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Biomedical subjects

R Joffe

Publications and source records attributed to R Joffe.

At least 19 recordsLinked to original sources

Report of the FELASA Working Group on evaluation of quality systems for animal units.

This report compares and considers the merits of existing, internationally available quality management systems suitable for implementation in experimental animal facilities. These are: the Good Laboratory Practice Guidelines, ISO 9000:2000 (International Organization for Standardization) and AAALAC International (Association for Assessment and Accreditation of Laboratory Animal Care International). Good laboratory practice (GLP) is a legal requirement for institutions undertaking non-clinical health and environmental studies for the purpose of registering or licensing for use and which have to be 'GLP-compliant'. GLP guidelines are often only relevant for and obtainable by those institutions. ISO is primarily an external business standard, which provides a management tool to master and optimize a business activity; it aims to implement and enhance 'customer satisfaction'. AAALAC is primarily a peer-reviewed system of accreditation which evaluates the organization and procedures in programmes of animal care and use to ensure the appropriate use of animals, safeguard animal well-being (ensuring state-of-the-art housing, management, procedural techniques, etc.) as well as the management of health and safety of staff. Management needs to determine, on the basis of a facility's specific goals, whether benefits would arise from the introduction of a quality system and, if so, which system is most appropriate. The successful introduction of a quality system confers peer-recognition against an independent standard, thereby providing assurance of standards of animal care and use, improving the quality of animal studies, and contributing to the three Rs-reduction, refinement and replacement.

Animal Husbandry↗

The adequacy of reporting randomized, controlled trials in the evaluation of antidepressants.

OBJECTIVE: To evaluate the adequacy of the reports of methodological and statistical aspects of randomized, controlled trials that evaluate antidepressant medications and the degree to which their results can be used in subsequent metaanalyses. DATA SOURCES: Randomized, controlled trials published in English that compared 2 antidepressant drugs with a placebo were reviewed. Papers were located using Medline and reference lists. DATA EXTRACTION: Each paper was evaluated using a checklist, and 3 summary criteria scores were derived: minimal, ideal, and overall. RESULTS: Only 9 of the 69 papers met the minimal criteria to be included in a metaanalysis (which would report the final sample size and an estimate of the mean and of the standard deviation); and 0 met all of the ideal criteria for reporting clinical trials. Out of a possible 100 points, the mean score for the articles was 51, and the highest score was 80. Scores were not related to the citation impact factor of the journal in which they appeared. CONCLUSIONS: Researchers must become more aware of the criteria for reporting clinical trials, and editors must insist more strenuously that these criteria be satisfied.

Antidepressive Agents↗

Differential pharmacological treatment response in high angry hostile and low angry hostile depressed patients: a retrospective analysis.

Fava et al., Am. J. Psychiatry 150 (1993)1158-1163, have recently proposed the existence of a sub-type of depressed patients who experience anger attacks. These investigators hypothesized that patients who experience anger attacks will respond better to a specific selective serotonin reuptake inhibitor (SSRI) medication than will depressed patients who do not experience anger attacks. Using a non-randomized, archival treatment methodology, 158 patients were classified as either high angry hostile (n = 83) or low angry hostile (n = 75). These patients had been treated with either a primarily noradrenergic reuptake inhibitor (desipramine) a SSRI (sertraline or paroxetine), or the combined serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine. A 2 (high angry hostile/low angry hostile) x 3 (medication type) analysis of variance (ANOVA) was non-significant, indicating no differential treatment effects.

1-Naphthylamine↗

Moclobemide versus fluoxetine in the treatment of major depressive disorder in adults.

The objective of the present study was to compare the safety and efficacy of moclobemide versus fluoxetine in adult patients with major depressive disorder. The design of the study was a multicenter, double-blind, comparative, and randomized trial. A 1- to 2-week single-blind placebo washout phase was followed by 6 weeks of double-blind treatment with moclobemide or fluoxetine. A total of 150 patients were enrolled in the study. There were 128 patients eligible to be randomized, with 66 patients receiving moclobemide and 62 patients receiving fluoxetine. At the termination of the study, patients in the moclobemide group were receiving a mean dose of 440 mg +/- 123 mg, while the mean dose in the fluoxetine group was 35 mg +/- 8 mg. No significant treatment differences were found for any of the efficacy parameters. Headache and nausea were the most frequently reported adverse events in both treatment groups. Headache and blurred vision were reported significantly more often (P < 0.05) in the fluoxetine group, whereas significantly more dry mouth was reported (P < 0.05) in the moclobemide group. These results provide supporting evidence of the comparable efficacy of moclobemide and fluoxetine and the better tolerability of moclobemide when used in the treatment of major depressive disorder.

Adult↗

Lack of association between thyroid and pineal responses to antidepressant treatment.

