A systematic review of medication safety and clinical outcomes related to drug interaction software.

We conducted a systematic search of MEDLINE, EMBASE, IPA, HealthStar and CINAHL, for English language, post-1990, prospective studies examining electronic drug interaction checking (eDIC) on the outcome of adverse drug interactions (ADI). Excluded studies were not prospective or measured non-patient specific outcomes. Four of 5848 studies were included.

Meta-analysis of depression and substance use and impairment among cocaine users.

Background: The study evaluated, among cocaine users, the hypothesized positive association of depression and concurrent cocaine use and impairment, alcohol use and impairment, and general drug use and impairment. The hypothesis that gender would moderate these associations, with women showing a stronger correlation between depression and measures of substance use and impairment, was also tested. Also examined was the association of depression with future cocaine use and impairment and substance use treatment participation.

Methodologic issues in health informatics trials: the complexities of complex interventions.

OBJECTIVE All electronic health (e-health) interventions require validation as health information technologies, ideally in randomized controlled trial settings. However, as with other types of complex interventions involving various active components and multiple targets, health informatics trials often experience problems of design, methodology, or analysis that can influence the results and acceptance of the research. Our objective was to review selected key methodologic issues in conducting and reporting randomized controlled trials in health informatics, provide examples from a recent study, and present practical recommendations.

Automated telephone reminder messages can assist electronic diabetes care.

Telephone reminder systems have been used to assist in the treatment of many chronic diseases. However, it is unclear if these systems can increase medication and appointment adherence in patients with diabetes without direct patient-provider telephone contact. We tested the feasibility of using an automated telephone reminder system (ATRS) to deliver reminder messages to 253 adults with diabetes enrolled in a randomized controlled trial.

A comprehensive appropriateness of prescribing questionnaire was validated by nominal consensus group.

Objective: To develop and validate a comprehensive Appropriateness of Prescribing Evaluation Questionnaire (APEQ) suitable for human and computer use.

Study Design And Setting: This study was part of an ongoing research program examining the effectiveness and cost-effectiveness of computerized prescribing decision support for providers, patients, and drug policy. A nominal group consensus process involved physicians, both primary care physicians and specialists, pharmacists, drug plan managers, patients, patient advocates, and pharmaceutical industry.

Outcomes of dosage adjustments used to manage antiretroviral drug interactions.

Dosage adjustments are often used to manage HIV drug interactions, but little is known about their clinical significance. We examined patients from the Ontario HIV Cohort Study to assess the effects of dosage adjustments on plasma viral load. A significant reduction (0.

Influence of decision aids on patient preferences for anticoagulant therapy: a randomized trial.

Background: Decision aids have been shown to be useful in selected situations to assist patients in making treatment decisions. Important features such as the format of decision aids and their graphic presentation of data on benefits and harms of treatment options have not been well studied.

Methods: In a randomized trial with a 3 x 2 factorial design, we investigated the effects of decision aid format (decision board, decision booklet with audiotape, or interactive computer program) and graphic presentation of data (pie graph or pictogram) on patients' comprehension and choices of 3 treatments for anticoagulation, identified initially as "treatment A" (warfarin), "treatment B" (acetylsalicylic acid) and "treatment C" (no treatment).

Best practices in EMR implementation: a systematic review.

As experience with Electronic Medical Record (EMR) implementations increases, new knowledge is gained on how to make these implementations more successful. Recently, several new conceptual frameworks described in the literature provide a richer understanding of what makes an EMR implementation successful. Using the systematic review process, we attempt to integrate the various frameworks into an over-arching framework that is comprehensive, yet pragmatic.

E-health interventions as complex interventions: improving the quality of methods of assessment.

E-health interventions require rigorous evaluation, preferably within a randomized trial. Health technology assessment and complex intervention methodologies exist, but are often not used in health informatics research. We propose a framework of methodologic issues which should be considered for every e-health intervention.

The rate of tension recovery in cardiac muscle correlates with the relative residual tension prevailing after restretch.

Isolated cardiac muscles generate tension more quickly at higher levels of Ca(2+) activation. We investigated the molecular mechanisms underlying this effect in permeabilized rat myocardial preparations by measuring the rate of tension recovery following brief shortening/restretch perturbations. Separate series of experiments used Ca(2+)-activating solutions with different pH values (pH 6.

Surveying a Chicago public housing development: methodological challenges and lessons learned.

During the winter and spring of 2003, the Survey Research Laboratory conducted a survey of residents of the Ida Wells and Madden Park housing developments on Chicago's near-south side. This article reviews existing research findings on using indigenous interviewers and reports the findings about the benefits and challenges of using residents as interviewers versus drawing from a regular pool of interviewers. Specifically, the authors talk about the challenges faced in using indigenous interviewers and then look at some data quality indicators among these two groups of interviewers, including cooperation rates, item nonresponse, and differences in responses to sensitive questions.

Nonresponse error in injury-risk surveys.

Background: Nonresponse is a potentially serious source of error in epidemiologic surveys concerned with injury control and risk. This study presents the findings of a records-matching approach to investigating the degree to which survey nonresponse may bias indicators of violence-related and unintentional injuries in a random-digit-dialed (RDD) telephone survey.

Methods: Data from a statewide RDD survey of 4155 individuals aged 16 years and older conducted in Illinois in 2003 were merged with ZIP code-level data from the 2000 Census.

