A comparison of the content and primary literature support for online medication information provided by Lexicomp and Wikipedia

Objectives: The research compared the comprehensiveness and accuracy of two online resources that provide drug information: Lexicomp and Wikipedia. Methods: Medication information on five commonly prescribed medications was identified and comparisons were made between resources and the relevant literature. An initial content comparison of the following three categories of medication information was performed: dose and instructions, uses, and adverse effects or warnings. The content comparison included sixteen points of comparison for each of the five investigated medications, totaling eighty content comparisons. For each of the medications, adverse reactions that appeared in only one of the resources were identified. When primary, peer-reviewed literature was not referenced supporting the discrepant adverse reactions, a literature search was performed to determine whether or not evidence existed to support the listed claims. Results: Lexicomp consistently provided more medication information, with information provided in 95.0% (76/80) of the content, compared to Wikipedia’s 42.5% (34/80). Lexicomp and Wikipedia had information present in 91.4% (32/35) and 20.0% (7/35) of dosing and instructions content, respectively. Adverse effects or warning content was provided in 97.5% (39/40) of Lexicomp content and 55.0% (22/40) of Wikipedia content. The “uses” category was present in both Lexicomp and Wikipedia for the 5 medications considered. Of adverse reactions listed solely in Lexicomp, 191/302 (63.2%) were supported by primary, peer-reviewed literature in contrast to 7/7 (100.0%) of adverse reactions listed only in Wikipedia. A review of US Food and Drug Administration Prescribing Information and the Adverse Event Reporting System dashboard found support for a respective 17/102 (16.7%) and 92/102 (90.2%) of Lexicomp’s adverse reactions that were not supported in the literature. Conclusion: Lexicomp is a comprehensive medication information tool that contains lists of adverse reactions that are not entirely supported by primary-peer reviewed literature

The Cost of Providing Comprehensive HIV Services to Key Populations : An Analysis of the LINKAGES Program in Kenya and Malawi

Introduction: Timely data on HIV service costs are critical for estimating resource needs and allocating funding, but few data exist on the cost of HIV services for key populations (KPs) at higher risk of HIV infection in low- and middle-income countries. We aimed to estimate the total and per contact annual cost of providing comprehensive HIV services to KPs to inform planning and budgeting decisions. Methods: We collected cost data from the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) program in Kenya and Malawi serving female and male sex workers, men who have sex with men, and transgender women. Data were collected prospectively for fiscal year (FY) 2019 and retrospectively for start-up activities conducted in FY2015 and FY2016. Data to estimate economic costs from the provider’s perspective were collected from LINKAGES headquarters, country offices, implementing partners (IPs), and drop-in centers (DICs). We used top-down and bottom-up cost estimation approaches. Results: Total economic costs for FY2019 were US$6,175,960 in Kenya and US$4,261,207 in Malawi. The proportion of costs incurred in IPs and DICs was 66% in Kenya and 42% in Malawi. The costliest program areas were clinical services, management, peer outreach, and monitoring and data use. Mean cost per contact was US$127 in Kenya and US$279 in Malawi, with a mean cost per contact in DICs and IPs of US$63 in Kenya and US$104 in Malawi. Conclusion: Actions undertaken above the service level in headquarters and country offices along with those conducted below the service level in communities, comprised important proportions of KP HIV service costs. The costs of pre-service population mapping and size estimation activities were not negligible. Costing studies that focus on the service level alone are likely to underestimate the costs of delivering HIV services to KPs

Effect on treatment adherence of distributing essential medicines at no charge : the CLEAN Meds randomized clinical trial

This work is supported by grant 381409 from the Canadian Institutes for Health Research, the Ontario SPOR Support Unit that is supported by the Canadian Institutes of Health Research and the Province of Ontario, the Canada Research Chairs program, and the St Michael’s Hospital Foundation.Importance: Nonadherence to treatment with medicines is common globally, even for life-saving treatments. Cost is one important barrier to access, and only some jurisdictions provide medicines at no charge to patients. Objective: To determine whether providing essential medicines at no charge to outpatients who reported not being able to afford medicines improves adherence. Design, Setting, and Participants: A multicenter, unblinded, parallel, 2-group, superiority, outcomes assessor-blinded, individually randomized clinical trial conducted at 9 primary care sites in Ontario, Canada, enrolled 786 patients between June 1, 2016, and April 28, 2017, who reported cost-related nonadherence. Follow-up occurred at 12 months. The primary analysis was performed using an intention-to-treat principle. Interventions: Patients were randomly allocated to receive free medicines on a list of essential medicines in addition to otherwise usual care (n = 395) or usual medicine access and usual care (n = 391). Main Outcomes and Measures: The primary outcome was adherence to treatment with all medicines that were appropriately prescribed for 1 year. Secondary outcomes were hemoglobin A1c level, blood pressure, and low-density lipoprotein cholesterol levels 1 year after randomization in participants taking corresponding medicines. Results: Among the 786 participants analyzed (439 women and 347 men; mean [SD] age, 51.7 [14.3] years), 764 completed the trial. Adherence to treatment with all medicines was higher in those randomized to receive free distribution (151 of 395 [38.2%]) compared with usual access (104 of 391 [26.6%]; difference, 11.6%; 95% CI, 4.9%-18.4%). Control of type 1 and 2 diabetes was not significantly improved by free distribution (hemoglobin A1c, -0.38%; 95% CI, -0.76% to 0.00%), systolic blood pressure was reduced (-7.2 mm Hg; 95% CI, -11.7 to -2.8 mm Hg), and low-density lipoprotein cholesterol levels were not affected (-2.3 mg/dL; 95% CI, -14.7 to 10.0 mg/dL). Conclusions and Relevance: The distribution of essential medicines at no charge for 1 year increased adherence to treatment with medicines and improved some, but not other, disease-specific surrogate health outcomes. These findings could help inform changes to medicine access policies such as publicly funding essential medicines. Trial Registration: ClinicalTrials.gov identifier: NCT02744963.Publisher PDFPeer reviewe

