Several explanations for the trends in the findings of recent trials were discussed. Given the similarity in trial findings, one key explanation was that non-pharmacolog- ical interventions in primary care provide little benefit for patients with musculoskeletal conditions and do not change the natural course of these conditions over time. Patient selection was discussed in relation to the problem of heterogeneity of the samples within previous trials, such that the average treatment effect masks a wide range of individual responses to treatment, including for exam- ple patients who benefit a great deal along with those who benefit little or not at all. Participants suggested there has been inadequate identification of important patient sub- groups in previous trials. Discussion highlighted that pre- vious trials had been based on a traditional, but perhaps unrealistic, expectation of moderate to large effects of non-pharmacological, primary care-based interventions for patients with common musculoskeletal patients. In fact, the overall message from previous trials is one of small and often short-term effects, some of which may be clinically meaningful whilst others may not. If the results of multiple high quality clinical trials give the 'true' pic- ture for the majority of patients, then dramatic improve- ments seen in individual patients are not representative of the impact of non-pharmacological therapies in general for populations with musculoskeletal conditions. Power- ing clinical trials to compare different interventions to show anything other than small differences between groups appeared particularly unrealistic.
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Abstract: Osteoarthritis (OA) is a chronic painful arthritis with increasing global prevalence. Current management involves non-pharmacological interventions and commonly used pharmacological treatments that generally have limited analgesic efficacy and multiple side effects. New treatments are therefore required to relieve patient symptoms and disease impact. A number of existing pharmacological therapies have been recently trialled in OA. These include extended-release triamcinolone and conventional disease- modifying anti-rheumatic drugs (DMARDs) used in the management of rheumatoid arthritis; generally, DMARDs have not shown a benefit in treating OA. Novel analgesic therapies are in development, including those targeting peripheral pain pathways. Disease-modifying osteoarthritis drugs (DMOADs) target key tissues in the OA pathophysiology process and aim to prevent structural progression; a number of putative DMOADs are in phase II development. There is preliminary evidence of structural improvement with some of these therapies but without concomitant symptom improvement, raising new considerations for future DMOAD trials.
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This review was carried out to understand various issues concerned with the patients of sickle cell disease (SCD). An attempt has been made to review the literature with respect to the multiple complications experienced by the SCD patients, variety of pharmacological therapies used throughout the world for SCD management. The literature highlighted the lack of reliable prevalence statistics, lower use of diagnostic measures, especially in rural areas. The literature indicated that varieties of medicinal plants are used regularly for the management of SCD related complications, such as sickling, infections, pain crisis, etc. Although, Bone marrow transplant, the only curative therapy and genetic counselling, have shown promising results for effective management of SCD, now a days people are using alternative pharmacological therapies for SCD management.
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Objective: Opioids are increasingly prescribed in the West, and have deleterious gastrointestinal consequences. Pharmacological therapies to treat opioid-induced constipation (OIC) are available, but their relative efficacy is unclear. We performed a systematic review and network meta-analysis to address this deficit in current knowledge. Design: We searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane central register of controlled trials through to December 2017 to identify randomised controlled trials (RCTs) of pharmacological therapies in the treatment of adults with OIC. Trials had to report a dichotomous assessment of overall response to therapy, and data were pooled using a random effects model. Efficacy and safety of pharmacological therapies was reported as a pooled relative risk (RR) with 95% confidence intervals (CIs) to summarise the effect of each comparison tested, and ranked treatments according to their P-score. Results: Twenty-seven eligible RCTs of pharmacological therapies, containing 9149 patients, were identified. In our primary analysis, using failure to achieve an average of ≥3 bowel movements (BMs) per week with an increase of ≥1 BM per week over baseline, or an average of ≥3 BMs per week, to define non -response the network meta-analysis ranked
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substantial differences in efficacy between duloxetine, milnacipran, and pregabalin. Rather, the evidence sug- gests that the majority of medications can provide an improvement in pain of 30% in half of the patients tak- ing the medication and that improvements in pain of 50% are seen in a third of patients. These observed bene- fits do not translate into global improvement in well-being as measured by Short Form Health Survey-36 (SF-36) or the Health Assessment questionnaire. Despite treat- ment, physical health perceptions remain substantially lower (1.5 standard deviations) in FMS than in the general population, and scores of patients with FMS are essentially equivalent to those seen in patients on chronic dialysis . Cyclobenzaprine, other SSRI anti- depressants (fluoxetine and paroxetine), and tramadol with and without acetaminophen can be regarded as second-line treatment options. Therapies with other drugs (for example, nabilone and quetiapine) remain experimental at this time.
