|
[Date Prev][Date Next]
[Chronological]
[Thread]
[Top]
[Dysphagia] Re: Reflux and feeding tubes
It seems so graphic and non-negotiable to me that we as professionals
educate, educate, educate to insure that our frail and elderly population
should not be subjected to invasive procedures to define the parameters of a
swallowing disorder, attend to those defined disorders via medical
interventions and then jump the fence. What happen to concept of dying with
dignity? We as SLP's have a role in that. The role of counseling has long
been largely ignored in our field--for all areas of
practice--developmentally delayed children, dysfluency, voice, et. al. This
is an extension of that. I truly believe that we were not educated at the
University level to take on the challenge of how to deal with the global
issues. The counseling component doesn't work if it falls into the
physician's arena, nor does it work with an FNP, PA or social worker. We
should feel challenged and step up to that challenge to insure the quality
of life until it is over. Thanks for listening, Patti
----- Original Message -----
From: <dysphagia-request@b9.com>
To: <dysphagia@b9.com>
Sent: Thursday, February 16, 2006 10:01 AM
Subject: Dysphagia Digest, Vol 27, Issue 19
> Send Dysphagia mailing list submissions to
> dysphagia@b9.com
>
> To subscribe or unsubscribe via the World Wide Web, visit
> http://lists.b9.com/mailman/listinfo/dysphagia
> or, via email, send a message with subject or body 'help' to
> dysphagia-request@b9.com
>
> You can reach the person managing the list at
> dysphagia-owner@b9.com
>
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of Dysphagia digest..."
>
>
> Today's Topics:
>
> 1. Re: reflux and feeding tubes (juliespeech)
> 2. Re: reflux and feeding tubes (wabeach@hsc.vcu.edu)
> 3. Hands on Endoscopy Practicum (Bartcyn@cs.com)
> 4. Re: reflux and feeding tubes (nando poppy)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Wed, 15 Feb 2006 17:28:43 -0500
> From: "juliespeech" <speechhuffman@nc.rr.com>
> Subject: Re: [Dysphagia] reflux and feeding tubes
> To: <dysphagia@b9.com>
> Message-ID: <007a01c6327f$2e36b350$0202a8c0@HuffmanDen>
> Content-Type: text/plain; format=flowed; charset="utf-8";
> reply-type=original
>
> Its so sad to me that we are universally not recognizing how
inappropriate
> it is to tube-feed an individual with advanced Alzheimer's. It
certainly
> makes me want to make sure my living will, and that of my family's is
ready
> to go! All the literature is so clear in this area-- why is it still
> happening when these poor folks end up hospitalized...
>
> Additionally, we can't as dysphagia therapists treat any one without
knowing
> a great deal about the esophagus, what symptoms are consistent with
> esophageal dysphagia, and what recommendations would be contraindicated
for
> a person with esophageal problems (how about meds in applesauce without
any
> fluids before or after in someone with a severe motility disorder???
yikes).
> For anyone out there still wanting to say, "that's not my part of the
> body... leave it to GI" a terrible disservice is being done. No, we
don't
> treat esophageal problems, but we can educate, properly differentiate
> oropharyngeal vs esophageal symptoms and make sure what we recommend is
> appropriate in the least!
>
> By the way, here's what ASHA has to say about it in case you think the
above
> is out of our scope of practice for the SLP. See--
> American Speech-Language-
>
> Hearing Association. (2004). Guidelines for Speechlanguage
>
> pathologists performing videofluoroscopic
>
> swallowing studies. ASHA Supplement 24, pp. 77??"92.
>
>
> Julie Huffman
> ----- Original Message -----
> From: <Drirenect@aol.com>
> To: <malindam@samhealth.org>; <dysphagia@b9.com>
> Sent: Wednesday, February 08, 2006 9:38 AM
> Subject: Re: [Dysphagia] reflux and feeding tubes
>
>
> It is unfortunate that many if not most of the difficulties associated
with
> swallowing in the patient with advanced dementing illness are
exacerbated if
> not caused by the use of anticholinergic, dopamine antagonist
> antipsychotics.
> This has been apparent for decades but only now getting more attention.
> SLPs
> could contribute significantly to the literature on the causes of
death -
> among them the malnutrition and dehydration that go along with
decreased
> intake
> of food as a result of the side efects of these medications. The
> contribution
> of these meds to mortality is high:
>
> Dec. 2, 2005
> N Engl J Med. 2005;353:2335-2341 ??" Conventional antipsychotics are at
least
> as likely as atypical agents to increase the risk for death among
elderly
> persons, and they should not replace atypical agents discontinued in
> response to
> the U.S. Food and Drug Administration (FDA) warning, according to the
> results
> of a retrospective cohort study reported in the Dec. 1 issue of The New
> England Journal of Medicine.
