Publications indexed in Medline and Embase originating from the Syrian Arab Republic: a survey.

Health research in the Syrian Arab Republic faces many difficulties, including limited funds, infrastructure and means of dissemination. In a search of Medline and Embase databases in March 2006 we extracted data on 386 biomedical papers originating from the Syrian Arab Republic. Embase had the superior coverage. A total of 64% were published in journals from Europe, 22% from North American journals and 12% in periodicals from the Middle East. Output of papers increased by 1.4 articles/year since 1979. The topics of 57% of papers were biomedical, with the remainder being pure science or agricultural/veterinarian issues. Dentistry, public health and surgery were the commonest subjects of the biomedical papers. Funding was largely from government.

Publications indexed in Medline and Embase originating from the Syrian Arab Republic: a survey

Health research in the Syrian Arab Republic faces many difficulties, including limited funds, infrastructure and means of dissemination. In a search of Medline and Embase databases in March 2006 we extracted data on 386 biomedical papers originating from the Syrian Arab Republic. Embase had the superior coverage. A total of 64% were published in journals from Europe, 22% from North American journals and 12% in periodicals from the Middle East. Output of papers increased by 1.4 articles/year since 1979. The topics of 57% of papers were biomedical, with the remainder being pure science or agricultural/veterinarian issues. Dentistry, public health and surgery were the commonest subjects of the biomedical papers. Funding was largely from government

Cessation of medication for people with schizophrenia already stable on chlorpromazine.

BACKGROUND: Chlorpromazine, one of the first generation of antipsychotic drugs, is effective in the treatment of schizophrenia. For most people schizophrenia is a life-long disorder but about a quarter of those who have a first psychotic breakdown do not go on to experience further breakdowns. Most people with schizophrenia are prescribed antipsychotic drugs, although use is often intermittent. The effects of stopping medication are not well researched in the context of systematic reviews. OBJECTIVES: To quantify the effects of stopping chlorpromazine for people with schizophrenia stable on this drug. SEARCH STRATEGY: We supplemented an electronic search of the Cochrane Schizophrenia Group Trials Register (March 2006) with reference searching of all identified studies. SELECTION CRITERIA: We included all relevant randomised clinical trials. DATA COLLECTION AND ANALYSIS: We independently inspected citations and abstracts, ordered papers and re-inspected and quality assessed these. We independently extracted data and resolved disputes during regular meetings. We analysed dichotomous data using fixed effects relative risk (RR) and the 95% confidence interval (CI). For continuous data, where possible, we calculated the weighted mean difference (WMD). We excluded the data where more than 40% of people were lost to follow up. MAIN RESULTS: We included ten trials involving 1042 people with schizophrenia stable on chlorpromazine. Even in the short term, those who remained on chlorpromazine were less likely to experience a relapse compared to people who stopped taking chlorpromazine (n=376, 3 RCTs, RR 6.76 CI 3.37 to 13.54, NNH XX CI XX to XX). Medium term (n=850, 6 RCTs, RR 4.04 CI 2.81 to 5.8, NNH 4 CI 3 to 7) and long term data were similar (n=510, 3 RCTs, RR 1.70 CI 1.44 to 2.01, NNH XX CI XX to XX). People allocated to chlorpromazine withdrawal were not significantly more likely to stay in the study compared with those continuing chlorpromazine treatment (n=374, 1 RCT, RR 1.14 CI 0.55 to 2.35). In sensitivity analyses, there was a significant difference in the 'relapse' outcome between trials for those diagnosed according to checklist criteria compared to those with a clinical diagnosis. AUTHORS' CONCLUSIONS: This review confirms clinical experience and quantifies the risks of stopping chlorpromazine medication for a group of people with schizophrenia who are stable on this drug. With its moderate adverse effects, chlorpromazine is likely to remain one of the most widely prescribed treatments for schizophrenia.

Evidence of clozapine's effectiveness in schizophrenia: a systematic review and meta-analysis of randomized trials.

OBJECTIVE: The purpose of this study was to evaluate all available trial-based evidence on the effectiveness of clozapine in schizophrenia as compared with conventional neuroleptics. METHOD: All randomized, controlled trials comparing clozapine with a conventional neuroleptic in which there was satisfactory concealment of patients' treatment allocation were located through electronic searches in all languages of several databases and through contacting authors of recent trials as well as the manufacturer of clozapine. At least two independent reviewers assessed trials for inclusion in the study and extracted data for meta-analysis. RESULTS: The review included 2,530 randomly assigned participants in 30 trials, most of them short-term. Clozapine-treated patients showed more clinical improvement and experienced significantly fewer relapses during treatment, although the risk of blood dyscrasias in long-term treatment may be as high as 7%. Scores on symptom rating scales showed greater improvement among clozapine-treated patients, who were also more satisfied with their treatment. However, there was no evidence that the superior clinical effect of clozapine is reflected in levels of functioning; on the other hand, global functional and pragmatic outcomes were frequently not reported. Clinical improvement was most pronounced in patients with treatment-resistant illness. CONCLUSIONS: This meta-analysis confirms that clozapine is more effective than conventional neuroleptics in reducing symptoms of patients with both treatment-resistant and nonresistant schizophrenia. Future trials should be long-term pragmatic community trials or should address the effectiveness of clozapine in special patient populations. An international standard set of outcomes, including pragmatic assessments of functioning, would greatly enhance the comparison and summation of trials and future assessments of effectiveness.