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At least 289 records · Page 16Linked to original sources
PubMed2006

Review: Combination therapy with non-clozapine atypical antipsychotic medication: a review of current evidence.

Use of combined antipsychotics for patients with treatment-resistant/refractory schizophrenia is common practice in psychiatry. The objective of this paper is to review the current literature on combining non-clozapine atypical antipsychotics as well as discussing the theoretical benefits and risks, and summarizing the implications for clinical practice. We found in cases of treatment-resistant schizophrenia, where clozapine is deemed inappropriate, combination therapy with non-clozapine atypical antipsychotics is a strategy worthy of consideration. Combinations using olanzapine with either amisulpride or risperidone--or quetiapine with risperidone--in theory act on different receptor profiles and in the limited data available have shown improvement in symptoms, been used most frequently, and on balance have more data on safety. Initial case reports suggest that aripiprazole combined with non-clozapine atypicals may worsen psychosis. The current literature, however, has significant limitations. For this reason, due to the lack of data on safety, caution is recommended. There needs to be further well-designed studies with the aim to specifically investigate the effects of combination therapy to allow the clinician to better balance the risks and benefits (both clinical and economical) of treatment.

Antipsychotic Agents↗
PubMed2003

Clinical review: high-frequency oscillatory ventilation in adults--a review of the literature and practical applications.

It has recently been shown that strategies aimed at preventing ventilator-induced lung injury, such as ventilating with low tidal volumes, can reduce mortality in patients with acute respiratory distress syndrome (ARDS). High-frequency oscillatory ventilation (HFOV) seems ideally suited as a lung-protective strategy for these patients. HFOV provides both active inspiration and expiration at frequencies generally between 3 and 10 Hz in adults. The amount of gas that enters and exits the lung with each oscillation is frequently below the anatomic dead space. Despite this, gas exchange occurs and potential adverse effects of conventional ventilation, such as overdistension and the repetitive opening and closing of collapsed lung units, are arguably mitigated. Although many investigators have studied the merits of HFOV in neonates and in pediatric populations, evidence for its use in adults with ARDS is limited. A recent multicenter, randomized, controlled trial has shown that HFOV, when used early in ARDS, is at least equivalent to conventional ventilation and may have beneficial effects on mortality. The present article reviews the principles and practical aspects of HFOV, and the current evidence for its application in adults with ARDS.

Adult↗
PubMed2004

Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery -- a systematic literature review.

Many adult patients require temporary inotropic support after cardiac surgery. We reviewed the literature systematically to establish, present and classify the evidence regarding choice of inotropic drugs. The available evidence, while limited in quality and scope, supports the following observations; although all beta-agonists can increase cardiac output, the best studied beta-agonist and the one with the most favourable side-effect profile appears to be dobutamine. Dobutamine and phosphodiesterase inhibitors (PDIs) are efficacious inotropic drugs for management of the low cardiac output syndrome. Dobutamine is associated with a greater incidence of tachycardia and tachyarrhythmias, whereas PDIs often require the administration of vasoconstrictors. Other catecholamines have no clear advantages over dobutamine. PDIs increase the likelihood of successful weaning from cardiopulmonary bypass as compared with placebo. There is insufficient evidence that inotropic drugs should be selected for their effects on regional perfusion. PDIs also increase flow through arterial grafts, reduce mean pulmonary artery pressure and improve right heart performance in pulmonary hypertension. Insufficient data exist to allow selection of a specific inotropic agent in preference over another in adult cardiac surgery patients. Multicentre randomized controlled trials focusing on clinical rather than physiological outcomes are needed.

Cardiac Output, Low↗
PubMed2006

Clinical review: a systematic review of corticosteroid use in infections.

Traditional teaching suggests that corticosteroids should be avoided during acute infectious episodes for fear of compromising the immune response. However, the outcome benefit shown through steroid administration in early septic shock implies this paranoia may be misplaced. We therefore performed a systematic review of the literature to identify the current strength of evidence for the use of corticosteroids in specified infections, and to make appropriate graded recommendations.

Adrenal Cortex Hormones↗
PubMed2003

Clinical review 158: Beyond radioiodine: a review of potential new therapeutic approaches for thyroid cancer.

