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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Perspectives for clinical research on bipolar disorders in the new millennium.
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Reboxetine: tolerability and safety profile in patients with major depression.
Since reboxetine acts selectively on the reuptake of noradrenaline, it has a different side-effects profile than drugs acting predominantly on the serotonin reuptake mechanism. Data from patients treated with reboxetine (n = 1503) or placebo/comparator drugs (n = 1027) show that reboxetine has no significant cardiovascular effects, a low potential for drug interactions, causes no significant impairment of cognitive or motor function and no increase in suicidal ideation. In contrast to certain serotonergic drugs, there is no evidence of any withdrawal syndrome upon abrupt discontinuation or tapering of reboxetine treatment. Sexual dysfunction appears in only a small fraction of the patients and mainly with doses higher than 8 mg daily. The rate of discontinuation due to adverse effects with reboxetine was not significantly different from that observed with placebo in short-term studies. The level of efficacy and apparently favourable tolerability profile makes reboxetine an important alternative in the medical treatment of depressive illness.
Colchicine for alcoholic and non-alcoholic liver fibrosis and cirrhosis.
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Curing gastric cancer--hone the scalpel with magic?
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Reliable and accessible reviews of the evidence for the effect of health care: the role of the Cochrane Collaboration and the CONSORT statement.
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Are we lowering LDL cholesterol sufficiently?
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Should we use anticoagulation for patients with chronic heart failure?
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Popular weight-loss diets: from evidence to practice.
The increasing number of overweight and obese individuals has become one of the leading public health concerns in many countries around the world. Concomitant with this increase in the prevalence of obesity has been the rise in the number of weight-loss diets, many of which alter macronutrient composition, but with the majority focused on carbohydrate restriction. Low-carbohydrate diets are attractive because they promise rapid weight loss without having to count calories and compromise the consumption of many palatable foods. By contrast, traditional dietary recommendations for weight loss endorse a fat-restricted and calorie-restricted diet high in complex carbohydrates. Evidence indicates that low-carbohydrate diets could be better in terms of short-term weight loss relative to traditional low-fat diets, but little is known about their long-term utility and safety. Diets based on the traditional Mediterranean dietary pattern are becoming increasingly popular because of their healthful benefits, particularly regarding cardiovascular outcomes. Mediterranean diets encourage consumption of a variety of palatable foods, optimizing adherence and sustainability. In this Review we discuss the current evidence on the efficacy of low-fat, low-carbohydrate and Mediterranean dietary patterns for weight loss, their potential mechanisms of action and important clinical considerations.
Evidence-based research in the primary dental care setting.
Evidence based practice is now recognised as an important topic for all health professionals, and rightly so. It is essential that clinical procedures we offer to our patients or drugs that we prescribe have been scientifically proven to be of benefit.
Should women under 50 be screened for breast cancer?
Despite some controversy in recent years, the majority of experts agree on the evidence for effectiveness of breast screening by mammography for women aged 50 years and above, but for those under 50 years, the picture is much less clear. However, the issue remains of importance both to policy makers and to individual women; although the incidence of breast cancer is lower at younger ages, the life years lost due to cancers diagnosed below 50 years amount to a third of all those lost due to the disease.
The TREND statement.
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Benefits and pitfalls of cardiovascular risk assessment.
One of the most important challenges facing modern preventative medicine is the problem of how best to identify and treat those at highest risk of developing cardiovascular disease, for whom appropriate management (ranging from lifestyle modification to therapeutic regimens) can improve both duration and quality of life. The use of risk assessment can contribute greatly to identifying those individuals who will benefit from risk-reducing interventions. However, assessment tools must always be used with care because some are not sufficiently accurate, while most systems are subject to an ageist bias because they do not take into account the benefits of long-term treatment or risk. Nonetheless, assessment techniques can provide a more logical approach to patient management, predict short-term benefits, and provide accurate data to substantiate a physician's clinical judgement.
Insulin resistance and vascular remodelling, in relation to left ventricular mass, geometry and function: an answer to LIFE?
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Knowledge of blood pressure levels and targets in patients with coronary artery disease in the USA.
Little is known about patient awareness of nationally recommended blood pressure targets, especially among patients with cardiac disease. To examine this issue, we interviewed 738 patients hospitalized with coronary artery disease to assess their knowledge of their systolic and diastolic blood pressure levels as well as corresponding national targets. We used bivariate and multivariate analyses to determine if any patient demographic or clinical characteristics were associated with blood pressure knowledge. Only 66.1% of patients could recall their own systolic and diastolic blood pressure levels. Only 48.9% of all patients could correctly name targets for these values. Knowledge of target blood pressure levels was particularly poor among patients who were female (odds ratio (OR) 0.69; 95% confidence interval (CI) 0.49-0.98), aged > or =60 years (OR 0.70, CI 0.51-0.97), without any college education (OR 0.48, CI 0.35-0.65), without a documented history of hypertension (OR 0.57, CI 0.39-0.84), and with known diabetes (OR 0.46, CI 0.33-0.66). Patients in the highest risk group, according to Joint National Committee guidelines stratification, were no more knowledgeable about their blood pressure levels and targets than lower risk patients. A significant proportion of patients hospitalized with coronary artery disease do not know their own blood pressure levels or targets. Current blood pressure education efforts appear inadequate, particularly for certain patient subgroups in which hypertension is an important modifiable risk factor.
Ultrasonography and graft patency.
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Overview of the pharmacogenetics of asthma treatment.
Asthma affects approximately 300 million individuals worldwide. Medications comprise a substantial portion of asthma expenditures. Despite the availability of three primary therapeutic classes of medications, there are a significant number of nonresponders to therapy. Available data, as well as previous pharmacogenetic studies, suggest that genetics may contribute as much as 60-80% to the interindividual variability in treatment response. In this methodologic review, after providing a broad overview of the asthma pharmacogenetics literature to date, we describe the application of a novel family-based screening algorithm to the analysis of pharmacogenetic data and highlight our approach to identifying and verifying loci influencing asthma treatment response. This approach seeks to address issues related to multiple comparisons, statistical power, population stratification, and failure to replicate from which previous population-based or case-control pharmacogenetic association studies may suffer. Identification of such replicable loci is the next step towards the goal of 'individualized therapy' for asthma.
Review article: nonsteroidal anti-inflammatory drug-associated gastrointestinal complications--guidelines for prevention and treatment.
Chronic ingestion of NSAIDs increases the risk for gastrointestinal complications, which range from dyspepsia to gastrointestinal bleeding, obstruction, and perforation. Among patients using NSAIDs, 0.1 to 2.0% per year suffer serious gastrointestinal complications. Patients who require analgesic therapy should be carefully assessed for the lowest possible dosage and shortest duration of NSAID use and for the potential of treatment with a non-NSAID pain reliever. These patients should also be assessed for factors that increase their risk of gastrointestinal complications, including increased age, concomitant anticoagulant or corticosteroid use, and past history of NSAID-associated gastrointestinal complications. The exact association between Helicobacter pylori infection and NSAID-related ulcer disease is unclear, and the routine testing and treatment of all NSAID using patients for H. pylori infection is not recommended at this time. NSAID-using patients who suffer from dyspepsia should have NSAIDs discontinued, the dosage changed, or be changed to a different class of NSAID. If NSAIDs cannot be discontinued, then an antisecretory agent should be initiated. Misoprostol prevents NSAID-associated gastrointestinal complications. Proton pump inhibitors are the most effective at healing NSAID-associated ulcers among patients who cannot discontinue NSAID therapy.