Personalized drug dosing necessary for older heart patients

Main Category: Cardiovascular / Cardiology
Also Included In: Seniors / Aging;  Heart Disease
Article Date: 20 Aug 2013 - 0:00 PDT Current ratings for:
Personalized drug dosing necessary for older heart patients

Older heart patients present unique challenges for determining the optimal dosages of medications, so a new study from researchers at Duke Medicine offers some rare clarity about the use of drugs that are used to treat patients with heart attacks.

For certain heart patients older than age 75, a half-dose of the anti-platelet drug prasugrel works about as well as the typical dosage of clopidogrel, according to a team led by the Duke Clinical Research Institute that looked at a sub-study of a large clinical trial.

"As people live longer throughout the world, it's increasingly important to establish appropriate treatments for conditions such as acute coronary syndromes that commonly occur later in life," said Matthew T. Roe, M.D., MHS, associate professor of medicine at Duke and lead author of a study published Aug. 20, 2013, in the journal Circulation.

"These patients are very vulnerable to side effects, including bleeding, if therapies are not properly dosed," Roe said. "Additionally, existing practice guidelines have few specific recommendations for older patients with acute coronary syndromes as little evidence has been accrued from prior clinical trials in this population."

People older than age 75 comprise less than 10 percent of the U.S. population, but account for 35 percent of patients with acute coronary syndrome (ACS), which includes a recent heart attack or unstable chest pain. ACS is typically treated with anti-platelet therapies.

Earlier studies, for example, had shown that the platelet inhibitor prasugrel reduced the risk of adverse outcomes compared with clopidogrel in ACS patients undergoing coronary stent implantation. Those studies used a 60-mg initial dose followed by a 10-mg/day maintenance dose.

At that dosage level, however, patients older than age 75 had an increased risk of intracranial and fatal bleeding, as did younger patients weighing 132 pounds or less. The results led to warnings by the U.S. Food and Drug Administration and the European Medicines Agency for the use of the 10 mg/day maintenance dose of prasugrel in those populations, and consideration of a reduced dose (5 mg/day) to mitigate bleeding complications.

To examine whether older patients might benefit from a lower dosage of prasugrel, the Duke-led researchers analyzed more than 2,000 older patients who participated in a large trial called TRILOGY ACS that compared prasugrel with clopidogrel to manage acute coronary syndromes without coronary stent implantation or coronary bypass surgery.

The findings from this study, the first long-term data on outcomes specifically from elderly patients treated with the reduced dose of prasugrel, determined that a smaller dosage of 5-mg/day of prasugrel presented no greater risk of bleeding problems than the commonly prescribed 75-mg dose of clopidogrel in the elderly population.

"The findings from our study indicate how difficult it is to identify the right dose of anti-clotting medications for the elderly, to improve outcomes after a heart attack," said co-author Magnus Ohman, professor of medicine at Duke and chairman of the TRILOGY ACS study. "While a lower dose seemed intuitive, it was safe but not more effective. Future dedicated studies need to continue to find the right therapies for the vulnerable elderly patients."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cardiovascular / cardiology section for the latest news on this subject.

The Association of Early Physician Follow-up and 30-Day Readmission after Non-ST-Segment Elevation Myocardial Infarction among Older Patients

In addition to Roe and Ohman, study authors include Shaun Goodman; Susanna Stevens; Judith Hochman; Shmuel Gottlieb; Bikur Cholim; Felipe Martinez; Anthony Dalby; William Boden; Harvey White; Dorairaj Prabhakaran; Kenneth Winters; Philip Aylward; Jean-Pierre Bassand; Darren McGuire; Diego Ardissino; Keith A.A. Fox; and Paul Armstrong. CIRCULATIONAHA.113.004569; Published online before print August 14, 2013, doi: 10.1161/?CIRCULATIONAHA.113.004569

The drug companies Eli Lilly and Daiichi Sankyo, which market and make prasugrel, funded the TRILOGY ACS study.

Roe receives grant funding and/or consulting fees from Lilly and Daiichi Sankyo. Ohman receives grant funding and travel expenses from the Lilly and Daiichi Sankyo. More detailed disclosures are provided in the published study.

Duke University Medical Center

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Duke University Medical Center. "Personalized drug dosing necessary for older heart patients." Medical News Today. MediLexicon, Intl., 20 Aug. 2013. Web.
20 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Personalized drug dosing necessary for older heart patients'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Big Pharma Companies will meet at the Geriatric Safe Medicines Summit to discuss performing clinical trials in older people, 16-17 September, London

Main Category: Conferences
Article Date: 19 Aug 2013 - 8:00 PDT Current ratings for:
Big Pharma Companies will meet at the Geriatric Safe Medicines Summit to discuss performing clinical trials in older people, 16-17 September, London

Patients over the age of 65 are prescribed the majority of prescription drugs used in the UK but are significantly under-represented in clinical trials. Statistics show that although over 65's carry 60% of the disease burden they are only represented at a rate of 32% in phase I-III Clinical Trials. Why do clinical trial recruitment designs neglect this patient population? 

