#16
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Öèòàòà:
àãà, â ñëó÷àå ñåðüåçíûõ Íß, êîòîðûå òðåáóþò âñêðûòèÿ ëå÷åíèÿ äëÿ ïðèíÿòèÿ ðåøåíèÿ äëÿ îêàçàíèÿ ïîìîùè ïàöèåíòîâ, èõ íå ìîãëî áûòü ìíîãî. Çíàÿ, êàê Âû ïîñòîÿííî ìàíèïóëèðóåòå äàííûìè, íå ïðèõîäèòñÿ Âàì âåðèòü.
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Ñ óâàæåíèåì |
#17
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ß ìíîãî ÷åãî ìîãó ñàìîñòîÿòåëüíî. Íî îòñóòñòâèå óêàçàíèÿ àáñîëþòíîãî ðèñêà â ïóáëèêàöèè - íå áîëåå, ÷åì ýëåìåíò ìàíèïóëÿöèè àóäèòîðèåé, óâû.
Êñòàòè, êîãäà ïðèõîäèòñÿ îáùàòüñÿ ñ ïàöèåíòàìè, êîòîðûå óæå óñïåëè îçíàêîìèòñÿ ñ äàííûìè íåêèõ èññëåäîâàíèé (èëè ñ ìåä. ðåêëàìîé çà ðóáåæîì) è ñïðàøèâàþò î áëàãàõ êîíêðåòíîé òåðàïèè, îáñóæäåíèå àáñîëþòíîãî ðèñêà ñîáûòèÿ îêàçûâàåòñÿ áîëåå ïîëåçíûì. Íó äà ýòî òîæå ìîè ïðîáëåìû è ôàðìèíäóñòðèþ îíè íå âîëíóþò (íå óäèâëþñü, åñëè ïëàíû ïî "ïðîäâèæåíèþ" ãëèôëîçèíîâ ñåé÷àñ áóäóò äàâàòü èìåííî êàðäèîëîãè÷åñêèì ïîäðàçäåëåíèÿì ìàðêåòèíãîâîé ñëóæáû ïðîèçâîäÿùèõ êîìïàíèé). |
#18
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Ê ïîñëåäíåìó âàøåìó êîììåíòàðèþ: îïÿòü äîìûñëèâàíèå çà ñîáåñåäíèêà, à ïîïðîñòó ãîâîðÿ, âðàíü¸. Äàííûìè ÿ íèêîãäà íå ìàíèïóëèðóþ, òàê ÷òî ýòî ëèøü åù¸ îäèí ïîêë¸ï, îñòàþùèéñÿ íà âàøåé ñîâåñòè, áóäå òàêîâàÿ èìååòñÿ.
Ìîãó ëèøü ñêàçàòü, ÷òî ðàçãîâàðèâàòü ñ Âàìè ìíå î÷åíü òÿæåëî, à äîâåðèå òàêæå èññÿêëî. Ì.á., íà ýòèõ æèâîòðåïåùóùèõ íîòàõ èìååò ñìûñë îñòàíîâèòüñÿ? |
#19
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Öèòàòà:
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Ñ óâàæåíèåì |
#20
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Êàê âñåãäà, äåìàãîãèÿ, ëîæü è õàìñòâî....
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#21
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êàê îáû÷íî, âìåñòî ïðèâåäåíèÿ êîíêðåòíûõ äàííûõ - ñ Âàøåé ñòîðîíû îñêîðáëåíèÿ è îáùèå ñëîâà, èáî ñêàçàòü íå÷åãî
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Ñ óâàæåíèåì |
#22
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Íåâîçìîæíî îáùàòüñÿ ñ ÷åëîâåêîì, îòðèöàþùèì íåîáõîäèìîñòü óêàçûâàòü àáñîëþòíûé ðèñê. Äà è î ïðî÷åì áûëî óæå ãîâîðåíî, à ïîäîáèå âåæëèâîñòè Âû îòðèíóëè ïåðâîé.
À ïðî ARR áûë õîðîøèé êîììåíòàðèé Äàéìîíäà è Ðàíñêîâà â îòâåò íà îòçûâ ê èõ ñòàòüå: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ìíå òàì ñèìïàòè÷íû ñëîâà î ïåðâîðîäíîì ãðåõå. Íî ýòî ÿ òàê, ê ñëîâó. Ñêàçàòü âàì ÷òî-òî ñâåðõ óæå ñêàçàííîãî ÿ è ïðàâäà íå ìîãó. |
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#23
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Òåìà êðàéíå âàæíàÿ äëÿ èíòåðïðåòàöèè äàííûõ. Âîò òîëüêî áû ëè÷íîãî ôàêòîðà ïîìåíåå.....
