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Kim SJ, Witchell EC, Conklin AI. Therapeutic carbohydrate restriction pre-COVID pandemic: assessing registered dietitians' knowledge, use and perceived barriers in Canada. Eur J Clin Nutr 2023; 77:98-104. [PMID: 35945261 DOI: 10.1038/s41430-022-01193-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND/OBJECTIVES Evidence supports therapeutic carbohydrate restriction (TCR) for managing appropriate patients with chronic illness, but little is known about TCR prescribing among dietitians. This study evaluated dietitians' knowledge, information use and needs for TCR in Canada. METHODS Registered dietitians (RDs) were recruited (n = 274) from January to December 2020 to collect semi-structured data using an online needs assessment survey (French and English). Descriptive and inferential statistics were used to describe and assess which nine RD practice characteristics predicted TCR prescription in clinical practice. RESULTS Respondents were located in all provinces and territories in Canada, with few international responses in the sample (3.5%). We found statistically significant differences between RDs who have prescribed TCR or not in four practice characteristics studied: level of knowledge (p < 0.001), reviewing literature (p = 0.02), clinician referrals (p < 0.001) or personal experience (p < 0.001). Multivariable models showed that the odds of prescribing TCR was associated with intermediate/expert knowledge (OR 5.92 [95% CI: 2.26-17.77]), clinician's referral (OR 3.22 [1.73-6.14]) and personal experience, whether a former user (OR 2.24 [1.09-4.72]) or a current user of TCR (OR 9.09 [2.70-42.09]), compared to no knowledge, no referral or no experience. CONCLUSION There is a strong link between the use, or lack, of TCR in clinical practice among RDs and their knowledge level, personal experience and clinician referrals/support. Scope exists to develop novel educational tools and resources on scientific evidence for TCR, and increase multidisciplinary teams, so as to better support RDs in Canada to safely implement TCR in appropriate patients with chronic illness.
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Affiliation(s)
- Son Jun Kim
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Eliana C Witchell
- Institute for Personalized Therapeutic Nutrition, Vancouver, BC, Canada
| | - Annalijn I Conklin
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
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Nogué M, Rambaud J, Fabre S, Filippi N, Jorgensen C, Pers YM. Long-term corticosteroid use and dietary advice: a qualitative analysis of the difficulties encountered by patient. BMC Health Serv Res 2019; 19:255. [PMID: 31027493 PMCID: PMC6486686 DOI: 10.1186/s12913-019-4052-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/31/2019] [Indexed: 12/23/2022] Open
Abstract
Background Nearly 1% of the population is currently treated with long-term corticosteroid therapy. When corticosteroids are introduced, information concerning potential adverse effects and recommendations for lifestyle changes aimed at preventing such effects is provided to patients. However, studies have shown patients often do not fully comprehend the information provided and have difficulty implementing the recommended dietary and physical activity advice. In this study, we aim to highlight the difficulties encountered by patients in comprehending and implementing recommendations in the context of long-term corticosteroid use. Such information can be used to better optimize care, particularly concerning adherence to the treatment, the diet, and thus improve the quality of life of patients. Methods We recruited adult patients under long-term corticosteroid (≥ 3 months, ≥ 5 mg/day) treatment from both general medicine and rheumatology practices. We performed a qualitative analysis based on semi-structured interviews of these patients. Transcripts of these interviews were then compiled and analysed using a thematic approach. Results Sixteen patients were included. Analysis of the interviews revealed that patients’ hope for effective corticosteroid treatment was counterbalanced by concerns over potential adverse effects. In some patients, the need to respect a strict and imposed diet induced psychological distress, potentially leading to eating disorders or fear of social exclusion. Furthermore, patient ambivalence toward the therapeutic education was highlighted, as well as the notion of filtering information, conscious or unconscious, as revealed by their lack of recall. The relationship with the physician also affected the treatment experience. Conclusion Our analysis of the personal experience of patients regarding recommended lifestyle changes associated with long-term corticosteroid treatment highlights patient difficulties and suggests different ways of improving therapeutic education. Electronic supplementary material The online version of this article (10.1186/s12913-019-4052-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Muriel Nogué
- Endocrinology therapeutic unit, Lapeyronie, University Hospital Lapeyronie, 371, avenue du doyen Gaston Giraud, 34295, Montpellier, France.
