Including a client sexual health pathway in a national youth mental health early intervention service--project rationale and implementation strategy.

Young people have higher rates of sexually transmissible infections (STIs) than the general population. Research has shown that there is a clear link between emotional distress, depression, substance abuse and sexual risk taking behaviours in young people. 'headspace' is a youth mental health early intervention service operating in more than 55 locations around Australia. This setting is ideal for accessing troubled young people who are at risk of STIs and are unlikely to attend mainstream general practice services. In 2013, a partnership was formed between headspace National Office and Hunter New England Local Health District to develop a clear clinical pathway to ensure at-risk headspace clients received sexual health assessments, advice, appropriate treatment and referral as indicated. This article describes the implementation of the pathway at the national level and a control trial to measure its efficacy. Future work will involve providing sustainable sexual health training for headspace general practitioner and allied health professionals to supplement the roll-out of the pathway in headspace centres across Australia. Support will also be provided in adapting headspace environments to encourage service utilization by Aboriginal and Torres Strait Islander and gay, lesbian, bisexual, transsexual and intersex young people.

The use of alternate-day lovastatin in hypercholesterolemic men.

OBJECTIVE: To quantitate the therapeutic effects of alternate-day lovastatin on serum lipoprotein values in a small group of men with primary hypercholesterolemia. DESIGN: Retrospective review of medical, pharmacy, and laboratory records. A paired Student's t-test was performed on absolute changes in lipoprotein values with an a priori p value less than or equal to 0.05 being statistically significant. SETTING: A lipid clinic within a tertiary care Department of Veterans Affairs Medical Center. PATIENTS: Twenty men (mean age 62.5 +/- 8.3 y) with mean +/- SD baseline low-density lipoprotein cholesterol (LDL-C) concentration of 161.3 +/- 21.9 mg/dL and triglyceride concentrations below 400 mg/dL. INTERVENTION: All patients had been prescribed lovastatin 20 mg every other day. MAIN OUTCOME MEASURES: The mean absolute and percent changes in lipoprotein values from baseline for patients receiving lovastatin 20 mg every other day and the percentage of patients attaining a target mean LDL-C concentration as defined by the National Cholesterol Education Panel Adult Treatment Panel II guidelines. RESULTS: Mean +/- SD total cholesterol and LDL-C were significantly reduced by 32.4 +/- 17.8 (14.0% +/- 7.8%) and 34.1 +/- 14.6 mg/dL (21.5% +/- 9.7%), respectively. No significant changes were seen in high- density lipoprotein cholesterol or triglycerides. Four of 20 patients (20%) attained a goal LDL-C concentration. CONCLUSIONS: Lovastatin 20 mg every other day may effectively lower LDL-C in some elderly men, and target LDL-C concentrations may be obtained in some patients.

Multidisciplinary committee on the abuse of prescription medications.

A program for (1) coordinating the care of patients suspected of abusing prescription medications and (2) providing data on the long-term outcomes of these interventions is described. A substance abuse committee composed of physicians, psychologists, pharmacists, and administrators was established to review individual cases of suspected misuse or abuse of medications at a large Department of Veterans Affairs medical center. After reviewing each case, the committee recommended specific actions, such as requesting that the identified medication be restricted from the patient or that the patient receive counseling or treatment for substance abuse. To evaluate the program's effectiveness, the records of the 161 cases referred to the committee between 1981 and 1992 were reviewed. The patient's outcome one year after committee intervention could be determined in 105 cases. Of those, 70 revealed either no evidence of continuing prescription drug abuse or reduced use of the targeted medication in the medical center. Eighteen other patients were no longer receiving care at the institution. A multidisciplinary substance abuse committee helped identify and treat patients suspected of abusing prescription drugs.

Impact of medication profile review on prescribing in a general medicine clinic.

The effect of medication profile review by a clinical pharmacist on prescribing in a general medicine clinic was studied. Patients who were receiving five or more prescription or nonprescription medications were randomly assigned to an intervention group (n = 315) or a control group (n = 257). A clinical pharmacist reviewed the medication profile of each intervention group patient on the day before the patient's clinic visit and attached a written profile review to the medical record for study by the physician during the visit. After each clinic day, the pharmacist obtained updated records of patients in both groups and collected data on the number and cost of medications ordered before and after the visits. After the clinic visits, the average number of medications and the average monthly medication cost per patient decreased by 0.21 and $0.60, respectively, for the intervention group, compared with increases of 0.48 and $3.31 for the control group. The net result of a single profile review was a decrease of 0.69 prescription per patient, for a monthly medication cost savings of $3.91. The number and cost of medications that were discontinued were significantly higher in the intervention group. The intervention group also had significantly fewer drugs added for previously documented medical problems. Medication profile review by a clinical pharmacist reduced both the number and cost of drugs for patients receiving five or more medications.

Nafarelin acetate: a gonadotropin-releasing hormone agonist for the treatment of endometriosis.

Nafarelin acetate is a gonadotropin-releasing hormone (GnRH) agonist proven as effective as danazol in treating endometriosis. Its proposed mechanism of action is the desensitization of pituitary GnRH receptors leading to a decrease in gonadotropin release, and ovarian hormone serum concentrations similar to those achieved in postmenopausal women. Nafarelin decreases or ablates the physical symptoms associated with endometriosis, and pregnancy rates following therapy with this drug are comparable to rates observed after danazol therapy. Nafarelin is administered by nasal inhalation and has been generally well tolerated. It is associated with a high incidence of adverse effects but they are rarely severe enough to cause withdrawal from treatment, and those occurring most frequently--hot flashes, vaginal dryness, and decreased libido--are a consequence of the hypoestrogenemia induced by the drug. Increased bone turnover occurs in women on nafarelin but biochemical parameters return to pretreatment concentrations by six months after termination of treatment. This agent's place in the therapy of endometriosis will be determined as clinical experience accumulates.

Central nervous system toxicity associated with concurrent use of triazolam and cimetidine.

A 49-year-old woman treated with cimetidine 300 mg tid for more than 18 months for Zollinger-Ellison syndrome experienced lethargy, dizziness, ataxia, and auditory and visual hallucinations after receiving triazolam 0.375 mg hs for sleep. Triazolam plasma concentrations were measured, and a triazolam elimination half-life was calculated to be approximately 8 hours (reported range 1.7-3 h). Cimetidine has been reported to decrease the apparent oral clearance of triazolam, resulting in increased triazolam plasma concentrations with the potential for exaggerated triazolam pharmacologic effects. Cimetidine may have been responsible for the unusually large elimination half-life in this patient. Until the mechanisms and clinical significance of this potential drug interaction are determined, clinicians should use the combination of triazolam and cimetidine with caution.