Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

AIM:To investigate prescribing pattern in low-dose aspirin users and physician awareness of preventing aspirin-induced gastrointestinal(GI) injury with combined protective medications.METHODS:A retrospective drug utilization study was conducted in the 2nd Affiliated Hospital,School of Medicine,Zhejiang University.The hospital has 2300 beds and 2.5 million outpatient visits annually.Data mining was performed on all aspirin prescriptions for outpatients and emergency patients admitted in 2011.Concomitant use of proton-pump inhibitors(PPIs),histamine 2-receptor antagonists(H2RA) and mucoprotective drugs(MPs) were analyzed.A defined daily dose(DDD) methodology was applied to each MP.A further investigation was performed in aspirin users on combination use of GI injurious medicines [non-steoid anti-inflammatory drugs(NSAIDs),corticosteroids and clopidogrel and warfarin] or intestinal protective drugs(misoprostol,rebamipide,teprenone and gefarnate).Data of major bleeding episodes were derived from medical records and adverse drug reaction monitoring records.The annual incidence of major GI bleeding due to low-dose aspirin was estimated for outpatients.RESULTS:Prescriptions for aspirin users receiving PPIs,H2RA and MPs(n = 1039) accounted for only 3.46% of total aspirin prescriptions(n = 30 015).The ratios of coadministration of aspirin/PPI,aspirin/H2RA,aspirin/MP and aspirin/PPI/MP to the total aspirin prescriptions were 2.82%,0.12%,0.40% and 0.12%,respectively.No statistically significant difference was observed in age between patients not receiving any GI protective medications and patients receiving PPIs,H2RA or MPs.The combined medication of aspirin and PPI was used more frequently than that of aspirin and MPs(2.82% vs 0.40%,P < 0.05) and aspirin/H2RA(2.82% vs 0.12%,P < 0.05).The values of DDDs of MPs in descending order were as follows:gefarnate,hydrotalcite > teprenone > sucralfate oral suspension > L-glutamine and sodium gualenate granules > rebamipide > sucralfate chewable tablets.The ratio of MP plus aspirin prescriptions to the total MP prescriptions was as follows:rebamipide(0.47%),teprenone(0.91%),L-glutamine and sodium gualenate granules(0.92%),gefarnate(0.31%),hydrotalcite(1.00%) and sucralfate oral suspension(0.13%).Percentages of prescriptions containing aspirin and intestinal protective drugs among the total aspirin prescriptions were:rebamipide(0.010%),PPI/rebamipide(0.027%),teprenone(0.11%),PPI/teprenone(0.037%),gefarnate(0.017%),and PPI/gefarnate(0.013%).No prescriptions were found containing coadministration of aspirin and other NSAIDs.Among the 3196 prescriptions containing aspirin/clopidogrel,3088(96.6%) prescriptions did not contain any GI protective medicines.Of the 389 prescriptions containing aspirin/corticosteroids,236(60.7%) contained no GI protective medicines.None of the prescriptions using aspirin/warfarin(n = 22) contained GI protective medicines.Thirty-five patients were admitted to this hospital in 2011 because of acute hemorrhage of upper digestive tract induced by low-dose aspirin.The annual incidence rates of major GI bleeding were estimated at 0.25% for outpatients taking aspirin and 0.5% for outpatients taking aspirin/warfarin,respectively.CONCLUSION:The prescribing pattern of low-dose aspirin revealed a poor awareness of preventing GI injury with combined protective medications.Actions should be taken to address this issue.

Clinical observation of acupuncture combined with medication for mild-to-moderate depression