| | | | - Sylvie Fabre
- Mutualist Hospital Beau-Soleil, Montpellier, France
| | - Nathalie Filippi
- Clinical immunology and osteoarticular diseases therapeutic unit, Lapeyronie University Hospital, Montpellier, France
| | - Christian Jorgensen
- Clinical immunology and osteoarticular diseases therapeutic unit, Lapeyronie University Hospital, Montpellier, France
| | - Yves-Marie Pers
- Clinical immunology and osteoarticular diseases therapeutic unit, Lapeyronie University Hospital, Montpellier, France
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Six M, Morin C, Fardet L. [Association between prescription of long-term systemic glucocorticoid therapy associated measures and prescriber's medical speciality]. Rev Med Interne 2019; 40:427-432. [PMID: 30683427 DOI: 10.1016/j.revmed.2018.10.388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/05/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In order to prevent some glucocorticoid-induced adverse events, adjuvant measures are often associated with prescription of long-term (≥3 months) systemic glucocorticoid therapy. The main objective of this study was to study the association between prescription of these measures and the medical specialty of the prescriber. METHODS A cross-sectional study was conducted through the website www.cortisone-info.fr. Patients visiting this website and receiving long-term glucocorticoid therapy were asked to fill a questionnaire asking them, among other things, the specialty of the physician who initiated glucocorticoids and the adjuvant measures they were prescribed at treatment initiation. RESULTS In all, 1383 patients answered the questionnaire and 843 (61%) questionnaires were analyzed (women: 70.6%, median age: 59 [44-70] years, current glucocorticoid dosage: 12.5 [5-30] mg/day, maximum dose: 42 [20-60] mg/day). The main prescribers were rheumatologists (30.5%) and internists (17.3%). Most adjuvant measures were heterogeneously prescribed and depended largely on the specialty of the prescribing physician. Some probably unnecessary measures in most patients (potassium supplementation, prevention of peptic ulcer, low-sodium diet) were frequently prescribed while other consensual measures (prevention of osteoporosis, vaccinations) were prescribed to less than half of patients. In multivariable analyses, most of the studied measures were more frequently prescribed by internists than by colleagues of other specialties. Pneumologists more often vaccinated patients against influenza or pneumococcus than their colleagues. CONCLUSION Adjuvant measures to long-term glucocorticoid therapy are heterogeneously prescribed. The prescriptions depend largely on the medical specialty of the prescribing physician.
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Affiliation(s)
- M Six
- Service de médecine interne, hôpital Saint Camille, 2, rue des pères Camilliens, 94360 Bry-sur-Marne, France.
| | - C Morin
- Service de médecine interne, hôpital Saint Camille, 2, rue des pères Camilliens, 94360 Bry-sur-Marne, France
| | - L Fardet
- Service de dermatologie, hôpital Henri-Mondor, 94000 Créteil, France; Équipe d'accueil EA7379 EpiDermE, université Paris-Est Créteil, 94000 Créteil, France
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Couvaras L, Trijau S, Delamotte G, Pradel V, Pham T, Lafforgue P. Description épidémiologique de la corticothérapie orale prolongée : résultats issus de la base de données de l’assurance maladie. Rev Med Interne 2018; 39:777-781. [DOI: 10.1016/j.revmed.2018.03.385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/11/2018] [Accepted: 03/30/2018] [Indexed: 10/16/2022]
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Bénard-Laribière A, Pariente A, Pambrun E, Bégaud B, Fardet L, Noize P. Prevalence and prescription patterns of oral glucocorticoids in adults: a retrospective cross-sectional and cohort analysis in France. BMJ Open 2017; 7:e015905. [PMID: 28760791 PMCID: PMC5642779 DOI: 10.1136/bmjopen-2017-015905] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To study trends in use of oral glucocorticoids (GCs) among adults, characteristics of oral GC initiators and prescriptions for the prevention of potential adverse effects associated with GC therapy. DESIGN First, a cross-sectional study repeated yearly was performed from 2007 to 2014 in a nationwide representative sample. Second, characteristics of initiators and patterns of GC therapy during the year following treatment initiation were described in a cohort of patients who began GC between 2007 and 2013. SETTING Population-based study using data from the French reimbursement healthcare system (covering approximately 90% of the population) in patients aged ≥18 years. RESULTS Over the study period, the prevalence of oral GC use ranged from 14.7% to 17.1% (95% CI 17.0%-17.2%) with a significant increase of 14.1% (95% CI +13.5% to +14.8%). The 2007-2013 cohort of oral GC initiators comprised 206 759 individuals. Oral GC use was mostly short-term (68% of unique reimbursement) and more than half of short-term users took concurrent antibiotics or respiratory/otological drugs. Chronic users (≥6 reimbursements/year) represented 1.8% (n=3789) of the cohort. The proportion of chronic users with comorbidities likely to be worsened by GC use (diabetes, psychotic disorders, osteoporosis) was 25%. Among patients at increased risk of osteoporosis, 62% received specific prevention/monitoring measures and only 27% had a bisphosphonate. Half of chronic oral GC users had a concurrent reimbursement of a proton pump inhibitor in the absence of non-steroidal anti-inflammatory drug use. CONCLUSIONS Oral GC use was highly widespread and increased among adults from 2007 to 2014. The overwhelming short-term use could mainly concern a growing use of unjustified prescriptions rather than situations with a favourable benefit/risk ratio. For chronic users, our findings plead for the development of interventions designed to improve monitoring with regard to the frequent comorbidities at risk and inappropriate prescribing of preventive therapeutic measures.
