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Multisystem failure: the story of anti-influenza drugs

Last year the Cochrane team, with the help of the BMJ’s open data campaign, finally got access to full clinical study reports on neuraminidase inhibitors. Tom Jefferson and Peter Doshi explain what the new systematic review found and how a series of failures meant that decisions about these drugs were made without the full evidence  
bmj.com
over 4 years ago
Www.bmj
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42

Dermatitis herpetiformis

A 28 year old woman presented with a raised, red and intensely itchy rash on the extensor surface of her elbows and buttocks, in groups of small blisters. There was no history of trauma, atopy, or recent illness. She had no gastrointestinal symptoms or change in bowel habit and had not lost weight. No major medical or surgical history was noted and she was not taking drugs on a regular basis. Owing to the appearance and location of the rash, together with pruritus, dermatitis herpetiformis was suspected.  
bmj.com
over 4 years ago
Www.bmj
1
4

What is an “n-of-1” trial?

Researchers assessed the effectiveness of “n-of-1” trials for the short term choice of drugs for osteoarthritis. The efficacy of sustained release paracetamol was compared with celecoxib in the management of symptoms associated with osteoarthritis. A series of double blind randomised n-of-1 controlled trials using a double dummy design was performed. The intervention was sustained release paracetamol (two 665 mg tablets, three times a day), or celecoxib (200 mg daily, or 200 mg twice a day for those who were already using this dose). Each treatment regimen was taken for two weeks, administered for three treatment cycles. The primary outcome measures included pain, stiffness, and functional limitation scores; preferred treatment; and adverse effects.1  
bmj.com
over 4 years ago
Www.bmj
1
3

Ketamine helps a third of patients with treatment resistant depression, finds small UK study

A course of ketamine delivered intravenously could potentially be used to treat severe depression in patients who do not respond to other drugs, a UK study has found.  
bmj.com
over 4 years ago
Www.bmj
1
11

Dermatitis herpetiformis

A 28 year old woman presented with a raised, red and intensely itchy rash on the extensor surface of her elbows and buttocks, in groups of small blisters. There was no history of trauma, atopy, or recent illness. She had no gastrointestinal symptoms or change in bowel habit and had not lost weight. No major medical or surgical history was noted and she was not taking drugs on a regular basis. Owing to the appearance and location of the rash, together with pruritus, dermatitis herpetiformis was suspected.  
bmj.com
over 4 years ago
Www.bmj
1
10

A man with a palpable abdominal mass and night sweats

A 78 year old man presented with an eight week history of left sided abdominal pain and back pain, associated with anorexia, 3 kg weight loss, and night sweats. He was previously well, had no medical history of note, was taking no regular drugs, and was an ex-smoker.  
bmj.com
over 4 years ago
Www.bmj
3
114

Anticoagulation in atrial fibrillation

Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also available. These novel oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) obviate many of warfarin’s shortcomings, and they have demonstrated safety and efficacy in large randomized trials of patients with non-valvular atrial fibrillation. However, the management of patients taking warfarin or novel agents remains a clinical challenge. There are several important considerations when selecting anticoagulant therapy for patients with atrial fibrillation. This review will discuss the rationale for anticoagulation in patients with atrial fibrillation; risk stratification for treatment; available agents; the appropriate implementation of these agents; and additional, specific clinical considerations for treatment.  
bmj.com
over 4 years ago
Www.bmj
1
6

What is an “n-of-1” trial?

Researchers assessed the effectiveness of “n-of-1” trials for the short term choice of drugs for osteoarthritis. The efficacy of sustained release paracetamol was compared with celecoxib in the management of symptoms associated with osteoarthritis. A series of double blind randomised n-of-1 controlled trials using a double dummy design was performed. The intervention was sustained release paracetamol (two 665 mg tablets, three times a day), or celecoxib (200 mg daily, or 200 mg twice a day for those who were already using this dose). Each treatment regimen was taken for two weeks, administered for three treatment cycles. The primary outcome measures included pain, stiffness, and functional limitation scores; preferred treatment; and adverse effects.1  
www.bmj.com
over 4 years ago
Preview
1
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AstraZeneca shares soar after Pfizer confirms bid talks - BBC News

