scholarly journals Update on the Treatment of Idiopathic Hypersomnia

2019 ◽  
Vol 5 (4) ◽  
pp. 207-214
Author(s):  
M. S. Schinkelshoek ◽  
R. Fronczek ◽  
G. J. Lammers
Keyword(s):  
Treatment Options ◽  
Pharmacological Therapy ◽  
Small Sample ◽  
Treatment Modalities ◽  
Lifestyle Advice ◽  
Pharmacological Interventions ◽  
First Choice ◽  
Idiopathic Hypersomnia ◽  
Small Sample Sizes

Abstract Purpose of Review Idiopathic hypersomnia is an incapacitating disorder with a profound impact on daytime performance and quality of life. The most commonly used treatment modalities are lifestyle advice and pharmacological therapy. We present an update on the evidence concerning treatment options for idiopathic hypersomnia. Recent Findings Evidence for non-pharmacological interventions is lacking; improvement in symptoms on introducing these interventions is often less pronounced than in narcolepsy. Additional pharmacological treatment is therefore usually initiated. The few treatment studies that have been performed are hampered by small sample sizes and the use of variable and often insufficiently validated outcome parameters for the whole spectrum of idiopathic hypersomnia symptoms. Conclusion Evidence on treatment is scarce. Since the efficacy of modafinil is consistently described and there is much experience with this substance, it is reasonable to start with modafinil as a first choice treatment. Methylphenidate and dexamphetamine are good alternatives. In the future, newer drugs such as sodium oxybate, pitolisant, and solriamfetol might be authorized for use in idiopathic hypersomnia.

Pharmacotherapy review: Emerging treatment modalities in transthyretin cardiac amyloidosis

2021 ◽  
Author(s):  
Emily Plumadore ◽  
Lindsay Lombardo ◽  
Katherine P Cabral
Keyword(s):  
Treatment Options ◽  
Disease State ◽  
Treatment Modalities ◽  
Limited Data ◽  
Limited Evidence ◽  
Agent Selection ◽  
Selection For ◽  
Tea Extract

Abstract Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose This review aims to summarize the evidence and pharmacological characteristics of treatment options for transthyretin amyloid cardiomyopathy (ATTR-CM). Additionally, this review highlights the role of clinical pharmacists in helping to secure newly introduced therapies. Summary ATTR-CM, a disease characterized by misfolded protein that is deposited in the myocardium and disrupts cardiac functioning, has historically been underdiagnosed due to the need for invasive biopsy and an illusion of rarity. Once diagnosed, limited treatment modalities for ATTR-CM have led providers to rely on nonpharmacological remedies or off-label use of medications with limited evidence of benefit. However, recent noninvasive diagnostic advancements and heightened disease state awareness have revealed increased prevalence of ATTR-CM. This has led to the introduction of several first-in-class pharmaceuticals with actions targeted at inhibiting the various phases of amyloidosis: TTR stabilizers include diflunisal and first-in-class, Food and Drug Administration (FDA)-approved tafamidis; TTR silencers include patisiran and inotersen; fibril disrupters include doxycycline with tauroursodeoxycholic acid; and alternative agents include green tea extract and curcumin. Conclusion ATTR-CM treatments have emerged and, despite current limited data, are continuing to evolve. Tafamidis, the only agent approved by FDA for ATTR-CM, shows promise to improve survival and quality of life in patients with ATTR-CM. Pharmacists can play a key role in assisting with agent selection for this disease state, as well as providing knowledge about current and future clinical trials evaluating the safety and efficacy of the available treatment modalities.

