伐伦克林对戒除低烟量烟草的帮助随机双盲安慰剂对照研

11December2010Volume341,Issue7785一.Research1.Stoppingsmokelesstobaccowithvarenicline:randomiseddoubleblindplacebocontrolledtrial伐伦克林对戒除低烟量烟草的帮助：随机双盲安慰剂对照研究2.Riskofrecurrenceafterafirstseizureandimplicationsfordriving:furtheranalysisoftheMulticentrestudyofearlyEpilepsyandSingleSeizures首次癫痫发作后再发风险及其对驾驶的影响：早期癫痫和单次发作的多中心研究的进一步分析3.Intrauterineexposuretocarbamazepineandspecificcongenitalmalformations:systematicreviewandcase-controlstudy卡马西平的宫内暴露和先天畸形：系统回顾和病例对照研究4.Non-specificeffectsofstandardmeaslesvaccineat4.5and9monthsofageonchildhoodmortality:randomisedcontrolledtrial在4.5-9个月时接种标准麻疹疫苗对儿童死亡率的非特异性效果：随机对照试验二.ClinicalReviewInvestigatingandmanagingchronicscrotalpain调查和处理慢性阴囊疼痛三.Practice1.EasilyMissed?:Infectiveendocarditis容易忽视：？感染性心内膜炎2.LessonoftheWeek:Acuteliverfailureafteradministrationofparacetamolatthemaximumrecommendeddailydoseinadults本周课程：成人扑热息痛每日最大推荐用量使用时的急性肝衰竭四.AnalysisHowdopatientsuseinformationonhealthproviders?病人如何利用关于健康提供者的信息Whatdopatientswantofperformanceinformation?病人想要什么样的表现信息？五.ObservationsLobbyWatch:TheInstituteforFiscalStudiesLobbyWatch：财政研究学院六.FeatureResearchEthics:Therulesofretraction研究伦理学：撤销的法则Briefing:TheBriberyAct:whatitmeansforyou主要信息：受贿艺术：对你意味着什么呢？ConflictandRape:Afterwar,whatnext?冲突和强奸：战后，接下来是什么呢？Commentary:whatinterventionsworkforvictimsofconflictrelatedrape?评论：什么样的噶怒措施对冲突中的强奸受害人有用呢？七.News1.Lowdoseaspirinreducesriskofdyingfromarangeofcancers小剂量阿司匹林可降低多种癌症死亡的风险2.NegotiatorstrytopersuadeJapan,Canada,andRussiatosoftenoppositiontoclimatetreaty谈判专家努力说服日本，加拿大和俄罗斯软化对气候变化协议的反对3.Consultantsshouldbeavailabletoadmitpatientstohospital12hoursaday顾问应该对住院病人提供每天12小时可能的服务4.SeniorToryministerisaskedtoscrutiniseLansley’splansforNHS保守党资深部长要求审议国民保健服务Lansley计划5.Cutsinsocialcarecouldputpressureonhospitalstocarefordyingpatients在社会关怀的削减可能把照顾临终病人的压力转嫁给医院6.Frenchdoctorsdemandtoknowwhydrugstayedonthemarketforsolong法国医生要求知道药物在市场上停留如此久的原因7.EuropeanMedicinesAgencywidensaccesstoitsdocuments欧洲药品管理局扩大获取其文件的范围8.Newcentreopensupclinicaltrialstomorecancerpatients新中心对更多的癌症患者开放临床试验9.TightregulationofFrenchdrugrepsmeanFrenchdoctorsgetmorebalancedinformationthandoctorsintheUS与法国医药代表的紧密关系意味着法国医生获得比美国医生更多的平衡信息10.IndependentdrugreviewgroupinCanadaissqueezedout加拿大独立审查组药物小组财政紧张八.Research摘要1.Stoppingsmokelesstobaccowithvarenicline:randomiseddoubleblindplacebocontrolledtrial伐伦克林对戒除低烟量烟草的帮助：随机双盲安慰剂对照研究ObjectiveToassesstheefficacyandsafetyofvarenicline(alicensedcigarettesmokingcessationaid)inhelpingusersofsmokelesstobaccotoquit.DesignDoubleblind,placebocontrolled,parallelgroup,multicentre,randomisedcontrolledtrial.SettingMedicalclinics(mostlyprimarycare)inNorwayandSweden.ParticipantsMenandwomenaged≥18whousedsmokelesstobaccoatleasteighttimesaday,withnoabstinenceperiodoverthreemonthswithinoneyearbeforescreening,whowantedtoquitalltobaccouse.Participantswereexcludediftheyusedanyotherformoftobacco(exceptsmokelesstobacco)ormedicationtostopsmokingwithinthreemonthsofscreeningorhadanypre-existingmedicalorpsychiatriccondition.InterventionsVarenicline1mgtwicedaily(titratedduringthefirstweek)orplacebofor12weeks,with14weeks’follow-upaftertreatment.MainoutcomemeasuresTheprimaryendpointwasthefourweekcontinuousabstinencerateattheendoftreatment(weeks9-12)confirmedwithcotinineconcentration.Asecondaryendpointwascontinuousabstinencerateforweeks9-26.Safetyandtolerabilitywerealsoevaluated.Results431participants(213varenicline;218placebo)wererandomisedandreceivedatleastonedoseofstudydrug.Participants’demographicsandbaselineuseofsmokelesstobaccoweresimilar(89%(189)and90%(196),respectively,weremen;meanageinbothgroupswas43.9;participantsusedsmokelesstobaccoproductsabout15timesaday,andabout80%firstusedsmokelesstobaccowithin30minutesafterawakening).Continuousabstinencerateatweek9-12washigherinthevareniclinegroupthantheplacebogroup(59%(125)v39%(85);relativerisk1.60,95%confidenceinterval1.32to1.87,P0.001;riskdifference20%;numberneededtotreat5).Theadvantageofvareniclineoverplacebopersistedthrough14weeksoffollow-up(continuousabstinencerateatweek9-26was45%(95)v34%(73);relativerisk1.42,1.08to1.79,P=0.012;riskdifference11%;numberneededtotreat9).Themostcommonadverseeventsinthevareniclinegroupcomparedwiththeplacebogroupwerenausea(35%(74)v6%(14)),fatigue(10%(22)v7%(15)),headache(10%(22)v9%(20)),andsleepdisorder(10%(22)v7%(15)).Fewadverseeventsledtodiscontinuationoftreatment(9%(19)and4%(9),respectively),andseriousadverseeventsoccurredintwo(1%)andthree(1%)participants,respectively.ConclusionVareniclinecanhelppeopletogiveupsmokelesstobaccoandhasanacceptablesafetyprofile.Theresponserateintheplacebogroupinthisstudywashigh,suggestingapopulationlessresistanttotreatmentthansmokers.2.Riskofrecurrenceafterafirstseizureandimplicationsfordriving:furtheranalysisoftheMulticentrestudyofearlyEpilepsyandSingleSeizures首次癫痫发作后再发风险及其对驾驶的影响：早期癫痫和单次发作的多中心研究的进一步分析ObjectiveTodetermineforhowlongafterafirstunprovokedseizureadrivermustbeseizure-freebeforetheriskofrecurrenceinthenext12monthsfallsbelow20%,enablingthemtoregaintheirdrivinglicence.DesignRandomisedcontrolledtrial:MulticentrestudyofearlyEpi