How the literature can help in medical treatment

Experience from various hospitals has shown that the information received from journal literature, indexes and databases has a direct positive impact in improving patient care. Twenty percent of the doctors interviewed advised that the information supplied to them directly influenced their treatment of patients and altered their methods applied in patient care. Speed and precision is very important in supplying information to the medical doctors and health professionals in order to give them time to digest the information before the decision on treatment is made. Some of the indexes and databases are briefly described, which will give the necessary information with the minimum time and effort for use in medical treatment. Machinery of access to the databases and indexes is suggested with the accent on the microcomputer programs which will allow even the health professionals and librarians who might be unfamiliar with the search techniques to use the databases and indexes effectively.     

Violence among persons diagnosed with schizophrenia: How pharmacists can help

Violence among those diagnosed with schizophrenia has been reported but is not a diagnostic component of the disorder. The position of the courts regarding fulfillment of the requisite intent to commit violent acts has not been extensively reported. This article discusses the impact of a diagnosis of schizophrenia in an individual and how the pharmacist can help integrate information into the health care system. The recent Supreme Court case of Clark versus Arizona and the older case of Patterson versus Cockrell are discussed with respect to the concept of intent (to commit the act) and the implications this has on an individual in the midst of a psychotic episode. Quality of life, the perception of the stigma associated with a diagnosis of schizophrenia, and pharmacotherapy are briefly discussed. The origin of schizophrenia is multifactorial. Persons with schizophrenia are not innately violent, but alteration in perception may precipitate aggressive acts. Given the complex and diverse nature of schizophrenia and the fact that even with successful pharmacological treatment residual symptoms may still be present, there is a need to provide information to health care practitioners and the court.     

How health services research can help clinical trials become more community relevant

U.S. agencies that fund addiction research have recently made major efforts to bridge “the gap between research and treatment”. One strategy developed by the National Institute on Drug Abuse is the “Clinical Trials Network”, which is designed to conduct effectiveness studies in real world, community-based programs rather than research settings. While a step in the right direction, these studies have focused almost exclusively on the effectiveness of standard treatment interventions using limited research methodologies. Health services issues that will determine the long-term acceptance or rejection of these interventions in the community have been largely ignored: the effects of process variables, how public health policy facilitates or hinders implementation, the perspectives and experiences of various stakeholders, and the relationships between addiction treatment and other community-based services. This paper suggests that addiction researchers need to look beyond the question of whether an intervention is “effective” and examine the community context within which those interventions are delivered. Adding this health services view to compliment clinical trials research requires examination of new research questions, broader designs of studies, modifications in the collection of data, and assessment of addiction policy. Recent studies examining recovery from addiction in sober living and Oxford houses are described as examples of community relevant research that could benefit from additional health services research.     

How adverse drug reactions can play a role in innovative drug research

We describe how adverse drug reactions (ADRs) can play an important role in pharmaceutical research and drug development. Not only do ADRs represent the risks and drawbacks associated with drugs but they can also be related to other knowledge available in pharmaceutical and medical research. We offer a model that can be used to systematically map the pathways through which ADRs can lead to innovative research. These pathways include chemical, therapeutic or pathophysiological steps that can be taken to arrive at new knowledge based on ADRs. We used the development of angiotensin-converting enzyme inhibitors, especially captopril, as a case study. The similarity between the ADR profiles of captopril and penicillamine was a starting point for further innovation. Historical analysis shows that in several instances research in the field of angiotensin-converting enzyme inhibitors has been triggered by ADRs. The model presented here might be applicable to other areas of innovative drug research.