The market reacts favourably to confirmation by the US drugs giant Pfizer that it has been in talks with AstraZeneca over a possible takeover bid.  
BBC News
over 4 years ago
Preview
1
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How many middle-aged men need HRT? - BBC News

Prescriptions for testosterone drugs are on the increase but there is growing concern that they are being over-used and may not be safe.  
BBC News
over 4 years ago
Www.bmj
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US drug firm Pfizer seeks to buy UK company AstraZeneca

Pfizer, the US pharmaceutical giant whose drugs include atorvastatin (Lipitor) and sildenafil (Viagra), is seeking to buy the UK drug firm AstraZeneca for £52bn (€63bn; $90bn), which would be one of the largest acquisitions in the drug sector in recent years.  
bmj.com
over 4 years ago
Preview
1
10

The slow death of lethal injection

The medicalization of execution was once seen as the solution to death penalty concerns. Instead it has only spawned new legal challenges, says Owen Dyer, and a tightening drugs embargo that now seriously threatens US states’ ability to continue capital punishment  
bmj.com
over 4 years ago
Preview
1
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Care home residents 'doped up', survey finds - BBC News

Large quantities of anti-psychotic drugs are being given to people with learning disabilities who are resident in hospitals or care homes.  
BBC News
over 4 years ago
Preview
1
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Drugs from the Sea, and Thalidomide at 50 - The Naked Scientists

Naked Scientists - 27th Aug 2011 - Drugs from the Sea, and Thalidomide at 50  
thenakedscientists.com
over 4 years ago
Preview
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Smart Pills: Drugs to Boost Brain Power - The Naked Scientists

Naked Scientists - 21st Nov 2010 - Smart Pills: Drugs to Boost Brain Power  
thenakedscientists.com
over 4 years ago
Preview
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Minister 'open-minded' on legal high solutions - BBC News

Crime minister Norman Baker says "all options" are being considered on the problem of legal highs, after the Home Office ruled out licensing of shops.  
BBC News
over 4 years ago
Preview
1
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Antimicrobial resistance is now widespread, warns WHO

Widespread resistance to antimicrobial drugs is not a future threat—it is happening now in hospitals and in the community, a report from the World Health Organization warns.1  
bmj.com
over 4 years ago
Preview
1
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ISCD ~ Independent Scientific Committee on Drugs

In clear and accessible language, Professor David Nutt’s Drugs Without the Hot Air argues the case for an evidence-based approach, challenging elements of drug policy and myths on the relative harms of legal and illegal drugs.  
drugscience.org.uk
over 4 years ago
Www.bmj
1
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Two thirds of deaths from asthma are preventable, confidential inquiry finds

Two in three deaths from asthma could be prevented by better management of the condition including personal asthma plans for patients, timely reviews of asthma care, and the prescription of more appropriate drugs, says the first confidential inquiry into asthma by the Royal College of Physicians.1  
www.bmj.com
over 4 years ago
Preview
1
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Painful diabetic neuropathy

Diabetes is a worldwide epidemic, and associated neuropathy is its most costly and disabling complication. Given the rising prevalence of painful diabetic neuropathy, it is increasingly important that we understand the best ways to diagnose and treat this condition. Diagnostic tests in this field are evolving rapidly. These include the use of skin biopsies to measure small unmyelinated fibers, as well as even newer techniques that can measure both small unmyelinated fibers and large myelinated fibers in the same biopsy. The main treatments for painful diabetic neuropathy remain management of the underlying diabetes and drugs for the relief of pain. However, emerging evidence points to major differences between type 1 and type 2 diabetes, including the ability of glycemic control to prevent neuropathy. Enhanced glucose control is much more effective at preventing neuropathy in patients with type 1 diabetes than in those with type 2 disease. This dichotomy emphasizes the need to study the pathophysiologic differences between the two types of diabetes, because different treatments may be needed for each condition. The impact of the metabolic syndrome on neuropathy in patients with type 2 diabetes may account for the difference between the two types of diabetes and requires further study. Finally, neuropathic pain is under-recognized and undertreated despite an ever evolving list of effective drugs. Evidence exists to support several drugs, but the optimal sequence and combination of these drugs are still to be determined.  
www.bmj.com
over 4 years ago