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main mechanism of both acid and non- acidic reflux in events both in healthy volunteers and patients, particularly in those with non-erosive reflux disease (NERD). Hence, pharmacological reduction of TLESRs could be a potential interesting target for treatment of GERD. Several drug targets have emerged from preclinical research of which a number of which have been tested in humans. The identification of pharmacologic receptors on the neural pathways mediating TLESR has opened the opportunity for the development of drugs that inhibit them and thereby gastroesophageal reflux. Several agents have been identified to reduce the triggering of TLESR, including CCK-A antagonists [ 31 , 32 ], anticholinergic agents
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Psychological and behavioral therapies for insomnia are also well supported by the scientific evidence. Meta- analyses and systematic reviews [22, 27, 34, 35] indicate that such treatments produce moderate to large im- provements in sleep onset latency (effect sizes = .87 to .88), total sleep time (effect sizes = 0.42 to 0.49), number of awakenings (effect sizes = 0.53 to 0.63), duration of awakenings (effect size = 0.65), and sleep quality ratings (effect size = 0.94). Approximately 70 % to 80 % of pa- tients benefit from treatment, with the best outcomes resulting from multifaceted therapies such as cognitive behavioral therapy (CBT) [19, 35]. Most of the evidence is derived from studies of patients with primary insom- nia. Applications of these therapies to patients with in- somnia and comorbid psychiatric or medical disorders have been more limited, but the available data suggest these treatments produce sleep improvements among patients with chronic pain , breast cancer , fibro- myalgia , mixed medical disorders , and depres- sion [40, 41]. These therapies also lead to improvements in mood status and reductions in other disease-specific symptoms [37, 38, 40].
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screening and diagnostic tools. The small sample size of health-care professionals may limit the generalizability of our findings; however, opinions were largely similar across the two professional disciplines. The collective felt that with the aging population, there needs to be new cognitive assessments that are reliable across a population that is variable with respect to language experience, education, and mobility. The age of technology has allowed for a greater access to information, diagnoses, and treatments. Individuals are seeking to have more ownership over their health. Eyetracking-based assess- ments would provide opportunities to have efficient screens of health status, and could ultimately be developed as self- screening tools. Alongside current research regarding the effi- cacy of pharmacological and non-pharmacological therapies for dementia, we are at the optimal time to develop efficient screening and diagnosis tools (either based in eyetracking tech- nology or otherwise) that can accommodate a diverse client population, be delivered by frontline staff, and deliver early indicators of clinically significant cognitive decline.
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As a result of the aforementioned limitations of antipsychotics to alleviate psychological and behavioural symptoms, non-pharmacological therapies are moving increasingly into the treatment focus of the clinical spectrum. Although they are currently reportedly underused within the treatment pool, non-pharmacological therapies can be considered as a beneficial option in the treatment of dementia (Abraha et. al, 2015). Among the most widely used non-pharmacological treatments, in regard to Alzheimer's dementia, the use of cognitive training represents the leading one (Berg-Weger & Stewart, 2017). Also, more and more attempts are being made, with the help of emotion-oriented treatment approaches to address the emotions and experiences of individuals with Alzheimer's dementia, which have been as well positively associated with a decrease in behavioural symptoms (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, 2009).
