bluuebunny/crossref_metadata_2025_split huggingface dataset:
PEM report number 5. Fluoxetine
Authors: Inman William , Kubota Kiyoshi , Pearce Gillian , Wilton Lynda 
Published: October 2006

AbstractThe selective serotonin reuptake inhibitor (SSRI) fluoxetine was first marketed in the United Kingdom in January 1989. It has been studied by Prescription‐Event Monitoring (PEM) in 12,692 patients who had received prescriptions from general practitioners in England between March 1989 and March 1990.There were more than twice as many females in the series as males and the average ages were 49.4 and 50.1 years respectively. The majority of patients were taking 20 mg daily (89%), but doses ranged up to 120 mg daily. Where an opinion had been given, fluoxetine was said to have been effective in 57% of patients.The events following treatment were compared with those reported after prescription of two other SSRIs, paroxetine and fluvoxamine, and with the ‘pooled’ results in 34 studies, in order to detect possible differences within the group of SSRIs and to obtain some impression of the background rates in a population of over 350,000 monitored by PEM.Coincidental with the PEM study there was much publicity, initiated in the United States by a report of suicidal and aggressive behaviour. A subsidiary study of doctors' and patients' attitudes before and after a heavily biased television programme was initiated about one‐fifth of the patients in the PEM study. There was no evidence to suggest that the frequency of aggressive or suicidal behaviour following the use of fluoxetine was increased.The overall incidence of side‐effects was low and no deaths were attributed to fluoxetine.
Generic prescribing in Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
Authors: Ogwuche E. A. , Olasehinde L. , Obiaga G. O. 
Published: October 2006

AbstractA study was carried out to assess the generic prescribing pattern among medical doctors in Ahmadu Bello University (ABU) Teaching Hospital, Zaria, Nigeria.The results indicate that 98 (49%) of the 200 drugs studied were prescribed using generic names while 64 (32%) were prescribed using both generic and proprietary names.One hundred and ninety‐two (96%) of the 200 drugs studied are on the Essential Drugs List (EDL), Second Revision 1991 of the Federal Ministry of Health, Lagos, Nigeria.The results further showed that out of the 77,889 prescriptions scrutinized, 48,451 (62.2%) were written using generic names only while 29,438 (37.8%) were prescribed using proprietary names.Based on the above findings, more prescriptions were written using generic names than proprietary names during the period of this study, showing that the government's effort towards educating doctors to prescribe generically is achieving the desired results.
The quality of information recorded on a UK database of primary care records: A study of hospitalizations due to hypoglycemia and other conditions
Authors: Van Staa Tjeerd‐Pieter , Abenhaim Lucien 
Published: October 2006

AbstractWe assessed the utility of the clinical information on the VAMP Research data bank. This data bank contains information recorded by general practitioners in the United Kingdom. We compared information derived from photocopied hospital discharge summaries and GPs' questionnaires to the information recorded in the data bank. Data were obtained on 553 discharge summaries for 452 persons registered in 269 medical practices.We found that the principal diagnosis of hospitalizations was present in the computerized records in 90.0 per cent of the time. Furthermore, 90.7 per cent of the discharge summaries for hypoglycemia were adequately recorded on the data bank, and 88.6 per cent of the data bank codes indicating hypoglycemia hospitalizations were correct. For most of the other reviewed medical conditions, we found that the sensitivity of computer notation and positive predictive value of computer codes was over 90 per cent. The agreement between computerized information on the severity of diabetes and GPs' questionnaire information was over 85 per cent.We concluded that the data in the VAMP Research data bank have a high level of completeness and validity.
Antidepressant drug use in an ambulatory elderly population: A 14‐year overview
Authors: Stewart Ronald B. , Marks Ronald G. , Padgett Phillip D. , Hale William E. 
Published: October 2006

