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4201. Addiction 2.0 Part 1

in the care of these medical disorders. In recent years, however, effective pharmacotherapies have emerged for two classes of substances that are particularly destructive when abused, as they commonly are: opioids (heroin and prescription narcotics) and alcohol. In this two-part entry, we will review the current state-of-the-art in strategies for addressing these conditions in the office-based practice setting. The great majority of affected patients do not seek dedicated substance abuse treatment (...) ‘Suboxone’), to deter its misuse by injection. A physician need only complete a relatively brief training course in order to obtain a DEA waiver authorizing prescribing. Thereafter, physicians can now incorporate treatment of heroin or prescription opioid dependence into everyday practice. Buprenorphine can be used as a long-term maintenance medication (much like methadone maintenance), or in tapering doses to prevent and treat withdrawal symptoms when the opioid drug of abuse is discontinued

2008 Clinical Correlations

4202. Grand Rounds: "Fibromyalgia and Homeopathy: Holmes, Hogwarts and the Prince of Wales"

and pharmaceutical companies who specialize in prescription medicine. Just because a product is natural doesn’t mean it’s less effective. On top of that, alternative medicines do not kill people. Substituting the right medicine with the wrong medicine does kill people. Comments are closed. Sites We Follow: Useful Links: Questions? Comments? Contact us! © New York University. All rights reserved. Electronic ISSN 1944-0030. The content of this site is intended for health care professionals.

2008 Clinical Correlations

4203. SSRIs: Do They Increase Rates of Suicide?

report. This study analyzed the prescription rates of SSRI antidepressants and the rates of suicide both before and after the black-box warning. Data from both the U.S. and the Netherlands was examined. A clear correlation between the decreased prescriptions and increased death by suicide was observed. It was also noted that various limitations in the meta-analysis that the FDA used as the basis for its warning exist. Most telling is that there were no completed suicides in this meta-analysis. Rather (...) RD, Brown CH, et al: Early evidence on the effects of the regulators’ suicidality warnings on the SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry. 2007;164:1356-1363. Share: | | One comment on “ SSRIs: Do They Increase Rates of Suicide? ” Well according to , it states… “There was no statistical difference in crude suicide rates among patients assigned to SSRIs, other antidepressants, or placebo ({chi}2=2.83, df=2, p>0.05). In addition, when groups were compared

2008 Clinical Correlations

4204. Evaluation of the Uptake of Advice, Directives and Guidelines to the NHS Concerning Patient Safety by the SABS System

patient safety by the Safety Alert Broadcast System Executive Summary Overview The Safety Alert Broadcast System (SABS) was established in 2004 as one of the responses to the recommendations in the Department of Health’s (DH) 2001 report Building a safer NHS for patients, itself the implementation plan following the DH’s 2000 report An organisation with a memory. SABS is an electronic system developed by the DH to disseminate patient safety alerts issued to the NHS from the Medicines and Healthcare (...) products Regulatory Agency (MHRA); the National Patient Safety Agency (NPSA); DH Estates and Facilities Division (DHE&F) and the DH itself (which has issued two). The aim of the SABS system is to bring the different types of alerts together into one electronic system and to streamline the way in which the alerts are issued. The system also requires trusts to feedback to the Patient Safety Team the relevance of the alert to the organisation, the action taken, and the date of the completion of the action

2007 York Health Economics Consortium

4205. Workplace interventions for people with common mental health problems

that described non-work based interventions; our main criteria were that the study passed the critical appraisal process and that employment was among the outcome measures. As a consequence there are several studies where the intervention was targeted at practitioners such as primary care physicians, but the outcomes were focused on return to work or remaining in employment for people with common mental health problems. Electronic searches produced more than 15000 references. Subsidiary searches included

2005 British Occupational Health Research Foundation

4206. A compliance questionnaire could discriminate among patients for drug taking behaviour and correct dosing in rheumatic diseas (Full text)

