BMJ : British medical journal
-
Randomized Controlled Trial Multicenter Study Comparative Study Pragmatic Clinical Trial
Tumour necrosis factor inhibitors versus combination intensive therapy with conventional disease modifying anti-rheumatic drugs in established rheumatoid arthritis: TACIT non-inferiority randomised controlled trial.
To determine whether intensive combinations of synthetic disease modifying drugs can achieve similar clinical benefits at lower costs to high cost biologics such as tumour necrosis factor inhibitors in patients with active rheumatoid arthritis resistant to initial methotrexate and other synthetic disease modifying drugs. ⋯ In patients with active rheumatoid arthritis who meet English criteria for biologics an alternative strategy with combinations of intensive synthetic disease modifying drugs gives non-inferior outcomes to treatment with tumour necrosis factor inhibitors. Costs are reduced substantially.Trial Registration ISRCTN 37438295.
-
Meta Analysis
Quantifying the risks of non-oncology phase I research in healthy volunteers: meta-analysis of phase I studies.
To quantify the frequency and seriousness of adverse events in non-oncology phase I studies with healthy participants. ⋯ Among 11,028 healthy participants who received study drug in non-oncology phase I studies, the majority (85%) of adverse events were mild. 34 (0.31%) serious adverse events occurred, with no life threatening events or deaths. Half of all adverse events were related to the study drug or to procedures. Extrapolation of these data to other types of phase I studies, especially with biological agents, may not be warranted.
-
Multicenter Study Comparative Study Observational Study
Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study.
To compare the safety and efficacy of hysteroscopic sterilization with the "Essure" device with laparoscopic sterilization in a large, all-inclusive, state cohort. ⋯ Patients undergoing hysteroscopic sterilization have a similar risk of unintended pregnancy but a more than 10-fold higher risk of undergoing reoperation compared with patients undergoing laparoscopic sterilization. Benefits and risks of both procedures should be discussed with patients for informed decisions making.
-
The increasing prevalence of obesity together with projected increases in diabetes over the next 20-30 years will put a substantial strain on the finances and resources of the US healthcare system. The best opportunity for broad scale treatment of obesity may lie in the primary care setting. ⋯ Overall, the evidence suggests that obesity treatment delivered in primary care has limited effectiveness. Questions remain about the optimal role of the primary care provider in the treatment of obesity and the prevention of weight gain, as well as potential systems approaches to the treatment of obesity.
-
Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. ⋯ Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to benefit ratio is a concern. An approach to integrating non-pharmacologic and pharmacologic treatments is described. Finally, the paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.