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            "abstractNote": "When considering both recommended and excessive medication dosages, almost\nall drugs have potentially serious adverse effects. Adverse effects (AEs) are any harmful\nor unintended reactions to medication. AEs can occur at doses normally used for\ntreatment or because of overdose. Due to known limitations in premarketing medication\ntrials (1–3), identification of adverse effects requires vigilant post-marketing surveillance.\nAgencies and investigators have recognized the potential for Electronic Medical Record\nSystems (EMRs) to characterize clinical correlations in large numbers of patients using\nprescription medications.\nThis thesis project explores one aspect of using EMRs to detect single drug\ningredient AEs – specifically, the feasibility of mining History and Physical (H&P) exam\nnotes to detect concurrent mentions of single drug ingredients and clinical findings\n(including both symptoms and diseases). In the remainder of this document, the term\n\"drug\"  will refer to a single (active) drug ingredient (as opposed to a multi-component\n\"combination\" medication or an inert ingredient), unless otherwise stated. Our approach\nidentifies drug and finding concepts using Natural Language Processing (NLP) of clinical\ntext. We hypothesize (based on previous work (2; 4–6)) that drug-finding pairs occurring\nin a higher-than expected number of records signify an underlying relationship between\ndrug and finding. If one can distinguish which pairs occur for known reasons, then one\ncan postulate that the remaining pairs occur for unknown reasons -- especially previously\nunrecognized potential adverse effects",
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            "abstractNote": "THE FDA BLACK BOX WARNING SYSTEM: THE UTMOST IN DRUG AND PATIENT\nSAFETY? Andrew Georgi (Sponsored by Paul Barash, MD, and Loreta Grecu, MD).\nDepartment of Anesthesiology, Yale University School of Medicine, New Haven, CT.\nOf the 7856ψ\npharmaceutical products under the purview of the Food and Drug\nAdministration (FDA), over six hundred have a black box warning (BBW). As the FDA’s highest\nlevel of warning included on drug package inserts, this notation is reserved for those drugs that\npose significant risks leading to “death or serious injury”. However, the types of warnings that\nwarrant this distinction have not been clearly identified and are not always readily justifiable. In\naddition, great variability exists among the drugs resources charged with transmitting this critical\ninformation to healthcare professionals and the public.\nThe objective of this paper is to establish the most comprehensive list of drugs with a\nBBW, classify their content according to organ systems, and in doing so evaluate the consistency\nof information presented by these widely-used drug resources. This was accomplished by crossreferencing\nand analyzing the drug BBW information from four resources: DailyMed,\nMicromedex, Facts & Comparisons, and BlackBoxRx.\nSix hundred and thirty-five drug/drug combinations were identified as having a BBW.\nThe most frequently affected organ systems were cardiovascular and pulmonary with 200/635\nand 144/635 drug BBWs, respectively. DailyMed was the most comprehensive list with 551/635\ndrugs, still a shortfall of 13%. The four lists were in complete agreement for 416/635 (65%) of\nthe drugs listed. This highlights the FDA’s need to review the black box warning system and\ndetermine how best to communicate this drug information accurately and efficiently to the\nhealthcare community.",
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            "note": "<p>Kesselheim, Aaron S<br/>Franklin, Jessica M<br/>Avorn, Jerry<br/>Duke, Jon D<br/>eng<br/>K08HS18465-01/HS/AHRQ HHS/<br/>KL2RR025760/RR/NCRR NIH HHS/<br/>Comparative Study<br/>Research Support, Non-U.S. Gov't<br/>Research Support, U.S. Gov't, P.H.S.<br/>England<br/>2013/04/27 06:00<br/>BMJ Qual Saf. 2013 Sep;22(9):727-34. doi: 10.1136/bmjqs-2012-001704. Epub 2013 Apr 25.</p>",
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            "title": "Current Status and Future Perspectives of Drug Information Systems",
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                    "lastName": "Tervonen"
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            "abstractNote": "The information lifecycle of a drug starts already during the drug discovery phase and continues far\ninto the future in prescription- and adverse-effect databases. In this paper, we describe the past\nliterature and existing technology of Drug Information Systems (DIS). We develop a mapping of DIS\nto the phased drug lifecycle taking into account the system information contents. The mapping shows\nthat currently there is a lack of DIS providing efficacy- and safety data in a suitable format. This lack\nseverely hinders the possibility of physicians, researchers, as well as regulatory authorities and the\npharmaceutical industry, to make quantitative analyses of efficacy and safety over a wide range of\ndrugs.",
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            "title": "Speaking the same language? International variations in the safety information accompanying top-selling prescription drugs",
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                    "creatorType": "author",
                    "firstName": "Aaron S",
                    "lastName": "Kesselheim"
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            "abstractNote": "BACKGROUND: The official prescribing information document distributed with a prescription drug is a key source of safety information, but it may include excessive or insufficient details. OBJECTIVES: To compare prescribing information approved by the US Food and Drug Administration with the UK, Canada and Australia to identify content differences in safety warnings. METHODS: For 20 top-selling prescription drugs, we used an automated natural language processing tool to calculate the number and severity of reported adverse drug reactions (ADRs). We fit hierarchical Poisson models and included fixed effects for other prescribing information characteristics. Separately, we analysed the appearance and content of 'black box' warnings. RESULTS: There was substantial variation in safety content of approved prescribing information. Canada had the highest median ADRs per drug (138 (IQR 86-234)) and the UK had the lowest (84 (IQR 51-111)). The number of ADRs reported was on average 50% higher in Canada compared with the USA (ratio of ADRs/document: 1.5, 95% CI 1.4 to 1.6, p<0.001). By contrast, there were on average 15% fewer ADRs listed in the UK compared with the USA (ratio of ADRs/document 0.85 (95% CI 0.78 to 0.93, p<0.001), and 21% fewer ADRs listed in Australia compared with the USS (ratio of ADRs/document 0.79, 95% CI 0.74 to 0.85, p<0.001). There were no variations in ADR severity. The presence and qualitative content of boxed warnings also showed substantial diversity. CONCLUSIONS: International variations exist in the presentation of safety data in drug prescribing information, which may have important implications for patient safety. Better international coordination is necessary to enhance use of this information for patient decision-making.",
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