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Affiliation(s)
- Anne Bénard-Laribière
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Pharmacoepidemiology Team, Bordeaux, France
| | - Antoine Pariente
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Pharmacoepidemiology Team, Bordeaux, France
- CHU Bordeaux, Service de Pharmacologie Médicale, Bordeaux, France
| | - Elodie Pambrun
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Pharmacoepidemiology Team, Bordeaux, France
| | - Bernard Bégaud
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Pharmacoepidemiology Team, Bordeaux, France
- CHU Bordeaux, Service de Pharmacologie Médicale, Bordeaux, France
| | - Laurence Fardet
- Université Paris Est Créteil (UPEC), Créteil, France
- CHU Henri Mondor, Service de Dermatologie, Créteil, France
| | - Pernelle Noize
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Pharmacoepidemiology Team, Bordeaux, France
- CHU Bordeaux, Service de Pharmacologie Médicale, Bordeaux, France
- CIC Bordeaux CIC1401, Bordeaux, France
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Fardet L, Petersen I, Nazareth I. Monitoring of patients on long-term glucocorticoid therapy: a population-based cohort study. Medicine (Baltimore) 2015; 94:e647. [PMID: 25881838 PMCID: PMC4602514 DOI: 10.1097/md.0000000000000647] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
About 1% of the general population receives long-term systemic glucocorticoids. The monitoring provided to these patients is unknown. We conducted a population-based cohort study using The Health Improvement Network database. A total of 100,944 adult patients prescribed systemic glucocorticoids for >3 months between January 2000 and December 2012 were studied. The monitoring done before prescribing glucocorticoid therapy and during exposure to the drug was examined. This included measurement of body weight, blood pressure, lipids, glucose and potassium levels, referrals for dual-energy X-ray absorptiometry (DEXA-scan) or to an ophthalmologist/optician, and vaccinations. We assessed factors associated with the odds of being monitored before and during exposure. Before glucocorticoid initiation, weight and blood pressure were monitored in < 20% and < 50% of patients, respectively. Glucose and lipid levels were monitored in less than one-third of the patients, while DEXA-scan and eye monitoring were offered to <15% of them. Vaccination against flu and pneumococcus was given to 57% and 46% of the patients, respectively. During exposure to the drug, <60% of patients who were prescribed the drug for more than a year had their weight, glucose, or lipid levels recorded at least once and <25% of patients were referred at least once for DEXA-scan or screening for eye diseases. Overall, the odds of being monitored were higher in older patients and in those with comorbidities. There were variations in the level of monitoring provided across the UK, but the monitoring has improved over the last 12 years. Although the extent of monitoring of people on long-term glucocorticoids has improved over time, the overall monitoring provided is not satisfactory, particularly in young patients and those without comorbidities.
