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Demystifying trial networks and network meta-analysis.

https://arctichealth.org/en/permalink/ahliterature113875
Source
BMJ. 2013;346:f2914
Publication Type
Article
Date
2013
Author
Edward J Mills
Kristian Thorlund
John P A Ioannidis
Author Affiliation
Faculty of Health Sciences, University of Ottawa, 35 University Drive, Ottawa, ON, Canada K1N 6N5. Edward.mills@uottawa.ca
Source
BMJ. 2013;346:f2914
Date
2013
Language
English
Publication Type
Article
Keywords
Data Interpretation, Statistical
Female
Humans
Information Services
Male
Meta-Analysis as Topic
Ontario
Randomized Controlled Trials as Topic
Research Design
Sensitivity and specificity
PubMed ID
23674332 View in PubMed
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Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study.

https://arctichealth.org/en/permalink/ahliterature168429
Source
BMJ. 2006 Jul 29;333(7561):224
Publication Type
Article
Date
Jul-29-2006
Author
Jari Tiihonen
Kristian Wahlbeck
Jouko Lönnqvist
Timo Klaukka
John P A Ioannidis
Jan Volavka
Jari Haukka
Author Affiliation
Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, FIN-70240 Kuopio, Finland. jari.tiihonen@niuva.fi
Source
BMJ. 2006 Jul 29;333(7561):224
Date
Jul-29-2006
Language
English
Publication Type
Article
Keywords
Adult
Antipsychotic Agents - therapeutic use
Cohort Studies
Community Mental Health Services - statistics & numerical data
Female
Finland - epidemiology
Humans
Length of Stay
Male
Patient Readmission - statistics & numerical data
Prospective Studies
Psychotic Disorders - drug therapy - mortality
Risk factors
Schizophrenia - drug therapy - mortality
Treatment Outcome
Treatment Refusal
Abstract
To study the association between prescribed antipsychotic drugs and outcome in schizophrenia or schizoaffective disorder in the community.
Prospective cohort study using national central registers.
Community care in Finland.
Nationwide cohort of 2230 consecutive adults hospitalised in Finland for the first time because of schizophrenia or schizoaffective disorder, January 1995 to December 2001.
Rates of discontinuation of drugs (all causes), rates of rehospitalisation, and mortality associated with monotherapy with the 10 most commonly used antipsychotic drugs. Multivariate models and propensity score methods were used to adjust estimates of effectiveness.
Initial use of clozapine (adjusted relative risk 0.17, 95% confidence interval 0.10 to 0.29), perphenazine depot (0.24, 0.13 to 0.47), and olanzapine (0.35, 0.18 to 0.71) were associated with the lowest rates of discontinuation for any reason when compared with oral haloperidol. During an average follow-up of 3.6 years, 4640 cases of rehospitalisation were recorded. Current use of perphenazine depot (0.32, 0.22 to 0.49), olanzapine (0.54, 0.41 to 0.71), and clozapine (0.64, 0.48 to 0.85) were associated with the lowest risk of rehospitalisation. Use of haloperidol was associated with a poor outcome among women. Mortality was markedly raised in patients not taking antipsychotics (12.3, 6.0 to 24.1) and the risk of suicide was high (37.4, 5.1 to 276).
The effectiveness of first and second generation antipsychotics varies greatly in the community. Patients treated with perphenazine depot, clozapine, or olanzapine have a substantially lower risk of rehospitalisation or discontinuation (for any reason) of their initial treatment than do patients treated with haloperidol. Excess mortality is seen mostly in patients not using antipsychotic drugs.
Notes
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Comment In: BMJ. 2006 Jul 29;333(7561):212-316873834
Comment In: BMJ. 2006 Aug 12;333(7563):35316902223
PubMed ID
16825203 View in PubMed
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Mortality in persons with mental disorders is substantially overestimated using inpatient psychiatric diagnoses.

