Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive e...Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.展开更多
目的:系统评价达泊西汀治疗早泄的有效性。方法:计算机及手工检索1979～2009年Medline、EMbase、Cochrane图书馆、中国生物医学文献、中文科技期刊全文数据库、CNKI数字图书馆,《中国男科学杂志》等5种相关杂志纳入达泊西汀治疗早泄相...目的:系统评价达泊西汀治疗早泄的有效性。方法:计算机及手工检索1979～2009年Medline、EMbase、Cochrane图书馆、中国生物医学文献、中文科技期刊全文数据库、CNKI数字图书馆,《中国男科学杂志》等5种相关杂志纳入达泊西汀治疗早泄相关的临床随机对照试验,评价和提取资料,RevMan软件Meta分析,进行系统评价。结果:共纳入5篇随机对照试验(randomized controlled trial,RCT),受试患者4433例。方法学质量评价3个试验为A级,2个为B级,将患者性生活时阴道内射精潜伏时间(intravaginal ejaculatory latency time,IELT)、总体感觉改善情况(patient-reported global impression of change,PGI)、性生活满意度(satisfaction with sexual intercourse,SWSI)、射精感觉控制(perceived control over ejaculation,PCOE)和早泄相关困惑感(personal distress related to ejaculation,PDRE)改善情况作为指标,经达泊西汀治疗9～24周,Meta分析结果表明,治疗前后IELT、SWSI及PCOE改善状况的加权均数差及其95%可信区间(CI)分别为1.38(1.21,1.55)、0.55(0.48,0.62)和0.63(0.49,0.78),P均<0.001;治疗组与安慰剂组相比,患者PGI问卷评分、SWSI、PCOE及PDRE改善状况OR值及其95%CI分别为3.56(2.60,4.88)、3.85(2.08,7.10)、2.87(2.30,3.58)和2.02(1.69,2.42),P均<0.001,差异具有统计学意义。被纳入的研究均报告无严重不良反应发生,绝大部分患者能耐受试验。结论:现有研究表明,达泊西汀能改善早泄患者症状,明显延长患者性生活阴道内射精潜伏时间,有效改善患者射精感觉控制评分,减轻患者困惑感,提高性生活满意度以及总体感觉评分。展开更多
Objective: Patients with major depressive disorder (MDD) often discontinue antidepressant therapy pre- maturely risking relapse, despite United Kingdom (UK) guidelines recommending therapy for up to at least six month...Objective: Patients with major depressive disorder (MDD) often discontinue antidepressant therapy pre- maturely risking relapse, despite United Kingdom (UK) guidelines recommending therapy for up to at least six months after remission. More information is needed on the patterns of antidepressant discontinuation in UK primary care. Objectives of the study were to assess the patterns, incidence and predictors of therapy discontinuation among MDD patients initiating treatment with selective serotonin reuptake inhibitors (SSRIs). Methods: This was a retrospective cohort study using general practices registered with the General Practice Research Database (GPRD). 15,274 patients with MDD receiving a first ever prescription (index) for an SSRI between 2006-2008 were identified in GPRD. Discontinuation (including temporary gaps) and cessation of antidepressant therapy were examined over follow-up. Predictors of incidence of discontinuation in the six months after index were assessed. Results: Incidence of discontinuation of antidepressant therapy over follow-up was 80.05 per 100 person years (95% CI 78.94 - 81.17). At six months after index 42% of patients had discontinued and 33% had ceased therapy altogether. Lower discontinuation of index SSRI therapy in the first six months after initiation was associated with higher age, higher body mass index (BMI), and comorbid irritable bowel syndrome. Higher discontinuation was associated with paroxetine or fluoxetine at index, and a more recent index calendar year. Conclusions: There is a significant risk of discontinuation of antidepressant therapy in the 6 months after initiation of treatment for MDD. This finding requires awareness by the general practitioner (GP) to ensure implementation of optimal treatment regimens, and minimization of therapy non-compliance among MDD patients.展开更多
文摘Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.
文摘目的:系统评价达泊西汀治疗早泄的有效性。方法:计算机及手工检索1979～2009年Medline、EMbase、Cochrane图书馆、中国生物医学文献、中文科技期刊全文数据库、CNKI数字图书馆,《中国男科学杂志》等5种相关杂志纳入达泊西汀治疗早泄相关的临床随机对照试验,评价和提取资料,RevMan软件Meta分析,进行系统评价。结果:共纳入5篇随机对照试验(randomized controlled trial,RCT),受试患者4433例。方法学质量评价3个试验为A级,2个为B级,将患者性生活时阴道内射精潜伏时间(intravaginal ejaculatory latency time,IELT)、总体感觉改善情况(patient-reported global impression of change,PGI)、性生活满意度(satisfaction with sexual intercourse,SWSI)、射精感觉控制(perceived control over ejaculation,PCOE)和早泄相关困惑感(personal distress related to ejaculation,PDRE)改善情况作为指标,经达泊西汀治疗9～24周,Meta分析结果表明,治疗前后IELT、SWSI及PCOE改善状况的加权均数差及其95%可信区间(CI)分别为1.38(1.21,1.55)、0.55(0.48,0.62)和0.63(0.49,0.78),P均<0.001;治疗组与安慰剂组相比,患者PGI问卷评分、SWSI、PCOE及PDRE改善状况OR值及其95%CI分别为3.56(2.60,4.88)、3.85(2.08,7.10)、2.87(2.30,3.58)和2.02(1.69,2.42),P均<0.001,差异具有统计学意义。被纳入的研究均报告无严重不良反应发生,绝大部分患者能耐受试验。结论:现有研究表明,达泊西汀能改善早泄患者症状,明显延长患者性生活阴道内射精潜伏时间,有效改善患者射精感觉控制评分,减轻患者困惑感,提高性生活满意度以及总体感觉评分。
文摘Objective: Patients with major depressive disorder (MDD) often discontinue antidepressant therapy pre- maturely risking relapse, despite United Kingdom (UK) guidelines recommending therapy for up to at least six months after remission. More information is needed on the patterns of antidepressant discontinuation in UK primary care. Objectives of the study were to assess the patterns, incidence and predictors of therapy discontinuation among MDD patients initiating treatment with selective serotonin reuptake inhibitors (SSRIs). Methods: This was a retrospective cohort study using general practices registered with the General Practice Research Database (GPRD). 15,274 patients with MDD receiving a first ever prescription (index) for an SSRI between 2006-2008 were identified in GPRD. Discontinuation (including temporary gaps) and cessation of antidepressant therapy were examined over follow-up. Predictors of incidence of discontinuation in the six months after index were assessed. Results: Incidence of discontinuation of antidepressant therapy over follow-up was 80.05 per 100 person years (95% CI 78.94 - 81.17). At six months after index 42% of patients had discontinued and 33% had ceased therapy altogether. Lower discontinuation of index SSRI therapy in the first six months after initiation was associated with higher age, higher body mass index (BMI), and comorbid irritable bowel syndrome. Higher discontinuation was associated with paroxetine or fluoxetine at index, and a more recent index calendar year. Conclusions: There is a significant risk of discontinuation of antidepressant therapy in the 6 months after initiation of treatment for MDD. This finding requires awareness by the general practitioner (GP) to ensure implementation of optimal treatment regimens, and minimization of therapy non-compliance among MDD patients.