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The data presented in this study point to a much higher cost of the surgical approach to TN treatment than the other two pharmacological protocols. This results directly from the high costs of surgical intervention and hospital stay before, during, and after the MVD. However, during follow-up, the maintenance of pain control in TN patients submitted to surgery requires less medical therapy than the other two protocols. Although being clearly the less expen- sive treatment during the first 4-week treatment period, the GBP + ROP protocol tends to be the most expensive therapy after stabilization of TN pain control (follow-up) due to the higher cost of GBP drug (Neurontin ® [Pfizer Laboratories,
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Because of the chronic nature of many conditions treated in physical medicine and rehabilitation, the percentage of usage of alternative therapies in rehabilitation settings ap- pears to be high . Krauss and his associates contacted 401 patients who used rehabilitation services and found 57% of former users of rehabilitation services have tried at least one alternative treatment . A lower percentage (29%) of rehabilitation outpatients reported such use in the previous year . Recent studies suggest that the highest percentages of alternative therapy use were in pa- tients with musculoskeletal problems and arthritis, in- cluding neck (57%) and back (47.6%) problems [6,17]. A 2000 study documented the top three therapies used among the rehabilitation population as acupuncture (85%), biofeedback (81%) and manipulation (80%) . Other studies in Canada and the US have listed mas- sage, chiropractic manipulation, vitamin mineral supple- mentation and acupuncture as the most commonly used therapies [6,10,19,20]. Shiflett and colleagues reported that rehabilitation patients had tried alternative therapy for several reasons: the extent of their symptoms and ac- companying disabling effects and a value system that in- volves patient participation in their own health care . We were unable to locate any studies which specifically addressed the use of alternative therapies amongst stroke rehabilitation patients.
Tennis elbow is a common chronic joint condition, which is characterized by pain and tenderness over the elbow [5, 6]. Limited movements at the elbow joint may severely disrupt daily activities and work, resulting in economic burden to the society . Ac- cording to previous studies [2, 3, 16], there are many therapies for tennis elbow, including topical and oral NSAIDs, corticosteroid injections, ultrasonics (US), and extracorporeal shock wave therapy (ESWT). Due to the non-invasive nature and little to no side effects or adverse events associated with ESWT and US, they are preferred by many patients and clinicians as the main adjuvant therapies for tennis elbow . In addition, the efficacy of these two therapies has been supported by a growing number of clinical studies
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supporting medical treatment. Management of migraine and TTH should include strategies relating to daily living activ- ities, family relationships, school, friends and leisure time activities. In the pharmacological treatment age and gender of children, headache diagnosis, comorbidities and side effects of medication must be considered. The goal of symptomatic treatment should be a quick response with return to normal activity and without relapse. The drug should be taken as early as possible and in the appropriate dosage. Supplemen- tary measures such as rest in a quiet, darkened room is rec- ommended. Pharmaco-prophylaxis is only indicated if lifestyle modification and non-pharmacological prophylaxis alone are not effective. Although many prophylactic medi- cations have been tried in paediatric migraine, there are only a few medications that have been studied in controlled trials. Multidisciplinary treatment is an effective strategy for chil- dren and adolescents with improvement of multiple outcome variants including frequency and severity of headache and school days missed because of headache. As a growing problem both children and families should be informed about medication overuse and the children’s drug-taking should be checked.
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If a quantitative synthesis was not feasible, we analyzed the data qualitatively. We placed greater emphasis on the conclusions from evidence from higher quality studies with more precise estimates of effect. We divided treatment strategies for ADHD by their comparators: FDA-approved pharmacologic versus nonpharmacologic and nonpharmacologic versus nonpharmacologic or placebo. Nonpharmacologic therapies include psychosocial interventions, behavioral interventions, school interventions, cognitive training therapies, learning training, biofeedback or neurofeedback, parent behavior training, dietary supplements (eg, omega fatty acids, vitamins, herbal supplements, probiotics), elimination diets, vision training, and chiropractic treatment. We combined studies of omega-3 and omega-6 fatty acids.
