Guide Providing Pharmacological Access to the Brain: Alternate Approaches

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Chronic renal impairment. Gout is associated with obesity, hypertension, hyperlipidaemia, diabetes, myocardial infarction, chronic renal impairment and kidney stones. Explain that ULT can eventually eliminate the crystals and cure gout. Consider prophylaxis to prevent acute attacks of gout when starting ULT. There is a need for slow, upward titration of ULT to reduce provocation of attacks.

There is a need for individualized dosing of ULT to achieve the desired sUA concentration treat to target. Dietary and lifestyle factors can also reduce urate concentrations, but they are ancillary to ULT. Involvement of nurses in patient education and management could optimize the standard of care and improve adherence to ULT Nurses often manage chronic conditions, such as asthma or diabetes, in primary care in the UK.

Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Search ADS. Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice. Rates of adherence and persistence with allopurinol therapy among gout patients in Israel.

Comparison of drug adherence rates among patients with seven different medical conditions. Medication adherence of patients with selected rheumatic conditions: a systematic review of the literature. Adherence and persistence to urate-lowering therapies in the Irish setting. Patient and provider barriers to effective management of gout in general practice: a qualitative study. Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study.

Long-term persistence and adherence on urate-lowering treatment can be maintained in primary care—5-year follow-up of a proof-of-concept study. Assessing clinical competence: recognition of case descriptions of rheumatic diseases by general practitioners.

Education and non-pharmacological approaches for gout | Rheumatology | Oxford Academic

Management of gout in the real world: current practice versus guideline recommendations. The management of gout at an academic healthcare center in Beijing: a physician survey. A qualitative study to explore health professionals' experience of treating gout: understanding perceived barriers to effective gout management.

General practitioners' perspectives on the management of gout: a qualitative study. Questionnaire survey evaluating disease-related knowledge for primary gout patients and doctors in South China. Improving the quality of care of musculoskeletal conditions in primary care.

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I have had flare-ups of gout, but lately I've read where gout can increase your chances of having a heart attack. What does gout have to do with heart health, and what can I do about it? Patients' knowledge and beliefs concerning gout and its treatment: a population based study. The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach.

Living with gout in New Zealand: an exploratory study into people's knowledge about the disease and its treatment. Patient awareness, knowledge and use of colchicine: an exploratory qualitative study in the Counties Manukau region, Auckland, New Zealand. Facilitators and barriers to adherence to urate-lowering therapy in African-Americans with gout: a qualitative study.

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Te Karu. Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study. Development and evaluation of a survey of gout patients concerning their knowledge about gout. Patient information about gout: an international review of existing educational resources. A qualitative and quantitative analysis of the characteristics of gout patient education resources. Online patient information resources on gout provide inadequate information and minimal emphasis on potentially curative urate lowering treatment. What are the effects of medication adherence interventions in rheumatic diseases: a systematic review.

Effects of skim milk powder enriched with glycomacropeptide and G milk fat extract on frequency of gout flares: a proof-of-concept randomised controlled trial. Seasonality and trends in the incidence and prevalence of gout in England and Wales — Low omega-3 fatty acid levels associate with frequent gout attacks: a case control study.

Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men. Food sources of protein and risk of incident gout in the Singapore Chinese Health Study. Clinically insignificant effect of supplemental vitamin C on serum urate in patients with gout: a pilot randomized controlled trial.

Coffee, tea, and caffeine consumption and serum uric acid level: the third national health and nutrition examination survey.


Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey. Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study. The serum urate-lowering impact of weight loss among men with a high cardiovascular risk profile: the Multiple Risk Factor Intervention Trial.

Effects of bariatric surgery on gout incidence in the Swedish Obese Subjects study: a non-randomised, prospective, controlled intervention trial. Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Managing patients with heart failure: a qualitative study of multidisciplinary teams with specialist heart failure nurses.

Expanding nurse practice in COPD: is it key to providing high quality, effective and safe patient care?

The effect of nurse-led diabetes self-management education on glycosylated hemoglobin and cardiovascular risk factors: a meta-analysis. Google Preview. A pharmacist-staffed, virtual gout management clinic for achieving target serum uric acid levels: a randomized clinical trial. Effectiveness of a pharmacist-based gout care management programme in a large integrated health plan: results from a pilot study.

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The Markov model constructed by McMahon et al. McDonnell and colleagues also compared the impact of two interventions: a hypothetical treatment and standard care [ 33 ]. No or little justification for omission of other comparators has been provided by the authors in these studies. The other two post-diagnostic studies did not explicitly state that they included standard pharmaceutical care alongside their new treatment [ 33 , 34 ].

Decision modelling guidelines recommend that the time horizon of a study should be sufficiently long to capture all the differences of the strategies being assessed; this may require a lifetime horizon [ 24 , 25 ]. Dementia is a chronic condition for which there is no cure; it also negatively affects survival times [ 39 ], suggesting that authors conducting economic evaluations of dementia interventions should pay special attention to ensure all intervention effects are captured.

Only three studies utilised a lifetime time horizon in their model [ 30 , 32 , 35 ] which is the most appropriate approach, in particular for risk-prevention or screening interventions, where health impacts and associated costs may not manifest for a long time after intervention. The latter was utilised by Mirsaeedi-Farahani et al.

However, given that the psychosocial nature of the intervention, the five-year time horizon may not capture all the costs and effects related to the intervention.

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When using preference-based measures for health outcomes, such as health utilities, to calculate Quality-Adjusted Life Years QALYs , decision modelling guidelines recommend that the utility weights are incorporated into the model appropriately, and the methods for derivation of utility weights are justified [ 25 ]. Four studies employed QALYs as their key outcome measures [ 26 , 28 , 32 , 34 ]. McMahon and colleagues [ 28 ] classified quality of life measures by disease severity mild, moderate and severe as well as residential status community or nursing home , resulting in six different utilities.

The utility weights were obtained from a US study, which used Health Utility Index Mark 2 to gather proxy-rated utilities of caregivers of people with AD [ 40 ].

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Mirsaeedi-Farahani et al. These were obtained from eight published studies; no further detail was provided as to how these utility weights were selected or calculated. Another study calculated QALYs by multiplying years of expected life by utility weights for people with and without dementia, without further breakdown into severity of disease [ 32 ]. Zhang and colleagues [ 26 ] also did not distinguish between different stages of disease; QALYs were calculated for people with and without dementia. Utility weights were obtained from a Swedish population study, where general population utilities were gathered using the EQ-5D instrument [ 41 ].

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It is unclear how the health-related quality of life HRQoL of the general population was applied to dementia. Three of the ten reviewed studies [ 27 , 30 , 33 ]. One study utilised scores collected as part of the study [ 27 ] Weimer and Sager [ 30 ] used MMSE scores to classify the severity of AD and ascribed varying health care costs to each level of disease severity. MMSE decline with and without treatment was obtained from a range of published literature. As both costs and health outcomes are dependent on disease onset and severity, characterisation of disease progression is, arguably, the most critical model input for producing accurate estimates.