https://arctichealth.org/en/permalink/ahliterature112688
Source
J Psychiatr Res. 2013 Oct;47(10):1298-303
Publication Type
Article
Date
Oct-2013
Author
Casey Crump
John P A Ioannidis
Kristina Sundquist
Marilyn A Winkleby
Jan Sundquist
Author Affiliation
Stanford University, Department of Medicine, Palo Alto, CA 94304-1426, USA. kccrump@stanford.edu
Source
J Psychiatr Res. 2013 Oct;47(10):1298-303
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death
Female
Humans
Inpatients
Male
Mental Disorders - diagnosis - epidemiology - mortality
Middle Aged
Proportional Hazards Models
Psychiatric Status Rating Scales
Retrospective Studies
Suicide - statistics & numerical data
Sweden - epidemiology
Young Adult
Abstract
Mental disorders are associated with premature mortality, and the magnitudes of risk have commonly been estimated using hospital data. However, psychiatric patients who are hospitalized have more severe illness and do not adequately represent mental disorders in the general population. We conducted a national cohort study using outpatient and inpatient diagnoses for the entire Swedish adult population (N = 7,253,516) to examine the extent to which mortality risks are overestimated using inpatient diagnoses only. Outcomes were all-cause and suicide mortality during 8 years of follow-up (2001-2008). There were 377,339 (5.2%) persons with any inpatient psychiatric diagnosis, vs. 680,596 (9.4%) with any inpatient or outpatient diagnosis, hence 44.6% of diagnoses were missed using inpatient data only. When including and accounting for prevalent psychiatric cases, all-cause mortality risk among persons with any mental disorder was overestimated by 15.3% using only inpatient diagnoses (adjusted hazard ratio [aHR], 5.89; 95% CI, 5.85-5.92) vs. both inpatient and outpatient diagnoses (aHR, 5.11; 95% CI, 5.08-5.14). Suicide risk was overestimated by 18.5% (aHRs, 23.91 vs. 20.18), but this varied widely by specific disorders, from 4.4% for substance use to 49.1% for anxiety disorders. The sole use of inpatient diagnoses resulted in even greater overestimation of all-cause or suicide mortality risks when prevalent cases were unidentified (~20-30%) or excluded (~25-40%). However, different methods for handling prevalent cases resulted in only modest variation in risk estimates when using both inpatient and outpatient diagnoses. These findings have important implications for the interpretation of hospital-based studies and the design of future studies.
PubMed ID
23806577 View in PubMed
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Pediatric versus adult drug trials for conditions with high pediatric disease burden.

https://arctichealth.org/en/permalink/ahliterature122347
Source
Pediatrics. 2012 Aug;130(2):285-92
Publication Type
Article
Date
Aug-2012
Author
Florence T Bourgeois
Srinivas Murthy
Catia Pinto
Karen L Olson
John P A Ioannidis
Kenneth D Mandl
Author Affiliation
Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. florence.bourgeois@childrens.harvard.edu
Source
Pediatrics. 2012 Aug;130(2):285-92
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Child
Cost of Illness
Drug Industry - statistics & numerical data
Drugs, Investigational - adverse effects - therapeutic use
Evidence-Based Medicine - statistics & numerical data
Female
Humans
Male
Quality Indicators, Health Care - standards - statistics & numerical data
Randomized Controlled Trials as Topic - standards - statistics & numerical data
Research Support as Topic
Sweden
Treatment Outcome
Abstract
Optimal treatment decisions in children require sufficient evidence on the safety and efficacy of pharmaceuticals in pediatric patients. However, there is concern that not enough trials are conducted in children and that pediatric trials differ from those performed in adults. Our objective was to measure the prevalence of pediatric studies among clinical drug trials and compare trial characteristics and quality indicators between pediatric and adult drug trials.
For conditions representing a high burden of pediatric disease, we identified all drug trials registered in ClinicalTrials.gov with start dates between 2006 and 2011 and tracked the resulting publications. We measured the proportion of pediatric trials and subjects for each condition and compared pediatric and adult trial characteristics and quality indicators.
For the conditions selected, 59.9% of the disease burden was attributable to children, but only 12.0% (292/2440) of trials were pediatric (P
Notes
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PubMed ID
22826574 View in PubMed
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