Clinical prediction guide A compliance questionnaire could discriminate among patients for drug taking behaviour and correct dosing in rheumatic diseases Free John F Steiner , MD, MPH Statistics from de Klerk E, van der Heijde D, Landewé R, et al . The compliance-questionnaire-rheumatology compared with electronic medication event monitoring: a validation study. J Rheumatol 2003 ; 30 : 2469 –75. Q In patients with rheumatic diseases, how well does the compliance questionnaire rheumatology (...) (CQR) predict compliance with taking medications and correct dosing compared with an electronic medication event monitoring system (MEMS)? Clinical impact ratings GP/FP/Primary care ★★★☆☆☆☆ Internal medicine ★★★★☆☆☆ Rheumatology ★★★★★★☆ METHODS Design: cohort study to validate a previously derived self administered questionnaire. Setting: outpatient rheumatology wards of 3 hospitals in the Netherlands. Patients: 127 patients (mean age 61 y, 57% women) who had rheumatoid arthritis and were taking

2005 Evidence-Based Medicine

4207. Guidelines on current good Radiopharmacy Practice (cGRPP) in the Preparation of Radiopharmaceuticals

the radiolabelling of kits. This implies the use of special clothing, sterile gloves, sterile vials, sterile syringes, sterile needles and sterile diluents, and that the work is done in a well-planned and expedient way. Radiation protection Control of personnel radiation exposure is performed with approved personal dosimeters, which are regularly checked and their readings recorded. This control may be supplemented with electronic dosimeters, finger dosimeters etc. After work, both personnel and work places must (...) , starting from the prescription to the administration of the individual patient doses. The instructions and Standard Operating Procedures (SOPs) should be written and independently approved for each procedure or activity associated with the operations of the department. SOPs should be reviewed and re-issued at least every two years. A specification should be available for each component used as well as for the finished radiopharmaceutical. Records should be kept for the legally required period of time

2007 European Association of Nuclear Medicine

4208. Guidance on the use of real ear measurement to verify the fitting of digital signal processing hearing aids

Scope 2 Introduction 3 Background information 3.1 Why adults and children need different approaches 3.2 Choice of real-ear insertion gain or real-ear aided response 3.3 Choice of prescription 3.4 Choice of stimulus type 4 Setting up the equipment 4.1 Ambient noise and environment 4.2 Calibration 4.3 Recording the results 5 Procedure for verification in adults 5.1 Tube calibration 5.2 Check calibration 5.3 Prepare patient 5.4 Otoscopy 5.5 Insertion of probe tube 5.6 Measure real-ear unaided response (...) their skills and experience. Wherever possible, the guidance is based on evidence, but where the evidence base does not exist, guidance is based on best practice as agreed between “experts” at the time of writing. As more evidence comes to light, this guidance will inevitably change. Guidance differs from recommendation in that it is less prescriptive, and deviations from it are acceptable under certain circumstances. The term real-ear measurement (REM) is used by audiologists to cover a range of different

2008 British Society of Audiology

4209. A cost-utility analysis of mitoxantrone hydrochloride and interferon beta-Ib in the treatment of patients with secondary progressive or progressive relapsing multiple sclerosis

, which were derived from the manufacturers' package inserts; the costs associated with treating urinary tract infections in patients treated with MHCl, which were estimated using fee-for-service prescription claims data from the Oregon Medicaid programme; and the costs related to therapy intake, such as referrals to the oncology unit, echocardiograms, pre-medication with an antiemetic, and determination of clinical tests as recommended by the package insert. Outpatient charges from these tests were (...) in the USA, and have been approved by the US Food and Drug administration for the treatment of patients with MS. You should decide if these are widely used health interventions in your own setting. Validity of estimate of measure of effectiveness The authors performed an adequate review of the literature, identifying studies through electronic searches and hand searches. It would appear that the review was conducted systematically, so as to identify all relevant research and minimise biases. Further

