Pharmacoepidemiology: current status, prospects, and problems

Article Abstract:

Although drugs are approved for specific uses, they are often prescribed for unapproved uses and may be used irrationally. An adverse drug reaction may occur from virtually any drug and many of these effects are undetected before the drug is marketed. Rigorous post-marketing surveillance of drug effects is necessary and has led to the discipline called pharmacoepidemiology. This new area of medicine focuses on the study of the use patterns and effects of drugs in large numbers of people. Many contributions from pharmacoepidemiology have already been made to public health, such as discovery of cervical cancer resulting from diethylstilbestrol (DES) 20 years earlier. Many serious and uncommon drug effects have been identified and have resulted in drugs being taken off the market or in a change in labeling. Hospitals will be required to document and evaluate all adverse drug reactions and drug utilization programs will be formed. Since the Food and Drug Administration has been under pressure to approve drugs earlier, there is an increased need for this type of continued post-marketing study. Physicians must continue to report adverse drug reactions to the FDA, pharmaceutical manufacturers, and to medical journals, since such reporting has already resulted in detecting many unusual and previously undetected reactions. There have been problems of overstating the relationship of a drug and an adverse effect; however, there has also been underreporting and lack of recognition of a potential relationship between a drug and its effect. Other methods of evaluating potential adverse drug effects involve the use of nurse-monitors based in hospitals. The research associated with the field of pharmacoepidemiology requires collaboration of practitioners from many disciplines, and an understanding of pharmacology, clinical medicine, and research methods is essential. More scholars are needed for continued work in this field; however, important contributions have already been made in the rational use of drugs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Drugs, Complications and side effects, Social policy, United States. Food and Drug Administration, Adverse drug reactions, Pharmacoepidemiology, editorial

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Current role of cryoamputation

Article Abstract:

Cryoamputation, also known as physiologic amputation, is a procedure in which a nonviable extremity is isolated using a tourniquet and then frozen using dry ice. This procedure stops the progression of gangrene and allows the patient to be prepared for surgery. Although it has been shown to decrease operative risk in seriously ill patients, this method is not widely used. A report is presented of the use of cryoamputation for major lower leg amputation in 320 patients. These cases represent 36 percent of the major leg amputations performed from 1971 through 1989 at two Georgia medical centers. Complications of physiologic amputation were uncommon: 3 percent of patients had minor freezing above the tourniquet which did not affect the final amputation level; and one percent of the patients developed infection which delayed stump closure. Overall mortality was 11 percent; this was comparable to that of patients undergoing primary surgical amputation. The revision rate for physiologic amputation was lower than that of primary surgical amputation (9 percent versus 17 percent). Physiologic amputation is a simple, effective and inexpensive technique that permits the patient's condition to be stabilized prior to surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Amputations of leg, Leg amputation, Cryosurgery

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Current concepts in the management of hypertensive crisis: emergencies and urgencies

Article Abstract:

The care and treatment of patients with hypertensive crises is discussed, including an overview of the most widely-used antihypertensive agents. Special nursing considerations are included.

Care and treatment, Usage, Hypertension, Holistic medicine

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