Ethnic differences in HIV risk among female commercial sex workers in Guyana: A case-control study

Objective. To identify biological and behavioral factors that predict HIV infection and determine the proportion of HIV infection that were attributable to different exposures among female Commercial Sex Workers (CSWs) of varying ethnic background.Method. A nested case-control study was conducted among 114 (53 cases and 61 controls) female CSWs in Georgetown, Guyana. A subset of data, devoid of personal identifiers, was extracted from a cross-sectional survey which collected baseline data for the evaluation of an intervention in this population. Association between exposure variables and the outcome were tested using multiple logistic regression analysis, controlling for age group and place of work. Predictors of HIV infection were identified using stepwise forward logistic regression analysis. Separate sub-group analyses were conducted to identify risk factors for HIV infection in the different ethnic groups. Adjusted odds ratios and 95% confidence intervals were calculated.Results. CSWs of African/mixed descent were four times more likely to be HIV infected compared to those of Indian descent (Adj. OR = 4.14; 95% CI: 1.45--11.85). HIV risk was higher among CSWs with ≤3 children (Adj. OR = 3.76; 95% CI: 1.34--10.55); ≥5 clients per night (Adj. OR = 3.49; 95% CI: 1.34--9.12); current syphilis (Adj. OR = 6.96; 95% CI: 2.6--18.63); and a history of syphilis (Adj. OR = 3.97; 95% CI: 1.56--10.14). No significant interaction was found between current syphilis and past syphilis. Independent predictors of HIV infection were African/Mixed ethnicity (Adj. OR = 6.05; 95% CI: 1.49--24.58); current syphilis (Adj. OR = 8.80; 95% CI: 2.39--32.49) and PID (Adj. OR = 3.15; 95% CI: 1.04--9.57). Number of clients per night (≥5); age at first sex (≤16 years); and syphilis (current and past) were associated with HIV infection among CSWs of African/Mixed descent. For those of Indian ethnicity current syphilis and crack-cocaine use were associated with HIV infection.Conclusion. In this study, ethnicity emerged as an independent predictor of HIV infection among female CSWs with those of African/mixed descent having a higher risk of infection. STDs also seem to be playing a major role in HIV spread in this population.</p

F-Benedectin-Benedectin-Index to Benedecting Document

Index to fiches obtained from FDA

Data from: 8-way randomized controlled trial of doxylamine, pyridoxine and dicyclomine for nausea and vomiting during pregnancy: restoration of unpublished information

Objectives: We report information about an unpublished 1970s study (“8-way” Bendectin Study) that aimed to evaluate the relative therapeutic efficacy of doxylamine, pyridoxine, and dicyclomine in the management of nausea and vomiting during pregnancy. We are publishing the trial's findings according to the restoring invisible and abandoned trials (RIAT) initiative because the trial was never published. Design: Double blinded, multi-centred, randomized placebo-controlled study. Setting: 14 clinics in the United States. Participants: 2308 patients in the first 12 weeks of pregnancy with complaints of nausea or vomiting were enrolled. Interventions: Each patient was randomized to one of eight arms: placebo, doxylamine/pyridoxine/dicylcomine, doxylamine/pyridoxine, dicylomine/pyridoxine, doxylamine, dicyclomine/pyridoxine, pyridoxine and dicyclomine. Each patient was instructed to take 2 tablets at bedtime and 1 additional tablet in the afternoon or morning if needed, for 7 nights. Outcomes: Reported outcomes included the number of hours of nausea reported by patients, the frequency of vomiting reported by patients and the overall efficacy of medication as judged by physicians. Results: Data from 1599 (69% of those randomized) participants were analyzed. Based on the available summary data of physician evaluation of symptoms and ignoring missing data and data integrity issues, the proportion of participants who were “evaluated moderate or excellent” was greater in each of the seven active treatment groups when compared with placebo (57%): doxylamine/pyridoxine/dicylcomine (14% absolute difference versus placebo; 95% CI: 4 to 24), doxylamine/pyridoxine (21; 95% CI 11 to 30), dicylomine/pyridoxine (21; 95% CI 11 to 30), doxylamine (20; 95% CI 10 to 29), dicyclomine/pyridoxine (4; 95% CI -6 to 14), pyridoxine (9; 95% CI -1 to 19) and dicyclomine (4; 95% CI -6 to 14). Based on incomplete information, the most common adverse events were apparently drowsiness and fatigue. There is a high risk of bias in these previously unpublished results given the high attrition rate in a 7 day trial, the lack of prespecified outcomes or analyses, and the exclusion of some data because of questionable data integrity. Conclusion: The available information about this “8-way Bendectin” trial indicates it should not be used to support the efficacy of doxylamine, pyridoxine or dicyclomine for the treatment of nausea and vomiting during pregnancy because of a high risk of bias

Direct assessment of qualia in a blindsight participant

Experimenters generally infer whether participants have visual experiences based on metacognitive responses. We showed a well-studied blindsight participant, GY, several definitions of the term "qualia" and then questioned him about whether he felt or he experienced qualia in his normal and blind fields. We found, contrary to others who have used different methods for measuring qualia, that GY does not have qualia for stationary stimuli in his blind field. This novel method for directly assessing qualia embraces the idea that experiences should be related by the experiencer, not the experimenter. © 2007 Elsevier Inc. All rights reserved.Link_to_subscribed_fulltex