Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 177
Filter
1.
Article in Chinese | WPRIM | ID: wpr-921767

ABSTRACT

Through investigating the current research on the effect of Naoxintong Capsules in the treatment of cerebral infarction with Qi deficiency and blood stasis syndrome and coronary heart disease angina pectoris, this study conducted a clinical comprehensive evaluation in "6+1" dimensions [safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine(TCM)], so as to highlight the advantages and clinical value of Naoxintong Capsules. By combining qualitative and quantitative methods, we used the multi-criteria decision analysis(MCDA) model to measure each dimension, and the results thereby were divided into four grades of A, B, C, and D in high-to-low order. Through literature review and evaluation, the adverse effects of Naoxintong Capsules are mainly caused by the gastrointestinal system. Since the safety risk is controllable based on current research, the safety evaluation is grade B. The effectiveness of Naoxintong Capsules combined with conventional western medicine in the treatment of cerebral infarction with Qi deficiency and blood stasis syndrome and coronary heart disease angina pectoris is evaluated as grade A, as compared with conventional therapy alone. The economy of Naoxintong Capsules, compared with Tongxinluo Capsules, is assessed as grade B. According to literature reports, Naoxintong Capsules exhibits outstanding clinical innovation in optimizing the current anti-platelet therapy strategy for patients with coronary heart disease after percutaneous coronary intervention(PCI), and the innovation is class A. Given the capsule formulation is convenient for storage and transportation, and its usage is easy for patients to grasp and accept, the suitability is grade B. The accessibility is grade A considering the price level, availability, and affordability, and the characteristics of TCM are evaluated as grade A from the perspectives of theoretical characteristics and human experience. The results of the comprehensive drug evaluation showed that the clinical value of Naoxintong Capsules is class A for treating cerebral infarction with Qi deficiency and blood stasis syndrome and coronary heart disease angina pectoris. According to the Guidelines for the Management of Comprehensive Clinical Evaluation of Drugs(trial 2021 version) issued by the National Health Commission, relevant policy results for basic clinical drug management can be formulated directly by procedure.


Subject(s)
Angina Pectoris , Capsules , Cerebral Infarction/drug therapy , Coronary Disease/drug therapy , Drugs, Chinese Herbal , Humans , Medicine, Chinese Traditional , Percutaneous Coronary Intervention , Qi
2.
Article in Chinese | WPRIM | ID: wpr-879194

ABSTRACT

The aim of the research was to evaluate the efficacy and safety associated with Shexiang Tongxin Dropping Pills combined with conventional therapy for patients with coronary heart disease(CHD). We searched 8 electronic databases up to November 2020, including PubMed, Cochrane Library, EMbase, Web of Science, CNKI, Wanfang, VIP and SinoMed. Eligible studies were clinical trials of Shexiang Tongxin Dropping Pills combined with conventional therapy used in the treatment of coronary heart disease(CHD). The Meta-analysis was performed using STATA 15 software. A total of 21 RCTs(n=2 186) were shortlisted for the Meta-analysis. The results of efficacy evaluation showed that the total effective rate of Shexiang Tongxin Dropping Pills combined with conventional therapy was higher than that of conventional therapy of coronary heart disease(RR=1.20, 95%CI[1.15, 1.26], Z=8.63, P<0.001). Furthermore, Shexiang Tongxin Dripping Pills combined with conventional therapy had better effect on electrocardiogram efficacy(RR=1.24, 95%CI[1.16, 1.34], Z=5.98, P<0.001) and the number of angina attacks(SMD=-2.30, 95%CI[-3.47,-1.14], Z=3.88, P<0.001), the duration of angina attack(SMD=-2.31, 95%CI[-3.07,-1.55], Z=5.97, P<0.001), with lower levels of LDL-C(SMD=-0.73, 95%CI[-1.32,-0.14], Z=2.42, P=0.016), TC(SMD=-1.16, 95%CI[-1.35,-0.96], Z=11.56, P<0.001) and TG(SMD=-0.87, 95%CI[-1.06,-0.68], Z=8.97, P<0.001), and higher levels of HDL-C(SMD=0.87, 95%CI[0.02, 1.71], Z=2.00, P=0.045). The results of safety evaluation showed that the incidence of adverse reactions of Shexiang Tongxin Dropping Pills combined with conventional therapy was lower than that of conventional therapy of coronary heart disease(RR=0.45, 95%CI[0.22, 0.91], Z=2.23, P=0.026). There were significant differences in the above outcome indexes between the two groups. After the Harbord method test, the total effective rate outcome index has publication bias, but the sensitivity analysis of the cut-and-fill method suggested that the result was stable. In general, limited by the quantity and quality of included literature, more high-quality studies are needed to further verify the conclusions of this study.


