This document summarizes a presentation on searching for information on adverse effects in systematic reviews. It discusses why identifying adverse effects is important, challenges in searching for this information, current practices, and evidence on where and how to search. Key points include that searching multiple databases and sources is needed; searching only MEDLINE may miss over 40% of relevant records; adverse effects terms are increasingly prevalent in records but should not be relied on alone; and Embase indexing terms are particularly useful. The presentation provides guidance on improving adverse effects searching and reporting.
Environmental scans versus horizon scans; systematic reviews versus rapid rev...Kimberly Yang
Talk comparing environmental scans with horizon scans, systematic reviews, rapid reviews, and core outcome sets, presented to Center for Medical Technology Policy (CMTP) staff by Kimberly F. Yang on September 28, 2015
Environmental scans versus horizon scans; systematic reviews versus rapid rev...Kimberly Yang
Talk comparing environmental scans with horizon scans, systematic reviews, rapid reviews, and core outcome sets, presented to Center for Medical Technology Policy (CMTP) staff by Kimberly F. Yang on September 28, 2015
Meta Analysis of Medical Device Data Applications for Designing Studies and R...NAMSA
Meta Analysis of Medical Device Data Applications for Designing Studies and Reinforcing Clinical Evidence discusses what meta analysis is as well as the potential benefits.
Evidence based orthodontics /certified fixed orthodontic courses by Indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Methods Pyramids as an Organizing Structure for Evidence-Based Medicine--SIGC...jodischneider
Keynote talk 2020-08-01 for the JCDL Workshop on Conceptual Models: https://sig-cm.github.io/news/JCDL-2020-CFP/
Discussion points:
* Methods are a key part of the Knowledge Organizing Structure for Evidence-Based Medicine.
* Methods relate to how we GENERATE evidence.
* Different methods generate evidence of different kinds and strength.
* I believe Methods can be useful in mining claims and arguments from papers: methods AUTHORIZE claims.
* More specialized hierarchies of evidence can be found in medicine
* Various groups are complicating the “evidence pyramid” hierarchy of evidence.
Clinical Trials Re-spec. The role of games and game concepts in the future of...Karel Van Isacker
Clinical Trials Re-spec. The role of games and game concepts in the future of clinical trials (Bill Byrom)
Interactive Technologies and Games (ITAG) Conference 2015
Health, Disability and EducationDates: Thursday 22 October 2015 - Friday 23 October 2015 Location: The Council House, NG1 2DT
Patient recruitment & retention is highlighted as the key factor in ensuring study success, the area of patient retention in clinical trials is often overlooked. Retention of patients throughout the life of a clinical trial is however extremely vital from scientific as well as economic point of view. Poor recruitment & retention negatively impacts on the overall evaluable data for regulatory submissions. Dropped participants must be replaced which incurs further expenditures and time delays. Subject dropout rates are estimated to range from 15-40% of enrolled participants in clinical trials.
Efforts to place the patient at the center of medical research, spurred by the Affordable Care Act’s founding of the Patient Centered Outcomes Research Institute, have begun to change the way clinical research is conceptualized and conducted. Such efforts hold great promise, but also raise potential challenges for ethical oversight. How should oversight bodies approach the presence of patients in potentially unfamiliar research roles, such as investigator? What forms of patient involvement in research, if any, warrant increased scrutiny from oversight bodies? How do we keep the patient voice from being ‘captured’ by special interest groups? This symposium brought together a diverse group of patients and community members, policymakers, bioethicists, and regulatory officials to address these and other issues.
This presentation was given as part of a searching workshop in the 6th GCC Evidence-Based Healthcare & Knowledge Translation in Riyadh, December 11-12, 2010. Organized by Sheikh Abdullah S Bahamdan Research Chair, at King Saud University. The presentation assumes prior knowledge of EBM principles. It goes over the hierarchy of information sources & how to get the information effectively & efficiently.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Emerging diagnostic technologies proving the clinical application through g...Lyssa Friedman
Next Generation Sequencing is an exciting new technology for diagnostics companies. But is it right for all products and for all companies? This presentation was delivered via Webinar for a IVD audience for Q1 Productions, March 25, 2014.
