Home About us Contact
|
Home About us Contact | ||
|
|
||
Controlled Data (controlled + data)
Selected AbstractsReview article: the optimal medical management of acute severe ulcerative colitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2010A. L. Hart Aliment Pharmacol Ther 2010; 32: 615,627 Summary Background, Management of acute severe ulcerative colitis (UC) is a clinical challenge, with a mortality rate of approximately 1,2%. The traditional management with intravenous corticosteroids has been modified by introduction of ciclosporin and more recently, infliximab. Aim, To provide a detailed and comprehensive review of the medical management of acute severe UC. Methods, PubMed and recent conference abstracts were searched for articles relating to treatment of acute severe UC. Results, Two-thirds of patients respond to intravenous steroids in the short term. In those who fail steroids, low-dose intravenous ciclosporin at 2 mg/kg/day is effective. Approximately 75% and 50% of patients treated with ciclosporin avoid colectomy in the short and long-terms, respectively. Long-term outcome of ciclosporin therapy is improved by introduction of azathioprine on discharge from hospital, together with oral ciclosporin as a bridging therapy. Controlled data show that infliximab is effective as rescue therapy for acute severe UC and the effect appears to be durable, although longer-term follow-up data are needed. Conclusions, Both ciclosporin and infliximab have demonstrated efficacy as rescue medical therapies in patients with acute severe UC, but surgery needs to be considered if there is failure to improve or clinical deterioration. [source] EFNS guideline on the treatment of cerebral venous and sinus thrombosisEUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2006K. Einhäupl Cerebral venous and sinus thrombosis (CVST) is a rather rare disease which accounts for <1% of all strokes. Diagnosis is still frequently overlooked or delayed due to the wide spectrum of clinical symptoms and the often subacute or lingering onset. Current therapeutic measures which are used in clinical practice include the use of anticoagulants such as dose-adjusted intravenous heparin or body weight-adjusted subcutaneous low-molecular-weight heparin (LMWH), the use of thrombolysis, and symptomatic therapy including control of seizures and elevated intracranial pressure. We searched MEDLINE (National Library of Medicine), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library to review the strength of evidence to support these interventions and the preparation of recommendations on the therapy of CVST based on the best available evidence. Review articles and book chapters were also included. Recommendations were reached by consensus. Where there was a lack of evidence, but consensus was clear we stated our opinion as good practice points. Patients with CVST without contraindications for anticoagulation should be treated either with body weight-adjusted subcutaneous LMWH or dose-adjusted intravenous heparin (good practice point). Concomitant intracranial haemorrhage related to CVST is not a contraindication for heparin therapy. The optimal duration of oral anticoagulation after the acute phase is unclear. Oral anticoagulation may be given for 3 months if CVST was secondary to a transient risk factor, for 6,12 months in patients with idiopathic CVST and in those with ,mild' hereditary thrombophilia. Indefinite anticoagulation (AC) should be considered in patients with two or more episodes of CVST and in those with one episode of CVST and ,severe' hereditary thrombophilia (good practice point). There is insufficient evidence to support the use of either systemic or local thrombolysis in patients with CVST. If patients deteriorate despite adequate anticoagulation and other causes of deterioration have been ruled out, thrombolysis may be a therapeutic option in selected cases, possibly in those without intracranial haemorrhage (good practice point). There are no controlled data about the risks and benefits of certain therapeutic measures to reduce an elevated intracranial pressure (with brain displacement) in patients with severe CVST. Antioedema treatment (including hyperventilation, osmotic diuretics and craniectomy) should be used as life saving interventions (good practice point). [source] Evaluating outpatient pharmacy services: a literature review of specialist heart failure servicesINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2006Tracey-Lea Hargraves Pharmacist (formerly) Objective To identify appropriate methods to evaluate a specialist pharmacy service for heart failure patients in an ambulatory care setting. Method An extensive literature review was undertaken to identify the published data on evaluative studies of specialist pharmacy services, including those directed at heart failure patients in an ambulatory care