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zondag 12 februari 2017

DTB: Spironolactone--potion or poison?

Spironolactone--potion or poison?

In 1999, the Randomized Aldactone Evaluation Study (RALES) demonstrated that spironolactone reduced mortality from 46% to 35% in patients with a history of severe heart failure.1 A subsequent review in the American Family Physician journal concluded that spironolactone is safe, easy to use and reasonably priced.2 In February 2016, the MHRA advised that "concomitant use of spironolactone with ACEi or ARB is not routinely recommended because of the risks of severe hyperkalaemia, particularly in patients with marked renal impairment".3 One of the triggers for the warning came from a coroner's Regulation 28 report on a patient who had died from hyperkalaemia associated with the use of spironolactone and lisinopril. Nevertheless, the MHRA advice seemed out of step with major guidelines on the management of heart failure and the summary of product characteristics (SPC) for spironolactone.4–6 Although RALES included patients...

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DTB Select: 2 | February 2017

MHRA clarifies spironolactone advice Statin dosing: morning or evening? PPI use and risk of community-acquired pneumonia Non-inferiority trials: caution needed CV safety of celecoxib? ADRs and emergency department visits Study questions use of duloxetine in stress incontinence New oral anticoagulants: more on GI bleeding risk

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Understanding qualitative research in health care

Qualitative studies are often used to research phenomena that are difficult to quantify numerically.1,2 These may include concepts, feelings, opinions, interpretations and meanings, or why people behave in a certain way. Although qualitative research is often described in opposition to quantitative research, the approaches are complementary, and many researchers use mixed methods in their projects, combining the strengths of both approaches.2 Many comprehensive texts exist on qualitative research methodology including those with a focus on healthcare related research.2-4 Here we give a brief introduction to the rationale, methods and quality assessment of qualitative research.

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{blacktriangledown} Daclizumab for MS

Daclizumab (Zinbryta—Biogen Idec) is a new injectable disease-modifying drug licensed for the treatment of relapsing forms of multiple sclerosis (MS) in adults.1 It is a humanised monoclonal antibody that modulates interleukin-2 signalling.1-3 Here, we review the evidence on daclizumab and consider its place in the management of MS.

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