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Ineffective Treatment (ineffective + treatment)

Distribution by Scientific Domains

Medical Sciences	87%

Selected Abstracts

FEIBA® in treatment of acute bleeding episodes in patients with haemophilia A and factor VIII inhibitors: a retrospective survey in regional haemophilia centre

HAEMOPHILIA, Issue 3 2009
P. SMEJKAL
Summary., FEIBA® (factor eight inhibitor by-passing activity) is used to achieve haemostasis in haemophiliacs with inhibitor. The aim of this study was to evaluate efficacy and consumption of the product in treatment of haemorrhages in haemophiliacs with factor VIII inhibitor, and determine factors that can influence the results of treatment. We used data from our haemophilia centre from years 2000,2008. Six haemophiliacs with factor VIII inhibitor were treated on demand with FEIBA® for 61 bleeding episodes (45 haemarthroses, six muscle bleeds, six other sites bleeds and four multiple sites bleeds). The median cumulative dose of FEIBA® per bleeding episode was 205 U kg,1. Bleeding was stopped in 96.7% (59 of 61) of events but re-bleeding occurred in 3 events (4.9%) within 48 h after cessation of bleeding. In home treatment (20 of 61) bleeding stopped in 90% (18 of 20) without recurrence and the median consumption per event was reduced to 153 U kg,1. Without the use of home treatment the median consumption was 250 U kg,1 per event and bleeding ceased definitely in 92.7% (38 of 41) of cases. The cumulative dose of FEIBA® was lower for three episodes with re-bleeding: median 96 U kg,1 but not in the two cases of ineffective treatment: 361 U kg,1. FEIBA® in management of bleeding episodes completely resolved the haemorrhage in 91.8% of events and in a further 4.9% if treatment was restarted. Using home treatment saved expenditure due to the lower cumulative dose needed for treatment of haemorrhage. [source]

Prescription practices of public and private health care providers in Attock District of Pakistan

INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2002
S. Siddiqi
Abstract The irrational use of drugs is a major problem of present day medical practice and its consequences include the development of resistance to antibiotics, ineffective treatment, adverse effects and an economic burden on the patient and society. A study from Attock District of Pakistan assessed this problem in the formal allopathic health sector and compared prescribing practices of health care providers in the public and private sector. WHO recommended drug use indicators were used to study prescription practices. Prescriptions were collected from 60 public and 48 private health facilities. The mean (±,SE) number of drugs per prescription was 4.1,±,0.06 for private and 2.7,±,0.04 for public providers (,p,<,0.0001). General practitioners (GPs) who represent the private sector prescribed at least one antibiotic in 62% of prescriptions compared with 54% for public sector providers. Over 48% of GP prescriptions had at least one injectable drug compared with 22.0% by public providers (,p,<,0.0001). Thirteen percent of GP prescriptions had two or more injections. More than 11% of GP prescriptions had an intravenous infusion compared with 1% for public providers (,p,<,0.001). GPs prescribed three or more oral drugs in 70% of prescriptions compared with 44% for public providers (,p,<,0.0001). Prescription practices were analysed for four health problems, acute respiratory infection (ARI), childhood diarrhoea (CD), fever in children and fever in adults. For these disorders, both groups prescribed antibiotics generously, however, GPs prescribed them more frequently in ARI, CD and fever in children (,p,<,0.01). GPs prescribed steroids more frequently, however, it was significantly higher in ARI cases (,p,<,0.001). For all the four health problems studied, GPs prescribed injections more frequently than public providers (,p,<,0.001). In CD cases GPs prescribed oral rehydration salt (ORS) less frequently (33.3%) than public providers (57.7%). GPs prescribed intravenous infusion in 12.3% cases of fever in adults compared with none by public providers (,p,<,0.001). A combination of non-regulatory and regulatory interventions, directed at providers as well as consumers, would need to be implemented to improve prescription practices of health care providers. Regulation alone would be ineffective unless it is supported by a well-established institutional mechanism which ensures effective implementation. The Federal Ministry of Health and the Provincial Departments of Health have to play a critical role in this respect, while the role of the Pakistan Medical Association in self-regulation of prescription practices can not be overemphasized. Improper prescription practices will not improve without consumer targeted interventions that educate and empower communities regarding the hazards of inappropriate drug use. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Routine testing for mismatch repair deficiency in sporadic colorectal cancer is justified