Objective:To discuss the clinical efficacy and plausible mechanism of Tiao Yang Qu Xie(regulating Yang to eliminate pathogenic factors)needling method plus paroxetine in treating mild-to-moderate depression.Methods:Sixty-six patients with mild-to-moderate depression were divided into an observation group and a control group using the random number table method,each consisting of 33 cases.Another 25 healthy subjects were recruited as a healthy group.The control group took oral paroxetine tablets for treatment,and the observation group received additional acupuncture treatment 3 times weekly.Both groups underwent 4-week treatment.Before treatment,after 2-week and 4-week treatment,and 2 weeks after treatment(follow-up),the patients were assessed using the Hamilton depression scale-17-item(HAMD-17),self-rating depression scale(SDS),self-rating anxiety scale(SAS),and traditional Chinese medicine(TCM)pattern element identification scale for depression.The two groups each randomly contributed 25 cases to detect the protein content of brain-derived neurotrophic factor(BDNF)before treatment and after 4-week treatment,and compared with the healthy group.Results:After 2-week treatment,the markedly effective and total effective rates were significantly higher in the observation group than in the control group(P<0.05);after 4-week treatment,the observation group significantly surpassed the control group in comparing the markedly effective rate(P<0.05).After 2 and 4 weeks of treatment and at the follow-up,the HAMD-17 total score and sleep disorder factor score were lower in the observation group than in the control group(P<0.05);the anxiety-somatic score was lower in the observation group than in the control group after 2-week treatment(P<0.05).After 2 and 4 weeks of treatment and at the follow-up,the observation group was lower than the control group in comparing the scores of SDS,SAS,and TCM pattern element identification scale for depression(P<0.05).After 4-week treatment,the observation group had an increased serum BDNF protein content,higher than that in the control group(P<0.05)and had no significant difference compared to the healthy group(P>0.05).Conclusion:Compared to the use of oral paroxetine alone,acupuncture plus paroxetine can produce more significant efficacy in treating mild-to-moderate depression and act faster in improving sleep disorder and anxiety-somatic symptoms;increasing the serum BDNF protein content may be a part of the mechanism underlying its antidepressant actions.

Effect of Glycerol Fructose Combined with Mannitol on Patients with Cerebral Hemorrhage and Cerebral Edema

Objective:To observe the effect of glycerol fructose combined with mannitol in the treatment of patients with clinical intracerebral hemorrhage complicated by cerebral edema and increased intracranial pressure,and to evaluate the clinical application value of this treatment.Methods:Seventy patients with cerebral hemorrhage complicated by brain edema were randomly divided into observation and control groups.Both groups had exactly the same number of study participants.There were some differences in specific treatment methods.The specific process is as follows:The control group was treated with mannitol,while the observation group was treated with dual-purpose glycerol fructose.Several important indicators after treatment in the two groups were scored,the effects between different groups were compared,and the effect of clinical treatment was evaluated.Results:The final effect was compared and analyzed.After data analysis,we found that the intracranial pressure of the observation group was lower,the volume of brain edema was significantly reduced(P<0.05),and the NIH Stroke Scale/Score(NIHSS)was lower(P<0.05).Conclusion:Using mannitol combined with glycerol fructose can achieve better treatment effect by significantly improving the problem of brain edema.

Analysis on Clinical Characteristics and Combination Medications of Elemene Injection in the Treatment of Esophageal Cancer in Real World Research

Objective:To explore the clinical characteristics of Elemene Injection in the treatment of patients with esophageal cancer.Methods:A total of 310 patients diagnosed with esophageal cancer from the Hoptital Information System(HIS)of 21 hospitals across the country were selected in the study,and these patients all had been treated with Elemene Injection.In this study,the clinical general medication record information,diagnosis scheme information,general treatment information and combined medications information were analyzed by frequency statistics and association rules.Results:Elemene Injection was used most in patients aged 46-65(177 cases,57.10%);male patients were more than female.Among the main diagnoses of the most seasons and solar terms in hospitalization,the top three diagnoses were esophageal malignant tumor,malignant tumor,and hypertension.In terms of combination medication,the combination of western medicine blood substitutes and perfusion fluids,general nutritional drugs,vitamins,antibacterial drugs,and immune-promoting drugs were the main ones;the combination of traditional Chinese medicine was mainly anti-tumor drugs(48.71%).In addition,among the combination medications,the highest frequency of Elemene Injection combined with western medicine and traditional Chinese medicine were Xiaoaiping Injection(消癌平注射液)and ascorbic acid.Conclusion:The main susceptible people of esophageal cancer was middle-aged around 46-65,and there were more male patients than female;through the first diagnosis of western medicine,it can be found that in addition to patients suffering from esophageal cancer or other cancers,patients with high blood pressure,heart disease,and diabetes could use Elemene Injection.Therefore,when receiving such patients,attention should be paid to checking whether the patient had such diseases.At the same time,when using Elemene Injection,it's necessary to pay attention to certain combined medications to avoid adverse reactions.