Chrononutrition and Breast Milk: A Review of Circadian Variation in Breast Milk Nutrient Composition

2021 ◽  
Vol 12 (2) ◽  
pp. 74-82
Author(s):  
Gugulethu Moyo ◽  
Shera Jackson ◽  
Allison Childress ◽  
John Dawson ◽  
Leslie Thompson ◽  
...  
Keyword(s):  
Amino Acids ◽  
Breast Milk ◽  
Literature Review ◽  
Current Knowledge ◽  
Circadian Variation ◽  
Small Sample ◽  
Review Of Literature ◽  
Small Sample Sizes

ObjectiveThe objective of this literature review was to identify and summarize the current knowledge on the circadian variation of breast milk nutrients and the implications of these findings.MethodA review of literature was conducted, including all relevant studies regardless of location and year of publication.ResultsThe amino acids tyrosine, histidine, aspartic acid and phenylalanine and energy were observed to be higher during the day. Fat and the vitamins B-1, B-2, B-3, B-6, and B-12 were higher at night. Other studies have shown conflicting results or no circadian variation for certain nutrients. Poor reproducibility and small sample sizes affect the quality of existing research.ConclusionMore research is needed, and longitudinal studies would help assess the effect of breast milk chrononutrition on the long-term health outcomes of infants.

scholarly journals A Gluten Free Diet in the Management of Epilepsy in People with Coeliac Disease or Gluten Sensitivity

2020 ◽  
Vol 2 (3) ◽  
pp. 281-299
Author(s):  
Zoë Gilbey ◽  
Justine Bold
Keyword(s):  
Coeliac Disease ◽  
Small Sample ◽  
Gluten Free Diet ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Exclusion Criteria ◽  
Search Terms ◽  
Small Sample Sizes ◽  
Eeg Pattern

The aim of this review was to assess the effects of a gluten free diet (GFD) in the management of epilepsy in people with coeliac disease (CD) or gluten sensitivity (GS). A systematic approach was used to undertake a literature review. Five electronic databases (PubMed; Scopus; Google Scholar; Cochrane Epilepsy Group specialised register; Cochrane Register of Controlled Trails (CENTRAL) via the Cochrane Register of Online Trials) were searched using predetermined relevant search terms. In total, 668 articles were identified. Duplicates were removed and predefined inclusion and exclusion criteria were applied, and a PRISMA flow chart was produced. Data was extracted using Covidence software. Twelve studies on Epilepsy and CD involving a total of 70 participants were selected for analysis; narrative synthesis was used owing to the small sample sizes in the selected studies. None of the 12 studies meeting inclusion criteria investigated gluten sensitivity and epilepsy. All the included studies support a link between epilepsy and CD. GFD was effective in 44 out of 70 participants across the studies in terms of a reduction of seizures, reduction of antiepileptic drugs (AEDs) or normalisation of EEG pattern. A total of 44 participants showed a reduction in seizures (across eight studies) and complete cessation of seizures was reported in 22 participants. In general, the earlier the GFD is implemented after the onset of seizures, the better the likelihood of the GFD being successful in supporting control of seizures. Mechanisms linking gluten with epilepsy are not fully understood; possible hypotheses include gluten mediated toxicity, immune-induced cortical damage and malabsorption. Evidence suggests the effectiveness of a GFD in supporting the management of epilepsy in patients with CD, although the quality of evidence is low. There appears to be a growing number of neurologists who are prepared to advocate the use of a GFD. A multidisciplinary approaches and further research are recommended. It could be argued that when balancing potential treatments such as AEDs or surgery, a GFD has a low likelihood of harm.

Modern Clinician-initiated Clinical Trials to Determine Optimal Therapy for Multidrug-resistant Gram-negative Infections

2019 ◽  
Vol 71 (2) ◽  
pp. 433-439
Author(s):  
Adam G Stewart ◽  
Patrick N A Harris ◽  
Mark Chatfield ◽  
Scott R Evans ◽  
David van Duin ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Multidrug Resistant ◽  
Small Sample ◽  
Consensus Approach ◽  
Gram Negative ◽  
Therapeutic Trials ◽  
Clinical Trial Designs ◽  
Small Sample Sizes