One of the greatest challenges in the management of patients with follicular cell-derived thyroid cancer is the treatment of tumors that progress despite surgery, radioiodine, and T(4) suppression of TSH. As knowledge of thyroid cancer biology improves, the potential exists to develop compounds targeted to treat thyroid cancers that do not respond to traditional therapy. Recently, the development of therapies targeted against specific molecular pathways involved in cancer progression has resulted in dramatic responses in patients with chronic myelogenous leukemia, gastrointestinal stromal tumors, and other cancers. A number of compounds are currently being evaluated in clinical trials that alter pathways involved thyroid cancer, and several of these agents have been tested in thyroid cancer in vitro and in vivo. In this review we will discuss the mechanisms of action and preclinical/clinical data for several of these compounds that have the potential to play an important role in the management of thyroid cancer in the future.

Alkyl and Aryl Transferases↗
PubMed2004

Clinical review 170: A systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer.

Radioactive iodine remnant ablation destroys residual thyroid tissue after surgical resection of papillary or follicular thyroid cancer. We systematically reviewed 1543 English references to determine whether remnant ablation decreases the risk of thyroid cancer-related death or recurrence after bilateral thyroidectomy for papillary or follicular thyroid cancer. In 13 cohort studies in which the analysis of thyroid cancer-related outcomes was statistically adjusted to a variable degree for prognostic factors or cointerventions, rates of recurrences of thyroid cancer-related outcomes were significantly decreased in the following: one of seven studies examining thyroid cancer-related mortality, three of six studies examining any tumor recurrence, three of three studies examining locoregional recurrence, and two of three studies examining distant metastases. Thyroid hormone suppressive therapy was not adjusted for in the majority of these analyses. In 18 cohort studies not adjusted for prognostic factors or interventions, the benefit of radioactive iodine ablation in decreasing the thyroid cancer-related mortality and any recurrence at 10 yr was inconsistent among centers. However, pooled analyses were suggestive of a statistically significant treatment effect of ablation for the following 10-yr outcomes: locoregional recurrence (relative risk of 0.31, 95% confidence interval, 0.2, 0.49) and distant metastases (absolute decrease in risk 3%, 95% confidence interval, risk decreases 1-4%). In conclusion, radioactive iodine ablation may be beneficial in decreasing recurrence of well-differentiated thyroid cancer; however, results are inconsistent among centers for some outcomes, and the incremental benefit of remnant ablation in low-risk patients treated with bilateral thyroidectomy and thyroid hormone suppressive therapy is unclear.

Humans↗
PubMed1998

Clinical review 97: Potential health benefits of dietary phytoestrogens: a review of the clinical, epidemiological, and mechanistic evidence.

Phytoestrogens represent a family of plant compounds that have been shown to have both estrogenic and antiestrogenic properties. A variety of these plant compounds and their mammalian metabolic products have been identified in various human body fluids and fall under two main categories: isoflavones and lignans. A wide range of commonly consumed foods contain appreciable amounts of these different phytoestrogens. For example, soy and flax products are particularly good sources of isoflavones and lignans, respectively. Accumulating evidence from molecular and cellular biology experiments, animal studies, and, to a limited extent, human clinical trials suggests that phytoestrogens may potentially confer health benefits related to cardiovascular diseases, cancer, osteoporosis, and menopausal symptoms. These potential health benefits are consistent with the epidemiological evidence that rates of heart disease, various cancers, osteoporotic fractures, and menopausal symptoms are more favorable among populations that consume plant-based diets, particularly among cultures with diets that are traditionally high in soy products. The evidence reviewed here will facilitate the identification of what is known in this area, the gaps that exist, and the future research that holds the most potential and promise.

Cardiovascular Diseases↗
PubMed1995

Invited review: computer aids for decision-making in diagnostic radiology--a literature review.

This review looks at a variety of different ways in which computers can be used to assist in the interpretation of radiological images and in radiological decision-making. The issues involved in the design of computerized decision aids are introduced and four criteria proposed for evaluating such aids: need, practicality, veracity and relevance. These criteria are used to assess research into decision aids based on: image databases, numerical methods, expert systems, image processing and image understanding systems. Possible directions for research leading to aids of practical value are discussed in the conclusion.

Decision Making, Computer-Assisted↗
PubMed2006

From meeting presentation to peer-review publication--a UK review.