model of service provision. Key findings Six studies were identified evaluating outpatient pharmacy services for heart failure. The pharmacy services provided in these settings were not well defined. The impact of the pharmacist was compared to ,usual care', that is care delivered without a pharmacist, by either a prospective randomised controlled trial (RCT), or before and after studies. In most cases the service was delivered by one pharmacist at one site. Services were primarily targeted at patients and focused on medication and lifestyle education, adverse drug reaction monitoring, and compliance/adherence. In all studies, there was a trend for improvement in the outcomes measured. Different study endpoints were examined, including process indicators such as compliance and outcome measures such as morbidity (clinical), quality of life (humanistic), and hospital admissions (economic). The ideal evaluative study would be an adequately powered, prospective, randomised controlled trial, comparing the effect of the pharmacist service to usual care (without the specified pharmacy service). Appropriate study endpoints including process indicators and outcome measures are needed. Identification of specific components and the extent of the service that would provide the most benefit to selected patient groups would be of interest. Conclusions Specialist ambulatory care pharmacy services have not been well defined or evaluated in the literature. Limited randomised controlled data exist. [source] Effect of 6-Month Whole Body Vibration Training on Hip Density, Muscle Strength, and Postural Control in Postmenopausal Women: A Randomized Controlled Pilot Study,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2004Sabine MP Verschueren Abstract High-frequency mechanical strain seems to stimulate bone strength in animals. In this randomized controlled trial, hip BMD was measured in postmenopausal women after a 24-week whole body vibration (WBV) training program. Vibration training significantly increased BMD of the hip. These findings suggest that WBV training might be useful in the prevention of osteoporosis. Introduction: High-frequency mechanical strain has been shown to stimulate bone strength in different animal models. However, the effects of vibration exercise on the human skeleton have rarely been studied. Particularly in postmenopausal women,who are most at risk of developing osteoporosis,randomized controlled data on the safety and efficacy of vibration loading are lacking. The aim of this randomized controlled trial was to assess the musculoskeletal effects of high-frequency loading by means of whole body vibration (WBV) in postmenopausal women. Materials and Methods: Seventy volunteers (age, 58,74 years) were randomly assigned to a whole body vibration training group (WBV, n = 25), a resistance training group (RES, n = 22), or a control group (CON, n = 23). The WBV group and the RES group trained three times weekly for 24 weeks. The WBV group performed static and dynamic knee-extensor exercises on a vibration platform (35,40 Hz, 2.28,5.09g), which mechanically loaded the bone and evoked reflexive muscle contractions. The RES group trained knee extensors by dynamic leg press and leg extension exercises, increasing from low (20 RM) to high (8 RM) resistance. The CON group did not participate in any training. Hip bone density was measured using DXA at baseline and after the 6-month intervention. Isometric and dynamic strength were measured by means of a motor-driven dynamometer. Data were analyzed by means of repeated measures ANOVA. Results: No vibration-related side effects were observed. Vibration training improved isometric and dynamic muscle strength (+15% and + 16%, respectively; p < 0.01) and also significantly increased BMD of the hip (+0.93%, p < 0.05). No changes in hip BMD were observed in women participating in resistance training or age-matched controls (,0.60% and ,0.62%, respectively; not significant). Serum markers of bone turnover did not change in any of the groups. Conclusion: These findings suggest that WBV training may be a feasible and effective way to modify well-recognized risk factors for falls and fractures in older women and support the need for further human studies. [source] Treatment of acquired hemophilia AJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2007P. W. COLLINS Summary., Acquired hemophilia A (AH) is an autoimmune disease that leads to potentially severe bleeding. Management relies on rapid and accurate diagnosis, control of bleeding episodes and eradication of the inhibitor by immunosuppression. There is extensive literature about the disease but only few controlled data are available. This paper reviews the current literature on treatment strategies for hemostatic therapy and inhibitor eradication. Potential future developments are discussed. [source] | ||||||||||