Meta Analysis of Medical Device Data Applications for Designing Studies and R...NAMSA
Meta Analysis of Medical Device Data Applications for Designing Studies and Reinforcing Clinical Evidence discusses what meta analysis is as well as the potential benefits.
Evidence based orthodontics /certified fixed orthodontic courses by Indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Methods Pyramids as an Organizing Structure for Evidence-Based Medicine--SIGC...jodischneider
Keynote talk 2020-08-01 for the JCDL Workshop on Conceptual Models: https://sig-cm.github.io/news/JCDL-2020-CFP/
Discussion points:
* Methods are a key part of the Knowledge Organizing Structure for Evidence-Based Medicine.
* Methods relate to how we GENERATE evidence.
* Different methods generate evidence of different kinds and strength.
* I believe Methods can be useful in mining claims and arguments from papers: methods AUTHORIZE claims.
* More specialized hierarchies of evidence can be found in medicine
* Various groups are complicating the “evidence pyramid” hierarchy of evidence.
Clinical Trials Re-spec. The role of games and game concepts in the future of...Karel Van Isacker
Clinical Trials Re-spec. The role of games and game concepts in the future of clinical trials (Bill Byrom)
Interactive Technologies and Games (ITAG) Conference 2015
Health, Disability and EducationDates: Thursday 22 October 2015 - Friday 23 October 2015 Location: The Council House, NG1 2DT
Patient recruitment & retention is highlighted as the key factor in ensuring study success, the area of patient retention in clinical trials is often overlooked. Retention of patients throughout the life of a clinical trial is however extremely vital from scientific as well as economic point of view. Poor recruitment & retention negatively impacts on the overall evaluable data for regulatory submissions. Dropped participants must be replaced which incurs further expenditures and time delays. Subject dropout rates are estimated to range from 15-40% of enrolled participants in clinical trials.
Efforts to place the patient at the center of medical research, spurred by the Affordable Care Act’s founding of the Patient Centered Outcomes Research Institute, have begun to change the way clinical research is conceptualized and conducted. Such efforts hold great promise, but also raise potential challenges for ethical oversight. How should oversight bodies approach the presence of patients in potentially unfamiliar research roles, such as investigator? What forms of patient involvement in research, if any, warrant increased scrutiny from oversight bodies? How do we keep the patient voice from being ‘captured’ by special interest groups? This symposium brought together a diverse group of patients and community members, policymakers, bioethicists, and regulatory officials to address these and other issues.
This presentation was given as part of a searching workshop in the 6th GCC Evidence-Based Healthcare & Knowledge Translation in Riyadh, December 11-12, 2010. Organized by Sheikh Abdullah S Bahamdan Research Chair, at King Saud University. The presentation assumes prior knowledge of EBM principles. It goes over the hierarchy of information sources & how to get the information effectively & efficiently.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Emerging diagnostic technologies proving the clinical application through g...Lyssa Friedman
Next Generation Sequencing is an exciting new technology for diagnostics companies. But is it right for all products and for all companies? This presentation was delivered via Webinar for a IVD audience for Q1 Productions, March 25, 2014.
Introduction to Adverse Drug Reactions in Pharmacovigilance and Drug Safety in Pharma, Biotech, Medical Device, Cosmeceutical and Foods.
Contact:
"Katalyst Healthcares & Life Sciences"
South Plainfield, NJ, USA
info@KatalystHLS.com
Pharmacovigilance Process Work Flow - Katalyst HLSKatalyst HLS
Introduction to Drug Safety & Pharmacovigilance Process Work Flow for Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Contact:
"Katalyst Healthcares & Life Sciences"
South Plainfield, NJ, USA
info@KatalystHLS.com
What are some of the challenges in pharmacovigilance? This presentation offers you more information on signal detection, signal management and risk minimisation measures.
Dr. Su Golder, NIHR Research Fellow at the University of York, presents findings from her recent publication: “Systematic review on the prevalence, frequency and comparative value of adverse events data in social media”.
Published Research, Flawed, Misleading, Nefarious - Use of Reporting Guidelin...John Hoey
Much published health sciences literature is misleading and biased
Efforts to correct this include use of reporting guidelines- criteria for doing science and reporting the results properly
Also discussion of conflicts of interest - how to report them.