> "Recently, the FDA issued an advisory stating that atypical
antipsychotic
> medications increase mortality among elderly patients," write Philip S.
> Wang,
> MD, DrPH, from the Brigham and Women's Hospital, Harvard Medical School
in
> Boston, Massachusetts, and colleagues. "However, the advisory did not
apply
> to
> conventional antipsychotic medications; the risk of death with these
older
> agents is not known."
> This retrospective cohort study included 22,890 patients 65 years of age
or
> older who had drug insurance benefits in Pennsylvania and who began
> receiving
> a conventional or atypical antipsychotic medication between 1994 and
2003.
> The investigators used analyses of mortality rates and Cox
> proportional-hazards
> models to compare the risk for death within 180 days, less than 40 days,
40
> to 79 days, and 80 to 180 days after starting therapy with an
antipsychotic
> drug.
> For all intervals studied, conventional antipsychotic medications were
> associated with a significantly higher adjusted risk for death than were
> atypical
> antipsychotic medications (</=180 days: relative risk [RR], 1.37; 95%
> confidence interval [CI], 1.27 - 1.49; <40 days: RR, 1.56; 95% CI,
1.37 -
> 1.78; 40 -
> 79 days: RR, 1.37; 95% CI, 1.19 - 1.59; and 80 - 180 days: RR, 1.27;
95%
> CI,
> 1.14 - 1.41). This increased risk for death persisted in all subgroups
> defined by the presence or absence of dementia or nursing home
residency.
> The greatest increases in risk occurred soon after therapy was started
and
> with higher dosages of conventional antipsychotic drugs. Increased risks
for
> conventional vs atypical antipsychotic medications persisted in
confirmatory
> analyses using propensity-score adjustment and instrumental-variable
> estimation.
> "If confirmed, these results suggest that conventional antipsychotic
> medications are at least as likely as atypical agents to increase the
risk
> of death
> among elderly persons and that conventional drugs should not be used to
> replace atypical agents discontinued in response to the FDA warning,"
the
> authors
> write. "To place this magnitude of risk in perspective, only cancer,
> congestive heart failure, and HIV infection conferred greater adjusted
risks
> in our
> analyses."
> Study limitations include possible underestimation of mortality
resulting
> from the use of conventional agents, study based on nonexperimental
data,
> lack
> of information on potential mechanisms through which conventional
> antipsychotic medications might increase the risk for death in the
short
> term, and lack
> of data on the causes of death.
> "Beyond arousing new concern about conventional agents, our data provide
no
> guidance with regard to which pharmacologic or nonpharmacologic
> interventions
> should be used to manage the many conditions and symptoms for which
> antipsychotic medications are used," the authors conclude.
"Traditionally,
> the
> benefits and risks of treatments in the elderly have simply been
> extrapolated from
> studies involving younger populations. As the recent FDA advisory and
the
> results of this study show, such a practice can be misleading, given the
> unique
> needs and susceptibilities of older persons."
> The National Institute of Mental Health and the Agency for Healthcare
> Research and Quality have disclosed that they supported this study.
> In an accompanying perspective, Wayne A. Ray, PhD, from the Vanderbilt
> University School of Medicine in Nashville, Tennessee, notes that the
> relative
> efficacy and long-term safety, including effects on mortality, of many
> widely
> used medications, are poorly understood. He discusses methodologic
> limitations
> of various approaches designed to fill this information gap.
> "Randomized trials would provide the most reliable data; however, in the
> absence of material reform of the system for the approval of new drugs,
> there is
> little incentive to conduct such trials," Dr. Ray writes. "Nonrandomized
> studies can provide valuable information, as does the thoughtful study
by
> Wang
> and colleagues. However, observational studies of overall mortality are
> particularly susceptible to numerous biases and thus must be conducted
with
> extreme
> care."
