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Published Clinical Studies (published + clinical_studies)
Selected AbstractsPhotodynamic Therapy for the Treatment of Cutaneous Neoplasia, Inflammatory Disorders, and PhotoagingDERMATOLOGIC SURGERY, Issue 5 2009EMILY TIERNEY MD BACKGROUND Photodynamic therapy (PDT) has demonstrated high efficacy, minimal side effects, and improved cosmetic outcome when used for the treatment of actinic keratoses (AK), basal cell carcinoma (BCC), squamous cell carcinoma, and photoaging. METHODS To review the literature on the use of PDT in dermatologic surgery using MEDLINE. RESULTS Published clinical studies using PDT in the treatment of AKs yield overall efficacy rates ranging from 50% to 71% with one treatment to as high as 88% to 90% with two or more treatments. For superficial BCC, initial clearance rates were 76% to 97%, and for Bowen's disease, initial clearance rates ranged from 72% to 94% overall. The use of PDT for photorejuvenation is a relatively new application of this technology, which has shown promise in improving the appearance of fine lines, pigmentary variation, and telangiectasias. CONCLUSIONS The advantages of photodynamic therapy include the capacity for noninvasive targeted therapy through topical application of aminolevulinic acid and methyl aminolevulinic acid, with outstanding cosmetic results. Although the theory behind the use of chemical photosensitizers and ultraviolet light to treat a wide variety of skin disorders is straightforward, the practical application of this technology is evolving. Additional research into the precise mechanisms of action for specific photosensitizers and optimal light sources will be highly beneficial to the advancement of this technology. [source] A cost-effectiveness analysis of caspofungin vs. liposomal amphotericin B for treatment of suspected fungal infections in the UKEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2007Karin Bruynesteyn Abstract Objective:, To evaluate the cost-effectiveness of caspofungin vs. liposomal amphotericin B in the treatment of suspected fungal infections in the UK. Methods:, The cost-effectiveness of caspofungin vs. liposomal amphotericin B was evaluated using a decision-tree model. The decision tree was populated using both data and clinical definitions from published clinical studies. Model outcomes included success in terms of resolution of fever, baseline infection, absence of breakthrough infection, survival and quality adjusted life years (QALYs) saved. Discontinuation due to nephrotoxicity or other adverse events were included in the model. Efficacy and safety data were based on additional analyses of a randomised, double blind, multinational trial of caspofungin compared with liposomal amphotericin B. Information on life expectancy, quality of life, medical resource consumption and costs were obtained from peer-reviewed published data. Results:, The caspofungin mean total treatment cost was £9762 (95% uncertainty interval 6955,12 577), which was £2033 (,2489; 6779) less than liposomal amphotericin B. Treatment with caspofungin resulted in 0.40 (,0.12; 0.94) additional QALYs saved in comparison with liposomal amphotericin B. Probabilistic sensitivity analysis found a 95% probability of the incremental cost per QALY saved being within the generally accepted threshold for cost-effectiveness (£30 000). Additional analyses with varying dose of caspofungin and liposomal amphotericin B confirmed these findings. Conclusion:, Given the underlying assumptions, caspofungin is cost-effective compared with liposomal amphotericin B in the treatment of suspected fungal infections in the UK. [source] Managing Hypertension: State of the ScienceJOURNAL OF CLINICAL HYPERTENSION, Issue 2006Jerome D. Cohen MD Hypertension management is both routine and a challenge. Updated guidelines emphasize the need to achieve increasingly stringent blood pressure goals to reduce cardiovascular morbidity and mortality; however, the blood pressure of many patients who have been diagnosed with hypertension is not well controlled. Treating prehypertension nonpharmacologically may preempt the progression to hypertension, whereas early and aggressive management of hypertension with antihypertensive agents reduces short- and long-term cardiovascular risk. Treatment decisions should follow current guidelines while evaluating recently published clinical studies. When choosing between agents from different therapeutic classes or combining agents, physicians should consider current and targeted blood pressure levels, the patient's demographic profile, the presence or absence of compelling cardiovascular and metabolic indications, other comorbidities, and concurrent medication(s). [source] Postcementation hypersensitivity: Scientific data versus dentists' perceptionsJOURNAL OF PROSTHODONTICS, Issue 2 2003Stephen F. Rosenstiel BDS Purpose The purpose of this article was to obtain dentists' opinions via an Internet survey as to the prevalence, causes, and prevention of postcementation sensitivity and compare their responses with published data on the problem. Materials and Methods Information as to respondents opinions of postcementation sensitivity was obtained from an Internet survey asking about their experience and for a ranking of the importance of each of 15 factors. Results A total of 466 valid responses were received. The incidence of postcementation sensitivity was estimated to be less than 2% by more than 2/3 of the dentists. The factors considered "very important" in reducing sensitivity by more than 50% of the respondents were desiccation, luting agent, occlusion, provisional, and water spray. Conclusions Comparing respondents' opinions with published