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A 5-year follow-up study of users of benzodiazepine: starting with diazepam versus oxazepam.

https://arctichealth.org/en/permalink/ahliterature282849
Source
Br J Gen Pract. 2016 Apr;66(645):e241-7
Publication Type
Article
Date
Apr-2016
Author
Ingunn Fride Tvete
Trine Bjørner
Tor Skomedal
Source
Br J Gen Pract. 2016 Apr;66(645):e241-7
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Adult
Anti-Anxiety Agents - therapeutic use
Anxiety - drug therapy - epidemiology
Depression - drug therapy - epidemiology
Diazepam - therapeutic use
Dose-Response Relationship, Drug
Drug Prescriptions - statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Middle Aged
Norway - epidemiology
Oxazepam - therapeutic use
Prescription Drug Misuse - statistics & numerical data
Prevalence
Proportional Hazards Models
Risk factors
Substance-Related Disorders - epidemiology
Abstract
Drug dependency may develop during long-term benzodiazepine use, indicated, for example, by dose escalation. The first benzodiazepine chosen may affect the risk of dose escalation.
To detect possible differences in benzodiazepine use between new users of diazepam and oxazepam over time.
This 5-year prescription database study included 19 747 new benzodiazepine users, inhabitants of Norway, aged 30-60 years, with first redemption for diazepam or oxazepam.
Individuals starting on diazepam versus oxazepam were analysed by logistic regression with sex, age, other drug redemptions, prescriber's specialty, household income, education level, type of work, and vocational rehabilitation support as background variables. Time to reach a daily average intake of =1 defined daily doses (DDD) over a 3-month period was analysed using a Cox proportional hazard regression model.
New users of oxazepam had a higher risk for dose escalation compared with new users of diazepam. This was true even when accounting for differences in sociodemographic status and previous drug use (hazard ratio [HR] 1.33, 95% confidence interval = 1.17 to 1.51).
Most doctors prescribed, according to recommendations, oxazepam to individuals they may have regarded as prone to and at risk of dependency. However, these individuals were at higher risk for dose escalation even when accounting for differences in sociodemographic status and previous drug use. Differences between the two user groups could be explained by different preferences for starting drug, DDD for oxazepam being possibly too low, and some unaccounted differences in illness.
Notes
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PubMed ID
26965028 View in PubMed
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Acute pain management in burn patients: appraisal and thematic analysis of four clinical guidelines.

https://arctichealth.org/en/permalink/ahliterature265210
Source
Burns. 2014 Dec;40(8):1463-9
Publication Type
Article
Date
Dec-2014
Author
Hejdi Gamst-Jensen
Pernille Nygaard Vedel
Viktoria Oline Lindberg-Larsen
Ingrid Egerod
Source
Burns. 2014 Dec;40(8):1463-9
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Acute Pain - etiology - psychology - therapy
Adaptation, Psychological
Adult
Analgesics - therapeutic use
Anti-Anxiety Agents - therapeutic use
Anxiety - drug therapy - psychology
Burn Units
Burns - complications - psychology - therapy
Child
Denmark
Evidence-Based Medicine
Humans
Hypnosis, Anesthetic
New Zealand
Pain Management - psychology - standards
Pain Measurement
Pain, Postoperative - psychology - therapy
Practice Guidelines as Topic - standards
Retrospective Studies
Sweden
United States
Abstract
Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units.
The study had a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II, and identified core themes in the guidelines.
The overall scores expressing quality in six domains of the AGREE instrument were variable at 22% (DK), 44% (SE), 100% (NZ), and 78% (USA). The guidelines from NZ and USA were highly recommended, the Swedish was recommended, whereas the Danish was not recommended. The identified core themes were: continuous pain, procedural pain, postoperative pain, pain assessment, anxiety, and non-pharmacological interventions.
The study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes.
PubMed ID
25277698 View in PubMed
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Alcohol consumption among Canadians taking benzodiazepines and related drugs.

