PubMed · 15652062
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Shailesh Kumar, Mark Oakley-Browne. 2004. Panic disorder.. https://pubmed.ncbi.nlm.nih.gov/15652062/
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This paper reviews Bayesian strategies for monitoring clinical trial data. It focuses on a Bayesian stochastic curtailment method based on the predictive probability of observing a clinically significant outcome at the scheduled end of the study given the observed data. The proposed method is applied to derive efficacy and futility stopping rules in clinical trials with continuous, normally distributed and binary endpoints. The sensitivity of the resulting stopping rules to the choice of prior distributions is examined and guidelines for choosing a prior distribution of the treatment effect are discussed. The Bayesian predictive approach is compared to the frequentist (conditional power) and mixed Bayesian-frequentist (predictive power) approaches. The interim monitoring strategies discussed in the paper are illustrated using examples from a small proof-of-concept study and a large mortality trial.
The forensic toxicology community has recognized flunitrazepam and its metabolite (7-aminoflunitrazepam) as compounds of concern for several years. In this procedure, the analytes were extracted from whole blood and urine onto single mode solid phase cartridges (butyl) using nitrazepam as an internal standard. The columns were washed with distilled water and hexane. All three compounds were eluted from the sorbent using an ethyl acetate-methanol solvent mixture. After collection and evaporation of the solvent, the residue was dissolved in A, 0.1% (v/v) aqueous trifluoroacetic acid for HPLC-PDA analysis or B, ethyl acetate for derivatization with pentafluoropropionic anhydride (PFPA) for analysis by gas chromatography-mass spectrometry (selected ion monitoring, SIM). A limit of quantitation for this method using HPLC-PDA was found to be 5 and 1.0 ng mL(-1) by SIM.
Anxiety disorders are characterised by excessive fears leading to distress or social disability. Anxiety disorders are difficult to recognise. General practitioners (GPs) should consider the possibility more often, especially in patients who make frequent visits with unexplained physical symptoms. The cornerstone of treatment is patient education, which can be supported by information leaflets provided by the Dutch College of General Practitioners. Cognitive behavioural therapy and antidepressants are equally effective therapies in most anxiety disorders. The choice should be made in collaboration with the patient. Pharmacological treatment is the first choice when a comorbid depression is involved. Cognitive behavioural therapy by the GP is optional considering the limitations of skills and time in general practice. Tricyclic antidepressants and selective serotonin re-uptake inhibitors are equally effective with most anxiety disorders. The choice must be made on the basis of side effects, comorbidity, and co-medication. Antidepressant therapy should be given for at least 6-12 months. The GP's choice oftreatment should lead to improvement within 8-12 weeks. Otherwise, consultation of or referral to a specialist in mental health care is mandatory.