Aims and ScopeThe Journal publishes original reports of studies in biopharmaceutics, drug disposition and pharmacokinetics, especially those which have a direct relation to the therapeutic use of drugs.This includes human pharmacological studies, and therapeutic response and toxicity related to plasma and tissue concentrations of drugs and their metabolites.Research on factors affecting the disposition of the clinical response to drugs, and on the design of drug dosage regimens and the treatment of overdose, based on pharmacokinetic principles, are accepted.Papers on analytical methodology, in vitro drug metabolism, and on animal models are also published, provided that either they facilitate the preceding types of investigation, or they are related to the use of drugs in man.
OBJECTIVE:
To develop an electronic decision support tool for anticoagulation and stroke prevention in patients with atrial fibrillation (AF) and demonstrate its efficacy through a randomized cluster controlled trial.
BACKGROUND:
Despite good evidence of the benefits of anticoagulation in preventing stroke in patients with AF, doctors are often reluctant to prescribe anticoagulation citing fear of patient falls and risk of bleeding.
A recent audit of stroke care in New Zealand revealed that among patients presenting with an acute ischaemic stroke, 40[percnt] had a known history of AF, however, only 24[percnt] of patients with AF were on anti-coagulants. Two audits confirmed the low use of anticoagulation in patients presenting to Wellington Hospital.
While AF is considered a disease of the heart, the end organ damage of stroke falls in the domain of the neurologist. We plan to address the low rates of anticoagulation through an electronic decision support (EDS) tool in order to reduce the rate of stroke.
DESIGN/METHODS:
Medtech is a patient management system used by 95[percnt] of primary care practices in New Zealand. We partnered with Best Practice Advocacy Centre (bpacNZ) and created a fully integrated EDS tool for anticoagulation and AF management.
RESULTS:
The EDS tool delivers prompts, support and guidance to the primary care physician for establishing a patient on anticoagulation whenever AF is identified. We plan a randomised cluster controlled trial, randomising primary care practices to either the intervention arm (EDS tool) or a control arm (current best practice), to prove efficacy of the EDS tool for increasing anticoagulation rates.
CONCLUSIONS:
Given that the existing technology base is well established nationwide, it is expected that this could become a national model which would have significant benefits for patient care and healthcare costs across the country. Disclosure: Dr. Jolliffe has nothing to disclose. Dr. Rosemergy has nothing to disclose. Dr. Lanford has nothing to disclose. Dr. Abernethy has nothing to disclose. Dr. Ranta has nothing to disclose.
The aim of the present study was to examine impairment of implicit learning in Parkinson's disease (PD) by means of a meta-analysis of studies that used the serial reaction time (SRT) task. The authors performed a systematic review and meta-analysis of published journal articles (1987-2005) that used the SRT task with patients with PD. The principal outcome measures used to compare studies were (a) the difference in reaction time between the last block of ordered sequence trials and the randomized block for PD and control participants and (b) fixed and random effects pooled estimates by the inverse weighting method. Six studies, including 67 patients with PD, met the inclusion criteria. The meta-analysis showed that implicit learning was impaired in PD, relative to healthy controls, with a standardized mean difference of 0.73 (95% confidence interval = 0.38, 1.07). Implicit sequence learning appears to be impaired in patients with PD. Some common methodological weaknesses and limitations in the reporting of statistical data are discussed.
Background: The prevalence of multiple sclerosis (MS) is not uniform, with a latitudinal gradient of prevalence present in most studies. Understanding the drivers of this gradient may allow a better understanding of the environmental factors involved in MS pathogenesis. Method: The New Zealand national MS prevalence study (NZMSPS) is a cross-sectional study of people with definite MS (DMS) (McDonald criteria 2005) resident in New Zealand on census night, 7 March 2006, utilizing multiple sources of notification. Capture—recapture analysis (CRA) was used to estimate missing cases. Results: Of 2917 people with DMS identified, the crude prevalence was 72.4 per 100,000 population, and 73.1 per 100,000 when age-standardized to the European population. CRA estimated that 96.7% of cases were identified. A latitudinal gradient was seen with MS prevalence increasing three-fold from the North (35°S) to the South (48°S). The gradient was non-uniform; females with relapsing—remitting/secondary-progressive (RRMS/SPMS) disease have a gradient 11 times greater than males with primary-progressive MS ( p < 1 × 10 -7 ). DMS was significantly less common among those of Māori ethnicity. Conclusions: This study confirms the presence of a robust latitudinal gradient of MS prevalence in New Zealand. This gradient is largely driven by European females with the RRMS/SPMS phenotype. These results indicate that the environmental factors that underlie the latitudinal gradient act differentially by gender, ethnicity and MS phenotype. A better understanding of these factors may allow more targeted MS therapies aimed at modifiable environmental triggers at the population level.
Multiple sclerosis (MS) is an immune‐driven, demyelinating disease of the central nervous system (CNS). Although many types of immune cells are involved in disease progression, activated monocytes are believed to be one of the first to arrive to the brain and initiate inflammation. However, little is known about how the two main monocyte subsets, CD14 ++ CD16 − and CD14 + CD16 + , are involved in MS. To understand how the phenotype and responses of these monocyte subsets are altered during MS, total monocytes and the purified monocyte subsets from healthy subjects ( n =29) and MS patients ( n =20) were characterized ex vivo and stimulated in vitro with lipopolysaccharide (LPS). The ex vivo analyses showed that total monocytes from MS patients had significantly elevated levels of CD40, CD86, HLA‐DR, CD64 and C‐C motif chemokine receptor 2 (CCR2), and this elevation was most marked on CD16 + monocytes. In vitro stimulation with LPS led to an increase in CD86, HLA‐DR, CD64 and IL‐6 production by monocytes from MS patients. Furthermore, in purified cultures, CD14 + monocytes were found to be the main producers of IL‐10 while CD16 + monocytes produced more IL‐12. In monocytes from MS patients, both subsets produced substantially more IL‐6, and the production of IL‐10 by the CD16 + subset was also significantly elevated compared with healthy monocytes. Together these findings highlight the important contribution of the CD16 + monocyte subset in driving inflammatory responses during MS.
The Journal publishes original reports of studies in biopharmaceutics.drug disposition and pharmacokinetics, especially those which have a direct relation to the therapeutic use of drugs.This includes human pharmacological studies, and therapeutic response and toxicity related to plasma and tissue concentrations of drugs and their metabolites.Research on factors affecting the disposition of the clinical response to drugs, and on the design of drug dosage regimens and the treatment of overdose, based on pharmacokinetic principles, are accepted.Papers on analytical methodology, in vitro drug metabolism, and on animal models are also published, provided that either they facilitate the preceding types of investigation, or they are related to the use of drugs in man.
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