SELFCARE FOCUS

A selection of newly published papers on self care from the worldwide literature

Every week, we will provide a brief summary and a link to the published abstract of newly published papers selected from the worldwide literature as being of particular interest to the SelfCare community.

EFFECT OF HOME TESTING OF INTERNATIONAL NORMALIZED RATIO ON CLINICAL EVENTS.

by: D B Matchar, A Jacobson, R Dolor et al.

N Engl J Med. 2010 Oct 21;363(17):1608-20

Summary: Warfarin anticoagulation reduces thromboembolic complications in patients with atrial fibrillation or mechanical heart valves, but effective management is complex, and the international normalized ratio (INR) is often outside the target range. Compared with venous plasma testing, point-of-care INR measuring devices allow greater testing frequencyand patient involvement and may improve clinical outcomes. 2922 patients taking warfarin because of mechanical heart valves or atrial fibrillation and who were competent in the use of point-of-care INR devices were randomized to either weekly self-testing at home or monthly high-quality testing in a clinic. Patients were followed for 2.0 to 4.75 years, for a total of 8730 patient-years of follow-up. The time to the first primary event (stroke, major bleeding episode, or death) was not significantly longer in the self-testing group than in the clinic-testing group (hazard ratio, 0.88; 95% confidence interval,0.75 to 1.04; P=0.14). The two groups had similar rates of clinical outcomes except that the self-testing group reported more minor bleeding episodes. Compared with monthly clinic testing, weekly self- testing did not delay the time to a primary event to the extent suggested by prior studies.

Abstract.

KNOWLEDGE AND ATTITUDES OF PHARMACISTS REGARDING OVER-THE-COUNTER EMERGENCY CONTRACEPTION IN SOUTH-EASTERN HUNGARY.

by: M Szuecs, A Prduczne-Szoelloesi, G Brtfai.

Eur J Contracept Reprod Health Care. 2010 Oct;15(5):336-42

Summary: In Hungary, the one-dose levonorgestrel-only emergency contraception pill (ECP) is available only with prescription. There is a perceived need among both doctors and women to introduce ECP over-the-counter (OTC). The aim of this study was to gain information  which, as in most geographical areas, was lacking so far on the knowledge and attitude of pharmacists relating to OTC use of ECP in South-Eastern Hungary. A questionnaire survey was completed by 108 pharmacists. Most (97%) were aware of the dosing schedule of the available ECP. 73.4% of the pharmacists estimated the effectiveness of ECP to be 80%. However, knowledge around side  effects, mode of action and effect on the menstrual cycle varied. 55% of the pharmacists would prefer OTC distribution of ECP.

Abstract.

OVER-THE-COUNTER DRUG USE-ESTIMATIONS WITHIN THE SWEDISH PAEDIATRIC POPULATION.

by: P Nydert, E Kimland, I Kull, S Lindemalm.

Eur J Pediatr. 2010 Oct 20

Summary: Three different sources were used to estimate the use of drugs sold over the counter (OTC) by the Swedish paediatric population during 2007-2008 as part of a European evaluation initiated by the European Medicines Agency. In Sweden, 1.25 OTC packages are sold quarterly per child (0-18years), and the children in both questionnaire studies use, on average, 0.9 OTC substances. Sixty-five percent of the children visiting an emergency ward and 67% of the 13-year-old Stockholm inhabitants had used at least one OTCD.

Abstract

SELF-MEDICATION WITH ANTIBIOTICS IN RURAL POPULATION IN GREECE: A CROSS-SECTIONAL MULTICENTER STUDY.

by: E Skliros, P Merkouris, A Papazafiropoulou, et al.

BMC Fam Pract. 2010 Aug 8;11:58

Summary: Self-medication is an important driver of antimicrobial overuse as well as a worldwide problem. The aim of this study was to estimate the use of antibiotics, without medical prescription, in 1,139 randomly selected adults, who visited 6 rural Health Centres in southern Greece, between November 2009 and January 2010. Use of antibiotics within the past 12 months was reported by 888 participants (77.9%). 508 individuals (44.6%) reported that they had received antibiotics without medical prescription at least once. The major source of self-medication was the pharmacy without prescription (76.2%). Fever (41.2%), common cold (32.0%) and sore throat (20.6%) were the most frequent indications for the use of self-medicated antibiotics.

