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Aoyagi K, Liew JW, Farrar JT, Wang N, Carlesso L, Kumar D, Frey Law L, Lewis CE, Nevitt M, Neogi T. Does weight-bearing versus non-weight-bearing pain reflect different pain mechanisms in knee osteoarthritis?: the Multicenter Osteoarthritis Study (MOST). Osteoarthritis Cartilage 2022; 30:545-550. [PMID: 34801670 PMCID: PMC8940656 DOI: 10.1016/j.joca.2021.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is predominantly characterized by pain with weight-bearing activities. Pain at rest also occurs but the mechanisms for this are not clear. We evaluated the relations of nociceptive signal alterations to weight-bearing and non-weight-bearing pain in knee OA. DESIGN We used data from a NIH-funded longitudinal cohort of older adults with or at risk of knee OA. We evaluated quantitative sensory testing (QST) measures (pressure pain threshold (PPT) at patellae and the wrist; mechanical temporal summation (TS); conditioned pain modulation (CPM)). Each WOMAC pain question was dichotomized as having at least moderate pain, and we further categorized them as weight-bearing pain and non-weight-bearing pain. We evaluated the relation of QST measures to each pain outcome using logistic regression, adjusting for potential confounders. RESULTS 2,749 participants (5,479 knees) were included (mean age 64 ± 11, 57% female). Each SD unit decrease in patellar PPT was associated with greater odds of both weight-bearing pain (OR 1.51 (95% CI 1.27, 1.79)) and non-weight-bearing pain (OR 1.46 (1.20-1.77)), while wrist PPT was associated with greater odds of weight-bearing pain (OR 1.27 (1.15, 1.39)) but only with pain during sitting/lying (OR 1.20 (1.01, 1.43)). TS was significantly associated with greater odds of pain with walking and stairs (OR 1.11 (1.01, 1.23), 1.11 (1.03, 1.20), respectively). CPM was not associated with any pain outcomes. CONCLUSIONS Our findings challenge the hypothesis that non-weight-bearing pain may reflect greater pain sensitization and/or inefficient CPM than weight-bearing pain in knee OA, suggesting other mechanisms are likely responsible.
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Affiliation(s)
- K Aoyagi
- Boston University School of Medicine, Boston, MA, USA.
| | - J W Liew
- Boston University School of Medicine, Boston, MA, USA.
| | - J T Farrar
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - N Wang
- Boston University School of Public Health, Boston, MA, USA.
| | | | - D Kumar
- Boston University School of Medicine, Boston, MA, USA.
| | | | - C E Lewis
- University of Alabama, Birmingham, AL, USA.
| | - M Nevitt
- University of California San Francisco, San Francisco, CA, USA.
| | - T Neogi
- Boston University School of Medicine, Boston, MA, USA.
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Hersh EV, Moore PA, Grosser T, Polomano RC, Farrar JT, Saraghi M, Juska SA, Mitchell CH, Theken KN. Nonsteroidal Anti-Inflammatory Drugs and Opioids in Postsurgical Dental Pain. J Dent Res 2020; 99:777-786. [PMID: 32286125 DOI: 10.1177/0022034520914254] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Postsurgical dental pain is mainly driven by inflammation, particularly through the generation of prostaglandins via the cyclooxygenase system. Thus, it is no surprise that numerous randomized placebo-controlled trials studying acute pain following the surgical extraction of impacted third molars have demonstrated the remarkable efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, etodolac, diclofenac, and ketorolac in this prototypic condition of acute inflammatory pain. Combining an optimal dose of an NSAID with an appropriate dose of acetaminophen appears to further enhance analgesic efficacy and potentially reduce the need for opioids. In addition to being on average inferior to NSAIDs as analgesics in postsurgical dental pain, opioids produce a higher incidence of side effects in dental outpatients, including dizziness, drowsiness, psychomotor impairment, nausea/vomiting, and constipation. Unused opioids are also subject to misuse and diversion, and they may cause addiction. Despite these risks, some dental surgical outpatients may benefit from a 1- or 2-d course of opioids added to their NSAID regimen. NSAID use may carry significant risks in certain patient populations, in which a short course of an acetaminophen/opioid combination may provide a more favorable benefit versus risk ratio than an NSAID regimen.
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Affiliation(s)
- E V Hersh
- Department of Oral Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - P A Moore
- Department of Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - T Grosser
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - R C Polomano
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - J T Farrar
- Departments of Epidemiology/Biostatistics and Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - M Saraghi
- Department of Dentistry/Oral and Maxillofacial Surgery, Jacobi Medical Center, Bronx, New York City, NY, USA
| | - S A Juska
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - C H Mitchell
- Department of Basic and Translational Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - K N Theken
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Affiliation(s)
- JT Farrar
- Department of Epidemiology; Hospital of the University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
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Little RJ, Cohen ML, Dickersin K, Emerson SS, Farrar JT, Neaton JD, Shih W, Siegel JP, Stern H. The design and conduct of clinical trials to limit missing data. Stat Med 2012; 31:3433-43. [PMID: 22829439 PMCID: PMC5944851 DOI: 10.1002/sim.5519] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 05/25/2012] [Accepted: 06/14/2012] [Indexed: 11/06/2022]
Abstract
This article summarizes recommendations on the design and conduct of clinical trials of a National Research Council study on missing data in clinical trials. Key findings of the study are that (a) substantial missing data is a serious problem that undermines the scientific credibility of causal conclusions from clinical trials; (b) the assumption that analysis methods can compensate for substantial missing data is not justified; hence (c) clinical trial design, including the choice of key causal estimands, the target population, and the length of the study, should include limiting missing data as one of its goals; (d) missing-data procedures should be discussed explicitly in the clinical trial protocol; (e) clinical trial conduct should take steps to limit the extent of missing data; (f) there is no universal method for handling missing data in the analysis of clinical trials - methods should be justified on the plausibility of the underlying scientific assumptions; and (g) when alternative assumptions are plausible, sensitivity analysis should be conducted to assess robustness of findings to these alternatives. This article focuses on the panel's recommendations on the design and conduct of clinical trials to limit missing data. A companion paper addresses the panel's findings on analysis methods.