2003 NHS Economic Evaluation Database.

4210. Cost-effectiveness of vaccination versus treatment of influenza in healthy adolescents and adults (Full text)

population The study population comprised healthy adults aged between 15 and 65 years. Setting The setting was primary care. The economic study was carried out in the USA. Dates to which data relate The effectiveness and resource use data were gathered from studies published between 1986 and 2000. The cost data were taken from published and electronic sources relating to 1993 to 2000, and were adjusted to 1997 prices. Source of effectiveness data The estimates for the final outcomes were derived from (...) health-related quality of life. Direct costs The direct costs to the health service were included. These were for hospitalisation, Guillain-Barre syndrome, visit to a clinician for ILI, influenza vaccine and administration (including patient time as a component), prescriptions and over-the-counter medication, and transport. The cost of the patient's time to be vaccinated was incorporated in the total cost of vaccination. The caregivers' time was valued from 1998 national census data, labour

2001 NHS Economic Evaluation Database.

4211. Clinical and economic outcomes of pharmacist recommendations in a Veterans Affairs medical center

summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology This study considered pharmacist recommendations to alter medication. A recommendation was defined as a suggestion made to a care provider that involved the application of the pharmacist's knowledge to a specific patient or prescription. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study (...) The cost data were taken retrospectively from the same patient sample that provided the effectiveness evidence. Study sample The authors reported that to obtain a statistical power of 80% at the 95% significance level, they required a minimum of 100 recommendations for each of the three settings (inpatient, outpatient and nursing home). The cases were selected consecutively from the electronic system used to document recommendations. Overall, 600 recommendations were included in the study

2002 NHS Economic Evaluation Database.

4212. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes

treated, total milligrams administered and total doses administered. The costs were adjusted to 1988 prices, by using the prescription drug component of the Consumer Price Index. The data was derived from longitudinal electronic medical records of the hospital. Currency US dollars ($). Sensitivity analysis Not sensitivity analysis was carried out. Estimated benefits used in the economic analysis 39.3% of patients received antibiotics over the 7 year study period. The proportion of patients who

1996 NHS Economic Evaluation Database.

4213. Modeling the cost and outcomes of pharmacist-prescribed emergency contraception

abortion, ectopic pregnancy and birth). The cost data were obtained from electronic and published sources from 1995 to 1999 and were adjusted to a 1998 price year. Discounting was, appropriately, not applied as the timeframe was only 9 months. The average costs were reported. Statistical analysis of costs Point estimates and a range of values were presented. No statistical analysis of the costs was reported. Indirect Costs The indirect costs were not included. Currency US dollars ($). Sensitivity (...) . Journal of the American Medical Women's Association 1998;53(5 Suppl 2):230-2. Indexing Status Subject indexing assigned by NLM MeSH Ambulatory Care Facilities /economics /utilization; Clinical Protocols /standards; Contraceptives, Postcoital /economics; Cost Savings; Decision Support Techniques; Drug Costs /statistics & Drug Prescriptions /economics; Female; Health Services Research; Humans; Models, Econometric; Monte Carlo Method; Outcome Assessment (Health Care); Pharmacies /economics /utilization

2001 NHS Economic Evaluation Database.

4214. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evidence from a meta analysis

very old patients (older than 74 years) were excluded. The mean age of the participants ranged from 50 to 67 years. Outcomes assessed in the review Studies that reported adherence rates, which were measured using the same method for both treatment groups, were eligible for inclusion. The studies could use any method to assess adherence. The included studies measured adherence using at least one of the following: pill count, patient interview, electronic compliance monitor, prescription refill data

2002 DARE.

4215. Screening for lipid disorders: diet and exercise therapy

. Such interventions had a very modest, if any, effect on lowering serum cholesterol. Moreover they may be associated with harms specific to children. Exercise interventions considered as a whole did not appear to have a large impact on lipid levels. However, some studies employing rigorous activity prescriptions and producing weight loss showed changes in lipid profiles that may be clinically meaningful. It was noted that these programmes have been difficult to implement widely. Authors' conclusions Diet (...) the search was restricted to English publications found on two electronic databases. The validity of the trials was assessed using published methods, which were implemented well. However, there was no description of the quality of evidence from different study designs, i.e. meta-analyses, RCTs and observational studies. Evidence from the better quality trials was not highlighted. Details of the primary data were given and appropriate information was tabulated. The narrative synthesis, which was split