Abstract

See also related article in SelfCare

A RANDOMISED, ASSESSOR BLIND, PARALLEL GROUP COMPARATIVE EFFICACY TRIAL OF THREE PRODUCTS FOR THE TREATMENT OF HEAD LICE IN CHILDREN–MELALEUCA OIL AND LAVENDER OIL, PYRETHRINS AND PIPERONYL BUTOXIDE, AND A “SUFFOCATION” PRODUCT.

by: S C Barker, P M Altman.

BMC Dermatology, 2010; 10: 6

Summary: In this study the efficacy and safety of three topical pediculicides were compared: a pediculicide containing melaleuca oil (tea tree oil) and lavender oil (TTO/LO); a head lice “suffocation” product; and a product containing pyrethrins and piperonyl butoxide (P /PB). The study was a randomised, assessor-blind, comparative, parallel study of 123 subjects with live head lice. The percentage of subjects louse-free one day after the last treatment with TTO/LO (41/42; 97.6%) and the head lice “suffocation” product (40/41, 97.6%) was significantly higher than with P /PB (10/40, 25.0%; adj. p < 0.0001). The high efficacy of the TTO/LO product and the head lice “suffocation” product offers an alternative to the pyrethrins-based product.

Abstract

See also related article in SelfCare

OTC TAMSULOSIN FOR BENIGN PROSTATIC HYPERPLASIA.

No Authors Listed

Drug Ther Bull. 2010 Oct;48(10):113-6

Summary: In 2010, tamsulosin, an alpha blocker previously only available on prescription, became available for OTC sale in the UK by pharmacists as a treatment for functional symptoms of benign prostatic hyperplasia (BPH) in men aged 45-75 years (Flomax Relief MR – Boehringer Ingelheim). DTB review the evidence on tamsulosin and assess whether its availability as an OTC product confers worthwhile advantages.

Abstract

See also related article in SelfCare

KNOWLEDGE GAPS AND MISCONCEPTIONS ABOUT OVER-THE-COUNTER ANALGESICS AMONG ADOLESCENTS ATTENDING A HOSPITAL-BASED CLINIC.

by: K M Wilson, P Singh, A K Blumkin et al.

Acad Pediatr. 2010 Jul-Aug;10(4):228-32. Epub 2010 Jun 9

Summary: Although many adolescents use over-the-counter (OTC) analgesics, their knowledge about these drugs is unclear. This study evaluates misconceptions and knowledge gaps about OTC side effects, risks, and interactions among 96 adolescents aged 14 to 20 years attending a hospital-based clinic. In conclusion, most adolescents use OTC analgesics, but many are confused about generic and brand name forms. There were also significant knowledge gaps about OTC use, side effects, and contraindications, especially for acetaminophen. Clinicians should be aware of the potential for OTC medication misuse by adolescent patients.

Abstract

SERIOUS MORBIDITY ASSOCIATED WITH MISUSE OF OVER-THE-COUNTER CODEINE-IBUPROFEN ANALGESICS: A SERIES OF 27 CASES.

by: M Y Frei,  S Nielsen, M D H Dobbin, C L Tobin.

Med J Aust. 2010 Sep 6;193(5):294-6

Summary: Prospective cases were collected from hospital-based addiction medicine specialists between May 2005 and December 2008 to investigate morbidity related to misuse of over-the-counter (OTC) codeine-ibuprofen analgesics. Twenty-seven patients with serious morbidity were included, mainly with gastrointestinal haemorrhage and opioid dependence. Although codeine can be considered a relatively weak opioid analgesic, it is addictive, and the significant morbidity and patient characteristics associated with overuse of codeine-ibuprofen analgesics support further awareness, investigation and monitoring of OTC codeine-ibuprofen analgesic use.