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Affiliation(s)
- R J Little
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA.
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Dworkin RH, Peirce-Sandner S, Turk DC, McDermott MP, Gibofsky A, Simon LS, Farrar JT, Katz NP. Outcome measures in placebo-controlled trials of osteoarthritis: responsiveness to treatment effects in the REPORT database. Osteoarthritis Cartilage 2011; 19:483-92. [PMID: 21396467 DOI: 10.1016/j.joca.2011.02.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 02/11/2011] [Accepted: 02/14/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment response in randomized clinical trials (RCT) of osteoarthritis (OA) has been assessed by multiple primary and secondary outcomes, including pain, function, patient and clinician global measures of status and response to treatment, and various composite and responder measures. Identifying outcome measures with greater responsiveness to treatment is important to increase the assay sensitivity of RCTs. OBJECTIVE To assess and compare the responsiveness of different outcome measures used in placebo-controlled RCTs of OA. SEARCH STRATEGY The Resource for Evaluating Procedures and Outcomes of Randomized Trials database includes placebo-controlled clinical trials of pharmacologic treatments (oral, topical, or transdermal) for OA identified from a systematic literature search of RCTs published or publicly available before August 5, 2009, which was conducted using PubMed, the Cochrane collaboration, publicly-available websites, and reference lists of retrieved publications. DATA COLLECTION AND ANALYSIS Data collected included: (1) pain assessed with single-item ratings and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale; (2) patient and clinician global measures of status, improvement, and treatment response; (3) function assessed by the WOMAC function subscale; (4) stiffness assessed by the WOMAC stiffness subscale; and (5) the WOMAC and Lequesne Algofunctional Index composite outcomes. Measures were grouped according to the total number of response categories (i.e., <10 categories or ≥10 categories). The treatment effect (difference in mean change from baseline between the placebo and active therapy arms) and standardized effect size (SES) were estimated for each measure in a meta-analysis using a random effects model. RESULTS There were 125 RCTs with data to compute the treatment effect for at least one measure; the majority evaluated non-steroidal anti-inflammatory drugs (NSAIDs), followed by opioids, glucosamine and/or chondroitin, and acetaminophen. In general, the patient-reported pain outcome measures had comparable responsiveness to treatment as shown by the estimates of treatment effects and SES. Treatment effects and SESs were generally higher for patient-reported global measures compared with clinician-rated global measures but generally similar for the WOMAC and Lequesne composite measures. CONCLUSIONS Comparing different outcome measures using meta-analysis and selecting those that have the greatest ability to identify efficacious treatments may increase the efficiency of clinical trials of treatments for OA. Improvements in the quality of the reporting of clinical trial results are needed to facilitate meta-analyses to evaluate the responsiveness of outcome measures and to also address other issues related to assay sensitivity.
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Affiliation(s)
- R H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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Mao JJ, Stricker CT, Bruner DW, Farrar JT, Bowman MA, Xie SX, Wolf J, DeMichele A. Onset and risk factors for aromatase inhibitor-related arthralgia in breast cancer survivors. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #1120
Purpose: Arthralgia is a common clinical phenomenon seen in postmenopausal women receiving aromatase inhibitors (AI). This study aims to evaluate the perceived onset, prevalence, and risk factors for AI-related arthralgia.
 Patients and Methods: We performed a cross-sectional analysis of a cohort of postmenopausal women with stage I-III breast cancer receiving adjuvant AI therapy at an outpatient breast oncology clinic at a large university hospital. Patient-reported symptoms and attribution of AI as a cause of arthralgia were main outcomes. Multivariate logistic regression analyses were performed to assess risk factor(s).
 Results: 300 patients have been enrolled, with a mean age of 61 +/- 10 years, 84% White, and 38(13%) Black. A total of 173 (58%) reported AI-related arhtralgia during the course of AI treatment and 139 (47%) attributed AI as a cause of their current arthralgia. While 103 (34%) reported having “arthritis” prior to AI initiation, 13% reported onset of symptoms within 1 month of medication initiation, 42% between 1-3 months, 27% between 3-6 months, 12% between 6-12 months, and 20% after 12 months. In a multivariate logistic regression model, time since last menstrual period (LMP) was the only significant predictor of reporting AI-related arthralgia; age, race, employment status, chemotherapy, and weight gain since breast cancer were not associated with the clinical syndrome. Controlling for these covariates, those who had LMP within 5 years had the highest probability of reporting AI-related arthralgia (73%), while those with LMP beyond 10 years had the lowest (35%), p=0.017. Prior arthritis was unrelated to AI-related arthralgia either in univariate or multivariate analyses.