2001 DARE.

4216. Appetite suppressants and valvular heart disease: a systematic review

' or 'fenfluramine' or 'dexfenfluramine'), the outcome measures and the study types. The search strategies were provided in the text. Relevant studies were identified through a combination of electronic searches and manual checks of the reference lists from previous review papers. Studies reported in any language were considered. Full journal publications were included; abstracts, letters, review articles and case reports were excluded. Study selection Study designs of evaluations included in the review (...) . The authors state further that despite withdrawal by regulatory authorities, sizeable numbers of people may still be consuming appetite suppressants from other sources, such as unlicensed prescriptions or Chinese herbal preparations. Therefore, safety information from this analysis continues to be relevant, both to slimmers who are still trying for a cure and to medical practitioners who may become involved in their care. Research: The authors state that judgements on drug safety should be backed

2002 DARE.

4217. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors

contact with care provided by doctors in primary care. Searching Recently published relevant journals, bibliographies and reference lists of reviews and papers were searched electronically and by hand. MEDLINE (from 1966 to 2001), EMBASE (from 1980 to 2001), CINAHL (from 1982 to 2001), the Science Citation Index, DARE, the National Research Register, the Cochrane Controlled Trials Register and the Cochrane EPOC Register of trials were searched for studies published in any language. Centres providing (...) , health service costs, and process of care measures. The process of care outcomes that were assessed were consultation length, prescriptions, investigations, return consultation and referrals. How were decisions on the relevance of primary studies made? The authors did not state how the papers were selected for the review, or how many reviewers performed the selection. Assessment of study quality Validity was assessed using criteria described by the review group of the Cochrane EPOC Group

2002 DARE.

4218. Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis

pregnancy to 14 months after birth. Other methods included the examination of prescriptions given to mothers, review of medical records and, in the case of a randomised controlled trial (RCT), the patients were assigned to aspirin or placebo. No information was available on the extent of aspirin exposure in the included studies. Participants included in the review Studies of women exposed to aspirin during the first trimester of pregnancy were eligible for inclusion. Studies were excluded (...) the first trimester may be associated with an increased risk of gastroschisis. CRD commentary The review question was clearly stated. A number of relevant electronic databases were searched and the subject headings used in the search strategy were given. There were no specific attempts to locate unpublished studies, only full publications were considered, and non-English articles were included only if they had an abstract in English; therefore, some studies may have been missed. The second stage

2002 DARE.

4219. Q9. How can different models of organisation or bed utilisation improve the care of patients dying in hospital?

and benefits of different palliative care models including nursing skill mix, models of service delivery and models of organisations or bed utilisation. Searching Electronic databases (years not given): MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Index of Scientific and Technical Proceedings, SIGLE, NHS Project Research System, Cancerlit, Health Planning and Administration, DHSS Data. Literature published since 1980, in English, French, German, Italian or Swedish was included. Selected papers (...) prescribing, 'change in insight', appropriate placement, survival, total number of inpatient days, proportion receiving anti- cancer treatment, patient satisfaction, prescription of antiemetics, laxatives and regulan. How were decisions on the relevance of primary studies made? The project researcher allocated all titles and abstracts to a research question number, 'irrelevant' or excluded. All those labelled irrelevant or excluded were double checked by another member of the research team. All those

1997 DARE.

4220. Interventions to improve antihypertensive drug adherence: a quantitative review of trials

-report, an electronic medication event monitoring system (MEMS), and pharmacy records of prescription refills. The adherence rate was defined as the proportion of prescribed doses taken. The most frequently used definition was that of Sackett et al. (see Other Publications of Related Interest), which defined adherence as greater than 80% pill consumption. Adherence was typically measured at the end of the study (e.g. the last study month), but in several cases adherence was reported for the entire (...) (or quasi-randomised) controlled trials published in peer-reviewed literature were considered. The study designs included were randomised controlled trials (RCTs), quasi-randomised trials in which assignment was by an arbitrary method or by minimisation, and crossover designs. Studies in which fewer than 10 participants were randomised were excluded. The length of follow-up ranged from 2 to 29 months. Specific interventions included in the review The interventions included the use of electronic vial

2000 DARE.

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