hazards, Blazer and Wu write, “clearly present” greater consequences later in life, when people often have chronic health conditions that can be aggravated by heavy drinking.

Yet, the researchers note, most people who binge are not dependent on alcohol, so their problem drinking may go unrecognized.

The message for doctors, Blazer said, is that they should be asking their older patients specifically about binge drinking.

Patients who do report bingeing may also need to be screened for other types of substance abuse, according to the researchers.

In this study, men who reported binge drinking had a higher risk of illegal drug use than men who drank but did not binge, while female binge drinkers had a heightened likelihood of prescription drug abuse.

U.S. spending on mental illness is soaring at a faster pace than spending on any other health care category, new government data released Wednesday shows.

The cost of treating mental disorders rose sharply between 1996 and 2006, from $35 billion (in 2006 dollars) to almost $58 billion, according to the report from the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

At the same time, the report showed, the number of Americans who sought treatment for depression, bipolar disorder and other mental health woes almost doubled, from 19 million to 36 million.

The new statistics come on the heels of a study, released Monday, that found antidepressant use among U.S. residents almost doubled between a similar time frame, 1996 and 2005.

Spending on mental illness showed a faster rate of growth over the 10-year period analyzed than costs for heart disease, cancer, trauma-linked disorders, and asthma.

According to the report, spending on heart disease rose from $72 billion in 1996 to $78 billion in 2006; cancer care rose from $47 billion to $58 billion; asthma costs climbed from $36 billion to $51 billion, and expenditures for trauma-related care rose from $46 billion to $68 billion.

In terms of per-patient costs, cancer led the way at $5,178 in 2006 (up slightly from $5,067 in 1996), while costs for trauma care and asthma rose sharply — from $1,220 to $1,953 and from $863 to $1,059, respectively.

On the other hand, average per-patient spending for heart conditions fell, from $4,333 to $3,964. And spending on mental disorders declined from $1,825 to $1,591.

In the Monday study, published in the Archives of General Psychiatry, researchers reported that 10.12 percent of U.S. residents aged 6 and over, or 27 million people, were using antidepressants in 2005, compared to 5.84 percent, or 13.3 million people, in 1996.

The increase seemed to span virtually all demographic groups.

“This is a 20-year trend and it’s very powerful,” remarked Dr. Eric Caine, chair of the department of psychiatry and co-director of the Center for the Study of Prevention of Suicide at the University of Rochester Medical Center.

Abstract and Introduction

Abstract

Study Objectives: To enhance physician and patient awareness of polypharmacy; to decrease the risks, drug costs, and waste resulting from polypharmacy; and to make the business case for reducing misuse, overuse, and underuse of drugs by reducing polypharmacy.
Design: Longitudinal, time series cohort.
Setting: Outpatient, managed care, integrated delivery system.
Patients: A total of 195,971 patients who received health care from the Henry Ford Medical Group and had health insurance coverage from the Health Alliance Plan.
Measurements and Main Results: Two identical interventions separated by 1 year were conducted in patients at high risk of harm from polypharmacy based on five categories of high-risk drug combinations (referred to as polypharmacy events). Six months of pharmacy claims data were reviewed before and after each intervention to identify these patients. The intervention program consisted of clinical pharmacists performing drug therapy reviews, educating physicians and patients about drug safety and polypharmacy, and working with physicians and patients to correct polypharmacy problems. Prescription cost/member/month, number of prescriptions/member/month, and rates of polypharmacy events/1000 members were measured before and after each of the two interventions. After the first intervention, the overall rate of polypharmacy events decreased from 29.01 to 9.43/1000 patients (67.5% reduction). The number of prescriptions/member/month decreased from 4.6 to 2.2 (52.2% reduction), prescription cost/member/month decreased from $222 to $113 (49.1% reduction), and overall institution drug cost was reduced by $4.8 million. Six months after the second intervention, the overall rate of polypharmacy events was reduced from 27.99 to 17.07/1000 (39% reduction), the number of prescriptions/member/month decreased from 4.5 to 4.0 (11.1% reduction), and prescription cost/member/month decreased from $264 to $239 (9.5% reduction). Overall institution drug costs were reduced by $1.3 million. Sustained effects were seen for all measures of polypharmacy (p=0.001).
Conclusions: These interventions reduced drug costs and numbers of prescriptions in a managed care cohort of patients at high risk for adverse drug events due to polypharmacy. By providing clinical information, decision support, patient self-management support, and care delivery redesign some of the problems resulting from polypharmacy can be solved.Introduction

A national survey of noninstitutionalized American adults indicated that more than 40% of persons aged 65 years or older take five or more different drugs/week, with 12% taking 10 or more.[1] Polypharmacy, however, may not only be appropriate but is often necessary to improve health outcomes and prevent disease progression in older persons with chronic conditions. However, overuse, underuse, and misuse of drugs have all been linked to serious health problems, disabilities, hospitalizations, and death.[2-4]

The term polypharmacy suggests that more drugs are prescribed and taken than are warranted clinically. Patients at greatest risk of polypharmacy consequences are the elderly, patients taking five or more concurrent drugs, those with multiple physicians and pharmacies, patients with concurrent comorbidities or impairments in vision or dexterity, and individuals who have recently been hospitalized.[5] According to one study, nearly one in four noninstitutionalized elderly Americans is taking potentially dangerous prescription drugs.[3]

Researchers who evaluated a cohort of older ambulatory persons estimated that as many as 27.6% of adverse drug events are preventable and occur most commonly with cardiovascular drugs, diuretics, nonopioid analgesics, antidiabetic agents, and anticoagulants.[6] Preventable drug-related morbidity is the fifth most costly health condition. In 2000, the United States spent $133 billion on drugs and an estimated $177 billion managing drug-related problems.[7] For every $1.00 spent on drug therapy, as much as $1.30 may be spent managing drug-related problems.[7] These concerns have prompted calls to action by numerous organizations, including the Centers for Medicare and Medical Services, the Institute for Health Care Improvement, the Institute for Health Care Quality, the National Committee for Quality Assurance, the National Quality Forum, and the Institute for Safe Medication Practices. Oversight of pharmaceutical care by clinical pharmacists has proven effective in improving quality and lowering cost of care in various venues.[8-14]

The goal of our longitudinal study was to improve drug safety through the reduction of polypharmacy in managed care patients. In patients receiving polypharmacy, we performed two identical interventions that consisted of clinical pharmacists performing drug therapy reviews, educating physicians and patients about drug safety and polypharmacy, and working with physicians and patients to correct polypharmacy problems. The intervention integrated the practice of pharmaceutical care with data extracted from pharmacy claims. Primary objectives were to enhance physician awareness of polypharmacy within our managed care network, decrease rates of selected high-risk polypharmacy combinations, and reduce drug costs resulting from polypharmacy.

Our secondary objective was to develop the business case for expanding the polypharmacy intervention program to all patients receiving health coverage from our institution. According to some authors, an intervention can be said to fulfill a business case for quality if it leads to a financial return on the investment needed to implement the intervention in a reasonable time and with a reasonable rate of discounting.[15] This return may consist of profit, reduced losses, or avoided costs. For a polypharmacy intervention to be sustainable, it must satisfy the business case for quality.