AbstractThe objective of the work was to identify changes in antidepressant drug use and determine if the prevalence of antidepressant use has changed over 14 years. A longitudinal analysis comparing antidepressant drug use at 14 yearly intervals from 1978–79 to 1991–92 was undertaken using the longitudinal health screening program of ambulatory elderly participants (Florida Geriatric Research Program). Participants included all subjects screened in the Florida Geriatric Research Program from 1 August 1978 to 31 July 1992. The outcome measures were self‐reported antidepressant drug use.Approximately 3.0 per cent (range of 2.3 to 3.2 per cent over 14 yearly intervals) of participants in this program reported the use of an antidepressant drug. There was no statistically significant change in antidepressant use between 1978–79 and 1991–92 (p > 0.6630). Across all study intervals women reported more frequent use of antidepressant drugs than men. In 1991–92, amitriptyline and imipramine represented over 50 per cent of all antidepressant drug use in this elderly population. Less than 6 per cent of all antidepressant drug use was for fluoxetine, the newest selective serotonin uptake inhibitor.The majority of elderly patients are receiving older tertiary amine tricyclic antidepressants such as amitriptyline, imipramine and doxepin that are not the preferred drugs for the elderly. Educational programs are needed to improve antidepressant prescribing for geriatric patients.
Estimating daily dose for pharmacoepidemiologic studies: Alprazolam as an example
Authors: Johnson Richard E. , McFarland Bentson H. , Corelle Charlotte A. , Woodson Gary T. 
Published: October 2006

AbstractPharmacoepidemiologic research utilizing large automated prescription databases requires measures of daily drug dose. The objectives of this report were to develop a measure of the average daily dose from such a database and to apply it to a specific drug (alprazolam) to determine if the average daily dose had changed over time.An estimate of the average daily dose was developed by calculating total exposure (in mg) over time and dividing it by the total number of days of exposure over the same time period. The total number of days of exposure was calculated with an algorithm linking prescriptions into periods of use if certain conditions were met.Applying the measure, the average daily dose of alprazolam increased after it was approved for use at higher doses, and we observed no seizure disorders among any users with highest average daily doses.Since the data fields to develop the measure appeared to be valid and are common to most automated prescription systems, and given an assumption that the receipt of multiple dispensings in a consistent temporal sequence indicates that the drug is consumed, average daily doses can be estimated from large automated prescription databases.
Antibiotic prescribing patterns in a medical unit in Hong Kong
Authors: Chan Thomas Y. K. , Chan Juliana C. N. , Tomlinson Brian , Critchley Julian A. J. H. 
Published: October 2006

AbstractAntibiotic prescribing patterns were retrospectively studied in one medical unit at the Prince of Wales Hospital in Hong Kong. Of the 563 patients admitted over a 5‐month period in 1991, 156 (27.7 per cent) received at least one oral or intravenous antibiotic. As a whole, the proportion of patients receiving antibiotics increased with age. An analysis of antibiotic prescribing patterns in 146 of these patients indicated that monotherapy with cefuroxime (32.9 per cent) or amoxycillin/ampicillin (21.9 per cent) was the most commonly used regimen during initial therapy of community, institutional or hospital‐acquired infections. Combination therapy (20.5 per cent) was mainly used for skin infections, septicaemia and biliary tract infections. Surprisingly, aminoglycosides (0.7 per cent) were rarely used. There is a need for larger studies on patients receiving antibiotic therapy in different specialities over longer periods particularly as antibiotics can account for 20 to 30 per cent of a hospital's total drug budget.
The single case format: Proposal for a structured message for the telematic transmission of information on individual case reports in pharmacovigilance
Authors: Moore N. , Montero D. , Coulson R. , De Abajo F. , Kreft‐Jais C. , Biron A. , Monteagudo J. L. 
Published: October 2006

AbstractThe development of telematic exchange of information in pharmacovigilance has as a consequence the necessary development of the messages used to transmit the information. The first of these messages is the one used to transmit information on individual case reports. Common formats exist on paper, but these have not been applied to electronic transmission. A structured message for the transmission of single case information has been developed within the ENS European research programme, by three National Pharmacovigilance administrations, and reviewed by the relevant European bodies. It has been submitted to the Western European Edifact Board MD9 for admission as an EDIFACT message, so that it will be possible to exchange information concerning these single cases, using standard EDI methodology.
Utilization dynamics and risk comparisons in studies that use prescription information
Authors: Van Staa Tjeerd‐Pieter , Abenhaim Lucien 
Published: October 2006