THE JOURNAL OF PATHOLOGY, Issue 4 2005
Robyn Lynne Ward
Abstract This study prospectively examines the accuracy of immunohistochemical staining in the identification of mismatch repair defective (MMRD) colorectal cancer in routine clinical practice. The potential impact of this information on decisions regarding adjuvant treatment and germline testing were quantified. A consecutive series of fresh tissue (836 cancers) was obtained from 786 individuals undergoing curative surgery for colorectal cancer at one institution. As part of normal practice, each tumour was screened for the expression of MLH1 and MSH2 by immunohistochemical staining (IHC) and relevant clinicopathological details were documented. Microsatellite instability (MSI) was assessed using standard markers. Overall, 108 (13%) tumours showed loss of staining for either MLH1 (92 tumours) or MSH2 (16 tumours). The positive predictive value of mismatch repair IHC when used alone in the detection of MSI tumours was 88%, and the negative predictive value was 97%. Specificity and positive predictive value were improved by correlation with microsatellite status. Tumour stage (HR 3.5, 95% CI 2.0,6.0), vascular space invasion (HR 1.9, 95% CI 1.2,3.0) and mismatch repair deficiency (HR 0.2, 95% CI 0.05,0.87) were independent prognostic factors in stages II and III disease. Screening by mismatch repair IHC could reasonably have been expected to prevent ineffective treatment in 3.6% of stage II and 7.6% of stage III patients. The frequency of germline mismatch repair mutations was 0.8%, representing six unsuspected hereditary non-polyposis colorectal cancer (HNPCC) cases. Routine screening of colorectal cancers by mismatch repair IHC identifies individuals at low risk of relapse, and can prevent unnecessary adjuvant treatments in a significant number of individuals. Abnormal immunohistochemistry should be confirmed by microsatellite testing to ensure that false-positive results do not adversely impact on treatment decisions. Copyright © 2005 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source]

The NOD2 defect in Blau syndrome does not result in excess interleukin-1 activity

ARTHRITIS & RHEUMATISM, Issue 2 2009
Tammy M. Martin
Objective Blau syndrome is a rare, autosomal-dominant, autoinflammatory disorder characterized by granulomatous arthritis, uveitis, and dermatitis. Genetics studies have shown that the disease is caused by single nonsynonymous substitutions in NOD-2, a member of the NOD-like receptor or NACHT,leucine-rich repeat (NLR) family of intracellular proteins. Several NLRs function in the innate immune system as sensors of pathogen components and participate in immune-mediated cellular responses via the caspase 1 inflammasome. Mutations in a gene related to NOD-2, NLRP3, are responsible for excess caspase 1,dependent interleukin-1, (IL-1,) in cryopyrinopathies such as Muckle-Wells syndrome. Furthermore, functional studies demonstrate that caspase 1,mediated release of IL-1, also involves NOD-2. The aim of this study was to test the hypothesis that IL-1, may mediate the inflammation seen in patients with Blau syndrome. Methods IL-1, release was measured in peripheral blood mononuclear cells cultured in vitro, obtained from 5 Blau syndrome individuals with a NOD2 (CARD15) mutation. Results We observed no evidence for increased IL-1, production in cells obtained from subjects with Blau syndrome compared with healthy control subjects. Furthermore, we presented 2 cases of Blau syndrome in which recombinant human IL-1 receptor antagonist (anakinra) was ineffective treatment. Conclusion Taken together, these data suggest that in contrast to related IL-1,,dependent autoinflammatory cryopyrinopathies, Blau syndrome is not mediated by excess IL-1, or other IL-1 activity. [source]