Dr Yen-Fu Chen's presentation on publication bias in service delivery research for the CLAHRC WM Scientific Advisory Group, 10th June 2015, Birmingham, UK
How predictive models help Medicinal Chemists design better drugs_webinarAnn-Marie Roche
All scientific disciplines, including medicinal chemistry, are experiencing a revolution in unprecedented rates of data being generated and the subsequent analysis and exploitation of this data is increasingly fundamental to innovation. Using data to design better compounds is a challenge for Medicinal and Computational chemists.
The design of small-molecule drug candidates, encompassing characteristics such as potency, selectivity and ADMET (absorption, distribution, metabolism, excretion and toxicity) is a key factor in the success of clinical trials and computer-aided drug discovery/design methods have played a major role in the development of therapeutically important small molecules for over three decades. These methods are broadly classified as either structure-based or ligand-based.
In this webinar our expert Dr. Olivier Barberan will discuss ligand-based methods and he will cover the following:
How to use only ligand information to predict activity depending on its similarity/dissimilarity to previously known active ligands.
- Discuss ligand-based pharmacophores, molecular descriptors, and quantitative structure-activity relationships and important tools such as target/ligand databases necessary for successful implementation of various computer-aided drug discovery/design methods in a drug discovery campaign.
Webinar: New RMC - Your lead_optimization Solution June082017Ann-Marie Roche
The drug discovery landscape is rapidly changing and drives the need to generate leads with lower attrition rates.
In this webinar, our expert Dr. Olivier Barberan discussed how NEW Reaxys Medicinal chemistry in NEW Reaxys allows better discovery and exploration of structure activity relationship and also supports a more efficient property-based drug design approach. He covered the following:
• How has RMC being transformed into a more accessible tool for all users, allowing complex searches and workflows to be easily carried out.
• A demonstration of how more than ever RMC is the only lead-optimization solution you will need.
Oil&Gas Thought Leader Webinar - New Plays for Old Ideas - Dr.Gabor TariAnn-Marie Roche
In our April 2017 webinar, three industry experts shared their research and demonstrated the importance of focusing on fundamental geologic and geophysical research approaches that integrate variety of data, information and concepts from disparate sources and related disciplines.
This back-to-fundamentals research can both inspire and accelerate exploration teams’ thinking about petroleum systems and lead to a path to success.
Dr Gabor Tari is currently the Group Chief Geologist at OMV. He has over 20 years’ experience working in upstream oil & gas and has worked for Amoco, BP, and Vanco, before joining OMV in 2007. Gabor has worked on exploration projects in basins around the globe, including Romania, Angola, North Africa, and the Middle East. He has authored over 50 scientific publications, presented papers at dozens of conferences, and most recently co-authored the book Permo-Triassic Salt Provinces of Europe, North Africa and the Atlantic Margins, with Dr Joan Flinch (Repsol) and Juan Soto, Professor of Geodynamics in the Granada University and in the Instituto Andaluz de Ciencias de la Tierra, Spain, which is currently available from Elsevier for pre-order online.
Gabor discussed and shared some examples of how new plays can be built on a solid foundation of petroleum system development and research, and how new ideas can be garnered from building on published research of oil & gas companies, academia, service providers and consultants.
Oil&Gas Thought-Leader Webinar - New Plays for Old Ideas - Dr. Rob ForknerAnn-Marie Roche
In our April 2017 webinar, three industry experts shared their research and demonstrated the importance of focusing on fundamental geologic and geophysical research approaches that integrate variety of data, information and concepts from disparate sources and related disciplines. This back-to-fundamentals research can both inspire and accelerate exploration teams’ thinking about petroleum systems and lead to a path to success.
Dr Rob Forkner is a carbonate geologist at Statoil, working in the carbonate plays and reservoirs research group in Austin, Texas, focusing on carbonate play prediction in Atlantic margin systems. Prior to Statoil, Rob worked at Maersk and Shell in onshore and offshore in well planning, geosteering, high-resolution sequence stratigraphy and facies prediction, carbonate sedimentology in unconventional assets, evaporite classification and prediction, rock typing, and more recently, carbonate system suppression and recovery during Oceanic Anoxic Events.