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Affiliation(s)
- Laurence Fardet
- From the University College London, Department of Primary Care and Population Health, London, UK (LF, IP, IN); Department of Dermatology, Henri Mondor Hospital, Paris, France (LF); and Université Paris Est Créteil, UPEC Paris 12, Créteil, France (LF)
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Complications de la corticothérapie chez les patients souffrant de maladie de Horton ou de pseudopolyarthrite rhizomélique. Rev Med Interne 2013; 34:438-43. [DOI: 10.1016/j.revmed.2013.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/15/2013] [Indexed: 12/11/2022]
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Fardet L. Effets indésirables métaboliques et cardiovasculaires des corticothérapies systémiques. Rev Med Interne 2013; 34:303-9. [DOI: 10.1016/j.revmed.2012.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/10/2012] [Indexed: 02/07/2023]
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Fardet L. Corticothérapies systémiques prolongées : tant reste à faire…. Rev Med Interne 2013; 34:253-4. [DOI: 10.1016/j.revmed.2013.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 02/11/2013] [Indexed: 11/29/2022]
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Sailler L, Pugnet G, Arlet P. [Systemic glucocorticoid therapy: associated measures]. Rev Med Interne 2013; 34:279-83. [PMID: 23312495 DOI: 10.1016/j.revmed.2012.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/10/2012] [Indexed: 12/27/2022]
Abstract
Long-term treatment with glucocorticoids results in many adverse effects. Prevention of osteoporosis is well codified, but prevention of other adverse effects is not. If there is some consensus on the prevention of glucocorticoid-induced adverse events, there are also many habits since interventional studies are lacking. A low caloric and low carbohydrate diet as well as a regular physical training are certainly necessary to avoid lipodystrophy, weight gain and diabetes mellitus. Some patients benefit from the repeated intervention of a dietetic or nutrition specialist. Physical training is often neglected though it is efficacious to limit severity of glucocorticoid-induced myopathy and probably to reduce vascular risk. Low sodium intake has no effect on lipodystrophy and its efficacy to prevent hypertension is doubtful. Benzodiazepines may be useful against anxiety, insomnia and nervousness when these symptoms are cumbersome. Anti-ulcer drugs are generally not indicated because glucocorticoids are not ulcerogenic. Hypokaliemia rarely occurs, so we prefer controlling serum potassium level 1 and 3 months after glucocorticoid initiation rather than systematically prescribe potassium supplementation. Patients on glucocorticoids are at increased risk for cardiovascular events. Due to the lack of studies specific to patients on long-term glucocorticoid therapy, the rules for the prescription of statins are the same as in the general population. There is no known prevention for cutaneous atrophy. However, use of adhesive tape should be strictly avoided when skin atrophy is severe. Prevention of infections is developed elsewhere.
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Affiliation(s)
- L Sailler
- Service de médecine interne, université de Toulouse, CHU Purpan, pavillon Sénac, 31059 Toulouse cedex 09, France.
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Lamchahab FE, Reffas W, Bouattar T, Abdellaoui EK, Ouzeddoun N, Bayahia R, Aouni A, El Fassi Fihri T, Senouci K, Ait Ourhroui M, Hassam B. [Evaluation of the prescription of long-term systemic steroid-therapy associated measures]. ANNALES PHARMACEUTIQUES FRANÇAISES 2012; 70:292-7. [PMID: 23020920 DOI: 10.1016/j.pharma.2012.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 07/08/2012] [Accepted: 07/14/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To prevent the occurrence of corticosteroid's side effects, adjuvant measures are prescribed in a very different way depending on the practitioner's experience. The aim of this study was to assess the physicians' practices regarding the prescription of long-term corticosteroid therapy. METHODS In May 2010, we realized a cross-sectional study among physicians in Ibn Sina University Hospital in Rabat. With a data collection form, we assessed the principal indications for prescribing steroids and the frequency of prescription of measures sometimes associated with systemic corticosteroid. RESULTS Fifty-nine out of eighty physicians completed the data collection form (response rate: 69.4%). Calcium-vitamin D supplementation was recommended by most of the physicians. Half of them were prescribing biphosphonate therapy. Most of them propose a low-sodium, a low-fat and a low-carbohydrate dietary regimen. Regular physical exercise was recommended by 35% of physicians. Gastric protection was indicating by 54.4% of practicians and potassium supplementation by 42.1% of them. Finally, the recommendation for influenza vaccination, hydrocortisone prescription and Synacthen(®) test, varied between physicians. CONCLUSION The prescription of adjuvant measures with a long-term corticosteroid therapy was very heterogeneous. There is no consensus regarding most of the measures.
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Affiliation(s)
- F E Lamchahab
- Service de dermatologie vénérologie, faculté de médecine et de pharmacie, université Mohamed V, CHU Ibn Sina, Rabat, Maroc.