 Conclusions: AI-related arthralgia is common and appears to be inversely related to the length of time since cessation of menstrual function. These findings suggest that estrogen withdrawal may compound these symptoms and may play a role in the mechanism of this disorder.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1120.
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Affiliation(s)
- JJ Mao
- 1 Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - CT Stricker
- 2 Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - DW Bruner
- 2 Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - JT Farrar
- 3 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - MA Bowman
- 1 Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - SX Xie
- 3 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - J Wolf
- 1 Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - A DeMichele
- 2 Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Mao JJ, Stricker CT, Farrar JT, Xie SX, Bowman MA, Bruner DW, Pucci D, Han X, DeMichele A. Feasibility trial of electro-acupuncture for aromatase inhibitor related arthralgia in breast cancer survivors. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #3105
Background: Arthralgia affects postmenopausal women receiving aromatase inhibitors (AI) for breast cancer. Given the existing evidence for electro-acupuncture (EA) for treatment of osteoarthritis in the general population, this study aims to establish the feasibility of studying EA for treating AI-related arthralgia.
 Patients and Methods: Postmenopausal women with stage I-III breast cancer with joint pain related to AIs were enrolled in a pilot single arm trial of acupuncture. Acupuncture was provided twice a week for 2 weeks followed by 6 weekly treatments (total of 10 treatments over 8 weeks). Manualized protocol was based on Chinese medicine diagnosis of “Bi” syndrome with eletro-stimulation of needles around the painful joint(s). Pain severity of the modified Brief Pain Inventory was used as the primary outcome. Joint stiffness and Joint interference were secondary outcomes. Patient Global Impression of Change (PGIC) was used to assess clinical relevance. Fatigue and anxiety were also evaluated. Paired-t tests were used for analysis.
 Results: Twelve women were enrolled and all provided data for analysis. From baseline to the end of intervention, patients reported improvement in pain severity (5.3 to 1.9), stiffness (6.9 to 2.4), and joint symptom interference (4.7 to 0.8), all P<0.001; 11/12 reported joint symptoms “very much improved” based on PGIC . Subjects also reported significant decrease in fatigue (4.4 to 1.9, p=0.005) and anxiety (7.1 to 4.8, p=0.01). One subject withdrew from interventions due to an adverse event (herpes zoster) thought to be unrelated to acupuncture. Two subjects reported grade 1 self-limiting pain associated with acupuncture. No infection or development or worsening of lymphedema was observed.
 Conclusion: EA is a potentially safe and effective treatment for AI-related arthralgia; thus, a randomized controlled trial is warranted to establish the short term and long term efficacy and safety of EA in breast cancer survivors.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3105.
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Affiliation(s)
- JJ Mao
- 1 Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - CT Stricker
- 2 Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - JT Farrar
- 3 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - SX Xie
- 3 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - MA Bowman
- 1 Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - DW Bruner
- 2 Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - D Pucci
- 2 Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - X Han
- 3 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - A DeMichele
- 2 Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Ravina B, Putt M, Siderowf A, Farrar JT, Gillespie M, Crawley A, Fernandez HH, Trieschmann MM, Reichwein S, Simuni T. Donepezil for dementia in Parkinson's disease: a randomised, double blind, placebo controlled, crossover study. J Neurol Neurosurg Psychiatry 2005; 76:934-9. [PMID: 15965198 PMCID: PMC1739697 DOI: 10.1136/jnnp.2004.050682] [Citation(s) in RCA: 204] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the safety and efficacy of a cholinesterase inhibitor, donepezil hydrochloride, for the treatment of dementia in Parkinson's disease (PD). METHODS This was a randomised double blind, placebo controlled, crossover study in 22 subjects with PD and dementia. Participants were randomised to receive either donepezil followed by identical placebo, or placebo followed by donepezil. Donepezil was administered at 5-10 mg/day. Treatment periods were 10 weeks with a washout period of 6 weeks between the two periods. The primary outcome measure was the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAScog). RESULTS Donepezil was well tolerated and most adverse events were mild. There was no worsening of PD symptoms as measured by the total or motor sections of the Unified Parkinson's Disease Rating Scale.There was a 1.9 point trend toward better scores on the ADAScog on treatment compared with placebo that was not statistically significant. The secondary cognitive measures showed a statistically significant 2 point benefit on the Mini Mental Status Examination and no change on the Mattis Dementia Rating Scale (MDRS). The Clinical Global Impression of Change (CGI) showed a significant 0.37 point improvement on donepezil. No improvement was observed on the MDRS or the Brief Psychiatric Rating Scale. Carryover between treatment periods was observed but was not statistically significant. CONCLUSIONS Donepezil was well tolerated and did not worsen PD. There may be a modest benefit on aspects of cognitive function. The possible clinical benefit measured by CGI was reflected in only one of the cognitive scales used in this study.