Îòíîñèòåëüíûé ðèñê äåìîíñòðàòèâåí òîëüêî êîãäà àáñîëþòíûå ðèñêè ñòàòèñòè÷åñêè çíà÷èìî îòëè÷àþòñÿ äðóã îò äðóãà. Îí òîãäà ñëóæèò êâàíòèôèêàöèåé ðàçíèöû ìåæäó ãðóïïàìè. Íî â ãðîìàäíîì ìíîæåñòâå ñëó÷àåâ, àáñîëþòíûå ðèñêè ñòàòèñòè÷åñêè íåðàçëè÷èìû íåñìîòðÿ íà êàæóùóþñÿ ðàçíèöó â àáñîëþòíûõ öèôðàõ èõ ñðåäíèõ âåëè÷èí. È âîò òîãäà åñòü ñîáëàçí ýòó "ðàçíèöó" ïðåäñòàâèòü êàê ÷òî-òî ðåàëüíîå: îòíîñèòåëüíûé ðèñê èä¸ò íà âûðó÷êó:-) ß íè÷óòü íå ïðîòèâ îòíîñèòåëüíîãî ðèñêà, íî îí èìååò ïðàâî èñïîëüçîâàòüñÿ òîëüêî êàê âòîðè÷íûé àíàëèç, êîãäà åñòü òâ¸ðäîå ñòàòèñòè÷åñêîå äîêàçàòåëüñòâî ðàçíèöû â àáñîëþòíûõ ðèñêàõ. Áåç ýòîãî îí áåññìûñëåí è îáìàí÷èâ. Îòíîñèòåëüíûé ðèñê ýòî îäèí èç ñàìûõ ëþáèìûõ ïðèìåðîâ êíèã ïðîôåññèîíàëüíûõ ñòàòèñòèêîâ ñ çàãëàâèÿìè òèïà " êàê âðàòü â ñòàòèñòèêå":-)
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Dr.B |
#24
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Íàâåðíîå, åñòü êàêîé - òî èñòîðè÷åñêèé øëåéô â ñïîðå êàðäèîëîãà è ýíäîêðèíîëîãà ïî òåìå ÑÄ è êàðäèíàëüíûå ðèñêè, è õî÷ó âåðèòü, ÷òî ãîðÿ÷íîñòü ñâÿçàíà èìåííî ñ ïðîôåññèîíàëüíîé çàèíòåðåñîâàííîñòüþ â äîêàçàííî îïòèìàëüíîì ïðåïàðàòå , êîòîðûé , â ñîîòâåòñòâèè ñ óêàçàíèÿìè FDA , è ãëþêîçó ñíèæàåò, è êàðäèíàëüíûå ðèñêè íå óâåëè÷èâàåò, à â èäåàëå óìåíüøàåò( ëþáîïûòíî, ÷òî ñòîèëî ïîñëå ðîñèãëèòàçîíà ïîÿâèòüñÿ òàêîìó òðåáîâàíèþ, êàê íà÷àëè ïîÿâëÿòüñÿ åìó ñîîòâåòñòâóþùèå ïðåïàðàòû)
Ñîâñåì íåäàâíî ìû ñ èçóìëåíèåì íàáëþäàëè çà ïûëêîé ëþáîâüþ êàðäèîëîãîâ ê àêàðáîçå ñ êîíöåïöèåé å¸ ïðîôèëàêòèçèðóþùåãî ýôôåêòà, òåïåðü âðîäå êàê àêàðáîçà çàáûòà. Ñåé÷àñ ìû îòðèöàåì âåðñèþ î òîì, ÷òî óëó÷øåíèå ïðè äèàáåòå íà SGLT2 ñâÿçàíî ñ ìî÷åãîííûì ýôôåêòîì ãëþêîçóðèè, íî èìåííî ìî÷åãîííûì ýôôåêòîì ãëþêîçóðèè è óâåëè÷åíèåì âÿçêîñòè îáúÿñíÿåò óâåëè÷åíèå àìïóòàöèé , ïðè÷¸ì âåäü íå òîëüêî çà ñ÷¸ò áîëüøîãî ïàëüöà. Èíôåêöèè ìî÷åâûõ ïóòåé è êåòîàöèäîç ïîíÿòíû, íî íè îäíà ìîëåêóëà ìèðà íå ñòîèò îáèäû êîëëåãè, ïðè÷¸ì êîëëåãè, ÷åñòíî è ñåðü¸çíî ðàáîòàþùåãî.
