Current Treatment Guidelines (current + treatment_guideline)

Distribution by Scientific Domains

Selected Abstracts

Interpreting clinical trials of diabetic dyslipidaemia: new insights

A. S. Wierzbicki
Current treatment guidelines highlight the importance of aggressive lipid-modifying therapy in reducing cardiovascular risk in patients with type 2 diabetes. Statins are established as the cornerstone of dyslipidaemia management in diabetic patients, based on their efficacy in lowering levels of low-density lipoprotein cholesterol (LDL-C). However, statins fail to address the high residual cardiovascular risk in treated patients, some of which may be attributable to low HDL cholesterol (HDL-C) and elevated triglycerides and to a preponderance of small, dense LDL particles, indicating the need for further intervention. Fibrates are effective against all components of atherogenic dyslipidaemia associated with type 2 diabetes. Clinical studies, most notably the Fenofibrate Intervention and Event Lowering in Diabetes, indicate that fibrates, most likely in combination with a statin, have a secondary role in reducing cardiovascular risk in patients with type 2 diabetes, particularly in those without prior cardiovascular disease or patients with low HDL-C. Results are awaited from the ongoing Action to Control Cardiovascular Risk in Diabetes trial to fully evaluate the outcome benefits of this combination strategy. [source]

Health Professionals' Attitudes toward Acute Diarrhea Management

Iain B. McIntosh
Background: Travelers' diarrhea is the most frequent health problem in those participating in international journeys, and is responsible for many consultations abroad and on return home. Methods: A questionnaire assessing attitudes toward treatment and management of travel-related and nontravel-related diarrhea was administered to 542 GPs, nurses and pharmacists. Results: Health professionals' attitudes to management of acute diarrhea are variable, with marked divergence regarding adherence to published "good practice" guidelines and recommendations. Inconsistencies exist in stated attitudes toward prescribing antispasmodics and antimotility agents and actual prescribing behavior. Conclusion: Current treatment guidelines may be outdated. Inappropriate or delayed treatment disadvantages the patient. Limiting the use of antidiarrheal agents can deny access, for those inflicted with diarrhea, to a medication which may shorten symptomatology and morbidity, and speed the return to normality. Review of guidelines for diarrhea management in adults is overdue, as is standardization of treatment response. Educational initiatives are required to encourage active intervention and improved provision of care. [source]

Treatment recommendations for chronic hepatitis B: An evaluation of current guidelines based on a natural history study in the United States,

HEPATOLOGY, Issue 4 2008
Myron John Tong
Current guidelines for treatment of chronic hepatitis B include hepatitis B e antigen (HBeAg) status, levels of hepatitis B virus (HBV) DNA, and serum alanine aminotransferase (ALT) values in the setting of either chronic hepatitis or cirrhosis. Based on findings from a prospective study of hepatitis B surface antigen (HBsAg)-positive patients, we determined whether these guidelines included patients who developed hepatocellular carcinoma (HCC) and who died of non-HCC liver-related complications. The criteria for treatment from four published guidelines were matched to a cohort of 369 HBsAg-positive patients enrolled in the study. During a mean follow-up of 84 months, 30 patients developed HCC and 37 died of non-HCC liver-related deaths. Using criteria for antiviral therapy as stated by the four guidelines, only 20%-60% of the patients who developed HCC, and 27%-70% of patients who died of non-HCC liver-related deaths would have been identified for antiviral therapy according to current treatment recommendations. If baseline serum albumin levels of 3.5 mg/dL or less or platelet counts of 130,000 mm3 or less were added to criteria from the four treatment guidelines, then 89%-100% of patients who died of non-HCC liver-related complications, and 96%-100% of patients who developed HCC would have been identified for antiviral therapy. In addition, if basal core promoter T1762/A1764 mutants and precore A1896 mutants also were included, then 100% of patients who developed HCC would have been identified for treatment. Conclusion: This retrospective analysis showed that the current treatment guidelines for chronic hepatitis B excluded patients who developed serious liver-related complications. (HEPATOLOGY 2008.) [source]

Prediabetes: a must to recognise disease state

W. Shehab Eldin
Summary Prediabetes mellitus (PDM) is defined as a state of abnormal glucose homeostasis in which deficiency or resistance to insulin is the hallmark. PDM precedes the development of overt type 2 DM. It is associated with increased mortality and morbidity and thus fits well with the criteria of a disease condition. Framing PDM as a disease and not a risk or a ,pre' stage for diabetes is needed to facilitate early management. Aim:, This review aims therefore to increase awareness of PDM as a disease state. Methods:, To do so, we shall preview guidelines for its diagnosis. Its prevalence and hazards will be then discussed. Finally, we shall elaborate on the current treatment guidelines. Result:, Enough evidence support the notion that PDM is a curable disease state. Conclusions:, The current recommendations for the treatment of PDM should be adhered. In addition, there is a room for the use of other pharmacological agents. [source]