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
>
>
> ------------------------------
>
> Message: 2
> Date: Thu, 16 Feb 2006 07:22:04 -0500
> From: <wabeach@hsc.vcu.edu>
>Subject: Re: [Dysphagia] reflux and feeding tubes
> To: "juliespeech" <speechhuffman@nc.rr.com>
> Cc: dysphagia@b9.com
> Message-ID: <200602161222.HAA26468@despina.vcu.edu>
> Content-Type: text/plain; charset=utf-8
>
> Just a brief thought. Living wills are not adequate to determine how
> aggressive medical management should be since they only obtain when
> the patient is terminally ill. A durable medical power of attorney,
> held by someone who will honor your wishes, is required to ensure that
> in non-terminal cases your wishes (whatever they are) will be carried
> out. State laws vary so make sure that you cover situations like PVS
> (which is not terminal so would not be covered by living wills).
>
> Woodford A. Beach, Ph.D., CCC/SP
> Senior Speech Pathologist
> Adjunct Asst. Professor, Neurology & PM&R
> Asst. Clinical Professor, Otolaryngology/Head & Neck Surgery
> Virginia Commonwealth University Medical Center
> Richmond, VA 23298
> Phone: 804-828-0207
> Fax: 804-828-8281
>
> -------------------
>> Its so sad to me that we are universally not recognizing how
> inappropriate
>> it is to tube-feed an individual with advanced Alzheimer's. It
> certainly
>> makes me want to make sure my living will, and that of my family's
> is ready
>> to go! All the literature is so clear in this area-- why is it
> still
>> happening when these poor folks end up hospitalized...
>>
>> Additionally, we can't as dysphagia therapists treat any one without
> knowing
>> a great deal about the esophagus, what symptoms are consistent with
>> esophageal dysphagia, and what recommendations would be
> contraindicated for
>> a person with esophageal problems (how about meds in applesauce
> without any
>> fluids before or after in someone with a severe motility disorder???
> yikes).
>> For anyone out there still wanting to say, "that's not my part of
> the
>> body... leave it to GI" a terrible disservice is being done. No, we
> don't
>> treat esophageal problems, but we can educate, properly
> differentiate
>> oropharyngeal vs esophageal symptoms and make sure what we recommend
> is
>> appropriate in the least!
>>
>> By the way, here's what ASHA has to say about it in case you think
> the above
>> is out of our scope of practice for the SLP. See--
>> American Speech-Language-
>>
>> Hearing Association. (2004). Guidelines for Speechlanguage
>>
>> pathologists performing videofluoroscopic
>>
>> swallowing studies. ASHA Supplement 24, pp. 77?-92.
>>
>>
>> Julie Huffman
>> ----- Original Message -----
>> From: <Drirenect@aol.com>
>> To: <malindam@samhealth.org>; <dysphagia@b9.com>
>> Sent: Wednesday, February 08, 2006 9:38 AM
>> Subject: Re: [Dysphagia] reflux and feeding tubes
>>
>>
>> It is unfortunate that many if not most of the difficulties
> associated with
>> swallowing in the patient with advanced dementing illness are
> exacerbated if
>> not caused by the use of anticholinergic, dopamine antagonist
>> antipsychotics.
>> This has been apparent for decades but only now getting more
> attention.
>> SLPs
>> could contribute significantly to the literature on the causes of
> death -
>> among them the malnutrition and dehydration that go along with
> decreased
>> intake
>> of food as a result of the side efects of these medications. The
>> contribution
>> of these meds to mortality is high:
>>
>> Dec. 2, 2005
>> N Engl J Med. 2005;353:2335-2341 ?- Conventional antipsychotics are
> at least
>> as likely as atypical agents to increase the risk for death among
> elderly
>> persons, and they should not replace atypical agents discontinued in
>
>> response to
>> the U.S. Food and Drug Administration (FDA) warning, according to
> the
>> results
>> of a retrospective cohort study reported in the Dec. 1 issue of The
> New
>> England Journal of Medicine.
>> "Recently, the FDA issued an advisory stating that atypical
> antipsychotic
>> medications increase mortality among elderly patients," write Philip
> S.
>> Wang,
>> MD, DrPH, from the Brigham and Women's Hospital, Harvard Medical
> School in
>> Boston, Massachusetts, and colleagues. "However, the advisory did
> not apply
>> to
>> conventional antipsychotic medications; the risk of death with these
> older
>> agents is not known."
>> This retrospective cohort study included 22,890 patients 65 years of
> age or
>> older who had drug insurance benefits in Pennsylvania and who began
>> receiving
>> a conventional or atypical antipsychotic medication between 1994
> and 2003.
>> The investigators used analyses of mortality rates and Cox
>> proportional-hazards
>> models to compare the risk for death within 180 days, less than 40
> days, 40
>> to 79 days, and 80 to 180 days after starting therapy with an
> antipsychotic
>> drug.
