Prescribing practices changing

Long-term use of hormone-replacement therapy and concurrent use of progestins appear to contribute to breast cancer risk.7 The use of postmenopausal estrogen-replacement therapy in women with a history of breast cancer generally is considered contraindicated. However, most experts believe that the safety and benefits of low-dose oral contraceptives currently outweigh the potential risks and that changes in the prescribing practice for the use of oral contraceptives are not warranted. Oral contraceptives are known to reduce the risk of ovarian cancer by about 40% and the risk of endometrial cancer by about 60%. 

Coveil, N.H., Jackson, C.T., Evans, A.C. Essock, S. M. (2002). Antipsychotic prescribing practices in Connecticut s public mental health system rates of changing medications and prescribing styles. Schizophr. Bull., 28( 1), 17-29. 

It is not often that researchers find their work leading to such widespread changes of behaviour. Still, the 44 per cent figure reveals a split opinion. Most physicians did not intend to alter their prescribing practices. Our analysis has provoked a vociferous and continuing debate on the effectiveness of antidepressants and the circumstances under which they should be prescribed. In this chapter I consider and respond to the various criticisms that have been levelled at our data-based conclusions about the efficacy of antidepressants. 

This chapter reviews and clarifies what is known and not known about the actual prevalence of psychotropic medication prescribing and use. Because much of the current concern has been galvanized by the recent dramatic upswings in prescribing rates, we first review the actual changes in prescribing practices that have taken... 

The Target Difference. Differences in trial outcomes fall into three grades (1) that the doctor will ignore, (2) that will make the doctor wonder what to do (more research needed), and (3) that will make the doctor act, i.e. change prescribing practice. 

A final area of research focuses on how the piU. can best be used by women. Physicians used to recommend pid-free hoHdays, but it is now known that there is no vaUd reason for this practice. Similarly, further research indicated that the U.S. EDA s restrictive guidelines for prescribing the piU. to women over the age of 35 are not justified, and those guidelines have been changed. EinaHy it is clear that cigarette smoking increases the risk of cardiovascular side effects, especially in women over 35 who utilize combination oral contraceptives. 

This series of trials, and many more, has led to the dramatic change in how HRT is currently prescribed and greater understanding of the associated risks. HRT, once thought of as a cure-all for menopausal symptoms, is now a therapy that should be used only to reduce the frequency and severity of vasomotor symptoms associated with menopause in women without risk factors for CHD or breast cancer. The changes that have occurred over the years in the use of HRT further support the importance of evidence-based practice and judicious medication use. 

Osteoarthritis is the most frequent arthritis encountered in medical practice. That is why 5 times more NSAIDs are prescribed for OA than for all other arthritides together. However, this therapeutic situation will change when more knowledge in the pathogenesis of OA is acquired by molecular research. 

First, it is unclear to what extent these changes in medication prescribing patterns reflect good or bad clinical practices, or both. To determine the prevalence of children who might benefit from medication treatments, population-based studies are needed that simultaneously determine the extent of treated and untreated disorder and that also carefully examine... 

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