ORCID Profile
0000-0003-2934-2242
Current Organisations
University of New South Wales School of Public Health and Community Medicine
,
University of Toronto
,
University of Melbourne
,
Bond University
,
Institute for Clinical Evaluative Sciences
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Related Links
Publications
COX-2, NSAIDs, and cardiovascular risk
Publisher: Springer Science and Business Media LLC
Date: 23-08-2007
Adverse reactions to frusemide in hospital inpatients
Publisher: BMJ
Date: 11-08-1979
Abstract: Out of 2580 medical inpatients included in a drug-surveillance programme, 585 (22.7%) were treated with frusemide. Of these, 123 (21.0%) had a total of 177 adverse reactions. The most common were hypovolaemia (85 cases), hyperuricaemia (54), and hypokalaemia (21). Most reactions were mild, and only three patients had potentially life-threatening effects. The incidence of adverse reactions increased significantly with daily dose, occurring in 47 patients (13.5%) given up to 40 mg, 42 (26.3%) given up to 80 mg, and 34 (43.6%) given over 80 mg (P less than 0.001). There was no clear association between side effects and a raised blood urea concentration on admission, confirming that treatment with frusemide is not more hazardous in patients with renal failure. Frusemide is a safe and highly effective diuretic. Nevertheless, in view of the potential seriousness of volume depletion, dosage should probably begin at 20 rather than 40 mg daily.
Desmopressin zur Minimierung von perioperativen allogenen Bluttransfusionen
Publisher: Hogrefe Publishing Group
Date: 09-2002
Pharmacoepidemiology as a focus for clinical epidemiology in developing countries
Publisher: Elsevier BV
Date: 1991
DOI: 10.1016/0895-4356(91)90120-X
Abstract: We present a concept of pharmacoepidemiology as a branch of clinical epidemiology having particular relevance to public health in developing countries. Planning to incorporate pharmacoepidemiology into the clinical epidemiology curriculum of the International Clinical Epidemiology Network (INCLEN) is discussed and an outline of training programs in pharmacoepidemiology at INCLEN universities is given.
Trial of streptokinase in ischaemic stroke [16]
Publisher: Elsevier BV
Date: 04-1995
DOI: 10.1016/S0140-6736(95)90794-7
Abstract: In this study, we evaluated the therapeutic efficacy and toxicity profile of chemotherapy combinations containing pemetrexed for patients with metastatic colorectal cancer. We investigated the optimal chemotherapy treatment regimen to provide a new option for third-line or after treatment of patients with advanced colorectal cancer. A total of 88 eligible patients with metastatic colorectal cancer were included in this study from April 2009 to March 2019 at the Department of Oncology, the First Affiliated Hospital of Nanjing Medical University. The baseline information and treatment outcomes of the patients were collected. Statistical analyses of different chemotherapy regimens focusing on objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and toxicity were conducted. The superior treatment regimen was determined, and its clinical outcomes were compared with those of the other treatment combinations to explore the factors that potentially contributed to the curative effect. The 88 patients in this study received 18 treatment regimens. In total, 53 patients had progressive disease (PD), 34 patients had stable disease (SD), 1 patient was assessed as complete response (CR), and no patients had a partial response (PR). The optimal regimen was pemetrexed + S-1 + bevacizumab. The 21 patients treated with this regimen exhibited a higher DCR [61.90% The combination of pemetrexed + S-1 + bevacizumab was found to be the optimal treatment regimen. This combination was superior to the other treatment regimens in terms of DCR and PFS with controllable toxicity. These results warrant further prospective exploratory clinical trials for pemetrexed-based chemotherapy in metastatic colorectal cancer.
The affordability of prescription medicines in Australia: are copayments and safety net thresholds too high?
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH11153
Abstract: Objective. To create and report survey-based indicators of the affordability of prescription medicines for patients in Australia. Method. A cross-sectional study of 1502 randomly selected participants in the Hunter Region of NSW, were interviewed by telephone. Main outcome measure. The self-reported financial burden of obtaining prescription medicines. Results. Data collection was completed with a response rate of 59.0%. Participants who had received and filled at least one prescription medicine in the previous 3 months, and eligible for analysis (n=952), were asked to self-report the level of financial burden from obtaining these medicines. Extreme and heavy financial burdens were reported by 2.1% and 6.8% of participants, respectively. A moderate level of burden was experienced by a further 19.5%. Low burden was recorded for participants who said that their prescription medicines presented either a slight burden (29.0%) or were no burden at all (42.6%). Conclusion. A substantial minority of participants who had obtained prescription medicines in the 3 months prior to survey experienced a level of financial burden from the cost of these medicines that was reported as being moderate to extreme. What is known about the topic? The Australian National Medicines Policy aims to, amongst other things, facilitate access to medicines at a cost that is affordable to in iduals and the community. Copayments combined with the safety net and brand price premium are the main determinants of the amount that patients pay for PBS listed prescription medicines. Previous surveys have reported on selected aspects of medicine affordability in Australia and have shown some groups in the population experience difficulty with the cost of their medicines. What does this paper add? This paper develops and reports on a set of indicators that can be used to periodically measure the level of self-reported financial burden experienced by Australians when obtaining prescription medicines. The analysis assesses affordability issues for both general patients and patients who are able to access prescription medicines using a concession card. What are the implications? Our research suggests that, as they stand, the copayment and safety net thresholds are not protecting nearly one-third of Australian patients from financial burden. Ongoing monitoring and evaluation is required to ensure the copayment and safety net thresholds do not jeopardise the National Medicines Policy’s principle of equitable and affordable access to medicines.
Walking the Path Together: Indigenous Health Data at ICES
Publisher: Longwoods Publishing
Date: 20-01-2018
Abstract: Indigenous data governance principles assert that Indigenous communities have a right to data that identifies their people or communities, and a right to determine the use of that data in ways that support Indigenous health and self-determination. Indigenous-driven use of the databases held at the Institute for Clinical Evaluative Sciences (ICES) has resulted in ongoing partnerships between ICES and erse Indigenous organizations and communities. To respond to this emerging and complex landscape, ICES has established a team whose goal is to support the infrastructure for responding to community-initiated research priorities. ICES works closely with Indigenous partners to develop unique data governance agreements and supports processes, which ensure that ICES scientists must work with Indigenous organizations when conducting research that involves Indigenous peoples.
DEFECTIVE ABSORPTION OF INJECTED INSULIN
Publisher: Elsevier BV
Date: 09-1978
Association Between Incretin-Based Drugs and the Risk of Acute Pancreatitis
Publisher: American Medical Association (AMA)
Date: 05-2012
DOI: 10.1001/JAMAINTERNMED.2016.1522
Abstract: The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. To determine whether the use of incretin-based drugs, compared with the use of 2 or more other oral antidiabetic drugs, is associated with an increased risk of acute pancreatitis. A large, international, multicenter, population-based cohort study was conducted using combined health records from 7 participating sites in Canada, the United States, and the United Kingdom. An overall cohort of 1 532 513 patients with type 2 diabetes initiating the use of antidiabetic drugs between January 1, 2007, and June 30, 2013, was included, with follow-up until June 30, 2014. Current use of incretin-based drugs compared with current use of at least 2 oral antidiabetic drugs. Nested case-control analyses were conducted including hospitalized patients with acute pancreatitis matched with up to 20 controls on sex, age, cohort entry date, duration of treated diabetes, and follow-up duration. Hazard ratios (HRs) and 95% CIs for hospitalized acute pancreatitis were estimated and compared current use of incretin-based drugs with current use of 2 or more oral antidiabetic drugs. Secondary analyses were performed to assess whether the risk varied by class of drug (DPP-4 inhibitors and GLP-1 agonists) or by duration of use. Site-specific HRs were pooled using random-effects models. Of 1 532 513 patients included in the analysis, 781 567 (51.0%) were male mean age was 56.6 years. During 3 464 659 person-years of follow-up, 5165 patients were hospitalized for acute pancreatitis (incidence rate, 1.49 per 1000 person-years). Compared with current use of 2 or more oral antidiabetic drugs, current use of incretin-based drugs was not associated with an increased risk of acute pancreatitis (pooled adjusted HR, 1.03 95% CI, 0.87-1.22). Similarly, the risk did not vary by drug class (DPP-4 inhibitors: pooled adjusted HR, 1.09 95% CI, 0.86-1.22 GLP-1 agonists: pooled adjusted HR, 1.04 95% CI, 0.81-1.35) and there was no evidence of a duration-response association. In this large population-based study, use of incretin-based drugs was not associated with an increased risk of acute pancreatitis compared with other oral antidiabetic drugs.
ARGON LASER PHOTOCOAGULATION IN BLEEDING PEPTIC ULCERS
Publisher: Elsevier BV
Date: 1982
Ties that bind: Multiple relationships between clinical researchers and the pharmaceutical industry
Publisher: American Medical Association (AMA)
Date: 28-11-2005
DOI: 10.1001/ARCHINTE.165.21.2493
Abstract: It is believed that pharmaceutical industry sponsorship of clinical research leads to the development of multiple ties between clinicians and the pharmaceutical industry. To quantify this relationship we conducted a survey of medical specialists listed in the Medical Directory of Australia in 2002 and 2003. A questionnaire was mailed that elicited information about all aspects of research relationships between clinicians and pharmaceutical companies. The odds of reporting multiple additional ties (financial and professional) with pharmaceutical companies by clinicians who had an active research relationship were compared with those who did not. All clinicians who returned a completed questionnaire about their research activities were included in the study. A questionnaire was mailed to 2120 medical specialists 823 (39%) responded. Of these, 338 (41%) reported involvement in industry-sponsored research in the previous year. They were more likely than others to have been offered industry-sponsored items or activities valued at more than 500 AU dollars (>382 US dollars odds ratio [OR], 3.5 95% confidence interval [CI], 2.6-4.7) and support for attending international conferences (OR, 5.4 95% CI, 3.9-7.4). The strongest associations were seen for acting as a paid consultant to industry (OR, 9.0 95% CI, 3.9-20.4) and for membership on advisory boards (OR, 6.9 95% CI, 5.1-9.6). There was a strong relationship between research collaboration and accumulation of industry ties. For 1 additional tie the OR was 2.2 (95% CI, 1.2-3.8) and rose to 6.3 (95% CI, 3.5-11.1) with 3 ties and 41.8 (95% CI, 14.5-143.4) with 6 or more ties. Medical specialists who have research relationships with the pharmaceutical industry are much more likely to have multiple additional ties than those who do not have research relationships. Institutional review should discourage clinical researchers from developing multiple ties.
Peptic ulcer and piroxicam
Publisher: BMJ
Date: 06-1985
The benefits of reducing cholesterol levels - the need to distinguish primary from secondary prevention: 1. A meta-analysis of cholesterol-lowering trials
Publisher: AMPCo
Date: 11-1991
'Pharmaceutical security': A new research agenda?
Publisher: AMPCo
Date: 09-1998
Indomethacin and perforated duodenal ulcer
Publisher: BMJ
Date: 19-04-1980
Changes in the dispensing of opioid medications in Canada following the introduction of a tamper-deterrent formulation of long-acting oxycodone: a time series analysis
Publisher: CMA Joule Inc.
Date: 22-11-2017
Sex ratios at birth after induced abortion
Publisher: CMA Joule Inc.
Date: 11-04-2016
DOI: 10.1503/CMAJ.151074
The pharmaceutical industry and disease mongering
Publisher: BMJ
Date: 27-07-2002
PERFORATED PEPTIC ULCER IN THE HUNTER REGION: A REVIEW OF 174 CASES
Publisher: Wiley
Date: 05-1992
DOI: 10.1111/J.1445-2197.1992.TB07200.X
Abstract: A review of 174 consecutive patients admitted with a diagnosis of perforated peptic ulcer to eight Hunter Region hospitals during 1979-86 is presented. Among the female admissions, the proportion of patients greater than 70 years of age was twice that in males. One-third of all perforations were in females who accounted for two-thirds of all perforated gastric ulcers. Multivariate analysis revealed that perforations located in the stomach and older age were both significant independent variables adversely affecting outcome following surgery. In contrast, shock at presentation and delay in operating were not statistically significant independent risk factors.
The pharmaceutical industry as a medicines provider
Publisher: Elsevier BV
Date: 11-2002
Autologous transfusion techniques: a systematic review of their efficacy
Publisher: Wiley
Date: 04-2004
Trends and uptake of new formulations of controlled‐release oxycodone in Canada
Publisher: Wiley
Date: 23-01-2018
DOI: 10.1002/PDS.4390
Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion
Publisher: John Wiley & Sons, Ltd
Date: 06-10-2010
Cholestatic hepatitis associated with flucloxacillin
Publisher: AMPCo
Date: 04-1993
DOI: 10.5694/J.1326-5377.1993.TB137624.X
Abstract: To estimate the frequency of cholestatic hepatitis of uncertain origin occurring among persons who had recently received flucloxacillin, a drug which has recently been reported as causing cholestatic hepatitis, and to compare this frequency with that related to oxytetracycline, a drug which has seldom been reported as causing this disorder. A retrospective cohort study using data automatically recorded on general practitioners' office computers. Some 600 general practices in the United Kingdom. 132,087 people who received flucloxacillin and 145,844 people who received oxytetracycline. Clinically documented cholestatic hepatitis of uncertain origin diagnosed 1-45 days after a prescription for flucloxacillin, 46-90 days after a prescription for flucloxacillin and, for comparison, 1-45 days after a prescription for oxytetracycline. There were 10 cases of cholestatic hepatitis of uncertain origin diagnosed within 45 days of receiving flucloxacillin that were either characteristic of or consistent with a syndrome recently described as being associated with this drug there was one such case 46-90 days after a prescription for flucloxacillin there were three such cases 1-45 days after a prescription for oxytetracycline. Flucloxacillin is a likely cause of cholestatic hepatitis. The risk is estimated to be in the range of 7.6 per 100,000 users (95% confidence interval, 3.6-13.9).
Preventing overdiagnosis: how to stop harming the healthy
Publisher: BMJ
Date: 28-05-2012
DOI: 10.1136/BMJ.E3502
Effects of prior use of non-steroidal anti-inflammatory drugs on renal function and transfusion requirements after upper gastrointestinal haemorrhage
Publisher: Springer Science and Business Media LLC
Date: 10-1992
DOI: 10.1007/BF02220606
Systematic review of the use of fibrin sealant to minimize perioperative allogeneic blood transfusion
Publisher: Oxford University Press (OUP)
Date: 06-2002
DOI: 10.1046/J.1365-2168.2002.02098.X
Abstract: Fibrin sealants have become popular in improving perioperative haemostasis and reducing the need for allogeneic red cell transfusion. A systematic review of randomized controlled trials was conducted to examine the efficacy of fibrin sealants in reducing perioperative blood loss and allogeneic red blood cell transfusion. Studies were identified by computer searches of Medline, Embase, Current Contents, the Cochrane Library, manufacturer websites (to January 2001), and bibliographic searches of published articles. Trials were eligible for inclusion if they involved adult elective surgery and reported quantitative data on blood loss, the proportion of patients exposed to allogeneic red cell transfusion and/or the volume of blood transfused. Twelve trials met the criteria for inclusion. Fibrin sealants reduced the rate of allogeneic blood transfusion (relative risk 0·40 (95 per cent confidence interval (c.i.) 0·26 to 0·61) five trials with 275 subjects) and reduced blood loss (weighted mean difference −151·68 (95 per cent c.i. −251·91 to −51·46) ml seven trials with 391 subjects). Generally, the trials were small and of poor methodological quality. Overall the results suggest that fibrin sealants are efficacious. Owing to lack of blinding, transfusion practices may have been influenced by knowledge of the patient's treatment status. This raises concern about blood transfusion practice as a response variable. Large methodologically rigorous trials of fibrin sealants with clinical outcomes are needed.
Prophylaxis against NSAID-induced ulcers
Publisher: AMPCo
Date: 12-1992
The Australian Guidelines for Subsidisation of Pharmaceuticals
Publisher: Springer Science and Business Media LLC
Date: 11-1992
The [14C]‐aminopyrine breath test. A comparison of different forms of analysis.
Publisher: Wiley
Date: 12-1979
DOI: 10.1111/J.1365-2125.1979.TB01041.X
Abstract: 1 Following ingestion of [14C]-aminopyrine, breath 14CO2 data were analysed from normal in iduals, patients with hepatic disease, epileptics receiving anticonvulsant therapy and volunteers before and after treatment with glutethimide. 2 The 'standard' 2 h [14C]-aminopyrine breath test discriminated successfully between the main groups but failed to detect the change in microsomal enzyme function produced by glutethimide. 3 A 'modified' form of the 2 h breath test calculated from the area under the breath specific activity curve detected the increase in demethylation following glutethimide. 4 The breath elimination constant (Kb) derived from the breath 14CO2 disappearance curve was as sensitive as the 'modified' 2 h breath test and was simpler to compute. 5 Glutethimide 500 mg/day for 14 days resulted in a 42% increase in the metabolic clearance of antipyrine and a 26% increase in demethylation of [14C]-aminopyrine.
National Medicinal Drug Policies: Their Relationship to Pharmacoepidemiology
Publisher: Wiley
Date: 07-03-2006
Acetylator phenotype in spontaneous SLE and rheumatoid arthritis
Publisher: BMJ
Date: 04-1979
DOI: 10.1136/ARD.38.2.171
Abstract: Acetylator phenotype was determined in 22 patients with spontaneous systemic lupus erythematosus and the proportion of 'slow' acetylators compared with that obtained in a group of patients with rheumatoid arthritis and a group of healthy controls. 73% of the SLE group were designated 'slow' compared with 72% of the rheumatoid group and 64% of the control group. These differences were not significant.
Selective COX-2 Inhibitors: A Promise Unfulfilled?
Publisher: Elsevier BV
Date: 02-2007
Stability of norepinephrine in blood
Publisher: Oxford University Press (OUP)
Date: 04-1985
Narrowing mortality gap between men and women over two decades: a registry-based study in Ontario, Canada
Publisher: BMJ
Date: 11-2016
Systematic review and meta-analysis of the use of fibrin sealant to prevent seroma formation after breast cancer surgery
Publisher: Oxford University Press (OUP)
Date: 14-06-2006
DOI: 10.1002/BJS.5432
Abstract: The use of fibrin sealant has been proposed as a means of preventing seroma formation following breast cancer surgery. Conflicting trial results require the efficacy of fibrin sealant to be reviewed critically. A systematic review of randomized controlled trials was conducted to examine the efficacy of fibrin sealants in reducing postoperative drainage and seroma formation after breast cancer surgery. Studies were identified by computer searches of Medline, Embase, the Cochrane Central Register of Controlled Trials and manufacturer websites (to June 2005), and bibliographic searches of published articles. Trials were eligible for inclusion if they reported data on postoperative drainage and the number of patients who developed a seroma. Eleven trials met the criteria for inclusion. Generally, the trials were small and of poor methodological quality. Fibrin sealant did not reduce the rate of postoperative seroma (relative risk 1·14, 95 per cent confidence interval (c.i.) 0·88 to 1·46), the volume of drainage (weighted mean difference − 117·7, 95 per cent c.i. − 259·2 to 23·8 ml), or the length of hospital stay (weighted mean difference − 0·38, 95 per cent c.i. − 1·58 to 0·83 days). The current evidence does not support the use of fibrin sealant in breast cancer surgery to reduce postoperative drainage or seroma formation.
Lesson From Canada’s Universal Care: Socially Disadvantaged Patients Use More Health Services, Still Have Poorer Health
Publisher: Health Affairs (Project Hope)
Date: 02-2011
DOI: 10.1377/HLTHAFF.2009.0669
Abstract: Lower socioeconomic status is commonly related to worse health. If poor access to health care were the only explanation, universal access to care should eliminate the association. We studied 14,800 patients with access to Canada's universal health care system who were initially free of cardiac disease, tracking them for at least ten years and seven months. We found that socially disadvantaged patients used health care services more than did their counterparts with higher incomes and education. We also found that service use by people with lower incomes and less education had little impact on their poorer health outcomes, particularly mortality. Countries contemplating national health insurance cannot rely on universal health care to eliminate historical disparities in outcomes suffered by disadvantaged groups. Universal access can only reduce these disparities. Our findings suggest the need to introduce large-scale preventive strategies early in patients' lives to help change unhealthy behavior.
Mandatory Disclosure of Pharmaceutical Industry-Funded Events for Health Professionals
Publisher: Public Library of Science (PLoS)
Date: 03-11-2009
Accumulation Of Chronic Conditions At The Time Of Death Increased In Ontario From 1994 To 2013
Publisher: Health Affairs (Project Hope)
Date: 03-2018
DOI: 10.1377/HLTHAFF.2017.1150
Abstract: With falling mortality rates for several diseases, patients are living longer with complex multimorbidities. We explored the burden of multimorbidity at the time of death, how it varies by socioeconomic status, and trends over time in Ontario, Canada. We calculated the proportions of decedents with varying degrees of multimorbidity and types of conditions at death, and we analyzed the trend from 1994 to 2013 in the number of conditions at the time of death. The prevalence of multimorbidity at death increased from 79.6 percent in 1994 to 95.3 percent in 2013. An upward trend in the number of conditions per person at death was observed for all chronic conditions except chronic coronary syndrome, congestive heart failure, and stroke. Chronic respiratory diseases and diabetes were disproportionately represented in low-income and deprived neighborhoods. The trend toward greater multimorbidity burden over time and the existence of steep socioeconomic gradients underscore the importance of integrated health care planning for preventing and managing multiple complex conditions.
Describing Treatment Effects to Patients: How They Are Expressed Makes a Difference
Publisher: Springer Science and Business Media LLC
Date: 11-2003
DOI: 10.1046/J.1525-1497.2003.20928.X
Abstract: To examine the impact of different presentations of equivalent information (framing) on treatment decisions faced by patients. A systematic review of the published literature was conducted. English language publications allocating participants to different frames were retrieved using electronic and bibliographic searches. Two reviewers examined each article for inclusion, and assessed methodological quality. Study characteristics were tabulated and where possible, relative risks (RR 95% confidence intervals) were calculated to estimate intervention effects. Thirty-seven articles, yielding 40 experimental studies, were included. Studies examined treatment (N = 24), immunization (N = 5), or health behavior scenarios (N = 11). Overall, active treatments were preferred when outcomes were described in terms of relative rather than absolute risk reductions or number needed to treat. Surgery was preferred to other treatments when treatment efficacy was presented in a positive frame (survival) rather than a negative frame (mortality) (relative risk [RR] = 1.51, 95% confidence interval [CI], 1.39 to 1.64). Framing effects were less obvious for immunization and health behavior scenarios. Those with little interest in the behavior at baseline were influenced by framing, particularly when information was presented as gains. In studies judged to be of good methodological quality and/or examining actual decisions, the framing effect, although still evident, was less convincing compared to the results of all included studies. Framing effects varied with the type of scenario, responder characteristics, scenario manipulations, and study quality. When describing treatment effects to patients, expressing the information in more than one way may present a balanced view to patients and enable them to make informed decisions.
Protocol for a scoping review of post-trial extensions of randomised controlled trials using individually linked administrative and registry data
Publisher: BMJ
Date: 02-2017
Fibrin sealant use for minimising peri-operative allogeneic blood transfusion
Publisher: Wiley
Date: 20-01-2003
The impact of WHO essential medicines policies on inappropriate use of antibiotics
Publisher: Public Library of Science (PLoS)
Date: 22-03-2016
Cell salvage for minimising perioperative allogeneic blood transfusion
Publisher: John Wiley & Sons, Ltd
Date: 14-04-2010
Erratum To: The health services burden of heart failure: an analysis using linked population health data-sets
Publisher: Springer Science and Business Media LLC
Date: 17-05-2013
Platelet-rich-plasmapheresis for minimising peri-operative allogeneic blood transfusion
Publisher: John Wiley & Sons, Ltd
Date: 20-01-2003
Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: Results of a collaborative meta-analysis
Publisher: BMJ
Date: 22-06-1996
DOI: 10.1136/BMJ.312.7046.1563
Abstract: To compare the relative risks of serious gastrointestinal complications reported with in idual non-steroidal anti-inflammatory drugs. Systematic review of controlled epidemiological studies that found a relation between use of the drugs and admission to hospital for haemorrhage or perforation. Hospital and community based case-control and cohort studies. (a) Estimated relative risks of gastrointestinal complications with use of in idual drugs, exposure to ibuprofen being used as reference (b) a ranking that best summarised the sequence of relative risks observed in the studies. 12 studies met the inclusion criteria. 11 provided comparative data on ibuprofen and other drugs. Ibuprofen ranked lowest or equal lowest for risk in 10 of the 11 studies. Pooled relative risks calculated with exposure to ibuprofen used as reference were all significantly greater than 1.0 (interval of point estimates 1.6 to 9.2). Overall, ibuprofen was associated with the lowest relative risk, followed by diclofenac. Azapropazone, tolmetin, ketoprofen, and piroxicam ranked highest for risk and indomethacin, naproxen, sulindac, and aspirin occupied intermediate positions. Higher doses of ibuprofen were associated with relative risks similar to those with naproxen and indomethacin. The low risk of serious gastrointestinal complications with ibuprofen seems to be attributable mainly to the low doses of the drug used in clinical practice. In higher doses ibuprofen is associated with a similar risk to other non-steroidal anti-inflammatory drugs. Use of low risk drugs in low dosage as first line treatment would substantially reduce the morbidity and mortality due to serious gastrointestinal toxicity from these drugs.
