1,720,993 research outputs found
A descriptive epidemiological study of interstitial lung disease in the United Kingdom general population
Get PDFInterstitial lung disease (ILD) is a heterogeneous group of parenchymal lung disorders having varied histopathologies. Although histologically different, the ILDs have rather similar clinical presentations consisting of increasing dyspnea, a restrictive lung function, impaired gas exchange, and widespread shadowing on chest radiography. Approximately two-thirds of ILD cases have no known etiology. The remaining one-third is either associated with connective tissue disease (CTD) or caused by various environmental or occupational exposures including inhalation of asbestos or other inorganic particles, inhalation of inorganic agents, certain drugs and radiation therapy. It is widely accepted that prevention, improved prognosis and quality of healthcare are dependent on a better understanding of disease epidemiology, and it is to this end that the present research contributes.
This doctoral research project makes use of a large and well-validated primary care database to investigate the frequency of ILD, the incidence of comorbidity after diagnosis, and characteristics of ILD patients at diagnosis compared to a general population control group. For many ILD subgroups an increase in incidence density and prevalence over time was observed, however it is uncertain to what extent secular trends played a role in these findings. Rates for all-cause mortality and comorbidities varied greatly across ILD subgroups, as did patient characteristics at diagnosis. This research project also delved deeper into specific epidemiological topics relating to certain ILD subgroups within the more broadly-classified, non-idiopathic ILD disease category
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Population-based studies on the natural history of psoriasis. and their role in the drug development process and in clinical practice
Get PDFPharmacoepidemiology has been defined as the study of the uses and the effects of drugs in large numbers of people and is important for the surveillance of drugs after marketing. With the recent movement from a reactive to a rather proactive pharmacovigilance, (pharmaco)epidemiological research plays an increasing role in basically all stages of the drug development process. Data on the disease planned to be treated with a new drug have to be gained which can be useful e.g. for the riskbenefit analysis of that compound (e.g. for the comparison of rates of adverse events in the treated population with the disease with rates of such events in the untreated population with the disease). Additionally, good knowledge of diseases is valuable for daily clinical practice. Hence, apart from the classical drug safety studies, pharmacoepidemiology groups conduct more and more disease epidemiology or drug utilisation studies in order to learn more about the natural history of diseases. The aim of this thesis was to increase the knowledge of psoriasis by providing new information and complementing existing data. Psoriasis is a chronic inflammatory skin disease which is common in certain parts of the world. The gain of new insights into the pathogenesis of this disease has prompted the recent development of new therapeutic drugs, primarily biologicals, and vice versa. The studies of this thesis were conducted with data from the General Practice Research Database, which contains longitudinal primary care clinical records from several million patients representative of the United Kingdom population. The general practitioners have been trained to record information on patient demographics and characteristics, lifestyle factors, symptoms, medical diagnoses, referrals to hospitals or specialists, and therapies in a standard and anonymous way. Several hundred studies have been conducted using this extensively validated database. In the first three case-control studies, the influence of beta-blockers and other antihypertensives (Study 3.1), of lithium and antipsychotics (Study 3.2), and of thiazolidinediones and other antidiabetics (Study 3.3) on the risk of developing psoriasis were investigated. The study population consisted of 36,702 patients with a first-time psoriasis diagnosis between 1994 and 2005 and the same number of patients without psoriasis, matched on age, sex, index date, general practitioner, and history in the database. Exposure to the drug classes was evaluated taking duration and timing of use and potential confounding into account. In contrast to the notion in the literature (including standard dermatology textbooks), which was mainly based on data from case reports and case series, use of beta-blockers and other antihypertensives did not materially alter the risk of incident psoriasis. On the contrary, the second study confirmed the suggestion that long-term exposure to lithium can induce psoriasis. Furthermore, for atypical antipsychotics, primarily olanzapine, a statistically significantly decreased psoriasis risk was found for current exposure of longer duration. This observation needs further confirmation. Small clinical trials had shown potential clinical benefits of thiazolidinediones on psoriasis symptoms. Study 3.3 additionally suggested that longer-term exposure to thiazolidinediones reduces the risk of developing psoriasis. The risk also tended to be decreased after use of metformin, however, this needs further investigation. Studies 3.4 to 3.6 were cohort studies with a nested case-control analysis in which the study population defined for Studies 3.1 to 3.3 (= cohort population) was followed for identification of incident diabetes mellitus (Study 3.4), myocardial infarction (MI) or stroke / transient ischaemic attack (TIA) (Study 3.5), and cancer (Study 3.6) in patients with or without psoriasis. Incidence rates (IRs) and unadjusted incidence rate ratios (IRRs) were calculated. In the nested case-control analysis, patients with the outcome of interest were matched on age, sex, and index date to four control patients from the cohort population, and the psoriasis history stratified by duration and severity (using treatment as proxy) was compared by calculating adjusted odds ratios (ORs). The overall diabetes IR in psoriatic patients was about 35% higher than in psoriasis-free patients. Psoriasis patients with intensive systemic treatment for their skin disease and a disease history of longer duration showed an about 2.5 times increased risk of diabetes compared to psoriasis-free patients. For MI and stroke / TIA the overall risk was not increased, but further analyses showed increased risks in subpopulations (e.g. severe psoriasis patients or patients <60 years of age [for MI]). The risk of lymphohaematopoietic or certain types of solid cancers was statistically significantly increased in patients with psoriasis, for solid cancers primarily in patients with a longer-term disease history. These large population-based studies further analysed existing hypotheses and raised new ones. The results may be valuable for healthcare professionals in their daily clinical practice and for pharmaceutical companies in the risk-benefit analysis of their drugs. Additionally, the example of the association between use of betablockers and psoriasis showed that there should be no place for dogmas in medicine and that conclusions can be challenged
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Rhabdomyolysis in association with simvastatin and amiodarone
No full textOBJECTIVE
To report a case of severe myopathy associated with concomitant simvastatin and amiodarone therapy.