AbstractThis paper considers the effects of the time‐window design on risk comparisons in studies that use prescription information. A time‐window constitutes the number of exposure days assigned to each prescription. Prescription information was drawn from the Quebec Social Insurance System, which covers reimbursement claims for all people aged 65 years or older (random sample of about 5000 NSAID users in 1988).Utilization dynamics as measured by refill dispensings were comparable between age or gender, but related to duration of prior NSAID use and drug type. We looked at the rates of starts of peptic ulcer therapy. The observed rates were lower with longer designs (4‐week window, 3.0; 12‐week window, 2.5; 24‐week window, 2.3). The strata based on age or gender showed a nondifferential rate attenuation with longer time‐windows. In contrast, strata which refill variability showed patterns of differential rate attenuation. A Monte‐Carlo simulation showed that uniform time‐windows in the presence of utilization variability can result in a bias away from the null.We conclude that excessively long time‐windows underestimate the risk of exposure. Furthermore, lack of adjustment for utilization differences can lead to a biased rate ratio.
Measles passive immunity in infants from vaccinated and disease acquired mothers
Authors: Silva Juan J. , Fernández Maria Del Pilar , Suárez Mónica , Toledo Maria , Silva Cecilia A. 
Published: October 2006

AbstractBackground — Despite the decline in the incidence of measles in Chile, epidemics continue to occur. In Chile, measles vaccine is administered at one year of age, therefore, we hypothesized that control of epidemic measles may be improved with a better understanding of the immunologic status of infants.Objective — To evaluate the immunologic status to measles of unvaccinated infants born to previously vaccinated and disease exposed mothers.Method — Group A subjects were pregnant women with a documented history of measles infection, and group B subjects were pregnant women with a documented history of measles vaccination. Maternal blood samples and cord blood were obtained immediately following delivery. Blood samples were obtained from infants at 6 and 9 months of age. Samples were tested for anti‐measles antibodies using an ELISA technique.Results — There were 41 subjects in group A and 35 in group B. Infant birth weight and the mothers age were comparable in the two groups. At delivery the titre of measles antibodies in cord blood was the same in the two groups. A higher mean antibody level pre‐delivery was observed in group A (disease exposed) mothers compared with group B (vaccinated) (p = 0.028). There was a significantly lower antibody titre at 6 months and 9 months compared with baseline in both groups (p = < 0.001), but no difference in titre between infants born to vaccinated versus disease exposed mothers. The levels of antibody titre were below protective levels at 6 and 9 months.Conclusion — There is a rapid decline in measles antibody levels observed by 6 months in infants from mothers either previously exposed to measles or vaccinated. There is inadequate protection of infants from measles by 6 months based on immunological status, with no difference in infant immunologic status of infants from disease exposed and previously vaccinated mothers.
Use of heparin for the prevention of venous thromboembolism
Authors: Vallano Antoni , Vallés Joan‐Antoni , Gracia Rosa Maria , Arnau Josep‐Maria , Duran Salvador , Laporte Joan‐Ramon 
Published: October 2006

AbstractThe value of heparin in the prevention of venous thromboembolism has been shown effective and safe by controlled studies. However, how these studies have influenced physicians' decisions in thrombo‐prophylaxis is not known. With the aim of evaluating the frequency and the appropriateness of prophylaxis for venous thromboembolism in our centre, we performed a cross‐sectional study on a specific day. Among 667 patients who were admitted to hospital on this day, 134 (20 per cent) were receiving heparin. This had been prescribed for the prophylaxis of venous thromboembolism to 82 (12 per cent) patients. Immobilization was the risk factor most strongly associated with prophylaxis. Prophylaxis with heparin was only used in 79 out of 444 high‐risk patients (21.6 per cent). One hundred and eighty‐three patients had been subject to major surgery and heparin was being given only to 34 of them (18.6 per cent). A wide variability in the use of prophylaxis, depending on the hospital ward, was also recorded. We conclude that prophylaxis with heparin is underused in our milieu.
Intercommunity variations in antidiabetic drug utilization and in prevalence of diabetes mellitus
Authors: Olsson Jonny , Tollin Claes , Nilsson Sven , Melander Arne 
Published: October 2006