Adverse reactions to N-acetylcysteine during treatment for paracetamol poisoning
Publisher: AMPCo
Date: 03-1989
DOI: 10.5694/J.1326-5377.1989.TB136496.X
Abstract: By using skinned-rabbit skeletal muscle fibers, the time courses of changes of thin filament-based x-ray reflections were followed at a 3.4-ms time resolution during thin-filament activation. To discriminate between the effects of calcium binding and myosin binding on thin-filament activity, measurements were performed after caged-calcium photolysis in fibers with full-filament or no-filament overlap, or during force recovery after a quick release. All three reflections examined, i.e., the second actin layer line (second ALL, reporting the tropomyosin movement), the sixth ALL (reporting actin structural change), and the meridional troponin reflections, exhibited calcium-induced and myosin-induced components, but their rate constants and polarities were different. Generally, calcium-induced components exhibited fast rate constants (>100 s(-1)). The myosin-induced components of the second ALL had a rate constant similar to that of the force (7-10 s(-1)), but that of the sixth ALL was apparently faster. The myosin-induced component of troponin reflection was the only one with negative polarity, and was too slow to be analyzed with this protocol. The results suggest that the three regulation-related proteins change their structures with different rate constants, and the significance of these findings is discussed in the context of a cooperative thin-filament activation mechanism.
The Canadian Network for Observational Drug Effect Studies (CNODES): Reflections on the first eight years, and a look to the future.
Publisher: Wiley
Date: 08-12-2020
DOI: 10.1002/PDS.4936
Pfizer Diflucan Partnership Program
Publisher: Elsevier BV
Date: 2003
Drugs as a cause of gastrointestinal disease
Publisher: Elsevier BV
Date: 06-1994
DOI: 10.1016/0950-3528(94)90005-1
Abstract: Free flaps in combination with arterial reconstruction by means of arteriovenous loops or bypass have, meanwhile, been established as a therapeutic option in defect reconstruction for areas without recipient vessels. Our aim was to analyse the long-term performance, flap autonomy, and the flap perfusion. Patients receiving this combined reconstruction at a single-centre institution were included. During follow-up examination, the patency of arterial reconstruction was investigated by duplex ultrasound. Flap micro-circulation was assessed by laser Doppler flowmetry and white light tissue spectrometry (O2C) as well as by indocyanine green fluorescence angiography. Twenty-three patients could be clinically followed up. Duplex ultrasound showed, in four cases, arterial pedicle occlusion in spite of vital flap. Comparison of the O2C perfusion parameters between flaps with occluded pedicles and those with intact inflow showed no significant difference (parameters sO2: P = .82 Flow: P = .31). Similar results were obtained by fluorescence angiography no significant difference could be detected between both groups (parameters Ingress P = .13 Ingressrate P = .54). Combined vascular reconstruction with free tissue transfer is associated with a good long-term outcome and wound closure. Even after flap transplantation to areas with critical tissue perfusion, the flap can develop autonomy and thus survive after pedicle occlusion.
What Drives Health-Care Spending Priorities? An International Survey of Health-Care Professionals
Publisher: Public Library of Science (PLoS)
Date: 20-02-2007
Grading quality of evidence and strength of recommendations.
Publisher: BMJ
Date: 17-06-2004
How do trainee doctors learn about research? Content analysis of Australian specialist colleges’ intended research curricula.
Publisher: Center for Open Science
Date: 12-10-2019
Abstract: Objectives:Patients do better in research-intense environments. The importance of research is reflected in the accreditation requirements of Australian clinical specialist colleges. The nature of college-mandated research training has not been systematically explored. We examined the intended research curricula of Australian trainee doctors described by specialist colleges, their constructive alignment, and the nature of scholarly project requirements.Design:We undertook content analysis of publicly available documents to characterise college research training curricula. Setting: We reviewed all publicly accessible information from the websites of Australian specialist colleges and their subspecialty isions. We retrieved curricula, handbooks, and assessment-related documents.Participants: Fifty-eight Australian specialist colleges and their subspecialty isions.Primary and secondary outcome measures: Two reviewers extracted and coded research-related activities as learning outcomes, activities, or assessments, by research stage (using, participating in or leading research) and competency based on Bloom’s Taxonomy (remembering, understanding, applying, analysing, evaluating, creating). We coded learning and assessment activities by type (e.g. formal research training, publication) and whether it was linked to a scholarly project. Requirements related to project supervisors’ research experience were noted.Results: Fifty-five of 58 Australian college subspecialty isions had a scholarly project requirement. Only 11 required formal research training two required an experienced research supervisor. Colleges emphasised a role for trainees in leading research in their learning outcomes and assessments, but not learning activities. Less emphasis was placed on using research, and almost no emphasis on participation. Most learning activities and assessments mapped to the ‘creating’ domain of Bloom’s Taxonomy, whereas most learning outcomes mapped to the ‘evaluating’ domain. Overall, most research learning and assessment activities were related to leading a scholarly project.Conclusions: Australian specialist college curricula appear to emphasise a role for trainees in leading research and producing research deliverables, but do not mandate formal research training and supervision by experienced researchers.
Achieving the World Health Organization's vision for clinical pharmacology
Publisher: Wiley
Date: 23-11-2015
DOI: 10.1111/BCP.12803
Consumption of NSAIDs and the development of congestive heart failure in elderly patients: An underrecognized public health problem
Publisher: American Medical Association (AMA)
Date: 27-03-2002
DOI: 10.1001/ARCHINTE.160.6.777
Abstract: Experimental studies have shown that administration of nonsteroidal anti-inflammatory drugs (NSAIDs) to susceptible in iduals can lead to the development of congestive heart failure (CHF). There have been few epidemiological investigations of the importance of this adverse effect. To estimate the relative risk of first admission to a hospital with CHF in recent users of NSAIDs, compared with nonusers, and to determine whether the estimated relative risk was increased in those with a history of heart disease and the extent to which the level of risk varied with the dose and half-life of the drugs consumed. We conducted a matched case-control study of the relationship between recent use of NSAIDs and hospitalization with CHF. Cases (n = 365) were patients admitted to hospitals with a primary diagnosis of CHF. Controls (n = 658) were patients without CHF who were admitted to the same hospitals as case patients. Structured interviews were used to obtain information on several study factors, including recent use of aspirin and other NSAIDs. Use of NSAIDs (other than low-dose aspirin) in the previous week was associated with a doubling of the odds of a hospital admission with CHF (adjusted odds ratio, 2.1 95% confidence interval, 1.2-3.3). Use of NSAIDs by patients with a history of heart disease was associated with an odds ratio of 10.5 (95% confidence interval, 2.5-44.9) for first admission with heart failure, compared with 1.6 (95% confidence interval, 0.7-3.7) in those without such a history. The odds of a first admission to a hospital with CHF was positively related to the dose of NSAID consumed in the previous week, and was increased to a greater extent with long half-life than with short half-life drugs. Assuming these relationships are causal, NSAIDs were responsible for approximately 19% of hospital admissions with CHF. The burden of illness resulting from NSAID-related CHF may exceed that resulting from gastrointestinal tract damage. NSAIDs should be used with caution in patients with a history of cardiovascular disease.
Regional inequalities in all-cause and premature mortality in Ontario
Publisher: Longwoods Publishing
Date: 31-01-2018
DOI: 10.12927/HCPAP.2018.25504
Abstract: Although all-cause mortality rates have fallen in many countries in the last 40 years, the well-off and city dwellers have experienced the greatest gains. In this paper, we report on socio-economic and regional variations in premature mortality in Ontario. Premature mortality rates were highest in areas with the greatest degrees of social deprivation. While premature mortality continued to fall in the least deprived group, they flattened in the other groups and rose between 2000-2007 and 2008-2015 in the most deprived group. There were substantial variations in premature mortality rates across the Local Health Integration Networks, with the greatest disadvantage being seen in the southeast, northwest and northeast regions of Ontario. These data present a major challenge to policy makers. Health, social and economic policies need to be directed toward narrowing the gaps we have identified here. We have excellent metrics with which to measure their success.
SOMATOSTATIN IN TREATMENT OF HAEMATEMESIS AND MELAENA
Publisher: Elsevier BV
Date: 1985
DOI: 10.1016/S0140-6736(85)91903-8
Abstract: 630 patients with haematemesis and melaena were randomly allocated to treatment by a constant intravenous infusion of either somatostatin or an apparently identical placebo in a double-blind controlled trial. Rebleeding was less common in treated patients (70 episodes in 315 in iduals compared with 89 episodes in 315 controls) but the difference was not significant. Operation rates were virtually identical (35 treated patients and 34 controls), while there were slightly more deaths in the treated group than in the controls (31 and 25, respectively). These results are in clear disagreement with those of other smaller series. Though it is not possible to be completely sure that treatment is not useful in some in iduals, earlier claims of marked benefit seem unlikely to be justified.
Response to authors re commentary: Renewed controversy over cardiovascular risk with non-steroidal anti-inflammatory drugs
Publisher: Oxford University Press (OUP)
Date: 30-03-2018
DOI: 10.1093/IJE/DYY051
ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions
Publisher: BMJ
Date: 12-10-2016
DOI: 10.1136/BMJ.I4919
Political and policy arguments for integrated data
Publisher: Swansea University
Date: 12-04-2017
Abstract: ABSTRACT IntroductionThere is little argument that integrated data can provide a valuable resource for improved health system management, planning, and accountability as well as discovery and commercial use, but policies to enable and support integrated data fall short of the potential represented by integrated data. To understand the current level of progress on policy for integrated data, we looked at two successful and two unsuccessful efforts to support the creation and use of integrated data in health systems. Methods/ApproachWe used document and literature analysis to develop descriptions of the Icelandic Health Sector Database Act, the creation of the Institute for Clinical Evaluative Sciences in Ontario (Canada), the care.data initiative in the United Kingdom, and the Health Datapalooza initiative in the US and used an Ideas, Institutions and Actors framework to compare the experience with integrated data policy and politics. Results and discussionOur analysis suggests that institutions around integrated data remain under-developed and largely focused on specific aspects of integrated data policy or use. There are at least two sets of dominant ideas around integrated data – data as a tool for economic development and health system performance and data as a threat to privacy and liberty – that are often diametrically opposed in different jurisdictions. To a great extent, powerful actors remain disengaged from integrated data discussions and leadership engaged in integrated data policy and politics remains isolated from larger policy and political discussions. The medical profession along with civil society groups can mount effective opposition to integrated data initiatives, although potentially for different reasons (accountability and privacy concerns respectively). ConclusionsOur analysis suggests several key issues around successful integrated data policy and politics that support the importance of strong leadership, an incremental approach to institution building that focuses on public benefits, strongly alignment to missions that are congruent with societal values, and stronger attention to effective and rapid implementation of policy. In addition to the cases studied here, the success of smaller sub-national (e.g. state or provincial) efforts suggests that smaller efforts tend to work better although their success may not receive the attention that could support larger efforts to integrate data on the national level. Further work should focus chiefly on the extension of these arguments to non-health sectors to realize the full value of integrated data.
Plasma Noradrenaline, Platelet α2 ‐Adrenoceptors, and Functional Scores during Ethanol Withdrawal
Publisher: Wiley
Date: 08-1990
DOI: 10.1111/J.1530-0277.1990.TB01187.X
Abstract: Plasma noradrenaline and platelet alpha 2-adrenoceptor density (sites/cell using 3H-rauwolscine with and without phentolamine) were correlated with withdrawal score in 23 hospitalized patients undergoing ethanol withdrawal. Control groups for plasma noradrenaline were 25 patients admitted to hospital for elective gastroscopy and 12 laboratory workers accustomed to venipuncture. Controls for platelet alpha 2-adrenoceptor measurements were a separate group of 31 normal subjects with a mean age close to that of the patients' withdrawing from ethanol. Plasma noradrenaline was significantly higher in the patients undergoing ethanol withdrawal than in patients admitted to hospital for elective endoscopy. Twelve laboratory controls had plasma noradrenaline levels significantly lower than either patient group. A significant though poor statistical correlation existed between ethanol withdrawal score and simultaneously determined plasma noradrenaline level. Platelet alpha 2-adrenoceptor sites/cell were reduced in ethanol withdrawal compared with the normal controls. Platelet alpha 2-adrenoceptor sites/cell increased over the first 24 hr of ethanol withdrawal but remained significantly lower than control values. The change in platelet adrenoceptors was accompanied by a fall in mean plasma noradrenaline. Thus, the stress of hospital admission itself is associated with an increase in plasma noradrenaline, but ethanol withdrawal enhances this increase, which is accompanied by and probably causes a reduction in platelet alpha 2-adrenoceptor numbers. These changes begin to return towards normal within 24 hr as the withdrawal reaction subsides.
AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.JCLINEPI.2008.10.009
Abstract: Our purpose was to measure the agreement, reliability, construct validity, and feasibility of a measurement tool to assess systematic reviews (AMSTAR). We randomly selected 30 systematic reviews from a database. Each was assessed by two reviewers using: (1) the enhanced quality assessment questionnaire (Overview of Quality Assessment Questionnaire [OQAQ]) (2) Sacks' instrument and (3) our newly developed measurement tool (AMSTAR). We report on reliability (interobserver kappas of the 11 AMSTAR items), intraclass correlation coefficients (ICCs) of the sum scores, construct validity (ICCs of the sum scores of AMSTAR compared with those of other instruments), and completion times. The interrater agreement of the in idual items of AMSTAR was substantial with a mean kappa of 0.70 (95% confidence interval [CI]: 0.57, 0.83) (range: 0.38-1.0). Kappas recorded for the other instruments were 0.63 (95% CI: 0.38, 0.78) for enhanced OQAQ and 0.40 (95% CI: 0.29, 0.50) for the Sacks' instrument. The ICC of the total score for AMSTAR was 0.84 (95% CI: 0.65, 0.92) compared with 0.91 (95% CI: 0.82, 0.96) for OQAQ and 0.86 (95% CI: 0.71, 0.94) for the Sacks' instrument. AMSTAR proved easy to apply, each review taking about 15 minutes to complete. AMSTAR has good agreement, reliability, construct validity, and feasibility. These findings need confirmation by a broader range of assessors and a more erse range of reviews.
Bridges to Iran [13]
Publisher: Elsevier BV
Date: 02-2003
Assessing the impact of the Australia-United States Free Trade Agreement on Australian and global medicines policy
Publisher: Springer Science and Business Media LLC
Date: 06-10-2005
Abstract: On 1 January 2005, a controversial trade agreement entered into force between Australia and the United States. Though heralded by the parties as facilitating the removal of barriers to free trade (in ways not achievable in multilateral fora), it also contained many trade-restricting intellectual property provisions and others uniquely related to altering pharmaceutical regulation and public health policy in Australia. The latter appear to have particularly focused on the world-respected process of federal government reimbursement after expert cost-effectiveness evaluation, popularly known as the Pharmaceutical Benefits Scheme ('PBS'). It remains uncertain what sort of impacts – if any – the Australia-United States Free Trade Agreement ('AUSFTA') will have on PBS processes such as reference pricing and their important role in facilitating equitable and affordable access to essential medicines. This is now the field of inquiry for a major three year Australian Research Council ('ARC')-funded study bringing together a team of senior researchers in regulatory theory from the Australian National University and pharmacoeconomics from the University of Newcastle. The project proposes to monitor, assess and analyse the real and potential impacts of the AUSFTA in this area, providing Australian policy-makers with continuing expertise and options. To the extent that the AUSFTA medicines provisions may represent animportant precedent in a global strategy by industry oncost-effectiveness evaluation of pharmaceuticals, the study will also beof great interest to policy makers in other jurisdictions.
Simultaneous glyburide/metformin therapy is superior to component monotherapy as an initial pharmacological treatment for type 2 diabetes
Publisher: Wiley
Date: 05-2002
DOI: 10.1046/J.1463-1326.2002.00211.X
Abstract: To evaluate whether simultaneous initial treatment of both insulin resistance and impaired beta-cell insulin secretion with glyburide/metformin tablets is superior to monotherapy with each component agent. In this randomized, parallel-group, placebo-controlled, multicentre study, 806 patients with type 2 diabetes (mean duration, 3 years) who had failed diet and exercise were randomly assigned to 4 weeks of therapy with placebo, glyburide 2.5 mg, metformin 500 mg, glyburide/metformin 1.25/250 mg, or glyburide/metformin 2.5/500 mg once daily. Doses were then titrated over 8 weeks based on glycaemic response. The primary outcome measure was change from baseline in mean HbA1c after 20 weeks. Changes in fasting plasma glucose, lipids and body weight were also assessed along with 2-h postprandial glucose and insulin values after a standardized meal. At week 20, patients taking glyburide/metformin 1.25/250 mg or 2.5/500 mg tablets had greater reductions in HbA1c levels (-1.48% and -1.53% respectively) compared with placebo (-0.21% both p < 0.001), glyburide (-1.24% p = 0.016 and p = 0.004 respectively) or metformin (-1.03% both p < 0.001). Fasting plasma glucose concentrations were reduced more in both glyburide/metformin groups compared with placebo and metformin (p < 0.001) patients in both combination therapy groups also had significantly lower postprandial glucose concentrations compared with placebo, glyburide and metformin. Initial combination treatment with glyburide/metformin tablets produces greater improvements in glycaemic control than either glyburide or metformin monotherapy. The superiority of initial therapy with glyburide/metformin tablets may arise from simultaneous treatment of both pathophysiological defects of type 2 diabetes.
Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion
Publisher: John Wiley & Sons, Ltd
Date: 16-03-2011
In reply to: Pattern of non-steroidal anti-inflammatory drug use in Australia 1990-1994
Publisher: AMPCo
Date: 11-1996
Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia
Publisher: BMJ
Date: 20-02-1999
Abstract: To evaluate the effect on general practitioners' prescribing of feedback on their levels of prescribing. Randomised controlled trial. General practice in rural Australia. 2440 full time recognised general practitioners practising in non-urban areas. Two sets of graphical displays (6 months apart) of their prescribing rates for 2 years, relative to those of their peers, were posted to participants. Data were provided for five main drug groups and were accompanied by educational newsletters. The control group received no information on their prescribing. Prescribing rates in the intervention and control groups for the five main drug groups, total prescribing and potential substitute prescribing and ordering before and after the interventions. The intervention and control groups had similar baseline characteristics (age, sex, patient mix, practices). Median prescribing rates for the two groups were almost identical before and after the interventions. Any changes in prescribing observed in the intervention group were also seen in the control group. There was no evidence that feedback reduced the variability in prescribing nor did it differentially affect the very high or very low prescribers. The form of feedback evaluated here-mailed, unsolicited, centralised, government sponsored, and based on aggregate data-had no impact on the prescribing levels of general practitioners.
Single-enantiomer drugs: Elegant science, disappointing effects
Publisher: Springer Science and Business Media LLC
Date: 2004
DOI: 10.2165/00003088-200443050-00002
Abstract: Most new drugs are marketed as single enantiomers but many older agents are still available in racemic form. As these drugs reach the end of their patent life manufacturers become interested in marketing single enantiomer equivalents. This is called 'chiral switching' and it has been claimed that it will bring clinical benefits in terms of improved efficacy, more predictable pharmacokinetics or reduced toxicity. We reviewed the clinical evidence and prices for three recently marketed single enantiomer versions of widely used racemic drugs: escitalopram, esomeprazole and levosalbutamol. Claims of increased efficacy were based on comparisons of non-equivalent doses and any advantages seemed small and clinically unimportant. Prices of esomeprazole and levosalbutamol were higher than their racemic alternatives and we predict that these prices will remain high despite the market presence of generic versions of the racemates. Patent protection and a perception of superiority based on promotion rather than evidence will maintain price premiums for single enantiomer drugs that are not justified on the basis of clinical performance.
Cohort profile: The hunter community study
Publisher: Oxford University Press (OUP)
Date: 07-01-2010
DOI: 10.1093/IJE/DYP343
Side-effects of non-steroidal anti-inflammatory drugs
Publisher: Elsevier BV
Date: 08-1988
DOI: 10.1016/S0950-3579(88)80021-9
Abstract: Despite a continuing lack of good quality epidemiological studies, our knowledge of the side-effects of NSAIDs has advanced in recent years. The most important reactions are those which are related predictably to the pharmacology of the drugs and these need to be considered whenever a NSAID is prescribed, particularly for patients who can be identified as belonging to high-risk groups. The important reactions are: 1. Gastrointestinal damage, which is now known to extend to some degree from the oesophagus to the rectum, although the acid contact areas of the stomach and duodenum are the most important. Although the studies have produced heterogeneous results, NSAIDs probably double or triple the risk of an in idual developing serious gastrointestinal haemorrhage or perforation. The risk increases with age and previous history of ulceration, and, in communities with particularly high use of NSAIDs, the drugs may account for up to 30% of all cases of ulcer complications. 2. Renal syndromes, of which functional renal impairment is the most important. This may precipitate cardiac failure, and hyperkalaemia is an additional hazard. Antagonism of the action of diuretics may contribute to the fluid retention, and antagonism of antihypertensive therapy is probably quite common and may result in additional unnecessary therapy. Patients at risk of functional renal impairment from NSAIDs can be identified readily and in these subjects the drugs have to be used with great care and with appropriate monitoring. 3. Respiratory effects, in particular acute bronchospasm in subjects with a history of aspirin sensitivity. NSAIDs should be used with caution in asthmatics, and patients purchasing NSAIDs without prescriptions need to be warned of these effects. Other uncommon serious reactions include hepatocellular damage, acute interstitial nephritis, agranulocytosis and aplastic anaemia, Stevens-Johnson syndrome and toxic epidermal necrolysis. These are unpredictable reactions which generally need not be considered before prescribing. However, in patients who present with any of these conditions, NSAIDs, because of their wide use, should always be considered as a possible cause.
Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion
Publisher: John Wiley & Sons, Ltd
Date: 17-10-2007
The use of non-prescription salbutamol inhalers by asthmatic patients in the Hunter Valley, New South Wales
Publisher: AMPCo
Date: 04-1989
Drug therapy reviews: Intravenous fluid therapy
Publisher: Oxford University Press (OUP)
Date: 12-1977
Parenteral aluminum administration in the dog: I. Plasma kinetics, tissue levels, calcium metabolism, and parathyroid hormone
Publisher: Elsevier BV
Date: 02-1984
DOI: 10.1038/KI.1984.25
Abstract: Aluminum (Al) may cause both osteomalacia and encephalopathy in dialysis patients. Little is known about the biology of Al. This study examined the initial distribution kinetics of Al and its biological effects after injections of 1 mg/kg/day into dogs for 3 to 5 weeks. Following one intravenous dose, the plasma half-life (x +/- SE) was 276 +/- 51.8 min, with an apparent volume of distribution of 1.30 +/- 0.17 liters or 5.90 +/- 0.30% body wt 10 to 21% of administered Al was excreted in the urine over 150 min, and the renal contribution to plasma clearance of Al correlated with GFR (r = 0.77, P less than 0.05). The total plasma clearance of Al (4.43 +/- 2.83 ml/min) exceeded the renal contribution to plasma clearance (1.94 +/- 0.36 ml/min) in each dog, and in only two instances did the renal contribution reach 50% of total plasma clearance. Serum calcium rose from 9.4 +/- 0.2 to 11.1 +/- 0.3 mg/dl and immunoreactive parathyroid hormone (iPTH) fell by 27 +/- 4% following one Al injection. With repeated Al injections, serum calcium increased from baseline levels of 10.2 +/- 0.07 mg/dl to 11.1 +/- 0.22 and 11.3 +/- 0.46 mg/dl after 1 and 2 weeks, respectively. Renal function declined in all dogs, and serum creatinine exceeded 3.5 mg/dl in four over the 5 weeks of study, serum calcium correlated with serum creatinine (r = 0.91, P less than 0.001). Liver, kidney, and spleen showed the highest tissue content of Al, and there was substantial uptake by bone the parathyroid content of Al was modest.(ABSTRACT TRUNCATED AT 250 WORDS)
Chronic Airways Disease in First Nations, Inuit and Métis in Canada
Publisher: Hindawi Limited
Date: 2012
DOI: 10.1155/2012/590658
Parenteral aluminum administration in the dog: II. Induction of osteomalacia and effect on vitamin D metabolism
Publisher: Elsevier BV
Date: 02-1984
DOI: 10.1038/KI.1984.26
Abstract: There is an association between bone aluminum (Al) accumulation and dialysis-associated osteomalacia (OM). To study whether Al is pathogenic in OM, quantitative bone histomorphometry was done in six dogs before (Bx 1) and after (Bx 2) 3 to 5 weeks of intravenous Al administration (1 mg Al /kg/day). Bone Al was determined by histochemical and chemical methods. The percent osteoid rose from 2.8 +/- 0.8 to 7.0 +/- 4.3% (mean +/- SD), P less than 0.05, and osteoid width increased from 5.7 +/- 0.6 to 8.0 +/- 1.2 mu, P less than 0.01, after Al. Bone Al rose from 1.3 +/- 1.6 to 94.0 +/- 19.0 mg/kg after Al, and the severity of OM, expressed as either percent forming surface or percent osteoid, correlated with bone Al measured histochemically and expressed as either percent surface or percent area of trabecular bone staining for Al (r = 0.85 - 0.90, P less than 0.01). Poor tetracycline uptake (six dogs), which indicates impaired mineralization, and little or no separation of tetracycline labels (four dogs) were noted at Bx 2 thus, bone apposition and formation rates were below the limits of detection. Resorptive surface did not change but trabecular volume, expressed as percent of tissue volume, fell from 22.1 +/- 3.0 to 17.1 +/- 1.4%, P less than 0.05. Serum levels of 1,25(OH)2D fell from 26.8 +/- 9.1 to 4.5 +/- 5.5 pg/ml after 17 days of Al serum 25(OH)D levels were unchanged. These data indicate that Al can cause OM and that its severity correlates with the bone Al content.2 +
The benefits of reducing cholesterol levels
Publisher: AMPCo
Date: 02-1992
INHIBITION OF DRUG METABOLISM BY OMEPRAZOLE
Publisher: Elsevier BV
Date: 07-1984
DOI: 10.1016/S0140-6736(84)92039-7
Abstract: Non-response to antidepressant medication is common in primary care. Little is known about how GPs manage patients with depression that does not respond to medication. To describe usual care for primary care patients with treatment-resistant depression (TRD). Mixed-methods study using data from a UK primary care multicentre randomised controlled trial. In total, 235 patients with TRD randomised to continue with usual GP care were followed up at 3-month intervals for a year. Self-report data were collected on antidepressant medication, number of GP visits, and other treatments received. In addition, 14 semi-structured face-to-face interviews were conducted with a purposive s le after the 6-month follow-up and analysed thematically. Most patients continued on the same dose of a single antidepressant between baseline and 3 months ( Usual care in patients with TRD mainly entailed taking antidepressants, and medication changes were uncommon. The high prevalence of physical and psychological comorbidity means that, when these patients consult, their depression may not be discussed. Strategies are needed to ensure the active management of this large group of patients whose depression does not respond to antidepressant medication.
