Meta-analysis of risk of gastrointestinal complications with NSAIDs. Authors should not have included data from one study.
Explore the source record for details and available documents.
Anti-Inflammatory Agents, Non-Steroidal↗
Biomedical subjects
D Henry
Publications and source records attributed to D Henry.
Valsartan, a new angiotensin II receptor antagonist: a double-blind study comparing the incidence of cough with lisinopril and hydrochlorothiazide.
The present study compares the occurrence of a dry, persistent cough with doses of 80 mg of valsartan, 10 mg of lisinopril, or 25 mg of hydrochlorothiazide in patients with a history of angiotensin-converting enzyme inhibitor-induced cough. This was a randomized, double-blind, active-controlled, parallel group, multicenter trial involving 129 adult outpatients with essential hypertension. After confirmation of angiotensin-converting enzyme inhibitor-induced cough during a 2 to 4 week challenge with lisinopril (followed by a washout period of 2 weeks), patients were randomized to receive 6 weeks of double-blind treatment once daily with 80 mg valsartan, 10 mg lisinopril, or 25 mg hydrochlorothiazide. Assessments were made at baseline and after 3 and 6 weeks of treatment. Comparability of response to treatment was assessed by mean sitting diastolic and systolic blood pressure at the end of treatment. The occurrence of a dry, persistent cough was significantly less (P < 0.001) at 3 and 6 weeks with valsartan (19.5%) than with lisinopril (68.9%), with no significant difference between valsartan and hydrochlorothiazide (19.0%). There were no statistically significant differences in reduction of blood pressure among the three treatment groups. The overall incidence of adverse experiences, whether or not treatment-related, was highest for lisinopril (86.7%) compared with valsartan (57.1%), and hydrochlorothiazide (61.9%). A dry cough in the lisinopril group accounted for this difference. There were no clinically significant changes in physical signs or in results of clinical laboratory evaluations during double-blind treatment, except for from metabolic changes in 3 patients receiving hydrochlorothiazide. In hypertensive patients with a history of angiotensin-converting enzyme inhibitor-induced cough, a single daily dose of 80 mg of valsartan produced therapeutic efficacy comparable to lisinopril but with significantly less cough.
Angiotensin Receptor Antagonists↗
Functional and oximetric assessment of patients after lung reduction surgery.
OBJECTIVE: The goal of this study was to clarify the issue of functional oxygen requirement by regimented exercise oximetry in patients undergoing lung reduction surgery. METHODS: Thirty-seven patients underwent lung reduction surgery and were followed up for at least 3 months. Patients routinely completed a 6-week program of cardiopulmonary rehabilitation. Preoperative and postoperative spirometry, dyspnea scores, 6-minute walk distances, respiratory mechanics, and exercise oximetry were recorded. RESULTS: After the operation, patients had a 37% increase in forced vital capacity and a 59% increase in forced expiratory volume in 1 second. Six-minute walk distance increased from 913 +/- 310 feet before the lung reduction operation to 1202 +/- 274 feet 6 months after the operation (p < 0.001). Maximal inspiratory and expiratory pressures were significantly increased in 16 patients after lung reduction surgery. Perceived dyspnea was significantly improved. Exercise pulse oximetry demonstrated that 83% of patients met American Thoracic Society criteria for supplemental oxygen use before lung reduction surgery. After the operation, 70% of patients continued to meet American Thoracic Society criteria for supplemental oxygen use. Notably, 10 patients with exertional desaturation while breathing room air discontinued supplemental oxygen use because of a reduction in dyspnea. CONCLUSIONS: These findings demonstrate significant subjective and functional improvements related to lung reduction surgery. Exercise-induced hypoxia was not reversed by lung reduction surgery. Discontinuance of supplemental oxygen use owing to reduction in dyspnea and improved physical performance may not be warranted in lieu of continued exertional desaturation.
Adult↗
Consumption of non-steroidal anti-inflammatory drugs and the development of functional renal impairment in elderly subjects. Results of a case-control study.
AIMS: The aim of the present study was to explore the level of risk associated with community use of non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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 individuals who are at risk of developing renal impairment.
Aged↗
Economic evaluation of pharmaceuticals: what are reasonable standards for clinical evidence--the Australian experience.
Explore the source record for details and available documents.
Australia↗
Haematological toxicities associated with dose-intensive chemotherapy, the role for and use of recombinant growth factors.