https://arctichealth.org/en/permalink/ahliterature153441
Source
Pharmacoepidemiol Drug Saf. 2009 Mar;18(3):203-10
Publication Type
Article
Date
Mar-2009
Author
Scott Veldhuizen
Terrance J Wade
John Cairney
Author Affiliation
Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, ON, Canada. scott_veldhuizen@camh.net
Source
Pharmacoepidemiol Drug Saf. 2009 Mar;18(3):203-10
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Alcohol Drinking
Anti-Anxiety Agents - therapeutic use
Anxiety Disorders - drug therapy
Benzodiazepines - administration & dosage - therapeutic use
Canada
Drug Interactions
Ethanol - administration & dosage
Female
Humans
Male
Middle Aged
Questionnaires
Sex Factors
Socioeconomic Factors
Abstract
Benzodiazepines and related drugs (BZDs) are widely used for the treatment of anxiety, insomnia and other conditions. The combination of BZDs with alcohol increases risk for oversedation, abuse, dependence and accidents. This study examines drinking behaviour among Canadians taking BZDs.
We use data from cycle 1.2 of the Canadian Community Health Survey, a large (n = 36,984) population survey conducted in 2002 by Statistics Canada. We use bivariate methods and logistic regression to test the independent association between BZD use and 2 levels of recent drinking in the general population, and then examine associations between drinking and sociodemographic factors within the group of BZD users.
Any drinking and heavy drinking are less common among users of BZDs than among other respondents, but these differences are small (any drinking, OR = 0.77, p = 0.02; heavy drinking, OR = 0.81, p = 0.13) when differences in respondent characteristics are controlled statistically. Among BZD users, any drinking is associated with male sex, younger age and not meeting criteria for a past-year anxiety disorder. Heavy drinking is associated only with younger age.
Heavy alcohol use is uncommon among users of BZDs, and the combination of alcohol and BZD use is rare in the general population. Differences between BZD users and others are not large when other factors are taken into account, however, which may call into question the effectiveness of physician and pharmacist warnings against this combination. People treated for an anxiety disorder with BZDs may be less likely to use alcohol than those taking them for other indications.
PubMed ID
19115421 View in PubMed
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Anxiety, Anxiety Symptoms, and Their Correlates in Persons with Dementia in Norwegian Nursing Homes: A Cause for Concern.

https://arctichealth.org/en/permalink/ahliterature292510
Source
Dement Geriatr Cogn Disord. 2017; 43(5-6):294-305
Publication Type
Journal Article
Date
2017
Author
Alka Rani Goyal
Sverre Bergh
Knut Engedal
Marit Kirkevold
Øyvind Kirkevold
Author Affiliation
Centre of Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad, Norway.
Source
Dement Geriatr Cogn Disord. 2017; 43(5-6):294-305
Date
2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Anti-Anxiety Agents - therapeutic use
Anxiety - diagnosis - drug therapy - etiology - psychology
Dementia - complications - diagnosis - epidemiology - psychology
Female
Homes for the Aged - statistics & numerical data
Humans
Male
Norway - epidemiology
Nursing Homes - statistics & numerical data
Patient Care Management - methods
Psychomotor Agitation - etiology - prevention & control - psychology
Abstract
Little is known about anxiety and its associations among persons with dementia in nursing homes. This study aims to examine anxiety, anxiety symptoms, and their correlates in persons with dementia in Norwegian nursing homes.
In all, 298 participants with dementia =65 years old from 17 nursing homes were assessed with a validated Norwegian version of the Rating Anxiety in Dementia scale (RAID-N). Associations between anxiety (RAID-N score) and demographic and clinical characteristics were analyzed with linear regression models.
Anxiety, according to a cutoff of =12 on the RAID-N, was found in 34.2% (n = 102) of the participants. Irritability (59.7%) and restlessness (53.0%) were the most frequent anxiety symptoms. The participants' general physical health, a wide range of neuropsychiatric symptoms, and anxiolytic use were significant correlates of higher RAID-N scores.
Knowledge about anxiety, anxiety symptoms, and their correlates may enhance early detection of anxiety and planning of necessary treatment and proactive measures among this population residing in nursing homes.
PubMed ID
28463828 View in PubMed
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Auditing hospital drug utilisation by means of defined daily doses per bed-day. A methodological study.