Subject(s)
Angina Pectoris , Coronary Disease/drug therapy , Drugs, Chinese Herbal/adverse effects , Electrocardiography , Humans
3.
Article in Chinese | WPRIM | ID: wpr-879193

ABSTRACT

To systemically evaluate the efficacy and safety of Gingko Ketone Ester Dropping Pills in treating angina pectoris and co-ronary heart disease. CNKI, Wanfang, SinoMed, PubMed, Cochrane Library and EMbase databases were retrieved on computer, and the randomized clinical trial(RCT) on Gingko Ketone Ester Dropping Pills in treating angina pectoris and coronary heart disease, which were published from the database establishment to December 31, 2019, were comprehensively collected. Literature screening, data extraction and quality evaluation were conducted independently by two researchers according to inclusion and exclusion criteria. Literature methodology quality evaluation was conducted with use of the Cochrane Handbook 5.3.0(bias risk assessment tool). Meta-analysis was performed with RevMan 5.3.0 software. A total of 10 RCTs were included. The results of the Meta-analysis showed that as compared with conventional Western medicine alone, the application of Gingko Ketone Ester Dropping Pills combined with conventional Western medicine treatment further improved the total effective rate and electrocardiogram effect(RR=1.43,95%CI[1.20,1.71],P<0.000 1). There were statistically significant differences in the number of angina attacks, the duration of angina and the amount of nitroglycerin used. In terms of safety indicators, four studies reported adverse reactions in the experimental group, including facial flu-shing, tachycardia, dizziness, dyspnea, nausea and other symptoms. Based on the existing findings, in the treatment of angina pectoris and coronary heart disease, Gingko Ketone Ester Dropping Pills combined with conventional Western medicine can improve the clinical total effective rate, electrocardiogram effect, number of angina attacks, duration of angina and the amount of nitroglycerin used. However, in the included studies, due to some methodological quality problems which would impact the reliability of literature results more high-quality randomized controlled trials are still needed for further verification.


Subject(s)
Angina Pectoris/drug therapy , Coronary Disease/drug therapy , Drugs, Chinese Herbal/adverse effects , Esters , Ginkgo biloba , Humans , Ketones/adverse effects , Randomized Controlled Trials as Topic , Reproducibility of Results
4.
Article in Chinese | WPRIM | ID: wpr-879192

ABSTRACT

The increasing burden of cardiovascular disease in China has become a major public health problem, and the prevention and treatment of cardiovascular disease is in urgent need. For the reality of integrated Chinese and Western medicine in the Chinese health care system, we can consider the service ability of traditional Chinese medicine. Xueshuan Xinmaining Tablet is a kind of Chinese patent medicine commonly used in the treatment of recovery stage of ischemic stroke and angina pectoris of coronary heart disease. Based on the data of hospitalized patients covered by national urban basic medical insurance of China Medical Insurance Research Association in 2013, this study evaluated the treatment cost and detailed composition of the cost for the patients with cerebral infarction and coronary heart disease treated by Xueshuan Xinmaining Tablets. At the same time, the differences in disease burden and direct medical expenses among Xueshuan Xinmaining Tablets group, Western medicine group and another commonly used Chinese patent medicine group were analyzed. Among the three groups of patients with cerebral infarction and coronary heart disease, the hospitalization rates caused by various causes(44.4% and 29.6%) and diseases(20.8% and 5.2%) in Xueshuan Xinmaining Tablets group were the lowest(all P<0.01), and the number of hospitalization times in half a year was highest in the common Chinese patent medicine group(all P<0.01). In patients with cerebral infarction, the median annual total outpatient expenses were 7 476.8, 7 601.8, 15 650.1 yuan respectively in Western medicine group, Xueshuan Xinmaining Tablets group and the common Chinese patent medicine group(P<0.01), and the median hospitalization expenses were 11 620.2, 14 988.9, 13 325.6 yuan respectively(P=0.058). In patients with coronary heart disease, the total outpatient expenses of the three groups were 6 831.4, 10 228.6, 13 132.4 yuan respectively(P<0.01), and the total hospitalization expenses were 13 354.7, 14 911.5, 15 725.3 yuan respectively(P=0.134). The results showed that in patients with cerebral infarction and coronary heart disease, the hospitalization rate was lowest in Xueshuan Xinmaining Tablets group, beneficial to the turnover of hospital beds and full use of hospital medical resources. The total annual outpatient cost of Xueshuan Xinmaining Tablets group was lower than that of common Chinese patent medicine group, beneficial to reduce the burden of disease.


Subject(s)
Cerebral Infarction/drug therapy , China , Coronary Disease/drug therapy , Cost of Illness , Drugs, Chinese Herbal/therapeutic use , Humans , Tablets
5.
Article in Chinese | WPRIM | ID: wpr-879098

ABSTRACT

This research was to evaluate the economics of Shexiang Tongxin Dropping Pills combined with conventional therapy for patients with coronary heart disease(CHD) in Chinese medical environment. From the perspective of medical insurance, a Markov model was established in this study based on the results of Meta-analysis comparing the effectiveness and safety of Shexiang Tongxin Dripping Pills combined with conventional treatment and conventional treatment alone. The experimental group was treated with She-xiang Tongxin Dropping Pills combined with conventional Western medicine treatment, while the control group was treated with conventional Western medicine treatment alone. The cost-utility analysis and sensitivity analysis were performed for the two regimens using Treeage pro. After 30 cycles of model simulation, according to the results of Markov model, the total cost and health output were CNY 237 795.73 and 16.36 QALYs(the quality adjusted life years, QALYs), respectively for Shexiang Tongxin Dropping Pills combined with conventional Western medicine treatment, CNY 247 396.55 and 16.36 QALYs respectively for the conventional Western medicine treatment alone. Compared with the conventional treatment alone, the Shexiang Tongxin Dropping Pills combined with conventional treatment had lower long-term cost and higher health output, with advantages of cost-utility and pharmacoeconomic advantages. The sensitivity analysis results showed that the conclusion was relatively stable. Based on the above results, it is considered that compared with the conventional Western medicine alone, Shexiang Tongxin Dropping Pill combined with conventional Western medicine is a treatment regimen with pharmacoeconomic advantages for the treatment of CHD.


