* Chronic constipation is common in elderly people in long stay hospital and nursing home care and regular laxative treatment is often required * There are few comparative clinical studies of commonly used laxatives * In this study a senna-fibre combination was more effective than lactulose in long stay elderly patients with constipation * Both treatments were well tolerated * The superior efficacy of the senna-fibre combination, without increase in side effects, resulted in considerable cost benefit compared with lactulose.combination the incidence of adverse effects was no different, both compounds being well tolerated.The issue of cost effectiveness was addressed in this study. A higher daily dose was needed for an effect with lactulose. There were significant cost savings with the senna-fibre combination over the study period. Extrapolation ofthese data to the large numbers of long stay elderly people in nursing homes and hospitals who require regular laxatives could result in considerable cost savings. These results would seem to concur with statements on the relative expense and efficacy of lactulose.' 4 12In conclusion, both the senna-fibre combination and lactulose were effective, well tolerated treatments for chronic constipation in long stay elderly patients. Under the study conditions the senna-fibre combination was more effective than lactulose and was a less expensive regimen, a significant advantage in times of clinical and financial audit. We thank the medical, nursing, and pharmacy staff in the participating units for their assistance with this study and Galen Limited and Madaus AG for their contribution towards the study. This means that such patients may tend to run out of medication, which could be related to the excess mortality from asthma. We investigated whether asthmatic patients were able to reliably assess the amount of medication remaining in a metered dose inhaler and whether they ever ran out ofmedication. Subjects, methods, and resultsFrom details of repeat prescriptions we identified all asthmatic patients attending a general practice who were aged [13][14][15][16][17][18][19][20][21][22] and used a metered dose inhaler. We notified the patients to come to the surgery with the inhalers they were currently using and any held in reserve. We asked the patients about their use of inhalers and assessed the inhalers by weight.2 When an inhaler's canister floats (at its floating weight) it has delivered its licensed number of doses.2 Although expellant may be obtained from an inhaler beyond its licensed number of doses (36 extra puffs on average for a Ventolin inhaler), there are no published data on the drug content of each puff. As 48 hours is generally required to get a repeat prescription from a general practice, a canister's red weight is when it contains enough expellant for 48 hours' use. 03 Agonists in metered dose inhalers are usually prescribed at two puffs four times daily. The red weight is thus the empty weight (when no further expellant can be obtained) plus the weight of ei...
EDrrOR,-Some of the issues raised by Bonneux and Barendregt have already been addressed in the discussion section of our paper. There is a fundamental misapprehension contained in Bonneux and Barendregt's second paragraph. Their argument is valid only if this department is assumed to have been responsible for all the cases of gastric cancer from a defined population. Since this was not the case, and referral patterns doubtless
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