Abstract Treatment options for multidrug-resistant (MDR) gram-negative infection are growing. However, postregistration, pragmatic, and clinician-led clinical trials in this field are few, recruit small sample sizes, and experience deficiencies in design and operations. MDR gram-negative therapeutic trials are often inefficient, only evaluating a single antibiotic or strategy at a time. Novel clinical trial designs offer potential solutions by attempting to obtain clinically meaningful conclusions at the end or during a trial, for many treatment strategies, simultaneously. An integrated, consensus approach to MDR gram-negative infection trial design is crucial.

scholarly journals Psychosocial Benefits of Cooking Interventions: A Systematic Review

2017 ◽  
Vol 45 (2) ◽  
pp. 167-180 ◽  
Author(s):  
Nicole Farmer ◽  
Katherine Touchton-Leonard ◽  
Alyson Ross
Keyword(s):  
Systematic Review ◽  
Quantitative Research ◽  
Psychosocial Outcomes ◽  
Self Esteem ◽  
Small Sample ◽  
Inclusion Criteria ◽  
Self Confidence ◽  
Small Sample Sizes ◽  
Psychosocial Benefits

Objectives. Cooking interventions are used in therapeutic and rehabilitative settings; however, little is known about the influence of these interventions on psychosocial outcomes. This systematic review examines the research evidence regarding the influence of cooking interventions on psychosocial outcomes. Methods. A systematic review of the literature examined peer-reviewed research using Embase, PubMed, CINALH Plus, and PsychInfo with the following search terms: cooking, culinary, baking, food preparation, cookery, occupational therapy, mental health, mood, psychosocial, affect, confidence, self-confidence, self-esteem, socialization, and rehabilitation. Inclusion criteria were the following: adults, English, influence of cooking interventions on psychosocial outcomes. PRISMA guidelines were used. Results. The search yielded 377 articles; and 11 ultimately met inclusion criteria and were reviewed. Generally, the quality of the research was weak due to nonrandomization, unvalidated research tools, and small sample sizes. However, inpatient and community-based cooking interventions yielded positive influences on socialization, self-esteem, quality of life, and affect. Conclusions. Finding benefits to cooking that extend beyond nutritional may be helpful in increasing motivation and frequency of cooking. This review suggests that cooking interventions may positively influence psychosocial outcomes, although this evidence is preliminary and limited. Further qualitative and rigorous quantitative research are needed to identify mechanisms by which cooking interventions may improve psychosocial outcomes.

Survival outcomes for various treatment modalities in advanced-stage grade 3 follicular lymphoma (FL3): A National Cancer Database (NCDB) study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 7554-7554
Author(s):  
Upama Giri ◽  
Eric Vick ◽  
Sophia SeoHyeon Lee ◽  
Alaa Altahan ◽  
Noam Avraham VanderWalde ◽  
...  
Keyword(s):  
Cox Regression ◽  
Small Sample ◽  
Response To Therapy ◽  
Stage Iii ◽  
Treatment Modalities ◽  
Advanced Stage ◽  
Sample Sizes ◽  
Significant Difference ◽  
Multi Agent ◽  
Small Sample Sizes