AbstractIn order to assess whether differences in the extent of antidiabetic drug utilization may be an indicator of variations in diabetes prevalence (Type 1 plus Type 2, including non‐pharmacologically treated diabetics), intercommunity variations of antidiabetic drug utilization (insulin plus oral agents) in Sweden were examined through sales expressed in defined daily doses per 1000 inhabitants per day and compared with intercommunity prevalence variations. There were large (two‐fold) and long‐lasting (>10 years) between‐county differences in antidiabetic drug sales. Low‐sales counties were found both in the doctor‐dense south and the doctor‐sparse north of Sweden, which argues against the assumption that the sales variation simply was due to different access to medical care. Recent diabetes prevalence figures have been obtained for eight municipalities in different parts of Sweden. In these, antidiabetic drug sales and diabetes prevalence (including non‐pharmacologically treated diabetics) showed a close correlation (r = 0.87; p < 0.01), supporting the assumption that variations in antidiabetic drug utilization may indicate variations in diabetes prevalence, at least in countries that, like Sweden, have uniform health care systems. The findings also suggest that, in Sweden, there is little intercommunity variation in the proportion of non‐pharmacologically treated diabetics. On the other hand, it is likely that there are many undetected diabetics in areas where no diabetes screening has been performed. Hence, although differences in antidiabetic drug sales may help to indicate where to look for differences in diabetes prevalence, drug sales data are no substitutes for prevalence studies.
Assessment of the risk associated with the use of individual non‐steroidal anti‐inflammatory drugs as causes of peptic ulcer bleeding
Authors: Langman M. J. S. 
Published: October 2006

AbstractUse of non‐steroidal anti‐inflammatory drugs (NSAIDs) has repeatedly been shown to be associated with a raised risk of ulcer occurrence, hospitalization or complications. Available data suggest that risks may differ significantly between drugs, with diclofenac and ibuprofen appearing to have the lowest associated risks. Clinical treatment strategies should take account of such information.
Intent to treat: TheReductio ad absurdumthat became gospel
Authors: Salsburg David 
Published: October 2006

AbstractThe ‘Intent to Treat’ paradigm for the analysis of a controlled randomized clinical trial is the direct result of applying the Neyman‐Pearson formulation of hypothesis testing. If other formulations are used, the ‘Intent to Treat’ paradigm makes no sense. Criticisms of the Neyman‐Pearson formulation and whether it is applicable to scientific investigations have appeared in the statistical and philosophical literature since it was first proposed. This paper reviews the nature of that criticism and notes why the Neyman‐Pearson formulation, and with it the ‘Intent to Treat’ paradigm, is inappropriate for use in the analysis of clinical trials.
Chronic sinusitis: Temporal occurrence and relationship to medical claims for upper respiratory infections and allergic rhinitis
Authors: Gable C. B. , Jones J. K. , Lian J. F. , Rajan M. , Kennedy C. 
Published: October 2006