Cost-Effectiveness Analysis in the Treatment of Hypertension: A Medical View
Publisher: Informa UK Limited
Date: 1999
DOI: 10.3109/10641969909061027
Abstract: The clinical benefits of anti-hypertensive treatment include reductions in stroke and myocardial infarction, heart failure, renal and ocular damage and possibly cognitive impairment. The cost-effectiveness of treatment generally falls within a range considered acceptable to funders of health care in developed countries, and has been shown to vary with age, gender and pre-treatment blood pressure. In a largely asymptomatic condition, small quality of life impairments resulting from treatment could offset these clinical and economic benefits, but evidence suggests that treatment is associated with slight improvements in quality of life. A limitation of these analyses is that the needs of developing countries are not met. The cost-effectiveness of anti-hypertensive treatment may be unattractive to developing countries when compared with interventions that achieve greater health gains per dollar spent.
Intravenous contrast media: Use and associated mortality
Publisher: AMPCo
Date: 11-1991
A systematic review of the skeletal effects of estrogen therapy in postmenopausal women. II. An assessment of treatment effects
Publisher: Informa UK Limited
Date: 1998
DOI: 10.3109/13697139809085526
Abstract: To combine the results of randomized controlled trials to provide overall estimates of the effect of estrogen treatment on fracture rates and measures of bone mass. Articles on estrogen treatment for osteoporosis published between 1977 and 1995 were identified. Studies selected were randomized controlled trials of the efficacy of estrogens in preventing loss of bone mass or fractures in postmenopausal women. Data extraction and quality assessment were performed in duplicate, with assistance of a manual. Raters were blinded as to authors and their affiliations and the publication details. With estimates of bone mass, the treatment effect size was defined as the difference in the mean annual change in bone mass between the treatment and control groups ided by the pooled standard deviation for change. In the case of fractures, efficacy was measured as the reduction in the numbers of in iduals experiencing new fractures with treatment. Effect sizes were pooled using the random effects model. Thirty-seven studies met the criteria for inclusion in the systematic review. Only one small secondary prevention trial contained evaluable data on vertebral fractures. This study found a fracture relative risk of 0.63 (95% confidence interval, CI 0.28-1.43) with estrogen treatment. There was more information on the effects of treatment on bone mass. Overall effect sizes ranged between 0.5 and 2.5 standard deviation (SD) units for change. A dose-response relationship was apparent but high doses of estrogens were not associated with effect sizes greater than those observed with recommended doses. There was no significant difference in efficacy between transdermal and oral administration of estrogens. Pooling of paired data from secondary prevention studies indicated that treatment effect sizes were smaller at the hip (0.92, 95% CI 0.3-1.5 SD units) than at the spine (2.1, 95% CI 0.9-3.3 SD units). No significant effects of co-intervention with calcium, progestogens or androgens were seen, although an additive effect of higher doses of calcium could not be ruled out. Clear-cut effects of estrogens in attenuating the postmenopausal decline in estimated bone mass were apparent in this literature. However, the trials were short-term and provide inadequate evidence on the effects of treatment on fracture risk.
Cimetidine and Tranexamic Acid for Upper-Gastrointestinal-Tract Bleeding
Publisher: Massachusetts Medical Society
Date: 24-11-1983
DOI: 10.1056/NEJM198311243092116
Abstract: Visual perception is influenced by attention deployed voluntarily or triggered involuntarily by salient stimuli. Modulation of visual cortical processing by voluntary or endogenous attention has been extensively studied, but much less is known about how involuntary or exogenous attention affects responses of visual cortical neurons. Using implanted microelectrode arrays, we examined the effects of exogenous attention on neuronal responses in the primary visual cortex (V1) of awake monkeys. A bright annular cue was flashed either around the receptive fields of recorded neurons or in the opposite visual field to capture attention. A subsequent grating stimulus probed the cue-induced effects. In a fixation task, when the cue-to-probe stimulus onset asynchrony (SOA) was <240 ms, the cue induced a transient increase of neuronal responses to the probe at the cued location during 40-100 ms after the onset of neuronal responses to the probe. This facilitation diminished and disappeared after repeated presentations of the same cue but recurred for a new cue of a different color. In another task to detect the probe, relative shortening of monkey's reaction times for the validly cued probe depended on the SOA in a way similar to the cue-induced V1 facilitation, and the behavioral and physiological cueing effects remained after repeated practice. Flashing two cues simultaneously in the two opposite visual fields weakened or diminished both the physiological and behavioral cueing effects. Our findings indicate that exogenous attention significantly modulates V1 responses and that the modulation strength depends on both novelty and task relevance of the stimulus. Significance statement: Visual attention can be involuntarily captured by a sudden appearance of a conspicuous object, allowing rapid reactions to unexpected events of significance. The current study discovered a correlate of this effect in monkey primary visual cortex. An abrupt, salient, flash enhanced neuronal responses, and shortened the animal's reaction time, to a subsequent visual probe stimulus at the same location. However, the enhancement of the neural responses diminished after repeated exposures to this flash if the animal was not required to react to the probe. Moreover, a second, simultaneous, flash at another location weakened the neuronal and behavioral effects of the first one. These findings revealed, beyond the observations reported so far, the effects of exogenous attention in the brain.
Cancer in First Nations people in Ontario, Canada: Incidence and mortality, 1991 to 2010
Publisher: Government of Canada
Date: 2021
Promoting cost effective prescribing
Publisher: BMJ
Date: 15-04-1995
Evaluation of a weight-adjusted single-bolus plasminogen activator in patients with myocardial infarction: A double-blind, randomized angiographic trial of lanoteplase versus alteplase
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-11-1998
DOI: 10.1161/01.CIR.98.20.2117
Abstract: Background —Lanoteplase (nPA) is a rationally designed variant of tissue plasminogen activator with greater fibrinolytic potency and slower plasma clearance than alteplase. Methods and Results —InTIME (Intravenous nPA for Treatment of Infarcting Myocardium Early), a multicenter, double-blind, randomized, double-placebo angiographic trial, evaluated the dose-response relationship and safety of single-bolus, weight-adjusted lanoteplase. Patients (n=602) presenting within 6 hours of acute myocardial infarction were randomized and treated with either a single-bolus injection of lanoteplase (15, 30, 60, or 120 kU/kg) or accelerated alteplase. The primary objective was to determine TIMI grade flow at 60 minutes. Angiographic assessments were also performed at 90 minutes and on days 3 to 5. Follow-up was continued for 30 days. Lanoteplase achieved its primary objective, demonstrating a dose-response in TIMI grade 3 flow at 60 minutes (23.6% to 47.1% of subjects, P .001). Similar results were observed at 90 minutes (26.1% to 57.1%, P .001). At 90 minutes, coronary patency (TIMI 2 or 3) increased across the dose range up to 83% of subjects at 120 kU/kg lanoteplase compared with 71.4% with alteplase. Thus, at this dose, lanoteplase was superior to alteplase in restoring coronary patency (difference, 12% 95% CI, 1% to 23%). The early safety experience in this study suggests that lanoteplase was well tolerated at all doses with safety comparable to that of alteplase. Conclusions —Lanoteplase, a single-bolus, weight-adjusted agent, increased coronary patency at 60 and 90 minutes in a dose-dependent fashion. Coronary patency at 90 minutes was achieved more frequently with 120 kU/kg lanoteplase than alteplase. In this study, safety with lanoteplase and alteplase was comparable. InTIME-II, a worldwide mortality trial, will evaluate efficacy and safety with this promising new agent.
A 3-year study of high-cost users of health care
Publisher: CMA Joule Inc.
Date: 11-01-2016
DOI: 10.1503/CMAJ.150064
Bringing epidemiology into drug utilisation research
Publisher: Wiley
Date: 18-02-2003
DOI: 10.1002/PDS.817
Socioeconomic gradients in all-cause, premature and avoidable mortality among immigrants and long-term residents using linked death records in Ontario, Canada
Publisher: BMJ
Date: 13-03-2017
A population-based study of homicide deaths in Ontario, Canada using linked death records
Publisher: Springer Science and Business Media LLC
Date: 24-07-2017
How do trainee doctors learn about research? Content analysis of Australian specialist colleges’ intended research curricula
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJOPEN-2019-034962
Abstract: Patients do better in research-intense environments. The importance of research is reflected in the accreditation requirements of Australian clinical specialist colleges. The nature of college-mandated research training has not been systematically explored. We examined the intended research curricula of Australian trainee doctors described by specialist colleges, their constructive alignment and the nature of scholarly project requirements. We undertook content analysis of publicly available documents to characterise college research training curricula. We reviewed all publicly accessible information from the websites of Australian specialist colleges and their subspecialty isions. We retrieved curricula, handbooks and assessment-related documents. Fifty-eight Australian specialist colleges and their subspecialty isions. Two reviewers extracted and coded research-related activities as learning outcomes, activities or assessments, by research stage (using, participating in or leading research) and competency based on Bloom’s taxonomy (remembering, understanding, applying, analysing, evaluating, creating). We coded learning and assessment activities by type (eg, formal research training, publication) and whether it was linked to a scholarly project. Requirements related to project supervisors’ research experience were noted. Fifty-five of 58 Australian college subspecialty isions had a scholarly project requirement. Only 11 required formal research training two required an experienced research supervisor. Colleges emphasised a role for trainees in leading research in their learning outcomes and assessments, but not learning activities. Less emphasis was placed on using research, and almost no emphasis on participation. Most learning activities and assessments mapped to the ‘creating’ domain of Bloom’s taxonomy, whereas most learning outcomes mapped to the ‘evaluating’ domain. Overall, most research learning and assessment activities were related to leading a scholarly project. Australian specialist college research curricula appear to emphasise a role for trainees in leading research and producing research deliverables, but do not mandate formal research training and supervision by experienced researchers.
Meta-analysis of risk of gastrointestinal complications with NSAIDs
Publisher: BMJ
Date: 08-02-1997
WHO Essential Medicines Policies and Use in Developing and Transitional Countries
Publisher: Public Library of Science (PLoS)
Date: 16-09-2014
Giving and receiving of gifts between pharmaceutical companies and medical specialists in Australia
Publisher: Wiley
Date: 03-08-2006
DOI: 10.1111/J.1445-5994.2006.01151.X
Abstract: This study investigated the 'gift-relationship' between pharmaceutical companies and doctors. The study was based on a survey questionnaire of 823 medical specialists from across Australia. The aim of this study was to investigate gifts offered to medical specialists in Australia by pharmaceutical companies, financial support actively sought by medical specialists for activities other than research and to consider what is ethically appropriate. A high percentage of specialists received offers of food (96%), items for the office (94%), personal gifts (51%) and journals or textbooks (50%). Most specialists were invited to product launches, symposia or educational events (75-84%) and 52% received offers of travel to conferences. A high proportion of offers were accepted (66-79%) except invitations to product launches (49%), sponsored symposia (53%) and offers of travel that included partners (27%). Fifteen per cent of specialists requested financial support from pharmaceutical companies for activities and items, including conferences, travel, educational activities, salaries and donations to specific funds. The study outlined guidelines on gifts from pharmaceutical companies and differing standards applying to gifts and grants for travel. We found that, although most gifts and requests for support complied with professional and pharmaceutical industry guidelines, some--including personal gifts, tickets to sporting events, entertainment and travel expenses for specialists' partners--did not. To ensure that physicians' judgements are free from real or perceived influence from industry and to maintain public trust, we support a shift towards more conservative standards on gifts and support for travel evident in recent guidelines.
All the right intentions but few of the desired results
Publisher: Longwoods Publishing
Date: 02-07-2012
Implications of the Australian guidelines for the United States
Publisher: Health Affairs (Project Hope)
Date: 1992
Economic Analysis as an Aid to Subsidisation Decisions: The Development of Australian Guidelines for Pharmaceuticals
Publisher: Springer Science and Business Media LLC
Date: 1992
DOI: 10.2165/00019053-199201010-00010
Abstract: Factors governing the entry of new drugs into clinical practice are changing, with increasing emphasis on economic issues. In future, organisations that subsidise the use of pharmaceuticals are likely to require sponsors to provide evidence of the cost-effectiveness of their products. The first national government to signal such an intention is the Commonwealth Government of Australia, which from January 1993 will require economic analyses in support of applications for listing of new pharmaceutical products on its schedule of pharmaceutical benefits. This move is underpinned by legislation that requires the country's Pharmaceutical Benefits Advisory Committee (PBAC) to consider costs and effectiveness when recommending listing of new drugs. The approach that has been recommended to the Committee is based on advice from a group of consultants, health economists and clinicians. The PBAC will use economic analyses as an aid to decision-making that will remain within a clinical framework the viewpoint will be societal, and analyses will include costs that fall outside the pharmaceutical benefits scheme. The preferred approach is comparative cost-effectiveness analysis with a particular emphasis on the marginal costs of obtaining additional health benefits with new drugs, compared with existing therapies. The use of analyses that are restricted to potential cost savings with new drugs is discouraged, as is the inclusion of indirect costs and benefits. To facilitate the conduct of economic analyses, it is planned to hold meetings with specialist clinicians to obtain consensus on a range of intermediate clinical outcome indicators, and to publish lists of 'standard' Australian costs that will be updated regularly. The approach being followed in Australia has implications for both the government and the pharmaceutical industry. The responsibility for monitoring the effects of this new policy lie with the government. The success, or otherwise, of the policy should not be gauged simply by the effects on the price of new drugs which, historically, have been relatively low in Australia. A full evaluation will require that more effort be put into clinical outcomes research and the development of population databases, an area in which Australia lags behind other countries.
Coverage by the news media of the benefits and risks of medications
Publisher: Massachusetts Medical Society
Date: 06-2000
Intravenous contrast media: use and associated mortality: In reply
Publisher: AMPCo
Date: 02-1992
Toxicity of dothiepin in overdose
Publisher: Elsevier BV
Date: 03-1994
Big Data and Population Health
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2017
Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk
Publisher: Public Library of Science (PLoS)
Date: 12-02-2013
Variability in the risk of major gastrointestinal complications from nonaspirin nonsteroidal anti-inflammatory drugs
Publisher: Elsevier BV
Date: 10-1993
DOI: 10.1016/0016-5085(93)90952-9
Abstract: We have assessed the extent to which the risk of serious gastrointestinal complications from nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs) varies with the age and sex of recipients, use of aspirin or alcohol, administration by the oral or rectal route, and dose and choice of drug. A case-control study was performed with prospective recruitment of cases of gastrointestinal bleeding or ulcer perforation and age- and sex-matched controls. Information on preadmission drug use obtained by structured interview. Six hundred forty-four patients and 1268 controls were recruited. The odds ratio for upper gastrointestinal complications in users compared with nonusers of NANSAIDs increased with age: or = 80 years, odds ratio 4.2 and was higher in women (5.4) than in men (1.9). There was a linear dose-response curve that was steeper in women than in men. Combined exposure suggested additive risks: NANSAIDs and aspirin, odds ratio 6.7 NANSAIDs and alcohol, odds ratio 6.0 NANSAIDs by the oral route were associated with an odds ratio of 2.3, compared with 11.4 with rectal administration. Piroxicam was associated with the highest risk, odds ratio 4.8 and ibuprofen the lowest risk, odds ratio 0.7. A number of factors can alter the risk of major gastrointestinal complications with NANSAIDs and need to be considered when in idual prescribing decisions are made.
Patient co-payments and use of prescription medicines
Publisher: Elsevier BV
Date: 02-2004
DOI: 10.1111/J.1467-842X.2004.TB00634.X
Abstract: To investigate how prescription co-payments influence the medicine use of Australian patients. Two surveys and an in-depth interview study were conducted in the Newcastle/Hunter region of New South Wales (NSW). A community-based survey explored how often prescription cost posed a barrier to prescription use. A general practice patient survey investigated the impact of prescription cost on the timing of medical consultations and prescription collection. Quantitative data were summarised using descriptive statistics associations between household characteristics and outcomes were explored using odds ratios and chi square analysis. In-depth interviews were conducted to explore the role of prescription cost in medicine use. The interview data were qualitatively analysed for relevant themes using 'grounded theory'. 420 of 950 households (44%) participated in the community survey: 110 (26%) reported delaying visiting a GP, 85 (20%) not buying all of their prescription medicines and 77 (18%) not refilling a prescription because of cost. Sixty-two (15%) households reported significant difficulties with prescription costs. Households with children had twice the odds of reporting significant difficulties than those without (OR= 2.0, 95% CI 1.2-3.5). Of the 442 (43%) GP patients who participated, 25 (6%) patients reported prescription cost as the reason for delaying their visit. Of the 291 patients who received a prescription, 26 (9%) patients reported cost as the reason for not collecting some or all of their prescriptions. Given the wide variation in patients' capacity to manage increased out-of-pocket costs, co-payments may add to patients' burden and place a potential barrier to safe and timely prescription use.
The health services burden of heart failure: an analysis using linked population health data-sets
Publisher: Springer Science and Business Media LLC
Date: 25-04-2012
Drug information centres: New role for pharmacists?
Publisher: SAGE Publications
Date: 04-1977
DOI: 10.1177/003693307702200211
Abstract: In the last few decades there has been a great increase in the number of new drugs available for general use. In consequence, drug information centres have been developed, particularly in U.S.A., to disseminate information on the uses, toxicity and cost of these drugs. Such centres have been slower to appear in the United Kingdom, with the exception of certain specialised centres, e.g. Poisons Information Bureaux. The present report describes the development of a drug information centre in Glasgow and gives preliminary data on its use during the last year. It is proposed that such centres provide a valuable aid in encouraging rational drug use particularly in hospitals. The centres may be run by a variety of interested personnel but in our view the professional group most likely to fill this role adequately is hospital pharmacists.
Using a journal club to navigate a maze of COVID-19 papers in a front-line hospital service
Publisher: BMJ
Date: 19-01-2023
Population risk and burden of health behavioral–related all-cause, premature, and amenable deaths in Ontario, Canada: Canadian Community Health Survey–linked mortality files
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.ANNEPIDEM.2019.01.009
Abstract: To examine the association of all-cause and premature mortality with four modifiable lifestyle behaviors and quantify the burden of behavioral-related premature death in Ontario, Canada. We analyzed a cohort of 149,262 adults in the 2000-2010 Canadian Community Health Surveys, linked to vital statistics data to ascertain deaths until December 31, 2015. The strength of the association between behaviors (smoking, body mass index, physical inactivity, and alcohol consumption) and all-cause and premature mortality was estimated using sex-specific Cox proportional hazards models. We estimated the proportion of deaths from causes amenable to the health system by behavior. After full adjustment, hazard ratios (95% confidence interval) for premature mortality were significantly increased for heavy smokers versus nonsmokers [males: 5.48 (4.55-6.60) females 4.45 (3.49-5.66)] obese class III versus normal weight [males: 2.47 (1.76-3.48) females: 1.73 (1.29-2.31)] and physically inactive versus active [males: 1.25 (1.07-1.45) females: 1.70 (1.41-2.04)]. In both sexes, a disproportionate burden of amenable deaths were experienced by heavy smokers, severely obese, physically inactive, and heavy drinkers. The findings emphasize the importance of prevention to reduce the prevalence of risk behaviors that contribute to a large burden of premature deaths that are amenable to the health system.
The effects of increased rehabilitation therapy after brain injury: Results of a prospective controlled trial
Publisher: SAGE Publications
Date: 10-2001
DOI: 10.1191/026921501680425225
Abstract: Objective: The objective was to investigate the effect of increased intensity of rehabilitation therapy provided to brain-injured subjects on the rate at which independence was regained and the duration of hospital admission. Design: A two-centre, prospective, controlled study with random allocation to groups. Setting: Two district general hospitals on the south coast of England. Subjects: Fifty-six people with moderate and severe head injury consecutively admitted to South ton and Poole hospitals between June 1995 and September 1997. Interventions: Increased intensity of rehabilitation therapy input without change in content. Results: Subjects receiving more intensive therapy made more rapid progress and were discharged home sooner. The different intensities of therapy employed in this study showed no evidence of a ‘ceiling’ effect and the ‘intervention group’ made significantly more rapid progress on tests of dependency during the period of admission. A clear response to increased therapy input was seen in one of the centres with more rapid functional improvement and a shorter length of hospital stay. This centre already had more therapy and better community facilities. No such benefits were seen at the other centre where the intervention group had a longer hospital stay than the routine group. Conclusion: Increasing the hours per week of therapy given to adults recovering from brain injury in hospital can accelerate the rate of recovery of personal independence and result in their being discharged from hospital sooner. Increased rehabilitation therapy after brain injury is associated with enhanced functional recovery and shorter hospital stay if provided in the context of an integrated service that can provide ongoing community support. There is no evidence of any ceiling effect of therapeutic intensity beyond which no further response is observed.
Prescribing costs: Whose responsibility?
Publisher: Therapeutic Guidelines Limited
Date: 04-1997
Retrospective analysis of trends in dispensing long-acting non-tamper-resistant oxycodone near the Canada-United States border
Publisher: CMA Joule Inc.
Date: 29-05-2015
Jaundice during cyproheptadine treatment
Publisher: BMJ
Date: 25-03-1978
Should Indirect Costs and Benefits be Included?
Publisher: Springer Science and Business Media LLC
Date: 06-1992
Impact of restricting diagnostic imaging reimbursement for uncomplicated low back pain in Ontario: a population-based interrupted time series analysis
Publisher: CMA Joule Inc.
Date: 13-10-2017
Indigenous health data and the path to healing
Publisher: Elsevier BV
Date: 11-2017
Problems with the interpretation of pharmacoeconomic analyses
Publisher: American Medical Association (AMA)
Date: 26-04-2000
Abstract: Pharmacoeconomic analyses are being used increasingly as the basis for reimbursement of the costs of new drugs. Reports of these analyses are often published in peer-reviewed journals. However, the analyses are complex and difficult to evaluate. To describe the nature of problems encountered in the evaluation and interpretation of pharmacoeconomic analyses used as a basis for reimbursement decisions. All major submissions to the Department of Health and Aged Care (DHAC) by the pharmaceutical industry for funding made under the Australian Pharmaceutical Benefits Scheme. Specifically, the DHAC's database of submissions that were received between January 1994 and December 1997 were reviewed. Of a total of 326 submissions, 218 had serious problems of interpretation and were included in the analysis. The nature of the serious problems reviewed were classified as estimates of comparative clinical efficacy, comparator issues, modeling issues, and calculation errors. All submissions in the DHAC's database were reviewed and data were extracted if both the DHAC evaluators and technical subcommittee considered problems to have a significant bearing on the decisions of the parent committee. Of a total of 326 submissions, 218 (67%) had significant problems and 31 had more than 1 problem. Of the 249 problems identified, 154 (62%) related to uncertainty in the estimates of comparative clinical efficacy, and 71 (28.5%) related to modeling issues, which included clinical assumptions or cost estimates, used in the construction of the economic models. There were 15 instances of disagreement over the choice of comparator, and serious calculation errors were found on 9 occasions. Overall, 159 problems (64%) were considered to be avoidable. Significant problems were identified in these pharmacoeconomic analyses. The intensive evaluation process used in the Australian Pharmaceutical Benefits Scheme allowed for identification and correction of pharmacoecomomic analysis problems, but the resources that are required may be beyond the capacity of many organizations, including peer-reviewed journals.