7554 Background: The prognosis, response to therapy and curability of FL3 is controversial. 5-year Overall Survival (OS) in the literature ranges from 35-72% (Ganti 2006). The aim of this study was to compare the OS for patients with advanced-stage FL3 managed with various treatment modalities. Methods: We identified patients (pts) diagnosed with stage III & IV FL3 between 2004 – 2012 from the NCDB and categorized them into 3 groups based on therapy – pts given single agent chemotherapy with or without radiotherapy were combined due to small sample sizes (SA±RT), multi agent chemotherapy without radiotherapy (MA-RT), and multi agent chemotherapy with radiotherapy (MA+RT). We calculated OS using Kaplan-Meier method and compared the results using Log Rank test. Cox regression model was used to identify other factors which had significant impact on OS. Results: 2,808 pts were identified – 1,508 (54%) with stage III and 1,300 (46%) with stage IV disease. Median age was 60 yrs (range 21-90yrs); 1,331 (47%) males, 1,477 (53%) females; 2,559 (91%) whites, 142 (5%) blacks. 170 cases (6%) were treated with SA±RT, 2,508 (89%) with MA-RT and 130 (5%) with MA+RT. There was no significant difference in 5-year OS between MA-RT (83%) and MA+RT (82%; HR 1.07, P=0.76). There was no difference between SA±RT (73%) and MA+RT (82%; HR 0.62, P=0.069) likely due to small sample sizes, but survival for MA-RT (83%) was significantly higher than SA±RT (73%; HR 1.78, p<0.001). Cox regression indicated that age (HR 1.04, P<0.001), sex (HR 0.77 for females, P=0.008), comorbidities (HR 1.48 for Charlson Deyo Score 1, P=0.001; HR 2.59 for Score 2, P<0.001), stage (HR 1.29, P=0.007), insurance status (HR 0.65 for insured, P=0.048) and increasing year of diagnosis (HR 0.91, P<0.001) also had significant impact on OS. Use of MA chemotherapy declined (2004 96% v 2012 91%, P=0.008) but there was no significant trend in use of radiotherapy (2004 5% v 2012 3%) during the periods studied. Conclusions: MA chemotherapy in pts with advanced-stage FL3 was associated with improved survival compared to SA therapy, and radiation does not appear to influence outcomes. Outcomes were superior to what has been previously reported.

scholarly journals Chronic Constipation: Current Treatment Options

2011 ◽  
Vol 25 (suppl b) ◽  
pp. 22B-28B ◽  
Author(s):  
Louis Wing Cheong Liu
Keyword(s):  
Chronic Constipation ◽  
Evaluation System ◽  
Serotonin Receptor ◽  
Treatment Options ◽  
Gastrointestinal Disorder ◽  
Treatment Modalities ◽  
Receptor Subtype ◽  
Bulking Agents ◽  
Quality Of Evidence

Chronic constipation is a common functional gastrointestinal disorder that affects patients of all ages. In 2007, a consensus group of 10 Canadian gastroenterologists developed a set of recommendations pertaining to the management of chronic constipation and constipation-dominant irritable bowel syndrome. Since then, tegaserod has been withdrawn from the Canadian market. A new, highly selective serotonin receptor subtype 4 agonist, prucalopride, has been examined in several large, randomized, placebo-controlled trials demonstrating its efficacy and safety in the management of patients with chronic constipation. Additional studies evaluating the use of stimulant laxatives, polyethylene glycol and probiotics in the management of chronic constipation have also been published. The present review summarizes the previous recommendations and new evidence supporting different treatment modalities – namely, diet and lifestyle, bulking agents, stool softeners, osmotic and stimulant laxatives, prucalopride and probiotics in the management of chronic constipation. A brief summary of lubiprostone and linaclotide is also presented. The quality of evidence is presented by adopting the Grading of Recommendations, Assessment, Development and Evaluation system. Finally, a management pyramid for patients with chronic constipation is proposed based on the quality of evidence, impact of each modality on constipation and on general health, and their availabilities in Canada.

scholarly journals The Effect of Mood on Judgments of Subjective Well-Being: Nine Tests of the Judgment Model

2016 ◽  
Author(s):  
Stevie C. Y. Yap ◽  
Jessica Wortman ◽  
Ivana Anusic ◽  
S. Glenn Baker ◽  
Laura Danielle Scherer ◽  
...  
Keyword(s):  
Life Satisfaction ◽  
Well Being ◽  
Small Sample ◽  
Subjective Well Being ◽  
Sample Sizes ◽  
Small Sample Sizes ◽  
Highly Cited