clinical studies, the incidence of postcementation sensitivity appears to be underestimated. There is little published evidence to support the importance of antimicrobials, desensitizing, or bonding agents, although these are considered effective by some dentists. Many respondents consider luting agent to be an important variable. [source] Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patientsJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2005S. SCHULMAN Summary., A variety of definitions of major bleeding have been used in published clinical studies, and this diversity adds to the difficulty in comparing data between trials and in performing meta-analyses. In the first step towards unified definitions of bleeding complications, the definition of major bleeding in non-surgical patients was discussed at the Control of Anticoagulation Subcommittee of the International Society on Thrombosis and Haemostasis. Arising from that discussion, a definition was developed that should be applicable to studies with all agents that interfere with hemostasis, including anticoagulants, platelet function inhibitors and fibrinolytic drugs. The definition and the text that follows have been reviewed and approved by the cochairs of the subcommittee and the revised version is published here. The intention is to also seek approval of this definition from the regulatory authorities. [source] CLINICAL COMPARISON OF LORAZEPAM VS.JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004DIAZEPAM IN THE CONTROL OF CANINE SEIZURES Lorazepam is a long-acting benzodiazepine that interacts with a high degree of affinity for the GABA receptor complex. This high affinity binding in turn leads to a prolonged duration of action. There are no published clinical studies documenting its duration of action in dogs or its ability to control seizures. The purpose of this study was to compare the duration of seizure control of lorazepam with diazepam in 16 dogs presenting in status epilepticus or with active cluster seizures. Previous seizure history and anticonvulsant therapy was not a consideration for inclusion into this study. Animals were excluded if there was a known metabolic, toxic or traumatic cause of the seizure. Dogs were randomly assigned to receive either lorazepam (0.2 mg/kg IV) or diazepam (0.5 mg/kg IV), and the clinicians were blinded as to which drug they were administering. The duration of the study was 12 hours from the time of drug administration, and the animals were monitored for any indication of seizure activity, including generalized motor activity, focal motor activity (e.g., movement of facial or limb musculature) and change in the level of consciousness. The study ended at 12 hours post-study drug administration or when the dog seized before the end of the 12 hour study period. The results indicated no significant difference between lorazepam versus diazepam with regard to median seizure-free interval (2.8 h for diazepam versus 3.4 h for lorazepam, p=0.58 by log rank test), or with regard to percent seizure-free for the duration of the observation period (1/8 for lorazepam versus 3/8 for diazepam, p=0.51 by Fisher's exact test). There was also no difference between the 2 drugs regarding the number of animals in which seizures were initially controlled (6/8 in each group). Lorazepam used at this dose does not appear to result in a significant increase in duration of seizure control for dogs with status epilepticus and cluster seizures. Additional studies may be warranted using higher doses of lorazepam. [source] Routine clinical use of alemtuzumab in patients with heavily pretreated B-cell chronic lymphocytic leukemia,,CANCER, Issue 10 2006A nation-wide retrospective study in Austria Abstract BACKGROUND. In previous studies, alemtuzumab demonstrated considerable activity in patients with previously treated B-cell chronic lymphocytic leukemia (CLL), including fludarabine-refractory disease. In this retrospective study, the authors evaluated the benefit of alemtuzumab monotherapy in unselected patients with advanced, previously treated CLL who received treatment in the routine clinical setting. METHODS. Data were collected from 115 consecutive patients who received alemtuzumab therapy at 25 participating centers in Austria. Patients received a median of 3 prior lines of therapy (range, 1,11 prior lines of therapy), and 59% had fludarabine-refractory disease. Alemtuzumab was administered intravenously or subcutaneously with a planned schedule of 30 mg 3 times per week for up to 12 weeks. Patients received valacyclovir and trimethoprim/sulfamethoxazole for antiinfective prophylaxis. RESULTS. The overall response rate was 23%, with complete responses achieved in 5% of patients. Stable disease (SD) was achieved in 36% of patients. After a median follow-up of 17.5 months, the median overall survival (OS) was 20.2 months for all patients. A multivariate Cox regression analysis that included pretreatment baseline characteristics, response to therapy, and cumulative dose of alemtuzumab indicated that bulky lymphadenopathy, the administration of ,3 previous therapies, and lack of response to alemtuzumab remained significant independent risk factors for inferior OS. The median OS had not been reached for responding patients. The median OS was 29.5 months for patients with SD and 10.8 months for patients with progressive disease. CONCLUSIONS. The broad use of alemtuzumab in the routine clinical practice setting is feasible and active in unselected patients with pretreated CLL, and the current results confirmed the activity and safety of this agent, as reported in previously published clinical studies. Cancer 2006. © 2006 American Cancer Society. [source] | ||||||||||