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Szwebel TA, Le Jeunne C. Risques cardiovasculaires d’une corticothérapie. Presse Med 2012; 41:384-92. [DOI: 10.1016/j.lpm.2012.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 01/04/2012] [Accepted: 01/09/2012] [Indexed: 11/15/2022] Open
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Fardet L, Petersen I, Nazareth I. [Description of oral glucocorticoid prescriptions in general population]. Rev Med Interne 2011; 32:594-9. [PMID: 21420765 DOI: 10.1016/j.revmed.2011.02.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 01/30/2011] [Accepted: 02/12/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE Very little is known about oral glucocorticoids (GCs) prescriptions in general population. METHODS Data of UK adult patients registered between January 1989 and December 2008 with general practices contributing to The Health Improvement Network (THIN) database were analyzed. We identified all patients aged 18 years and older who received at least one oral GCs prescription. Short-term treatments (i.e., <3 months) were differentiated from long term (i.e., ≥3 months) ones. Demographical data of patients being prescribed such treatments and reason for prescriptions over the 20 years were described. The annual prevalence of GCs prescriptions was assessed. RESULTS The study population consisted of 4,518,753 adult patients (26,035,154 person-years of follow-up). Overall, 810,009 oral GCs treatments (220,195,154 person-years of follow-up) were prescribed in 384,897 patients. Over the 20 years, the mean prevalence of oral GCs prescriptions was 0.85% [0.84-0.85], increasing from 0.65% [0.57-0.74] in 1989 to 0.91% [0.90-0.93] in 2008. Short-term therapies (median duration of prescription: 9 days [6-10], median cumulative prednisone equivalent (PE) dosage: 210 mg [150-420]) represented 79.3% of treatments and 11.9% of prevalence whereas it was the opposite for long term prescriptions (median duration of prescription: 215 days [126-490], median cumulative PE dosage: 2000 mg [950-4310]). Women were more prescribed GCs. Median age at first GCs prescription was 56.1 years [39.4-70.4] and 67.4 years [54.0-76.8] for short-term and long-term therapies, respectively. Reasons for prescription were mainly pulmonary diseases. CONCLUSION About 1% of the UK general population receives GCs therapy in any point of time. This prevalence has constantly increased over the last 20 years.
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Affiliation(s)
- L Fardet
- Service de médecine interne, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Goichot B. Peut-on prédire l’insuffisance surrénale secondaire à la corticothérapie ? Rev Med Interne 2010; 31:329-31. [DOI: 10.1016/j.revmed.2010.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 01/26/2010] [Indexed: 10/19/2022]
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Fardet L, Kettaneh A, Gérol J, Tolédano C, Tiev KP, Cabane J. [Short-term effect of dietary-sodium intake on arterial blood pressure of patients treated with systemic corticosteroids: a prospective, randomised, crossover study]. Rev Med Interne 2009; 30:741-6. [PMID: 19361897 DOI: 10.1016/j.revmed.2009.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 02/14/2009] [Accepted: 03/06/2009] [Indexed: 11/16/2022]
Abstract
INTRODUCTION It is unknown if the level of dietary-sodium intake influences blood pressure in patients receiving systemic corticosteroids. METHODS Randomized, single centre, crossover trial involving patients starting systemic corticosteroid therapy and having initial blood pressure less or equals to 159/99 mm Hg. The first period of sodium regimen was randomized (<3 g/j versus >6 g/j) and each period of sodium regimen lasted 3 weeks. No washout period was performed. Blood pressure was recorded for each patient at inclusion and after 3 weeks and 6 weeks. Moreover, all patients were asked to record on a standardized questionnaire everything they ate during 1 week of each period regimen. Questionnaires were analysed by a dietician for mean daily energy and sodium intakes during each period. Mixed models were used to estimate the relationship between sodium intake and blood pressure variations. RESULTS Between June 2006 and June 2008, 49 patients were randomized, 24 in group 1 (first period regimen=salt<3g/day; women: 63%; mean age: 56+/-21 years; baseline prednisone dosage: 54+/-19 mg/day) and 25 in group 2 (first period regimen=salt>6g/day; women: 56%; mean age: 60+/-19 years; baseline prednisone dosage: 56+/-16 mg/day). Mean daily salt intakes were 2.5+/-1.8 and 9.3+/-1.9 g/day during the first period and 7.8+/-3.2 and 3.8+/-2.9 g/day during the second period, respectively for group 1 and group 2. Blood pressure variations were not significantly associated with daily salt intakes or with randomisation group. No order effect was evidenced. By comparison with baseline, systolic blood pressure increased by greater than 20 mm Hg at week 6 in five patients (2 in group 1 and 3 in group 2). CONCLUSION At short-term, sodium intake does not seem to influence blood pressure variations in patients starting systemic corticosteroids therapy.
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Affiliation(s)
- L Fardet
- Service de médecine interne, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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