Clinical Study on Treatment of Knee Osteoarthritis with Combined Acupuncture and Medication

Objective： To observe the effect of treatment for proliferative knee osteoarthritis （KOA） using combined acupuncture and medicated compression. Method： All 328 cases were randomized into an observation and control group, 164 cases in each. Combined acupuncture and medicated compression were adopted in the observation group, while oral administration of Zhui Feng Tou Gu Wan （Wind-removing and Bone-penetrating Pills） were adopted in the control group. The clinical effects in the two groups were evaluated 40 days after the treatment. Result： There were significant differences in both marked and total effective rates （P〈0.05）. Conclusion Combined acupuncture and medicated compression can obtain better effect for KOA than oral administration of the Wind-Removing and Bone-Penetrating pills.

Therapeutic Effect Analysis on Combined Acupuncture and Medication for Peripheral Facial Paralysis

Objective： To investigate the therapeutic efficacy of combined acupuncture and medication for peripheral facial paralysis. Methods： Sixty-six cases with peripheral facial paralysis were randomly allocated into a treatment group and a control group, 33 cases in each group. The cases in the treatment group were treated with combined electroacupuncture and Chinese medicine formula, while the cases in the control group were treated by electroacupuncture alone. Results： The recovery rate in the treatment group was significantly higher than the control group （P〈0.05）. In addition, the time length for recovery in the treatment group tended to be shorter than the control group. Conclusion： Combined acupuncture and medication can obtain better effect than electroacupuncmre alone for peripheral facial paralysis.

Clinical Study on Combined Needle-embedding and Medication for Depressive Sleep Disorder

Objective： To observe the clinical efficacy of combined needle-embedding and SSRIs for depressive sleep disorder. Method： Upon admission, 71 depression cases were randomized into needle-embedding group of 24 cases, using combined needle-embedding and SSRls, acupuncture group of 21 cases, using combined acupuncture and SSRIs, and medication group of 26 cases, using SSRIs alone. Alter 1, 2, 4 and 6 weeks of treatment, the HAMD sleep scores were compared. Result： The HAMD sleep scores in the needle-embedding and acupuncture group were remarkably superior to the medication group and there was significant statistical difference after 1, 2 and 4 weeks of treatment （P〈0.01）. However, there was no statistical difference after 6 weeks of treatment. Conclusion： SSRIs can improve HAMD sleep scores. The combined needle-embedding or acupuncture with SSRIs can work faster and better than medication alone. There was no statistical difference between needle-embedding and acupuncture group, however, needle-embedding can reduce the treatment frequencies and therefore has more active clinical meaning.

Clinical Observation of Combined Acupuncture ＆ Medications in Treating Dysspermia Infertility

Objective： To observe the curative effect of combined acupuncture and medication on infertility due to seminal abnormality. Method： Thirty-eight patients with seminal abnormality were separately treated by acupuncture and traditional Chinese medications （“Erxian Decoction”） plus Clomiphene. Results and Conclusion： The total effective rate was 96.0% in the acupuncture plus traditional Chinese medication group （26 cases） and 66.7% in the acupuncture and western medication groups （12 cases）. Statistical analysis showed a significant difference （P〈0.05）. The cure rate and the pregnancy rate were 38.5% and 30.8% respectively in the acupuncture and traditional Chinese medication group. Both of them were higher than 8.3% and 8.3% in the acupuncture and western medication group respectively, but there were no statistically significant differences. In the two groups of patients, seminal volume, liquefaction time and viscosity and spermatozoal density, death rate and one-hour survival rate took a significant turn for the better after treatment as compared with before treatment （P〈 0.05）. In the acupuncture and traditional Chinese medication groups of patients, symptoms markedly improved after treatment as compared with before treatment.

