Future Clinical (future + clinical)

Distribution by Scientific Domains

Terms modified by Future Clinical

  • future clinical application
  • future clinical studies
  • future clinical trials
  • future clinical use

  • Selected Abstracts

    Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome

    C. J. Bijkerk
    Summary Background :,Both high-fibre dietary advice and the prescription of fibre as a bulking agent are very common in primary and secondary care management of irritable bowel syndrome. Irritable bowel syndrome patients with constipation may have delayed intestinal transit. Therefore, fibres that accelerate intestinal transit may be beneficial in these patients. The uncertain benefits reported in several clinical studies, however, have led us to reappraise the value of fibre in irritable bowel syndrome management. Aim :,To quantify the effect of different types of fibre on global and symptom relief from irritable bowel syndrome. Methods :,Using a structured literature search in MEDLINE (1966,2002), we selected randomized controlled trials involving irritable bowel syndrome patients treated with fibre. Analyses were performed for the total group and for trials using soluble and insoluble fibre separately. Results :,Seventeen studies were included in the analysis. None investigated primary care irritable bowel syndrome patients. Fibre, in general, was effective in the relief of global irritable bowel syndrome symptoms [relative risk, 1.33; 95% confidence interval (CI), 1.19,1.50]. Irritable bowel syndrome patients with constipation may receive benefit from fibre treatment (relative risk, 1.56; 95% CI, 1.21,2.02), but there was no evidence that fibre was effective in the relief of abdominal pain in irritable bowel syndrome. Soluble and insoluble fibre, separately, had different effects on global irritable bowel syndrome symptoms. Soluble fibre (psyllium, ispaghula, calcium polycarbophil) showed significant improvement (relative risk, 1.55; 95% CI, 1.35,1.78), whereas insoluble fibre (corn, wheat bran), in some cases, worsened the clinical outcome, but there was no significant difference compared with placebo (relative risk, 0.89; 95% CI, 0.72,1.11). Conclusions :,The benefits of fibre in the treatment of irritable bowel syndrome are marginal for global irritable bowel syndrome symptom improvement and irritable bowel syndrome-related constipation. Soluble and insoluble fibres have different effects on global irritable bowel syndrome symptoms. Indeed, in some cases, insoluble fibres may worsen the clinical outcome. Future clinical studies evaluating the effect and tolerability of fibre therapy are needed in primary care. [source]

    Research Priorities for Human Immunodeficiency Virus and Sexually Transmitted Infections Surveillance, Screening, and Intervention in Emergency Departments: Consensus-based Recommendations

    Jason S. Haukoos MD
    Abstract This article describes the results of the human immunodeficiency virus (HIV) and sexually transmitted infections (STI) prevention in the emergency department (ED) component of the 2009 Academic Emergency Medicine Consensus Conference entitled "Public Health in the ED: Surveillance, Screening, and Intervention." The objectives were to use experts to define knowledge gaps and priority research questions related to the performance of HIV and STI surveillance, screening, and intervention in the ED. A four-step nominal group technique was applied using national and international experts in HIV and STI prevention. Using electronic mail, an in-person meeting, and a Web-based survey, specific knowledge gaps and research questions were identified and prioritized. Through two rounds of nomination and refinement, followed by two rounds of election, consensus was achieved for 11 knowledge gaps and 14 research questions related to HIV and STI prevention in EDs. The overarching themes of the research priority questions were related to effectiveness, sustainability, and integration. While the knowledge gaps appear disparate from one another, they are related to the research priority questions identified. Using a consensus approach, we developed a set of priorities for future research related to HIV and STI prevention in the ED. These priorities have the potential to improve future clinical and health services research and extramural funding in this important public health sector. [source]

    Physiological Effects of a Novel Immune Stimulator Drug, (1,4)-,- d -Glucan, in Rats

    Ravishankar Koppada
    We investigated physiological and immunological effects of a low and a high dose of ,- d -glucan (0.5 and 10 mg/kg), in vivo, testing the hypothesis that intravenous administration of ,- d -glucan does not affect haemodynamic, respiratory, haematological, and immune responses in normal rats. Male rats (300,400 g) were anaesthetized, tracheostomized, and catheterized in one femoral artery and vein. The mean arterial blood pressure and heart rate were continuously recorded. The baselines for gas exchange, differential blood cell count, and plasma concentration of TNF-,, IL-1,, IL-4, IL-6, and IFN-, were determined. Rats were then randomly assigned to controls (n = 7), a low dose (0.5 mg/kg; n = 10), and a high dose (10 mg/kg; n = 7) of ,- d -glucan for a six 6 hr study period. Gas exchange, differential cell count, plasma concentration of TNF-,, IL-1,, IL-4, IL-6, and IFN-,, and mean arterial blood pressure values remained within physiological range. Intravenous administration of 10 mg/kg ,- d -glucan created tachycardia, associated with hyperventilation, and significant reductions in the blood haemoglobin and haematocrit concentrations. We suggest that these in vivo effects of ,- d -glucan should be considered for future clinical and/or experimental trials. [source]

    The new World Health Organization classification of haematopoietic and lymphoid tumours: a dermatopathological perspective

    D.N. Slater
    Summary The World Health Organization (WHO) has published a new consensus classification of tumours of haematopoietic and lymphoid tissue, based on recognizable disease entities defined by clinical and scientific criteria. The WHO does not support the use of stand-alone organ-related classifications, such as for skin. The Royal College of Pathologists (London) has adopted the WHO classification in its minimum dataset for the histopathological reporting of lymphoma and this will be used in the National Health Service Skin Cancer Dataset. The purpose of this review is to highlight the principal primary and secondary cutaneous haematopoietic and lymphoid tumours that are defined in the WHO classification. The review also discusses selected problematical areas in the WHO classification relevant to the skin and contains suggestions to encourage a unified approach in the use of the WHO coded summary. These represent an attempt to facilitate future progress and research in the field of cutaneous lymphoma. They are perceived as possible building-blocks for wider discussion and not as alterations to the classification. The WHO classification has been compared with a road map that indicates directions for future clinical and scientific research. [source]

    Depression and Obesity: Implications for Assessment, Treatment, and Research

    Melissa A. Napolitano
    Markowitz, Friedman, and Arent (2008) review the literature on the relationship between obesity and depression and (a) highlight behavioral, cognitive, physiological, and social mechanisms potentially elucidating these links and (b) provide a valuable resource both for clinicians and researchers. This commentary underscores (a) the strengths of the article; (b) additional areas of consideration; (c) implications for treatment; and (d) future clinical and research opportunities. Also included are suggestions for the design and measurement of future longitudinal observational studies, intervention trials, and other conceptual models. Finally, we comment on the responsibility of the scientist practitioner not only to consider evaluating and treating each behavior in isolation, but also to take an inclusive approach and apply the common features of evidence-based treatment for both obesity and depression. [source]