Showing papers by "Jeffrey K Aronson published in 2014"

The need for randomization in animal trials: an overview of systematic reviews.

Abstract: Background and Objectives: Randomization, allocation concealment, and blind outcome assessment have been shown to reduce bias in human studies. Authors from the Collaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies (CAMARADES) collaboration recently found that these features protect against bias in animal stroke studies. We extended the scope the work from CAMARADES to include investigations of treatments for any condition. Methods: We conducted an overview of systematic reviews. We searched Medline and Embase for systematic reviews of animal studies testing any intervention (against any control) and we included any disease area and outcome. We included reviews comparing randomized versus not randomized (but otherwise controlled), concealed versus unconcealed treatment allocation, or blinded versus unblinded outcome assessment. Results: Thirty-one systematic reviews met our inclusion criteria: 20 investigated treatments for experimental stroke, 4 reviews investigated treatments for spinal cord diseases, while 1 review each investigated treatments for bone cancer, intracerebral hemorrhage, glioma, multiple sclerosis, Parkinson's disease, and treatments used in emergency medicine. In our sample 29% of studies reported randomization, 15% of studies reported allocation concealment, and 35% of studies reported blinded outcome assessment. We pooled the results in a meta-analysis, and in our primary analysis found that failure to randomize significantly increased effect sizes, whereas allocation concealment and blinding did not. In our secondary analyses we found that randomization, allocation concealment, and blinding reduced effect sizes, especially where outcomes were subjective. Conclusions: Our study demonstrates the need for randomization, allocation concealment, and blind outcome assessment in animal research across a wide range of outcomes and disease areas. Since human studies are often justified based on results from animal studies, our results suggest that unduly biased animal studies should not be allowed to constitute part of the rationale for human trials. © 2014 Hirst et al.

Checklist for standardized reporting of drug-drug interaction management guidelines.

Abstract: Purpose Inconsistencies and omissions in drug–drug interaction (DDI) management guidelines may lead to harm and suboptimal therapy. The purpose of this study was to define a checklist for DDI management guidelines to help developers produce high-quality guidelines that will support healthcare providers in clinical practice.

Medical eponyms: taxonomies, natural history, and the evidence

Abstract: Jeffrey Aronson discovers that the golden age of the eponym was the 1950s, not the 19th century. He provides taxonomies and a natural history

Failed phlebotomy? Think William Harvey

Abstract: Why do health professionals take blood in the wrong direction? Shortly before his death in 1657, William Harvey told the young Robert Boyle that the main thing that convinced him of the circulation of the blood was that the valves in arm veins prevent flow down the arm.1 This is a truth universally acknowledged, but ignored, given that it is the retrograde direction in which all hopeful phlebotomists expect blood to flow into their needles. We sometimes get away with it, when the blood, travelling headwards up a vein, struggles past the occluding needle, does an about turn, and ends up in the right place. Sometimes. The headwards …

Management of pain during injection of propofol

Abstract: SummaryThe results of this narrative review and published systematic reviews suggest that to reduce the risk of pain during injection with propofol one should use a lipid emulsion of propofol, injected into a large vein, preceded by lidocaine 0.5 mg/kg with venous compression for 30–120 s. The addition of other compounds can also be recommended, and ketamine 0.4 mg/kg (adult dose) may be the additional drug of choice, particularly because the combination of ketamine and propofol (ketofol) has added therapeutic benefits. In children Emla cream is an option, but to be effective it must be applied about 4 h before propofol is injected.

The adverse effects of nitrous oxide

Abstract: SummaryNitrous oxide (N2O) has been used as an anaesthetic agent since 1844. It has two well recognized adverse effects: it oxidizes Co(I) to Co(II) and so inactivates vitamin B12, and its high partial pressure in blood allows it to expand into cavities in the body such as the pleural space. Impairment of the action of vitamin B12 can cause both megaloblastic anaemia and, especially in recreational users of N2O, the syndrome of subacute combined degeneration of the spinal cord. The overall cardiovascular effects in noncardiac surgery seem to be minor. N2O is probably a human teratogen.

When I use a word . . .“Well tolerated” is intolerable

Abstract: Let me be plain. I can’t stand intolerance. On the other hand, I’m not sure about tolerance either. It’s not obvious, but “tolerance” comes from the Latin word ferre , to carry, whose principal parts, from different roots, are ferro , ferre , tuli , latum (see BMJ 2000;320:625). And “tolerance” carries several technical meanings. Pharmacological tolerance can be acquired or natural. Acquired tolerance is reduced sensitivity to a drug, from previous exposure either to it or (cross-tolerance) to another drug. It should not be confused with tachyphylaxis or …

Vitamins, amino acids, and drugs and formulations used in nutrition

Abstract: The Side Effects of Drugs Annuals form a series of volumes in which the adverse effects of drugs and adverse reactions to them are surveyed. The series supplements the contents of Meyler's Side Effects of Drugs: the International Encyclopedia of Adverse Drug Reactions and Interactions . This review of the January 2012 to June 2013 publications on vitamins, amino acids and drugs and formulations used in nutrition covers vitamin A (carotenoids), vitamins of the B group (cobalamins, folic acid and folinic acid, hopantenic acid, pyridoxine, riboflavin, tetrahydrobiopterin and sapropterin and thiamine), vitamin C (ascorbic acid), vitamin D analogues, vitamin E (tocopherol), vitamin K analogues, amino acids (arginine, glycine, and ornithine) and enteral and parenteral nutrition.