Clinical Observation on Combined Acupuncture and Medication for Osteoporosis in Postmenopausal Women

Objective： To observe the clinical effect of combined acupuncture and medication for osteoporosis in postmenopausal women. Methods： A total of 100 cases with postmenopausal osteoporosis were randomly allocated into a treatment group and a control group, 50 in each group. The cases in the treatment group were treated with electroacupuncture coupled with Calcitriol soft capsules, while the cases in the control group were treated with electroacupuncture alone. Results： There were significant differences in treatment effects between the treatment group and control group （P〈0.05）. Conclusion： Combined acupuncture and medication can obtain a marked effect for postmenopausal osteoporosis.

Therapeutic Effect Observation on Combined Acupuncture and Medication for Ovulation

Objective：To observe the curative effect of acupuncture plus medicine in treating ovulatory dysfunctional infertility.Method：All 36 cases with anovulatory infertility were randomly allocated into a control group （19 cases） and an observation group （17 cases）.The cases in the control group were treated with 50 mg of oral administration Clomiphene once a day for 5 d,and 50 menstrual cycles were observed.The cases in the observation group were treated with combined acupuncture and the same medication as those in the control group and 45 menstrual cycles were observed.During the treatment sessions,the follicular development,ovulation,thickness of the endometrium,cervical mucus and pelvic fluid were observed and recorded.Results：The cases in the observation group showed significantly higher ovulation and pregnancy rates,along with thickening of the endometrium.In addition,no luteinized unruptured follicle syndrome （LUFS） occurred in the observation group.Conclusion：Acupuncture coupled with oral administration Clomiphene can obtain higher ovulation and conception rates than oral Clomiphene alone.

Therapeutic Observation on Combined Acupuncture and Medication for Recurrent Facial Dermatitis

Objective: To observe the clinical efficacy of acupoint injection plus medication in treating recurrent facial dermatitis(RFD). Methods: Fifty-eight patients with RFD were randomized into a treatment group and a control group, 29 in each. The treatment group was intervened by acupoint injection with BCG-PSN plus oral administration of Fexofenadine Hydrochloride, and the control group was by Fexofenadine Hydrochloride only. The clinical efficacies were compared between the two groups, and a follow-up study was conducted to investigate the recurrence rate. Results: The total effective rate was 96.6% in the treatment group versus 65.5% in the control group, and the difference was statistically significant(P<0.01). Of the cured and improved patients in the treatment group, the recurrence rates were 10.7%, 25.0%, and 32.1% respectively 3 months, 6 months, and 12 months after treatment, versus 31.6%, 36.8%, and 73.7% in the control group, and the differences were statistically significant(P<0.05). Conclusion: Acupoint injection plus medication is an effective method in treating RFD.

Clinical characteristics of Danshen Ligustrazine injection in the treatment of coronary heart disease with hypertension-A real world study

Objective:To explore the characteristics and rules of Danshen Ligustrazine Injection in the treatment of coronary heart disease with hypertension.Methods:From the information systems of 12 tertiary tier-one hospitals across the country,we extracted the medical data of the application of Danshen Ligustrazine Injection in the treatment of patients with coronary heart disease and hypertension.After normalization,the model was established by Apriori algorithm,and the association rules were analyzed by Clementine 12.0 software.Results:Most of the 1928 patients were between 75 and 90 years old(54.26%).There were more males than females,most with type 2 diabetes,cerebral infarction,etc.Each dose was more than 10 mL(52.78%).Aspirin enteric-coated tablets(67.63%),L-carnitine injection(58.77%),and atorvastatin calcium capsules(50.93%)were often used in combination with safflower yellow pigment(22.20%),Shexiang Baoxin Pill(16.55%),Suxiao Jiuxin Pill(15.09%);the most commonly used combination of western medicine was anticoagulant thrombolytic and antiplatelet drugs(85.84%),and the type of Chinese medicine was Huoxuehuayu(72.98%);The most common combination of two western medicines was L-carnitine injection+aspirin enteric-coated tablets,with a support of 41.9%;The most common combination of two Chinese and western medicines is western medicine·anti-anginal medicine+western medicine·anticoagulant thrombolytic and antiplatelet drugs with a support of 67.6%.Conclusion:Danshen Ligustrazine injection is mainly used in elderly patients with coronary heart disease and hypertension,with many comorbidities.The dosage standard needs to be optimized.The combination of drugs and guidelines should coordinate with each other,which provide clues for clinical diagnosis and treatment and optimization of medication.

