Medical literature, evaluating

Limited results from clinical laboratory evaluations suggested that the GABAj l agonists zaleplon (Rush et al. 1999b) and Zolpidem (Rush et al. 1999a) produce effects that are consistent with abuse potential comparable to that of the benzodiazepine triazolam. The reported incidence of dependence on Zolpidem in the medical literature is low, compared with that for benzodiazepines, and is characterized by use of high doses, often in individuals with a history of substance abuse (Hajak et al. 2003 Vartzopoulos et al. 2000). 

If you look in the medical literature, you will often see the term placebo defined as a non-specific treatment. What does it mean to say that a treatment is not specific It could mean that the treatment is effective for many different disorders, rather than for only one particular condition. In this sense, placebos are indeed non-specific. Besides depression, placebos have been shown to affect anxiety, pain, ulcers, irritable bowel syndrome, Parkinson s disease, angina, autoimmune diseases, Alzheimer s disease, rheumatoid arthritis, asthma, gastric function, sexual dysfunction and skin conditions. We know this from the thousands of studies in which placebos have been used as control conditions, against which the effects of medication have been evaluated, and from studies that were specifically designed to assess the placebo effect. 

As when evaluating the published medical literature, results from economic analyses should not be taken at face value. Claims of cost-effectiveness must be supported by assessments against appropriate comparators. Analyses comparing against placebo should be viewed with caution unless the drug or therapy in question is the very first treatment available for that disease. Reports should be detailed, clear and transparent. It is crucial that readers are able... 

Information in the PI is typically based on the studies submitted by a drug s manufacturer. The FDA has also utilized spontaneous adverse event case reports as a tool in the evaluation of drug-grapefruit juice interaction labeling. Other sources of data that contribute to labeled information include studies or case reports from the medical literature. 

Because of differences in pharmacokinetics in infants and children, simple proportionate reduction in the adult dose may not be adequate to determine a safe and effective pediatric dose. The most reliable pediatric dose information is usually that provided by the manufacturer in the package insert. However, such information is not available for the majority of products, even when studies have been published in the medical literature, reflecting the reluctance of manufacturers to label their products for children. Recently, the FDA has moved toward more explicit expectations that manufacturers test their new products in infants and children. Still, most drugs in the common formularies, eg, Physicians Desk Reference, are not specifically approved for children, in part because manufacturers often lack the economic incentive to evaluate drugs for use in the pediatric market. 

Army. 1975. Toxicity to aquatic organisms and chemistry of nine selected waterborne pollutants from munitions manufacture - a literature evaluation. Washington, DC U.S. Army Medical Research and Development Command. Document no. AD A010660. 

Clinical case reports of unusual treatments or response to therapy have presented a plethora of questions that remain to be answered. Case series and descriptions of experience with treatment protocols or the impact of pharmacist interventions are useful contributions to the literature. Evaluation of economics and outcomes has been an important area of research in critical care. The critically ill patient patient typically receives a large number of different and often expensive medications, and is monitored with expensive devices. Pharmacists have characterized various aspects of the cost of care, although comprehensive pharmacoeconomic outcome research is... 

Drug manufacturers may identify ADEs through several means, including spontaneous reports by healthcare providers or patients, clinical studies, and reviews of the medical literature. Once the company is aware of an ADE, the data are evaluated, the seriousness and ex-... 

As when evaluating the published medical literature, results from economic analyses should not be taken at face value . Reports should be detailed, clear and transparent. It is crucial that readers be able to follow exactly what was done (with justification) throughout the analysis. Care should also be taken to determine that the type of analysis performed (for example CEA, CBA) corresponds with the analytical technique purported to be used in the study. Zarnke and colleagues sampled the published literature to assess whether evaluations labelled as cost-benefit analyses met the contemporary definition using CBA methodology. They reported that 53% of the 95 studies assessed were reclassified as cost comparisons because health outcomes were not appraised. Several authors have developed checklists that are useful when evaluating the overall quality of an economic analysis. One of the best-known checklists is given in Box 20.1. 

For a more detailed description of the concepts in critical appraisal, a series of articles published in the Journal of the American Medical Association (JAMA) provides a useful tool for practitioners who are evaluating clinical trials. ° These users guides to the medical literature—developed by The Evidence-Based Medicine Working Group, a group of clinicians at Canada s McMaster University and colleagues across North America—can help to assess the validity of primary studies as well as review articles. 

Randolph AG, Haynes RB, Wyatt JC, et al. Users guides to the medical literature XVIII. How to use an article evaluating the clinical impact of a computer-based clinical decision support system. JAMA 1999 282 67-74. 

Important to all who evaluate NHL pahents for response and also to those who would like to compare clinical results from one publication in the medical literature... 

The word vulnerable is used to denote the probability of exhibiting a clinically significant event in the future. The word vulnerable has been employed in a variety of reports in the medical literature, all of which portray conditions predisposed to injury. In this respect, the term vulnerable plaque is most appropriate to classify plaques susceptible to complications. In contrast, interventional cardiologists and cardiovascular pathologists retrospectively explain the plaque responsible for eoronary occlusion and death as a culprit plaque, apart from its histopathological appearance. However, for prospective evaluation, diagnosis, and treatment, clinicians require a term like culprit for identifying such plaques before an event occurs. 

Sources of information that can be accessed for evaluating products include the Hazardous Substances Data Base, which contains a summary of the fate of the substance in the environment and can be accessed via MEDLARS (Medical Literature Analysis and Retrieval System) [a.405], the EPA AQUIRE (Environmental Protection Agency-Aquatic Life) data base, which contains a listing of aquatic toxicity data for many industrial chemicals [a.406], Syracuse University s data base of fate studies [a.407], and quantitative structure-activity relationships (QSARs) such as the EPA programme ECOSAR (Ecological... 

Polypharmacy is often a consequence of the cascade of problems. A literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality (Hajjar et al. 2007). The reviewers states that many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring . 

Other workers with flavoring-related BO were not appropriately diagnosed, even after reports of flavoring-related BO were published in the scientific literature (Kreiss et ah, 2002a Lockey et ah, 2002 Parmet and von Essen, 2002), public health commimications (CDC, 2002), and the press. Frequent misdiagnoses by physicians included asthma, bronchitis, and emphysema due to a presumptive diagnosis, an incomplete medical evaluation, and/or failure to make a coimection with occupational exposures. 

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