>> For all intervals studied, conventional antipsychotic medications
> were
>> associated with a significantly higher adjusted risk for death than
> were
>> atypical
>> antipsychotic medications (</=180 days: relative risk [RR], 1.37;
> 95%
>> confidence interval [CI], 1.27 - 1.49; <40 days: RR, 1.56; 95% CI,
> 1.37 -
>> 1.78; 40 -
>> 79 days: RR, 1.37; 95% CI, 1.19 - 1.59; and 80 - 180 days: RR, 1.27;
> 95%
>> CI,
>> 1.14 - 1.41). This increased risk for death persisted in all
> subgroups
>> defined by the presence or absence of dementia or nursing home
> residency.
>> The greatest increases in risk occurred soon after therapy was
> started and
>> with higher dosages of conventional antipsychotic drugs. Increased
> risks for
>> conventional vs atypical antipsychotic medications persisted in
> confirmatory
>> analyses using propensity-score adjustment and instrumental-variable
>> estimation.
>> "If confirmed, these results suggest that conventional antipsychotic
>> medications are at least as likely as atypical agents to increase
> the risk
>> of death
>> among elderly persons and that conventional drugs should not be used
> to
>> replace atypical agents discontinued in response to the FDA
> warning," the
>> authors
>> write. "To place this magnitude of risk in perspective, only cancer,
>> congestive heart failure, and HIV infection conferred greater
> adjusted risks
>> in our
>> analyses."
>> Study limitations include possible underestimation of mortality
> resulting
>> from the use of conventional agents, study based on nonexperimental
> data,
>> lack
>> of information on potential mechanisms through which conventional
>> antipsychotic medications might increase the risk for death in the
> short
>> term, and lack
>> of data on the causes of death.
>> "Beyond arousing new concern about conventional agents, our data
> provide no
>> guidance with regard to which pharmacologic or nonpharmacologic
>> interventions
>> should be used to manage the many conditions and symptoms for which
>> antipsychotic medications are used," the authors conclude.
> "Traditionally,
>> the
>> benefits and risks of treatments in the elderly have simply been
>> extrapolated from
>> studies involving younger populations. As the recent FDA advisory
> and the
>> results of this study show, such a practice can be misleading, given
> the
>> unique
>> needs and susceptibilities of older persons."
>> The National Institute of Mental Health and the Agency for
> Healthcare
>> Research and Quality have disclosed that they supported this study.
>> In an accompanying perspective, Wayne A. Ray, PhD, from the
> Vanderbilt
>> University School of Medicine in Nashville, Tennessee, notes that
> the
>> relative
>> efficacy and long-term safety, including effects on mortality, of
> many
>> widely
>> used medications, are poorly understood. He discusses methodologic
>> limitations
>> of various approaches designed to fill this information gap.
>> "Randomized trials would provide the most reliable data; however, in
> the
>> absence of material reform of the system for the approval of new
> drugs,
>> there is
>> little incentive to conduct such trials," Dr. Ray writes.
> "Nonrandomized
>> studies can provide valuable information, as does the thoughtful
> study by
>> Wang
>> and colleagues. However, observational studies of overall mortality
> are
>> particularly susceptible to numerous biases and thus must be
> conducted with
>> extreme
>> care."
>>
>> _______________________________________________
>> Dysphagia mailing list
>> Dysphagia@b9.com
>> http://lists.b9.com/mailman/listinfo/dysphagia
>>
>>
>> _______________________________________________
>> Dysphagia mailing list
>> Dysphagia@b9.com
>> http://lists.b9.com/mailman/listinfo/dysphagia
>>
>>
> Woodford A. Beach, Ph.D., CCC/SP
> Senior Speech Language Pathologist, VCUMC
> Adjunct Asst. Professor, Neurology
> Adjunct Asst. Professor, PM&R
> Asst. Clinical Professor, Otolaryngology/Head & Neck Surgery
> Virginia Commonwealth University
> Richmond, VA 23298
>
>
>
> ------------------------------
>
> Message: 3
> Date: Thu, 16 Feb 2006 08:26:31 -0500
> From: Bartcyn@cs.com
> Subject: [Dysphagia] Hands on Endoscopy Practicum
> To: asha-div13@lists.asha.org, dysphagia@b9.com
> Message-ID: <47080FAB.15642AF0.0015B7D3@cs.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> A few spaces are still available for the 2 day course in Orlando, March
11th and 12th, 2006 with Mike Crary and Giselle Mann, supported by KayPentax
and Medtronic Xomed. They will supply different systems (including
pediatric scopes) and we will use the sterile endosheaths. MANY
opportunities to scope each other and sign off on supervised scopes of
normals. An Intro course is available as a home/study for review, and/or to
get you up to speed to scope the first day.