DEVELOPMENT ON CLINICAL TREATMENT OF CONSTIPATION WITH ACUPUNCTURE AND MOXIBUSTION

In the present paper, the authors review recent developmarrt of clinical treatment of constipation with acupunctire and moxibustion from ① body acupuncture therapy including special needling manipulations, as Ziwu Daojiu Needling, etc. and acupoint combination,②electrcacupunture therapy, ③ scalp-acupuncture therapy, ④ auricular acupuncture therapy, ⑤ needleembedding and acupoint-catgut-embedding therapies, ⑥ acupoint-application therapy, ⑦ combinged acupuncture aud medication therapy, ⑧ other therapies such as cupping therapy and holo-therapy, and ⑨ considerations about the action of acupuncture in the treatmnt of constipation and its prospect. Up to now, researches on the effect of acupuncture in treating constipation are seldom seen, thus, much attention should be paid about this by clinical and experimental researchers.

Cardiotoxicity of current antipsychotics:Newer antipsychotics or adjunct therapy?

Use of newer antipsychotics for substitution of current antipsychotics might be one way awaiting to be clinically verified to address antipsychotic cardiotoxic effects.Alternatively,the combination of existing antipsychotics with cardioprotective agents is also beneficial for patients with mental disorders for avoiding cardiotoxicity to the maximum.

Clinical study of acupuncture combined with medication for the elderly with Alzheimer disease

Objective:To observe the impact of mind-regulating acupuncture plus donepezil on the cognitive ability,mean cerebral blood flow velocity,event-related potential P300,and activities of daily living(ADL)in the aged patients with Alzheimer disease(AD).Methods:Sixty senile AD patients were divided into a treatment group and a control group following the envelope method for random allocation,with 30 cases in each group.Based on the conventional treatment of the internal medicine,the control group received oral donepezil,and the treatment group received oral donepezil plus mind-regulating acupuncture.After 4-week treatment,the two groups were evaluated by the mini-mental state examination(MMSE),Alzheimer disease assessment scale-cognitive part(ADAS-Cog),and ADL;changes in P300 and the mean cerebral blood flow velocity were also observed.Results:Before treatment,there were no significant differences in the scores of MMSE,ADAS-Cog,or ADL between the two groups(P>0.05).The MMSE score increased after treatment in both groups and was notably higher in the treatment group than in the control group,showing intra-group and inter-group statistical significance(P<0.05).After treatment,the ADAS-Cog and ADL scores dropped in both groups and were markedly lower in the treatment group than in the control group,also showing intra-group and inter-group statistical significance(P<0.05).Compared with the same group before treatment,the latency of P300 was shortened and the amplitude was extended in both groups,all with statistical significance(P<0.05);the latency was shorter and the amplitude was larger in the treatment group than in the control group after treatment,presenting significant between-group differences(P<0.05).The mean blood flow velocity accelerated after the intervention in both groups,and the differences were statistically significant(P<0.05);the improvement in the treatment group was more notable than that in the control group(P<0.05).Conclusion:Mind-regulating acupuncture plus donepezil can regulate the latency and amplitude of P300,increase cerebral blood flow,and improve the learning and memory abilities of AD patients.

Clinical Observation of Combined Acupuncture and Medications in Treating 90 Cases of Facial Palsy

Peripheral facial palsy, namely Bell palsy, is one of the common diseases in the department of acupuncture. Facial palsy, popularly called wry mouth and eye, is primarily manifested by the motor malfunction of the muscles of the expression on the affected side. The author adopted combined acupuncture and medications to treat 90 cases of facial palsy from June 2005 to June 2007, and attained good effects. It is now reported as follows.