Subject(s)
Coronary Disease/drug therapy , Drugs, Chinese Herbal , Economics, Pharmaceutical , Female , Humans
6.
Article in Chinese | WPRIM | ID: wpr-879087

ABSTRACT

With the process of urbanization and population aging in China, the burden of cardiovascular disease and the incidence of coronary heart disease among postmenopausal women have greatly increased. Studies have found that the incidence of coronary heart disease in postmenopausal women is closely related to the level of estrogen, but there are still difficulties of low efficiency and large side effects in current therapies. Kidney deficiency has a strong correlation with reproductive development and overall function. The clinical manifestations and characteristics of postmenopausal coronary heart disease patients conform to the pathogenesis of kidney deficiency in traditional Chinese medicine. The kidney-invigorating method has a good efficacy in treating postmenopausal coronary heart disease patients. This paper summarizes clinical and pharmacological evidences, expounds the relationship between kidney deficiency and the level of estrogen, and the pathological mechanism of the kidney-tonifying method in the treatment of coronary heart disease, and defines the clinical efficacy and advantages of the kidney-tonifying method. The method may become an effective method to prevent and treat postmenopausal coronary heart disease, and is expected to benefit patients with coronary heart disease better.


Subject(s)
China , Coronary Disease/drug therapy , Drugs, Chinese Herbal/therapeutic use , Estrogens , Female , Humans , Kidney , Medicine, Chinese Traditional
7.
Article in Chinese | WPRIM | ID: wpr-878934

ABSTRACT

To systematically evaluate the clinical efficacy and safety of Danhong Injection combined with conventional therapy in improving diabetes mellitus complicated with coronary heart disease. Based on the online literature database(CNKI, Wanfang, VIP, PubMed, Web of Science, Cochran Library), the Chinese and English papers about the randomized controlled trial(RCT) of Danhong Injection in the treatment of diabetes mellitus complicated with coronary heart disease were searched comprehensively from the establishment of the databases to January 1, 2020. The papers were screened strictly according to the inclusion and exclusion criteria. Based on Jadad scale, the risk assessment of literature was carried out, and Meta-analysis was performed by STATA 12.0 software. Seventeen RCTs were included, involving 1 453 patients. The results of Meta-analysis showed that the combination of Danhong Injection and conventio-nal treatment could improve the clinical comprehensive effective rate(RR=1.47, 95%CI[1.38, 1.58], P<0.000 1), electrocardiogram(ECG) efficiency(RR=1.30, 95%CI[1.16, 1.46], P<0.000 1), efficiency of the angina pectoris(RR=1.41, 95%CI[1.25, 1.58], P<0.000 1), cholesterol level(SMD=-1.05, 95%CI[-1.95,-0.16], P=0.02), low-density lipoprotein(LDL) level(SMD=-0.50, 95%CI[-0.79,-0.21], P<0.000 1), coronary angina attack frequency(SMD=-3.71, 95%CI[-4.05,-3.36], P<0.000 1) and duration of angina pectoris(SMD=-2.96, 95%CI[-3.25,-2.66], P<0.000 1), with statistically significant differences. But the differences in fasting plasma glucose(FPG)(SMD=-0.19, 95%CI[-0.45, 0.08], P=0.16), plasma glucose of two hours after meal(2 hPG)(SMD=0.19, 95%CI[-0.11, 0.49], P=0.22), and high-density lipoprotein(HDL) level(SMD=0.10, 95%CI[-0.30, 0.49], P=0.62) after treatment were not statistically significant. Compared with the control group, there was no significant difference in adverse reactions(SMD=-2.96, 95%CI[-3.25,-2.66], P=0.75). The existing evidence shows that the combination of Western medicine and Danhong Injection can improve the clinical effect for diabetes mellitus complicated with coronary heart disease and has no obvious adverse reactions. However, due to the low level of overall literature evidence, high risk and some kind of publication bias, it still needs more high-quality randomized controlled trials and low-bias studies for further verification.