> There are some incredible air fares specials online to Orlando, and the
hotel block closes 2-28-06 at $105.
> Call Cindy at 352-256-6082 for more information
>
>
> ------------------------------
>
> Message: 4
> Date: Thu, 16 Feb 2006 09:02:06 -0500
> From: "nando poppy" <nando11504@hotmail.com>
> Subject: Re: [Dysphagia] reflux and feeding tubes
> To: speechhuffman@nc.rr.com, dysphagia@b9.com
> Message-ID: <BAY105-F21E52D31ED2308AE0E34FE94FB0@phx.gbl>
> Content-Type: text/plain; format=flowed
>
> why do they keep putting tubes into adv. alzheimers? $$$$$$$$$$$$$.
For
> some reason we can not allow someone to die in this country, that we
have to
> do whatever it takes to keep them alive. it's a shame. we can put an
> animal to sleep when it is in pain, but not a human when they state they
> want to die.
>
>
>>From: "juliespeech" <speechhuffman@nc.rr.com>
>>To: <dysphagia@b9.com>
>>Subject: Re: [Dysphagia] reflux and feeding tubes
>>Date: Wed, 15 Feb 2006 17:28:43 -0500
>>
>>Its so sad to me that we are universally not recognizing how
inappropriate
>>it is to tube-feed an individual with advanced Alzheimer's. It
certainly
>>makes me want to make sure my living will, and that of my family's is
ready
>>to go! All the literature is so clear in this area-- why is it still
>>happening when these poor folks end up hospitalized...
>>
>>Additionally, we can't as dysphagia therapists treat any one without
>>knowing a great deal about the esophagus, what symptoms are consistent
with
>>esophageal dysphagia, and what recommendations would be contraindicated
for
>>a person with esophageal problems (how about meds in applesauce without
any
>>fluids before or after in someone with a severe motility disorder???
>>yikes). For anyone out there still wanting to say, "that's not my part
of
>>the body... leave it to GI" a terrible disservice is being done. No, we
>>don't treat esophageal problems, but we can educate, properly
differentiate
>>oropharyngeal vs esophageal symptoms and make sure what we recommend is
>>appropriate in the least!
>>
>>By the way, here's what ASHA has to say about it in case you think the
>>above is out of our scope of practice for the SLP. See--
>>American Speech-Language-
>>
>>Hearing Association. (2004). Guidelines for Speechlanguage
>>
>>pathologists performing videofluoroscopic
>>
>>swallowing studies. ASHA Supplement 24, pp. 77??"92.
>>
>>
>>Julie Huffman
>>----- Original Message ----- From: <Drirenect@aol.com>
>>To: <malindam@samhealth.org>; <dysphagia@b9.com>
>>Sent: Wednesday, February 08, 2006 9:38 AM
>>Subject: Re: [Dysphagia] reflux and feeding tubes
>>
>>
>>It is unfortunate that many if not most of the difficulties associated
with
>>swallowing in the patient with advanced dementing illness are
exacerbated
>>if
>>not caused by the use of anticholinergic, dopamine antagonist
>>antipsychotics.
>>This has been apparent for decades but only now getting more attention.
>>SLPs
>>could contribute significantly to the literature on the causes of
death -
>>among them the malnutrition and dehydration that go along with
decreased
>>intake
>>of food as a result of the side efects of these medications. The
>>contribution
>>of these meds to mortality is high:
>>
>>Dec. 2, 2005
>>N Engl J Med. 2005;353:2335-2341 ??" Conventional antipsychotics are at
>>least
>>as likely as atypical agents to increase the risk for death among
elderly
>>persons, and they should not replace atypical agents discontinued in
>>response to
>>the U.S. Food and Drug Administration (FDA) warning, according to the
>>results
>>of a retrospective cohort study reported in the Dec. 1 issue of The New
>>England Journal of Medicine.
>>"Recently, the FDA issued an advisory stating that atypical
antipsychotic
>>medications increase mortality among elderly patients," write Philip S.
>>Wang,
>>MD, DrPH, from the Brigham and Women's Hospital, Harvard Medical School
in
>>Boston, Massachusetts, and colleagues. "However, the advisory did not
apply
>>to
>>conventional antipsychotic medications; the risk of death with these
older
>>agents is not known."
