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D N Juurlink

Publications and source records attributed to D N Juurlink.

5 recordsLinked to original sources
PubMed2001

Major trauma in elderly adults receiving lipid-lowering medications.

BACKGROUND: Some clinical trials, laboratory experiments, and in vitro studies suggest that lipid-lowering medications predispose a person to traumatic injury. METHODS: We used population-based administrative database analysis to study adults age 65 years or more over a 5-year interval (n = 1,348,259). RESULTS: About 12% of the cohort received a prescription for a lipid-lowering medication and about 88% did not. The two groups had similar distributions of age, gender, and income. Overall, 2,557 (0.2%) were hospitalized for major trauma. Those who received a lipid-lowering medication were 39% less likely to sustain a major trauma than those who did not receive such medication (95% confidence interval, 29 to 47). Similar results were observed after adjustment for age, gender, and income; cardiac and neurologic medications; and lethality. No other cardiac or neurologic medication was associated with an apparent safety advantage. CONCLUSION: Lipid-lowering medications do not lead to a clinically important increase in the absolute risk of major trauma for elderly patients in the community.

Age Distribution↗
PubMed2000

Hyperbaric oxygen for carbon monoxide poisoning.

BACKGROUND: Poisoning with carbon monoxide (CO) remains an important cause of accidental and intentional injury worldwide. Several unblinded nonrandomized trials have suggested that the use of hyperbaric oxygen (HBO) prevents the development of neurological sequelae. This has led to the widespread use of HBO in the management of patients with carbon monoxide poisoning. OBJECTIVES: To assess the effectiveness of hyperbaric oxygen (HBO) compared to normobaric oxygen (NBO) for the prevention of neurologic symptoms in patients with acute carbon monoxide poisoning. SEARCH STRATEGY: We searched MEDLINE (1966-present), EMBASE (1980-present), and the Controlled Trials Register of the Cochrane Collaboration, supplemented by a manual review of bibliographies of identified articles and discussion with recognized content experts. SELECTION CRITERIA: All randomized controlled trials involving non pregnant adults acutely poisoned with carbon monoxide, regardless of severity, with adequate or unclear allocation concealment were examined. Trials with a score of 3 out of 5 or higher on the validity instrument of Jadad were included in the primary analysis. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted from each trial information on the number of randomized patients, types of participants, the dose and duration of the intervention, and the prevalence of neurologic symptoms at follow-up. A pooled odds ratio (OR) for the presence of neurologic symptoms at one month follow-up was calculated using a random effects model. MAIN RESULTS: Six randomized controlled trials were identified. The trials were of varying quality. Three trials employing different doses of NBO and HBO were included in the primary analysis. The severity of CO poisoning was inconsistent between trials. At one month follow-up after treatment, symptoms possibly related to carbon monoxide poisoning were present in 81 of 237 patients (34.2%) treated with HBO, compared with 81 of 218 patients (37.2%) treated with NBO (O.R. for benefit with HBO 0.82; 95% CI 0.41-1.66). REVIEWER'S CONCLUSIONS: There is no evidence that unselected use of HBO in the treatment of acute CO poisoning reduces the frequency of neurological symptoms at one month. However, evidence from the available randomized controlled trials is insufficient to provide clear guidelines for practice. Further research is needed to better define the role of HBO, if any, in the treatment of carbon monoxide poisoning. This research question is ideally suited to a multicentre, randomized, double-blind controlled trial.

Carbon Monoxide Poisoning↗
PubMed2000

Gastrointestinal decontamination for enteric-coated aspirin overdose: what to do depends on who you ask.

CONTEXT: Overdoses with enteric-coated preparation are common. The optimal means by which to limit drug absorption in such cases is controversial. OBJECTIVE: To describe the recommendations for gastrointestinal decontamination issued by North American poison control centers for a hypothetical patient, (an adult male with normal vital signs), presenting 1 hour after ingesting 500 mg/kg of enteric-coated aspirin. DESIGN: Telephone survey of 76 poison control centers in North America. Seven toxicologists who contributed to the American Academy of Clinical Toxicology/European Association of Poison Centres and Clinical Toxicologists position statements on gastrointestinal decontamination were also surveyed for informal comparison. RESULTS: Most poison control centers (99%) and all of the toxicologists (100%) participated in the survey. Four centers (5 %) recommended syrup of ipecac and 38 (51%) recommended gastric lavage, compared with 0% and 0% of toxicologists, respectively. Seventy-three centers (97%) recommended at least one dose of activated charcoal, compared with 6 toxicologists (86%). Twenty-one poison centers (28%) recommended whole-bowel irrigation, compared with 3 toxicologists (43%). A total of 36 different courses of action were suggested by respondents at the poison centers. Some of these recommendations were potentially harmful. CONCLUSIONS: Considerable variability exists in the recommendations of North American poison control centers for the gastrointestinal decontamination of patients with large, acute overdoses of enteric-coated aspirin.

Adult↗