Oil&Gas Thought-Leader Webinar - New Plays for Old Ideas - Dr. Sander HoubenAnn-Marie Roche
In our April 2017 webinar, three industry experts shared their research and demonstrated the importance of focusing on fundamental geologic and geophysical research approaches that integrate variety of data, information and concepts from disparate sources and related disciplines.
This back-to-fundamentals research can both inspire and accelerate exploration teams’ thinking about petroleum systems and lead to a path to success.
Dr. Sander Houben is a biostratrapher and researcher within the Basin Analysis team at TNO, Netherlands Organisation for Applied Scientific Research, and the leading research institute for applied sciences in the Netherlands. As part of the Basin Analysis Team, Sander provides scientific and technical expertise regarding stratigraphic and paleo-environmental constraints for multidisciplinary projects. In addition to conducting research, he leads TNO’s biostratigraphic consultancy research programs.
Embase for pharmacovigilance: Search and validation March 22 2017Ann-Marie Roche
Scientific literature plays a critical role in Pharmacovigilance and Drug Safety workflows. Monitoring literature for mentions of adverse drug reactions (ADRs) is mandated by regulatory bodies, and marketing authorization holders (MAHs) that do not properly report ADRs can be subject to heavy fines. With an increasing volume of unstructured content to cover, along with rising labor costs, MAHs are looking for ways to make their literature monitoring more effective and efficient.
Abstract and indexing (A&I) databases play an important role in Literature Monitoring – due to the vast amount of scientific literature published daily – in order for MAH’s to locate specific articles or conference presentations that may be relevant for their products (for both benefit/risk analysis and ADR detection). Rather than reading all the literature, MAH’s create search strategies that identify the relevant records in A&I databases and execute the searches regularly. GVP module VI mandates that searches are done at least weekly, but many companies maintain a daily monitoring and review cycle.
In this webinar, Senior Product Development Manager Embase, Dr. Ivan Krstic discussed best practices for saving time, staying current, validating search strategies and mitigating risk in the face of these increasingly complex processes in literature monitoring
Literature Management for Pharmacovigilance: Outsource or in-house solution? ...Ann-Marie Roche
Pharmaceutical companies are required to screen scientific literature on a regular basis and this comes with many challenges, such as handling large amounts of data, building search strings and integrating EMA MLM results. Out-sourcing literature screening to service providers reduces the workload for the PV-team, but how does it impact the literature management process overall? Maybe it results in decreased oversight and additional activities like audits and reconciliation? And what about building the search strategy?
During this webinar our PV expert, Dr. Joyce De Langen spoke about the following:
• The importance of literature management in Pharmacovigilance and the challenges.
• An evaluation of the benefits and risks of outsourcing literature management versus alternative solutions.
About the speaker:
Joyce de Langen, Ph.D has more than 10 years of experience in the domain of pharmacovigilance and drug safety. Through her work in the pharmaceutical industry, academia and regulatory authorities, Joyce has developed a broad perspective and knowledge in pharmacovigilance and drug safety.
The All-New 2016 Engineering Academic Challenge - developed by students for students
The Engineering Academic Challenge (formerly as the Knovel Academic Challenge) is an immersive, 5-week interactive problem-set competition, featuring weekly thematic engineering challenges built around five transdisciplinary themes inspired by the National Academy of Engineering Grand Challenges.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Systematic Reviews: Searching for information on adverse effects by Dr. Su Golder, University of York, UK
1. Centre for Reviews and Dissemination
Systematic reviews: Searching for
information on adverse effects
Dr Su Golder su.golder@york.ac.uk
2. Centre for Reviews and Dissemination
Systematic reviews: Searching for
information on adverse effects
Dr Su Golder
su.golder@york.ac.uk
3. Centre for Reviews and Dissemination
Structure for Today’s Webinar
Why we should search for information on
adverse effects?
Why information on adverse effects
difficult to search for?
How we currently search for information
on adverse effects?
How we should search for information on
adverse effects?
4. Centre for Reviews and Dissemination
Why search for information on
adverse effects?