Challenges which include co-morbidities, polypharmacy drug-drug interactions, adherence formulation challenges are just some of the difficulties faced when performing clinical trials in this population, not to mention the problems of delivery.

SMi's inaugural Geriatrics Safe Medicines Summit, taking place on the 16th-17th of September 2013 in London, will look to tackle these issues and will address Benefit-risk in this patient population and how clinical trials could be better designed to facilitate the participation of the elderly in clinical trials.

According to Nina Lee Barnett, Consultant pharmacist, Northwick Park Hospital who is speaking on day one "I am really looking forward to participating in this meeting. It is great to see a programme which includes internationally renowned contributors from a wide variety of backgrounds, all delivering sessions which support safer use of medicines in older people. This meeting is an opportunity to foster collaboration on research projects which include older people and to break down barriers preventing studies in this age demographic."

Through a novel range of case studies attendees will discover new market gaps, market strategies and focus on EMA geriatric medicines strategy and how modelling and simulation along with new patient reporting systems support clinical trials in older people.

Keynote speakers include Solange Rohou, Director Regulatory Affairs, AstraZeneca who will be presenting on: What has been done since the revision of the ICH E7 guideline? The Companies' view and Barbro Westerholm, Member of Swedish Parliament, who will speak on: Patient perspectives on healthy ageing.

Event highlights include:

Discover the benefits of performing clinical trials in older people Identify the key challenges and considerations when conducting clinical trials in older people Address reasons for clinical trial retention difficulties Discuss how modelling and simulation along with new patient reporting systems support clinical trials in older people Explore new market gaps and discover new market strategy Focus on the EMA geriatric medicines strategy

For the full conference programme and further information please visit:? http://www.smi-online.co.uk/goto/geriatricsummit55.asp

Alternatively contact Jonathan Collins on +44 (0)20 7827 6734 or email: jcollins@smi-online.co.uk

Sponsorship opportunities are available for this event, please contact Alia Malick on +44(0) 20 7827 6168.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our conferences section for the latest news on this subject.

About SMi Group

Established since 1993, the SMi Group is a global event-production company that specializes in Business-to-Business Conferences, Workshops, Masterclasses and online Communities. We create and deliver events in the Defence, Security, Energy, Utilities, Finance and Pharmaceutical industries.

We pride ourselves on having access to the world’s most forward thinking opinion leaders and visionaries, allowing us to bring our communities together to Learn, Engage, Share and Network. We hold events in over 30 major cities throughout the world including London, Paris and Singapore and to date have welcomed over 200,000 participants from 80 countries. For more information, please visit http://www.smi-online.co.uk

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Ltd, SMi Group. "Big Pharma Companies will meet at the Geriatric Safe Medicines Summit to discuss performing clinical trials in older people, 16-17 September, London." Medical News Today. MediLexicon, Intl., 19 Aug. 2013. Web.
19 Aug. 2013. APA
Ltd, S. (2013, August 19). "Big Pharma Companies will meet at the Geriatric Safe Medicines Summit to discuss performing clinical trials in older people, 16-17 September, London." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/265006.php.

Please note: If no author information is provided, the source is cited instead.

'Big Pharma Companies will meet at the Geriatric Safe Medicines Summit to discuss performing clinical trials in older people, 16-17 September, London'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

With a little help from their Virtual friend, older Latino adults get more exercise

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Seniors / Aging;  Arthritis / Rheumatology;  Hypertension
Article Date: 16 Aug 2013 - 1:00 PDT Current ratings for:
With a little help from their Virtual friend, older Latino adults get more exercise

When it comes to getting motivated to exercise and do things that are good for our health, sometimes all it takes is a little help from our friends.

This was certainly the case for a group of older, Latino adults in Northern California: They benefited from the advice and encouragement of a virtual friend - a physical-activity adviser named Carmen, a new study reports.

Individuals who participated in an exercise program guided by the virtual adviser had an eight-fold increase in walking compared with those who did not, according to the study, published online today in the Journal of Health Communication. Led by researchers at the Stanford University School of Medicine, it is believed to be among the first "e-health" studies geared toward a non-English speaking, older-adult population with low literacy.