Diagnosis and treatment of atrial fibrillation in the acute care setting

ACNP-BC, Fatima Nottingham MS
Abstract Purpose: To discuss the causes of atrial fibrillation (AF), risk factors, and pathophysiology, and review current treatment guidelines for AF in the inpatient setting. Data sources: Peer-reviewed medical and nursing journals, American College of Cardiology (ACC), American Heart Association (AHA), and European Society of Cardiology (ESC) practice guidelines. Conclusions: There are many predisposing factors to AF and a variety of treatment modalities. Nurse practitioners (NPs) should acquaint themselves with the pathophysiology and evidence-based treatments in order to provide individually based care to patients. Implications for practice: Pharmacological management is often warranted in patients with AF. NPs must be aware of updated clinical evidence in order to properly treat patients to provide symptomatic relief and improve quality of life. [source]

Interventions for treating traumatized permanent front teeth: avulsed (knocked out) and replanted

P Day
Background:, Dental trauma is common. One of the most severe injuries is when a permanent tooth is knocked completely out (avulsed) of the mouth. In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on how best to prepare teeth for replantation. Objectives:, To compare the effects of a range of interventions for managing traumatized permanent teeth with avulsion injuries. Search strategy:, The Cochrane Oral Health Group's Trials Register (to 28th October 2009); CENTRAL (The Cochrane Library 2009, Issue 4); MEDLINE (1950 to October 2009); EMBASE (1980 to October 2009);; and reference lists of articles were searched. There were no language restrictions. Selection criteria:, Only randomized controlled trials (RCTs), that included a minimum follow-up period of 12 months, for interventions for avulsed and replanted permanent teeth were considered. Data collection and analysis:, Two review authors independently extracted data and assessed trial quality and the risk of bias in studies to be included. Main results:, Three studies, involving a total of 162 patients and 231 teeth were identified. Study one (with a high risk of bias) investigated the effect of extra-oral endodontics. This showed no significant difference in radiographic resorption compared with intra-oral endodontics provided at week 1 for teeth avulsed for longer than 60 minutes dry time. Study two (which had a moderate risk of bias) investigated a 10-minute soaking in thymosin alpha 1 prior to replantation and then its further use as a daily gingival injection for the first 7 days. They reported a strong benefit at 48 months (14% with periodontal healing in the control group versus 77% for the experimental group). Study three (with a high risk of bias) investigated a 20-minute soaking with gentamycin sulphate (4 107 U/L) for both groups prior to replantation and then the use of hyperbaric oxygen daily in the experimental group for 80 minutes for the first 10 days. They reported a strong benefit at 12 months (43% periodontal healing versus 88% for the experimental group). There was no formal reporting of adverse events. Authors' conclusions:, The available evidence suggests that extra-oral endodontics is not detrimental for teeth replanted after more than 60 minutes dry time. Studies with moderate/high risk of bias indicate that soaking in thymosin alpha 1 and gentamycin sulphate followed by hyperbaric oxygen may be advantageous. However, they have not previously been reported as interventions for avulsed teeth and need further validation. More evidence with low risk of bias is required and, with the low incidence of avulsed teeth, collaborative multicentre trials are indicated. Plain language summary:, Treatments for managing knocked out and replanted front teeth. Injuring your front teeth during childhood is common. One of the most severe injuries occurs when the tooth is knocked totally out of the mouth (avulsed). Often the best option is to replant the tooth as quickly as possible. This is true only for permanent teeth. Once replanted the tooth can heal in two ways if managed correctly. Ideally the ligament around the root reforms and the tooth can be expected to last as long as any other tooth; this is known as ,periodontal healing'. When there is too much damage to the ligament, healing occurs by bony replacement and the tooth is replaced by bone and lost over a few years. This is called ,bony healing'. Bony healing causes significant problems in the medium term for children and treatments for this are the subject of a different Cochrane review. A missing front upper tooth or teeth, as a result of not replanting an avulsed tooth or as a treatment for bony healing, can have a major effect on dental and facial ,good looks'. This can affect the individual's self-esteem and general social interaction, as well as how others think and see them. This Cochrane review investigated what treatments encourage the tooth to repair by periodontal healing. Three studies were found. The benefits of these treatments require further investigation before specific medicaments can be advised. This is because the studies had weakness in their design which may have influenced the benefits they found. The following general treatment principle can be concluded which reinforces current treatment guidelines: For teeth with little chance of periodontal healing, a root canal treatment can be carried out before the tooth is replanted without further detrimental effects. [source]