https://arctichealth.org/en/permalink/ahliterature246539
Source
Eur J Clin Pharmacol. 1980;17(3):183-7
Publication Type
Article
Date
1980
Author
U. Bergman
I. Christenson
B. Jansson
B E Wiholm
Source
Eur J Clin Pharmacol. 1980;17(3):183-7
Date
1980
Language
English
Publication Type
Article
Keywords
Anti-Anxiety Agents - therapeutic use
Drug Prescriptions
Drug Utilization - trends
Humans
Hypnotics and Sedatives - therapeutic use
Medication Systems, Hospital
Sweden
Utilization Review - methods
Abstract
The utilisation of hypnotics, sedatives, and minor tranquillisers (HSmT) was studied by means of drug-delivery and hospital occupancy statistics for 1975-1977 in a Swedish university hospital. A total of 0.53 so-called defined daily doses (DDD)/bed-day were delivered in 1975, implying that every second patient might have regularly been prescribed HSmT. The benzodiazepines were predominant with 71% of the deliveries. Five major drugs accounted for 88%. The drug pattern and the range of DDD/day-bed (0.09-1.18) differed considerably between the departments. Drugs not recommended by the hospital's Pharmacy and Therapeutics Committe accounted only for 3% of deliveries. In a drug surveillance study performed in two medical wards, HSmT were prescribed for 43% of 274 patients. Drug delivery and prescription data were in broad agreement. Drug information activities in the hospital had a clearly discernable influence on the delivered DDD/bed-day. This measure is an inexpensive indicator of drug utilisation in a hospital and a suitable basis for therapeutic audit.
PubMed ID
6102519 View in PubMed
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Benzodiazepine prescription to middle-aged women: it is done indiscriminately by family physicians?

https://arctichealth.org/en/permalink/ahliterature243325
Source
Postgrad Med. 1982 Apr;71(4):115-20
Publication Type
Article
Date
Apr-1982
Author
W W Rosser
Source
Postgrad Med. 1982 Apr;71(4):115-20
Date
Apr-1982
Language
English
Publication Type
Article
Keywords
Age Factors
Anti-Anxiety Agents - therapeutic use
Canada
Diazepam - therapeutic use
Female
Humans
Life Change Events
Marriage
Middle Aged
Oxazepam - therapeutic use
Physician's Role
Sex Factors
Stress, Psychological - drug therapy
Substance-Related Disorders
Abstract
It has been frequently suggested that physicians' indiscriminate prescribing has caused the high level of patient use of benzodiazepines. To determine whether this was true at Ottawa Civic Hospital's Family Medicine Centre, patient charts of women aged 45 to 65-the age-sex group that received the highest number of new prescriptions for diazepam (Valium) or oxazepam (Serax) - were studied. Middle-aged women who received a new prescription for one of these drugs visited the office significantly more often, had more marital problems, and experienced significantly more life crisis situation than a control group of nonrecipients. These results suggest that the high rate of prescribing is related to high levels of reported life stress in middle-aged women. Further studies in other centers are needed to conclusively disprove the popularly held idea that benzodiazepines are indiscriminately prescribed by physicians.
PubMed ID
6122203 View in PubMed
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Breast Cancer Screening: Women's Experiences of Waiting for Further Testing.