"The results indicate that a virtual adviser delivering culturally and linguistically adapted physical activity advice led to meaningful four-month increases in walking relative to control among underserved older adults," the study says. "This interactive technology, which requires minimal language and computer literacy, may help reduce health disparities by ensuring that all groups benefit from 'e-health' opportunities."

The lead author of the study is Abby King, PhD, professor of health research and policy and of medicine, and director of the Healthy Aging Research & Technology Solutions laboratory at the Stanford Prevention Research Center.

Electronic games and programs that promote healthy habits have proliferated in recent years. King studies the effectiveness of those specifically targeted toward older adults and said she believes older adults represent the perfect population for such interventions. "[They] are at particular risk for the chronic diseases that can be positively influenced by reasonably modest improvements in physical activity," she and her co-authors write in the paper.

This study was based on an earlier study of a successful two-month, physical activity intervention geared toward older, primarily low-income African-Americans. The earlier study, led by Timothy Bickmore, PhD, associate professor at Northeastern University, involved the use of an interactive computer character that simulated face-to-face counseling; participants interacted with the adviser by touching responses shown on the computer screen.

The new study, of which Bickmore is a co-author, targeted another underserved (and often inactive) population: low-income, older, Latino adults. The digital adviser was modified to fit in with local Latino culture and to offer interactions in English or Spanish.

For the trial, King and her colleagues recruited 40 inactive adults, ages 55 and older, from a primarily Latino population in San Jose, Calif. More than 92.5 percent self-identified as Latino, and 81 percent reported an annual household income of less than $50,000. The great majority (92 percent) reported a history of chronic illnesses, with the most common being high blood pressure, high cholesterol and arthritis.

Study participants were randomly assigned to a four-month walking intervention, coached by Carmen the virtual adviser, or to a control group. Those in the intervention program were taught to use a pedometer to track their daily steps. During weekly sessions, Carmen evaluated their pedometer information to provide them with personalized feedback, problem-solving and goal-setting. Participants were encouraged to interact weekly with Carmen, who was made available to them through a computer at a local senior center.

The researchers looked at the change in walking behavior at two months and four months, and also assessed whether the participants were adopting any strategies taught by Carmen. After four months, the researchers found that participants increased the amount of time they walked by an average of about 253 minutes each week - eight times more than the increase in the control group.

The investigators also found that five motivational behavior-change strategies significantly increased over four months for those in the intervention program. These included "understanding the risks of inactivity, committing oneself to being physically active, substituting more active alternatives, rewarding oneself for being physically active and reminding oneself to be physically active," the study said. These skills, it noted, "have been associated with positive health behavior change in other populations."

"While we hoped that the culturally tailored, individualized program would appeal to older Latino adults, we were surprised and gratified to see how well the group of participants randomized to receive Carmen-based counseling actually did," King said.

King also said she was heartened that so many participants requested access to Carmen after the data-collection period of the study was over. The researchers left the computer program at the senior center for an additional 20 weeks, and all but one of the participants assigned to the intervention interacted with Carmen during that time.

The study enrollment was small, but the researchers are encouraged by the results. "We believe that, with some additional development and larger-scale testing, these types of virtual adviser programs have the potential for wide adoption and dissemination throughout other communities," King said, adding that the virtual adviser could be modified based on the ethnicity of other targeted groups.

King and Bickmore were recently awarded a National Institutes of Health grant to conduct a larger, randomized trial of the program. They plan to assess Carmen's effectiveness as a personal adviser over a longer time period and identify who might benefit the most from using this type of support. The plan is to deploy Carmen at numerous community centers across the San Francisco Bay Area.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our obesity / weight loss / fitness section for the latest news on this subject.

Other Stanford co-authors of the paper include research assistant Maria Ines Campero and Leslie Pruitt, PhD, who was a senior research scientist at the time the study was conducted.

The study was supported by a Public Health Service grant (R21CA127511) from the National Cancer Institute. Information about Stanford's Department of Health Research and Policy and the Department of Medicine, both of which also supported the research, is available at http://medicine.stanford.edu/.

Stanford University Medical Center

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Stanford University Medical Center. "With a little help from their Virtual friend, older Latino adults get more exercise." Medical News Today. MediLexicon, Intl., 16 Aug. 2013. Web.
16 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'With a little help from their Virtual friend, older Latino adults get more exercise'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Prisons and partner organisations must do more to provide health and social care to growing population of older prisoners, UK

Main Category: Public Health
Article Date: 14 Aug 2013 - 2:00 PDT Current ratings for:
Prisons and partner organisations must do more to provide health and social care to growing population of older prisoners, UK

More needs to be done in prisons to look after a growing population of older male prisoners, according to research by The University of Manchester.