Cyclooxygenase‐2 inhibitors and coronary occlusion – exploring dose–response relationships
Publisher: Wiley
Date: 08-05-2006
Informatics: Make sense of health data
Publisher: Springer Science and Business Media LLC
Date: 11-2015
DOI: 10.1038/527031A
Basic Principles of Clinical Pharmacology Relevant to Pharmacoepidemiology Studies
Publisher: Wiley
Date: 07-03-2006
Monitoring the safety of over the counter drugs
Publisher: BMJ
Date: 28-11-1987
DOI: 10.1136/BMJ.295.6610.1414-B
Abstract: During the prone positioning of patients for scoliosis surgery, bony prominences should be protected to avoid pressure necrosis and the face should be carefully positioned to protect the eyes and ears, etc. The author reports a lower lip necrosis in a 16 year-old female as a complication of improper prone positioning during scoliosis surgery. The condition was treated successfully with an advancement flap.
L‐643.441: an H2‐receptor antagonist with potent and long‐lasting effects in man.
Publisher: Wiley
Date: 08-1985
DOI: 10.1111/J.1365-2125.1985.TB05043.X
Abstract: Submaximal dose pentagastrin tests conducted in normal male volunteers with L-643.441, a novel histamine H2-receptor antagonist, indicate that it is a potent and long-acting inhibitor of gastric acid secretion. The effect appears dose-dependent and single doses of 50 mg are sufficient to reduce secretory potential by at least 50% when examined 24 h after drug administration. No adverse effects attributable to treatment were observed.
Observations from the OMERACT Drug Safety Summit, May 2008
Publisher: The Journal of Rheumatology
Date: 09-2009
Abstract: Due to mounting concern about determination of benefit and risk in the context of product development and clinical practice the OMERACT Executive identified the need to bring together a variety of specialists to define risk. At the Drug Safety Summit held at OMERACT 9, specialists spoke on their given topics and the group considered risk in the context of formally posed questions.
Promoting quality use of medicines in South-East Asia: reports from country situational analyses
Publisher: Springer Science and Business Media LLC
Date: 05-07-2018
The risk of coronary thrombosis with cyclo‐oxygenase‐2 inhibitors does not vary with polymorphisms in two regions of the cyclo‐oxygenase‐2 gene
Publisher: Wiley
Date: 09-09-2011
ENZYME INDUCTION BY EATING CHARCOAL‐GRILLED STEAK WITH NO EFFECT ON BLOOD LIPIDS
Publisher: Wiley
Date: 10-1989
DOI: 10.1111/J.1440-1681.1989.TB01516.X
Abstract: 1. There has been interest in the suggestion that enzyme-inducing drugs, such as anticonvulsants, may produce beneficial changes in lipoprotein levels, in particular a rise in the ratio of high density lipoprotein cholesterol to total cholesterol. 2. This controlled study observed the effects of diets of charcoal or oven-cooked beef on antipyrine clearance (a commonly used measure of drug metabolizing capacity), the apparent oral clearance of phenacetin (a measure of cytochrome P448-dependent enzyme activity) and blood lipids in 18 healthy volunteers. 3. Charcoal-cooked beef increased antipyrine clearance by an average of 20% (P less than 0.059) and increased the apparent oral clearance of phenacetin fivefold (P less than 0.01). In contrast, oven-cooked beef did not significantly alter either measure of microsomal function. Neither diet had any effects on blood lipids. 4. We conclude that the type and degree of enzyme induction achieved by this type of dietary manipulation does not produce beneficial changes in lipoprotein profiles. A previously noted rise in high density lipoprotein cholesterol levels in volunteers fed charcoal-cooked beef may have been due to the effects of charcoal formed by charring of the beef during cooking.
How to Ascertain Drug Safety in the Context of Benefit. Controversies and Concerns: Table 1.
Publisher: The Journal of Rheumatology
Date: 09-2009
Abstract: There is great concern about clearly defining benefit and risk in the context of both drug development and clinical practice. In view of this pressure, the OMERACT Executive identified the need to bring together clinical trialists, pharmacoepidemiologists, clinicians, clinical epidemiologists, statistical experts, and regulatory representatives to discuss different approaches to define risk and perhaps improved ways to express it. Each attendee spoke on a given topic and the group was charged to consider the issue of risk in the context of formally posed questions. This article provides a summary of the presentations and outlines the discussions that followed.
Misleading drug promotion?no sign of improvements
Publisher: Wiley
Date: 19-10-2004
DOI: 10.1002/PDS.953
Patients as a direct source of information on adverse drug reactions
Publisher: BMJ
Date: 08-10-1988
Abstract: To determine whether patients should participate directly in detecting adverse reactions to drugs their ability to provide written reports of symptoms experienced during treatment with amoxycillin or trimethoprim-sulphamethoxazole was investigated. When compared with telephone interviews forms on which patients reported events were reliable (the observed agreement with the same statements posed during telephone calls was 85%, kappa = 0.56) and valid (sensitivity = 54%, specificity = 94%). Patients were also supplied with forms that invited them to report adverse reactions, and their perceptions were compared with those of a panel of experts, who were informed of all clinical events that had been reported during the detailed telephone interviews. Patients were more conservative than the experts in attributing clinical events to drug treatment. The extent of agreement varied and was notably poor for skin and bowel complaints (kappa = 0.13 in each case). The performance of event report forms and reaction report forms as instruments of detection was compared in a hypothetical situation in which the experts' views represented the "truth" about adverse reactions to a new drug. Event reporting had a higher sensitivity than reaction reporting (42% v 24%) but a lower specificity (58% v 98%). National centres monitoring adverse drug reactions should probably resist pressure to accept reports of reactions directly from the public, but a system based on large scale reporting of events might be valuable in aiding the early detection of symptomatic reactions to new drugs.
What are the roles and responsibilities of the media in disseminating health information?
Publisher: Public Library of Science (PLoS)
Date: 26-07-2005
Glucomannan and risk of oesophageal obstruction
Publisher: BMJ
Date: 03-1986
DOI: 10.1136/BMJ.292.6520.591-A
Abstract: Chronopharmacology studies the effect of the timing of drug administration on drug effect. Here, we measured the influence of 4 timing moments on fentanyl-induced antinociception in healthy volunteers. Eight subjects received 2.1 μg/kg intravenous fentanyl at 2 pm and 2 am, with at least 2 weeks between occasions, and 8 others at 8 am and 8 pm. Heat pain measurements using a thermode placed on the skin were taken at regular intervals for 3 hours, and verbal analog scores (VAS) were then obtained. The data were modeled with a sinusoid function using the statistical package NONMEM. The study was registered at trialregister.nl under number NTR1254. A significant circadian sinusoidal rhythm in the antinociceptive effect of fentanyl was observed. Variations were observed for peak analgesic effect, duration of effect, and the occurrence of hyperalgesia. A peak in pain relief occurred late in the afternoon (5:30 pm) and a trough in the early morning hours (5:30 am). The difference between the peak and trough in pain relief corresponds to a difference in VAS of 1.3-2 cm. Only when given at 2 am, did fentanyl cause a small but significant period of hyperalgesia following analgesia. No significant changes were observed for baseline pain, sedation, or the increase in end-tidal CO(2). The variations in fentanyl's antinociceptive behavior are well explained by a chronopharmacodynamic effect originating at the circadian clock in the hypothalamus. This may be a direct effect through shared pathways of the circadian and opioid systems or an indirect effect via diurnal variations in hormones or endogenous opioid peptides that rhythmically change the pain response and/or analgesic response to fentanyl.
Ranitidine in acute upper gastrointestinal haemorrhage
Publisher: BMJ
Date: 27-11-1982
DOI: 10.1136/BMJ.285.6354.1575-B
Abstract: Copolymer-1 (Cop-1) is a peptide with immunomodulatory properties, approved by the Food and Drug Administration of United States in the treatment of multiple sclerosis. Cop-1 has been shown to exert neuroprotective effects and induce neurogenesis in cerebral ischemia models. Nevertheless, the mechanism involved in the neurogenic action of this compound remains unknown. The choroid plexus (CP) is a network of cells that constitute the interphase between the immune and central nervous systems, with the ability to mediate neurogenesis through the release of cytokines and growth factors. Therefore, the CP could play a role in Cop-1-induced neurogenesis. In order to determine the participation of the CP in the induction of neurogenesis after Cop-1 immunization, we evaluated the gene expression of various growth factors (brain-derived neurotrophic factor, insulin-like growth factor 1, neurotrophin-3) and cytokines (tumor necrosis factor alpha, interferon-gamma, interleukin-4 (IL-4), IL-10 and IL-17), in the CP at 14 days after ischemia. Furthermore, we analyzed the correlation between the expression of these genes and neurogenesis. Our results showed that Cop-1 was capable of stimulating an upregulation in the expression of the genes encoding for brain-derived neurotrophic factor, insulin-like growth factor 1, neurotrophin-3 and IL-10 in the CP, which correlated with an increase in neurogenesis in the subventricular and subgranular zone. As well, we observed a downregulation of IL-17 gene expression. This study demonstrates the effect of Cop-1 on the expression of growth factors and IL-10 in the CP, in the same way, presents a possible mechanism involved in the neurogenic effect of Cop-1.
A population-based study of the drug interaction between proton pump inhibitors and clopidogrel
Publisher: CMA Joule Inc.
Date: 31-03-2009
DOI: 10.1503/CMAJ.082001
Frequency and pattern of radionuclide administration to medical patients in a general hospital
Publisher: Springer Science and Business Media LLC
Date: 1977
DOI: 10.1007/BF00257268
EARLY EXPERIENCE WITH A VERTICAL SPINNING-DISC NEBULISER
Publisher: Elsevier BV
Date: 09-1981
Drug prices and value for money: The Australian Pharmaceutical Benefits Scheme
Publisher: American Medical Association (AMA)
Date: 23-11-2005
Commentary: Renewed controversy over cardiovascular risk with non-steroidal anti-inflammatory drugs
Publisher: Oxford University Press (OUP)
Date: 29-01-2018
DOI: 10.1093/IJE/DYX284
A prompt to the web: The media and health information seeking behaviour
Publisher: Public Library of Science (PLoS)
Date: 03-04-2012
Development of hematopoietic cancers after implantation of total joint replacement
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-1996
DOI: 10.1097/00003086-199608001-00026
Abstract: The evidence from the 4 epidemiologic studies published before mid 1995, which have investigated the incidence of cancers in patients who have undergone joint implants, is conflicting. The results of the 2 earlier studies suggested a sustained increase in the risk of lymphoma and leukemia after total hip arthroplasty. The results of the 2 more recent studies have not confirmed this, although in 1 study an increased risk was observed in the first year after implantation. The heterogeneity may be statistical in origin, but could also have a biologic explanation in the greater proportion of metal on metal prostheses used before 1973. All 4 studies used national data as the comparison. Here, are presented the results of 2 matched cohort studies and a case control study set in North America and Scotland, and an overview of the 4 previous studies. Neither the results of the matched studies of patients operated on after 1973 nor the results of the latter 2 published studies suggest an increased risk of lymphoma or leukemia. If metal on metal articulations are reintroduced, careful surveillance is essential.
[14C]aminopyrine breath analysis and conventional biochemical tests as predictors of survival in cirrhosis
Publisher: Springer Science and Business Media LLC
Date: 09-1985
DOI: 10.1007/BF01309509
Abstract: The relationship between Fas -1377 G/A polymorphism and cancer susceptibility has been implicated in accumulating data. However, the data presented inconsistent results. This study was devised to investigate the association of Fas -1377 G/A polymorphism and cancer susceptibility in a large number of participants. The databases of PubMed, Embase, and Web of Science were searched and a total of 27 case-control studies including 13,355 cases and 16,078 controls were included in this meta-analysis. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed-effects model. Statistical analyses were performed by using Stata software. The results suggested that Fas -1377 G/A polymorphism was overall associated with cancer susceptibility (additive model: OR, 1.16, 95%CI = 1.06-1.27, Pheterogeneity = 0.381 recessive model: OR, 1.19, 95%CI = 1.10-1.29, Pheterogeneity= 0.137). In the subgroup analysis by cancer type, significantly increased risk was observed in breast cancer (additive model: OR, 1.24, 95%CI = 1.04-1.58, Pheterogeneity = 0.614 recessive model: OR, 1.24, 95%CI = 1.02-1.51, Pheterogeneity = 0.349) and lung cancer (recessive model: OR, 1.25, 95%CI = 1.04-1.49, Pheterogeneity = 0.090). Similarly, elevated cancer risk associated with Fas -1377 G/A polymorphism was revealed in Asians. The combined results suggest that Fas -1377 G/A polymorphism might modulate cancer susceptibility in an Asian-specific manner.
Acute respiratory failure and CNS-depressing drugs
Publisher: Oxford University Press (OUP)
Date: 05-1981
Abstract: Data from a drug surveillance programme were analysed to estimate the frequency with which patients with a diagnosis of respiratory failure had been exposed to CNS-depressing drugs. Eleven out of 37 patients with respiratory failure had received such medication. A detailed comparison of these patients and controls admitted to hospital because of respiratory disease who did not develop respiratory failure failed to reveal significant differences in drug usage. This unexpected finding suggests that patients with respiratory disease of equal severity may vary greatly in their tendency to develop carbon dioxide retention following administration of drugs with respiratory depressant properties.
Published pharmacoeconomic analyses: science or marketing?
Publisher: Wiley
Date: 09-2003
Effectiveness of COVID‐19 vaccines: findings from real world studies
Publisher: AMPCo
Date: 22-07-2021
DOI: 10.5694/MJA2.51182
Recent trends in the prescribing of cholesterol lowering drugs in Australia. A report from the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee
Publisher: AMPCo
Date: 09-1991
DOI: 10.5694/J.1326-5377.1991.TB142294.X
Abstract: To determine the recent pattern of use of hypolipidaemic drugs in the Australian community. Drug utilisation study employing prescription data collected during the operation of the Australian Pharmaceutical Benefits Scheme (PBS). Non-hospital drug use in Australia. All patients, pensioners and non-pensioners, who received prescriptions for hypolipidaemic agents under the PBS between January 1987 and December 1989. The total number of prescriptions, average quantity dispensed with each prescription, defined daily doses (DDD) and Australian population figures for pensioners and non-pensioners were used to express the consumption of hypolipidaemic agents as DDD/1000 in iduals/day. Between the March quarter 1987 and the December quarter 1989 prescribing of hypolipidaemics for the Australian community increased from 68,120 to 304,760 prescriptions per quarter, which translates to a rise in use from 1.2 to 5.2 DDD/1000 inhabitants/day. This included a rise in the use of clofibrate from 0.6 to 2.6 DDD/1000 inhabitants/day, and of cholestyramine from 0.6 to 1.9 DDD/1000 inhabitants/day. Prescribing of hypolipidaemics for pensioners increased from 29,569 to 123,440 prescriptions per quarter. This translated into a rise in use from 3.7 to 14.8 DDD/1000 pensioners/day. Notable rises were seen for clofibrate, 1.9 to 8.1 DDD/1000 pensioners/day, and cholestyramine, 1.6 to 4.7 DDD/1000 pensioners/day. In comparison published data from the Nordic countries and the United States showed a lower overall use of hypolipidaemics and declining consumption of clofibrate. The trend in Australia was unusual in that the use of clofibrate increased to a greater extent than that of the resins, cholestyramine and colestipol which are generally preferred for treatment of hypercholesterolaemia. Possible reasons for this include: the better tolerability of clofibrate its readier availability during the study period the recommendation by the Pharmaceutical Benefits Advisory Committee that clofibrate was the preferred drug when triglyceride levels were also elevated and the limited availability of newer hypolipidaemic agents.
Personal formularies: An index of prescribing quality?
Publisher: Springer Science and Business Media LLC
Date: 07-2001
Abstract: (1) To determine the extent to which Australian general practitioners (GPs) restrict the numbers of agents they prescribe within a drug class ('personal formularies') (2) To assess concordance of these drug choices with standards based on established guidelines or recognised good prescribing practices (3) To assess the potential of these measures as indicators of the quality of prescribing. Australian Health Insurance Commission (HIC) prescription data (1994 1997) for around 15,400 GPs providing 1500 or more Medicare services per year were analysed. Measures of an in idual GP's use of a personal formulary (determined by number of agents) and concordance with prescribing criteria based on specified drugs for five classes of commonly prescribed drugs were derived. Non-steroidal anti-inflammatory drugs (NSAIDs): GP concordance was higher with a non-specified personal formulary (any five NSAIDs) than with a list of specified drugs (five NSAIDs of 'low' or 'medium' risk of gastrointestinal toxicity), and concordance with both increased over time. In 1997, around 70% of GPs used five or fewer NSAIDs for 90% of their prescribing 47% of GPs had 90% of prescribing from five selected agents. Angiotensin converting enzyme inhibitors/angiotensin-II receptor antagonists: The introduction of new agents appeared to increase the size of the GPs' personal formularies, and concordance with defined standards decreased over time. Antibacterial agents: Concordance with a specified drug standard (nine drugs listed in the Australian Antibiotic Guidelines) increased substantially over time but was largely due to increased prescribing of two heavily promoted drugs. Beta-blocking agents: Over time, GPs restricted most prescribing to two agents, atenolol and metoprolol. Calcium channel blockers: GPs did not appear to restrict prescribing of these drugs most GPs prescribed all five agents available. Australian GPs use 'personal formularies'. Formulary size varies with the drug class, can change over time as new agents become available, and its contents can be influenced by promotional activities. Prescribing standards based on numbers of drugs used may not always reflect rational prescribing choices. Criteria based on specified drugs provide more rigorous prescribing standards, but may give a misleading picture of prescribing quality in the absence of information on patients and the indications for treatment. Personal formulary measures are potentially useful prescribing indicators but need to be carefully defined and interpreted. GPs should be encouraged to identify their personal formularies and review the drugs included in them.
Attitudes of physicians and public to pharmaceutical industry ‘gifts’
Publisher: Wiley
Date: 05-2010
DOI: 10.1111/J.1445-5994.2010.02233.X
Abstract: Few studies have reported the attitudes of both in idual doctors and members of the public toward the appropriateness of 'gifts' from pharmaceutical companies. To investigate the attitudes of both doctors and members of the public toward the appropriateness of receiving particular 'gifts' from pharmaceutical companies, and to consider whether public acceptability is a suitable criterion for determining the ethical appropriateness of 'gifts'. A survey questionnaire of medical specialists in Australia and a survey questionnaire of members of the public itemized 23 'gifts' (valued between AU$10 and AU$2500) and asked whether or not each was appropriate. Both medical specialists and members of the public believe certain 'gifts' from pharmaceutical companies are appropriate but not others. There was a tendency for members of the public to be more permissive than medical specialists. Although some professional guidelines place importance on the attitudes of the general public to 'gift' giving, and other guidelines give importance to a need for transparency and public accountability, we question whether public acceptability is a suitable criterion for determining the ethical appropriateness of 'gifts'. We suggest that more weight be given to the need for independence of clinical decision making, with empirical evidence indicating that even small 'gifts' can bias clinicians' judgments, and to important values such as the primacy of patient welfare, autonomy and social justice. We conclude that it is time to eliminate giving and receiving of promotional items between the pharmaceutical industry and members of health professions.
Differential pricing of drugs: a role for cost-effectiveness analysis?
Publisher: Elsevier BV
Date: 06-2002
Durable efficacy of metformin/glibenclamide* combination tablets (Glucovance®) during 52 weeks of open-label treatment in type 2 diabetic patients with hyperglycaemia despite previous sulphonylurea mo
Publisher: Hindawi Limited
Date: 20-10-2004
DOI: 10.1111/J.1742-1241.2004.00316.X
Abstract: Oral anti-diabetic combinations that address insulin resistance and beta-cell dysfunction (e.g. metformin and glibenclamide) represent a rational therapeutic option for patients uncontrolled on monotherapy. A 52-week, open-label extension to a double-blind study evaluated metformin-glibenclamide combination tablets (Glucovance) in 477 patients with hyperglycaemia despite sulphonylurea therapy. Reductions in HbA1C were maintained, with a mean reduction of -1.7% after 52 weeks, compared with the baseline value for the double-blind trial. Eighty-five patients receiving 4 x 500 mg/2.5 mg tablets daily displayed a marked improvement in HbA1c following up-titration to a regimen of 2 x 500 mg/2.5 mg + 3 x 500 mg/5 mg tablets. Lipid profiles improved significantly. The combination tablets were well tolerated: 11.1% of patients reported hypoglycaemic symptoms (all either mild or moderate severity). No patient withdrew or required pharmacologic intervention for hypoglycaemia. Metformin-glibenclamide combination tablets are an effective and well-tolerated therapeutic option for intensifying oral anti-diabetic therapy.
An analysis of news media coverage of complementary and alternative medicine.
Publisher: Public Library of Science (PLoS)
Date: 11-06-2008
Systematic review of autologous transfusion techniques
Publisher: Wiley
Date: 06-2005
Omeprazole: effects on oxidative drug metabolism.
Publisher: Wiley
Date: 08-1984
DOI: 10.1111/J.1365-2125.1984.TB02452.X
Abstract: Omeprazole, a substituted benzimidazole, and a potent inhibitor of gastric parietal cell H+/K+ ATPase, was tested for drug interactions at two dose levels (30 mg and 60 mg/day) in man using the model drugs [14C]-aminopyrine and antipyrine. Elimination of both models was assessed before and after 15 days treatment with omeprazole. In addition [14C]-aminopyrine metabolism was assessed on day 2 of treatment to investigate the rapidity of onset of any effect. In 10 healthy male volunteers omeprazole 60 mg/day for 14 days prolonged aminopyrine 14CO2 half life (t1/2), measured on the 15th day, by 21% (P less than 0.05), and reduced percent dose demethylated in 2 h (ABT2) by 19% (P less than 0.005). No effect was seen on day 2 of therapy. After 14 days treatment antipyrine half-life was prolonged by 10% (P less than 0.025) and clearance was reduced by 14% (P = 0.063). In nine healthy male volunteers omeprazole 30 mg/day for 14 days prolonged aminopyrine 14CO2 by 13% and reduced ABT2 by 11%. Both changes just failed to reach statistical significance. At this dose antipyrine metabolism was unaltered. As the dose of omeprazole used in clinical practice may be less than 30 mg/day it is unlikely that metabolic inhibition will occur during routine use, although it will be necessary to test for interactions with therapeutically more important compounds. Interactions should be looked for when large doses of omeprazole are being used to treat hypersecretory states.
What are the Roles and Responsibilities of the Media in Disseminating Health Information?
Publisher: Apple Academic Press
Date: 15-04-2011
DOI: 10.1201/B13122-13
Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placeb
Publisher: Elsevier BV
Date: 06-2020
Propranolol steady-state pharmacokinetics are unaltered by omeprazole
Publisher: Springer Science and Business Media LLC
Date: 1987
DOI: 10.1007/BF00637632
Abstract: Understanding translational control in gene expression relies on precise and comprehensive determination of translation initiation sites (TIS) across the entire transcriptome. The recently developed ribosome-profiling technique enables global translation analysis, providing a wealth of information about both the position and the density of ribosomes on mRNAs. Here we present an approach, global translation initiation sequencing, applying in parallel the ribosome E-site translation inhibitors lactimidomycin and cycloheximide to achieve simultaneous detection of both initiation and elongation events on a genome-wide scale. This approach provides a view of alternative translation initiation in mammalian cells with single-nucleotide resolution. Systemic analysis of TIS positions supports the ribosome linear-scanning mechanism in TIS selection. The alternative TIS positions and the associated ORFs identified by global translation initiation sequencing are conserved between human and mouse cells, implying physiological significance of alternative translation. Our study establishes a practical platform for uncovering the hidden coding potential of the transcriptome and offers a greater understanding of the complexity of translation initiation.