>>This retrospective cohort study included 22,890 patients 65 years of age
or
>>older who had drug insurance benefits in Pennsylvania and who began
>>receiving
>>a conventional or atypical antipsychotic medication between 1994 and
2003.
>>The investigators used analyses of mortality rates and Cox
>>proportional-hazards
>>models to compare the risk for death within 180 days, less than 40 days,
40
>>to 79 days, and 80 to 180 days after starting therapy with an
>>antipsychotic
>>drug.
>>For all intervals studied, conventional antipsychotic medications were
>>associated with a significantly higher adjusted risk for death than were
>>atypical
>>antipsychotic medications (</=180 days: relative risk [RR], 1.37; 95%
>>confidence interval [CI], 1.27 - 1.49; <40 days: RR, 1.56; 95% CI,
1.37 -
>>1.78; 40 -
>>79 days: RR, 1.37; 95% CI, 1.19 - 1.59; and 80 - 180 days: RR, 1.27;
95%
>>CI,
>>1.14 - 1.41). This increased risk for death persisted in all subgroups
>>defined by the presence or absence of dementia or nursing home
residency.
>>The greatest increases in risk occurred soon after therapy was started
and
>>with higher dosages of conventional antipsychotic drugs. Increased risks
>>for
>>conventional vs atypical antipsychotic medications persisted in
>>confirmatory
>>analyses using propensity-score adjustment and instrumental-variable
>>estimation.
>>"If confirmed, these results suggest that conventional antipsychotic
>>medications are at least as likely as atypical agents to increase the
risk
>>of death
>>among elderly persons and that conventional drugs should not be used to
>>replace atypical agents discontinued in response to the FDA warning,"
the
>>authors
>>write. "To place this magnitude of risk in perspective, only cancer,
>>congestive heart failure, and HIV infection conferred greater adjusted
>>risks in our
>>analyses."
>>Study limitations include possible underestimation of mortality
resulting
>>from the use of conventional agents, study based on nonexperimental
data,
>>lack
>>of information on potential mechanisms through which conventional
>>antipsychotic medications might increase the risk for death in the
short
>>term, and lack
>>of data on the causes of death.
>>"Beyond arousing new concern about conventional agents, our data provide
no
>>guidance with regard to which pharmacologic or nonpharmacologic
>>interventions
>>should be used to manage the many conditions and symptoms for which
>>antipsychotic medications are used," the authors conclude.
"Traditionally,
>>the
>>benefits and risks of treatments in the elderly have simply been
>>extrapolated from
>>studies involving younger populations. As the recent FDA advisory and
the
>>results of this study show, such a practice can be misleading, given the
>>unique
>>needs and susceptibilities of older persons."
>>The National Institute of Mental Health and the Agency for Healthcare
>>Research and Quality have disclosed that they supported this study.
>>In an accompanying perspective, Wayne A. Ray, PhD, from the Vanderbilt
>>University School of Medicine in Nashville, Tennessee, notes that the
>>relative
>>efficacy and long-term safety, including effects on mortality, of many
>>widely
>>used medications, are poorly understood. He discusses methodologic
>>limitations
>>of various approaches designed to fill this information gap.
>>"Randomized trials would provide the most reliable data; however, in the
>>absence of material reform of the system for the approval of new drugs,
>>there is
>>little incentive to conduct such trials," Dr. Ray writes. "Nonrandomized
>>studies can provide valuable information, as does the thoughtful study
by
>>Wang
>>and colleagues. However, observational studies of overall mortality are
>>particularly susceptible to numerous biases and thus must be conducted
>>with extreme
>>care."
>>
>>_______________________________________________
>>Dysphagia mailing list
>>Dysphagia@b9.com
>>http://lists.b9.com/mailman/listinfo/dysphagia
>>
>>
>>_______________________________________________
>>Dysphagia mailing list
>>Dysphagia@b9.com
>>http://lists.b9.com/mailman/listinfo/dysphagia
>
> _________________________________________________________________
> Express yourself instantly with MSN Messenger! Download today - it's
FREE!
> http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/
>
>
>
> ------------------------------
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
> End of Dysphagia Digest, Vol 27, Issue 19
> *****************************************
>
>
> --
> No virus found in this incoming message.
> Checked by AVG Free Edition.
> Version: 7.1.375 / Virus Database: 267.15.9/261 - Release Date:
2/15/2006
>
>
--------------------------------------------------------------------------------
|
|