Cracking the egg: molecular dynamics and evolutionary aspects of the transition from the fully grown oocyte to embryo.

Fully grown oocytes (FGOs) contain all the necessary transcripts to activate molecular pathways underlying the oocyte-to-embryo transition (OET). To elucidate this critical period of development, an extensive survey of the FGO transcriptome was performed by analyzing 19,000 expressed sequence tags of the Mus musculus FGO cDNA library. Expression of 5400 genes and transposable elements is reported.

Systematic overview of drug interactions with antidepressant medications.

Objective: Antidepressants are commonly used drugs with potential for numerous drug interactions. This study aims to systematically review the literature on drug interactions with antidepressants.

Methods: We searched MEDLINE (1966 to November 2003) and EMBASE (1980 to 2003), using the heading drug interactions combined with individual antidepressant names.

The role of antimalarials in the exacerbation of psoriasis: a systematic review.

Objective: To critically review the body of literature that refutes or supports the role of antimalarials in the exacerbation of psoriasis.

Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were reviewed to identify English-language publications from 1966-2005 examining the role of antimalarials in the exacerbation of psoriasis. A total of 374 articles were identified, of which 32 studies met the inclusion criteria.

Does celecoxib potentiate the anticoagulant effect of warfarin? A randomized, double-blind, controlled trial.

Background: The management of patients who are receiving warfarin therapy and have musculoskeletal problems that require treatment with a nonsteroidal antiinflammatory drug (NSAID) is problematic because NSAID use may increase the risk for bleeding. Cyclooxygenase-2 selective NSAIDs such as celecoxib may be less likely to promote gastrointestinal bleeding; however, there are concerns that they could potentiate the anticoagulation effect of warfarin.

Objective: To determine whether celecoxib potentiates the anticoagulant effect of warfarin, as measured by the international normalized ratio (INR).

Splenic peliosis with spontaneous splenic rupture: report of two cases.

Background: Peliosis is a rare condition characterised by multiple cyst-like, blood-filled cavities within the parenchyma of solid organs. Most commonly affecting the liver, isolated splenic peliosis is an even more unique phenomenon. Patients with the condition are often asymptomatic.

Can current electronic systems meet drug safety and effectiveness requirements?

Background: Every health policy jurisdiction is endeavoring to enhance its ability to evaluate drug effectiveness, safety and cost in the real world (pharmacosurveillance).

Methods: A nominal group consensus conference of stakeholders finalized data items deemed necessary for pharmacosurveillance. Large administrative datasets (LADs), electronic health records (EHRs) and electronic patient registries (PRs), were investigated as sources of this information and for their vulnerability to methodologic bias.

Cultural variability in the effects of question design features on respondent comprehension of health surveys.

Purpose: The aim is to identify the characteristics of common health survey questions that may be associated with cross-cultural variability in question comprehension.

Methods: Interviews with respondents representing four cultural subgroups in the United States were analyzed through behavior coding to identify survey question characteristics that may be associated with cross-cultural variability in comprehension. Using survey responses as the unit of analysis, nested within survey respondents and survey questions, hierarchical linear modeling was used to examine the effects of four questionnaire design features on cultural variations in comprehension difficulties.

Are brand-name and generic warfarin interchangeable? A survey of Ontario patients and physicians.

Background: The issue of therapeutic equivalence has been a source of controversy in Canada since the approval of generic warfarin products in 2000.

Objectives: We surveyed Ontario patients and physicians on perceptions of generic warfarin and brand substitution.

Methods: Self-administered questionnaires employed 7.

The impact of reference pricing of nonsteroidal anti-inflammatory agents on the use and costs of analgesic drugs.

Objective: To estimate the effect of reference pricing (RP) of nonsteroidal anti-inflammatory drugs (NSAIDs) on drug subsidy program and beneficiary expenditures on analgesic drugs.

Data Sources/study Setting: Monthly claims data from Pharmacare, the public drug subsidy program for seniors in British Columbia, Canada, over the period of February 1993 to June 2001.

Study Design: RP limits drug plan reimbursement of interchangeable medicines to a reference price, which is typically equal to the price of the lowest cost interchangeable drug; any cost above that is borne by the patient.

Dose-reducing H2 receptor antagonists in the presence of low glomerular filtration rate: a systematic review of the evidence.

Background: While it is recommended that H2 receptor antagonists (H2RAs) be dose reduced in the presence of low glomerular filtration rate (GFR), in practice such adjustments often do not occur. We reviewed the evidence for this recommendation.

Methods: We searched multiple medical reference databases for relevant cohort studies and randomized clinical trials.

Are brand-name and generic warfarin interchangeable? Multiple n-of-1 randomized, crossover trials.

Background: Warfarin is a commonly used anticoagulant in North America. Several generic formulations have been approved, raising concern over the safety and efficacy of these products compared with brand-name Coumadin.

Objective: To ensure that generic warfarin products can be safely interchanged with Coumadin.

Systematic overview of warfarin and its drug and food interactions.

Background: Warfarin is a highly efficacious oral anticoagulant, but its use is limited by a well-founded fear of bleeding. Drug and food interactions are frequently cited as causes of adverse events with warfarin. We provide an updated systematic overview of the quality, clinical effect, and importance of these reported interactions.