PubMed · 16776182
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Keiichi Kamijo. 2006-05-28. [Painless thyroiditis].. https://pubmed.ncbi.nlm.nih.gov/16776182/
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We consider Bayesian sensitivity analysis for unmeasured confounding in observational studies where the association between a binary exposure, binary response, measured confounders and a single binary unmeasured confounder can be formulated using logistic regression models. A model for unmeasured confounding is presented along with a family of prior distributions that model beliefs about a possible unknown unmeasured confounder. Simulation from the posterior distribution is accomplished using Markov chain Monte Carlo. Because the model for unmeasured confounding is not identifiable, standard large-sample theory for Bayesian analysis is not applicable. Consequently, the impact of different choices of prior distributions on the coverage probability of credible intervals is unknown. Using simulations, we investigate the coverage probability when averaged with respect to various distributions over the parameter space. The results indicate that credible intervals will have approximately nominal coverage probability, on average, when the prior distribution used for sensitivity analysis approximates the sampling distribution of model parameters in a hypothetical sequence of observational studies. We motivate the method in a study of the effectiveness of beta blocker therapy for treatment of heart failure.
BACKGROUND AND OBJECTIVE: The expenses of health insurances are continuously raising. With implementation of evidence-based medicine resulting in polypharmacy, compliance is decreasing and patients as well as physicians are facing unintentional drug interactions. Furthermore the arbitrary use of additional drugs apart from prescribed medication has to be considered. The objective of this study was to analyse polypharmacy, compliance and utilisation patterns for non-prescription medications (OTC) in patients with cardiovascular diseases. METHODS: 100 patients with cardiovascular diseases (45 women, 55 men, 58 - 87 years) were interviewed using a questionnaire. The compliance was determined by the Morisky-Score. RESULTS: 78 % of the patients received more than four pills every day (median 8.34). Most common products were beta-blockers (89 %), ACE-Inhibitors/Sartans (69 %) and aspirin (65 %). Only 52 % of the patients knew the indications of their medication. Although 83 % of the patients claimed to be absolutely compliant concerning their medication, the Morisky-Score revealed a high compliance only in 52 %. The compliance decreased significantly if the number of prescribed medication increased to more than four pills a day. 48 % of the patients took regularly non-prescription products, 35 % more than three additional products daily. Most commonly multivitamins, minerals, herbals and non-steroidal anti-inflammatory drugs were used. This non-prescription medication did not affect the compliance of the patients. CONCLUSIONS: Polypharmacy with more than four pills daily leads to a lower compliance and can therefore influence the implementation of guideline-medicine. Non-prescription medication is widely used and should be considered because of their potential side-effects and drug interactions.
RATIONALE: Atypical antipsychotics improve cognitive function, including working memory, in schizophrenia. Some atypical antipsychotics have been reported to activate the locus coeruleus and induce beta-adrenoceptor antagonist sensitive c-Fos-like immunoreactivity in the prefrontal cortex. MATERIALS AND METHODS: The present study investigated the effects of chronic treatment of rats with risperidone (1 mg kg(-1) day(-1) s.c.), clozapine (10 mg kg(-1) day(-1) s.c.), or acidified saline vehicle control for 2, 4, or 8 weeks on spatial working memory performance in a delayed matching-to-place water maze task with a 60-s inter-trial retention interval with and without acute challenge with propranolol (10 mg/kg i.p.). RESULTS: Treatment with risperidone for 8 weeks, but not 2 or 4 weeks, significantly improved working memory performance. In contrast, treatment with clozapine for up to 8 weeks did not improve working memory. Acute challenge with propranolol blocked the improvement in working memory produced by chronic treatment with risperidone, but had no significant effect on performance in saline- or clozapine-treated animals. CONCLUSIONS: The delayed matching-to-place water maze task may prove valuable in the investigation of the behavioural pharmacology of the cognitive effects of antipsychotic drugs. These data suggest that beta adrenoceptors may contribute to the cognitive effects of chronic treatment with atypical antipsychotics.