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Biomedical subjects

John Geddes

Publications and source records attributed to John Geddes.

At least 19 recordsLinked to original sources
PubMed2006

Topiramate for acute affective episodes in bipolar disorder.

BACKGROUND: Bipolar disorder is a common recurrent illness with high levels of chronicity. Treatment resistance persists despite the use of established medications, such as lithium and valproate. New medications are required for the treatment of refractory cases. Retrospective and open-label trials have suggested that the anticonvulsant topiramate may be efficacious in bipolar disorder. There is a need to clarify the evidence available in the form of randomised controlled trials for its use in bipolar disorder. OBJECTIVES: To review the evidence for the efficacy and acceptability of topiramate in the treatment of acute mood episodes in bipolar disorder. SEARCH STRATEGY: The Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) group search strategy was used. The following databases were searched:The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), September 2003;The Cochrane Controlled Clinical Trials Register (CCCTR), September 2003;EMBASE (1980 to December 2003);MEDLINE (1966 to December 2003);LILACS;PsycLIT;Psyndex.Reference lists of relevant papers and major textbooks of mood disorder. Handsearches (specialist journals and conference proceedings). Authors, other experts in the field and pharmaceutical companies were contacted for knowledge of suitable published or unpublished trials. SELECTION CRITERIA: Randomised controlled trials which compared topiramate with placebo or with active agents in the treatment of any acute mood episodes in bipolar disorder. Participants were patients with bipolar disorder and were males and females of all ages. DATA COLLECTION AND ANALYSIS: Data extraction and methodological quality assessment were performed independently by two reviewers. For analysis, relative risk was used for binary efficacy outcomes and the weighted mean difference or standardised mean difference was used for continuously distributed outcomes. MAIN RESULTS: One randomised controlled trial met the inclusion criteria for the review, a comparison between topiramate and bupropion sustained release (SR) in the adjunctive treatment of depressed patients with bipolar disorder. However, the trial had several limitations in methodology and in the description of data. Its data regarding efficacy required clarification before it could be analysed according to the protocol of this systematic review. From the limited data available, topiramate had efficacy similar to bupropion SR in the adjunctive treatment of bipolar depression. Both groups of subjects suffered a high drop-out rate. There was no significant difference between the topiramate and the bupropion treated groups in those dropping out for any reason (relative risk 1.60, 95% confidence interval 0.65 to 3.96). There was no significant difference in those withdrawing from the study due to adverse effects (relative risk 1.50, 95% confidence interval 0.51 to 4.43). Although the data on weight loss were not analysed formally, weight loss was marked in the topiramate treated group. Several unpublished trials have been identified and data from these trials may be included in future reviews. AUTHORS' CONCLUSIONS: There is insufficient evidence on which to base any recommendations regarding the use of topiramate in any phase of bipolar illness, either in monotherapy or as an adjunctive treatment.

Affective Disorders, Psychotic↗
PubMed2006

Meta-analysis in the assessment of treatment outcome.

Randomized clinical trials provide the most reliable estimates of the benefits and harms of treatments. Limited sample sizes restrict their power to allow informative analyses of secondary outcomes, or patient subgroups. The overall results of trials only apply to the average patient and clinical application ignores the individual patient differences.Meta-analysis in the context of a systematic review can produce more precise estimates of effect by combining the results of primary studies. This is particularly valuable for investigating rare, but important outcomes such as suicide. Variations between the trial-specific results can be investigated by meta-regression. Individual patient data meta-analyses (IPDMAs) are potentially much more powerful designs because they allow analysis of patient-level variables. As more genetic factors are identified that might account for treatment variability between individuals, IPDMAs offer a powerful strategy that can be used on existing trial data sets. Despite practical difficulties, IPDMAs are increasingly being conducted.

Genetic Predisposition to Disease↗
PubMed2006

Designing for e-Health: recurring scenarios in developing grid-based medical imaging systems.

The paper draws on a number of Grid projects, particularly on the experience of NeuroGrid, a UK project in the Neurosciences tasked with developing a Grid-based collaborative research environment to support the sharing of digital images and patient data across multiple distributed sites. It outlines recurrent socio-technical issues, highlighting the challenges of scaling up technological networks in advance of the regulatory networks which normally regulate their use in practice.

Biomedical Research↗
PubMed2005

Bipolar disorder.

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Antidepressive Agents↗
PubMed2004

Depressive disorders.

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Antidepressive Agents, Second-Generation↗
PubMed2003

Generating evidence to inform policy and practice: the example of the second generation "atypical" antipsychotics.

The introduction of the second generation "atypical" antipsychotics has been heralded as a major advance in the treatment of schizophrenia and other psychotic disorders. Systematic reviews have revealed only modest advantages over conventional antipsychotics and uncertainty about long-term efficacy and safety, yet the second generation antipsychotic drugs have been widely accepted into clinical practice. Although the existing evidence of the benefits and harms of atypical antipsychotics can facilitate decision making about individual patients, the randomized evidence remains inadequate to make valid and fully evidence-based policy statements such as clinical practice guidelines that are designed to apply to groups of patients. Further large randomized trials are needed, but these require patients and clinicians to be in equipoise, or substantially uncertain, about alternative therapies. Premature clinical practice guidelines or expert opinion can lead to changes in clinical practice that make it difficult or impossible to conduct the required trials and are therefore a disservice to patients.

Antipsychotic Agents↗
PubMed2003

Bipolar disorder.

Explore the source record for details and available documents.

Antidepressive Agents↗
PubMed2003

Depressive disorders.

Explore the source record for details and available documents.

Antidepressive Agents, Second-Generation↗
PubMed2003

Bipolar disorder.

Explore the source record for details and available documents.

Antidepressive Agents↗