Life satisfaction judgments are thought to represent an overall evaluationof the quality of a person’s life as a whole. Thus, they should reflectrelatively important and stable characteristics of that person’s life.Previous highly cited research has suggested that transient factors, suchas the mood that a person experiences at the time that well-being judgmentsare made, can influence these judgments. However, most existing studiesused small sample sizes, and few replications have been attempted. Ninedirect and conceptual replications of past studies testing the effects ofmood on life satisfaction judgments were conducted using sample sizes thatwere considerably larger than previous studies (Ns = 202, 200, 269, 118,320, 401, 285, 129, 122). Most of the nine studies resulted innonsignificant effects on life satisfaction and happiness judgments, andthose that were significant were substantially smaller than effects foundin previous research.______________________________________

scholarly journals Isotretinoin, Acne and Depression: A Prospective Controlled Study

2021 ◽  
Vol 79 (3) ◽  
pp. 241-245
Author(s):  
Laura V. Langer ◽  
Lucas Prim ◽  
Thelma Skare ◽  
Virginia Wrublevski ◽  
Renato Nisihara
Keyword(s):  
Short Form ◽  
Small Sample ◽  
Treatment Modalities ◽  
Controlled Study ◽  
Short Form Health Survey ◽  
Form Health ◽  
And Control ◽  
Prospective Controlled Study ◽  
Short Form Health

Introduction: Acne and isotretinoin, one of its treatment, have been linked to the occurrence of depression. Our aim was to study if isotretinoin is associated with depression in a sample of acne patients followed for 6 months comparing them with acne patients under other treatment modalities and control patients without acne. Methods: One hundred individuals were included: 50 controls and 50 with acne (24 using and 26 not using isotretinoin). Patients and controls answered the Beck Depression Inventory (BDI) and the 12 Item-Short Form Health Survey for quality of life (SF-12). Acne patients repeated this evaluation in 90 and 180 days. Results: No differences were found between controls and acne patients regarding BDI results but controls performed worse in the SF-12 mental domain (p=0.004). No differences were found within the acne group between those treated and not treated with isotretinoin in the comparison of the BDI and SF-12 (mental and physical domains) in days 0. 90 and 180 (all with p>0.05). Conclusion: In this small sample isotretinoin treatment showed to be safe regarding the occurrence of depression.

scholarly journals Chronic Constipation: Current Treatment Options

2011 ◽  
Vol 25 (suppl b) ◽  
pp. 22B-28B ◽  
Author(s):  
Louis Wing Liu
Keyword(s):  
Chronic Constipation ◽  
Evaluation System ◽  
Serotonin Receptor ◽  
Treatment Options ◽  
Gastrointestinal Disorder ◽  
Treatment Modalities ◽  
Receptor Subtype ◽  
Bulking Agents ◽  
Quality Of Evidence

Chronic constipation is a common functional gastrointestinal disorder that affects patients of all ages. In 2007, a consensus group of 10 Canadian gastroenterologists developed a set of recommendations pertaining to the management of chronic constipation and constipationdominant irritable bowel syndrome. Since then, tegaserod has been withdrawn from the Canadian market. A new, highly selective serotonin receptor subtype 4 agonist, prucalopride, has been examined in several large, randomized, placebo-controlled trials demonstrating its efficacy and safety in the management of patients with chronic constipation. Additional studies evaluating the use of stimulant laxatives, polyethylene glycol and probiotics in the management of chronic constipation have also been published. The present review summarizes the previous recommendations and new evidence supporting different treatment modalities – namely, diet and lifestyle, bulking agents, stool softeners, osmotic and stimulant laxatives, prucalopride and probiotics in the management of chronic constipation. A brief summary of lubiprostone and linaclotide is also presented. The quality of evidence is presented by adopting the Grading of Recommendations, Assessment, Development and Evaluation system. Finally, a management pyramid for patients with chronic constipation is proposed based on the quality of evidence, impact of each modality on constipation and on general health, and their availabilities in Canada.

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