Unpleasant, often serious – hospitalisation,
disability, death (USA: 4th to 6th leading
cause of death) (Lazarou 1998)
Worsen quality of life, make people stop
treatment
Cost (estimates of £2 billion per year to UK
NHS) (Compass 2008)
Can be a deciding factor in decision-making
5. Centre for Reviews and Dissemination
Why is information on adverse
effects difficult to identify?
• AEs often treated as secondary
or even tertiary outcomes.
Poor reporting or absence of
adverse effects terms in titles,
abstracts and indexing
• Wide range of terms for adverse
effects. Inconsistent
terminology and indexing
• False hits; ‘Relative Risk’, ‘Self-
harm’, ‘Patient safety’, ‘adverse
effects were not considered’
• May wish to identify all adverse
effects. Hard to predict/plan (specific
terms may not be known in advance)
• Relevant adverse effects may come
from a range of study designs, not
just RCTs
• Adverse effects may not be limited to a
particular condition
• Many data sources: specialist
databases, unpublished data, industry
funded data, surveillance data, tertiary
sources
6. Centre for Reviews and Dissemination
Where do authors of systematic
reviews search for adverse effects?
Analysis of 849 reviews of adverse
effects (Golder et al 2013, Golder et al
2014)
Number of databases searched
median 2 (range 0 to 25)
increasing over time
greater if information professional involved
7. Centre for Reviews and Dissemination
Quiz Time
Q: Which are the top three resources used
to identify information on adverse effects?
A: Cochrane Library, MEDLINE and contacting
experts
B: MEDLINE, reference checking, and Embase
C: Embase, Derwent Drug File and BIOSIS
Previews
8. Centre for Reviews and Dissemination
Which are the top three resources
used to identify information on
adverse effects?
1. MEDLINE: 96%
2. Reference checking: 76%
3. Embase: 54%
4. CENTRAL or Cochrane Library: 45%
5. Contacting experts: 22%
9. Centre for Reviews and Dissemination
How do authors of systematic
reviews search for adverse effects?
62% search with adverse effects terms
46% with named adverse effect
e.g. headache, bleed, sepsis
5% with generic adverse effect terms
e.g. adverse effects, side effects, complications etc.
11% with both
10. Centre for Reviews and Dissemination
The evidence on where to search for
adverse effects
Systematic review comparing sources of
information on adverse effects (Golder et al 2010)
Case study systematic review of glitazones and
fractures (Golder et al 2012a)
Case study systematic review of the safety of
spinal fusion (unpublished)
11. Centre for Reviews and Dissemination
Systematic review of previous
research (Golder et al 2010)
Objective
Summarise all the literature comparing 2 or more
sources to identify adverse effects
Results
19 included studies
8/10 cases searching Embase retrieved more
relevant references than MEDLINE
Limitations
Many of the included studies are out of date
Little overlap in the sources compared
12. Centre for Reviews and Dissemination
Case study with a drug intervention
(Golder et al 2012a)
Long-term use of glitazones and fractures in
type 2 diabetes
Searched over 60 sources (beyond usual
practice)
Used intervention (glitazones) and outcome
(fractures) search terms
No diabetes terms used
Multiple textwords and indexing
13. Centre for Reviews and Dissemination
Quiz Time
Q: Which database retrieved the highest
number of relevant records for this review
on fracture and glitazones?
