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Am Fam Physician. 2000;61(4):1107-1108

Combination Therapy Is Effective When Withdrawing Benzodiazepines

(27th Annual Meeting of the North American Primary Care Research Group) Elderly patients with insomnia who underwent cognitive and behavioral therapy during a gradual withdrawal from benzodiazepines had a discontinuation rate twice that of patients who had gradual withdrawal alone. This is the conclusion of a randomized clinical trial of 65 patients (mean age: 67 years) who had been taking benzodiazepines for chronic insomnia every night for at least three months. The combined therapy group (35 patients) received cognitive and behavioral therapy and gradual benzodiazepine withdrawal. The cognitive and behavioral therapy consisted of eight weekly small-group sessions with a psychologist. The withdrawal schedule called for a 25 percent reduction of dosage at each two-week interval. The comparison group (30 patients) received the same benzodiazepine withdrawal schedule alone. Benzodiazepine withdrawal and changes in sleep measures were monitored daily in both groups. Benzodiazepine discontinuation was successful in 76.5 percent of patients in the combined therapy group, compared with 37.9 percent in the comparison group, and this difference was maintained at three- and 12-month follow-ups. The authors note that long-term use of benzodiazepines is not recommended in the elderly because of the association with impaired memory, increased risk of fractures due to falls and increased risk of motor vehicle crashes.—lucie baillargeon, m.d., m.s.c., et al., Centre Universitaire de Quebec, Quebec City, Canada.

Side Effects from NSAID Use Are Often Self-Managed by Older Patients

(North American Primary Care Research Group) Results of a cross-sectional survey of primary care physicians and a longitudinal study of their patients indicate that the majority of older patients receiving nonsteroidal anti-inflammatory drugs (NSAIDs) manage the side effects themselves, causing many primary care physicians to underestimate the risk of morbidity related to gastrointestinal toxicity among this population. The 66 physicians who were surveyed had referred patients to the study. The 500 patients included in the study were at least 50 years of age and were currently receiving NSAIDs or were prescribed NSAIDs at the time of the baseline survey. Patients completed a baseline survey and two follow-up surveys. Data from the first 50 patients showed 35 percent reported having gastrointestinal side effects from the use of NSAIDs. Nearly all of these patients managed these side effects independent of their physician by taking the dosage with food, reducing the amount of the dosage or using over-the-counter medications. The physicians estimated that the patients to whom they prescribed NSAIDs experienced gastrointestinal side effects only “occasionally” (5 to 15 percent of the time).—christopher v. chambers, m.d., et al., Jefferson Medical College, Philadelphia, Pa.

Frequency of Obtaining Family History Varies in Family Practice

(North American Primary Care Research Group) The rate of taking family medical history information during office visits in community family practices is low, but it is also highly variable from physician to physician, according to a study of 4,454 consecutive patient visits in the offices of 138 family physicians in Ohio. Results showed that family history was discussed in 51 percent of office visits involving a new patient and 22 percent of visits involving an established patient. Visits involving family histories were more likely to be for well care than for acute or chronic illnesses, and tended to be longer in duration. Family physicians varied in how frequently they obtained family histories, from zero to 81 percent of office visits. Patients were more likely to discuss their family history if they were in good health, younger or middle-aged, married women. Physicians were more likely to obtain a family history if they were younger and residency-trained. The investigators encourage the use of family histories as a clinical tool for the assessment of genetic and familial health risks.—louise s. acheson, m.d., et al., Case Western Reserve University, Cleveland, Ohio.

Study Shows That Patients Need Education About Antibiotic Usage

(North American Primary Care Research Group) Because most patients do not know how antibiotics work, they often disagree with their physician over whether or not an antibiotic should be prescribed for their current condition. This is the conclusion of a study conducted in 20 family practices in New England. Of the 1,507 consecutive adult patients seen, 1,326 completed a self-administered survey with eight questions. Results showed that 52 percent of patients did not know how antibiotics worked, and 61 percent were unable to define antibiotic resistance. Although most patients knew which diseases antibiotics were indicated for individually, only 28 percent correctly identified all diseases. Twenty percent of patients did not receive antibiotics but felt they were needed, and 5 percent of patients were able to persuade their physician to prescribe antibiotics even though the physician felt an antibiotic was not indicated. The investigators recommend interventions to educate the patient about antibiotics and the diagnostic reasoning behind the physician's decision not to prescribe antibiotics.—donya a. powers, m.d., et al, Partners in Family Health Care, East Providence, R.I.

Certain Foods Can Provoke Asthma Symptoms in Adult Patients

(North American Primary Care Research Group) Eliminating certain foods shown to provoke asthma can lead to improved lung function and a subsequent decrease in needed medication, according to a study of 90 adult patients with asthma. During a six-week period, one half of the patients were placed on an elimination and rotation diet, while the control group continued their normal diet, medication and lifestyle. Lung functions were determined before and after a six-week period. Symptoms improved immediately in the trial group, and, consequently, medication was reduced starting with the bronchodilator and then gradually cortisone medication was reduced. Despite receiving no medication, the majority of the patients in the trial group showed improvement (15.33 percent mean improvement of their predicted one-second forced expiratory volume values), while patients in the control group saw little improvement (3.06 percent) and still needed their medication. Analysis showed that 70 percent of the asthma was provoked by foods alone, 20 percent by foods and an inhalant, and only 10 percent by an inhalant alone. Foods that provoked asthma symptoms included the following: milk products; grains and fruits such as banana, avocado and citrus; and vegetables, such as potato and tomato. The investigators recommend that physicians who manage asthma pay special attention to the identification and avoidance of foods and other factors that provoke asthma in adults.—gus borok, b.s.c., et al., Gadenkloof, Pretoria, South Africa.

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