High-dose chemotherapy is increasingly accepted as a treatment approach in a number of tumour types. However, there are controversies surrounding its efficacy and there is a need to consider its safety. In view of this, much effort has been directed towards the provision of adequate supportive care strategies to prevent toxicities and to ameliorate myelosuppression. Severe anaemia and its associated symptoms, for example, fatigue can have a debilitating effect on a patient's quality of life and often necessitates red blood cell transfusions. Erythropoietin, a glycoprotein hormone which stimulates red blood cell production, has been established for the treatment of anaemia in patients with chronic renal insufficiency. It is currently approved in most countries for treating anaemia associated with cancer, and its role is emerging especially in patients undergoing high-dose chemotherapy. This paper gives an overview of the studies conducted to date with epoetin alfa (recombinant human erythropoietin) in patients receiving allogeneic and autologous bone marrow transplants or peripheral blood stem cells in conjunction with high-dose chemotherapy. In addition, there are some novel clinical applications for epoetin alfa: for example, in delayed anaemia, as a supportive strategy prior to high-dose chemotherapy and as a synergistic enhancer of blood progenitor cell mobilisation in combination with granulocyte-colony-stimulating factor (G-CSF).
Anemia↗
A randomized trial of clarithromycin as prophylaxis against disseminated Mycobacterium avium complex infection in patients with advanced acquired immunodeficiency syndrome.
BACKGROUND: Disseminated infection with Mycobacterium avium complex is the most common opportunistic infection in patients with advanced stages of the acquired immunodeficiency syndrome (AIDS). We studied the efficacy and safety of prophylactic treatment with clarithromycin, a macrolide antibiotic. METHODS: We conducted a randomized, placebo-controlled, double-blind study of clarithromycin in patients with AIDS in the United States and Europe. Entry criteria included blood cultures that were negative for M. avium complex, a Karnofsky performance score of 50 or higher, a CD4 cell count of 100 or less per cubic millimeter, and a life expectancy of at least six months. RESULTS: After the first interim analysis, the study was stopped. M. avium complex infection developed in 19 of the 333 patients (6 percent) assigned to clarithromycin and in 53 of the 334 (16 percent) assigned to placebo (adjusted hazard ratio, 0.31; 95 percent confidence interval, 0.18 to 0.53; P<0.001). During the follow-up period of about 10 months, 32 percent of the patients in the clarithromycin group died and 41 percent of those in the placebo group died (hazard ratio, 0.75; P=0.026). In the clarithromycin group, isolates from 11 of the 19 patients with M. avium complex infection were resistant to clarithromycin. Prophylaxis with clarithromycin was associated with an increased incidence of taste perversion (11 percent in the clarithromycin group vs. 2 percent in the placebo group, P<0.001) and rectal disorders (8 percent vs. 3 percent, P = 0.007); however, the frequency of more severe adverse events was similar in the two groups (7 percent and 6 percent, respectively). CONCLUSIONS: In patients with advanced AIDS, the prophylactic administration of clarithromycin is well tolerated, prevents M. avium complex infection, and reduces mortality.
AIDS-Related Opportunistic Infections↗
Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis.
OBJECTIVE: To compare the relative risks of serious gastrointestinal complications reported with individual non-steroidal anti-inflammatory drugs. DESIGN: Systematic review of controlled epidemiological studies that found a relation between use of the drugs and admission to hospital for haemorrhage or perforation. SETTING: Hospital and community based case-control and cohort studies. MAIN OUTCOME MEASURES: (a) Estimated relative risks of gastrointestinal complications with use of individual drugs, exposure to ibuprofen being used as reference; (b) a ranking that best summarised the sequence of relative risks observed in the studies. RESULTS: 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. CONCLUSIONS: 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.
Anti-Inflammatory Agents, Non-Steroidal↗
Prescription drug utilization following patient co-payment changes in Australia.
In November 1990 major patient co-payment changes were introduced into the Pharmaceutical Benefits Scheme (PBS), which accounts for around 90% of all community prescriptions in Australia. Interrupted time series analyses were performed to assess the impact of these co-payment changes on the prescription levels of defined groups of 'discretionary' and 'essential' drugs for both the general community and for a subgroup comprising elderly returned servicemen and women. While the co-payment changes themselves had a significant immediate effect on lowering the use of both categories of drugs, the effects were substantially larger for the 'discretionary' groups in both cases. Notably there was a clear post-intervention trend for increased prescriptions of 'essential' drugs after the initial decline, which was not evident for the 'discretionary' drugs. The introduction of programmes to compensate high risk groups in Australia may have enabled the co-payment to become a more selective policy instrument than has been shown in other settings.
Journal Article↗
Patterns of psychopathology among urban poor children: comorbidity and aggression effects.
A sample of 3,647 children from Grades 1-6 of inner-city and other urban poor communities and diverse ethnic groups were evaluated for co-occurrence of clinical-level scores on syndrome scales of the Teacher Report Form of the Child Behavior Checklist. Besides examining the relative rate of co-occurring syndromes, the contribution of residence location, ethnicity, age, and gender to such patterns were examined. Latent class analyses were applied to determine the makeup of basic patterns of co-occurring syndromes. Results suggest that comorbidity and the type of comorbidity pattern are related to residence. Gender and ethnicity are also related to pattern. Aggression seems to be a central aspect of the type of co-occurring patterns found among urban poor children. Its presence relates to poorer functioning, particularly in conjunction with internalizing syndromes.