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Affiliation(s)
- B Ravina
- NINDS, Neuroscience Center Rm 2225, 6001 Executive Blvd, Rockville, MD 20892-9257, USA.
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Mikuls TR, Farrar JT, Bilker WB, Fernandes S, Saag KG. Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD). Rheumatology (Oxford) 2005; 44:1038-42. [PMID: 15870145 DOI: 10.1093/rheumatology/keh679] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES : To examine adherence to validated quality indicators assessing the quality of allopurinol use in the treatment of gout and asymptomatic hyperuricaemia. METHODS We determined physician adherence in the UK General Practice Research Database (GPRD) to three validated quality indicators developed to assess the quality of allopurinol prescribing practices. These indicators were developed to assess: (i) dosing in renal impairment; (ii) concomitant use with azathioprine or 6-mercaptopurine; and (iii) use in the treatment of asymptomatic hyperuricaemia. We also examined the association of patient-level factors (sociodemographics, comorbidity, follow-up duration and concomitant medicine use) with the treatment of asymptomatic hyperuricaemia using multivariable logistic regression. RESULTS Of the 63 105 gout patients, 185 (0.3%) were eligible for Quality Indicator 1 and 52 (0.1%) were eligible for Quality Indicator 2. There were an additional 471 patients with asymptomatic hyperuricaemia eligible for Quality Indicator 3. Rates of practice deviation for the three individual quality indicators ranged from 25 to 57%. Male sex, older age, a history of chronic renal failure, and a greater number of concomitant medications were significantly associated with increased odds of inappropriate treatment for asymptomatic hyperuricaemia. Hypertension and diuretic use were associated with lower odds of this practice. CONCLUSIONS One-quarter to one-half of all patients eligible for at least one of the validated quality of care indicators were subject to possible allopurinol prescribing error, suggesting that inappropriate prescribing practices are widespread with this agent. Future interventions aimed at reducing inappropriate allopurinol use are needed and should be targeted towards high-risk groups, including older men and those receiving multiple concomitant medications.
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Affiliation(s)
- T R Mikuls
- Department of Medicine, Division of Clinical Immunology and Rheumatology, 510 20th Street South, FOT 8th Floor, Birmingham, AL 35294, USA
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Mikuls TR, Farrar JT, Bilker WB, Fernandes S, Schumacher HR, Saag KG. Gout epidemiology: results from the UK General Practice Research Database, 1990-1999. Ann Rheum Dis 2005; 64:267-72. [PMID: 15647434 PMCID: PMC1755343 DOI: 10.1136/ard.2004.024091] [Citation(s) in RCA: 325] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the epidemiology of gout and gout treatment in the United Kingdom using a large national practice based population. METHODS Data from the UK General Practice Research Database from 1990 to 1999 were examined. Physician diagnoses and drug codes were used, and trends in gout incidence and treatment examined. Additionally, disease prevalence for the year 1999 was assessed. To examine the association of gout with comorbid disease, the prevalence of select health conditions and drug use was compared with the corresponding prevalences seen in osteoarthritis, adjusting for both age and sex. RESULTS From 1 January 1990 to 31 December 1999 overall gout incidence remained relatively stable, ranging from a low of 11.9 cases (95% confidence interval (CI) 11.5 to 12.3) in 1991 to a high of 18.0 cases (95% CI 17.6 to 18.4) per 10 000 patient-years in 1994. Gout prevalence in 1999 was 1.4% with rates approaching 7% in men over the age of 65. Drugs used for the treatment of gout remained constant in prevalent cases with the exception of a significant decline in non-steroidal anti-inflammatory drug use over the 10 year follow up. Compared with patients with osteoarthritis, patients with gout were significantly more likely to have cardiovascular disease, hypertension, diabetes, and chronic renal failure, and were more likely to have used diuretics or ciclosporin, or both. CONCLUSION Although gout is common in the UK, particularly among older men, the incidence of the disease seems to have remained stable during the 1990s.
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Affiliation(s)
- T R Mikuls
- Department of Medicine, University of Nebraska Medical Center and Omaha VA Medical Center, Omaha, NE, USA
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Abstract
OBJECTIVE To construct a clinical prediction model for the early identification of children destined to develop refractory temporal lobe epilepsy (TLE) 2 years after epilepsy onset. METHODS Patients with TLE between 1 and 18 years old seen in the Division of Neurology at Children's Hospital of Philadelphia during 1999 were identified through billing records and chart review. Data were abstracted independently on 5 candidate predictor variables for refractory TLE and on seizure frequency outcome at 2 years after epilepsy onset. RESULTS One hundred twenty patients met inclusion criteria and had at least 2 years of follow-up. Forty-five of 120 patients (37.5%) had refractory TLE at 2 years after onset, and 75 of 120 (62.5%) were seizure free. Three significant predictors of refractory TLE were found on bivariate analysis: an early risk factor for epilepsy (risk ratio = 3.5 [95% CI 2.2, 5.6]), temporal lobe abnormality on MRI scan (2.9 [95% CI 1.9, 4.6]), and failure of the first antiepileptic drug (AED) trial (16.5 [95% CI 6.3, 43.9]). Logistic regression indicated that the best model to predict refractory TLE contained only the variable "failure of first AED trial," with a positive predictive value of 0.89 (95% CI 0.76, 0.96) and negative predictive value of 0.95 (95% CI 0.87, 0.99) to predict "refractory TLE" at 2 years. CONCLUSIONS Failure of first AED trial accurately predicts refractory TLE at 2 years after onset, based on retrospective cohort data in children. If verified prospectively and with longer follow-up, this finding should support earlier consideration of surgical options.