Burden of health behaviours and socioeconomic position on health care expenditure in Ontario
Publisher: F1000 Research Ltd
Date: 16-10-2019
DOI: 10.12688/F1000RESEARCH.18205.2
Abstract: Background: Smoking, unhealthy alcohol consumption, poor diet and physical inactivity are leading risk factors for morbidity and mortality, and contribute substantially to overall healthcare costs. The availability of health surveys linked to health care provides population-based estimates of direct healthcare costs. We estimated health behaviour and socioeconomic-attribute healthcare costs, and how these have changed during a period when government policies have aimed to reduce their burden. Methods: The Ontario s les of the Canadian Community Health Surveys (conducted in 2003, 2005, and 2007-2008) were linked at the in idual level to all records of health care use of publicly funded healthcare. Generalized linear models were estimated with a negative binomial distribution to ascertain the relationship of health behaviours and socioeconomic risk factors on health care costs. The multivariable cost model was applied to unlinked, Ontario CCHS s les for each year from 2004 to 2013 to examine the evolution of health behaviour and socioeconomic-attributable direct health care expenditures over a 10-year period. Results: We included 80,749 respondents, aged 25 years and older, and 312,952 person-years of follow-up. The cost model was applied to 200,324 respondents aged 25 years and older (CCHS 2004 to 2013). During the 10-year period from 2004 to 2013, smoking, unhealthy alcohol consumption, poor diet and physical inactivity attributed to 22% of Ontario’s direct health care costs. Ontarians in the most disadvantaged socioeconomic position contributed to 15% of the province’s direct health care costs. Combined, these health behaviour and socioeconomic risk factors were associated with 34% ($134 billion) of direct health care costs (2004 to 2013). Over this time period, we estimated a 1.9% reduction in health care expenditure ($5.0 billion) attributable to improvements in some health behaviours, most importantly reduced rates of smoking. Conclusions: Adverse health behaviours and socioeconomic position cause a large direct health care system cost burden.
Burden of health behaviours and socioeconomic position on health care expenditure in Ontario
Publisher: F1000 Research Ltd
Date: 18-03-2019
DOI: 10.12688/F1000RESEARCH.18205.1
Abstract: Background: Smoking, unhealthy alcohol consumption, poor diet and physical inactivity are leading risk factors for morbidity and mortality, and contribute substantially to overall healthcare costs. The availability of health surveys linked to health care provides population-based estimates of direct healthcare costs. We estimated health behaviour and socioeconomic-attribute healthcare costs, and how these have changed during a period when government policies have aimed to reduce their burden. Methods: The Ontario s les of the Canadian Community Health Surveys (conducted in 2003, 2005, and 2007-2008) were linked at the in idual level to all records of health care use of publicly funded healthcare. Generalized linear models were estimated with a negative binomial distribution to ascertain the relationship of health behaviours and socioeconomic risk factors on health care costs. The multivariable cost model was then applied to unlinked, cross-sectional CCHS s les for each year from 2004 to 2013 to examine the evolution of health behaviour and socioeconomic-attributable direct health care expenditures over a 10-year period. Results: We included 80,749 respondents, aged 25 years and older, and 312,952 person-years of follow-up. The cost model was applied to 200,324 respondents aged 25 years and older (CCHS 2004 to 2013). During the 10-year period from 2004 to 2013, smoking, unhealthy alcohol consumption, poor diet and physical inactivity attributed to 22% of Ontario’s direct health care costs. Ontarians in the most disadvantaged socioeconomic position contributed to 15% of the province’s direct health care costs. Taken together, health behaviours and socioeconomic position were associated with 34% ($134 billion) of direct health care costs (2004 to 2013). Over this time period, we estimated a 1.9% reduction in health care expenditure ($5.0 billion) attributable to improvements in some health behaviours, most importantly reduced rates of smoking. Conclusions: Health behaviours and socioeconomic position cause a large direct health care system cost burden.
Regional variation of premature mortality in Ontario, Canada: a spatial analysis
Publisher: Springer Science and Business Media LLC
Date: 31-07-2019
Agreement between two measures of drug use in a low-prevalence population
Publisher: Elsevier BV
Date: 1991
DOI: 10.1016/0306-4603(91)90058-P
Abstract: The present study examined the agreement between two measures of prevalence of drug use in the community: self-report and specific pharmacological analyses of urine s les. The data were collected in the context of a random community survey of health practices and attitudes. A random 20% of the households participating in the health study were targeted for biochemical assay. Compliance with urine delivery was relatively high at 79%. Urine s les were screened qualitatively for cannabinoids and benzodiazepines using the enzyme multiplied immunoassay technique (EMIT) (Syva Diagnostics, Palo Alto, CA). Screening for pharmaceuticals used a standard thin-layer chromatography (TLC) technique. Agreement between the self-report and biochemical assay estimates of prevalence was statistically significant (p less than .05). While self-report of substance use is not a perfect measure of consumption, it remains a relatively economical and reasonably accurate method of obtaining estimates of substance use in community s les.
La déclaration RECORD (Reporting of Studies Conducted Using Observational Routinely Collected Health Data) : directives pour la communication des études réalisées à partir de données de santé collecté
Publisher: CMA Impact Inc.
Date: 25-02-2019
DOI: 10.1503/CMAJ.181309
Cardiovascular risk with non-steroidal anti-inflammatory drugs
Publisher: Public Library of Science (PLoS)
Date: 27-09-2011
Coverage with evidence development: The Ontario experience
Publisher: Cambridge University Press (CUP)
Date: 04-2011
DOI: 10.1017/S0266462311000018
Abstract: Background: For non-drug technologies, there is often residual uncertainty following systematic review, mainly due to inadequate evidence of efficacy. The unwillingness to make decisions in the presence of uncertainty may lead to passive diffusion and intuitive decision making with or without public pressure. This may affect health system sustainability. There is increasing interest in post-market evaluation through processes that include coverage with evidence development (CED) to address residual uncertainty regarding effectiveness and cost-effectiveness. Global experience of CED has been slow to develop despite their potential contribution to decision making. Methods: Ontario's field evaluation program to better inform decision making represents a collaboration between physicians, policy decision makers and academic centers. We report results of the first ten CEDs from this program to assess whether they achieved their objective of influencing policy by addressing residual uncertainty following systematic review. Results: Since 2003, nineteen field evaluation studies to resolve residual uncertainty following systematic review have been completed, ten of which met the criteria of CED and are the focus of this report. There was more than one patient subgroup or intervention in three of the CEDs. This provided the basis for evaluating thirteen outcomes. In each case, the CED addressed the uncertainty and led to a decision based on the systematic review and CED result. The CEDs led to adoption of the technology in six instances, modified adoption in three instances and withdrawal in four instances. Conclusions: CED makes an important contribution to translating evidence to decision making. Methodologies are needed to increase the scope and reduce timelines for CEDs, such as the use of linked comprehensive and robust data sets and collaborative studies with other jurisdictions. CED before making long-term funding decisions, especially where there is uncertainty of effectiveness, safety or cost-effectiveness, should be increasingly funded by health systems.
GASTROINTESTINAL HAEMORRHAGE. Fibrinolysis and upper gastrointestinal bleeding
Publisher: Elsevier BV
Date: 02-1993
Media reporting of health interventions: signs of improvement, but major problems persist.
Publisher: Public Library of Science (PLoS)
Date: 18-03-2009
AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both
Publisher: BMJ
Date: 21-09-2017
DOI: 10.1136/BMJ.J4008
Using Evidence to Combat Overdiagnosis and Overtreatment: Evaluating Treatments, Tests, and Disease Definitions in the Time of Too Much
Publisher: Public Library of Science (PLoS)
Date: 07-2014
Ethics and evidence based medicine
Publisher: BMJ
Date: 11-04-1998
DOI: 10.1136/BMJ.316.7138.1151
Abstract: Ehlers-Danlos syndrome (EDS) is a rare, genetically variable, heterogenous group of (currently recognized) thirteen connective tissue disorders characterized by skin hyperextensibility, tissue fragility, and generalized joint hypermobility. In addition to these commonly recognized phenotypes, recent studies have notably highlighted variable ophthalmic features in EDS. In this review, we comprehensively gather and discuss the ocular manifestations of EDS and its thirteen subtypes in the clinical setting.
Does it matter who writes medical news stories?
Publisher: Public Library of Science (PLoS)
Date: 14-09-2010
Generating real-world evidence on the quality use, benefits and safety of medicines in australia: history, challenges and a roadmap for the future
Publisher: MDPI AG
Date: 18-12-2021
Abstract: Australia spends more than $20 billion annually on medicines, delivering significant health benefits for the population. However, inappropriate prescribing and medicine use also result in harm to in iduals and populations, and waste of precious health resources. Medication data linked with other routine collections enable evidence generation in pharmacoepidemiology the science of quantifying the use, effectiveness and safety of medicines in real-world clinical practice. This review details the history of medicines policy and data access in Australia, the strengths of existing data sources, and the infrastructure and governance enabling and impeding evidence generation in the field. Currently, substantial gaps persist with respect to cohesive, contemporary linked data sources supporting quality use of medicines, effectiveness and safety research exemplified by Australia’s limited capacity to contribute to the global effort in real-world studies of vaccine and disease-modifying treatments for COVID-19. We propose a roadmap to bolster the discipline, and population health more broadly, underpinned by a distinct capability governing and streamlining access to linked data assets for accredited researchers. Robust real-world evidence generation requires current data roadblocks to be remedied as a matter of urgency to deliver efficient and equitable health care and improve the health and well-being of all Australians.
14C aminopyrine breath test: a detailed examination
Publisher: BMJ
Date: 10-1979
New drugs for peptic ulcer
Publisher: Wiley
Date: 09-1984
DOI: 10.5694/J.1326-5377.1984.TB113104.X
Abstract: [This corrects the article DOI: 10.1055/s-0043-123468.].
Aspirin use in children: heeding the warning?
Publisher: Wiley
Date: 12-02-2010
DOI: 10.1111/J.1753-6405.1992.TB00022.X
Abstract: In 1986, the Australian Government issued warnings about the use of aspirin for children and adolescents after the link had been established between aspirin use and Reye's syndrome in America. This study questioned a representative community s le of parents in Newcastle, New South Wales, about their awareness of this caution, and their recent aspirin use for children under 18 years. While 65% of women and 47% of men reported that they were aware of the Government recommendations, only 8% of women and 9% of men reported obtaining this information from the printed warning on the medicine container or packet. Despite awareness of the warnings, almost one third of parents reported administering aspirin to their children. When it is necessary to caution patients about the use of over-the-counter medications, it is not sufficient to use package labelling as the main site of information.
Male-biased infant sex ratios and patterns of induced abortion
Publisher: CMA Joule Inc.
Date: 11-04-2016
DOI: 10.1503/CMAJ.160183
Effects of information framing on the intentions of family physicians to prescribe long-term hormone replacement therapy
Publisher: Springer Science and Business Media LLC
Date: 10-1999
DOI: 10.1046/J.1525-1497.1999.09028.X
Abstract: To determine whether the way in which information on benefits and harms of long-term hormone replacement therapy (HRT) is presented influences family physicians' intentions to prescribe this treatment. Family physicians were randomized to receive information on treatment outcomes expressed in relative terms, or as the number needing to be treated (NNT) with HRT to prevent or cause an event. A control group received no information. Primary care. Family physicians practicing in the Hunter Valley, New South Wales, Australia. Estimates of the impact of long-term HRT on risk of coronary events, hip fractures, and breast cancer were summarized as relative (proportional) decreases or increases in risk, or as NNT. Intention to prescribe HRT for seven hypothetical patients was measured on Likert scales. Of 389 family physicians working in the Hunter Valley, 243 completed the baseline survey and 215 participated in the randomized trial. Baseline intention to prescribe varied across patients-it was highest in the presence of risk factors for hip fracture, but coexisting risk factors for breast cancer had a strong negative influence. Overall, a larger proportion of subjects receiving information expressed as NNT had reduced intentions, and a smaller proportion had increased intentions to prescribe HRT than those receiving the information expressed in relative terms, or the control group. However, the differences were small and only reached statistical significance for three hypothetical patients. Framing effects were minimal when the hypothetical patient had coexisting risk factors for breast cancer. Information framing had some effect on family physicians' intentions to prescribe HRT, but the effects were smaller than those previously reported, and they were modified by the presence of serious potential adverse treatment effects.
Blood transfusion and autologous donation: A survey of post-surgical patients, interest group members and the public
Publisher: Wiley
Date: 02-2005
DOI: 10.1111/J.1365-3148.2005.00544.X
Abstract: Before planned surgery, patients may choose autologous donation in order to avoid the small, but potential, risks of receiving an allogeneic blood transfusion. This study examined the perceived risks of allogeneic blood transfusions, preferences and willingness to pay for autologous donation and the desired role in the decision-making process in three populations: post-surgical patients, special interest group members and the general public. Quantitative and qualitative data were collected from 206 respondents with the help of computer-assisted semi-structured telephone interviews. Thirty-three per cent of the s le voiced concerns about receiving allogeneic blood transfusions. The risks of hepatitis C virus, human immunodeficiency virus, variant Creutzfeldt-Jakob disease and a haemolytic reaction were perceived as being low, but were rated as numerically higher than those of other life events that have equal probability. Autologous donation was perceived as removing all the risks associated with transfusion, and respondents were willing to pay a median $976 AUD ($664 US) to use this technique. Over 80% of respondents preferred to be involved in making the decision about whether to use autologous donation. Even though autologous donation is not 'risk-free' and the blood supply is very safe, people overestimate the associated risks and have a preference for their own blood. Decision aids presenting balanced information on the advantages and disadvantages of both allogeneic and autologous blood may be required.
Changes in dispensing of medicines proposed for re-purposing in the first year of the COVID-19 pandemic in Australia
Publisher: Public Library of Science (PLoS)
Date: 15-06-2022
DOI: 10.1371/JOURNAL.PONE.0269482
Abstract: Since COVID-19 was first recognised, there has been ever-changing evidence and misinformation around effective use of medicines. Understanding how pandemics impact on medicine use can help policymakers act quickly to prevent harm. We quantified changes in dispensing of common medicines proposed for “re-purposing” due to their perceived benefits as therapeutic or preventive for COVID-19 in Australia. We performed an interrupted time series analysis and cross-sectional study using nationwide dispensing claims data (January 2017-November 2020). We focused on six subsidized medicines proposed for re-purposing: hydroxychloroquine, azithromycin, ivermectin, colchicine, corticosteroids, and calcitriol (Vitamin D analog). We quantified changes in monthly dispensing and initiation trends during COVID-19 (March-November 2020) using autoregressive integrated moving average models and compared characteristics of initiators in 2020 and 2019. In March 2020, we observed a 99% (95%CI: 96%-103%) increase in hydroxychloroquine dispensing (approximately 22% attributable to new users), and a 199% increase (95%CI: 184%-213%) in initiation, with an increase in prescribing by general practitioners (42% in 2020 vs 25% in 2019) rather than specialists. These increases subsided following regulatory restrictions on prescribing. There was a small but sustained increase in ivermectin dispensing over multiple months, with an 80% (95%CI 42%-118%) increase in initiation in May 2020 following its first identification as potentially disease-modifying in April. Other than increases in March related to stockpiling, we observed no change in the initiation of calcitriol or colchicine during COVID-19. Dispensing of corticosteroids and azithromycin was lower than expected from April through November 2020. While most increases in dispensing observed early on during COVID-19 were temporary and appear to be related to stockpiling among existing users, we observed increases in the initiation of hydroxychloroquine and ivermectin and a shift in prescribing patterns which may be related to the media hype around these medicines. A quick response by regulators can help limit inappropriate repurposing to lessen the impact on medicine supply and patient harm.
The association between psychostimulant use in pregnancy and adverse maternal and neonatal outcomes: results from a distributed analysis in two similar jurisdictions.
Publisher: Oxford University Press (OUP)
Date: 22-09-2022
DOI: 10.1093/IJE/DYAC180
Abstract: Conflicting evidence suggests a possible association between use of prescribed psychostimulants during pregnancy and adverse perinatal outcomes. We conducted population-based cohort studies including pregnancies conceived between April 2002 and March 2017 (Ontario, Canada N = 554 272) and January 2003 to April 2011 [New South Wales (NSW), Australia N = 139 229]. We evaluated the association between exposure to prescription hetamine, methylphenidate, dextro hetamine or lisdexamfetamine during pregnancy and pre-ecl sia, placental abruption, preterm birth, low birthweight, small for gestational age and neonatal intensive care unit admission. We used inverse probability of treatment weighting based on propensity scores to balance measured confounders between exposed and unexposed pregnancies. Additionally, we restricted the Ontario cohort to social security beneficiaries where supplementary confounder information was available. In Ontario and NSW respectively, 1360 (0.25%) and 146 (0.10%) pregnancies were exposed to psychostimulants. Crude analyses indicated associations between exposure and nearly all outcomes [OR range 1.15–2.16 (Ontario) 0.97–2.20 (NSW)]. Nearly all associations were attenuated after weighting. Pre-ecl sia was the exception: odds remained elevated in the weighted analysis of the Ontario cohort (OR 2.02, 95% CI 1.42–2.88), although some attenuation occurred in NSW (weighted OR 1.50, 95% CI 0.77–2.94) and upon restriction to social security beneficiaries (weighted OR 1.24, 95% CI 0.64–2.40), and confidence intervals were wide. We observed higher rates of outcomes among exposed pregnancies, but the attenuation of associations after adjustment and likelihood of residual confounding suggests psychostimulant exposure is not a major causal factor for most measured outcomes. Our findings for pre-ecl sia were inconclusive exposed pregnancies may benefit from closer monitoring.
Sex ratios among Canadian liveborn infants of mothers from different countries
Publisher: CMA Joule Inc.
Date: 16-04-2012
DOI: 10.1503/CMAJ.120165
Cardiovascular Risk and Inhibition of Cyclooxygenase
Publisher: American Medical Association (AMA)
Date: 04-10-2006
DOI: 10.1001/JAMA.296.13.JRV60011
Abstract: Evidence that rofecoxib increases the risk of myocardial infarction has led to scrutiny of other nonsteroidal anti-inflammatory drugs (NSAIDs). Regulatory agencies have provided variable advice regarding the cardiovascular risks with older nonselective NSAIDs. To undertake a systematic review and meta-analysis of controlled observational studies to compare the risks of serious cardiovascular events with in idual NSAIDs and cyclooxygenase 2 inhibitors. Searches were conducted of electronic databases (1985-2006), scientific meeting proceedings, epidemiological research Web sites, and bibliographies of eligible studies. Eligible studies were of case-control or cohort design, reported on cardiovascular events (predominantly myocardial infarction) with cyclooxygenase 2 inhibitor, NSAID use, or both with nonuse/remote use of the drugs as the reference exposure. Of 7086 potentially eligible titles, 17 case-control and 6 cohort studies were included. Thirteen studies reported on cyclooxygenase 2 inhibitors, 23 on NSAIDs, and 13 on both groups of drugs. Two people independently extracted data and assessed study quality with disagreements resolved by consensus. Data were combined using a random-effects model. A dose-related risk was evident with rofecoxib, summary relative risk with 25 mg/d or less, 1.33 (95% confidence interval [CI], 1.00-1.79) and 2.19 (95% CI, 1.64-2.91) with more than 25 mg/d. The risk was elevated during the first month of treatment. Celecoxib was not associated with an elevated risk of vascular occlusion, summary relative risk 1.06 (95% CI, 0.91-1.23). Among older nonselective drugs, diclofenac had the highest risk with a summary relative risk of 1.40 (95% CI, 1.16-1.70). The other drugs had summary relative risks close to 1: naproxen, 0.97 (95% CI, 0.87-1.07) piroxicam, 1.06 (95% CI, 0.70-1.59) and ibuprofen, 1.07 (95% CI, 0.97-1.18). This review confirms the findings from randomized trials regarding the risk of cardiovascular events with rofecoxib and suggests that celecoxib in commonly used doses may not increase the risk, contradicts claims of a protective effect of naproxen, and raises serious questions about the safety of diclofenac, an older drug.
Access to routinely collected data for population health research: experiences in Canada and Australia
Publisher: Elsevier BV
Date: 10-2018
Glyburide/metformin combination product is safe and efficacious in patients with type 2 diabetes failing sulphonylurea therapy
Publisher: Wiley
Date: 30-10-2002
DOI: 10.1046/J.1463-1326.2002.00229.X
Abstract: To compare the efficacy, safety and tolerability of a fixed combination glyburide/metformin preparation with those of glyburide or metformin alone in patients with type 2 diabetes inadequately controlled by sulphonylurea, diet and exercise. In this 16-week, randomized, double-blind, parallel group study, 639 patients with inadequate glycaemic control on at least half-maximal dose of sulphonylurea were randomly assigned to: glyburide 10 mg b.i.d. (n = 164) metformin 500 mg (n = 153) glyburide/metformin 2.5 mg/500 mg (n = 160) or glyburide/metformin 5 mg/500 mg (n = 162). Titration was allowed to maximum doses of 2000 mg for metformin or 10 mg/2000 mg and 20 mg/2000 mg for glyburide/metformin 2.5 mg/500 mg and 5 mg/500 mg respectively. The primary outcome measure was HbA1c level after 16 weeks secondary end-points included fasting and 2-h post-prandial plasma glucose. Adverse events (AEs) were recorded and summarized by treatment group. Both strengths of glyburide/metformin equally reduced mean HbA1c by 1.7% more than did glyburide alone (p < 0.001), and by 1.9% more than did metformin alone (p < 0.001). Final mean fasting plasma glucose concentrations were also lower in both glyburide/metformin groups than in the glyburide (-2.8 mmol/l, -51.3 mg/dl p < 0.001) and metformin groups (-3.6 mmol/l, -64.2 mg/dl p < 0.001). Safety and tolerability were similar across all treatment groups, except for a higher incidence of gastrointestinal AEs in the metformin monotherapy group, and more patients reporting mild or moderate symptoms of hypoglycaemia while taking glyburide/metformin. Both glyburide/metformin tablet strengths produced, with equal efficacy, significantly better glycaemic control than monotherapy with either agent. These data also confirm that glycaemic efficacy does not require maximal sulphonylurea doses in combination with metformin.
Characterising violent deaths of undetermined intent: a population-based study, 1999–2012
Publisher: BMJ
Date: 06-10-2017
DOI: 10.1136/INJURYPREV-2017-042376
Abstract: Violent deaths classified as undetermined intent (UD) are sometimes included in suicide counts. This study investigated age and sex differences, along with socioeconomic gradients in UD and suicide deaths in the province of Ontario between 1999 and 2012. We used data from the Institute for Clinical Evaluative Sciences, which has linked vital statistics from the Office of the Registrar General Deaths register with Census data between 1999 and 2012. Socioeconomic status was operationalised through the four dimensions of the Ontario Marginalization Index. We computed age-specific and annual age-standardised mortality rates, and risk ratios to calculate risk gradients according to each of the four dimensions of marginalization. Rates of UD-classified deaths were highest for men aged 45–64 years residing in the most materially deprived (7.9 per 100 000 population (95% CI 6.8 to 9.0)) and residentially unstable (8.1 (95% CI 7.1 to 9.1)) neighbourhoods. Similarly, suicide rates were highest among these same groups of men aged 45–64 living in the most materially deprived (28.2 (95% CI 26.1 to 30.3)) and residentially unstable (30.7 (95% CI 28.7 to 32.6)) neighbourhoods. Relative to methods of death, poisoning was the most frequently used method in UD cases (64%), while it represented the second most common method (27%) among suicides after hanging (40%). The similarities observed between both causes of death suggest that at least a proportion of UD deaths may be misclassified suicide cases. However, the discrepancies identified in this analysis seem to indicate that not all UD deaths are misclassified suicides.
Greater toxicity in overdose of dothiepin than of other tricyclic antidepressants
Publisher: Elsevier BV
Date: 1994
DOI: 10.1016/S0140-6736(94)90940-7
Abstract: Epidemiological studies have implicated dothiepin in a greater number of self-poisoning deaths than would be expected from its use. We have prospectively assessed the clinical toxicity of dothiepin and other tricyclic antidepressants (TCAs) in overdose. We followed-up consecutively admitted patients with TCA poisoning managed by our department between January, 1987, and August, 1992. 75 patients had taken dothiepin, 101 amitriptyline, 83 doxepin, and 61 other TCAs. Death after TCA poisoning is rare nowadays, so we used intermediate outcome measures--general seizures, tachyarrhythmias, sedation, and QRS width on the electrocardiogram. 15 patients had seizures and 7 tachyarrhythmias. When we excluded patients who had taken more than one TCA, general seizures were more likely after dothiepin than after other TCAs (9/67 vs 5/220) as were arrhythmias (4/67 vs 3/220). Rates of other complications were similar. The dothiepin group had ingested a larger dose, attributable to the larger average tablet strength, than patients who took other TCAs. The odds ratio for seizures with dothiepin versus other TCAs was 6.7 (95% Cl 2.2-20.7) unadjusted and 7.1 (2.2-23.2) after adjustment for sex, age, and ingested dose. The corresponding odds ratios for arrhythmias were 4.6 (1.0-21.1) and 3.4 (0.7-16.3). Dothiepin in overdose seems to be proconvulsant. Patients with only minor sedation and normal limb-lead QRS width may still have major complications. Consideration should be given to the use of other antidepressants in patients at risk of seizures or suicide. Regulatory authorities should review the need for a 75 mg strength tablet of any TCA.
Fatal agranulocytosis attributed to co-trimoxazole therapy
Publisher: BMJ
Date: 30-07-1977
Cyclooxygenase Inhibitors and Cardiovascular Risk—Reply
Publisher: American Medical Association (AMA)
Date: 14-02-2007
Flucloxacillin and cholestatic hepatitis
Publisher: AMPCo
Date: 04-1994
The Pharmaceutical Benefits Scheme: economic evaluation works...but is not a panacea
Publisher: Therapeutic Guidelines Limited
Date: 12-2002
Selective COX‐2 inhibitors, NSAIDs and congestive heart failure: differences between new and recurrent cases
Publisher: Wiley
Date: 03-04-2008
Asthma and Chronic Obstructive Pulmonary Disease (COPD) prevalence and health services use in Ontario Métis
Publisher: Public Library of Science (PLoS)
Date: 23-04-2014
Monitoring adverse reactions to new drugs: “restricted release” or “monitored release”?