Abstract

DISCUSSING SIDE EFFECTS OF OVER-THE-COUNTER MEDICINES: IMPACT OF ADDING PERCENTAGE DATA.

by: M Seyed-Hosseini, J Taylor, D Quest.

Int J Pharm Pract. 2010 Oct;18(5):275-81

Summary: OTC medicine users. Both effectiveness and side effects were of concern before receiving side effect percentages, while effectiveness subsequently became more important as the frequency data seemed to provide reassurance.

Abstract

MISUSE OF OVER-THE-COUNTER CODEINE-CONTAINING ANALGESICS: DEPENDENCE AND OTHER ADVERSE EFFECTS.

by: G M Robinson, S Robinson, P McCarthy, C Cameron.

N Z Med J. 2010 Jun 25;123(1317):59-64

Summary:  Case records of all admissions to a hospital detoxification unit of codeine dependency were reviewed over a 2-year period. An unfamiliar pattern of complications including gastric ulcer, gastrointestinal bleeding, hepatotoxicity, and inflammatory bowel conditions may relate to higher codeine content in combination products, and marketing strategies. There is a need for increased pharmacovigilance around these and other OTC medications.

Abstract

PRESCRIBING AND SALE OF OPHTHALMIC CHLORAMPHENICOL FOLLOWING RECLASSIFICATION TO OVER-THE-COUNTER AVAILABILITY.

by: R Walker, A Hinchliffe.

Int J Pharm Pract. 2010 Oct;18(5):269-74

Summary:  The impact of OTC availability of chloramphenicol eye drops and eye ointment was investigated on the prescribing and overall supply of ophthalmic chloramphenicol in primary care. In the 40 months following reclassification 2.9 million packs of chloramphenicol were sold in England and 152,024 in Wales, 2.2 times greater than the calculated reduction in ophthalmic antibacterial prescription items in England and 2.9 times greater than that seen in Wales. Following reclassification there have been significant increases in the supply of ophthalmic antibacterials in England and Wales.

Abstract

GENERAL PRACTITIONERS’ VIEWS AND EXPERIENCES OF OVER-THE-COUNTER SIMVASTATIN IN SCOTLAND.

by: D Stewart, I T Cunningham, D Hansford, et al.

Br J Clin Pharmacol. 2010 Sep;70(3):356-9

Summary:  In 2004 simvastatin was reclassified in the UK from prescription only to OTC. This study was to determine the views and experiences of Scottish GPs towards CVD risk assessment by community pharmacists and the supply and sale of simvastatin. A majority of GPs surveyed did not support the supply of OTC simvastatin by the community pharmacist, being particularly concerned by the lack of cholesterol and blood pressure data in the CHD risk assessment prior to sale.

Abstract

See also related article in SelfCare

PAINACTION-BACK PAIN: A SELF-MANAGEMENT WEBSITE FOR PEOPLE WITH CHRONIC BACK PAIN.

by: E Chiauzzi, L A Pujol,  M Wood,  K Bond, R Black, E Yiu, K Zacharoff.

Pain Med. 2010 Jul;11(7):1044-58. Epub 2010 Jun 8 – 47 refs

Summary:  Websites to engage people in self-care of specific conditions are an attractive idea. This controlled study found that an interactive self management website for chronic back pain sufferers appeared to improve a range of pain parameters as well as anxiety, stress and depression ratings.

Abstract

ONLINE DIABETES SELF-MANAGEMENT PROGRAM: A RANDOMIZED STUDY

by: K Lorig,  P L Ritter,  D D Laurent, K Plant, M Green, V B Jernigan, S Case.

Diabetes Care. 2010 Jun;33(6):1275-81. Epub 2010 Mar 18

Summary:  An on-line type 2 diabetes self management system appeared to improve patient activation, self-efficacy and glycated hemoglobin levels at 6 months compared to usual care.  Interestingly, follow-up reinforcement did not appear to add value.