Subject(s)
Angina Pectoris , Coronary Disease/drug therapy , Diabetes Mellitus , Drugs, Chinese Herbal , Humans
8.
Article in Chinese | WPRIM | ID: wpr-877623

ABSTRACT

OBJECTIVE@#To compare the therapeutic effect on type 2 diabetes mellitus (T2DM) complicated with angina pectoris of coronary heart disease between the combined therapy of acupuncture and western medication and the simple administration of western medication.@*METHODS@#A total of 134 patients with T2DM and angina pectoris of coronary heart disease were randomly divided into two groups, i.e. an acupuncture plus medication group (67 cases, 3 cases dropped off) and a medication group (67 cases, 4 cases dropped off). The routine western medication was used according to symptoms in the patients of both groups. In the acupuncture plus medication group, on the base of medication, acupuncture was applied to Jianshi (PC 5), Quchi (LI 11), Neiguan (PC 6), etc. The needles were retained for 20 min in each treatment and 3 treatments of acupuncture were required weekly. The treatment was given consecutively for 8 weeks in the two groups. Separately, before and after treatment, the symptom scores of TCM were observed and the indexes were detected, including glycolipid metabolism [fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), glucosylated hemoglobin (HbA1c), triacylglycerol (TG) and total cholesterol (TC)], islet β cell function [homeostasis model assessment-β (HOMA-β), homeostasis model assessment-IR (HOMA-IR), fasting insulin (FINS) and insulin sensitivity index (ISI)], cardiac function indexes [cardiac output (CO), early diastolic peak velocity/late diastolic peak velocity (E/A), left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF)], as well as electrocardiogram QT dispersion (QTd). Besides, the clinical therapeutic effects were compared between the two groups.@*RESULTS@#After treatment, the TCM symptom scores and the values of FPG, 2hPG, HbA1c, TG, TC, HOMA-IR, FINS, E/A and LVEDD as well as QTd were all lower than those before treatment in the two groups (@*CONCLUSION@#The combined therapy of acupuncture and medication is effective in treatment of T2DM complicated with angina pectoris of coronary heart disease. Such therapy effectively improves glucolipid metabolism, islet β cell function, cardiac function and myocardial blood supply. Its curative effect is better than the simple administration of western medicine.


Subject(s)
Acupuncture Therapy , Angina Pectoris/etiology , Blood Glucose , Coronary Disease/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Humans , Stroke Volume , Ventricular Function, Left
10.
Rev. bras. cir. cardiovasc ; 34(1): 17-21, Jan.-Feb. 2019. tab
Article in English | LILACS | ID: biblio-985246

ABSTRACT

Abstract Objective: To investigate the clinical significance of serum cystatin C (Cys-C) and high-sensitivity C-reactive protein (hs-CRP) in coronary heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI). Methods: One hundred and twenty-eight CHD patients were divided into drug treatment (56 cases) and PCI treatment (72 cases) groups, receiving conventional drug treatment and PCI plus conventional drug treatment, respectively. At admission time and 4 weeks after treatment, the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, and left ventricular end systolic diameter were measured. At admission time and 24h, 72h, 1 week, and 4 weeks after treatment, the serum levels of Cys-C and hs-CRP were determined. Results: After 4 weeks of treatment, LVEF in the PCI treatment group was significantly higher than that before treatment (P<0.01) and it was significantly higher than in the drug treatment group at the same time (P<0.01). Cys-C and hs-CRP level in the PCI treatment group were significantly higher than in the drug treatment group 72h and 1 week after treatment (P<0.05 or P<0.01), respectively, but they were significantly lower than in the drug treatment group 4 weeks after treatment (P<0.01). There were obvious interaction effects between grouping factor and time factor in Cys-C (F=3.62, P<0.05) and hs-CRP (F=17.85, P<0.01). Conclusion: Serum levels of Cys-C and hs-CRP are closely related to the heart function in CHD patients undergoing PCI, and they may be used for predicting the outcome of PCI.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , C-Reactive Protein/analysis , Coronary Disease/surgery , Coronary Disease/blood , Cystatin C/blood , Percutaneous Coronary Intervention/methods , Reference Values , Stroke Volume/physiology , Time Factors , Body Mass Index , Treatment Outcome , Ventricular Dysfunction, Left/physiopathology , Coronary Disease/physiopathology , Coronary Disease/drug therapy
11.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.652-655.
Monography in Portuguese | LILACS | ID: biblio-1009187
12.
Rev. colomb. cardiol ; 24(3): 298-298, mayo-jun. 2017. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-900531

ABSTRACT

Resumen La enfermedad de Erdheim-Chester es una histiocitosis celular diferente a la histiocitosis de Langerhans, de origen incierto. Se caracteriza por una implicación multi-orgánica debida a la infiltración de los histiocitos CD68+/CD1a-, en forma de xantogranulomas, que afectan principal y comúnmente a la metáfisis y diáfisis de huesos largos. El diagnóstico se realiza mediante biopsia, donde se revelan histiocitos CD68+/CD1a-, carencia de proteína S, y presencia de gránulos de Birbeck. Se ha subestimado la implicación cardiovascular. Reportamos un caso de un varón de 67 años con la enfermedad de Erdheim-Chester e infarto de miocardio agudo, debido a implicación coronaria, además de enfermedad ósea, vascular, pituitaria y retroperitoneal. Revisamos la literatura relevante y describimos el tratamiento clínico de estos pacientes.


Abstract Erdheim-Chester disease is a non-Langerhans cell histiocytosis of uncertain origin. It is characterized by multiorgan involvement due to infiltration of CD68+/CD1a- histiocytes, in the form of xantogranulomas, most commonly affecting the metaphysis and diaphysis of long bones. The diagnosis is made by biopsy showing CD68+/CD1ahistiocytes, lack of S protein and Birbeck granules. Cardiovascular involvement is underestimated. We report a case of a 67 year-old man with Erdheim-Chester disease and acute myocardial infarction due to coronary involvement, in addition to bone, vascular, pituitary and retroperitoneal disease. We review relevant literature and describe the clinical management of these patients.