A: MEDLINE
B: Embase
C: Science Citation Index (SCI)
14. Centre for Reviews and Dissemination
Case study with a drug intervention: top
databases (Golder et al 2012a)
0%
10%
20%
30%
40%
50%
60%
70%
Percentage of all
publications
retrieved (n=58)
15. Centre for Reviews and Dissemination
Case study with a drug intervention:
unique records (Golder et al 2012a)
0
2
4
6
8
10
12
GSK Registry Science Citation
Index (SCI)
Embase BIOSIS Previews British Library
Direct
Medscape DrugInfo
Unique
relevant
records
16. Centre for Reviews and Dissemination
Case study with a drug intervention:
sources required (Golder et al 2012a)
Minimum combination of sources
Science Citation Index Embase
BIOSIS Previews GSK website
Medscape DrugInfo British Library Direct
Thomson Reuters Integrity* Conference Papers Index*
AHFS First Handsearching**
Reference checking
*either database
** ten key journals
17. Centre for Reviews and Dissemination
Case study with a medical device
(unpublished)
Safety of recombinant human bone
morphogenetic protein-2 (rhBMP-2)
Searched 10 databases plus reference
checking, contacting authors and automated
current awareness service
Used intervention terms; recombinant human
bone morphogenetic protein-2 (rhBMP-2) and
spinal fusion
Multiple textwords and indexing
18. Centre for Reviews and Dissemination
Case study with a medical device: top
databases
0%
10%
20%
30%
40%
50%
60%
70%
Embase Science
Citation Index
(SCI)
MEDLINE PubMED CENTRAL ToxFile
Percentage of all
publications retrieved
(n=82)
19. Centre for Reviews and Dissemination
Case study with a medical device: unique
records
0
1
2
3
4
5
6
7
8
9
Science Citation
Index (SCI)
Embase CENTRAL MEDLINE PubMED ToxFile
Unique relevant records
20. Centre for Reviews and Dissemination
Case study with a medical device:
sources required
Minimum combination of sources
Science Citation Index (SCI)
Embase
CENTRAL
MEDLINE or PubMED
Reference checking
Contacting authors
Automated current awareness service
21. Centre for Reviews and Dissemination
The evidence on how to search for
adverse effects
Analysis of records from 3 systematic reviews of
drug interventions (Derry et al 2001)
Analysis of records from 26 systematic reviews of
drug interventions (Golder et al 2012b)
Analysis of records from case study systematic
review of a medical device (unpublished)
22. Centre for Reviews and Dissemination
Analysis of records from 3 systematic
reviews of adverse drug effects (Derry
et al 2001)
Objective
To assess the presence or absence of adverse effects terms
in the title, abstract or indexing of records of articles with
adverse effects data
Results
23% of trials that reported adverse effects data had no
adverse effects terms in title, abstract or indexing of records
in MEDLINE or Embase
Guidance
Do not rely on adverse effects terms
Check full-text versions of retrieved articles
23. Centre for Reviews and Dissemination
Analysis of records from 26
systematic reviews of adverse drug
effects (Golder et al 2012b)
Objective 1
To assess the presence or absence of adverse effects
terms in the title, abstract or indexing of records of articles
with adverse effects data published since 2001
Results
8% of articles published after 2001 that reported adverse
effects data had no adverse effects terms in title, abstract
or indexing of records in MEDLINE or Embase
24. Centre for Reviews and Dissemination
Database records with any adverse
effects terms (Golder et al 2012b)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Terms in any location Terms in title or abstract Indexing terms
MEDLINE
EMBASE
Science Citation Index (SCI)
25. Centre for Reviews and Dissemination
Quiz Time
Q: Which of the following search terms
retrieves the highest number of relevant
records in MEDLINE?
A: ‘adverse effects’ as a subheading
B: ‘adverse adj3 event$’ in title or abstract
C: ‘safety’ in title or abstract
26. Centre for Reviews and Dissemination
Top search terms in MEDLINE
(Golder et al 2012b)
1 ‘adverse effects (ae)’ Floating subheading 51%
2 ‘adverse adj3 event$’ Title or abstract 32%
3 ‘safety’ Title or abstract 31%
4 ‘adverse adj2 events’ Title or abstract 29%
5 ‘risk’ Title or abstract 28%
6 ‘drug effects (de)’ Floating subheading 27%
7 ‘complications (co)’ Floating subheading 18%
27. Centre for Reviews and Dissemination
Top search terms in Embase
(Golder et al 2012b)
1 ‘adverse drug reaction(ae)’ Floating subheading 83%
2 ‘side effect(si)’ Floating subheading 83%