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Affiliation(s)
- D J Dlugos
- Pediatric Regional Epilepsy Program, Division of Neurology, Children's Hospital of Philadelphia, PA 19014, USA.
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Farrar JT, Portenoy RK. Neuropathic cancer pain: the role of adjuvant analgesics. Oncology (Williston Park) 2001; 15:1435-42, 1445; discussion 1445, 1450-3. [PMID: 11758872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Neuropathic pain may be defined as pain related to abnormal somatosensory processing in either the peripheral or central nervous system. This pathophysiologic label is typically applied when the painful symptom is associated with an overt injury to neural structures, is part of a recognized syndrome, or has a dysesthetic quality (usually burning, shooting, or electrical). Most neural injury does not lead to clinically important neuropathic pain, but sometimes even a small degree of tissue injury can precipitate severe pain. In the cancer population, neuropathic pain is often related to compression, direct neoplastic invasion of the peripheral nerves or spinal cord, or to a neuropathy caused by chemotherapy. To manage neuropathic pain in this population, nonopioid adjuvant drugs that are neuroactive or neuromodulatory are often needed to complement opioid therapy. The primary adjuvant analgesics are anticonvulsant and antidepressant medications, but a wide variety of other drugs are also used. To optimize analgesic therapy in patients with neuropathic pain, both opioid and adjuvant analgesics must be used effectively.
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Affiliation(s)
- J T Farrar
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia 19104-6021, USA.
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Cepeda MS, Farrar JT, Roa JH, Boston R, Meng QC, Ruiz F, Carr DB, Strom BL. Ethnicity influences morphine pharmacokinetics and pharmacodynamics. Clin Pharmacol Ther 2001; 70:351-61. [PMID: 11673751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Our objective was to evaluate ethnic differences in response to morphine and to determine whether any detectable differences were pharmacokinetically based. METHODS This cohort study was carried out in a teaching hospital. Sixty-six young, healthy male subjects from 3 ethnic groups (Caucasians, native Indians, and Latinos; n = 22 in each group) consented to participate. All subjects received an intravenous morphine bolus of 0.08 mg/kg followed by 0.002 mg/kg. min infused for 30 minutes. Respiratory response was evaluated with the carbon dioxide rebreathing method before and at 25, 95, 180, and 360 minutes after morphine administration. Vital signs and opioid side effects were recorded, and serial blood samples were analyzed for morphine, morphine-3-glucuronide, and morphine-6-glucuronide (M6G). RESULTS All 3 groups had suppression of the ventilatory response to hypercapnia, but the degree of blunting of the ventilatory response differed among groups. Compared with Caucasians, native Indians had an additional 18% reduction in ventilatory response after morphine administration (95% confidence interval, -35% to -2%). The incidence of side effects was similar in all groups (P =.18). Caucasians had higher plasma levels of M6G than did native Indians or Latinos. M6G areas under 6-hour concentration-versus-time curve were as follows: Caucasians, 12,065 +/- 4354; native Indians, 8464 +/- 4809; and Latinos, 9156 +/- 3764 ng. min/mL (P =.03). CONCLUSIONS Ethnicity influences the response to morphine. Native Indians are more susceptible to morphine depression of the ventilatory response than Caucasians, despite the higher serum M6G levels in Caucasians.
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Affiliation(s)
- M S Cepeda
- Department of Anesthesia, Javeriana University, Bogota, Colombia
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Abstract
OBJECTIVE The goal of this analysis is a better understanding of the issues involved in establishing the amount of change in pain that must be reported by subjects, participating in clinical trials and using standard pain scales, to indicate a clinically important difference. DESIGN A review of the literature and a discussion of relevant concepts are presented. The focus is on outcome measures of pain commonly used in the studies described, including pain intensity, pain relief, global assessment of the medication effect, and requirement for an extra dose of rescue medication to treat a pain episode. The standard analysis statistics used to summarize the data are the central tendency of the groups being compared (i.e., mean, median, or mode), and the proportion of subjects that achieve one or more specific levels of benefit. RESULTS The analysis of the proportion of responders in the groups being compared allows for a more easily understandable clinical importance of the results. CONCLUSIONS An analysis of the proportion of responders is a clinically relevant analysis for many pain clinical trials and should be presented for one or more levels of response as appropriate. This will allow the readers to more easily interpret the results and apply them to clinical practice.
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Affiliation(s)
- J T Farrar
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
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Cappell MS, Waye JD, Farrar JT, Sleisenger MH. Fifty landmark discoveries in gastroenterology during the past 50 years. A brief history of modern gastroenterology at the millennium: Part II. Gastrointestinal motility, nutrition, and diseases of the lower gastrointestinal tract, liver, and pancreas. Gastroenterol Clin North Am 2000; 29:513-50, viii. [PMID: 10836192 DOI: 10.1016/s0889-8553(05)70125-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
During the last half century, many outstanding discoveries have revolutionized the clinical practice and science of gastroenterology. Although the scientific results are widely disseminated, the discoverers have received inadequate recognition and the history of their discoveries is largely unstudied and unknown. At the millennium, a committee selected 50 landmark discoveries in gastroenterology during the past 50 years. A brief history of each landmark discovery is presented. Part I was presented in the previous issue of Gastroenterology Clinics of North America. Part II presents landmark discoveries in gastrointerintal (GI) motility, clinical trials, nutrition, and diseases of the lower GI tract, liver, biliary tree, and pancreas.