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Medicinal plants are the Nature’s gift to human beings to help them pursue a disease-free healthy life. Plants have been used as drugs by humans since thousands of years ago. As a result of accumulated experience from the past generations, today, all the world’s cultures have an extensive knowledge of herbal medicine. Two thirds of the new chemicals identified yearly were extracted from higher plants. 75% of the world’s population used plants for therapy and prevention. In the US, where chemical synthesis dominates the pharmaceutical industry, 25% of the pharmaceuticals are based on plant-derived chemicals . Plants are a valuable source of a wide range of secondary metabolites, which are used as pharmaceuticals, agrochemicals, flavours, fragrances, colours, biopesticides and food additives [2-32]. Phytochemical analysis of Eupatorium cannabinum showed that it contained volatile oil, sesqiterpene lactones- the major one being eupatoriopicrin, polyphenols, flavonoids, pyrrolizidine alkaloids, tannins, terpenoids, saponins and immunoactive polysaccharides. The previous pharmacological studies revealed that the plant possessed cytotoxic, antimicrobial, antioxidant, antiinflammatory, immunological, choleretic, hepatoprotective, insecticidal and repellent effects. The current review will highlight the chemical constituents and pharmacological effects of Eupatorium cannabinum. Synonyms:
Abstract: Hepatocellular carcinoma (HCC) is the fifth most frequently occurring cancer glob- ally and predominantly develops in the setting of various grades of underlying chronic liver disease, which affects management decisions. Image-guided percutaneous ablative or transarterial therapies have acquired wide acceptance in HCC management as a single treatment modality or combined with other treatment options in patients who are not amenable for surgery. Recently, such treatment modalities have also been used for bridging or downsizing before definitive treatment (ie, surgical resection or liver transplantation). This review focuses on the use of minimally invasive image-guided locoregional therapies for HCC. Additionally, it highlights recent advancements in imaging and catheter technology, embolic materials, chemotherapeutic agents, and delivery techniques; all lead to improved patient outcomes, thereby increasing the interest in these invasive techniques.
(35 years) and excluded patients with concomitant asthma. These differences have most likely improved our possibility to evaluate real life care of COPD patients in general practice in Denmark, not least for pharmacological treatment due to the exclusion of patients with doctor-diagnosed concomitant asthma. In line with this, it also offered us the opportunity to investigate the quality of care for younger patients with doctor-diagnosed COPD, where the clinical picture will pos- sibly more likely lead to a diagnosis of asthma.
The development of an international action plan targeting the reduction of the harmful effects of alcohol consumption is a key recommendation of the World Health Organisation (2007). Although national and international policies advocate a more responsible approach to alcohol consumption, it is likely that ADS will continue to be a significant health problem. Pharmacological approaches as discussed in this article have an important role to play in the overall management of ADS. However they must be used in conjunction with psychosocial intervention to maximise successful outcomes.
We conducted educational therapy concurrently in the outpa- tient examination room and in the physical therapy sessions. We instructed the patient and his mother in the entity and pathophysiology of CRPS I and the effectiveness of phar- macological and physical therapies, showing illustrations depicting the mechanism of pain and providing published medical articles about pediatric CRPS I. With these educa- tional interventions and a graph of his SuperVAS score history, the patient and his mother understood the abnormal transition of ankle sprain, and they could accept the diagnosis of CRPS I and pharmacological (NSAIDs and pregabalin) treatments, which are unusual for children with normal ankle sprain. We felt the educational therapy was an indispensable factor for the successful outcome in the present patient.
This systematic review with meta-analysis suggests that interventions such as physical activity, cognitive behav- ioral therapy, phytotherapy, and pharmacological treat- ment improve QOL in patients with SLE, being more evident in cognitive behavioral therapy. However, the methodological quality of the included articles and the small sample sizes propose that new randomized clinical trials be performed. The studies should be elaborated with greater methodological rigor and a greater number of patients.