CASE SUMMARY
A 63-year-old white man with underlying insulin-dependent diabetes, recent coronary artery bypass surgery, and postoperative hemiplegia was treated with aspirin, metoprolol, furosemide, nitroglycerin, and simvastatin. Due to recurrent atrial fibrillation, oral anticoagulation with phenprocoumon and antiarrhythmic treatment with amiodarone were initiated. Four weeks after starting simvastatin 40 mg/day and 2 weeks after initiating amiodarone 1 g/day for 10 days, then 200 mg/day, he developed diffuse muscle pain with generalized muscular weakness. Laboratory investigations revealed a significant increase of creatine kinase (CK) peaking at 40 392 U/L. Due to a suspected drug interaction of simvastatin with amiodarone, both drugs were stopped. CK normalized over the following 8 days, and the patient made an uneventful recovery. An objective causality assessment revealed that the myopathy was probably related to simvastatin.
DISCUSSION
Myopathy is a rare but potentially severe adverse reaction associated with statins. Besides high statin doses, concomitant use of fibrates, defined comorbidities, and concurrent use of inhibitors of cytochrome P450 are important additional risk factors. This is especially relevant if statins predominantly metabolized by CYP3A4 are combined with inhibitors of this isoenzyme. Amiodarone is a potent inhibitor of several different CYP isoenzymes, including CYP3A4.
CONCLUSIONS
Avoiding the concomitant use of drugs with the potential to inhibit CYP-dependent metabolism (eg, amiodarone) or elimination of statins may decrease the risk of statin-associated myopathy. Alternatively, if drug therapy with a potent CYP inhibitor is inevitable, choosing a statin without relevant CYP metabolism (eg, pravastatin) should be considered
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Medication safety in the hospital setting - role and tools for the Swiss hospital pharmacist
Get PDFThe role of Swiss hospital pharmacists has changed substantially over the last decade. In the past, the
pharmacist’s responsibility centered upon the timely dispensing and delivery of medication. However, at
the present time, the hospital pharmacist is involved as a critical partner in the entire medication use
process, focusing on the safe and effective use of drugs.
The aims of this work are to 1) Describe Swiss hospital pharmacists’ perceptions of their current and
future role in medication safety and 2) Identify efficient tools to allow hospital pharmacists to proactively
address medication safety.
1) Survey of medication safety activities in Swiss hospitals: The role of the hospital pharmacist
A structured online survey was sent to all 41 Swiss hospital pharmacy directors to assess current
medication safety activities.
The 26 respondents (response rate 62%) employed an average of 0.76 pharmacist full-time employees
per 100 beds (European average: 1 full-time employee per 100 beds). Swiss hospital pharmacists are
participating in pharmacy & therapeutics committee meetings (23/26 hospitals, 88%) and providing
pharmacovigilance (12/26, 46%). Clinical pharmacy services are offered in 25/26 institutions (96%)
Other activities identified among 22 participants included the implementation of eHealth tools (11/22
hospitals, 50%) and the increase of clinical pharmacy services (4/22, 18%).
Tools most likely used in medication safety activities among 24 respondants were direct observation
(23/24, 96%), critical incident reporting system (20/24, 83%), and chart review (16/23, 67%). Surveys
(7/24, 29%) and analysis of MedWatch data (8/26, 33%) were less often utilized. Of the respondents,
38% (9/24) were not familiar with the trigger tool technology.
2) Medication safety assessment methods: How can institutions efficiently address drug-related
problems?
Organizations, including the Institute for Safe Medication Practice, recommend different methods for the
assessment of medication safety, including incident reporting (IR), direct observation (OB), chart review
(CH) and trigger tool analysis (TR). However, the optimal method for identifying drug-related problems
(DRPs) is unknown.
Pubmed, Embase and Scopus databases were systematically searched for any comparative study in
which IR, OB, CH and TR were compared to one another. Twenty-eight studies were included in this
review.
All four assessment techniques have different strengths and weaknesses. Overlap between different
methods in identifying DRPs is minimal. While TR appears to be the most effective and labor-efficient
method, IR best identifies high severity DRPs. Considering the lack of overlap and the ability of each
method to identify different medication errors, the use of a combination of methodologies is strongly
recommended.
Different examples applying methods recommended for medication safety assessment are provided.
Although staff resources are limited, our survey showed that Swiss hospital pharmacists are proactively
participating in medication safety activities.
Several available methods like trigger tool and incident reporting allow for an effective, labor-efficient
approach to medication safety assessment. With Swiss physicians increasingly dispensing drugs and the
discipline of pharmacology also in the hands of physicians, comprehensive medication safety
assessment potentially creates important professional opportunities for hospital pharmacists in
Switzerland
- …