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Affiliation(s)
- M S Cappell
- Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York, USA
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Farrar JT. Returning control of health care to the patient-physician nexus. Dig Dis Sci 2000; 45:840-4. [PMID: 10795743 DOI: 10.1023/a:1005596202158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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18
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Cappell MS, Waye JD, Farrar JT, Sleisenger MH. Fifty landmark discoveries in gastroenterology during the past 50 years. A brief history of modern gastroenterology at the millennium: Part I. Gastrointestinal procedures and upper gastrointestinal disorders. Gastroenterol Clin North Am 2000; 29:223-63, viii. [PMID: 10752023 DOI: 10.1016/s0889-8553(05)70113-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
During the last half century, many outstanding discoverers have revolutionized the clinical practice and science of gastroenterology. Whereas the scientific results are widely disseminated, the discoverers have received inadequate recognition, and the history of their discoveries is poorly known. At the millennium, a committee selected the 50 landmark discoveries in gastroenterology during the past 50 years. A brief history of each landmark discovery is presented. Part I presents the landmark discoveries in gastrointestinal (GI) procedures and in upper GI disorders. Part II of this presentation, which covers landmark discoveries in other areas of gastroenterology, will publish in Part II of the volume on High Risk Gastrointestinal Bleeding.
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Affiliation(s)
- M S Cappell
- Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York, USA
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Litwin MS, McNaughton-Collins M, Fowler FJ, Nickel JC, Calhoun EA, Pontari MA, Alexander RB, Farrar JT, O'Leary MP. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol 1999; 162:369-75. [PMID: 10411041 DOI: 10.1016/s0022-5347(05)68562-x] [Citation(s) in RCA: 586] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Chronic abacterial prostatitis is a syndrome characterized by pelvic pain and voiding symptoms, which is poorly defined, poorly understood, poorly treated and bothersome. Research and clinical efforts to help men with this syndrome have been hampered by the absence of a widely accepted, reliable and valid instrument to measure symptoms and quality of life impact. We developed a psychometrically valid index of symptoms and quality of life impact for men with chronic prostatitis. MATERIALS AND METHODS We conducted a structured literature review of previous work to provide a foundation for the new instrument. We then conducted a series of focus groups comprising chronic prostatitis patients at 4 centers in North America, in which we identified the most important symptoms and effects of the condition. The results were used to create an initial draft of 55 questions that were used for formal cognitive testing on chronic prostatitis patients at the same centers. After expert panel review formal validation testing of a revised 21-item draft was performed in a diverse group of chronic prostatitis patients and 2 control groups of benign prostatic hyperplasia patients and healthy men. Based on this validation study, the index was finalized. RESULTS Analysis yielded an index of 9 items that address 3 different aspects of the chronic prostatitis experience. The primary component was pain, which we captured in 4 items focused on location, severity and frequency. Urinary function, another important component of symptoms, was captured in 2 items (1 irritative and 1 obstructive). Quality of life impact was captured with 3 items about the effect of symptoms on daily activities. The 9 items had high test-retest reliability (r = 0.83 to 0.93) and internal consistency (alpha = 0.86 to 0.91). All but the urinary items discriminated well between men with and without chronic prostatitis. CONCLUSIONS The National Institutes of Health chronic prostatitis symptom index provides a valid outcome measure for men with chronic prostatitis. The index is psychometrically robust, easily self-administered and highly discriminative. It was formally developed and psychometrically validated, and may be useful in clinical practice as well as research protocols.
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Affiliation(s)
- M S Litwin
- Department of Urology, University of California, Los Angeles, USA
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Farrar JT, Cleary J, Rauck R, Busch M, Nordbrock E. Oral transmucosal fentanyl citrate: randomized, double-blinded, placebo-controlled trial for treatment of breakthrough pain in cancer patients. J Natl Cancer Inst 1998; 90:611-6. [PMID: 9554444 DOI: 10.1093/jnci/90.8.611] [Citation(s) in RCA: 170] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with cancer frequently experience episodes of acute pain, i.e., breakthrough pain, superimposed on their chronic pain. Breakthrough pain is usually treated with short-acting oral opioids, most of which provide some relief after 15-20 minutes, with peak effects after 30-45 minutes. Oral transmucosal fentanyl citrate (OTFC), a unique formulation of the opioid fentanyl, has been shown to provide meaningful pain relief within 5 minutes in patients following surgery. We conducted a multicenter, randomized, double-blinded, placebo-controlled trial of OTFC for cancer-related breakthrough pain. METHODS Patients who were 18 years of age or older, receiving the equivalent of at least 60 mg oral morphine or at least 50 microg transdermal fentanyl per day for chronic cancer-related pain, and experiencing at least one episode of breakthrough pain per day were studied. After titration to an effective OTFC dose, subjects were given 10 randomly ordered treatment units (seven OTFC units and three placebo units) in the form of identical lozenges. If acceptable pain relief was not achieved within 30 minutes, subjects were instructed to take their previous breakthrough pain medication (i.e., rescue medication). Pain intensity, pain relief, and use of rescue medication were evaluated at 15-minute intervals over a 60-minute period. RESULTS Eighty-nine of 92 patients who received the randomized treatment were assessable (i.e., treated with at least one unit of OTFC and one unit of placebo). OTFC produced significantly larger changes in pain intensity and better pain relief than placebo at all time points (two-sided P<.0001). Episodes treated with placebo required the use of rescue medication more often than episodes treated with OTFC (34% versus 15%; relative risk = 2.27; 95% confidence interval = 1.51-3.26; two-sided P<.0001). CONCLUSIONS OTFC appears effective in the treatment of cancer-related breakthrough pain.