With antidepressant treatment for major depression there are decreases in thyroid hormone levels and increases in pineal function. We have conducted a study to examine whether there is a relationship between pineal and thyroid hormone measures as well as between hormone measures and response to treatment in patients treated with desipramine. Measures of thyroid activity included thyroxine, triiodothyronine, T3 resin uptake, and TSH. Pineal function was determined by measurement of 6-suphatoxymelatonin in three consecutive 8 hour pools. Hormone measures as well as Hamilton depression scores were obtained prior to treatment and at the end of 5 weeks of treatment. As in previous studies, thyroid measures decreased, pineal activity increased, and Hamilton scores decreased significantly with treatment. No correlations were found between these measures, suggesting that if there is a relationship between them it is not a direct one.

Adult↗

Diffuse Lewy body disease: clinical features in nine cases without coexistent Alzheimer's disease.

OBJECTIVE: To further elucidate the relation between diffuse Lewy body disease and Parkinson's disease. METHODS AND RESULTS: The clinical features of nine cases of pure diffuse Lewy body disease without pathological evidence of coexisting Alzheimer's neuritic pathology were reported. All patients were aged less than 70 years at onset (mean 62 years). Five patients presented with clinical features, which included assymetric resting tremor had levodopa responsiveness, which were initially indistinguishable from idiopathic Parkinson's disease. All five patients later became demented (mean of three years after presentation). Two further patients presented with parkinsonism and dementia and two patients presented with dementia and developed parkinsonism at a later stage. Hallucinations appeared 2.5-9 years after the onset of symptoms in six patients and were a presenting feature in one patient. All patients met the pathological criteria of idiopathic Parkinson's disease, with respect to the midbrain changes, in addition to having diffuse cortical Lewy bodies. CONCLUSIONS: Diffuse Lewy body disease may present a parkinsonism, dementia, or both depending on whether the Lewy body pathology begins in the midbrain, the cortex, or both together. When it begins in the midbrain, diffuse Lewy body disease is indistinguishable initially from idiopathic Parkinson's disease. Diffuse Lewy body disease may be a common cause of dementia complicating Parkinson's disease.

Aged↗

Change in thyroid hormone levels following response to cognitive therapy for major depression.

OBJECTIVE: Various somatic antidepressant treatments of depression are associated with substantial but limited decreases in T4 levels. This study examined changes in patients' thyroid hormone levels during a period of cognitive behavior therapy. METHOD: Thyroid hormone levels of 30 patients with major depressive disorder were measured before and after they received 20 weekly sessions of cognitive behavior therapy. RESULTS: There were significant decreases in measures of T4 in the 17 responders to cognitive behavior therapy and increases in the 13 nonresponders. CONCLUSIONS: Cognitive behavior therapy has an effect on the thyroid axis similar to that of somatic antidepressant treatments.

Adult↗

Antidepressant treatment of depression: a metaanalysis.

OBJECTIVE: To carry out a metaanalysis of antidepressant studies to calculate the effect sizes for antidepressant effect in depressive disorder. METHOD: A metaanalysis of all antidepressant studies that included an active comparison drug as well as placebo was used to calculate the effect size. Articles were selected from a MEDLINE search for the period January 1966 to June 1995. Forty-nine studies were included in the metaanalysis. RESULTS: The effect sizes for antidepressant treatment are moderately larger than for placebo. A larger effect size was observed in studies where objective diagnostic criteria for depression were used. CONCLUSIONS: We conclude that the superior efficacy of antidepressants over placebo can be demonstrated.

Antidepressive Agents↗

An open study of oral flesinoxan, a 5-HT1A receptor agonist, in treatment-resistant depression.

Flesinoxan, a full 5-HT1A receptor agonist, was administered (4-8 mg) to treatment-resistant depressed patients in an open study. Safety and tolerance of the substance appeared satisfactory. Headache, dizziness and nausea were the most frequently reported side effects. The observations suggested that flesinoxan is an antidepressant agent and that it may be of particular value in some difficult, treatment-resistant depressions. Based on these observations, a double-blind, placebo-controlled evaluation of flesinoxan's efficacy appears warranted.

Adult↗

Gait disturbances.

Walking is a complex motor skill and is governed by a number of interlinked pathways from the cortex above to the muscles below. The author outlines some of the important features in the history and examination of the patient with a gait disorder.

Brain Diseases↗

Antidepressants in group psychotherapy.

This article alerts us to consider depression as a relatively frequent cause of impasse in the course of group psychotherapy. The authors recommend the combined use of antidepressant medication along with group psychotherapy when such depression is confirmed independently outside the group. Common obstacles and pitfalls preventing successful combined treatment are reviewed; the depressive logjam is differentiated from common resistance; and profiles of responders versus nonresponders are described. A rationale of the combined treatment, its results, and implications for group therapists are all delineated.

Adult↗

Hyperthyroxinemia in major affective disorders.

Ninety-nine patients fulfilling DSM-III criteria for primary major affective disorder, either bipolar or unipolar, were studied. A 12% prevalence of elevated thyroxine levels was found. Three of the 12 hyperthyroxinemia patients also had elevated free thyroxine index. No statistically significant difference in response to antidepressant treatment was observed between the hyperthyroxinemia group and the normal serum thyroxine group.

Adult↗