Treatment strategies for ADHD: an evidence-based guide to select optimal treatment

2018 ◽  
Vol 24 (3) ◽  
pp. 390-408 ◽  
Author(s):  
Arthur Caye ◽  
James M. Swanson ◽  
David Coghill ◽  
Luis Augusto Rohde
Keyword(s):  
Treatment Strategies ◽  
Optimal Treatment ◽  
Evidence Based

Evidence-based optimal treatment strategy of patients with angina pectoris

2008 ◽  
Vol 149 (7) ◽  
pp. 293-298
Author(s):  
András Jánosi
Keyword(s):  
Angina Pectoris ◽  
Treatment Strategy ◽  
Optimal Treatment ◽  
Evidence Based ◽  
Optimal Treatment Strategy

A szerző összefoglalja a stabil angina pectoris optimális kezelésével kapcsolatos evidenciákat. Az invazív kezelési stratégia (katéterterápia) térnyerése a stabil angina pectoris esetében is megfigyelhető. Számos országban – így hazánkban is – a percutan intervenciók száma meghaladja a műtéti beavatkozások gyakoriságát. A percutan intervenció, illetve a revascularisatiós műtét helyének meghatározása az angina pectoris kezelésében igen fontos és sokszor vitatott klinikai probléma. A szerző áttekinti a lehetséges három kezelési mód (gyógyszeres kezelés, percutan intervenció, revascularisatiós műtét) eredményességét vizsgáló randomizált tanulmányokat, illetve az ezekből levonható következtetéseket. A rendelkezésre álló adatok azt igazolják, hogy – a diagnózis objektív módszerrel is alátámasztott felállítása után első lépésben – a rizikófaktorok korrekciója, az életmódrendezés és az optimális gyógyszeres kezelés a választandó kezelési stratégia. Optimális gyógyszeres kezelésnek tekintjük a statin-, aszpirin-, ACE-gátló-terápiát és a tünetek befolyásolására irányuló antianginás kezelést, amelyben a béta-blokkoló alkalmazásának elsőrendű jelentősége van. A percutan intervenció első terápiás eszközként történő alkalmazása nem indokolt, mivel nincs adat arra, hogy javítaná az életkilátásokat, illetőleg a beavatkozással megelőzhető lenne a szívinfarktus. Amennyiben a panaszok gyógyszeres kezeléssel nem vagy nem eléggé befolyásolhatók, indokolt a revascularisatio (percutan intervenció vagy műtét) elvégzése, mivel e beavatkozásokkal a gyógyszeres kezelésnél jobban javítható a funkcionális stádium. A revascularisatiós műtét bizonyos esetekben (pl. főtörzsszűkület, háromérbetegség és csökkent balkamra-funkció) a panaszok kedvező befolyásolásán túlmenően a betegek életkilátásait is javítja. A rendelkezésre álló kezelési lehetőségek optimális megválasztása nemcsak a betegek számára fontos, hanem komoly gazdasági jelentősége is van.

Fidelity and Its Relationship to Implementation Effectiveness, Adaptation, and Dissemination

2017 ◽  
Author(s):  
Jennifer D. Allen ◽  
Rachel C. Shelton ◽  
Karen M. Emmons ◽  
Laura A. Linnan
Keyword(s):  
Public Health ◽  
Treatment Strategies ◽  
Implementation Fidelity ◽  
Population Level ◽  
The United States ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Health Gains ◽  
Significant Public Health ◽  
Research Continuum

There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.

Survey of Rejection Prophylaxis Following Suture Removal in Penetrating Keratoplasty in Germany

2021 ◽  
Author(s):  
Sonja Heinzelmann ◽  
Daniel Böhringer ◽  
Philip Christian Maier ◽  
Berthold Seitz ◽  
Claus Cursiefen ◽  
...  
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Treatment Strategies ◽  
Cost Benefit ◽  
Topical Steroids ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Open Questions ◽  
The Face

Abstract Background Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following suture removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres. Objective The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany. Methods Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated. Results All centres perform a double-running cross-stitch suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after suture removal. There are differences in intensity (1 – 5 times daily) and tapering (2 – 20 weeks) of the topical steroids following suture removal. Two centres additionally use systemic steroids for a few days. Discussion Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following suture removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.

Avascular Osteonecrosis of the Talus: Current Treatment Strategies

2021 ◽  
pp. 107110072110510
Author(s):  
Hanci Zhang ◽  
Amanda N. Fletcher ◽  
Daniel J. Scott ◽  
James Nunley
Keyword(s):  
Risk Factors ◽  
Clinical Diagnosis ◽  
Treatment Strategies ◽  
Core Decompression ◽  
Bone Grafts ◽  
Current Treatment ◽  
Optimal Treatment ◽  
Patient Specific ◽  
Avascular Osteonecrosis ◽  
Current Trends

Avascular osteonecrosis (AVN) of the talus (AVNT) is a painful and challenging clinical diagnosis. AVNT has multiple known risk factors and etiologies and presents at different stages in severity. Given these unique factors, the optimal treatment solution has yet to be determined. Both joint-preserving and joint-sacrificing procedures are available, including core decompression and arthrodeses. Recently, new salvage and replacement techniques have been described including vascularized pedicle bone grafts and total talus replacement using patient-specific prosthesis; however, evidence remains limited. This review examines the current trends AVNT treatment and the emerging data behind these novel techniques.

scholarly journals Biomarkers for sepsis: past, present and future

2016 ◽  
Vol 10 (4) ◽  
pp. 301 ◽  
Author(s):  
Giuseppe Chesi ◽  
Natale Vazzana ◽  
Claudio Giumelli
Keyword(s):  
Clinical Practice ◽  
Risk Stratification ◽  
Supportive Care ◽  
Early Identification ◽  
Antibiotic Stewardship ◽  
Treatment Strategies ◽  
Severe Infection ◽  
Antibiotic Use ◽  
Evidence Based ◽  
Drug Resistant

Sepsis is a complication of severe infection associated with high mortality and open diagnostic issues. Treatment strategies are currently limited and essentially based on prompt recognition, aggressive supportive care and early antibiotic treatment. In the last years, extensive antibiotic use has led to selection, propagation and maintenance of drug-resistant microorganisms. In this context, several biomarkers have been proposed for early identification, etiological definition, risk stratification and improving antibiotic stewardship in septic patient care. Among these molecules, only a few have been translated into clinical practice. In this review, we provided an updated overview of established and developing biomarkers for sepsis, focusing our attention on their pathophysiological profile, advantages, limitations, and appropriate evidence-based use in the management of septic patients.

scholarly journals Upper urinary tract draining in acute gestational pyelonephritis: What for? When? For how long?

2019 ◽  
Vol 7 (3) ◽  
pp. 35-40 ◽  
Author(s):  
K. L. Lokshin
Keyword(s):  
Urinary Tract ◽  
Upper Urinary Tract ◽  
Scientific Data ◽  
Optimal Treatment ◽  
Evidence Based

Diagnosis and optimal treatment of urological conditions in pregnant have lots of controversy due to a lack of objective and evidence-based data. This is equally true in for acute gestational pyelonephritis patients, particularly in the context of indications for upper urinary tract ‘de-obstruction’/ draining, and catheter stay in situ time. This review is a compilation of current scientific data concerning upper urinary tract draining in patients with acute gestational pyelonephritis, as well analysis of our own data and results.

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