Subject(s)
Aged , Coronary Disease/drug therapy , Angiography , Pathogenesis, Homeopathic , Erdheim-Chester Disease
13.
In. Vieira, Joaquim Edson; Rios, Isabel Cristina; Takaoka, Flávio. Anestesia e bioética / Anesthesia and bioethics. São Paulo, Atheneu, 8; 2017. p.2333-2348.
Monography in Portuguese | LILACS | ID: biblio-847983
15.
Rev. latinoam. enferm. (Online) ; 24: e2705, 2016. tab
Article in English | LILACS, BDENF | ID: biblio-960985

ABSTRACT

Abstract Objective: to psychometrically test the Brazilian version of the Treatment Satisfaction Questionnaire for Medication - TSQM (version 1.4), regarding ceiling and floor effect, practicability, acceptability, reliability and validity. Methods: participants with coronary heart disease (n=190) were recruited from an outpatient cardiology clinic at a university hospital in Southeastern Brazil and interviewed to evaluate their satisfaction with medication using the TSQM (version 1.4) and adherence using the Morisky Self-Reported Measure of Medication Adherence Scale and proportion of adherence. The Ceiling and Floor effect were analyzed considering the 15% worst and best possible TSQM scores; Practicability was assessed by time spent during TSQM interviews; Acceptability by proportion of unanswered items and participants who answered all items; Reliability through the Cronbach's alpha coefficient and Validity through the convergent construct validity between the TSQM and the adherence measures. Results: TSQM was easily applied. Ceiling effect was found in the side effects domain and floor effect in the side effects and global satisfaction domains. Evidence of reliability was close to satisfied in all domains. The convergent construct validity was partially supported. Conclusions: the Brazilian TSQM presents evidence of acceptability and practicability, although its validity was weakly supported and adequate internal consistency was observed for one domain.


Resumo Objetivos: realizar o teste psicométrico da versão brasileira do Treatment Satisfaction Questionnaire for Medication - TSQM (versão 1.4) [Questionário Satisfação com Tratamento Medicamentoso] com relação aos efeitos de teto e chão, praticidade, aceitabilidade, confiabilidade e validade. Métodos: os participantes com doença cardíaca coronária (n=190) foram recrutados num ambulatório de cardiologia de um hospital universitário no sudeste do Brasil e entrevistados para avaliar satisfação em relação ao tratamento medicamentoso através da TSQM (versão 1.4) e adesão através da Morisky Self-Reported Measure of Medication Adherence Scale [Medida de Auto-Relato de Adesão ao Tratamento Medicamentoso] e proporção de aderência. Os efeitos Teto e Chão foram analisados considerando os 15% piores e 15% melhores escores possíveis obtidos no TSQM; Praticidade foi avaliada pelo tempo gasto na aplicação do TSQM durante a entrevista; Aceitabilidade foi verificada pela proporção de itens não respondidos e participantes que responderam todos os itens; Confiabilidade foi verificada com o coeficiente alfa de Cronbach e Validade através da validade de construto convergente entre o TSQM e as medidas de adesão. Resultados: o TSQM foi facilmente aplicado. O efeito teto foi encontrado no domínio efeitos colaterais e o efeito chão foi encontrado nos domínios efeitos colaterais e satisfação global. Evidência de confiabilidade foi próxima de satisfatória em todos os domínios. A validade de construto convergente foi parcialmente apoiada. Conclusões: a versão brasileira do TSQM apresenta evidência de aceitabilidade e praticidade embora sua validade tenha sido pouco apoiada e consistência interna adequada foi observada em um domínio.


Resumen Objetivos: testar las propiedades psicométricas de la versión brasileña del Treatment Satisfaction Questionnaire for Medication - TSQM (versión 1.4), considerando los efectos techo y suelo, factibilidad, aceptabilidad, confiabilidad y validez. Métodos: participantes con enfermedad coronaria (n=190) fueron reclutados de una clínica ambulatoria de cardiología en un hospital universitario en el sudeste de Brasil y entrevistados para evaluar su satisfacción con la medicación con el TSQM (versión 1.4) y su adhesión con la Morisky Self-Reported Measure of Medication Adherence Scale y proporción de adhesión. Los efectos techo y suelo fueron analizados considerando los 15% peores y mejores puntuaciones en el TSQM; la factibilidad fue evaluada por el tiempo gasto durante las entrevistas de TSQM; la aceptabilidad por la proporción de ítems no respondidos y participantes que contestaron a todos los ítems; la confiabilidad con el coeficiente alfa de Cronbach y la validez de constructo convergente entre el TSQM y las medidas de adhesión. Resultados: el TSQM fue aplicado con facilidad. El efecto de techo fue encontrado en el dominio de los efectos secundarios y el efecto suelo en los dominios de efectos secundarios y satisfacción global. Las evidencias de confiabilidad fueron aproximadamente satisfechas en todos los dominios. La validez de constructo convergente fue parcialmente apoyada. Conclusiones: la versión brasileña del TSQM presenta evidencias de aceptabilidad y factibilidad, a pesar del soporte débil a su validez y de la observación de consistencia interna adecuada para un dominio.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Patient Satisfaction , Coronary Disease/drug therapy , Self Report , Patient Reported Outcome Measures , Psychometrics , Brazil , Reproducibility of Results
16.
Rev. latinoam. enferm. (Online) ; 24: e2692, 2016. tab
Article in English | LILACS, BDENF | ID: biblio-961037