Abstract

See also related article in SelfCare

DOES THE USE OF A HANDHELD FAN IMPROVE CHRONIC DYSPNEA? A RANDOMIZED, CONTROLLED, CROSSOVER TRIAL

by: S Galbraith, P Fagan,  P Perkins,  A Lynch,  S Booth.

J Pain Symptom Manage. 2010 May;39(5):831-8

Summary: This study suggests that the use of a handheld fan directed at the face to produce cooling may reduce breathlessness in patients with chronic dyspnea.  This simple palliative measure may be of value in self management of advanced disease.

Abstract

 

MOTIVATION AND ITS RELATIONSHIP TO ADHERENCE TO SELF-MONITORING AND WEIGHT LOSS IN A 16-WEEK INTERNET BEHAVIORAL WEIGHT LOSS INTERVENTION

by: K H Webber, D F Tate, D S Ward, J M Bowling.

J Nutr Educ Behav. 2010 May-Jun;42(3):161-7. Epub 2010 Feb 6

Summary: This study evaluated a 16 week internet-based behavioural weight-loss intervention. Autonomous motivation was a predictor of adherence to self monitoring and weight loss and remained high in those achieving a 5% weight reduction.

Abstract

WHAT WORKS FOR PEOPLE WITH BIPOLAR DISORDER? TIPS FROM THE EXPERTS.

by: M Suto, G Murray, S Hale, E Amari, E E Michalak.

Journal of affective disorders, 2010 Jul;124(1-2):76-84. Epub 2009 Dec 6

Summary:  This study investigated high functioning individuals with bipolar disorder to determine which self management strategies they were adopting.  This is an interesting hypothesis-generating exercise looking at the potential for self care of a difficult chronic condition.

Abstract

SEVERE HYPOGLYCAEMIA ASSOCIATED WITH INGESTING COUNTERFEIT MEDICATION.

by: S K Chaubey,  K S Sangla,  E N Suthaharan, Y M Tan.

The Medical journal of Australia, 2010 Jun 21;192(12):716-7

Summary: A case report which adds to the growing literature on the risks associated with unregulated self-medication. Drugs purchased from illegal sources may be ineffective – but also contaminated and potentially dangerous as in this case.

Abstract

COMPARISON OF AT-HOME AND IN-OFFICE TOOTH WHITENING USING A NOVEL SHADE GUIDE.

by: J B da-Costa, R McPharlin, R D Paravina, J L Ferracane

Operative  dentistry, 2010 Jul-Aug;35(4):381-8

Summary: In this small controlled study, 5 days of home tooth whitening produced similar cosmetic results and tolerability compared to a single procedure performed in a dental office setting, but was preferred by a strong majority of subjects.

Abstract

POPULAR MEDICINE AND SELF-CARE IN A MEXICAN MIGRANT COMMUNITY: TOWARD AN EXPLANATION OF AN EPIDEMIOLOGICAL PARADOX.

by: A Waldstein.

Medical anthropology, 2010 Jan;29(1):71-107

Summary:  This ethnographic study suggests that an ethnic tradition favouring self care and self medication may help explain why US Hispanic populations have paradoxically good health outcomes despite their economically disadvantaged status.

Abstract

TELEMONITORING AND SELF-MANAGEMENT IN THE CONTROL OF HYPERTENSION (TASMINH2): A RANDOMISED CONTROLLED TRIAL.

by: R J McManus,  J Mant, E P Bray, R Holder, M I Jones, S Greenfield, B Kaambwa, M Banting, S Bryan, P Little, B Williams, F D Hobbs.

Lancet. 2010 Jul 17;376(9736):163-72. Epub 2010 Jul 8 – 36 refs

Summary: This large study in a general practice setting compared the control of hypertension in a group of patients randomised to a regimen of self monitoring and self titration of treatment combined with telemonitoring, compared to usual care. The self care/ telemonitoring group had significantly lower systolic blood pressure than the controls at 6 and 12 months, suggesting that more direct patient involvement in management of hypertension may improve outcomes.

Abstract

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