Acupuncture combined with medication for postherpetic neuralgia affecting the head and face:a randomized controlled trial

Objective:To observe the efficacy of needling the Xi-Cleft points of yang meridians plus topical surrounding needling and pregabalin in treating postherpetic neuralgia(PHN)affecting the head and face and its influence on quality of life(QOL).Methods:Eighty patients with PHN affecting the head and face were randomized into an acupuncture-medication group and a Western medication group by their visiting sequence,with 40 cases in each group.The Western medication group took pregabalin capsules orally,75 mg each time,twice a day.The dosage could increase to 150 mg each time and twice a day within 1 week based on the efficacy and tolerance.The treatment lasted for 5 weeks.The acupuncture-medication group was given additional surrounding needling at the herpes zoster on the head and face,and Xi-Cleft points of yang meridians were chosen according to the affected area for acupuncture,once every other day,for 5 weeks in total.Results:Prior to treatment,there were no significant differences in the visual analog scale(VAS)and QOL scores between the two groups(both P>O,05).After treatment,VAS and QOL scores dropped significantly in both groups(all P<0.01),and were significantly lower in the acupuncture-medication group than in the Western medication group(both P<0.01).The total effective rate was 67.5%in the Western medication group,versus 92.5%in the acupuncture-medication group,and the b etwee n-group difference was statistically significant(P<0.05).Conclusion:Based on oral administration of pregabalin,needling the Xi-Cleft points of yang meridians and topical surrounding needling can reduce PHN,notably improve patients'QOL,and produce more significant efficacy than oral administration of pregabalin alone。

Effect of Combined Acupuncture and Medication for Hypertension due to Type 2 Diabetes Mellitus and Plasma Neuropeptide Y

Objective： To observe the effect of combined acupuncture and medication for hypertension due to type 2 diabetes and plasma Neuropeptide Y （NPY）. Methods： Sixty cases with hypertension due to type 2 diabetes were randomized into two groups. Thirty cases in the treatment group were treated with acupuncture and oral extended release nifedipine tablets, while 30 cases in the control group were treated with oral extended release nifedipine tablets alone. After 15 d of treatment, the blood pressure and NPY contents in two groups were observed. Results： The blood pressure and NPY contents in the two groups were remarkably reduced （P〈0.01） and the effect in the treatment group was superior to the control group （P〈0.01）. Conclusion： Combined acupuncture and medication can significantly reduce blood pressure and the NPY contents.

The role of government in the mode of ＂medical care and support＂

Along with the acceleration of population aging process, the government as a social security gatekeeper responsibility has become increasingly prominent, improve public finance policy, properly solve the pension problem has become the important work of governments at all levels. Under the guidance of national policy, the State Council ＂on promoting health and pension services combined guidance＂ put forward to 2020, the medical and health care services and resources to achieve the ordered shared, covering urban and rural areas, appropriate scale.functional^reasonable.comprehensive and continuous medical support with service network is basically formed. In this paper, the background of the aging population, the interpretation of the meaning of the combination of medical and support, analysis of the combination of medical support mode. It is pointed out that in public finance from the perspective of medical support with the development mode will face the difficulty of system design is not sufficient, the division of responsibilities is unknown, limitations of existing policies, human, financial and material resources lack of. At last on the basis of the proposed development of medical support combined with the pension service model emphasizes the role of the govenunent to speed up the system construction and innovation of financial subsidies. improve the policy system and other measures.

Research on the path of medical service combination from the perspective of departmental cooperation

As an innovative mode of social endowment, combining medical care with modern medical care technology and old-age service is an important direction of a series of social problems caused by the deepening of aging and the intensification of aging process in China. It is the inevitable choice for the development of Chinese characteristics for the aged. At present, with the continuous development of the combination of medical care and rehabilitation, the process of combination of medical care and breeding is slow, and the problems of inter departmental cooperation, high cost of resource integration and low service efficiency have emerged. The paper puts forward that multi head management of different responsibility management body is a bottleneck problem that hinders the integration of medical care. From the objective and subjective two points of view, the administrative system level barrier and the inter departmental interest game are the important reasons that obstruct the medical support and break through the estrangement of the Department and realize the cooperation. Then, according to the theory of large part system reform, the author boldly proposes the idea of establishing a new comprehensive functional department that specializes in the management of pension related affairs.