The findings, just published by the National Institute for Health Research (NIHR) Journals Library in Health Services and Delivery Research, showed 44% of prisons do not have a policy on the care and management of older prisoners and there was a lack of integration between health and social care services.

Planning for an older prisoner's release from jail was also frequently non-existent leading to their health and social care needs not being met once they were out in the community - unless they lived in probation-approved premises immediately on release.

Professor Jenny Shaw, from the Offender Health Research Network based at the Institute of Brain Behaviour and Mental Health at The University of Manchester, said specialised assessments were required for older patients because they have more complex health and social care needs than their younger counterparts and those of a similar age living in the community.

Earlier studies have shown approximately 85% of older prisoners having had one or more major illness with the most frequently reported health conditions being cardiovascular diseases, arthritis, back problems, respiratory diseases and depression. They are also at greater risk of becoming isolated and are less likely to have social support, putting them at a greater risk of developing mental health difficulties.

The Manchester research, led by Professor Shaw, looked at serving male prisoners over age 60 at all prisons in England and Wales.

It found some positive improvements including that the number of prisons appointing a member of staff to act as an Older Prisoner Lead had increased in recent years. But these staff did not all appear to be fully active in their roles in tailoring and improving services for older prisoners.

The study also found the Department of Health's recommendation to provide older prisoners with a specific health and social care assessment when they arrived at prison was largely unmet.

Professor Shaw said: "There seems to be ambiguity regarding the responsibility for older prisoners' social care. We also found that the geographical organisation of social services can result in the responsible social service being located a considerable distance from where prisoners are being held. In such instances, local social services do not co-ordinate their care."

"Older prisoners have on average almost three unmet health and social care needs on entry to prison and the most frequent unmet need was in relation to knowing where to get information about their care. We are now calling for a series of improvements to be made."

Suggested improvements include housing older prisoners near to where they will live when they are released to improve the co-ordination of their care and a thorough health and social care entry assessment for all older prisoners which is then reviewed throughout their sentence. Guidelines also set out how to systematically address these health needs during a prisoner's sentence and will now be piloted at a number of prisons in England.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our public health section for the latest news on this subject.

Health and social care services for older male adults in prison: the identification of current service provision and piloting of an assessment and care planning model

Health Services and Delivery Research - DOI: 10.3310/hsdr01050

Senior J, Forsyth K, Walsh E, O'Hara K, Stevenson C, Hayes A, Short V, Webb R, Challis D, Fazel S, Burns A, Shaw J

The University of Manchester

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

The University of Manchester. "Prisons and partner organisations must do more to provide health and social care to growing population of older prisoners, UK." Medical News Today. MediLexicon, Intl., 14 Aug. 2013. Web.
14 Aug. 2013. APA
The University of Manchester. (2013, August 14). "Prisons and partner organisations must do more to provide health and social care to growing population of older prisoners, UK." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/264776.php.

Please note: If no author information is provided, the source is cited instead.

'Prisons and partner organisations must do more to provide health and social care to growing population of older prisoners, UK'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Rapamycin showed limited effects on aging in older mice

Main Category: Seniors / Aging
Article Date: 29 Jul 2013 - 0:00 PDT Current ratings for:
Rapamycin showed limited effects on aging in older mice

The immunosuppressive drug rapamycin has been shown to increase longevity in mice even when treatment begins at an advanced age. It is unclear if the extension of life also correlates with prolonged health and vigor.

In the current issue of the Journal of Clinical Investigation, Dan Ehninger and colleagues at the German Center for Neurodegenrative Diseases evaluated age-associated characteristics in mice treated with rapamycin. They found that rapamycin improved memory and spatial learning, reduced thyroid follicle size, and reduced body fat in older mice. However, many of these same attributes were also improved in young mice treated with the drug, indicating an age-independent drug effect.

The prevalence of cancer, a common cause of mouse mortality, was also decreased in older treated mice. The authors did find that rapamycin treatment had no effect on several age related symptoms, including cardiovascular and liver function, loss of muscle mass, strength retention, or balance.

These data suggest that rapamycin treatment may increase lifespan through reduction of cancer rates, and the drug may be useful for relief of some age related conditions.

In the accompanying commentary, Arlan Richards of the University of Texas Health Science Center at San Antonio suggests that clinical trials to study the effect of rapamycin on age related neurodegenerative diseases of the elderly such as Alzheimer's disease should be considered.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our seniors / aging section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Journal of Clinical Investigation. "Rapamycin showed limited effects on aging in older mice." Medical News Today. MediLexicon, Intl., 29 Jul. 2013. Web.
29 Jul. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Rapamycin showed limited effects on aging in older mice'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here