Publisher: BMJ
Date: 12-03-1977
Pharmaceuticals, intellectual property and free-trade: The case of the US-Australia free trade agreement
Publisher: Pluto Journals
Date: 09-2004
DOI: 10.1080/0810902042000255705
Abstract: Australia did poorly in several key areas of the recently completed free trade agreement with the US. It failed to insulate the Pharmaceutical Benefits Scheme (PBS) from significant change, and conceded to increased intellectual property standards. The PBS, as a system of effective bargaining with multinational pharmaceutical firms, has been deeply compromised and higher drug prices can be expected over time. The intellectual property chapter strengthens the position of patent owners and undermines the evolution of a competitive generics industry. These developments are part of a broader and internationally coordinated strategy being pursued by pharmaceutical multinationals to globalize and strengthen patent rights and monopoly profits.
Association between the regional variation in premature mortality and immigration in Ontario, Canada
Publisher: Springer Science and Business Media LLC
Date: 27-05-2020
DOI: 10.17269/S41997-020-00330-5
Abstract: Health region differences in immigration patterns and premature mortality rates exist in Ontario, Canada. This study used linked population-based databases to describe the regional proportion of immigrants in the context of provincial health region variation in premature mortality. We analyzed all adult premature deaths in Ontario from 1992 to 2012 using linked population files, Canadian census, and death registry databases. Geographic boundaries were analyzed according to 14 health service regions, known as Local Health Integration Networks (LHINs). We assessed the role of immigrant status and regional proportion of immigrants in the context of these health region variations and assessed the contribution using sex-specific multilevel negative binomial models, accounting for age, in idual- and area-level immigration, and area-level material deprivation. We observed significant premature mortality variation among health service regions in Ontario between 1992 and 2012. Average annual rates ranged across LHINs from 3.03 to 6.40 per 1000 among males and 2.04 to 3.98 per 1000 among females. The median rate ratio (RR) decreased for men from 1.14 (95% CI 1.06, 1.19) to 1.07 (95% CI 1.00, 1.11) after adjusting for year, age, area-based material deprivation, and in idual- and area-level immigration, and among females reduced from 1.13 (95% CI 1.05, 1.18) to 1.04 (95% CI 1.00, 1.05). These adjustments explained 84.1% and 94.4% of the LHIN-level variation in males and females respectively. Reduced premature mortality rates were associated with immigrants compared with those for long-term residents in the fully adjusted models for both males 0.43 (95% CI 0.42, 0.44) and females 0.45 (0.44, 0.46). The findings demonstrate that health region differences in premature mortality in Ontario are in part explained by in idual-level effects associated with the health advantage of immigrants, as well as contextual area-level effects that are associated with regional differences in the immigrant population. These factors should be considered in addition to health system factors when looking at health region variation in premature deaths.
Meta-analysis - Its role in assessing drug safety
Publisher: Wiley
Date: 05-1999
DOI: 10.1002/(SICI)1099-1557(199905/06)8:3<167::AID-PDS418>3.0.CO;2-F
Occurrence of pregnancy and pregnancy outcomes during isotretinoin therapy
Publisher: CMA Joule Inc.
Date: 25-04-2016
DOI: 10.1503/CMAJ.151243
Building a Systematic Online Living Evidence Summary of COVID-19 Research
Publisher: European Association for Health Information and Libraries EAHIL
Date: 24-06-2021
DOI: 10.32384/JEAHIL17465
Abstract: Throughout the global coronavirus pandemic, we have seen an unprecedented volume of COVID-19 researchpublications. This vast body of evidence continues to grow, making it difficult for research users to keep up with the pace of evolving research findings. To enable the synthesis of this evidence for timely use by researchers, policymakers, and other stakeholders, we developed an automated workflow to collect, categorise, and visualise the evidence from primary COVID-19 research studies. We trained a crowd of volunteer reviewers to annotate studies by relevance to COVID-19, study objectives, and methodological approaches. Using these human decisions, we are training machine learning classifiers and applying text-mining tools to continually categorise the findings and evaluate the quality of COVID-19 evidence.
Unlocking First Nations health information through data linkage
Publisher: Swansea University
Date: 22-05-2018
Abstract: IntroductionThe importance of Indigenous data sovereignty and Indigenous-led research processes is increasingly being recognized in Canada and internationally. For First Nations in Ontario, Canada, access to routinely-collected demographic and health systems data is critical to planning and measuring health status and outcomes in their populations. Linkage of this data with the Indian Register (IR), under First Nations data governance, has unlocked data for use by First Nations organizations and communities. ObjectivesTo describe the linkage of the IR database to the Ontario Registered Persons Database (RPDB) within the context of Indigenous data sovereignty principles. MethodsDeterministic and probabilistic record linkage methods were used to link the IR to the RPDB. There is no established population of First Nations people living in Ontario with which we could establish a linkage rate. Accordingly, several approaches were taken to determine a denominator that would represent the total population of First Nations we would hope to link to the RPDB. ResultsOverall, 201,678 in iduals in the national IR database matched to Ontario health records by way of the RPDB, of which 98,562 were female and 103,116 were male. Of those First Nations in iduals linked to the RPDB, 90.2% (n=181,915) lived in Ontario when they first registered with IR, or were affiliated with an Ontario First Nation Community. The proportion of registered First Nations people linking to the RPDB improved across time, from 62.8% in the 1960s to 94.5% in 2012. Conclusions This linkage of the IR and RPDB has resulted in the creation of the largest First Nations health research study cohort in Canada. The linked data are being used by First Nations communities to answer questions that ultimately promote wellbeing, effective policy, and healing.
Improved Outcomes With Early Collaborative Care of Ambulatory Heart Failure Patients Discharged From the Emergency Department
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-11-2010
DOI: 10.1161/CIRCULATIONAHA.110.940262
Abstract: The type of outpatient physician care after an emergency department visit for heart failure may affect patients' outcomes. Using the National Ambulatory Care Reporting System, we examined the care and outcomes of heart failure patients who visited and were discharged from the emergency department in Ontario, Canada (April 2004 to March 2007). Early collaborative care by a cardiologist and primary care (PC) physician within 30 days after discharge was compared with PC alone. Care for 10 599 patients (age, 74.9±11.9 years 50.2% male) was provided by PC alone (n=6596), cardiologist alone (n=535), or concurrently by both cardiologist and PC (n=1478) 1990 did not visit a physician. Collaborative care patients were more likely to undergo assessment of left ventricular function (57.4% versus 28.7%), noninvasive stress testing (20.1% versus 7.8%), and cardiac catheterization (11.6% versus 2.7%) compared with PC. Drug prescriptions (patients ≥65 years of age) demonstrated higher use of angiotensin-converting enzyme inhibitors (58.8% versus 54.6%), angiotensin receptor blockers (22.7% versus 18.1%), β-adrenoceptor antagonists (63.4% versus 48.0%), loop diuretics (84.2% versus 79.6%), metolazone (4.8% versus 3.4%), and spironolactone (19.8% versus 12.7%) within 100 days after emergency department discharge for collaborative care compared with PC. In a propensity-matched model, mortality was lower with PC compared with no physician visit (hazard ratio, 0.75 95% confidence interval, 0.64 to 0.87 P .001). Collaborative care reduced mortality compared with PC (hazard ratio, 0.79 95% confidence interval, 0.63 to 1.00 P =0.045). Sole cardiology care conferred a trend to increased mortality (hazard ratio, 1.41 versus collaborative care 95% confidence interval, 0.98 to 2.03 P =0.067). Early collaborative heart failure care was associated with increased use of drug therapies and cardiovascular diagnostic tests and better outcomes compared with PC alone.
Renal and cardiovascular toxicity of non-steroidal anti-inflammatory drugs
Publisher: Springer Science and Business Media LLC
Date: 03-2000
Cost-effectiveness of different interferon beta products for relapsing-remitting and secondary progressive multiple sclerosis: Decision analysis based on long-term clinical data and switchable treatme
Publisher: Springer Science and Business Media LLC
Date: 22-06-2013
Abstract: Multiple sclerosis (MS) is a highly debilitating immune mediated disorder and the second most common cause of neurological disability in young and middle-aged adults. Iran is amongst high MS prevalence countries (50/100,000). Economic burden of MS is a topic of important deliberation in economic evaluations study. Therefore determining of cost-effectiveness interferon beta (INF β) and their copied biopharmaceuticals (CBPs) and biosimilars products is significant issue for assessment of affordability in Lower-middle-income countries (LMICs). A literature-based Markov model was developed to assess the cost-effectiveness of three INF βs products compared with placebo for managing a hypothetical cohort of patients diagnosed with relapsing remitting MS (RRMS) in Iran from a societal perspective. Health states were based on the Kurtzke Expanded Disability Status Scale (EDSS). Disease progression transition probabilities for symptom management and INF β therapies were obtained from natural history studies and multicenter randomized controlled trials and their long term follow up for RRMS and secondary progressive MS (SPMS). A cross sectional study has been developed to evaluate cost and utility. Transitions among health states occurred in 2-years cycles for fifteen cycles and switching to other therapies was allowed. Calculations of costs and utilities were established by attachment of decision trees to the overall model. The incremental cost effectiveness ratio (ICER) of cost/quality adjusted life year (QALY) for all available INF β products (brands, biosimilars and CBPs) were considered. Both costs and utilities were discounted. Sensitivity analyses were done to assess robustness of model. ICER for Avonex, Rebif and Betaferon was 18712, 11832, 15768 US Dollars ($) respectively when utility attained from literature review has been considered. ICER for available CBPs and biosimilars in Iran was $847, $6964 and $11913. The Markov pharmacoeconomics model determined that according to suggested threshold for developing countries by world health organization, all brand INF β products are cost effective in Iran except Avonex. The best strategy among INF β therapies is CBP intramuscular INF β-1a (Cinnovex). Results showed that a policy of encouraging accessibility to CBPs and biosimilars could make even high technology products cost-effective in LMICs.
NSAIDs and risk of upper gastrointestinal bleeding
Publisher: Elsevier BV
Date: 03-1991
Assessment of Long-term Follow-up of Randomized Trial Participants by Linkage to Routinely Collected Data
Publisher: American Medical Association (AMA)
Date: 21-12-2018
Using linked health administrative data to assess the clinical and healthcare system impact of chronic diseases in Ontario
Publisher: Longwoods Publishing
Date: 15-07-2011
Prescription Drug Utilization Following Patient Co-Payment Changes in Australia
Publisher: Wiley
Date: 11-1996
DOI: 10.1002/(SICI)1099-1557(199611)5:6<385::AID-PDS246>3.0.CO;2-8
Repeat testing for SARS-COV-2: Persistence of viral RNA is common, and clearance is slower in older age groups
Publisher: Cold Spring Harbor Laboratory
Date: 09-2020
DOI: 10.1101/2020.08.27.20183483
Abstract: Queensland’s Novel Coronavirus (SARS-CoV-2) suppression program has been relatively successful. Initially, it involved extensive community testing and repeat s ling of positive in iduals for release from isolation. This enabled study of several characteristics, including persistence of detectable virus and how apparent viral clearance rates varied by age and sex. We conducted an exploratory analysis of Queensland Pathology SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) test results. Kaplan Meier analyses were used to estimate median time to apparent viral clearance, and Cox regression to explore the effects of sex and age. In iduals tested for presence of SARS-CoV-2 in the upper respiratory tract between January 19 and June 4, 2020. Presence of viral RNA detected by RT-PCR. We analyzed 97,476 in iduals. Median age was 41y (range -105y), and 57.2% (95% CI 57.2, 57.2) were female. In total, 958 (0.98% 95% CI 0.92,1.05) tested positive for SARS-CoV-2. Positivity rates were lower in regional areas than cities, in females (OR 0.80, 95% CI 0.70, 0.91), and in those aged 16y and below (p .01, test for trend). Of the 958 positive in iduals, 243 had two or more (max 17) additional tests, and 92% (95% CI 88.1, 95.2) remained positive after 10 days (max 76 days) after the initial result. Median time to apparent viral clearance was longer in those 65y and over compared to those under 65y (29 v 43 days, HR 1.85 95% CI 1.17, 2.90), and was unaffected by sex (HR 0.93 95% CI 0.66, 1.30). Females and those 16y and under were less likely to test positive for SARS-CoV-2. Detectable RNA may persist for long periods, negating the value of repeat testing for declaring in iduals free of infection. Viral clearance rates appear lower in those over 65y of age compared with younger in iduals. “The known” - Early in the COVID-19 pandemic, 2 negative RT-PCR swabs were used to achieve negative status in infected in iduals - There are few published data on the patterns of results seen with repeat testing in Australia. “The new” - We analysed data from a large cohort of people tested for viral RNA in Queensland - We found that females and those 16 y and under were less likely to test positive. - Viral RNA was detectable for up to 76 days, with % testing positive for more than 10 days. - Viral clearance was slower in those over the age of 65. “The implications” - There is likely to be little value in repeat RT-PCR testing to declare in iduals free from infection. The first Australian cases of infection with SARS-CoV-2 were reported in January 2020. 1 During the initial phase the peak daily infection rate was in late March 2020 and by the end of June 2020 there had been around 8000 cases and 104 deaths. 2 Initially, the majority of cases were acquired outside the country rather than by local transmission. 3 The cumulative incidence rates (June 2020) of around 400/million, and mortality of 4/million, were towards the lower end of the rates that have been experienced in other high-income countries, although these are rising quickly with recent outbreaks in Victoria and New South Wales. 3 Rates of infection remain relatively low in Queensland. 3 In Queensland, the criteria for testing in iduals for SARS-CoV-2 changed during the pandemic. Initially, to be tested in Queensland people were required to meet both epidemiological (return from a high-risk country), and clinical criteria (suggestive symptoms). With progression of the pandemic, testing criteria were modified to clinical criteria only (details provided below). The rollout of a comprehensive testing program and the availability of data from repeated within-subject testing carried out in the initial stages of the Covid-19 pandemic provided an opportunity to conduct an exploratory study to address several questions. We investigated population testing rates and how they varied over time. We estimated the proportions of in iduals who returned positive tests and how these varied with location age and sex. We also estimated apparent rates of clearance of viral RNA from the upper respiratory tract of subjects with repeated tests, and the extent to these varied with age and sex.
Diclofenac hepatitis
Publisher: BMJ
Date: 11-1991
Abstract: The characteristics of liver damage associated with the use of diclofenac, a popular nonsteroidal anti-inflammatory drug, were investigated by reviewing adverse drug reaction reports for Australia. Twenty six patients were reported for whom diclofenac was the sole suspected drug cause of their liver damage. The average age of the patients was 64 years (range 37-84 years) 19 (70%) were women. The most common clinical features were jaundice, hepatomegaly, anorexia, and nausea. Features of drug hypersensitivity were not reported. Duration of treatment with diclofenac before the onset of the illness ranged from 6-417 days (median 76 days). The most prominent biochemical abnormalities were raised serum aspartate transaminase and alanine transaminase activity of up to 30 to 40 times the upper limit of the normal range. Recovery generally started soon after withdrawal of diclofenac and the decrease in aspartate transaminase and alanine transaminase for the group was exponential, with half lives of around 13 days. The average total dose taken by 18 patients for whom accurate data were available was 8.7 g (range 1.4-63.5 g) and, unexpectedly, there was a significant relation between the logarithm of the dose of diclofenac and the logarithms of the peak and mean transaminase levels. Hepatocellular damage during treatment with diclofenac seems to be a rare event. From this analysis of Australian reports it seems that in a small subgroup of patients liver injury may be a direct toxic effect of diclofenac or a metabolite.
Repeat testing for SARS-CoV-2: persistence of viral RNA is common, and clearance is slower in older people
Publisher: AMPCo
Date: 26-04-2021
DOI: 10.5694/MJA2.51036
Disease mongering: Expanding the boundaries of treatable disease
Publisher: Wiley
Date: 11-2008
DOI: 10.1111/J.1445-5994.2008.01814.X
Abstract: Traditionally, the promotional activities of medical industries have been product specific. In recent years, however, there have been ex les where companies have worked through partnerships, which have included clinicians, to expand the boundaries of treatable disorders. The main motivation appears to be to increase sales of commercial products. The term 'disease mongering' has been applied to these activities. Whereas some disease awareness programmes may bring benefits in the form of improved recognition and management of disorders, the presence of strong commercial interests probably distorts the traditional processes by which treatable diseases have been defined. This can result in in idual patients being exposed to potential harms, with little expectation of benefit and will place an unwarranted burden on the publicly funded health-care system. None of this can happen without the collaboration of the medical profession that needs to be aware of the risks of becoming involved in commercially supported 'consensus' groups that are reviewing the definition and management of diseases.
Fatal peptic ulcer complications and the use of non-steroidal anti-inflammatory drugs, aspirin, and corticosteroids
Publisher: BMJ
Date: 14-11-1987
DOI: 10.1136/BMJ.295.6608.1227
Abstract: Although non-steroidal anti-inflammatory drugs are known to cause peptic ulcer and its complications, controversy exists about the number of deaths from ulcer which are attributable to their use. A case-control study was therefore performed to determine whether prior use of non-steroidal and other anti-inflammatory compounds was associated with an increased case fatality rate from complications of peptic ulcer. Non-steroidal anti-inflammatory drugs were used by 39% of a series of 80 patients who had died from peptic ulcer complications and by 37% of 160 controls who were survivors matched for sex, age, ulcer site, and nature of complication (odds ratio 1.1 95% confidence interval 0.6 to 2.1). Similarly, the rates of prior use of aspirin by cases and controls were almost identical (odds ratio 1.2 95% confidence interval 0.5 to 1.9). Thus neither nonsteroidal anti-inflammatory drugs nor aspirin were associated with increased case fatality rates from peptic ulcer complications. In contrast, corticosteroids were associated with an increased mortality (odds ratio 4.2 95% confidence interval 0.9 to 25.6). Although this increase in the estimated relative risk was not statistically significant, a review of the case records indicated that most deaths in steroid users were due to serious sepsis, indicating that there might be a causal association between use of the drugs and the mode of death.
Empirical uncertainty and moral contest: A qualitative analysis of the relationship between medical specialists and the pharmaceutical industry in Australia
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.SOCSCIMED.2005.07.037
Abstract: Alliances between the medical profession and the pharmaceutical industry have become increasingly widespread in recent years. While there are clearly benefits for doctors and their patients derived from the medical profession working with industry, concern has arisen that the commercial imperative of industry may conflict with physicians' independence and professional integrity. This paper reports the findings of an in-depth interview study with 50 Australian medical specialists undertaken to explore how and why they interact with the pharmaceutical industry and to gain insight into specialists' moral evaluation of the relationship and its consequences. Analysis of the qualitative data led to the categorizing medical specialists into three types--Confident Engagers, Ambivalent Engagers and Avoiders--based on their descriptions and evaluations of their relationship. The majority of interviewees believed that some relationship with the pharmaceutical industry was inevitable, that there were both risks and benefits associated with the relationship and that as in iduals they were competent in minimizing the risks and maximizing the benefits. However, their views erged on the extent and magnitude of the risks and benefits. The data suggested that there is considerable variance in specialists' judgments of what constituted appropriate industry largesse. Specialists' relationship with the pharmaceutical industry has inherent tensions that are managed by different doctors in different ways. Moral evaluation of the relationship and its consequences varies and the ethical concerns surrounding the relationship appeared as an area of contest. The findings suggest that in developing normative guidelines for academic and professional practice, policy makers should recognise and account for the complexity of the relationship and for the variation in medical specialists' views and feelings.
Liberating the data from clinical trials
Publisher: BMJ
Date: 16-09-2015
DOI: 10.1136/BMJ.H4601
Risk of Bias in Systematic Reviews of Non-Randomized Studies of Adverse Cardiovascular Effects of Thiazolidinediones and Cyclooxygenase-2 Inhibitors: Application of a New Cochrane Risk of Bias Tool
Publisher: Public Library of Science (PLoS)
Date: 05-04-2016
CHANGING TRENDS IN PERFORATED PEPTIC ULCER DURING THE PAST 45 YEARS
Publisher: Wiley
Date: 09-1992
DOI: 10.1111/J.1445-2197.1992.TB07071.X
Abstract: Since 1944 there has been a dramatic change in the pattern of admissions for perforated peptic ulcer (PPU) to the Royal Newcastle Hospital, the main teaching hospital of the Hunter Region, Australia. Between 1944 and 1950, females accounted for 6% of all perforations since then the proportion of females admitted with this complication has risen to 32%. Simultaneously, the modal age for PPU has shifted from the fifth to the seventh decade and the ratio of gastric to pyloroduodenal perforations has fallen from 1.1:1 to 0.6:1. No good explanation for this change in the natural history of PPU, also noted elsewhere, is evident.
Erythromycin-associated cholestatic hepatitis
Publisher: AMPCo
Date: 04-1993
DOI: 10.5694/J.1326-5377.1993.TB137625.X
Abstract: To estimate the risk of cholestatic hepatitis of uncertain origin in patients who had recently received erythromycin, a drug which is known to cause this disorder. A retrospective cohort study using data automatically recorded on general practitioners' office computers. Some 600 general practices in the United Kingdom. 366,064 people who received erythromycin. Clinically documented cholestatic hepatitis of uncertain origin diagnosed 1-45 days after a prescription for erythromycin. There were 13 cases of cholestatic hepatitis of uncertain origin diagnosed within 45 days of receiving erythromycin which were either characteristic of or consistent with a syndrome previously described as being associated with this drug. The risk of cholestatic jaundice associated with erythromycin is estimated to be in the range of 3.6 per 100,000 users (95% confidence interval, 1.9-6.1).
IQWiG methods – a response to two critiques
Publisher: Wiley
Date: 09-09-2010
DOI: 10.1002/HEC.1658
Erratum to The Australian Guidelines for Subsidisation of Pharmaceuticals
Publisher: Springer Science and Business Media LLC
Date: 1993
DOI: 10.1007/BF03260130
Cimetidine and ranitidine: comparison of effects on hepatic drug metabolism.
Publisher: BMJ
Date: 20-09-1980
Abstract: Paired studies of hepatic microsomal function were conducted in eight subjects during treatment with two histamine H2 antagonists, cimetidine and ranitidine. Cimetidine but not ranitidine inhibited the metabolism of antipyrine (phenazone) and demethylation of aminopyrine (aminophenazone) as measured by breath 14CO2 production after intravenous injection of 14C-aminopyrine. These results suggest that the metabolic inhibitory actions on the liver may be separated from H2 antagonist effects, and that ranitidine has an advantage over cimetidine by not inhibiting microsomal drug oxidative function.
Therapeutic comparison of thiol compounds in severe paracetamol poisoning
Publisher: SAGE Publications
Date: 1977
DOI: 10.1177/000456327701400155
Abstract: Twelve patients with toxic blood concentrations of paracetamol were treated with either cysteamine or amino-acid solution. None of the patients developed severe liver damage, although transient mild biochemical abnormalities developed in three. None of the patients treated with amino-acid solution had side effects due to therapy, whereas all those treated with cysteamine did. It is recommended that amino-acid solutions be used as a temporary measure in patients suspected of massive paracetamol overdose while awaiting estimation of blood paracetamol concentration.
Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage
Publisher: BMJ
Date: 29-04-1989
DOI: 10.1136/BMJ.298.6681.1142
Abstract: To see whether fibrinolytic inhibitors are of value when given to patients with upper gastrointestinal haemorrhage. Meta-analysis of six randomised double blind placebo controlled trials. Two methods used for obtaining an overall estimate of effect, including a random effects model incorporating any heterogeneity of outcome in the estimate of the overall treatment effect. Inpatient care in hospitals in the United Kingdom, Sweden, and Australia. 1267 Patients admitted to hospital with primary diagnosis of acute upper gastrointestinal haemorrhage. Five of the six trials included a high proportion of elderly patients. Most patients were bleeding from peptic ulcers in the stomach and duodenum (43-88%) or gastric erosions (4-23%). A variable proportion had a degree of clinical shock at entry. Tranexamic acid 3-6 g/day given intravenously for two or three days followed by 3-6 g/day by mouth for a further three to five days (four trials) or 4.5-12 g/day by mouth for two to seven days (two trials). Frequency of recurrent haemorrhage, need for surgery, and death. Treatment with tranexamic acid was associated with a 20-30% reduction in the rate of rebleeding, a 30-40% reduction (95% confidence interval 10% to 60%) in mortality. Treatment with tranexamic acid may be of value to patients considered to be at risk of dying after an upper gastrointestinal haemorrhage.
What do health care professionals know about childhood asthma?
