Home About us Contact
|
Home About us Contact | ||
|
|
||
Risk-benefit Analysis (risk-benefit + analysis)
Selected AbstractsScreening for intracranial aneurysms in autosomal dominant polycystic kidney diseaseNEPHROLOGY, Issue 4 2003Review Article SUMMARY: Screening patients with autosomal dominant polycystic kidney disease (ADPKD) for asymptomatic intracranial aneurysms has been proposed as a method of reducing the morbidity and mortality associated with aneurysm rupture. However, recent studies have shown lower spontaneous rupture rates of small aneurysms and higher risks of significant complications with interventions than previously reported. Risk-benefit analysis has not demonstrated any benefit of screening ADPKD patients without a history of subarachnoid haemorrhage (SAH) for intracranial aneurysms, and has suggested that screening might cause harm. [source] Evaluating the evidence from clinical trials in chronic hepatitis CJOURNAL OF VIRAL HEPATITIS, Issue 2006R. S. Brown Jr Summary., A number of studies are being published on investigational agents for the treatment of patients with chronic hepatitis C. Before incorporating new medications into therapy or electing to postpone therapy until an investigational agent receives regulatory approval, it is important to evaluate the following specific features of the published evidence: quality of the evidence, precision of the treatment effect, magnitude of the treatment effect, magnitude of the hazards, and other factors such as risk-benefit analysis and cost, including cost-effectiveness. Previous studies of treatment of patients with the disease allow us to establish some benchmarks and provide structure to evaluate the evidence of the efficacy and safety of these newer drugs. [source] Calculated Ultraviolet Exposure Levels for a Healthy Vitamin D StatusPHOTOCHEMISTRY & PHOTOBIOLOGY, Issue 6 2006Ann R. Webb The dangers of overexposure to sunlight have been well publicized, but less attention has been given to an acknowledged benefit of exposure to UV radiation; that being the cutaneous synthesis of vitamin D3. Here we define a standard vitamin D dose on the basis of recently recommended requirements for vitamin D that take account of its risk reduction role in a variety of diseases, and present a web-based tool that enables the reader to calculate associated exposure times for any time and place using either default values or user-selected conditions. Either it is not possible to synthesize vitamin D3 at high latitudes in winter, or the exposure time required to reach a standard dose is sometimes impractical. Where solar UV is sufficient, a risk-benefit analysis of sunburn vs. vitamin D3 synthesis shows that the best time for brief sun exposure is in the middle of the day. For low solar elevation angles common at high latitudes, a fine line exists between adequate UV exposure for vitamin D3 synthesis and a risk of sun burn. [source] Guide to drug porphyrogenicity prediction and drug prescription in the acute porphyriasBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 5 2007Stig Thunell What is already known about this subject ,,Many drug safety lists for acute porphyrias, largely based on anecdotal evidence, are put forward, but no methods or rationale for the risk estimates are given. ,,Many unexplained discrepancies between the lists exist. What this study adds ,,A standardized method for assessment of the risk that a certain drug may activate these diseases has been developed. ,,It also allows risk assessments for drugs lacking porphyria related clinical experience. ,,About one thousand therapeutic drugs have been classified with regard to porphyrogenicity by the proposed method, which is most valuable for the care of porphyria patients. Aims This paper addresses two common problems in the care of carriers of acute porphyria: the choice of safe drugs for pharmacotherapy and the strategy to apply when potentially unsafe drugs cannot be avoided. Methods and results A technique is presented for prediction of risk that a certain drug may activate the disease in a gene carrier for acute porphyria. It is based on a model explaining the clinical manifestations as a result of the acute overloading of a deficient enzyme within the hepatic heme biosynthetic chain. The capacity of the drug for induction of the rate-limiting enzyme in heme biosynthesis, e.g. housekeeping 5-aminolevulinate synthase (ALAS1), is assessed by critical appraisal of reports of the outcomes of clinical use of the drug, and by theoretical criteria. The assessment occurs within the frame of a flow-scheme employing variables of increasing specificity, i.e. endocrine properties of the drug, structure and metabolism pointing to affinity to cytochrome P450, hepatic load in therapeutic use, recognized affinity to major CYP species, capacity for CYP-induction or irreversible inhibition, and capacity to activate or modulate the transduction mechanisms of nuclear receptors affecting ALAS1-gene transcription. It is proposed that in the absence of a safer alternative, an urgently needed drug not should be withheld on the grounds of potential porphyrogenicity. After risk-benefit analysis it should be prescribed, but individualized preventive measures adapted to patient vulnerability may be needed. Conclusions About 1000 therapeutic drugs categorized with regard to porphyrogenicity by the technique proposed are presented on the internet (http://www.drugs-porphyria.org). [source] | ||||||||||