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Ã.À. Ìåëüíè÷åíêî |
#25
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Ðåöåíçèðîâàííàÿ ñòàòüÿ
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Dapagliflozin in patients with type 2 diabetes mellitus: a pooled analysis of safety data from Phase 2b/3 clinical trials Aim Dapagliflozin is a highly selective sodium–glucose cotransporter-2 inhibitor for the treatment of type 2 diabetes mellitus (T2DM). This pooled analysis evaluated the safety and tolerability of dapagliflozin in patients with T2DM. Methods Data were pooled from 13 placebo-controlled trials of up to 24 weeks’ duration (dapagliflozin, n=2360; placebo, n=2295). Larger placebo/comparator-controlled pools of 21 (≤208 week; dapagliflozin, n=5936; control, n=3403) and 30 trials (≥12 week; dapagliflozin, n=9195; control, n=4629) assessed the rare adverse events (AEs) of diabetic ketoacidosis (DKA) and lower-limb amputation, respectively. Results Over 24 weeks, the overall incidence of AEs and serious AEs (SAEs) was comparable for dapagliflozin and placebo; 60.0% versus 55.7% and 5.1% versus 5.4%, respectively. Rates of hypoglycemia, volume depletion AEs, urinary tract infections (UTIs) and fractures were balanced between groups. Genital infections were more frequent with dapagliflozin (5.5%) versus placebo (0.6%) and renal function AEs occurred in 3.2% versus 1.8% of patients (most common renal AE was decreased creatinine clearance: 1.1% versus 0.7%). In the 21-study pool, one SAE of DKA and three AEs of ketonuria/metabolic acidosis occurred with dapagliflozin versus none with control; estimated combined incidence for these events was 0.03% (95% CI:0.010–0.089). In the 30-study pool, lower-limb amputation occurred in eight (0.1%) and seven (0.2%) patients receiving dapagliflozin and control, respectively. Conclusion The overall incidence of AEs and SAEs was comparable in the dapagliflozin and placebo/control groups, including the incidence of hypoglycemia, volume depletion, fractures, UTIs, amputations and DKA. Genital infections were more frequent with dapagliflozin than placebo.
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Ñ óâàæåíèåì |
#26
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Îáíàðóæèëà ïðîäîëæåíèå ïåðåïèñêè òîëüêî ñåé÷àñ, èáî òîãäà áûëî íå äî ýòîãî, ãîòîâèëàñü ê ðîäàì. Îïÿòü ñî ñòîðîíû ãîñïîäèíà Ñàìèòèíà ïåðåäåðãèâàíèè ñëîâ, ðå÷ü øëà íå îá îòðèöàíèè âàæíîñòè ARR, à î òîì, ÷òî íå íóæíî îáâèíÿòü èññëåäîâàòåëåé â ïîïûòêå ââåñòè çàáëóæäåíèå òîëüêî èç-çà òîãî, ÷òî îíè íå óêàçàëè ARR. Åå ìîæíî ðàññ÷èòàòü ñàìîñòîÿòåëüíî. Âïðî÷åì, ñìûñëà äàëüíåéøèõ äèñêóññèé ñ íèì íå âèæó.
Îòíîñèòåëüíî àìïóòàöèé, ïîâòîðþñü: ïîâûøåííûé ðèñê àìïóòàöèé ïðîäåìîíñòðèðîâàí ïîêà òîëüêî íà êàíàãëèôëîçèíå, êîòîðûé ÿâëÿåòñÿ íåñåëåêòèâíûì, â îòëè÷èè îò äàïà- è ýìïàãëèôëîçèíà. Ïîýòîìó óòâåðæäàòü, ÷òî ýòî êëàññ-ýôôåêò ðàíî. ×òî êàñàåòñÿ ãèïîòåç ïàòîôèçèîëîãè÷åñêîãî îáúÿñíåíèÿ àìïóòàöèé çà ñ÷åò äèóðåòè÷åñêîãî ýôôåêòà: 1) ïàòîôèçèîëîãè÷åñêèå îáúÿñíåíèÿ âñåãäà ëèøü ãèïîòåçû ïîêà íåò êëèíè÷åñêîãî ïîäòâåðæäåíèÿ; 2) äèóðåòè÷åñêèé ýôôåêò ó èíãèáèòîðîâ SGLT-2 î÷åíü ñëàáûé; 3) ÷òî êàñàåòñÿ ðîñòà àìïóòàöèé íà äèóðåòèêàõ, øëà ðå÷ü òîëüêî î òèàçèäíûõ äèóðåòèêàõ, íå ïðèïîìíþ òàêèõ äàííûõ íà ïåòëåâûõ äèóðåòèêàõ, âîçìîæíî ìåíÿ ïîïðàâÿò, åñëè åñòü òàêèå äàííûå. Íå ãîâîðÿ î òîì, ÷òî ðå÷ü èäåò îá èññëåäîâàíèè ñðàâíåíèÿ òèàçèäíûõ äèóðåòèêîâ ñ äðóãèìè àíòèãèïåðòåíçèâíûìè ïðåïàðàòàìè, ïðåæäå âñåãî èíãèáèòîðàìè ÀÏÔ, òàê ÷òî âåðîÿòíî ïðè÷èíà íå â äèóðåòè÷åñêîì ýôôåêòå, à îá îòñóòñòâèè ïîçèòèâíûõ ýôôåêòîâ íà ýíäîòåëèàëüíóþ ôóíêöèþ, ïî ñðàâíåíèþ ñ äðóãèìè àíòèãèïåðòåíçèâíûìè ïðåïàðàòàìè. Çäåñü òàêæå ìîãóò áûòü ðàçíûå ïàòîãåíåòè÷åñêèå òåîðèè
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Ñ óâàæåíèåì |