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Affiliation(s)
- J T Farrar
- University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
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Strom BL, Schinnar R, Bilker WB, Feldman H, Farrar JT, Carson JL. Gastrointestinal tract bleeding associated with naproxen sodium vs ibuprofen. Arch Intern Med 1997; 157:2626-31. [PMID: 9531232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The risk of gastrointestinal tract bleeding requiring hospitalization associated with naproxen sodium was compared with that with ibuprofen, using a prescription database to approximate over-the-counter dosing. OBJECTIVE To evaluate the safety of naproxen sodium. METHODS A claims database containing Ohio Medicaid data from January 1986 through February 1993 and Michigan Medicaid data from April 1983 through July 1993 was used to compare 101,318 patients dispensed naproxen sodium with 277,601 patients dispensed ibuprofen. Using a case-cohort design, all 59 patients from the full cohort who had been hospitalized with upper gastrointestinal tract bleeding (UGIB) that developed within 14 days after the first prescription for the study drugs were compared with a subcohort made up of a 10% random sample of subjects selected from the combined drug cohorts. RESULTS The incidence of UGIB occurring within 14 days after the first prescription in the naproxen sodium cohort was 26 (0.026%) of 101,318 (95% confidence interval [CI], 0.017%-0.038%), compared with 33 (0.012%) of 277,601 patients (95% CI, 0.008%-0.017%) in the ibuprofen cohort. Overall, the use of naproxen sodium vs ibuprofen was associated with an adjusted relative risk of 2.0 (95% CI, 1.1-3.8). Among people with multiple prescriptions, the crude relative risk for those receiving therapy in a dose typical of over-the-counter use was 4.1 (95% CI, 1.2-13.8). CONCLUSIONS The overall incidence of UGIB is low with both drugs. There is little additional absolute risk posed by the use of low-dose naproxen sodium, compared with low-dose ibuprofen, despite an increased relative risk. However, given the widespread use of these drugs, a substantial number of additional cases of UGIB could result from use of naproxen sodium. This increased risk should be considered, especially for patients whose baseline risk of UGIB is elevated.
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Affiliation(s)
- B L Strom
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia 19104-6021, USA
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Farrar JT. American Gastroenterological Association. The centennial year: the development of important ideas during the last 100 years. Gastroenterology 1997; 112:287. [PMID: 8978370 DOI: 10.1016/s0016-5085(97)70245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Liu GT, Volpe NJ, Schatz NJ, Galetta SL, Farrar JT, Raps EC. Severe sudden visual loss caused by pseudotumor cerebri and lumboperitoneal shunt failure. Am J Ophthalmol 1996; 122:129-31. [PMID: 8659591 DOI: 10.1016/s0002-9394(14)71981-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Severe vistral acuity loss associated with pseudotumor cerebri is usually caused by chronic optic disk edema or a retinal abnormality. METHODS We treated a women, with known pseudotumor cerebri treated with a lumboperitoneal shunt, who developed acute pallied optic disk swelling and visual acuity of R.E.: no light perception and L.E.: 20/70 in association with lumboperitoneal shunt failure. There were no contributory retinal lesions. RESULTS The patient underwent optic nerve sheath fenestration and lumboperitoneal shunt revision. Visual acuity improved to 20/20 in both eyes. The papilledema resolved. CONCLUSION The severe sudden visual loss was attributed to axoplasmic stasis and optic nerve ischemia associated with a sudden rise in intracranial pressure.
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Affiliation(s)
- G T Liu
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
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Sekeres MA, Farrar JT, Strom BL. The J-curve interpreted. An alternative explanation of the results. J Gen Intern Med 1996; 11:379-80. [PMID: 8803748 DOI: 10.1007/bf02600053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Farrar JT, Strom BL. Drug utilization evaluation: is big brother watching? J Gen Intern Med 1995; 10:530-1. [PMID: 8523161 DOI: 10.1007/bf02602414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Affiliation(s)
- R D Shamburek
- Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond
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Farrar JT. Medicine needs a code of ethics. Mil Med 1986; 151:130. [PMID: 3083293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Farrar JT. Support for ideas: the last 1000 years and the next ten. The Presidential Address. Gastroenterology 1983; 85:517-21. [PMID: 6873600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Farrar JT. The effects of drugs on intestinal motility. Clin Gastroenterol 1982; 11:673-81. [PMID: 7140003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Tasaka K, Williams L, Farrar JT. Characteristics of intraluminal pressure sensing balloons of different materials. Pflugers Arch 1979; 379:303-5. [PMID: 572543 DOI: 10.1007/bf00581438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The physical properties of the balloons made of some polymeric substances were studied. The polyurethanes provided high frequency characteristics but air-leaking disqualified except ECD-651 which was most satisfactory: low permeability and ease of fabrication. Saran was proper but troublesome in making the balloon. Polypropylene and polyethylene, available in film, required heat sealing, which resulted in deformity and low frequency characteristics.