ABSTRACT

Objectives: to undertake the cultural adaptation of, and to evaluate the measurement properties of, the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale in coronary heart disease (CHD) patients, with outpatient monitoring at a teaching hospital. Method: the process of cultural adaptation was undertaken in accordance with the international literature. The data were obtained from 147 CHD patients, through the application of the sociodemographic/clinical characterization instrument, and of the Brazilian versions of the Morisky Self-Reported Measure of Medication Adherence Scale, the General Perceived Self-Efficacy Scale, and the Self-efficacy for Appropriate Medication Adherence Scale. Results: the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented evidence of semantic-idiomatic, conceptual and cultural equivalencies, with high acceptability and practicality. The floor effect was evidenced for the total score and for the domains of the scale studied. The findings evidenced the measure's reliability. The domains of the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented significant inverse correlations of moderate to strong magnitude between the scores of the Morisky scale, indicating convergent validity, although correlations with the measure of general self-efficacy were not evidenced. The validity of known groups was supported, as the scale discriminated between "adherents" and "non-adherents" to the medications, as well as to "sufficient dose" and "insufficient dose". Conclusion: the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented evidence of reliability and validity in coronary heart disease outpatients.


Objetivos: realizar a adaptação cultural e avaliar as propriedades de medida, versão brasileira, da Self-efficacy for Appropriate Medication Adherence Scale em coronariopatas, com seguimento ambulatorial em hospital universitário. Método: o processo de adaptação cultural foi realizado conforme a literatura internacional. Os dados foram obtidos junto a 147 coronariopatas, pela aplicação do instrumento de caracterização sociodemográfica/clínica e das versões brasileiras da Morisky Self-Reported Measure of Medication Adherence Scale, da General Perceived Self-Efficacy Scale e da Self-efficacy for Appropriate Medication Adherence Scale. Resultados: a versão brasileira da Self-efficacy for Appropriate Medication Adherence Scale apresentou evidências de equivalências semântico-idiomática, conceitual e cultural, com elevada aceitabilidade e praticabilidade. Foi evidenciado efeito chão para o escore total e domínios da escala em estudo. Os achados evidenciaram confiabilidade da medida. Os domínios da versão brasileira da Self-efficacy for Appropriate Medication Adherence Scale apresentaram correlações inversas significativas de moderada a forte magnitude entre os escores da escala de Morisky, apontando validade convergente, embora não tenham sido evidenciadas correlações com a medida de autoeficácia geral. A validade de grupos conhecidos foi apoiada, uma vez que a escala discriminou entre "aderentes" e "não aderentes" aos medicamentos bem como "dose suficiente" e "dose insuficiente". Conclusão: a versão brasileira da Self-efficacy for Appropriate Medication Adherence Scale apresentou evidências de confiabilidade e validade em coronariopatas em seguimento ambulatorial.


Objetivos: realizar la adaptación cultural y evaluar las propiedades de medición, de la versión brasileña, de la Self-efficacy for Appropriate Medication Adherence Scale, en pacientes con coronariopatías, con acompañamiento en ambulatorio, en hospital universitario. Método: el proceso de adaptación cultural fue realizado conforme la literatura internacional. Los datos fueron obtenidos de 147 pacientes con enfermedad de las arterias coronarias (coronariopatía) aplicando el instrumento de caracterización sociodemográfica/clínica y las versiones brasileñas de la Morisky Self-Reported Measure of Medication Adherence Scale, de la General Perceived Self-Efficacy Scale y de la Self-efficacy for Appropriate Medication Adherence Scale. Resultados: la versión brasileña de la Self-efficacy for Appropriate Medication Adherence Scale presentó evidencias de equivalencias semánticas idiomáticas, conceptuales y culturales, con elevada aceptabilidad y practicidad. Fueron evidenciados el efecto suelo para el puntaje total y para los dominios de la escala que se estudia. Los hallazgos evidenciaron la confiabilidad de la medición. Los dominios de la versión brasileña de la Self-efficacy for Appropriate Medication Adherence Scale presentaron correlaciones inversas significativas de moderada a fuerte magnitud, entre los puntajes de la escala de Morisky, apuntando una validez convergente, a pesar de que en éste fueron evidenciadas correlaciones con la medición de autoeficacia general. La validez de grupos conocidos fue soportada, debido a que la escala discriminó entre "adherentes" y "no adherentes" a los medicamentos, así como "dosis suficiente" y "dosis insuficiente". Conclusión: la versión brasileña de la Self-efficacy for Appropriate Medication Adherence Scale presentó evidencias de confiabilidad y validez en pacientes con coronariopatías, acompañados en ambulatorio.