AbstractBackground — Preliminary data suggest that upper respiratory infection diagnoses, but not allergic rhinitis diagnoses, are temporally related to chronic sinusitis diagnoses.Methods — We analysed monthly medical claims (ICD‐9CM codes) for allergic rhinitis, upper respiratory infection and chronic sinusitis for 1990–1991 from three databases: the National Disease and Therapeutic Index (NDTI), the COMPASS Ohio Medicaid and the Blue Cross/Blue Shield of Minnesota (BC/BS‐MN). We also assessed the timing and prevalence of upper respiratory infection, allergic rhinitis and chronic sinusitis in 200 cases from Ohio Medicaid.Results — We found statistically significant positive correlations between upper respiratory infection and chronic sinusitis in NDTI (r = 0.96), Ohio Medicaid (r = 0.95), and BC/BS‐MN (r = 0.92), and statistically significant negative correlations between allergic rhinitis and chronic sinusitis in the NDTI (r = −0.55) and the BC/BS MN data (r = −0.57); the correlation between allergic rhinitis and chronic sinusitis in Ohio data was negative but not significant. Of the 200 sampled chronic sinusitis cases, 51.5% had upper respiratory infection with no allergic rhinitis‐related diagnoses in the previous year; 12.0% had both upper respiratory infection‐ and allergic rhinitis‐related diagnoses and 31% had neither. In the 90 days before chronic sinusitis, 74% of patients ages < 10 and 54% of ages > 10 had upper respiratory infection.Conclusions — In these populations, upper respiratory infection diagnoses were closer temporally to chronic sinusitis diagnoses than were allergic rhinitis diagnoses. In the 200 cases, upper respiratory infection was diagnosed more frequently than allergic rhinitis prior to chronic sinusitis. Although not indicative of a cause‐effect relationship, these data suggest that upper respiratory infection may be a more common risk factor than allergic rhinitis for chronic sinusitis.
Frequency of adverse events among users of talwin Nx
Authors: Terris Barbara Z. , Jick Susan S. , Beeman Douglas W. , Jick Hershel 
Published: October 2006

AbstractWe used the automated data files at Group Health Cooperative to identify 1587 outpatient users of oral Talwin, Nx, a combination of pentazocine and naloxone. The clinical records of the Talwin users were reviewed to determine the occurrence of adverse events which were noted in the record in the four weeks after receipt of the drug. The overall rate of adverse events was 8.7 per cent with 6.7 per cent being directly attributed to the effect of Talwin Nx. Gastrointestinal effects were the most common adverse effect and were reported by 3.7 per cent of the patients. Hallucinations, the most serious effect, were experienced by 10 (0.6 per cent) recipients of the drug. None of the subjects in the study had any long‐term effect. Among those who received higher doses, the rate of adverse events was higher than it was for those who received lower doses. Compared to our previous study of oral pentazocine in hospitalized patients, Talwin Nx had a similar rate of hallucinations and a higher rate of gastrointestinal side‐effects.
Hyperlipidaemia in primary care — a randomized controlled trial on treatment information in Sweden: Design and methodology
Authors: Wahlström R. , Tomson G. , Diwan V. K. , Beermann B. , Sterky G. 
Published: October 2006

AbstractThis paper presents the design and methodology of a large scale information dissemination experiment in Swedish primary care, executed in collaboration with policy makers and information pharmacists, and focused on the effects of an information package presented verbally by community pharmacists, with regard to the doctors' knowledge, attitudes, perceptions and practice in the treatment of hyperlipidaemia.The main study group comprised 570 doctors, belonging to 67 matched pairs of community health centres (CHCs), randomization being performed at group (i.e. CHC) level to minimize ethical and practical problems. The information derived from national expert guidelines, and was presented at four group sessions during six months at each of the intervention group CHCs, 79% of which fulfilled this requirement. Baseline and outcome data were collected from prescriptions, serum cholesterol test results, questionnaires on attitudes and case‐management evaluation. Moreover, interviews and field observations were conducted in a subsample of CHCs. We demonstrate ways of overcoming methodological problems such as minimizing the Hawthorne effect by introducing an extra, control group and the expectancy effect by not obtaining informed consent until the end of the study period.There was a non‐respondence rate of 21% which is similar to results in trials on drug efficacy. The acceptance rate vis‐à‐vis the study evaluation was 86%, but might have been higher had the ethical and methodological aspects special to experiments with treatment information been better understood. The information model has afterwards been used in Sweden for information campaigns focused on therapeutic guidelines.