3 exp drug safety/ Emtree indexing term 38%
4 ‘adverse adj3 event$’ Title or abstract 32%
5 ‘safety’ Title or abstract 28%
6 ‘adverse adj2 events’ Title or abstract 28%
7 ‘risk’ Title or abstract 27%
28. Centre for Reviews and Dissemination
Analysis of records from 26
systematic reviews of adverse drug
effects (Golder et al 2012c)
Objective 2
The second objective of this analysis was to
measure the performance of suggested
adverse effects search filters/hedges
29. Centre for Reviews and Dissemination
Average sensitivity of adverse effects
search filters in 26 systematic reviews
(Golder et al 2012c)
0%
20%
40%
60%
80%
100%
120%
Buckingham with
quality filter
Buckingham without
quality filter
BMJ Clinical Evidence Badgett Golder excluding
specific adverse
effects
Golder including
specific adverse
effects
MEDLINE
EMBASE
30. Centre for Reviews and Dissemination
Analysis of records from case study
systematic review of a medical
device (unpublished)
Objective
To assess the presence or absence of adverse effects
terms in the title, abstract or indexing of records of
articles with adverse effects data
Results
4% of articles that reported adverse effects data of a
medical device had no adverse effects terms in title,
abstract or indexing of records in MEDLINE or
Embase
31. Centre for Reviews and Dissemination
Top search terms for adverse effects
of a medical device in MEDLINE
1 ‘adverse effects (ae)’ Floating subheading 47%
2 ‘complication$’ Title or abstract 35%
3 ‘postoperative complications/’ MeSH indexing term 27%
4 ‘safety’ Title or abstract 20%
5 ‘safely’ Title or abstract 20%
6 ‘blood loss’ Title or abstract 20%
32. Centre for Reviews and Dissemination
Top search terms for adverse effects
of a medical device in Embase
1 ‘complication (co)’ Floating subheading 49%
2 ‘complication$’ Title or abstract 35%
3 ‘pseudarthrosis/’ Emtree indexing term 24%
4 ‘adverse drug reaction (ae)’ Floating subheading 22%
5 ‘postoperative complication/’ Emtree indexing term 20%
6 ‘blood loss’ Title or abstract 18%
7 ‘bleeding/’ Emtree indexing term 18%
8 ‘dysphagia/’ Emtree indexing term 18%
33. Centre for Reviews and Dissemination
Take home messages
Including adverse effects in systematic reviews is
important so that clinicians, patients and policy
makers can make balanced decisions and minimise
harm.
Searches of multiple databases and non-database
sources are required in systematic reviews of
adverse effects.
Searching only MEDLINE may miss over 40% of
the relevant references.
34. Centre for Reviews and Dissemination
Take home messages
Adverse effects terms increasingly prevalent in title,
abstract or indexing
Searchers may cautiously rely on adverse effects
search terms
Indexing terms for adverse effects much more
prevalent in Embase
Subheadings particularly useful in Embase and
MEDLINE
35. Centre for Reviews and Dissemination
Future
More reviews are including adverse effects
either as secondary outcome (in addition to
effectiveness) or as primary outcome
Better reporting
CONSORT Extension for Harms (Ioannidis et
al 2004)
PRISMA Harms Extension (Zorzela et al
2014)
36. Centre for Reviews and Dissemination
Guidance
Cochrane Handbook
Higgins JPT, Green S (editors). Cochrane Handbook for
Systematic Reviews of Interventions Version 5.1.0 [updated
March 2011]. The Cochrane Collaboration, 2011. Available
from www.cochrane-handbook.org.
CRD’s Guidance
Systematic Reviews: CRD’s guidance for undertaking reviews
in health care.
http://www.york.ac.uk/inst/crd/pdf/Systematic_Reviews.pdf
BMC Paper
Loke YK, Price D, Herxheimer A. Systematic reviews of
adverse effects: framework for a structured approach. BMC
Med Res Methodol 2007;7:32.
37. Centre for Reviews and Dissemination
Help and support
Cochrane Adverse Effects Methods Group
http://aemg.cochrane.org/
Discussion List
http://lists.cochrane.org/mailman/listinfo/aemg
Twitter
@CAEMG1
39. Centre for Reviews and Dissemination
References
Badgett R, Chiquette E, Anagnostelis B, Mulrow C. Locating reports of serious adverse drug
reactions (PowerPoint presentation).[1999. http://medinformatics.uthscsa.edu/#FILTERS
Buckingham J., Fisher B., Saunders D. Evidence based medicine tool kit: search strategies for
articles on harm/etiology [Internet] Alberta, AB, Canada: University of Alberta; 2005
BMJ Clinical Evidence. Search filters. BMJ [Internet] 2006 [cited 9 May 2006].
http://www.clinicalevidence.com/ceweb/about/search_filters.jsp.