Subject(s)
Humans , Health Surveys , Coronary Disease/drug therapy , Self Efficacy , Culture , Medication Adherence , Psychometrics , Brazil , Reproducibility of Results
17.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 24(4): 18-22, out.-dez. 2014.
Article in Portuguese | LILACS | ID: lil-761236

ABSTRACT

Inibição da PCSK9 constitui um dos mais promissores avanços para o tratamento da hipercolesterolemia nos últimos anos. Esta pró-proteína convertase ao interagir com a LDL e seu receptor hepático determina a degradação do receptor. Por meio de anticorpos monoclonais, esta ação é inibida na corrente circulatória e, desta forma, o receptor após captar a LDL pode ser reciclado muitas vezes, permitindo eficiente redução do LDL-colesterol. Estes fármacos se mostraram surpreendentemente bem tolerados, com perfil de segurança similar ao placebo e produziram reduções no LDL-C ao redorde 60%, independentemente de terapia prévia com outros hipolipemiantes como estatinas ou ezetimiba. Além disso,reduzem também a lipoproteína Lp (a), uma ação que não se observa com as estatinas. Estudos prospectivos destinado sao exame do impacto em desfechos cardiovasculares estão atualmente em curso e poderão ampliar as indicações hoje previstas, como seu uso para hipercolesterolemias primárias graves ou intolerância a estatinas.


Inhibition of PCSK9 constitutes one of the most promising advances for the treatment of hypercholesterolemia in thelast years. This proprotein convertase interacts with LDLand its receptor determining degradation of the receptor.Through the use of monoclonal antibodies, this effectis inhibited in the bloodstream, and thus, after the LDL capture, the receptor can be recycled many times, promotingan effective LDL-C decrease. Surprisingly, these drugsshowed safety profile similar to placebo and were very well tolerated, achieving LDL-C lowering around 60%, beyond previous therapies with statins or ezetimibe. In addition, these drugs also decrease lipoprotein Lp (a), an effect not observed with statins. Prospective studies aimedto evaluate the impact of treatment on cardiovascular eventsare currently ongoing and they may increase the possible indications recognized today, such as severe primary hypercholesterolemias or statin intolerance.


Subject(s)
Humans , Coronary Disease/complications , Coronary Disease/metabolism , Coronary Disease/drug therapy , Hyperlipoproteinemia Type II/drug therapy , Antibodies, Monoclonal , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Lipoproteins, LDL/blood
18.
Braz. j. med. biol. res ; 47(5): 432-437, 02/05/2014. tab, graf
Article in English | LILACS | ID: lil-709430

ABSTRACT

It is not known whether the addition of ezetimibe to statins adds cardiovascular protection beyond the expected changes in lipid levels. Subjects with coronary heart disease were treated with four consecutive 1-week courses of therapy (T) and evaluations. The courses were: T1, 100 mg aspirin alone; T2, 100 mg aspirin and 40 mg simvastatin/10 mg ezetimibe; T3, 40 mg simvastatin/10 mg ezetimibe, and 75 mg clopidogrel (300 mg initial loading dose); T4, 75 mg clopidogrel alone. Platelet aggregation was examined in whole blood. Endothelial microparticles (CD51), platelet microparticles (CD42/CD31), and endothelial progenitor cells (CD34/CD133; CDKDR/CD133, or CD34/KDR) were quantified by flow cytometry. Endothelial function was examined by flow-mediated dilation. Comparisons between therapies revealed differences in lipids (T2 and T3<T1 and T4 for total cholesterol, LDL-C, and triglycerides; P<0.002 for all), as well as for endothelial function (T2>T1 and T4, P=0.001). Decreased platelet aggregation was observed after aspirin (arachidonic acid, T1<T3 and T4, P=0.034) and clopidogrel (adenosine, T3 and T4<T1 and T2, P<0.0001) therapy. Simvastatin/ezetimibe diphosphate did not change platelet aggregation, the amount of circulating endothelial and platelet microparticles, or endothelial progenitor cells. Cardiovascular protection following therapy with simvastatin/ezetimibe seems restricted to lipid changes and improvement of endothelial function not affecting the release of microparticles, mobilization of endothelial progenitor cells or decreased platelet aggregation.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Azetidines/pharmacology , Cell-Derived Microparticles/drug effects , Coronary Disease/drug therapy , Endothelial Progenitor Cells/drug effects , Platelet Aggregation/drug effects , Simvastatin/pharmacology , Anticholesteremic Agents/pharmacology , Aspirin/therapeutic use , Cholesterol, LDL/blood , Drug Combinations , Flow Cytometry , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic use , Triglycerides/blood
19.
Rev. méd. Chile ; 141(7): 870-878, jul. 2013. ilus
Article in Spanish | LILACS | ID: lil-695768