Aggression↗
Virtual echography. The simulation of ultrasonographic examination.
We present a Virtual Echographic System. Because this examination is particularly difficult, developing a simulator is very useful to give students some common databases of pathological samples on which they could experiment image acquisition and evaluate their understanding of clinical cases. We have applied our method to the simulation of thigh ultrasonographic examination for thrombosis diagnosis. A preliminary system, focusing on image generation, has been developed. Virtual echographic slices are generated using a particular interpolation technique and a deformation model of significant structures. Resulting images have a visual quality similar to usual ones.
Computer Simulation↗
The Community Living Attitudes Scale, Mental Retardation Form: development and psychometric properties.
We described the development and psychometric properties of the Community Living Attitudes Scale, Mental Retardation Form (CLAS-MR), a 40-item measure based on the input of self-advocates and focused on contemporary community living philosophies. The CLAS-MR, which consists of four subscales that tap attitudes about people with mental retardation, demonstrated acceptable internal consistency, retest reliability, and construct validity with samples of 104 college students and 283 community members. Using data from a sample of 355 staff members from community agencies, we confirmed the factor structure of the measure. Given the importance of attitudes toward persons with mental retardation in policy making and community inclusion, the CLAS-MR can help chronicle the diffusion of the new paradigm of empowered community living for persons with mental retardation.
Activities of Daily Living↗
Attitudes of community-living staff members toward persons with mental retardation, mental illness, and dual diagnosis.
Attitudes of 340 staff members in 120 community living programs for people with mental retardation, mental illness, and dual diagnosis and a comparison sample of 152 community members were assessed using the Community Living Attitudes Scale, a measure of attitudes toward inclusion. Results showed that community agency supervisory and managerial staff held more favorable attitudes toward community living philosophy. Community support staff who worked with people who have mental retardation saw that population as less similar to other people than did the comparison sample and were less likely to endorse exclusion of persons with mental retardation than were those in the comparison sample. Retrospective analyses showed that training in inclusion philosophy was related to more inclusive, empowering attitudes among staff members.
Activities of Daily Living↗
A preliminary study of ritonavir, an inhibitor of HIV-1 protease, to treat HIV-1 infection.
BACKGROUND: Ritonavir is a potent inhibitor in vitro of human immunodeficiency virus type 1 (HIV-1) protease, which is needed for virions to mature and become infective. We assessed the safety and efficacy of ritonavir in patients with HIV-1 infection. METHODS: We administered ritonavir orally to 62 patients in one of four dosages during a 12-week trial containing a 4-week randomized, placebo-controlled, double-blinded phase followed by an 8-week dose-blinded phase. We assessed the response with serial measurements of plasma viremia and serial CD4 cell counts. RESULTS: Fifty-two patients completed the 12-week trial. Diarrhea and nausea were the most common side effects, and reversible elevations in serum triglyceride and gamma-glutamyltransferase levels were the most frequent laboratory abnormalities. Ritonavir had a rapid antiviral effect, with a mean maximal reduction in the number of copies of HIV-1 RNA per milliliter of plasma that ranged from 0.86 to 1.18 log in the four dosage groups. After 12 weeks of treatment, the antiviral effect was partially maintained, with a mean reduction in plasma viremia of 0.5 log. When we used a more sensitive assay for HIV-1 RNA in a subgroup of 20 patients, we found that plasma viremia decreased by a mean of 1.7 log. This antiviral effect was partly sustained at week 12, with a mean reduction of approximately 1.1 log. The patients' CD4 cell counts rose during treatment with ritonavir (median increase, 74 and 83 cells per cubic millimeter at weeks 4 and 12, respectively). CONCLUSIONS: The protease inhibitor ritonavir is well tolerated and has a potent antiviral effect, as shown by substantial decreases in plasma viremia and significant elevations in CD4 cell counts. Expanded clinical trials of ritonavir are warranted.
Adult↗
Comparing treatments.
Explore the source record for details and available documents.
Clinical Trials as Topic↗
Trial of streptokinase in ischaemic stroke.
Explore the source record for details and available documents.
Cerebrovascular Disorders↗
Promoting cost effective prescribing.
Explore the source record for details and available documents.
Australia↗
Efficacy of tricyclic drugs in treating child and adolescent depression: a meta-analysis.
OBJECTIVE: To examine whether tricyclic antidepressants are superior to placebo in the treatment of child and adolescent depression. DESIGN: Meta-analysis of 12 randomised controlled trials comparing the efficacy of tricyclic antidepressants with placebo in depressed subjects aged 6-18 years. MAIN OUTCOME MEASURES: Most studies employed several depression rating scales. For each study the "best available" measure was chosen by using objective criteria, and individual 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 individual and pooled ratios for the odds of improvement in treated compared with control subjects. RESULTS: 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 sample 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. CONCLUSIONS: Tricyclic antidepressants appear to be no more effective than placebo in the treatment of depression in children and adolescents.
Adolescent↗