30 Jan 09
Posted in General at 0:28 by Laci
By I Gustavsena, JG Bramnessb, S Skurtveitb, A Engelandb, I Neutele and J Mørlanda
Sleep Medicine 2008;9:818-822
Despite the high prescription rate of benzodiazepine-like hypnotics (z-hypnotics), there is limited information on the road traffic accident risk associated with the use of these drugs. We wanted to investigate whether filling a prescription for zopiclone or zolpidem was associated with increased risk of road traffic accidents at a national population level. Nitrazepam and flunitrazepam were used as comparator drugs.
Method
All Norwegians 18–69 years (3.1 million) were followed-up from January 2004 until the end of September 2006. Information on prescriptions, road traffic accidents and emigration/death was obtained from three Norwegian population-based registries. The first week after the hypnotics had been dispensed was considered to be the exposure period. Standardized incidence ratios (SIRs) were calculated by comparing the incidence of accidents in the exposed person-time to the incidence of accidents in the unexposed person-time.
Results
During exposure, 129 accidents were registered for zopiclone, 21 for zolpidem, 27 for nitrazepam and 18 for flunitrazepam. The SIRs were (SIR for all ages and both sexes combined; 95% CI): z-hypnotics (zopiclone + zolpidem) 2.3; 2.0–2.7, nitrazepam 2.7; 1.8–3.9 and flunitrazepam 4.0; 2.4–6.4. The highest SIRs were found among the youngest users for all hypnotics.
Conclusions
This study found that users of hypnotics had a clearly increased risk of road traffic accidents. The SIR for flunitrazepam was particularly high.
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20 Jan 09
Posted in General at 10:00 by Laci
By J Eisenach, A Borgeat, Z Bosnjak, T Brennan, J Kersten, E Kochs, J Lerman, D Warner, J Wiener-Kronish
Anesthesiology 2008;109:962-972
Welcome to the 2008 year in review, highlighting articles that the Editorial Board believes exemplify the mission of Anesthesiology, to advance the science and practice of perioperative, critical care, and pain medicine through the promotion of seminal discovery. Our goals are to remind you of articles that may change your clinical practice today, to help you better understand the scientific basis of current practice, and to provide glimpses into the future. We recognize how busy you are and hope these brief synopses guide you to new and relevant information.
The full-text on-line articles are a click away at our newly redesigned Web site-www.anesthesiology.org -described more fully in an editorial in this issue.1 In addition to the synopses chronicled in this review, the Anesthesiology Web site now offers new functionality, such as most viewed or most in the press, that will also help you to determine the most relevant and important content for your practice and research. Two thousand eight is the first full calendar year during which content is regularly highlighted through the American Society of Anesthesiologists Press Release office, and the press release program has met with remarkable success. Throughout the year, several news releases were picked up by more than 1,000 news outlets, including nearly all the major news media entities. As Editors, we are very excited about the public interest in research and other content published in the Journal because press interest stresses the critically important medical advances in our specialty and offers well-deserved recognition to the outstanding authors who publish with us.
This year saw the reorganization of our Table of Contents into the three major medical branches of our specialty: perioperative, critical care, and pain medicine. Although we could have organized these synopses into these three areas, we chose to provide a more clinically focused approach. As such, the first six articles address preoperative assessment; the next eight articles address intraoperative care, and the final four articles address postoperative and critical care.
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05 Jan 09
Posted in General at 0:40 by Laci
By A S Kesselheim, A S Misono, J L Lee, M R Stedman, M A Brookhart, N K Choudhry and W H Shrank
JAMA 2008;300:2514-2526
Use of generic drugs, which are bioequivalent to brand-name drugs, can help contain prescription drug spending. However, there is concern among patients and physicians that brand-name drugs may be clinically superior to generic drugs.
Objectives
To summarize clinical evidence comparing generic and brand-name drugs used in cardiovascular disease and to assess the perspectives of editorialists on this issue.
Data sources
Systematic searches of peer-reviewed publications in MEDLINE, EMBASE, and International Pharmaceutical Abstracts from January 1984 to August 2008.
Study selection
Studies compared generic and brand-name cardiovascular drugs using clinical efficacy and safety end points. We separately identified editorials addressing generic substitution.
Data extraction
We extracted variables related to the study design, setting, participants, clinical end points, and funding. Methodological quality of the trials was assessed by Jadad and Newcastle-Ottawa scores, and a meta-analysis was performed to determine an aggregate effect size. For editorials, we categorized authors’ positions on generic substitution as negative, positive, or neutral.
Results
We identified 47 articles covering 9 subclasses of cardiovascular medications, of which 38 (81%) were randomized controlled trials (RCTs). Clinical equivalence was noted in 7 of 7 RCTs (100%) of β-blockers, 10 of 11 RCTs (91%) of diuretics, 5 of 7 RCTs (71%) of calcium channel blockers, 3 of 3 RCTs (100%) of antiplatelet agents, 2 of 2 RCTs (100%) of statins, 1 of 1 RCT (100%) of angiotensin-converting enzyme inhibitors, and 1 of 1 RCT (100%) of {alpha}-blockers. Among narrow therapeutic index drugs, clinical equivalence was reported in 1 of 1 RCT (100%) of class 1 antiarrhythmic agents and 5 of 5 RCTs (100%) of warfarin. Aggregate effect size (n = 837) was –0.03 (95% confidence interval, –0.15 to 0.08), indicating no evidence of superiority of brand-name to generic drugs. Among 43 editorials, 23 (53%) expressed a negative view of generic drug substitution.
Conclusions
Whereas evidence does not support the notion that brand-name drugs used in cardiovascular disease are superior to generic drugs, a substantial number of editorials counsel against the interchangeability of generic drugs.
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15 Sep 08
Posted in General at 15:38 by Laci
By A H Lee, B Afessa
Critical Care Medicine 2007;35:1517-1521
Smokers admitted to the intensive care unit may receive nicotine replacement therapy to prevent withdrawal. However, the safety of nicotine replacement in the critically ill has not been studied. The objective of this study was to determine the impact of nicotine replacement on the outcome of critically ill patients.
Design
Retrospective, case-control.
Setting
The medical intensive care unit of a tertiary academic hospital.
Patients
Patients who were active smokers at admission to the intensive care unit were included in the study. Those who received nicotine replacement therapy were considered as cases, and those who did not receive nicotine replacement were considered as controls.
Interventions
None.
Measurements and Main Results
For each of the 90 cases, one control smoker who did not receive nicotine replacement therapy was selected based on the severity of illness and then age. Outcome was measured by hospital mortality and 28-day intensive care unit-free days, defined as the number of days spent outside of intensive care or without mechanical ventilation by a living patient following admission to intensive care. The mean mortality rate predicted by the Acute Physiology and Chronic Health Evaluation III was 9.2% for the cases compared with 10.3% for the controls (p = .7127). The observed hospital mortality rate was 20% in the cases vs. 7% in the control group (p = .0085). When adjusted for the severity of illness and invasive mechanical ventilation, nicotine replacement therapy was independently associated with increased mortality (odds ratio, 24.6; 95% confidence interval, 3.6-167.6; p = .0011). The mean (sd) 28-day intensive care unit-free days were 20.7 (10.5) in the case group compared with 23.4 (7.1) in the control group (p = .0488).
Conclusions
Our study shows that nicotine replacement therapy is associated with increased hospital mortality in critically ill patients. However, because of the limitations of the study, a future study based on a better case-control design is warranted.
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