ABSTRACT

Background: Implementation of health programs to reduce cardiovascular risk, are needed for secondary prevention of cardiovascular diseases. Aim: To evalúate achievements of secondary prevention goals, pharmacologic prescription and major cardiovascular events in patients with coronary artery disease. Material and Methods: Patients who had a first event of acute coronary syndrome, angioplasty or revascularization surgery, between January 2008 and June 2010, were contacted for a clinical and laboratory evaluation between June and October 2011. Results: Seven hundred and two medical records were reviewed and 245 eligible patients were identified. Ofthese, we assessed 202 patients aged 64 ± 10 years (70% males). Sixty seven percent had two ormore cardiovascular riskfactors. A goal ofHDL cholesterol level over 40 mg/dL was achieved in 91 % of patients, smoking cessation in 84% and a total cholesterol < 200 mg/dL in 66%. A blood pressure below 130/85 mm Hgwas achieved in 30% of patients, a normal BMI in 19% and LDL cholesterol levels below 70 mg/dL in 18%. At the moment of assessment, 87%> were using aspirin, 78%> statins, 74% angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists and 66%o were using β - blockers. Twenty two percent of patients had a major cardiovascular event during the follow up, which lasted 28 ± 8 months. Conclusions: A low percentage of cardiovascular goals achievement was observed in this sample of patients, with a high prevalence of overweight and obesity. A high percentage quit smoking after their first cardiovascular event. Despite the high percentage of drug prescription, hypertension and dyslipidemia were not fully controlled.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cardiovascular Diseases/prevention & control , Drug Prescriptions/statistics & numerical data , Cross-Sectional Studies , Cardiovascular Diseases/drug therapy , Coronary Disease/drug therapy , Goals , Risk Factors , Socioeconomic Factors
20.
Rev. costarric. cardiol ; 14(1/2): 9-13, ene.-dic. 2012. graf, tab
Article in Spanish | LILACS | ID: lil-657750

ABSTRACT

La anticoagulación con heparinas de bajo peso molecular (HBPM) es una herramienta terapéutica fundamental para el tratamiento de la enfermedad tromboembólica. En el presente reporte se evidencia la importancia de cuantificar la actividad del anticuerpo antifactor X activado (Xa) para el monitoreo de la enoxaparina y analizar los grupos de pacientes en riesgo de tener niveles inferiores al terap‚utico. M‚todos: se estudiaron 34 pacientes adultos, anticoagulados con enoxaparina durante el periodo 2009-2011. Asimismo, se realizó un análisis descriptivo de las características demográficas y clínicas de todo los pacientes, en donde se indicaron las causas de la anticoagulación, la comorbilidades y el tipo de anticoagulación. Se midió la actividad anti-Xa 4 horas después de la administración de enoxaparina. Resultados: El promedio de edad de los pacientes fue de 62,3+17,7 años. Un 72,71 por ciento de los pacientes utilizaron enoxaparina como indicación para el síndrome coronario agudo. La comorbilidad más importante fue la combinación con la hipertensión arterial. El aclaramiento renal promedio fue de 62,47 ml/min, solamente tres pacientes tuvieron un aclaramiento menor a 30 ml/min; un 44,1 por ciento de los pacientes eran obesos. El 55,9 por ciento de los pacientes tuvo niveles anti-factor Xa dentro del rango terapéutico y un 35,3 por ciento tuvo valores de anti factor Xa profilácticos. Conclusión: El manejo del paciente adulto que recibe terapia anticoagulación con HBPM presenta una alta complejidad, hecho que se ve reflejado tanto a su perfil demográfico como clínico. También, se considera importante contar con la determinación del factor anti Xa para el monitoreo de HBPM para cierto grupo de pacientes vulnerables y con ello lograr el efecto deseado con esta terapia, debido a que existe un alto porcentaje de pacientes con niveles fuera del rango terapéutico.


Anticoagulation is an important therapeutic tool for patients with thromboembolic disease who receive therapy with lowmolecular weight heparins (LMWH). This report gives evidence about the importance of determining the activity of Anti-Xaactivity for monitoring enoxaparin and for identifying those patients who need this analysis based on some risk factors.Methods: We studied 34 adult patients who received enoxaparin as anticoagulation therapy during the period 2009-2011. We performed a descriptive analysis of demographic and clinical characteristics of all patients, indicating thereasons for anticoagulation, comorbidities and type of anticoagulation. We determined the anti-Xa activity 4 hours afteradministration of enoxaparin.Results: The mean age of patients was 62,3 + 17,7 years, regardless of gender. 72,7% of patients received enoxaparin astherapy for an acute coronary syndrome. The most frequent comorbidity was hypertension. The average of renal clearancewas 62,47 ml/min, only three patients had a renal clearance below 30 ml/min. 44,1% of the patients were obese. 55, 9%of patients were within therapeutic levels of anti-Xa activity and 35,3% of patients had an anti-Xa activity considered asprophylactic.Conclusion: The management of adult patients receiving anticoagulation therapy with LMWH is complex and it isreflected in their demographic and clinical characteristics. It is important to determine Anti-Xa activity to monitor the useof enoxaparin as anticoagulant therapy because of the high variability found in certain groups of patients.


Subject(s)
Humans , Male , Female , Middle Aged , Costa Rica , Coronary Disease/diagnosis , Coronary Disease/drug therapy , Factor X , Factor Xa , Heparin, Low-Molecular-Weight , Thromboembolism/diagnosis , Thromboembolism/drug therapy
SELECTION OF CITATIONS
SEARCH DETAIL