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Farrar JT. Franz Joseph Ingelfinger. Master of maieutics. Am J Dig Dis 1977; 22:387-8. [PMID: 324266 DOI: 10.1007/bf01072199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Farrar JT. The obligations of a professional. Am J Dig Dis 1977; 22:69-70. [PMID: 402069 DOI: 10.1007/bf01077400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Intraluminal pressure recordings have been performed in 14 unanesthetized dogs via a Mann-Bollman fistula by means of an air-filled balloon catheter system and a water-filled catheter system. The dynamic response is adequate for studying intraluminal pressures of the small intestine. Resting pressures in the proximal, middle and distal jejunum averaged approximately 6 mm Hg above atmosphere and no appreciable differences were noted between the different areas. The contraction time of simple, monophasic waves was fairly constant (approximately 1.0 s in duration) and usually unrelated to amplitude of the wave. Propulsion of intraluminal contents occurred in the absence of complex (type III) waves. A pressure wave in a proximal segment of jejunum was temporally related to a wave occurring 5 cm distally. The mean intervals between the proximal and distal contractions were: 0.42 s in the proximal jejunum; 0.74 s in the middle jejunum; 1.56 s in the distal jejunum; 2.79 s in the ileum. These time lags have a log normal distribution. The length of the physiologic segment in the jejunum of the dog varied from 1.0-8.0 cm and was usually 2-4 cm.
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Yau WM, Makhlouf GM, Edwards LE, Farrar JT. The action of cholecystokinin and related peptides on guinea pig small intestine. Can J Physiol Pharmacol 1974; 52:289-303. [PMID: 4838190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Yau WM, Makhlouf GM, Edwards LE, Farrar JT. The Action of Cholecystokinin and Related Peptides on Guinea Pig Small Intestine. Can J Physiol Pharmacol 1974. [DOI: 10.1139/y74-041] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The mode of action of cholecystokinin (CCK), an octapeptide fragment of CCK, caerulein, and pentagastrin on isolated guinea pig ileal muscle was investigated and their relative potencies determined. On a molar basis, octapeptide-CCK and caerulein were about twice as potent as CCK, whereas pentagastrin and Urecholine were respectively 23 and 46 times less potent. Scopolamine (6.84 × 10−4 M) inhibited the response to all four peptides relatively less than the response to Urecholine. Tetrodotoxin (0.1 μg/ml) inhibited the response to all peptides by 91%. It was concluded that the effect of these peptides on ileal muscle was largely mediated by cholinergic mechanisms. It could not be ascertained, however, whether the effect resulted solely from release of acetylcholine by nerve endings or from the participation of acetylcholine mainly as a synergist of the peptides' action on smooth muscle fibers.
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Yau WM, Makhlouf GM, Edwards LE, Farrar JT. Mode of action of cholecystokinin and related peptides on gallbladder muscle. Gastroenterology 1973; 65:451-6. [PMID: 4728980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Vlahcevic ZR, Miller JR, Farrar JT, Swell L. Kinetics and pool size of primary bile acids in man. Gastroenterology 1971; 61:85-90. [PMID: 5088530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Vlahcevic ZR, Buhac I, Farrar JT, Bell CC, Swell L. Bile acid metabolism in patients with cirrhosis. I. Kinetic aspects of cholic acid metabolism. Gastroenterology 1971; 60:491-8. [PMID: 5554239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Vlahcevic ZR, Bell CC, Buhac I, Farrar JT, Swell L. Diminished bile acid pool size in patients with gallstones. Gastroenterology 1970; 59:165-73. [PMID: 4915192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Farrar JT. Hill-climbing and medical care. Am J Dig Dis 1970; 15:775-8. [PMID: 5455939 DOI: 10.1007/bf02235998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Ramirez M, Farrar JT. The effect of secretin and cholecystokinin-pancreozymin on the intraluminal pressure of the jejunum in the unanesthetized dog. Am J Dig Dis 1970; 15:539-44. [PMID: 5445634 DOI: 10.1007/bf02238114] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Farrar JT. Clinical manifestations of esophagitis. Postgrad Med 1968; 44:132-5. [PMID: 5714850 DOI: 10.1080/00325481.1968.11693421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Farrar JT, Bernstein JS. Recording of intraluminal gastrointestinal pressures by a radiotelemetering capsule. Gastroenterology 1968; 54:Suppl:770-1. [PMID: 5653795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Bloom AA, LoPresti P, Farrar JT. Motility of the intact human colon. Gastroenterology 1968; 54:232-40. [PMID: 5711907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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