Publisher: Wiley
Date: 02-1993
DOI: 10.1111/J.1440-1754.1993.TB00436.X
Abstract: The aim of this study was to examine the level of knowledge about childhood asthma in paediatric nurses, pharmacists and general practitioners to assess their potential value as sources of accurate information for patients with asthma. The main outcome measure was the score obtained on an asthma knowledge questionnaire which had been validated previously. The maximum possible score was 31. Eighty-three general practitioners had a mean score of 28.1 (range 14-31) 82 pharmacists scored a mean of 24.2 (range 15-30) and 30 paediatric nurses had a mean score of 25.5 (range 16-30). General practitioners scored well in most questions but had some worrying deficiencies, particularly in distinguishing preventive therapy from symptom relieving medication. Pharmacists and paediatric nurses had a number of problems in certain important areas. In particular pharmacists as a group were unaware of many of the clinical features of asthma, had misconceptions, such as the need to avoid cow's milk, and recorded incorrect responses to clinical scenarios of acute treatment. Paediatric nurses tended to overestimate the side effects of inhaled medications, and also the value of auscultation. They had poor knowledge of exercise-induced asthma. The data overall suggest that specific educational strategies should be devised for different groups of health professionals who manage children with asthma and suggest that poor knowledge on the part of health care providers may contribute to morbidity.
Serotonin-Norepinephrine Reuptake Inhibitors and the Risk of AKI
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
DOI: 10.2215/CJN.11271114
The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis
Publisher: CMA Joule Inc.
Date: 20-01-2009
DOI: 10.1503/CMAJ.081109
Non-prescription use of bronchodilator aerosols
Publisher: Wiley
Date: 1992
The Fight against Disease Mongering: Generating Knowledge for Action
Publisher: Public Library of Science (PLoS)
Date: 11-04-2006
Potential for bias in economic analyses
Publisher: Massachusetts Medical Society
Date: 07-11-1991
Rising prescription drug costs: Whose responsibility?
Publisher: AMPCo
Date: 07-1997
Australian pharmaceutical policy: Price control, equity, and drug innovation in Australia
Publisher: Springer Science and Business Media LLC
Date: 28-03-2008
DOI: 10.1057/PALGRAVE.JPHP.3200170
Abstract: This paper outlines the increasing salience of drug "innovation" in the debate for reform of Australia's pharmaceutical policy, particularly change to Australia's price control mechanisms. The pharmaceutical industry has consistently criticised the central role of price control in Australia's pharmaceutical regulatory regime as an impediment to drug innovation and industry growth. Despite ambivalent or contrary evidence on the impact of price control on drug innovation, this criticism, and the appeals for reform it supports, appear to be increasingly influential in directing pharmaceutical policy. This is particularly evident in the implementation of the Australia/United States Free Trade Agreement, which has led to a weakening of the historical process of evidence-based reference pricing in Australia. Should drug innovation come to dominate Australian pharmaceutical policy, there is the potential to precipitate a devaluing of the current public orientation of regulation and diminish equitable access to affordable pharmaceuticals. The manner in which trade policy has effectively undermined a publicly funded pharmaceutical benefits scheme has clear implications for many countries that maintain such programmes.
Prescription medicines: decision-making preferences of patients who receive different levels of public subsidy
Publisher: Wiley
Date: 12-08-2014
Identifying the most effective essential medicines policies for quality use of medicines: A replicability study using three World Health Organisation data-sets
Publisher: Public Library of Science (PLoS)
Date: 06-02-2020
The effects of information framing on the practices of physicians
Publisher: Springer Science and Business Media LLC
Date: 10-1999
DOI: 10.1046/J.1525-1497.1999.09038.X
Abstract: The presentation format of clinical trial results, or the "frame," may influence perceptions about the worth of a treatment. The extent and consistency of that influence are unclear. We undertook a systematic review of the published literature on the effects of information framing on the practices of physicians. Relevant articles were retrieved using bibliographic and electronic searches. Information was extracted from each in relation to study design, frame type, parameter assessed, assessment scale, clinical setting, intervention, results, and factors modifying the frame effect. Twelve articles reported randomized trials investigating the effect of framing on doctors' opinions or intended practices. Methodological shortcomings were numerous. Seven papers investigated the effect of presenting clinical trial results in terms of relative risk reduction, or absolute risk reductions or the number needing to be treated gain/loss (positive/negative) terms were used in four papers verbal/numeric terms in one. In simple clinical scenarios, results expressed in relative risk reduction or gain terms were viewed most positively by doctors. Factors that reduced the impact of framing included the risk of causing harm, preexisting prejudices about treatments, the type of decision, the therapeutic yield, clinical experience, and costs. No study investigated the effect of framing on actual clinical practice. While a framing effect may exist, particularly when results are presented in terms of proportional or absolute measures of gain or loss, it appears highly susceptible to modification, and even neutralization, by other factors that influence doctors' decision making. Its effects on actual clinical practice are unknown.
Consumption of non‐steroidal anti‐inflammatory drugs and the development of functional renal impairment in elderly subjects. Results of a case‐control study
Publisher: Wiley
Date: 07-1997
DOI: 10.1046/J.1365-2125.1997.00631.X
Abstract: The aim of the present study was to explore the level of risk associated with community use of non-steroidal anti-inflammatory drugs (NSAIDs). We carried out a matched case-control study of the relationship between recent use of NSAIDs and the presence of functional renal impairment present at the time of hospitalisation with a range of clinical problems. Cases (n = 110) were consecutive patients admitted acutely to hospital who had serum creatinine levels greater than or equal to 0.15 mmol l(-1) , which improved by 20% or more within the next 14 days, or prior to discharge from hospital. Controls (n= 189) were subjects of the same sex and age (to within 5 years) as the cases, who were admitted to the same hospital, who had normal serum creatinine levels (<0.12 mmol l(-1) throughout their hospital stay. Information on a number of study factors, including recent use of aspirin and other NSAIDs, was obtained by structured interview. Overall, there was a weak association between consumption of NSAIDs (including non-prophylactic aspirin) and the development of functional renal impairment-adjusted odds ratios (OR) with use of NSAIDs in the previous week or in the previous month: OR 1.5 (95% CI 0.80, 2.9) and 1.8 (95% CI 0.97, 3.4) respectively. In subjects with a previous history of renal disease the adjusted OR was 6.6 (0.75, 57.8) and in those with a history of gout or hyperuricaemia the OR was 7.2 (1.3, 40.2). There was a weak positive relationship between the dose of drug consumed in the previous week and the odds of functional renal impairment. The relationship between risk and published figures for drug half-lives (t1/2) was stronger. The odds ratio increased from 1.2 (95% CI 0.61, 2.4) with a t1/2 < or = 4 h, to 4.8 (1.5, 15.8) with a t1/2 of < or = 12 h (P=0.012, test for trend). This relationship remained statistically significant after adjustment for a number of clinical variables and the dose of drug ingested. NSAIDs are an important cause of functional renal impairment in subjects with renal disease or a history of gout or hyperuricemia. The half-life of the drug is more important than the ingested dose in determining the risk of this outcome. Long half-life drugs should be avoided in in iduals who are at risk of developing renal impairment.
Improvement in pain interference and function by an allied health pain management program: Results of a randomized trial
Publisher: Wiley
Date: 20-07-2021
DOI: 10.1002/EJP.1836
Abstract: Chronic pain is a significant health problem worldwide and requires a biopsychosocial treatment approach. Access to traditional pain medicine specialist services is limited and innovative treatment models are required to support patients in tertiary care. The study evaluated the clinical effectiveness and safety of the Treatment Access Pathway (TAP), an allied health expanded scope model of care which included innovative group assessment and collaboration with patients to create in idualized treatment plans. One hundred and eighty‐one patients referred to a tertiary level chronic pain service were randomly allocated to either the TAP or the waitlist study groups. Primary (pain interference) and secondary outcome measures were collected at recruitment and again at 6 months. Per‐protocol analyses were utilized due to high participant attrition (46% across groups). The TAP group reported greater reductions in pain interference at 6 months than waitlist group (0.9, 95% CI: 0.2–1.6), with more than half of the TAP group (52%) reporting clinically significant improvement. In addition, statistically significant differences between the TAP and waitlist groups were observed for objective measurements of walking endurance (5.4 m, 95% CI: 1.7–9.1) and global impressions of change (1.4 unit decrease, 95% CI: 1–1.9). Nil adverse events were recorded. The study suggests that an expanded scope allied health model of care prioritizing patient choice and group‐based interventions provides modest benefits for tertiary‐referral chronic pain patients. TAP warrants further investigation as a potentially viable alternative for tertiary healthcare where traditional pain services are unavailable or have long waiting lists. The study tests effectiveness and safety of an expanded scope allied health‐led chronic pain program. Despite a high attrition rate, the study showed reduced pain interference and increased physical function in those who completed the protocol. The results are promising and support introduction of this model as an adjunct to existing traditional chronic pain models of care, with a particular focus on improving participant retention in the program. Additionally, the model of care can be used as a standalone chronic pain model of care where no other pain management resources are available. The study was registered on ANZCTR (Trial ID: ACTRN12617001284358).
Cimetidine and ranitidine in duodenal ulcer
Publisher: BMJ
Date: 16-08-1980
Abstract: Two histamine H2 antagonists, cimetidine and ranitidine, given in doses of 1 g daily and 200 mg daily to 18 and 20 patients respectively proved equivalent in promoting healing of duodenal ulcer. No adverse effects occurred during the trial, though serum urea and creatinine concentrations tended to rise slightly during treatment with cimetidine but not ranitidine. Choice between the two drugs is likely to be influenced by overall patterns of adverse effects rather than considerations of in idual potency.
Are antifibrinolytic drugs equivalent in reducing blood loss and transfusion in cardiac surgery? A meta-analysis of randomized head-to-head trials
Publisher: Springer Science and Business Media LLC
Date: 04-07-2005
The likely impact on drug regulation in Australia
Publisher: AMPCo
Date: 03-1986
Public Payments to Physicians in Ontario Adjusted for Overhead Costs
Publisher: Longwoods Publishing
Date: 11-2012
In reply [8]
Publisher: American Medical Association (AMA)
Date: 21-06-2006
Drug use in Australia: A community prevalence study
Publisher: AMPCo
Date: 06-1992
DOI: 10.5694/J.1326-5377.1992.TB121556.X
Abstract: To estimate the prevalence of drug use in a representative Australian community. Using a Census district s ling framework supplied by the Australian Bureau of Statistics, we randomly selected dwellings for our survey. A household was defined as all those people living permanently at the postal address. All eligible members of each household, 15 years and older, were asked to participate. The data were collected in the context of a large scale general population survey of health practices and attitudes, conducted in the Greater Newcastle area of New South Wales, during 1987 and 1988. Seventy-two per cent of eligible in iduals approached (2623) agreed to participate in the survey. Participants were asked about their use of a number of drug types: medically prescribed drugs, non-prescription drugs, tobacco, alcohol and illicit drugs. For alcohol, only the results for use at a hazardous level according to the National Health and Medical Research Council guidelines are reported here. Seventy-eight per cent (95% confidence interval, 76%-80%) of the community s le reported having recently consumed at least one of these drug types. There were significant age and sex differences in drug use. A greater proportion of women and the older age groups (over 45 years) reported the use of both non-prescription and prescription medications than did men and the younger age groups. Conversely, a significantly greater proportion of men and the younger age groups reported the use of social and illicit drugs. The importance of regular, representative, methodologically comparable community studies of drug use is stressed, particularly in view of the inadequacy of the current routine sources of epidemiological data on drug use.
Nonsteroidal anti-inflammatory drugs and peptic ulcer hospitalization rates in New South Wales
Publisher: Elsevier BV
Date: 04-1993
DOI: 10.1016/0016-5085(93)90277-J
Abstract: Consumption of nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDS) increased substantially during the 1980s. The effects of this trend on hospitalization rates for peptic ulcer in different age groups in New South Wales, Australia, was investigated. A population model based on sales of NANSAIDS and aspirin, age specific estimates of the relative risk of ulcer complications with these drugs, and hospitalization data for 1979 through 1988 was created. All age groups increased consumption of NANSAIDS. The increases were greatest in elderly subjects, with women over age 65 years increasing the prevalence of their use of the drugs from 11.9% in 1979 to 22.5% in 1988 and males over age 65 increasing use from 9.7% to 20%. Aspirin use remained relatively unchanged in all age groups. Hospitalization rates for peptic ulcer decreased in both sexes under age 64 despite increasing use of NANSAIDs. Hospitalization increased in males and females over age 65, but in females the increase was substantially greater than predicted by the computer model. In women and men over age 75 the increases in hospitalization rates predicted by the model were only 18% and 33%, respectively, of the observed rises. The increasing hospitalization rate for peptic ulcer among elderly subjects was only partly explained by the increasing consumption of NANSAIDS. Further research is needed.
Plasma High-Density Lipoproteins
Publisher: Massachusetts Medical Society
Date: 05-04-1979
Disease mongering is now part of the global health debate
Publisher: Public Library of Science (PLoS)
Date: 27-05-2008
Doctors and drug companies
Publisher: Public Library of Science (PLoS)
Date: 02-11-2010
Pharmacoeconomics and policy decisions: The australian health care system
Publisher: Elsevier BV
Date: 05-1999
DOI: 10.1016/S0149-2918(99)80012-5
Abstract: This paper provides an overview of the use of pharmacoeconomic analysis in the process that governs drug reimbursement decisions in Australia. It discusses the methods by which drugs are evaluated, both clinically and economically, and the means by which these 2 facets are amalgamated the types of pharmacoeconomic data submitted in support of requests for reimbursement the methods and standards used to assess these data some of the more commonly encountered flaws in the data submitted and how the different types of data influence reimbursement decisions.
Association between availability of non-prescription β2 agonist inhalers and undertreatment of asthma
Publisher: BMJ
Date: 05-06-1993
DOI: 10.1136/BMJ.306.6891.1514
Abstract: To determine whether the availability of beta 2 agonist inhalers without prescription leads to undertreatment of asthma. Cross sectional study of adequacy of treatment in asthmatic subjects who purchased beta 2 agonist inhalers and subjects who obtained inhalers by prescription. Community pharmacies in New South Wales, Australia. 403 eligible consecutive asthmatic subjects aged 13 to 55 purchasing salbutamol metered dose inhalers over the counter or by prescription 197 attended for follow up and spirometry and 139 returned 14 day symptom, peak flow, and medication diaries. Severity of asthma assessed on frequency of day time and night time wheezing, frequency of inhaler use, and peak expiratory flow rates. Adequacy of treatment according to published guidelines. Of the 139 patients who completed the diary 83, (60%) purchased their inhalers without prescription and 83 were undertreated. The characteristics of patients in the prescription and purchasing groups were similar. Multiple logistic regression analysis identified use of non-prescribed salbutamol as being associated with a 2.9-fold increase in the odds of undertreatment (95% confidence interval 1.3 to 6.8). Smoking increased the odds of undertreatment (3.3, 1.2 to 9.5) and use of a peak flow meter reduced the odds (0.11, 0.04 to 0.34). Adjustment for frequency of consultation made use of non-prescription salbutamol insignificant (1.4, 0.55 to 3.8). Attitudes to services provided by doctors and pharmacists were favourable and not associated with undertreatment. Over the counter purchase of salbutamol is associated with infrequent consultation with doctors and undertreatment of asthma.
Clinical care of pregnant and postpartum women with COVID‐19: Living recommendations from the National COVID‐19 Clinical Evidence Taskforce
Publisher: Wiley
Date: 29-10-2020
DOI: 10.1111/AJO.13270
Effect of computerised prescribing on use of antibiotics
Publisher: AMPCo
Date: 03-2003
Drug information for consumers
Publisher: Elsevier BV
Date: 12-2001
DOI: 10.1111/J.1467-842X.2001.TB00327.X
Abstract: To investigate the information-seeking behaviour of medicine users. A telephone survey and follow-up in-depth interviews of a random s le of the adult population in the Hunter Region, NSW, Australia. The survey sought information on medicine use, information seeking, and satisfaction and understanding of the information received. In-depth interviews examined the barriers and facilitators of information seeking. Seven hundred and eighty-six people completed the telephone survey and 58 completed the follow-up interviews. Over half (51%) of the medicine users sought information, primarily to 'manage' their medicines, such as how to use the medicine. Over 30% of the questions asked by users related to 'therapeutic choices', such as how well the medicine worked for a particular condition. Doctors and pharmacists were the most frequent sources of information. A small proportion (10%) reported a potential unmet need for medicines information by indicating they would have liked to ask a question, but did not, or were dissatisfied with the information they received. Barriers to information seeking included perceptions that health care professionals were 'too busy', and that they were unwilling to provide information. Physicians and pharmacists continue to play an important role in providing consumers with medicines information. Although the reported level of unmet need was low, a significant proportion identified needs relating to information on therapeutic choice, rather than 'classical' drug information. Medicines-related information for the public should include advice on comparative performance of drugs, and be provided within the wider framework of general health information.
Adverse Effects of Anti-ulcer Drugs
Publisher: Springer Science and Business Media LLC
Date: 06-1981
DOI: 10.2165/00003495-198121060-00004
Abstract: The purpose of this study is to define the rate of implant failure and risk factors for failure in patients treated operatively for displaced medial epicondyle fractures.Patients <18 years of age with medial epicondyle humerus fractures that were treated with screw or k-wire fixation between 2005 and 2015 were eligible. Inclusion criteria included follow-up until radiographic union and no known medical conditions that could impair healing.Thirty four patients with 35 fractures were identified with an average age of 12 years old. 11.4% (n = 4/35) of fractures were treated using K-wires, 25.7% (n = 9/35) were treated using a screw and washer construction, and 62.9% (n = 22/35) were treated using screw alone. There were 16 reported complications (46%) including implant prominence requiring reoperation (6), implant failure (1), and fracture displacement (1). Other complications included non-union/delayed union (4), new ulnar nerve palsy (2), and decreased range of motion (2). Rates of complications were not different between the types of fixation (P = 1.0). Those who developed complications were younger than those who did not (P = 0.05). 91.4% of patients returned to full activity including weight bearing and throwing sports.Although 25% of patients experienced implant complications and the overall complication rate approached 50%, nearly all reported return to full activity.
V. Meta-Analysis of the Efficacy of Hormone Replacement Therapy in Treating and Preventing Osteoporosis in Postmenopausal Women
Publisher: The Endocrine Society
Date: 04-2023
DOI: 10.1210/ER.2001-5002
Abstract: To review the effect of hormone replacement therapy (HRT) on bone density and fractures in postmenopausal women. We searched MEDLINE and EMBASE from 1966 to 1999, the Cochrane Controlled Register, citations of relevant articles, and proceedings of international meetings for eligible randomized controlled trials. We contacted osteoporosis investigators to identify additional studies, and primary authors for unpublished data. We included 57 studies that randomized postmenopausal women to HRT or a control (placebo or calcium/vitamin D) and were of at least 1 yr in duration. Seven of these studies reported fractures. For each study, three independent reviewers assessed the methodological quality and abstracted the data. HRT showed a trend toward reduced incidence of vertebral fractures [relative risk (RR) 0.66, 95% confidence interval (CI) 0.41-1.07 5 trials] and nonvertebral fractures (RR 0.87, 95% CI 0.71-1.08 6 trials). HRT had a consistent effect on bone mineral density (BMD) at all sites. The difference between HRT and control in the percent change in bone density at 2 yr was 6.76 (5.83, 7.89 21 trials) at the lumbar spine and 4.53 (3.68, 5.36 14 trials) and 4.12 (3.45, 4.80 9 trials) at the forearm and femoral neck, respectively. HRT has a consistent, favorable and large effect on bone density at all sites. The data show a nonsignificant trend toward a reduced incidence in vertebral and nonvertebral fractures.
What the public learns about screening and diagnostic tests through the media.
Publisher: AMPCo
Date: 09-2012
DOI: 10.5694/MJA11.11504
The relationship between non-steroidal anti-inflammatory drugs, the development of peptic ulcer and its complications-can we estimate risk?
Publisher: Birkhäuser Basel
Date: 1985
DOI: 10.1007/978-3-0348-7720-6_13
Abstract: There is growing evidence to support an important role for vitamin D and related hormones, parathyroid hormone and fibroblast growth factor 23 (FGF23), on cardiac remodeling in chronic kidney disease. Our objective was to determine the relationships between vitamin D and cardiac remodeling in chronic kidney disease and the effects of parathyroid hormone and FGF23 on these associations. In 1431 participants from the Chronic Renal Insufficiency Cohort study, we measured 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)2D), FGF23, and parathyroid hormone and performed quantitative echocardiography. Using linear regression methods, we determined significant negative interactions between 25(OH)D and FGF23 on left ventricular (LV) mass (P=0.016), end-diastolic volume (P=0.029), and end-systolic volumes (P=0.021). In participants with an FGF23 level greater than the median of 123.5 RU/mL, each doubling of 25(OH)D was associated with a 2.5% (95% confidence interval, -4.8, -0.2) lower LV mass. This association was less pronounced with FGF23 levels less than the median (0.4% 95% confidence interval, -1.9, 2.7). Conversely, in participants with deficient 25(OH)D levels <20 ng/mL, each doubling of FGF23 was associated with a 3.4% (95% confidence interval, 1.2, 5.6) greater LV mass compared with only a 1.6% (95% confidence interval, -0.2, 3.5) difference in participants with sufficient 25(OH)D. Similar findings were observed with 25(OH)D and volumes (P<0.05), and 1,25(OH)2D and LV mass and volumes (P<0.005). There was no effect modification by parathyroid hormone. We identified significant interactions among 25(OH)D, 1,25(OH)2D, and FGF23 on cardiac remodeling. Increased LV mass and cavity dilatation were observed with low 25(OH)D and high FGF23. Our findings suggest that consideration of both hormones is crucial to understanding the role of either in cardiac remodeling, and may have important therapeutic implications.
Severe Hypokalemia in Hospitalized Patients
Publisher: American Medical Association (AMA)
Date: 09-1979
Hyponatraemia during carbamazepine treatment
Publisher: BMJ
Date: 08-01-1977
Pharmaceutical benefits scheme policy: Confused and tough on patients
Publisher: Wiley
Date: 09-03-2006
Health Systems and Sustainability: Doctors and Consumers Differ on Threats and Solutions
Publisher: Public Library of Science (PLoS)
Date: 27-04-2011
Transparency in pricing arrangements for medicines listed on the Australian Pharmaceutical Benefits Scheme
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/AH090192
Abstract: Australia?s system for assessing the cost-effectiveness of drugs for listing under the Pharmaceutical Benefits Scheme (PBS) is recognised internationally. A variety of mechanisms, such as evidencebased rules for determining eligibility for initial or continuing subsidy, price-volume agreements, rebates, and caps on government expenditure are used to contain PBS expenditures. In this paper we assess the extent of use of special pricing arrangements in Australia and how and where they are communicated to health professionals and the community. We searched publicly available documents published by the Pharmaceutical Benefits Advisory Committee (PBAC) and the Pharmaceutical Benefits Pricing Authority (PBPA). We found 73 medicines where special pricing arrangements had been applied and where prices appearing on the Schedule of Pharmaceutical Benefits might differ from those considered to be ?cost-effective? by the PBAC. Reporting of these special pricing agreements was inconsistent and generally non-transparent. In some, the lack of transparency may have reflected the desire of manufacturers to disguise the true negotiated price, lest it weaken their negotiation position in other jurisdictions.
Patterns of analgesic and anti-inflammatory medicine use by Australian veterans
Publisher: Wiley
Date: 19-11-2007
DOI: 10.1111/J.1445-5994.2007.01516.X
Abstract: We examined analgesic and anti-inflammatory medicine use by Australian veterans before and after the introduction of selective Cox-2 inhibitors. We studied cohorts of Gold Card-holding veterans using prescription data held by the Department of Veterans' Affairs for the period 1 July 1998 to 30 June 2004. Outcomes were volume dispensed, average daily quantity and cumulative incidence of use of paracetamol-containing and aspirin-containing medicines, non-selective and Cox-2-selective non-steroidal anti-inflammatory drugs (NSAIDs), tramadol and dextropropoxyphene. Overall, we found high levels of use of analgesic and anti-inflammatory medicines, which increased by 43% over the study period. Use of paracetamol-containing medicines was overtaken by NSAIDs in 1999/2000, corresponding to the introduction of the Cox-2-selective agents. Between 12 and 17% of Cox-2-selective medicine recipients were supplied amounts indicative of continuous use in relatively high doses and 51% of veterans received at least one relatively Cox-2-selective medicine (celecoxib, rofecoxib, meloxicam, diclofenac) by the end of the study period. Dextropropoxyphene use declined during the study and tramadol use increased 10-fold. This study shows very high levels of Cox-2 inhibitor use during the 6-year period. Cox-2-selective agents were more likely to be taken continuously and at higher doses than non-selective NSAIDs. This is relevant in view of the cardiovascular toxicity of this group of medicines. The study shows the value of using unit record dispensing data to assess drug use patterns. Linking dispensing records to hospital separation and mortality data will further enhance our ability to monitor drug safety.
Severe hypokalemia in hospitalized patients
Publisher: American Medical Association (AMA)
Date: 09-1979
How pharmacoepidemiology networks can manage distributed analyses to improve replicability and transparency and minimize bias.