Chou R, Aronsonb N, Atkinsc D, Ismailad AS, Santaguidad P, Smith DH, et al. AHRQ Series Paper 4:
Assessing harms when comparing medical interventions: AHRQ and the Effective Health-Care
Program J Clin Epidemiol 2010;63:502-12.
Compass. Adverse drug reactions wastes NHS £2BN reveals Compass. Compass; London; 2008.
[cited 2008 18 Sep]. Available from: http://www.compassonline.org.uk/news/item.asp?n=1551.
Derry S, Loke YK, Aronson JK. Incomplete evidence: the inadequacy of databases in tracing
published adverse drug reactions in clinical trials. BMC Med Res Methodol 2001;1:7.
Golder S, McIntosh HM, Duffy S, Glanville J, Developing efficient search strategies to identify reports
of adverse effects in MEDLINE and EMBASE. Health Info Libr J. 2006 Mar;23(1):3-12.
Golder S, Loke YK. Sources of information on adverse effects: a systematic review. Health Info Libr J
2010;27(3)176-90.
40. Centre for Reviews and Dissemination
References
Golder S, Loke YK. The contribution of different information sources for adverse effects data. Int J
Technol Assess Health Care. 2012a;28(2):133-7.
Golder S, Loke YK. Failure or success of electronic search strategies to identify adverse effects data.
JMLA 2012b;100(2):130-4.
Golder S, Loke YK. The performance of adverse effects search filters in MEDLINE and EMBASE.
Health Info Libr J 2012c;29(2):141-51.
Golder S, Loke YK, Zorzela L. Some improvements are apparent in identifying adverse effects in
systematic reviews from 1994 to 2011. J Clin Epidemiol 2013;66(3):253-60.
Golder S, Loke YK, Zorzela L. Comparison of search strategies in systematic reviews of adverse
effects to other systematic reviews. Health Info Libr J 2014.
Ioannidis JP, Evans SJ, Gotzsche PC, O'Neill RT, Altman DG, Schulz K, Moher D. Better reporting of
harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med 2004;
141(10):781-788.
Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reaction in hospitalized patients: a
meta-analysis of prospective studies. JAMA 1998;279:1200-5.
Wieland S, Dickersin K. Selective exposure reporting and Medline indexing limited the search
sensitivity for observational studies of the adverse effects of oral contraceptives. J Clin Epidemiol.
2005 Jun;58:6:560-7.
Zorzela L, Golder S, Liu, Y, Pilkington K, Hartling L, Joffe A, Loke Y, Vohra S. Quality of reporting in
systematic reviews of adverse events: systematic review. BMJ. 2014;348.
Editor's Notes
This tutorial will give guidance on the relative value and contribution of searching different sources
(database and non-database) to identify adverse effects data. The tutorial will use a scenario drawn
from a real-life situation, namely a systematic review and meta-analysis of thiazolidinedionerelated fractures in patients with type 2 diabetes mellitus. A detailed evaluation of each source
searched will be presented including the sensitivity, precision, and number needed to read from
searching each source and from different combinations of sources, and the effect of searching the
sources in different orders. At the end tips and tricks to solve specific issues in identifying information
on adverse effects will be given.
This tutorial will give guidance on the relative value and contribution of searching different sources
(database and non-database) to identify adverse effects data. The tutorial will use a scenario drawn
from a real-life situation, namely a systematic review and meta-analysis of thiazolidinedionerelated fractures in patients with type 2 diabetes mellitus. A detailed evaluation of each source
searched will be presented including the sensitivity, precision, and number needed to read from
searching each source and from different combinations of sources, and the effect of searching the
sources in different orders. At the end tips and tricks to solve specific issues in identifying information
on adverse effects will be given.
Our core work programme is funded by the NIHR, England; the Department of Health, Public Health Agency, Northern Ireland; and the National Institute for Social Care and Health Research, Welsh Assembly Government.