https://arctichealth.org/en/permalink/ahliterature161697
Source
Oncol Nurs Forum. 2007 Jul;34(4):847-53
Publication Type
Article
Date
Jul-2007
Author
Patricia Pineault
Author Affiliation
Quebec Action Network for the Health of Women, Montreal, Canada. ppineault@cooptel.qc.ca
Source
Oncol Nurs Forum. 2007 Jul;34(4):847-53
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Aged
Anti-Anxiety Agents - therapeutic use
Anxiety - drug therapy - epidemiology
Biopsy, Needle - psychology
Breast Neoplasms - diagnosis - epidemiology - nursing - psychology
Female
Health Care Surveys
Humans
Mammography - psychology
Middle Aged
Oncology Nursing - statistics & numerical data
Patient Education as Topic - statistics & numerical data
Patient satisfaction
Professional-Patient Relations
Quebec - epidemiology
Social Support
Time Factors
Waiting Lists
Abstract
To describe anxiety experienced by participants in a breast cancer screening program who have received an abnormal screening mammography result and are waiting for further testing and diagnosis and to identify the social support needed during this period.
Exploratory, descriptive.
Quebec Breast Cancer Screening Program (QBCSP) participants in Montreal, Canada.
Nonprobability sample of 631 asymptomatic women, aged 50-69, who had abnormal screening mammogram results in the two months prior to the survey and who spoke or read French or English.
Mailed self-report questionnaire.
Anxiety, social support, and breast cancer screening.
Fifty-one percent of the participants were quite or very anxious at every stage of the prediagnostic phase. Seventy-five percent expressed their feelings to family and friends whose support was comforting but did not diminish participants' anxiety. Satisfaction from social support offered by healthcare professionals reduced their anxiety.
To decrease anxiety in the prediagnostic phase, women need support from healthcare professionals during the early stage of the screening process to prevent exacerbation of their concerns. Support has to be integrated into a continuity-of-care process.
Nurses can play a significant role in breast cancer screening programs. They can evaluate, at an early stage, participant anxiety and offer the appropriate social support. They also can ensure the follow-up and personalized support required while a patient awaits a diagnosis.
PubMed ID
17723985 View in PubMed
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The CANMAT task force recommendations for the management of patients with mood disorders and comorbid anxiety disorders.

https://arctichealth.org/en/permalink/ahliterature127358
Source
Ann Clin Psychiatry. 2012 Feb;24(1):6-22
Publication Type
Article
Date
Feb-2012
Author
Ayal Schaffer
Diane McIntosh
Benjamin I Goldstein
Neil A Rector
Roger S McIntyre
Serge Beaulieu
Richard Swinson
Lakshmi N Yatham
Author Affiliation
Mood and Anxiety Disorders Program, Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. ayal.schaffer@sunnybrook.ca
Source
Ann Clin Psychiatry. 2012 Feb;24(1):6-22
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Advisory Committees
Anti-Anxiety Agents - therapeutic use
Antidepressive Agents - therapeutic use
Anxiety Disorders - epidemiology - etiology - therapy
Bipolar Disorder - epidemiology - etiology - therapy
Canada
Child
Cognitive Therapy - methods
Comorbidity
Depressive Disorder, Major - epidemiology - etiology - therapy
Humans
Mood Disorders - epidemiology - etiology - therapy
Obsessive-Compulsive Disorder - epidemiology - etiology - therapy
Panic Disorder - epidemiology - etiology - therapy
Phobic Disorders - epidemiology - etiology - therapy
Stress Disorders, Post-Traumatic - epidemiology - etiology - therapy
Abstract
Comorbid mood and anxiety disorders are commonly seen in clinical practice. The goal of this article is to review the available literature on the epidemiologic, etiologic, clinical, and management aspects of this comorbidity and formulate a set of evidence- and consensus-based recommendations. This article is part of a set of Canadian Network for Mood and Anxiety Treatments (CANMAT) Comorbidity Task Force papers.
We conducted a PubMed search of all English-language articles published between January 1966 and November 2010. The search terms were bipolar disorder and major depressive disorder, cross-referenced with anxiety disorders/symptoms, panic disorder, agoraphobia, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Levels of evidence for specific interventions were assigned based on a priori determined criteria, and recommendations were developed by integrating the level of evidence and clinical opinion of the authors.
Comorbid anxiety symptoms and disorders have a significant impact on the clinical presentation and treatment approach for patients with mood disorders. A set of recommendations are provided for the management of bipolar disorder (BD) with comorbid anxiety and major depressive disorder (MDD) with comorbid anxiety with a focus on comorbid posttraumatic stress disorder, use of cognitive-behavioral therapy across mood and anxiety disorders, and youth with mood and anxiety disorders.
Careful attention should be given to correctly identifying anxiety comorbidities in patients with BD or MDD. Consideration of evidence- or consensus-based treatment recommendations for the management of both mood and anxiety symptoms is warranted.
PubMed ID
22303519 View in PubMed
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