Dialogues in Clinical Neuroscience | Year: 2010
Knowledge of pharmacotherapeutic treatment options in obsessive-compulsive disorder (OCD) has grown considerably over the past 40 years. Serotonergic antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and clomipramine, are the established pharmacologic first-line treatment of OCD. Medium to large dosages and acute treatment for at least 3 months are recommended until efficacy is assessed. In case of significant improvement, maintenance treatment is necessary. Unfortunately, about half of the patients do not respond sufficiently to oral serotonergic antidepressants; augmentation with atypical antipsychotics is an established second-line drug treatment strategy. Alternatives include intravenous serotonergic antidepressants and combination with or switch to cognitive behavioral psychotherapy. Remarkably, a considerable proportion of OCD patients still do not receive rational drug treatment. Novel research approaches, such as preliminary treatment studies with glutamatergic substances, and trials with further drugs, as well as needed aspects of future research, are reviewed. © 2010, LLS SAS. All rights reserved. Source
The Cochrane database of systematic reviews | Year: 2014
Self management interventions help patients with chronic obstructive pulmonary disease (COPD) acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable patients to control their disease. Since the first update of this review in 2007, several studies have been published. The results of the second update are reported here. 1. To evaluate whether self management interventions in COPD lead to improved health outcomes.2. To evaluate whether self management interventions in COPD lead to reduced healthcare utilisation. We searched the Cochrane Airways Group Specialised Register of trials (current to August 2011). Controlled trials (randomised and non-randomised) published after 1994, assessing the efficacy of self management interventions for individuals with COPD, were included. Interventions with fewer than two contact moments between study participants and healthcare providers were excluded. Two review authors independently assessed trial quality and extracted data. Investigators were contacted to ask for additional information. When appropriate, study results were pooled using a random-effects model. The primary outcomes of the review were health-related quality of life (HRQoL) and number of hospital admissions. Twenty-nine studies were included. Twenty-three studies on 3189 participants compared self management versus usual care; six studies on 499 participants compared different components of self management on a head-to-head basis. Although we included non-randomised controlled clinical trials as well as RCTs in this review, we restricted the primary analysis to RCTs only and reported these trials in the abstract.In the 23 studies with a usual care control group, follow-up time ranged from two to 24 months. The content of the interventions was diverse. A statistically relevant effect of self management on HRQoL was found (St George's Respiratory Questionnaire (SGRQ) total score, mean difference (MD) -3.51, 95% confidence interval (CI) -5.37 to -1.65, 10 studies, 1413 participants, moderate-quality evidence). Self management also led to a lower probability of respiratory-related hospitalisation (odds ratio (OR) 0.57, 95% CI 0.43 to 0.75, nine studies, 1749 participants, moderate-quality evidence). Over one year of follow-up, eight (95% CI 5 to 14) participants with a high baseline risk of respiratory-related hospital admission needed to be treated to prevent one participant with at least one hospital admission, and 20 (95% CI 15 to 35) participants with a low baseline risk of hospitalisation needed to be treated to prevent one participant with at least one respiratory-related hospital admission.No statistically significant effect of self management on all-cause hospitalisation (OR 0.77, 95% CI 0.45 to 1.30, 6 studies, 1365 participants, low-quality evidence) or mortality (OR 0.79, 95% CI 0.58 to 1.07, 8 studies, 2134 participants, very low-quality evidence) was detected. Also, dyspnoea measured by the (modified) Medical Research Council Scale ((m)MRC) was reduced in individuals who participated in self management (MD -0.83, 95% CI -1.36 to -0.30, 3 studies, 119 participants, low-quality evidence). The difference in exercise capacity as measured by the six-minute walking test was not statistically significant (MD 33.69 m, 95% CI -9.12 to 76.50, 6 studies, 570 participants, very low-quality evidence). Subgroup analyses depending on the use of an exercise programme as part of the intervention revealed no statistically significant differences between studies with and without exercise programmes in our primary outcomes of HRQoL and respiratory-related hospital admissions.We were unable to pool head-to-head trials because of heterogeneity among interventions and controls; thus results are presented narratively within the review. Self management interventions in patients with COPD are associated with improved health-related quality of life as measured by the SGRQ, a reduction in respiratory-related hospital admissions, and improvement in dyspnoea as measured by the (m)MRC. No statistically significant differences were found in other outcome parameters. However, heterogeneity among interventions, study populations, follow-up time and outcome measures makes it difficult to formulate clear recommendations regarding the most effective form and content of self management in COPD. Source
Spectrum | Date: 2015-03-13
A wirelessly operable cooking appliance for cooking food products includes a wireless communication device. A computing device, such as a smartphone, can wirelessly communicate with the cooking appliance to control and monitor the cooking appliance.
Agency: Cordis | Branch: FP7 | Program: CP-TP | Phase: NMP.2013.4.0-3 | Award Amount: 6.15M | Year: 2014
Early detection of an incipient wound infection is a challenge for the attending physician , since its early diagnosis allows the timely initiation of treatment, thus reducing the severity of the disease . Currently, however, wound infection is not diagnosed until becoming already evident. As a consequence, the treatment of the patient is further complicated and more likely to have a negative outcome4. Often wounds are treated with antibiotics before even the infection appears, leading to overdoses and development of bacterial resistance to antibiotics. Considering that optimal efficiency is reached when a material serves multiple functions without compromise, consortium partners have discovered the means to convert wound dressings into a diagnostic tool capable to inform both patient and therapist about the wound status, thus directing towards the following therapeutic step. The proposed functional materials include a real time diagnostic reaction that positively influences the wound healing due to the timely intervention to treat infection or proteolytic stasis in the wound The novel InFact technology will be translated into a low-cost, real-time diagnostic tool as a constituent part of a wound dressing material, i.e. the triple-P materials concept: - Protective - by a decoy substrate for destructive proteases - Predictive providing a cumulative wound status signal to predict the infection transition - Proactive - changing the dressing according to a signal, rather than on a schedule base, will provide therapeutic response in time, and not too late. More specifically, the functional materials (e.g. absorbent fibres and hydrocolloid pads) will incorporate immobilized substrates for three enzymes: myeloperoxidase, lysozyme and elastase. Upon infection, these enzymatic activities are highly elevated in wound fluids, and can be detected by the color change of the functional materials, visible via a window in the dressing.
Spectrum | Date: 2015-08-20
An expandable vertebral body replacement is presented. The device has an inner and outer housing longitudinally moveable on one-another which locks in place using a retention member. This can be locked or fortified by several described options. Also presented is a method for expanding said device embodiments and a system for an expandable vertebral body replacement.