INTRODUCTION: Annual academic surgical meetings provide a forum for the discussion of research. For the wide-spread dissemination of this information, peer-reviewed publication is required. The aim of this study was to compare the amount of presentations which go on to publication from 4 UK-based surgical meetings. MATERIALS AND METHODS: We determined whether a presentation had led to a successful publication using PubMed, a median of 28 months following each meeting. We compared the ASGBI publication rate with the meetings of the Vascular Surgical Society (VSSGBI), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Transplantation Society (BTS). We also compared the median impact factor of journals used. RESULTS: The ASGBI and BTS had a similar rate of presentations resulting in publication, with 35% and 36% at 2 years, respectively. The VSS had a significantly greater proportion of presentations resulting in publication (54% at 2 years; P = 0.004), whilst the ACPGBI had significant fewer (24% at 2 years; P = 0.006). There was no difference in the median impact factors of the journals used between the meetings (Kruskal Wallis P = 0.883). CONCLUSIONS: There is a significant variation between meetings in terms of turning presentations into publications. However, the majority of abstracts have still not been fully published within 2 years of presentation at the meeting.

Bibliometrics↗
PubMed1988

Medicare program; utilization and quality control peer review program; third Scope of Work for peer review organizations--HCFA. Notice.

This notice describes new requirements for the third Scope of Work for Utilization and Quality Control Peer Review Organizations (PROs) for fiscal year 1989, beginning October 1, 1988. This notice implements section 4091(b)(1) of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203), which requires us to publish a new policy or procedure adopted by the Secretary that affects substantially the performance of contract obligations at least 30 days before the date the policy or procedure is to be used. It also implements other provisions of Pub. L. 100-203, as well as requirements of the Omnibus Budget Reconciliation Act of 1986.

Humans↗
PubMedDate not supplied

[Visual suppression during eye movements (a brief review on the problem of the mechanisms and their role in visual perception). I. A brief review and the mechanisms].

A problem of visual suppression during eye movements is discussed. The short critical review of the main published papers is adduced. A comparative analysis of the literary and author's data has been considered. These data provide evidence for the existence of three but not two (how is maintained) mechanisms of visual suppression: a retinal, efferent copy, and proprioceptive (from extraocular muscles) signals. The proprioceptive mechanism is more powerful than efferent copy. Both retinal and extraretinal mechanisms of visual suppression are discussed in detail. The sources and the passage's pathways of the extraretinal signals are considered thoroughly. It is shown that the retino-geniculate system provide mainly retinal mechanisms vs the tecto-thalamic system provide extraretinal mechanisms.

Animals↗
PubMed2001

[Systematic reviews in practice. VIII. Searching and assessing systematic reviews].

In a systematic review (SR) the information from the original studies is searched, selected, extracted, appraised and summarised in a transparent, valid and reproducible manner. SRs are therefore an efficient and reliable source of information for the clinician, health policy maker and researcher. SRs can be identified in various sources. The search strategy is determined by the desired comprehensiveness, the availability of various sources and the need for additional comments on the SR by a referee. In Medline a sensitive filter is available for searching SRs. An SR should be based on a carefully formulated clinical question that can be answered on the basis of data from the original studies. SRs should be thoroughly assessed as they can differ substantially in terms of quality. In such an appraisal the following aspects should be considered: question, search strategy, selection of studies, quality assessment, data extraction and data presentation, (statistical) summary of the data, statistical and clinical heterogeneity, results and conclusion. Various assessment lists are available. Differences in conclusions between SRs on the same subject can be analysed in a systematic manner and can often be resolved.

Data Interpretation, Statistical↗
PubMed2002

Treating malnutrition with megestrol acetate: literature review and review of our experience.

Megestrol acetate is a semi-synthetic progestational steroid that was originally used as a therapeutic modality for metastatic breast and endometrial cancers. What was originally considered to be it's most frequent side effect, an increase in appetite and in body weight, has gradually become an established treatment of malnutrition in patients with the acquired immuno-deficiency syndrome or with non-hormone responsive cancers. The use of megestrol acetate in treating malnutrition in older persons, in patients on dialysis and in a number of other situations is currently under investigation. The authors review the evidence available to support the use of megestrol acetate in treating malnutrition in these selected groups, and the problems associated with administering megestrol acetate; they also report on their own experience with megestrol acetate in the geriatric population.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Choledochal cysts: a retrospective review of 28 patients and a review of the literature.