Publisher: Wiley
Date: 15-01-2019
DOI: 10.1002/PDS.4722
Abstract: Several pharmacoepidemiology networks have been developed over the past decade that use a distributed approach, implementing the same analysis at multiple data sites, to preserve privacy and minimize data sharing. Distributed networks are efficient, by interrogating data on very large populations. The structure of these networks can also be leveraged to improve replicability, increase transparency, and reduce bias. We describe some features of distributed networks using, as ex les, the Canadian Network for Observational Drug Effect Studies, the Sentinel System in the USA, and the European Research Network of Pharmacovigilance and Pharmacoepidemiology. Common protocols, analysis plans, and data models, with policies on amendments and protocol violations, are key features. These tools ensure that studies can be audited and repeated as necessary. Blinding and strict conflict of interest policies reduce the potential for bias in analyses and interpretation. These developments should improve the timeliness and accuracy of information used to support both clinical and regulatory decisions.
Pattern of non-steroidal anti-inflammatory drug use in Australia 1990-1994: A report from the drug utilization sub-committee of the pharmaceutical benefits advisory committee
Publisher: AMPCo
Date: 05-1996
Benzodiazepine use as a cause of cognitive impairment in elderly hospital inpatients
Publisher: Oxford University Press (OUP)
Date: 03-1995
Abstract: Benzodiazepine drugs are used very frequently by the elderly and have been associated with a number of untoward events in them. In an earlier publication, we showed that there was an association between benzodiazepine use and episodes of confusion in hospital. The purpose of this study was to examine that association in more detail by studying only patients with intact cognitive function on admission and by taking into consideration a range of demographic, drug use, and clinical confounders. A prospective cohort study was carried out of inpatients who had normal cognitive function on admission to hospital. The subjects were 418 hospital inpatients who had a normal result of a Mini-Mental State Examination (MMSE) performed within 24 hours of admission. They were aged 59-88 years. A clinical history and detailed drug use history were taken on admission and then the patients were followed prospectively for 10 days or until discharge, whichever was sooner. The MMSE was repeated every 2 days and all significant clinical events and episodes of delirium noted. 10.8% (95% Confidence Interval [CI]: 7.8-13.8%) of patients developed cognitive impairment (as indicated by a decrease in the MMSE). Factors that were statistically significantly related to the development of cognitive impairment included admission diagnoses of cancer or central nervous system (CNS) disease, alcohol consumption > 40 gms/day, hypoxia, and presence of benzodiazepines in the urine on admission. After adjusting for age, alcohol consumption, and admission diagnoses, those who reported taking benzodiazepines in daily doses equivalent to 5 mg or more of diazepam were at significantly higher risk of cognitive impairment than those who had not taken benzodiazepines (adjusted odds ratio = 3.5 95% CI: 1.4-8.8). Twenty-one (5.0%, 95% CI: 2.9-7.1%) patients developed delirium as defined by the DSM-IIIR criteria. Age and hypoxia were statistically significantly related to the development of delirium. Due to the small number of cases of delirium, the power of the study to detect significant associations was low. Elderly hospital inpatients who have intact cognitive function on admission to hospital have a low risk of developing cognitive impairment and delirium during their hospital stay. In this population, however, benzodiazepine use accounted for 29% of cases of cognitive impairment which did occur. The data also suggest that dehydration, urinary retention, and an admission diagnosis of CNS disease may be important risk factors for delirium.
Specialist or generalist care? A study of the impact of a selective admitting policy for patients with cardiac failure
Publisher: Oxford University Press (OUP)
Date: 08-2000
Abstract: The debate on the respective roles of medical specialists and generalists has tended to portray them as alternatives, rather than seeking ways to build on the complementary skills of these professional groups. We wished to evaluate the impact of a selective admitting policy that attempts to exploit the complementary strengths of specialists and generalists. Prospective cohort study of patients admitted to hospital with congestive heart failure. Public hospital in New South Wales, Australia. Subjects aged 60 years or more with congestive heart failure defined by the Framingham criteria (see Appendix). A selective admission policy which referred patients with identifiable single system disorders to the relevant subspecialist, while patients with multiple medical problems were admitted under a general physician. Length of hospital stay, survival, quality of life and satisfaction with care. Two-hundred and seventy-five patients with congestive heart failure were followed up from admission to 1 year after discharge from hospital. Of these, 102 were cared for by cardiologists and 154 by generalists. The patients under the generalists were older, had greater co-morbidity, but appeared to have less severe cardiac disease than those cared for by cardiologists. The use of cardiac drugs and investigations was similar in the two groups. The generalists' patients had a longer length of hospital stay, but the cardiologists' patients had a higher mortality during the early follow-up period. There were no differences in levels of satisfaction with care or in health-related quality of life between the two groups of patients. Multivariate analysis suggested that any differences in outcomes between the two groups of patients were due to the severity of underlying disease, and co-morbidity, rather than the quality of care that was provided by the physicians. It is possible to implement a hospital admission policy that selectively refers patients with congestive heart failure to specialists or generalists, according to the presence of co-morbid conditions, without adversely affecting the outcomes of care. Such a policy should represent optimum use of the complementary skills of these professional groups.
Failure of 2 h [14C]‐aminopyrine breath test to demonstrate microsomal enzyme induction by glutethimide [proceedings]
Publisher: Wiley
Date: 11-1978
Moral hazard and prescription medicine use in Australia - The patient perspective
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1016/J.SOCSCIMED.2004.08.005
Abstract: All Australian citizens are provided affordable access to prescription medicines through the nation's system of universal pharmaceutical subsidies--the pharmaceutical benefits scheme. The rapid increase in pharmaceutical related expenditure has generated the concern that Australians are taking advantage of prescription subsidies and are using more medicines than are necessary, thereby creating a 'moral hazard'. This concern is predicated on a number of assumptions about patient behaviour rather than on empirical observation. These assumptions amount to a view that patients are consumers who treat prescription medicines as common goods subject to informed and rational calculation of the cost and benefits of their use. This paper reports the findings of an in-depth interview study undertaken to explore how prescription cost influences Australians' medicine use. Qualitative data were analysed to compare medicine users' descriptions of the role of prescription cost in medicine use against the assumptions that underlie the belief in moral hazard. Moral hazard did not appear to be significantly operating in the accounts of medicine use collected for this study. Interviewees' accounts of medicine use revealed an act characterised by ambivalence, a mix of desire and antipathy, faith and suspicion. Medicines appeared in interviewees' accounts as both pharmacologically and symbolically potent substances, which despite their familiarity as objects, are often mysterious to non-expert patients. Cost appeared as a secondary factor in patients' decision to access a prescription medicine. Using a prescription was predicated on the medicine being necessary, with necessity typically established by an expert doctor prescribing the medicine. Prescription medicines did not appear as 'common goods' where subsidised access motivates a 'consumer' to demand more or make the prospect of prescription use more attractive or necessary.
Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group.
Publisher: Springer Science and Business Media LLC
Date: 12-2004
The benefits of reducing cholesterol levels - the need to distinguish primary from secondary prevention 2. Implications for heart disease prevention in Australia
Publisher: AMPCo
Date: 11-1991
Adverse drug reactions: Can consumers provide early warning?
Publisher: Wiley
Date: 09-1994
Cimetidine and Tranexamic Acid in the Treatment of Acute Upper-Gastrointestinal-Tract Bleeding
Publisher: Massachusetts Medical Society
Date: 30-06-1983
DOI: 10.1056/NEJM198306303082606
Abstract: The Australian lungfish has been studied for more than a century without any knowledge of the longevity of the species. Traditional methods for ageing fish, such as analysis of otolith (ear stone) rings is complicated in that lungfish otoliths differ from teleost fish in composition. As otolith s ling is also lethal, this is not appropriate for a protected species listed under Australian legislation. Lungfish scales were removed from 500 fish from the Brisbane, Burnett and Mary rivers. A sub-s le of scales (85) were aged using bomb radiocarbon techniques and validated using scales marked previously with oxytetracycline. Lungfish ages ranged from 2.5-77 years of age. Estimated population age structures derived using an Age Length Key revealed different recruitment patterns between river systems. There were statistically significant von Bertalanffy growth model parameters estimated for each of the three rivers based on limited s le sizes. In addition, length frequency distributions between river systems were also significantly different. Further studies will be conducted to review drivers that may explain these inter-river differences.
Endoscopio Coagulation for Gastrointestinal Bleeding
Publisher: Massachusetts Medical Society
Date: 21-01-1988
DOI: 10.1056/NEJM198801213180314
Abstract: In budding yeast, the major regulator of the mitotic exit network (MEN) is Tem1, a GTPase, which is inhibited by the GTPase-activating protein (GAP), Bfa1/Bub2. Asymmetric Bfa1 localization to the bud-directed spindle pole body (SPB) during metaphase also controls mitotic exit, but the molecular mechanism and function of this localization are not well understood, particularly in unperturbed cells. We identified four novel Cdc5 target residues within the Bfa1 C-terminus: (452)S, (453)S, (454)S, and (559)S. A Bfa1 mutant in which all of these residues had been changed to alanine (Bfa1(4A)) persisted on both SPBs at anaphase and was hypo-phosphorylated, despite retaining its GAP activity for Tem1. A Bfa1 phospho-mimetic mutant in which all of these residues were switched to aspartate (Bfa1(4D)) always localized asymmetrically to the SPB. These observations demonstrate that asymmetric localization of Bfa1 is tightly linked to its Cdc5-dependent phosphorylation, but not to its GAP activity. Consistent with this, in kinase-defective cdc5-2 cells Bfa1 was not phosphorylated and localized to both SPBs, whereas Bfa1(4D) was asymmetrically localized. BFA1(4A) cells progressed through anaphase normally but displayed delayed mitotic exit in unperturbed cell cycles, while BFA1(4D) cells underwent mitotic exit with the same kinetics as wild-type cells. We suggest that Cdc5 induces the asymmetric distribution of Bfa1 to the bud-directed SPB independently of Bfa1 GAP activity at anaphase and that Bfa1 asymmetry fine-tunes the timing of MEN activation in unperturbed cell cycles.
Factors influencing the uptake of technologies to minimize perioperative allogeneic blood transfusion: An interview study of national and institutional stakeholders
Publisher: Wiley
Date: 20-05-2001
DOI: 10.1046/J.1445-5994.2001.00047.X
Abstract: Alternatives to allogeneic blood transfusion exist and are being used to varying extents in Australian hospitals. Evidence on effectiveness and cost-effectiveness is generally inconclusive and provides a suboptimal basis for policy development. To describe the influences on uptake of transfusion technologies as perceived by national and institutional stakeholders. Qualitative interview study. Interview transcripts were coded and analysed independently by at least two researchers. Participants had opportunity to comment on their transcript and the manuscript. A total of 71 interviews were conducted with representatives of the media, specialist medical societies, consumer special interest groups, the Australian Red Cross Blood Service (ARCBS), government, private health insurers, technology manufacturers, prominent clinicians in the area and a s le of clinicians drawn from hospitals with variable use of blood-saving technologies. Technical advances and acceptance of lower transfusion triggers were identified as the main influences on the decrease in use of allogeneic blood transfusion in the past decade. Participants indicated that patients were most aware and supportive of autologous predonation. Participants noted that 'enthusiasts' were involved in educating about the need for alternatives, negotiating resourcing and maintaining the use of a technology. Funding mechanisms were seen as main barriers to use of alternatives. A discrepancy was noted in the rigour of evaluation and regulation of pharmaceuticals and devices rocedures. Uptake of blood transfusion technologies by institutions was dependent mostly on funding arrangements and the presence of an 'enthusiast'. Critical review of the evidence for effectiveness or cost-effectiveness of these technologies was rarely mentioned. Opportunities exist for evidence-based medicine principles to play a greater role in policy decisions in this area.
Continuous infusion of frusemide in refractory oedema
Publisher: BMJ
Date: 12-08-1978
Efficacy of tricyclic drugs in treating child and adolescent depression: A Meta-analysis
Publisher: BMJ
Date: 08-04-1995
Abstract: To examine whether tricyclic antidepressants are superior to placebo in the treatment of child and adolescent depression. Meta-analysis of 12 randomised controlled trials comparing the efficacy of tricyclic antidepressants with placebo in depressed subjects aged 6-18 years. Most studies employed several depression rating scales. For each study the "best available" measure was chosen by using objective criteria, and in idual and pooled effect sizes were calculated as the number of standard deviations by which the change scores for the treatment groups exceeded those for the control groups. Where authors had reported numbers "responding" to treatment we calculated in idual and pooled ratios for the odds of improvement in treated compared with control subjects. From the six studies presenting data which enabled an estimation of effect size the pooled effect size was 0.35 standard deviations (95% confidence interval of -0.16 to 0.86) indicating no significant benefit of treatment. From the five studies presenting data on the number of "responders" in each group, the ratio of the odds of a response in the treated compared with the control subjects was calculated and the pooled odds ratio was 1.08 (95% confidence interval of 0.53 to 2.17) again indicating no significant benefit of treatment. The pooled s le had more than an 80% chance of detecting a treatment effect of 0.5 standard deviations or greater. There was an inverse relation between study quality and estimated treatment effect. Tricyclic antidepressants appear to be no more effective than placebo in the treatment of depression in children and adolescents.
MENINGITIS. How long to treat bacterial meningitis
Publisher: Elsevier BV
Date: 02-1993
DOI: 10.1016/0140-6736(93)90287-Q
Abstract: Digital pathology represents an electronic environment for performing pathologic analysis and managing the information associated with this activity. The technology to create and support digital pathology has largely developed over the last decade. The use of digital pathology tools is essential to adapt and lead in the rapidly changing environment of 21st century neuropathology. The utility of digital pathology has already been demonstrated by pathologists in several areas including consensus reviews, quality assurance (Q/A), tissue microarrays (TMAs), education and proficiency testing. These utilities notwithstanding, interface issues, storage and image formatting all present challenges to the integration of digital pathology into the neuropathology work environment. With continued technologic improvements, as well as the introduction of fluorescent side scanning and multispectral detection, future developments in digital pathology offer the promise of adding powerful analytic tools to the pathology work environment. The integration of digital pathology with biorepositories offers particular promise for neuropathologists engaged in tissue banking. The utilization of these tools will be essential for neuropathologists to continue as leaders in diagnostics, translational research and basic science in the 21st century.
Cooperative partnerships or conflict-of-interest? A national survey of interaction between the pharmaceutical industry and medical organizations.
Publisher: Wiley
Date: 04-2005
DOI: 10.1111/J.1444-0903.2004.00799.X
Abstract: There is extensive and varied interaction between the pharmaceutical industry and the medical profession. Most empirical research concerns contact between in idual physicians and industry, and reflects North American experience. We sought to clarify the extent and nature of relationships between the pharmaceutical industry and Australian medical organizations. We administered questionnaires to 63 medical organizations concerned with clinical practice, continuing medical education or professional accreditation, or the political representation of medical professionals. Survey instruments were received from 29 organizations, giving a response rate of 46%. Seventeen of these organizations (59%) had received support from one or more pharmaceutical company in the past financial year. Support was predominantly for annual conferences, with some support for continuing medical education, research, travel and library purchases. The majority of organizations had an academic journal or newsletter, and 10 (34%) accepted revenue from pharmaceutical advertising. Twenty organizations (72%) had policies or guidelines covering their relationship with industry. Few organizations indicated that they would be unable to continue their activities without pharmaceutical industry support. These data indicate a high level of inter-action between the pharmaceutical industry and medical organizations in Australia. While most organizations have policies for guiding their relationship with industry, it is unclear whether these are effective in preventing conflicts of interest and maintaining public trust.
Effectiveness of
COVID
‐19 vaccines: findings from real‐world studies
Publisher: Wiley
Date: 29-03-2022
DOI: 10.5694/MJA2.51479
Tofacitinib Persistence in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study
Publisher: The Journal of Rheumatology
Date: 10-2020
Abstract: To compare medication persistence of tofacitinib with persistence of injectable biological disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA). We performed a retrospective new-user cohort study of patients with RA in the IBM MarketScan Research Databases. New users of tofacitinib or bDMARD were identified between November 2012 and December 2016. Persistence, in number of years, was the time between treatment initiation and the earliest occurrence of discontinuation or switching from the medication prescribed at cohort entry. Persistence of tofacitinib was compared with bDMARD persistence using Cox proportional hazards regression with adjustment for high-dimensional propensity scores. Similar methods were used for an analysis of post first-line therapy in patients who switched to tofacitinib from a bDMARD. New tofacitinib users (n = 1031) were 56 years of age, on average, and 82% were women. New bDMARD users (n = 17,803) were 53 years of age, on average, and 78% were women. New tofacitinib users had shorter medication persistence (median 0.81 yrs) compared to bDMARD patients (1.02 yrs). After adjustment, the HR for discontinuation of tofacitinib compared with bDMARD was 1.14 (95% CI 1.05–1.25). Patients who switched to tofacitinib from a bDMARD had longer persistence than patients who switched to a bDMARD (adjusted HR for discontinuation 0.90, 95% CI 0.83–0.97). Further research is warranted to understand the reasons for discontinuation of tofacitinib despite its ease of administration and to understand the observed differences between switchers and new users.
The changing pattern of toxicity to digoxin
Publisher: Oxford University Press (OUP)
Date: 06-1981
Abstract: Toxicity to digoxin was monitored in 437 consecutive recipients in a comprehensive drug surveillance programme, Adverse reactions developed in 19.5% and, in contrast to previous reports, were generally of a relatively benign nature. There were no drug-related deaths, but patients with adverse reactions spent longer in hospital. Low body weight, impaired renal function, old age and concurrent use of diuretics in idually did not increase the risk of toxicity. This was attributed to improvements in the prescribing of digoxin. There was a highly significant excess of gastrointestinal reactions in women, which tended to occur early in the course of therapy. This susceptibility is not widely recognized. The use of loading doses may have caused many early reactions and it is suggested that this practice cold be abandoned in all but the most urgent cases.
Ventricular tachyarrhythmia and sudden cardiac death with domperidone use in Parkinson's disease
Publisher: Wiley
Date: 19-05-2016
DOI: 10.1111/BCP.12964
Aging in Ontario: Using Population-Based Data in the Evaluation of Trends in Health System Use
Publisher: Longwoods Publishing
Date: 26-04-2011
Platelet-rich-plasmapheresis for minimising peri-operative allogeneic blood transfusion
Publisher: Wiley
Date: 16-03-2011
Epidemiological assessment of the association between NSAIDS and peptic ulcer complications
Publisher: Birkhäuser Basel
Date: 1988
DOI: 10.1007/978-3-0348-9160-8_8
Abstract: The prevalence of obesity has increased dramatically worldwide, whereas the types of treatment and their efficacy have not substantially changed over the last two decades. Additionally, drugs used to control weight gain could occasionally create untoward effects in cardiovascular functions, as well as in behaviors, memory, sleep, and emotions because the molecular machinery responsible for ingestion control is interconnected with or shared by the above domains. How each group of drugs preserves the privacy of its message in the mutual network is not fully understood. In the present essay, the graph theory approach was used to explore some aspects of molecular signaling as though they were a 'language'. Its emphasis is on 'molecular polysemy', a term that refers to the ability of biomolecules to be used like words in natural languages more than one-way. This has physiological and clinical implications, in particular when planning drug designs with "specially engineered shotgun loads" that target a combination of biomolecules that assure a better therapeutic outcome without causing deficits in connected but patho-physiologically irrelevant bystanders.
Medical Research and the News Media
Publisher: Massachusetts Medical Society
Date: 24-02-2005
The safety and cost-effectiveness of low osmolar contrast media. Can economic analysis determine the real worth of a new technology?
Publisher: AMPCo
Date: 06-1991
The efficiency frontier approach to economic evaluation of health‐care interventions
Publisher: Wiley
Date: 24-06-2010
DOI: 10.1002/HEC.1629
Abstract: IQWiG commissioned an international panel of experts to develop methods for the assessment of the relation of benefits to costs in the German statutory health-care system. The panel recommended that IQWiG inform German decision makers of the net costs and value of additional benefits of an intervention in the context of relevant other interventions in that indication. To facilitate guidance regarding maximum reimbursement, this information is presented in an efficiency plot with costs on the horizontal axis and value of benefits on the vertical. The efficiency frontier links the interventions that are not dominated and provides guidance. A technology that places on the frontier or to the left is reasonably efficient, while one falling to the right requires further justification for reimbursement at that price. This information does not automatically give the maximum reimbursement, as other considerations may be relevant. Given that the estimates are for a specific indication, they do not address priority setting across the health-care system. This approach informs decision makers about efficiency of interventions, conforms to the mandate and is consistent with basic economic principles. Empirical testing of its feasibility and usefulness is required.
OMEPRAZOLE: EFFECTS ON OXIDATIVE DRUG METABOLISM IN THE RAT
Publisher: Wiley
Date: 05-1986
DOI: 10.1111/J.1440-1681.1986.TB00916.X
Abstract: Omeprazole, a substituted benzimidazole and a potent gastric antisecretory drug has been tested for inhibition of microsomal drug oxidative function in the rat. A single dose of 40 mg/kg prolonged pentobarbitone sleeping times from 118 (range 73-168) min to 195 (159-222) min (P less than 0.01), pentobarbitone half-lives from 89 (63-114) to 112 (54-146) min (P less than 0.05) and aminopyrine breath 14CO2 half-lives from 43 (37-51) to 56 (49-79) min (P less than 0.05). Omeprazole in doses of 20 mg/kg or less had no significant effect. In prolonging pentobarbitone sleeping times omeprazole 40 mg/kg and an equimolar (30 mg/kg) dose of cimetidine were approximately equipotent. These results contrast with studies in man in which much smaller doses of omeprazole have been shown to produce clinically significant inhibition of drug metabolism.
Related Organisations
University Of New South Wales School Of Public Health And Community Medicine
Location: Australia
University Of Glasgow
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
Unlocking Health Information For Older First Nations Populations
Start Date: 2015
End Date: 2018
Funder: Canadian Institutes of Health Research
View Funded ActivityPopulation Health Analytics In Action: Improving Impact, Sustainability & Equity Of The Health Care System
Start Date: 2016
End Date: 2021
Funder: Canadian Institutes of Health Research
View Funded ActivityCIHR/Health Canada Team In Policies For Equitable Access To Medications
Start Date: 2008
End Date: 2013
Funder: Canadian Institutes of Health Research
View Funded ActivityInjecting Evidence Into Health Policy Coverage: Working With The Media
Start Date: 2009
End Date: 2015
Funder: Canadian Institutes of Health Research
View Funded ActivityReducing Deaths From Pesticide Poisoning - Establishing A Regional Toxicology Research Centre.
Start Date: 2003
End Date: 2011
Funder: National Health and Medical Research Council
View Funded ActivityMedicines And Ageing
Start Date: 2013
End Date: 2018
Funder: National Health and Medical Research Council
View Funded ActivityAMSTAR-NRS: Helping Decision Makers Distinguish High And Low Quality Systematic Reviews Of Non-randomized Studies
Start Date: 2013
End Date: 2015
Funder: Canadian Institutes of Health Research
View Funded ActivityStrengthening Local Knowledge-to-action For Sustainable Aboriginal And Universal Childhood Immunization
Start Date: 2008
End Date: 2009
Funder: Canadian Institutes of Health Research
View Funded ActivityAll-cause And Cause-specific Mortality Trends In Ontario: Implications For Health And Health Systems
Start Date: 2015
End Date: 2016
Funder: Canadian Institutes of Health Research
View Funded ActivityCanadian Drug Safety And Effectiveness Research Network (CDSERN)
Start Date: 2008
End Date: 2013
Funder: Canadian Institutes of Health Research
View Funded ActivityA Network Meta-Analysis Of The Cardio-Cerebrovascular Risk Associated With The Anti-Parkinsonian Combination Of Levodopa/carbidopa/entacapone
Start Date: 2012
End Date: 2012
Funder: Canadian Institutes of Health Research
View Funded ActivityCanadian Centre For Applied Research In Cancer Control (ARCC): Advancing Health Economics, Services, Policy And Ethics
Start Date: 2009
End Date: 2014
Funder: Canadian Cancer Society
View Funded ActivityCanadian Network For Observational Drug Effect Studies (CNODES)
Start Date: 2011
End Date: 2015
Funder: Canadian Institutes of Health Research
View Funded ActivityOntario SPOR SUPPORT Unit
Start Date: 2013
End Date: 2018
Funder: Canadian Institutes of Health Research
View Funded ActivityNewfoundland And Labrador CNODES Demonstration Project
Start Date: 2014
End Date: 2015
Funder: Canadian Institutes of Health Research
View Funded ActivityGender Disparities In Perinatal And Child Health And Maternal Well-being Associated With Maternal Country Of Birth
Start Date: 2013
End Date: 2016
Funder: Canadian Institutes of Health Research
View Funded ActivityCentre Of Research Excellence In Medicines Intelligence
Start Date: 2020
End Date: 2025
Funder: National Health and Medical Research Council
View Funded ActivityGender Disparities In Perinatal And Child Health And Maternal Well-being Associated With Maternal Country Of Birth
Start Date: 2013
End Date: 2014
Funder: Canadian Institutes of Health Research
View Funded Activity