Evaluating Co-primary Endpoints Collectively in Clinical Trials,

BIOMETRICAL JOURNAL, Issue 1 2009
Qian H. Li
Abstract Often a treatment is assessed by co-primary endpoints so that a comprehensive picture of the treatment effect can be obtained. Co-primary endpoints can be different medical assessments angled at different aspects of a disease, therefore, are used collectively to strengthen evidence for the treatment effect. It is common sense that if a treatment is ineffective, the chance to show that the treatment is effective in all co-primary endpoints should be small. Therefore, it may not be necessary to require all the co-primary endpoints to be statistically significant at the 1-sided 0.025 level to control the error rate of wrongly approving an ineffective treatment. Rather it is reasonable to allow certain variation for the p -values within a range close to 0.025. In this paper, statistical methods are developed to derive decision rules to evaluate co-primary endpoints collectively. The decision rules control the error rate of wrongly accepting an ineffective treatment at the level of 0.025 for a study and the error rate at a slightly higher level for a treatment that works for all the co-primary endpoints except perhaps one. The decision rules also control the error rates for individual endpoints. Potential applications in clinical trials are presented (© 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]

Quality of poisoning management advice in the Monthly Index of Medical Specialties Annual

EMERGENCY MEDICINE AUSTRALASIA, Issue 5-6 2005
James Mallows
Abstract Background:, The Monthly Index of Medical Specialties (MIMS) contains Therapeutic Goods Administration-approved product information supplied by manufacturers. It is widely used by health-care professionals but is not specifically designed as a toxicology reference. Objectives:, To determine how widespread the use of MIMS is as a toxicology reference. To evaluate the quality of poisoning management advice it contains. Methods:, First, a survey of 500 consecutive calls to the NSW Poison Information Centre (PIC) was undertaken asking health-care workers which toxicology references were consulted prior to calling and which references they would use if the PIC were not available. Second, a consensus opinion for poisoning management was obtained, for 25 medications which are either commonly involved in poisoning or potentially life-threatening in overdose, by review of 5 current toxicology references for contraindicated treatments, ineffective treatments and specific recommended treatments and antidotes. MIMS poisoning management advice was then compared with this toxicology consensus opinion. Results:, In total, 276 doctors and 222 nurses were surveyed. Prior to calling the PIC 22.8% of doctors and 6.8% of nurses consulted MIMS. In total, 25.7% of doctors and 39.6% nurses stated they would use the MIMS for poisoning management advice if the PIC were not available. For the 25 drugs assessed, 14 contained inaccurate poisoning management: 1 recommended ineffective treatments and 14 omitted specific treatments or antidotes. Conclusion:, The MIMS is often used as a toxicology reference by physicians prior to calling the PIC. It contains a number of significant inaccuracies pertaining to management of poisonings and should not be used as a primary reference for poisoning advice. [source]

Topiramate in painful diabetic polyneuropathy: findings from three double-blind placebo-controlled trials

ACTA NEUROLOGICA SCANDINAVICA, Issue 4 2004
The Topiramate Diabetic Neuropathic Pain Study Group
Objectives , To evaluate the efficacy and tolerability of topiramate in patients with painful diabetic polyneuropathy. Materials and methods , Patients with moderate to extreme pain (0,4 Categorical Pain Scale score , 2) were randomized to placebo or topiramate (100, 200, or 400 mg/day) in three similar double-blind trials. The primary efficacy analysis was pain reduction from final visit to baseline in the 100-mm Visual Analog Scale (VAS) for the intent-to-treat populations. Results , After 18,22 weeks of double-blind treatment, pain reductions were numerically greater with topiramate in two studies but differences between topiramate and placebo in VAS scores or in the secondary efficacy endpoints did not reach statistical significance in any of the three studies. Across all studies, 24% of topiramate-treated patients and 8% of placebo-treated patients discontinued due to adverse events; groups did not differ in the occurrence of serious adverse events. Conclusion , These studies did not find topiramate to be significantly more effective than placebo in reducing pain scores in patients with painful diabetic polyneuropathy. Several design features may have precluded the studies from having sufficient sensitivity to differentiate effective and ineffective treatments. The study design and results are instructive for other investigators designing future clinical studies in neuropathic pain. [source]