Retained choledochal cysts have been associated with recurrent cholangitis, portal hypertension and malignant lesions of the biliary tract. The authors reviewed the cases of 23 females and 5 males who had congenital cystic dilatation of the biliary tree; 26 were seen primarily and 2 were referred because of complications from previous surgery. Patient age at presentation ranged from 6 weeks to 46 years. The presenting complaints in 25 patients were pain or jaundice, or both; the classic triad of pain, jaundice and an abdominal mass was present in only 3 patients. Primary cyst excision was performed in 11 patients. Internal drainage procedures were performed in 12 patients, external drainage procedures in 3 patients and no direct operative procedure in 2 patients. Follow-up ranged from 1 to 20 years. Nine of 11 patients with primary excision were asymptomatic; 2 had recurrent cholangitis and required treatment for bile duct stricture. Five patients with retained cysts were asymptomatic. Recurrent cholangitis occurred in seven patients. Six patients required at least one reoperation, but only two had secondary cyst excision. The long-term complication rate for patients with retained cysts was 66.7% and for those with primary excision was 18%. The findings of this study support the current recommendation of primary excision of choledochal cysts. Symptomatic patients with retained cysts should have secondary cyst excision. Asymptomatic patients with retained cysts are at risk for malignancy and should undergo lifelong periodic radiologic examinations and liver-function testing.

Adolescent↗
PubMed1991

[Marginal periodontium and osseointegrated implants--literature review and own investigations. 1. Literature review].

A review from literature is given to problems of osseointegration of implants, to the biologic host defensive mechanism against plaque accumulation in the marginal region of osseointegrated implants as well as to problems of functional occlusal stress of such implants. Results of an investigation at IMZ-implants are integrated in the discussion: size of plaque accumulation, quality of subgingival plaque (dark field microscopy), bleeding on probing, pocket depth, correlation between these clinical signs.

Dental Implantation, Endosseous↗
PubMed1989

Medicare program; Utilization and Quality Control Peer Review Program; third Scope of Work for Peer Review Organizations.

This notice describes new requirements for the third Scope of Work for Utilization and Quality Control Peer Review Organizations (PROs) for fiscal year 1989, beginning October 1, 1988. This notice implements section 4091(b)(1) of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203), which requires us to publish a new policy or procedure adopted by the Secretary that affects substantially the performance of contract obligations at least 30 days before the date the policy or procedure is to be used. It also implements other provisions of Pub. L. 100-203, as well as requirements of the Omnibus Budget Reconciliation Act of 1986.

Humans↗
PubMed1998

Major review: ocular sighting dominance: a review and a study of athletic proficiency and eye-hand dominance in a collegiate baseball team.

PURPOSE REVIEW: Laterality preference in sensory and motor functions of symmetrically disposed organisms have been studied for centuries. The relation between handedness and the eyes and vision (ocular sighting dominance) has been a focal point despite their physiologic dissimilarity. STUDY: To examine a college varsity baseball team for handedness and ocular sighting dominance to determine if their patterns of eye-hand dominance differed from the normal population and/or contributed to their individual relative success compared to their peers. Specifically: whether crossed eye- hand dominance favors the batter and uncrossed eye-hand dominance favors the pitcher. SUBJECTS AND METHODS: Twenty five UF varsity players were examined. All were male. Their visual acuity, stereoscopic vision, ocular motility and ocular sighting dominance were determined, the last by a pointing test which allowed the diagnosis of a central form of ocular dominance, but was not per se affected by handedness. Handedness was determined by preferred arm for throwing or hitting. No subject was ambidextrous. A control population was established consisting of the first 100 consecutive adults seen by the first author in the UF Eye Center with 20/20 vision O.U. and a normal eye exam. RESULTS: The control group displayed eye-hand dominance patterns similar to those previously reported in the literature for the general population. In the experimental group of baseball players, the incidence of conventionally predominant (in normals) ipsilateral or uncrossed eye-hand dominance was much lower (39%) than the normal control population (65%). The incidence of contralateral or crossed eye- hand dominance was 35%, twice that of the normal control population (18%) (p<0.01). The incidence of central ocular dominance with right or left handedness was 26% or 50% higher than a normal control population (17%) (p<0.25). With regard to individual performance, those players with central ocular dominance, whether right or left handed, were the most successful players in both pitching and batting. Pitchers who were uncrossed eye-hand dominant were distinctly more successful than crossed. Batters who were crossed eye-hand dominant were slightly more successful than uncrossed. CONCLUSIONS: The pattern of eye-hand dominance appears related to athletic proficiency for baseball. Warning: Note well: This information may be useful in career guidance but does not justify or medically indicate attempts to alter ocular sighting dominance or eye-hand dominance patterns as these are determined probably genetically or at such an early age that they cannot be successfully altered later. Attempts to so alter them are historically fraught with irremediable psychological or physical injury to the subject, including permanent incapacitating double vision.

Adult↗